Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

Abstract

Introduction: Our purpose was, applying a strictly defi ned protocol for urethral profi lometry, 1) to test the repeatability of same session rest maximum urethral closure pressure (MUCP) and 2) to search for correlation between women complaint and the changes in MUCP value (rest and dynamic tests). Materials and Methods:A population of 140 consecutive women referred for evaluation of lower urinary tract dysfunction was stratifi ed in 4 groups according with the urinary symptoms: stress, urge, mixed incontinence and continent and in each group in 3 age groups (young, middle age and old). The sequence of tests recorded in supine position was: urethral pressure profi le at rest bladder empty, after bladder fi lling at 250 mL (reference test), stress profi le, fatigability (before (rest) and after 10 successive strong coughs), then in standing position. Results: In all groups, there was no signifi cant difference between the two MUCP values at rest bladder fi lled. In the three incontinent groups, MUCP was higher bladder empty than bladder fi lled (p < 0.05) except in the young sub-group. Stress incontinence led to signifi cant decrease of MUCP during dynamic tests in the young group. MUCP was not modifi ed after fatigability test in women with urge complaint whatever age. Conclusion: When recorded following a strictly defi ned protocol, MUCP at rest bladder fi lled has a good repeatability in individual. However a complex sequence of tests during urethral pressure profi lometry remains discussed in middle-age and old age--groups, it allows specifying the stress component of incontinence in young women and the urgency component in all age-groups. INTRODUCTIONControversies about the role of urethral pressure profi lometry (UPP) in clinical practice (1-3) are mainly based on the reproducibility of the measurements and on the lack of standardization (4).Other main controversies are related to the predictive value of the preoperative maximum urethral closure pressure (MUCP) and the success of the surgery of stress incontinence (5-9) and the postoperative quality of life (10). Conversely, De Lancey (11) found that MUCP was the most characteristic parameter of stress incontinence.In our urodynamic laboratory, we have defi ned a strict protocol for UPP which is routinely applied in order to rule out many causes of variability. It consists of a well-defi ned sequence Vol. 38 (6): 809-817, November -December, 2012 Is a sequence of tests during urethral pressure profi lometry correlated with symptoms assessment in women? ___ _______________________________________________ ____________________________________________

Measurement of Dynamic Urethral Pressures with a High-Resolution Manometry System in Continent and Incontinent Women

“…Our limits of agreement for MUCPs with repeated measures using HRM technology were similar to repeated measures with withdrawal water-perfusion side-hole manometry(13). This catheter was tolerable to patients and normal volunteers with a median score of 1 on a VAS scale 0–10 and was more comfortable than water-perfusion UPP despite being a larger catheter, likely because the side-hole and withdrawal technique are less comfortable than the smooth HRM catheter that stays in place and does not require withdrawal.…”

The Anatomy of Caprine Female Urethra and Characteristics of Muscle and Bone Marrow Derived Caprine Cells for Autologous Cell Therapy Testing

“…In women, the UPP is described as bell‐shape with MUCP situated centrally. The mean MUCP in goats amounted 63.5 ± 5.9 cm H 2 O (Dorflinger et al, ; Valentini et al, ) and the mean FUL ‐ 3.8 cm. In healthy women, MUCP amounts about 60–70 cm H 2 O and FUL ‐ 2–4 cm (Dorflinger et al, ), however, it is important to stress that the data from urodynamic measurements vary between centers and studies.…”

A Method for Recording Urethral Pressure Profiles in Female Rats

“…The first modification involved the transurethral catheter. Currently available transurethral catheters for human UPP recording have relatively larger dimensions and cannot be directly used in female rats [ 9 , 15 – 21 , 24 – 27 ]. We chose a 3 Fr.…”

“…Some groups consider these differences to be artifacts. A hypothesis has been proposed that the passage of a flexible but straight catheter through a curved urethra results in application of additional forces on the transducer caused by catheter bending [ 15 , 28 ]. Other groups consider these differences to be physiological phenomena.…”

“…UPP recording is a classic technique used in basic science and clinical practice for determining urinary sphincter dysfunction as a source of genuine stress incontinence or urethral obstruction [ 7 , 15 – 19 ]. Brown and Wickham were the first to describe and report a method for recording a constant UPP curve using a water-perfusion catheter system [ 20 ].…”