Leak point pressure at different bladder volumes in stress urinary incontinence in women: Comparison between Valsalva and coughinduced leak point pressure

Abstract

Introduction: We compared Valsalva leak point pressure (VLPP) in urodynamically proven stress urinary incontinence (SUI) in women at different bladder volumes; examined the relationship between VLPP and cough-induced leak point pressure (CLPP) compared by incontinence severity; and evaluated the influence of bladder volume on each leak point pressure (LPP). Methods: Women with urodynamically proven SUI who underwent serial VLPP and CLPP measurement at bladder volumes of 150, 200, 250, and 300 mL were included in this study (n=228). LPP determination was repeated two times in each subject after finishing one series of LPP measurement. LPP at different bladder volumes was compared by subjective symptom severity of Stamey grade. Results: Patients mean age was 51.3±7.6 years (range: 40-65 years). Stamey grade I, II, and III was assigned to 68 (29.8%), 102 (44.7%), and 58 (25.4%) patients, respectively. Mean CLPP was higher than VLPP (p=0.002) at every bladder volume. VLPP and CLPP were significantly decreased by the increase of bladder volume (p=0.001). The mean first positive LPPs were significantly lower at higher Stamey grade (p=0.004). Conclusions: LPP is more frequently induced by cough than by the Valsalva maneuver. VLPP and CLPP decreased significantly with bladder filling and those with severe symptoms of SUI are more likely to have low LPP.

Valsalva Leak Point Pressure Measurement in Women with Stress Urinary Incontinence: At what Bladder Volume?

“…Based on the chronologic evolution of the recommended bladder volume (Table 1) and the evidence provided, a bladder volume of 200-250ml may express VLPP without elevating detrusor pressure and therefore reflect the internal sphincter function. Furthermore, Maximum urethral closure pressure (MUCP) can also provide additional information about urethra function in women with SUI [21,22]. Hence, further studies correlating MUCP and VLPP measured at different bladder volume can contribute in the consensus of bladder volume and VLPP measurement.…”

“…He mentioned a significant decrease of VLPP from the bladder volume of 150ml to 300ml and between 150ml and maximum cystometric capacity. Similarly, Young Seo et al [21] found a decrease of VLPP at a bladder volume of 250ml compared to 150 -200ml and further indicated that a bladder volume of 200ml for the demonstration of VLPP has 50% increase in the detection of ISD. On the contrary, Petrou et al [27] observed no change in VLPP with the bladder volume and concluded that the volume in the bladder should not affect the VLPP as long as the detrusor pressure is kept at a level that does not affect the urethra.…”

“…Meanwhile, Eu Chang wang et al [21] reported an excellent intraindividual reproducibility of VLPP at a bladder volume of 250ml. This review therefore highlights different bladder volume used to demonstrate VLPP in various studies and exhibits the effect of the bladder volume on VLPP.…”

“…Yet, at bladder capacity, there is risk of detrusor pressure elevation. Among the eight studies, one study did not notice any observable effect of the bladder volume on VLPP [27], while five studies [3,[19][20][21]25,26] described a decreasing VLPP value with increasing bladder volume. This suggests that there is an inverse correlation between VLPP and bladder volume which implies that higher bladder volumes mildly increase the detrusor pressure [3] which opens the EUS and subsequently results in a low VLPP.…”

“…The effect of bladder volume on VLPP has been mentioned but little agreement exists on the volume to use during this test as summarized in Table 1. Certain authors described that VLPP decreased progressively [19][20][21] as the bladder volume increased during filling in the same patients. In fact, during a VLPP measurement, the total vector force on the urethra includes [5] the detrusor pressure, the abdominal pressure, for the study and the abdominal viscera.…”