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

Abstract

Objectives Female stress urinary incontinence (SUI) is caused by urethral dysfunction during dynamic conditions, but current technology has limitations in measuring urethral pressures under dynamic conditions. An 8-French high resolution manometry catheter (HRM) currently in clinical use in gastroenterology may accurately measure urethral pressures under dynamic conditions because it has a 25ms response rate and circumferential pressure sensors along the length of the catheter (ManoScan® ESO, Given Imaging). We evaluated the concordance, repeatability, and tolerability of this catheter. Methods We measured resting, cough, and strain maximum urethral closure pressures (MUCPs) using HRM and measured resting MUCPs with water perfusion side-hole catheter urethral pressure profilometry (UPP) in 37 continent and 28 stress incontinent subjects. Maneuvers were repeated after moving the HRM catheter along the urethral length to evaluate whether results depend on catheter positioning. Visual analog pain scores evaluated the comfort of HRM compared to UPP. Results The correlation coefficient for resting MUCPs measured by HRM vs. UPP was high (r = 0.79, p<0.001). Repeatability after catheter repositioning was high for rest, cough, and strain with HRM: r= 0.92, 0.89, and 0.89. Mean MUCPs (rest, cough, strain) were higher in continent than incontinent subjects (all p < 0.001) and decreased more in incontinent subjects than continent subjects during cough and strain maneuvers compared to rest. Conclusions This preliminary study shows that HRM is concordant with standard technology, repeatable, and well tolerated in the urethra. Incontinent women have more impairment of their urethral closure pressures during cough and strain than continent women.

Dynamic maximum urethral closure pressures measured by high-resolution manometry increase markedly after sling surgery

“…Postoperative cough and strain MUCPs were similar to MUCPs seen in continent women [10]. We found a high mean increase even when we included those subjects who did not improve after surgery.…”

“…Because each 4-mm sensor has a 2-mm sensing area and there are 3-mm spaces between sensors, there are 5-mm sections along the urethra that are not measured with this system. Our previous experiments, in which the catheter was moved several millimeters and pressure recordings repeated, demonstrated that the location of this nonmeasured area does not appear to affect maximum pressure measured [10].…”

“…A high-resolution manometry (HRM) system (ManoScan® ESO; Covidien, Culver City, CA) has recently been shown to be well tolerated in the bladder and urethra and to provide pressure measurements that correlate well with waterperfusion urethral pressure profilometry measurements at rest [10]. The potential advantage of this technology is that it has a fast 25-ms response time and can measure circumferential pressures at many points along the urethra at once without a withdrawal technique.…”

The female continence mechanism measured by high resolution manometry: Urethral bulking versus midurethral sling

“…Furthermore, withdrawal can be irritating and induce urethral contractions, which can artifactually increase urethral pressure measurements. The newest technology for pressure measurements is a high‐resolution manometry (HRM) catheter (ManoScan™ ESO, Covidien) which has been validated by our group for use in the urethra . Compared to conventional technology, this catheter is easier to use with faster response times (25 ms), can measure multiple sites simultaneously, and can remain stationary for measurement recordings.…”

“…Compared to conventional technology, this catheter is easier to use with faster response times (25 ms), can measure multiple sites simultaneously, and can remain stationary for measurement recordings. Our prior work has shown that it has a high correlation with traditional water‐perfusion catheters, excellent test‐retest reliability, and is better tolerated by patients . This technology has never before been used to explore urethral changes after transurethral bulking procedures.…”