Urethral Closure Pressure at Stress: A Predictive Measure for the Diagnosis and Severity of Urinary Incontinence in Women

Pizzoferrato, Anne Cécile; Fritel, Xavier; Bader, G.; Dompeyre, Philippe

doi:10.5213/inj.1732686.343

Cited by 6 publications

(9 citation statements)

References 18 publications

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“…SUI group older than controls. Similar parity and no significant difference in BMI between groups Pizzoferrato et al (2017) [ 122 ] France SUI: N = 358; age = 40.2 ± 12.1 years to 63.3 ± 15.4 years (mild-severe) and BMI = 21.8 ± 2.8 kg/m 2 to 28.1 ± 6.8 kg/m 2 (mild-severe). Controls: N = 42; age = 45.1 ± 14.9 and BMI = 24.1 ± 3.9 kg/m 2 .…”

Section: Appendixmentioning

confidence: 87%

“…Several studies found that maximal urethral pressure (MUP) measured at rest [ 14 , 83 , 96 – 98 , 115 , 122 ] and MUCP (the difference between MUP and bladder pressure using filling cystometry) [ 10 , 14 , 15 , 93 , 96 – 98 , 105 , 115 , 116 ] were lower in stress-incontinent than in continent women. Urethral closure pressure measured in supine position was negatively associated with greater severity of SUI [ 95 ].…”

Section: Summative Measures Of Suimentioning

confidence: 99%

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The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis

et al. 2021

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Introduction and hypothesis To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. Methods For the data sources, a structured search of the peer-reviewed literature (English language; 1960–April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed manuscripts that reported on anatomical, physiological or functional differences between females with signs and/or symptoms consistent with SUI and a concurrently recruited control group of continent females without any substantive urogynecological symptoms. Of 4629 publications screened, 84 met the inclusion criteria and were retained, among which 24 were included in meta-analyses. Results Selection bias was moderate to high; < 25% of studies controlled for major confounding variables for SUI (e.g., age, BMI and parity). There was a lack of standardization of methods among studies, and several measurement issues were identified. Results were synthesized qualitatively, and, where possible, random-effects meta-analyses were conducted. Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. Meta-analyses showed that observed bladder neck dilation and lower functional urethral length, bladder neck support and maximum urethral closure pressures are strong characteristic signs of SUI. Conclusion The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. While there is also evidence of impaired urethral support and levator ani function, standardized approaches to measurement are needed to generate higher levels of evidence.

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Section: Appendixmentioning

confidence: 87%

Section: Summative Measures Of Suimentioning

confidence: 99%

The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis

et al. 2021

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“…Symptoms of SUI are manifested as the involuntary flow of urine from the urethra when the patient coughs, sneezes or runs, all of which elevate abdominal pressure [2]. It is generally recognized that urethral closure pressure is the key factor maintaining continence [3]. When exertion raises the intra-abdominal pressure, an insufficient pressure of urethral closure will cause leakage.…”

Section: Introductionmentioning

confidence: 99%

Contasure-needleless single incision slings versus transobturator slings (TOT/TVT-O) for female patients with stress urinary incontinence: a systematic review and meta-analysis

et al. 2020

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Background To assess the current evidence on the effectiveness and safety of Contasure-Needleless (C-NDL) versus transobturator slings (TOT/TVT-O) in the management of female stress urinary incontinence (SUI). Methods A comprehensive literature review of articles that investigated the efficacy and safety of C-NDL and TOT/TVT-O was performed based on studies published before June 2019 and retrieved from PubMed, Embase, CNKI and the Cochrane Library. Two reviewers searched the literature, independently extracted the data and evaluated the quality of the data according to the inclusion and exclusion criteria. A meta-analysis was performed by using Review Manager 5.3 software. Results Seven studies with 1188 SUI female patients without intrinsic sphincter deficiency (ISD) or mixed urinary incontinence were included. Our meta-analysis showed that the clinical efficacy of C-NDL is statistically non-inferior to that of TOT / TVT-O in terms of subjective cure rate [OR = 0.77, 95% confidence interval (CI) (0.53 to 1.10), p = 0.15] and objective cure rate [OR = 0.78, 95% CI (0.53 to 1.13), p = 0.19]. In addition, operating times were statistically shorter with C-NDL compared to TOT / TVT-O [mean difference (MD) = − 7.38, 95% CI (− 10.73 to − 4.04), p < 0.0001]. In terms of the postoperative visual analogue scale (VAS) and the incidence of postoperative pain, C-NDL has a greater advantage [MD = − 1.71, 95% CI (− 2.91 to − 0.50), p = 0.005]; [OR = 0.21, 95% CI (0.05 to 0.96), p = 0.04]. Complication rates were statistically similar between the groups, except for groin pain which was higher in TOT / TVT-O. Conclusion Our data suggest that C-NDL slings have similar short-term efficacy as TOT/TVT-O in curing SUI patients. Compared with TOT/TVT-O, C-NDL is associated with a shorter operative time, and the incidence of postoperative pain is decreased. Nevertheless, these findings should be further confirmed through large-volume, well-designed prospective randomized controlled trials (RCTs) with long-term follow-up.

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“…Searching for a specific SUI biomarker, our team conducted a previous study about MUCP at stress (during coughing) in a population of 400 women 20 . Although this measure was the most discriminating measure of the SUI, it was difficult to reproduce.…”

Section: Discussionmentioning

confidence: 99%

Valsalva urethral profile (VUP): A urodynamic measure to assess stress urinary incontinence in women

Dompeyre

Pizzoferrato

Normand

et al. 2020

Neurourology and Urodynamics

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Aims We aimed to assess the value of the Valsalva urethral profile (VUP) in case of stress urinary incontinence (SUI). Methods Six hundred and ninety‐four women without pelvic organ prolapse were included in this prospective monocentric study. SUI was diagnosed from symptoms using the International Continence Society definition, and severity using two validated questionnaires (USP and ICIQ‐SF). The urodynamic parameters studied were maximal urethral closure pressure (MUCP) and functional length (FL). Both were performed at rest, during a Valsalva maneuver (v‐MUCP and v‐FL) and again at rest. Correlation analyses and ROC curves were used to assess the value of the clinical and urodynamic measurements. Results In our population, based on the questionnaires, 172 (24.8%) women were diagnosed with pure SUI on symptoms, 71 (10.2%) with urgency urinary incontinence and 392 (56.5%) with mixed urinary incontinence; 59 (8.5%) women were continent. The v‐MUCP was the most correlated parameter to the severity of SUI (ρ: −0.63) and the most predictive of SUI risk, with a threshold value of 35 cm H2O (Se = 0.82, Sp = 0.86). The v‐FL was significantly shortened in case of SUI. Conclusions The v‐MUCP and v‐FL are global measurements of urethral resistance during stress. With a threshold value of 35 cm H2O, the v‐MUCP was the most discriminating parameter for the diagnosis of SUI, with a good reliability.

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Urethral Closure Pressure at Stress: A Predictive Measure for the Diagnosis and Severity of Urinary Incontinence in Women

Cited by 6 publications

References 18 publications

The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis

The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis

Contasure-needleless single incision slings versus transobturator slings (TOT/TVT-O) for female patients with stress urinary incontinence: a systematic review and meta-analysis

Valsalva urethral profile (VUP): A urodynamic measure to assess stress urinary incontinence in women

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