Valsalva leak point pressures in women with genuine stress incontinence: Reproducibility, effect of catheter caliber, and correlations with other measures of urethral resistance

Bump, Richard C.; Elser, Denise M.; Theofrastous, James P.; McClish, Donna K.

doi:10.1016/0002-9378(95)90281-3

Cited by 128 publications

(62 citation statements)

References 13 publications

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“…It was particularly re-assuring to us that our ALPP and RLPP data are comparable to other published data [Damaser et al, 2003]. ALPP can be a¡ected by urethral catheter size [Bump et al, 1995]. On the other hand, when measuring RLPP via retrograde sphincterometry [Bors, 1948;Comiter et al, 1997b], the urethral sphincter is downstream from the catheter, and therefore not obstructed by the measuring device.…”

Section: Discussionsupporting

confidence: 82%

The role of angiotensin II in stress urinary incontinence: A rat model

Phull

Salkini

Escobar

et al. 2006

Neurourology and Urodynamics

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Aims: Pharmacological treatment for stress urinary incontinence (SUI) is limited to the use of nonselective alpha-agonists, which are often ine¡ective. Non-adrenergic mechanisms have also been implicated in urethral closure, including angiotensin II (Ang-II), which has been demonstrated throughout the urinary tract. We investigate the role of Ang-II in urethral tone in a rat model of SUI. Methods: Abdominal leak point pressure (ALPP) and retrograde urethral pressure pro¢lome-try (RLPP) were measured in 70 female virgin rats. Thirty rats underwent pudendal nerve injury (PNT), 30 had circumferential urethrolysis (U-Lys), and 10 had sham surgery. Rats received daily doses of Angiotensin Type 1 (AT-1) receptor inhibitor (20 mg/kg), Angiotensin Type 2 (AT-2) receptor antagonist (10 mg/kg), or Ang-II (2 mg/kg). Results: Following U-Lys, RLPP and ALPP decreased from 21.4 AE 2.0 and 39.2 AE 3.3 mm Hg, to 13.1 AE1.5 and 21.6 AE 1.9 mmHg, respectively (P<0.01). After PNT, RLPP, and ALPP decreased from 21.0 AE 1.6 and 41.9 AE 3.0 mmHg to 13.1 AE1.5 and 24.7 AE 3.3 mmHg, respectively (P<0.01). AT-1 inhibitor caused signi¢cant decrease in RLPP and ALPP from 21.0 AE 6.2 and 41.8 AE 9.4 mmHg, to 12.0 AE 3.8 and 25.6 AE 6.6 mmHg, respectively (P<0.01). Likewise, AT-2 treatment reduced RLPP and ALPP from 21.4 AE 6.3 and 40.1 AE1.7 mmHg, to 13.5 AE 5.7 and 31.0 AE 7.2 mmHg, respectively (P<0.01). Following surgery, Ang-II administration restored RLPP and ALPP to baseline presurgical values. Conclusions: AT-1 and AT-2 receptor inhibition signi¢cantly lowers urethral resistance, comparable to either neurogenic or urethrolytic injury. Ang-II treatment restored urethral tone in rats with intrinsic sphincter dysfunction. Ang II appears to serve a functional role in the maintenance of urethral tone and stress continence.

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Section: Discussionsupporting

confidence: 82%

The role of angiotensin II in stress urinary incontinence: A rat model

Phull

Salkini

Escobar

et al. 2006

Neurourology and Urodynamics

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“…This study also shows that basal symptom severity is representative of VLPP and CLPP; we confirmed previous reports that have shown strong correlation between the subjective symptom grade and LPP in these patients. [4][5][6]10 McGuire et al introduced the concept of type III incontinence, the most severe form of incontinence of ISD. 16 They noted that some patients show repeated failure from the retropubic suspension surgery for the correction of SUI and described that patients with failed surgery had a deficient urethral sphincter function characterized by open bladder neck and proximal urethra at rest with minimal or no urethral movement during increased intra-abdominal pressure.…”

Section: Discussionmentioning

confidence: 99%

“…9 It has been reported that CLPP is significantly higher than VLPP in the same women. 5 Kuo reported in a videourodynamic comparison study between VLPP and CLPP that a lower LPP was observed, measured by VLPP rather than by CLPP to diagnose ISD. The author determined a significant inverse correlation between the severity of incontinence and VLPP, and showed that CLPP was higher than VLPP in the majority (87.1%) of the 116 women with SUI.…”

Section: Introductionmentioning

confidence: 98%

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

Seo¹,

Kim²,

Yu³

et al. 2016

CUAJ

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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.

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“…Algunos autores le encuentran de escasa utilidad dado su baja reproducibilidad debido a que los resultados se pueden ver influenciados por factores tales como la presencia de catéter vesical, volumen vesical, la capacidad de las pacientes para generar presión con Valsalva y el importante solapamiento existente entre continentes e incontinentes [17][18][19][20] . Frente a éstos, otros autores refieren que es un test reproducible [21][22][23] e inclusive Finazzy y cols. 24 no encuentran variaciones en función de la presencia o no de catéter vesical y la posición de la paciente.…”

Section: Comentariosunclassified

Utilidad de la determinación de la presión abdominal de fuga en el diagnóstico de la incontinencia de orina femenina en la época del TVT

et al. 2004

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la incontinencia de esfuerzo tratada con TVT en función de la presión abdominal de fuga (PAF).MATERIAL Y MÉTODO: Estudio retrospectivo de 52 pacientes operadas entre 1999 y 2002 que tenían estudio urodinámico y determinación de la PAF, con seguimiento mínimo de 3 meses. Se analizan las características clínicas y resultados respecto de la desaparición de la incontinencia al esfuerzo como de la sensación subjetiva y satisfacción de las pacientes. Denominamos grupo 1 si la PAF>100; grupo 2 entre 61 y 100; y grupo 3 si la PAF<60.RESULTADOS: En el grupo 1 había 19 pacientes, 17 en el 2 y 16 en el 3. No existieron diferencias entre los 3 grupos respecto a la edad, paridad, menopausia, histerectomía, años de evolución, cirugía previa, presencia y grado de cistocele, asociación de colporrafia al TVT y tipo de anestesia utilizada. El grado clínico de Obrink aumentó a medida que disminuía la PAF (grado 3 en 26,32% del grupo 1; 31,58% del 2 y 68,71% del 3).La continencia al esfuerzo se consiguió en el 100% de las pacientes de los grupos 1 y 2, y en el 93,75% del grupo 3. La aparición de complicaciones, especialmente inestabilidad de novo o cuadros de urgencia-frecuencia así como la persistencia de inestabilidad en algunos casos de incontinencia mixta, hizo que el grado de satisfacción de las pacientes fuese del 79% en el grupo 1, 76,5% en el 2 y del 62,5% en el 3.CONCLUSIONES: La determinación de la PAF no parece influir en la decisión de implantar un TVT, pero sí permite diferenciar un grupo (PAF<60 cm de agua) cuyos resultados esperados son ligeramente peores.PALABRAS CLAVE: Incontinencia urinaria de esfuerzo. TVT. Presión abdominal de fuga. Uretropexia. ABSTRACT USEFULNESS OF ABDOMINAL LEAK POINT PRESSURE DETERMINATION IN THE DIAGNOSIS OF FEMALE URINARY INCONTINENCE IN THE TVT ERA OBJECTIVE:To analyse our results about continence in the treatment of female urinary incontinence with the tension-free vaginal tape (TVT) procedure based on abdominal leak point pressure (ALPP). PATIENTS AND METHODS:Retrospective study of the fifty two patients who had urodynamic study and abdominal leak point pressure determination and were operated on between 1999 and 2002 for stress urinary incontinence. We reviewed the data of clinical history, physical examination and urodynamic report, surgery, complications, and objective and subjective results. Those patients having ALPP>100 are included in group 1, between 61 and 100 in group 2 and less than 60 in group 3.RESULTS: There were 19 patients in group 1, 17 in group 2 and 16 in group 3. We found no difference between the three groups regarding age, delivery, menopause, hysterectomy, evolution, previous surgery, grade of cystocele, association of anterior colporraphy to TVT and type of anaesthesia. The Obrink clinical grade increased as the ALPP decreased (grade 3 in 26.32% of group 1, 31.58% in group 2 and 68.71% in group 3).100% of patients in groups 1 and 2 were continent with effort and 93.75% in group 3. Complications, especially de novo instability or urgency-frequency episodes or per...

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Valsalva leak point pressures in women with genuine stress incontinence: Reproducibility, effect of catheter caliber, and correlations with other measures of urethral resistance

Cited by 128 publications

References 13 publications

The role of angiotensin II in stress urinary incontinence: A rat model

The role of angiotensin II in stress urinary incontinence: A rat model

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

Utilidad de la determinación de la presión abdominal de fuga en el diagnóstico de la incontinencia de orina femenina en la época del TVT

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