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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

  • Richard C. Bump
    Correspondence
    Reprint requests: Richard Bump, MD, Department of Obstetrics and Gynecology, Box 3609, Duke University Medical Center, Durham, NC 27710.
    Affiliations
    Departments of Obstetrics and Gynecology, Medical College of Virginia/Virginia Commonwealth University, Richmond, Virginia, USA

    Department of Obstetrics and Gynecology Duke University Medical Center, Durham and Winston-Salem, North Carolina, USA
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  • Denise M. Elser
    Affiliations
    Departments of Obstetrics and Gynecology, Medical College of Virginia/Virginia Commonwealth University, Richmond, Virginia, USA
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  • James P. Theofrastous
    Affiliations
    Department of Obstetrics and Gynecology Duke University Medical Center, Durham and Winston-Salem, North Carolina, USA
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  • Donna K. McClish
    Affiliations
    Department of Biostatistics, Medical College of Virginia/Virginia Commonwealth University, Richmond, Virginia, USA
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  • Continence Program for Women Research Group
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      Abstract

      OBJECTIVES: The Valsalva leak point pressure has been promoted as an alternative to urethral pressure profilometry as a measure of urethral resistance in women with genuine stress incontinence. Our aims were to evaluate the reproducibility of the Valsalva leak point pressure, to assess the effect of catheter caliber on the Valsalva leak point pressure, and to compare vesical Valsalva leak point pressure to other measures of urethral resistance.
      STUDY DESIGN: Sixty consecutive women with genuine stress incontinence underwent duplicate Valsalva leak point pressure determinations by use of 8F and 3F vesical and 8F vaginal catheters. Subjects also underwent a standard resting urethral pressure profilometry, cough leak point pressure determinations, and pressure-flow micturition studies.
      RESULTS: Leakage was demonstrated on both Valsalva maneuvers in approximately 80% of subjects with both catheters. In subjects who leaked with both strains there was an extremely high correlation between the test-retest Valsalva leak point pressure within both catheters. The intercatheter correlation between the 8F and 3F Valsalva leak point pressures was significant but much weaker than the intracatheter correlations; 8F Valsalva leak point pressures were significantly higher than 3F Valsalva leak point pressures, although there were individual exceptions to this observation. Urethral pressure profilometry measures and micturition opening pressures were poorly correlated with Valsalva leak point pressure. Cough and vaginal Valsalva leak point pressures were significantly correlated with vesical Valsalva leak point pressure, but cough leak point pressures were significantly higher and vaginal Valsalva leak point pressures were significantly lower than the vesical Valsalva leak point pressure.
      CONCLUSIONS: Valsalva leak point pressure is a simple and reproducible technique for evaluating urethral resistance in women with genuine stress incontinence. However, variations in Valsalva leak point pressure measurement must be precisely described, standardized, and validated before a technique can be advocated for clinical use.

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