Abstract
The aim of this study was to determine the characteristics of women who meet the criteria for intrinsic sphincteric deficiency (ISD) on maximum urethral closure pressure (MUCP) but not on leak point pressure (LPP) measurement. We performed a cross-sectional chart review of every patient who underwent multichannel, microtransducer urodynamic testing in our center between 1994 and 1996 (n=423). From this population we culled a sub-population of women who fit into one of the following two groups: women with no evidence of ISD on MUCP or LPP and women with evidence of ISD on MUCP only. Logistic regression was used to identify independent predictors of group membership. Increasing age (>60.5 years) and a positive supine empty stress test were the only independent predictors of membership in the group of women with ISD on MUCP only. Knowledge of these risk factors may help clinicians in choosing appropriate pre-operative testing.
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Abbreviations
- ISD :
-
Intrinsic sphincteric deficiency
- LPP :
-
Leak point pressure
- MUCP :
-
Maximum urethral closure pressure
References
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Editorial Comment: Valsalva leak point pressures and maximum urethral closure pressures are two different tests that can be used to evaluate and quantify urethral sphincteric function. The authors performed a cross-sectional study to determine the characteristics of women whose diagnosis of ISD would be missed based on an abnormal MUCP defined as <20 cm H20 if only a LPP was assessed. They found that of 305 patients with a normal LPP defined as >60 cm H20, 288 patients also had a normal MUCP (Group A) compared to 17 patients who had an abnormal MUCP (Group B). In comparing 18 patients characteristics, they found that age greater than 60 years and a positive supine empty stress test were independent risk factors for membership in Group B. It is known that both MUCP and LPP are fraught with variables making each difficult to standardize and validate. One could question whether a MUCP with a cutoff <20 cm can truly be used to define ISD. This brings up a related criticism described as a limitation by the authors—mainly that LPP were measured only at a bladder volume of 150 cc. Perhaps if the measurements were repeated at a larger bladder volume, there would have been an even greater correlation between MUCP and LPP. More needs to be done in the future to better standardize tests used to evaluate urethral function. As the authors mentioned, however, with the success of suburethal slings for all types of stress incontinence, perhaps this is a moot point.
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Murphy, M., Culligan, P.J., Graham, C.A. et al. Is the leak point pressure alone an accurate indicator of intrinsic sphincteric deficiency?. Int Urogynecol J 15, 294–297 (2004). https://doi.org/10.1007/s00192-004-1154-8
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DOI: https://doi.org/10.1007/s00192-004-1154-8