The Comparison of Valsalva and Cough-induced Leak Point Pressures in Patients with Stress Urinary Incontinence

Kim, Joa Jun; Lee, Tack; Yun, Sang Min

Abstract

PURPOSE: We evaluated Valsalva and cough-induced leak point pressure measurements identically and compared their reliability in the patients with stress urinary incontinence (SUI).
MATERIALS AND METHODS
Seventy-five patients complaining of SUI were assessed with medical history, uro-gynecological examination, any factors that could affect voiding symptoms, and videourodynamic study consisting of Valsalva leak point pressure (VLPP), cough-induced leak point pressure (CILPP) on supine and erect position, prospectively. We observed the location and descent of bladder neck on fluoroscopic images, and VLPP, CILPP synchronously. The bladder neck position, the degree of bladder neck descent, VLPP and CILPP were compared, then the correlation of each was analysed.
RESULTS
The lower the position of initial bladder neck is, the more severe the descent of the bladder neck is in supine (Valsalva; r=0.305, p<0.01, cough; r=0.333, p=0.01) and erect (Valsalva; r=0.341, p<0.01, cough; r=0.512, p<0.01). The descent of bladder neck and VLPP is significantly correlated in supine (r=0.251, p<0.05) and erect (r=0.293, p<0.01). The descent of bladder neck and CILPP is also significantly correlated in erect (r=0.254, p<0.05), but not in supine position (r=0.232, p>0.05). VLPP and CILPP in SUI type III are significantly lower than those in SUI type I and II (p<0.05), but VLPP and CILPP were not correlated to subjective symptoms of SUI.
CONCLUSIONS
Both VLPP and CILPP are reliable in evaluation of SUI. However, ecause VLPP is reliable regardless of position and easier than CILPP in the measurement, it is expected as more useful method. If CILPP is used, it must be evaluated in the erect position.