CORRELATION OF VALSALVA LEAK POINT PRESSURE WITH SUBJECTIVE DEGREE OFSTRESS URINARY-INCONTINENCE IN WOMEN

Purpose: We correlated symptoms of stress urinary incontinence in wome n with intrinsic urethral function, as measured by Valsalva leak point pressure. In addition, we assessed the effects of urethral hypermobil ity, baseline resting abdominal pressure, patient age and menopausal s tatus on Valsalva leak point pressure. Materials and Methods: We evalu ated 64 consecutive women (mean age 50 years, range 20 to 79) with com plaints of stress urinary incontinence. Initially the patient history was obtained and the subjective degree of stress urinary incontinence was graded as 1, 2 or 3 according to the SEAPI-QMN classification. Mul tichannel video urodynamics were then performed. At a volume of 150 to 200 ml. (or half bladder capacity when functional capacity was less t han 150 mi.) filling was stopped. Resting, coughing and progressive Va lsalva maneuvers were performed to determine Valsalva leak point press ure and the presence of urethral hypermobility. Valsalva leak point pr essure was defined as the minimum total vesical pressure required to c ause urinary incontinence in the absence of a detrusor contraction. Ur odynamics were completed and detrusor instability or stress induced in stability was noted. Results: Of the 64 women 52 (81.3%) had stress ur inary incontinence. The exact test for trend demonstrated a statistica lly significant difference in the number of patients with a Valsalva l eak point pressure of 90 cm. water or less (p = 0.0002) and 60 cm. wat er or less (p = 0.0002) among the 3 symptom groups. There was no corre lation between Valsalva leak point pressure and resting vesical (which equals abdominal) pressure, patient age or menopausal status, or urge incontinence or detrusor instability among the 3 groups. Conclusions: The subjective degree of stress urinary incontinence can predict intr insic urethral function as measured by Valsalva leak point pressure. H igher grades of stress urinary incontinence have a higher likelihood o f a low Valsalva leak point pressure. Many women with grade 2 or 3 str ess urinary incontinence have a Valsalva leak point pressure of 90 cm, water or less despite urethral hypermobility and they may have a comp onent of intrinsic urethral deficiency.