VALSALVA LEAK POINT PRESSURES IN WOMEN WITH GENUINE STRESS-INCONTINENCE - REPRODUCIBILITY, EFFECT OF CATHETER CALIBER, AND CORRELATIONS WITH OTHER MEASURES OF URETHRAL RESISTANCE

OBJECTIVES: The Valsalva leak point pressure has been promoted as an a lternative 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 press ure, and to compare vesical Valsalva leak point pressure to other meas ures of urethral resistance. STUDY DESIGN: Sixty consecutive women wit h genuine stress incontinence underwent duplicate Valsalva leak point pressure determinations by use of 8F and 3F vesical and 8F vaginal cat heters. Subjects also underwent a standard resting urethral pressure p rofilometry, cough leak point pressure determinations, and pressure-fl ow micturition studies. RESULTS: Leakage was demonstrated on both Vals alva maneuvers in approximately 80% of subjects with both catheters. i n subjects who leaked with both strains there was an extremely high co rrelation between the test-retest Valsalva leak point pressure within both catheters. The intercatheter correlation between the 8F and 3F Va lsalva leak point pressures was significant but much weaker than the i ntracatheter correlations; 8F Valsalva leak point pressures were signi ficantly higher than 3F Valsalva leak point pressures, although there were individual exceptions to this observation. Urethral pressure prof ilometry measures and micturition opening pressures were poorly correl ated with Valsalva leak point pressure. Cough and vaginal Valsalva lea k 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 l ower than the vesical Valsalva leak point pressure. CONCLUSIONS: Valsa lva leak point pressure is a simple and reproducible technique for eva luating 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.