RETROGRADE LEAK POINT PRESSURE FOR EVALUATING POSTRADICAL PROSTATECTOMY INCONTINENCE

Objectives. To evaluate a technique of measuring the retrograde leak p oint pressure (RLPP) for assessing men with postradical prostatectomy stress urinary incontinence (SUI). Methods. We measured RLPP in adult men by retrograde infusion of the distal urethra while simultaneously recording intraurethral pressure. The reproducibility of this test, an d its dependence on urethral infusion rate, bladder volume, and anteri or urethral catheter position, were evaluated. RLPP and abdominal leak point pressure (ALPP) measurements were performed in postradical pros tatectomy patients. RLPP was compared with ALPP and with severity of i ncontinence determined by pad usage. Results. Repeated RLPP measuremen ts were not significantly different and did not change with bladder vo lume up to half capacity or with the location of the catheter in the a nterior urethra. The differences between RLPP measurements with infusi on rates of 2, 4, and 8 mL/min were also not significant. Twenty-seven men were evaluated 6 to 108 months after surgery. Of these, 22 (81%) demonstrated SUI. Mean RLPP in men without SUI (79.2 +/- 14 cm H2O) wa s significantly higher than in men with SUI (51.9 +/- 13 cm H2O, P < 0 .01). In men with SUI, ALPP and RLPP were significantly correlated, an d ALPP (49.8 +/- 24 cm H2O) was not significantly different from RLPP (51.9 +/- 13 cm H2O). Pad use and RLPP were also significantly related . Conclusions. RLPP measurements are reproducible and simple to perfor m, The pressure at which leakage occurs is easily identifiable as the plateau pressure. RLPP correlates significantly with the lowest of mul tiple ALPP measurements in men with SUI. This technique represents a r eliable urodynamic alternative for evaluating men with postradical pro statectomy SUI. Copyright 1997 by Elsevier Science Inc.