Computerassisted measurement and standardisation of leak-point-pressure during coughing (cough leak point-pressure CLPP) for the diagnosis of stress urinary incontinence

Purpose: Since the early 90s Leak-Point-Pressure (LPP) has been favoured fo r the diagnosis of stress and urinary incontinence. So far, there is no sta ndardisation of LPP and the method is considerably prone to disturbance. Th e aim of this study was to develop a simple computerassisted, minimally inv asive method to measure LPP during coughing (CLPP) with simultaneous automa tic registration of loss of urine as standard method in routine diagnostik procedure. Material and Methods: The Ellipse/AUDACT system of the company Andromeda Me dizinische Systeme GmbH, Taufkirchen, was used as a basis to develop a spec ific software. To test practicability, reproducibility and diagnostic relia bility of the evaluation of CLPP, a pilot study including 30 patients with stress incontinence was performed. Results: During measurement two signals (pabd and leak flow) are registered . Application of a transurethral catheter is unnecessary. For analysis purp ose a plot demonstrating abdominal pressure (y-axis) and leak flow (x-axis) is produced. The values for CLPP shown include the time-lag between pressu re and flow, duration of the leak, Qmax of the leak, pressure during maximu m leak, end of leak and CLPP. The pilot study shows that the technique pres ented is a practicable method in routine use. The assignment of leak to pre ssure signal presents no problem. All data of the CLPP measurement are repr oducible. Severity of incontinence correlates solely with leak Qmax. Conclusions: Measurement of CLPP as presented in a routine setting is simpl e and minimal time consuming. The pilot study shows that ail measurement da ta are reproducible and obtainable with a minimum of invasion. Analysis of measurements in various types of incontinence indicate that not only stress urinary incontinence but also other forms of incontinence can be diagnosed .