Low Valsalva leak-point pressure and success of retropubic urethropexy

The aim of this study was to determine whether an isolated low Valsalva lea k-point pressure (VLPP) is predictive of intrinsic sphincter deficiency (IS D) and can be an independent risk factor for retropubic urethropexy failure in patients with a normal maximal urethral closure pressure (MUCP). Twenty -four women with urodynamically proven genuine stress incontinence with low VLPP (< 60 cmH(2)O) and normal MUCP (>20 cmH(2)O) were evaluated subjectiv ely and objectively by complex urodynamic testing before and after undergoi ng a modified Burch urethropexy. Success rates were then compared to histor ical success rates for subjects with ISD treated with retropubic urethropex y using an exact one-sample test for binomial proportions. Patients were fo llowed postoperatively for a mean of 11.1 months, with a range of 5-16 mont hs. Twenty-two of the 24 (91.7%) were continent on postoperative cystometry . This differs significantly from the published success rates of 50% (P <0. 001), if a low VLPP alone were predictive of ISD. Retropubic urethropexy wa s successful in the majority of our patients with genuine stress incontinen ce with a low VLPP and normal MUCP.