The patient has a typical history of stress urinary incontinence, but we could not show it
in the clinical exam or during the urodynamic. Probably the pelvic floor contraction
during effort, could be the cause that the patient does not lose urine in the provoked
maneuvers of the exam. In the videourodynamic the bladder neck and the proximal urethra
are closed at rest, and placed at level, or above the border of the inferior symphysis
pubis. During effort the bladder neck and the proximal urethra open, but there is no loss
During rest the bladder neck is placed above the border of the inferior pubic symphysis.
At the moment of effort the bladder neck and the proximal urethra open and fall less than
2 cm, urinary loss occurring during the increase of intra abdominal pressure, which
generally is high (>65 cm/H20). Normally, there is no cystocele, or just a light degree
During rest the bladder neck is closed and placed above the inferior border of the pubic
symphysis. During effort the bladder neck and the proximal urethra open and fall more than
2 cm, we observe a cystourethrocele with an inferior rotation of urinary loss. We might
have a presence of a urinary incontinence type II A, together with a sphincterian
incontinence, seen by the low value of the Valsalva Leak Point Pressure (Fig.3).
The bladder neck is closed at rest and located at the level of the inferior border of the
pubic symphysis or below it. During effort there may or may not be more falling of the
bladder, and urinary loss occurs with the opening of the bladder neck and the proximal
urethra, generally with pressure of urinary loss above 65 cm/H20. Type II B: incontinence
may also coexist with sphincterian incontinence, and in this case we will observe low
pressure of loss (<60cm/H20) (Fig.4).
We observe the bladder neck and the proximal urethra open at rest, and in the absence of
detrusor contraction. Urinary loss occurs with a minimum intravesical raise (<60
cm/H20), or only in orthostatic position. The proximal urethra does not work anymore as a
sphincter (Fig 5).