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Commented Abstracts

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  • Removal of transurethral catheter during urodynamics may unmask stress urinary incontinence.
    Maniam P, Goldman HB.
    J Urol 2002 May;167(5):2080-2 


PURPOSE: The measurement of Valsalva leak point pressure may have an important role in the treatment algorithm of women with stress urinary incontinence. However, some patients with stress urinary incontinence may not have leakage during standard urodynamic studies and, thus, the Valsalva leak point pressure cannot be determined. We hypothesized that the transurethral catheter may inhibit leakage during urodynamics.

MATERIALS AND METHODS: We evaluated 21 consecutive women presenting with complaints of stress urinary incontinence who failed to have leakage on urodynamic studies. Bedside cystometry was performed, followed by urodynamics using a 6Fr transurethral catheter. When stress urinary incontinence was not noted, the catheter was removed and the Valsalva leak point pressure was measured using the intraabdominal pressure catheter.

RESULTS: No woman had leakage on urodynamic studies with the catheter in place, although 11 of  21 had leakage after the catheter was removed and 15 had leakage on bedside cystometry. All 11 patients with leakage at catheter removal showed leakage on bedside stress testing. Mean Valsalva leak point pressure in those with leakage was 67 cm. water.

CONCLUSIONS: Patients with a history of stress urinary incontinence and those with a positive bedside stress test who do not have leakage during a Valsalva maneuver on urodynamic studies should repeat the Valsalva maneuver with the catheter out. This technique may unmask stress urinary incontinence and allow the measurement of Valsalva leak point pressure.

                                 EDITORIAL COMMENT

An appreciable portion of patients directed for a urodynamic study does not present urinary loss during the Valsalva maneuver during the realization of the Valsalva Leak Point Pressure. Some patients do not leak by voluntary contraction of the sphincter, because of the embarrassing aspect of the exam. The patient is conscious of the leak and, involuntarily tries to avoid incontinence increasing the peri-urethral musculature tonus. Another portion of patients cannot reproduce, in a urodynamic study environment the situations in which occur the incontinence episodes out of the laboratory. Independent of the motive it is believed that, in general, these patients have leakage with abdominal pressure, which are relatively high. It is curious to observe that in Manian and Goldmanīs work the pressures of medium loss obtained were relatively low (67 cmH20) against this usual notion. The authors decided on the hypothesis that the catheter, in some patients, may be of a compressive effect on the surrounding tissues, helping in the sealing effect of the urethra and diminishing a chance of urinary loss. Another aspect of importance is that the removal of the urethral catheter unmasked stress urinary incontinence only in patients that lost urine during the physical exam (simple cystometry), but in no women that during the exam did not leak with the maneuvers. 

Aparecido Donizeti Agostinho

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