JOURNAL OF FEMALE
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.
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.
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.
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.
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.
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