Valsalva Leak Point Pressure to Determine Internal Sphincter Deficiency in Stress Urinary Incontinence

False-negative finding in urodynamic study for the chief complaint. Does it interfere with the clinical outcomes for the treatment of SUI or OAB syndromes?

PURPOSE

False-negative urodynamic findings may mislead or prevent planned treatments due to unmatched findings with the clinical presentation. We hypothesized that the absence of urodynamic demonstration of SUI or OAB on urodynamics would interfere with clinical outcomes.

MATERIALS AND METHODS

We prospectively studied 124 women with (94) or without (30) demonstrable SUI after sling operations. Similarly, 64 women with OAB syndrome with (38) or without (26) demonstrable DO were also compared after treatment with anticholinergic agents. Patients were assessed with the UDI-6 and IIQ-7 questionnaires 3 and 6 months after treatment.

RESULTS

Only 76% of SUI patients demonstrated urine leakage during urodynamics. The UDI-6 score was higher in the demonstrable-SUI and demonstrable-DO groups, while the IIQ-7 score was comparable within the incontinence or urgency/frequency groups. Demonstrable and non-demonstrable SUI-operated patients showed similar outcomes. Patients with urgency syndromes with or without demonstrable DO had a similar rate of improvement with anticholinergic therapy.

CONCLUSIONS

Women with clinical complaints of SUI objectively demonstrated on urodynamics presented the same subjective clinical outcome as those with SUI lacking objective demonstration when measured by the UDI-6 and IIQ-7 questionnaires. Similarly, patients with OAB syndrome with or without demonstrable DO had similar clinical improvement when treated with anticholinergics and measured using the same questionnaires.

Does uroflow predict ISD?

AIM

The term superflow has been given to abnormally high flow rates in women, and has been thought to be indicative of intrinsic sphincteric deficiency (ISD), as ISD is associated with low urethral pressure. Pelvic organ prolapse (POP) damages the sphincteric mechanism extrinsic to the urethra. The aim of this study was to determine if ISD can be predicted from voiding flow rates in women with symptomatic POP.

METHODS

The charts of 82 patients who had undergone surgery for repair of symptomatic vaginal prolapse were reviewed. Uroflow and urodynamic endpoints were compared between dry and stress incontinent patients, and correlations between abdominal leak point pressures (LPP) and pressure/flow data evaluated.

RESULTS

Average maximum flow (Q(max)) at uroflow was greater than at urodynamics with no significant difference in voided volumes. Twenty eight patients were found to have urodynamic stress incontinence (SUI), and an additional 19 to have "occult" stress incontinence. Patients with SUI had higher flow rates at urodynamics than continent patients. Voiding detrusor pressures and flow rates were not different when categorized by LPP cutoffs of 100 and 60 cm/w. Abdominal leak point pressure did not significantly correlate with any uroflow or urodynamic pressure/flow parameter.

CONCLUSIONS

Flow rates, whether determined by uroflow testing or at urodynamics, are not predictive of ISD as defined by a low abdominal leak point pressure, in patients with symptomatic POP. Either the effect of ISD on flow rates is a non-linear complex relationship or LPP does not adequately define ISD.