Abstract
Purpose
To clarify the association between clinically defined simple stress urinary incontinence (SUI) symptoms and urodynamic SUI, we examined the relationship between Valsalva leak point pressure (VLPP) as measured by the Q-tip test and Stamey grade in simple female SUI.
Methods
Two hundred grade I or II female SUI patients with SUI symptom were examined by reviewing medical history; physical examination; urethral mobility as assessed by Q-tip test; stress test; and cystometry, including VLPP measurement. On the basis of the VLPP, patients were classified into urethral hypermobility [UH, subdivided into anatomical incontinence (AI) and equivocal incontinence (EI)] or intrinsic sphincter deficiency groups for analysis of the relationship between VLPP and Stamey grade and Q-tip angle.
Results
Seventy-eight patients were included, and the mean patient age was 54 ± 7.5 years, mean SUI symptom duration 2.8 years (range 0.5–6 years), mean VLPP 103.6 ± 18.4 cm H2O, and mean Q-tip angle 28.6° ± 7.2°. Fifty-three patients were categorized as Stamey grade I, 25 as Stamey grade II, 51 as AI, and 27 as EI. VLPP was found to be negatively correlated with Q-tip angle (Rs = −0.798, Y = −0.313X + 60.95, P < 0.001), and classifications of VLPP and Stamey grade have positive correlation (χ 2 = 4.9130, P = 0.0267).
Conclusions
In simple female SUI, VLPP is associated with the Q-tip angle and Stamey grade, which may help to reduce some of urodynamic items.
Similar content being viewed by others
References
Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21:5–26
Montesino-Semper MF, Jimenez-Calvo JM, Cabases JM et al (2013) Cost-effectiveness analysis of the surgical treatment of female urinary incontinence using slings and meshes. Eur J Obstet Gynecol Reprod Biol 171(1):180–186
Abrams P, Cardozo L, Fall M et al (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178
Tantanasis T, Daniilidis A, Pantelis A et al (2013) Minimally invasive techniques for female stress urinary incontinence, how, why, when. Arch Gynecol Obstet 288:995–1001
Shah SM, Gaunay GS (2012) Treatment options for intrinsic sphincter deficiency. Nat Rev Urol 9:638–651
Serati M, Cattoni E, Siesto G et al (2013) Urodynamic evaluation: can it prevent the need for surgical intervention in women with apparent pure stress urinary incontinence? BJU Int 112:E344–E350
Serati M, Ghezzi F, Cattoni E et al (2012) Tension-free vaginal tape for the treatment of urodynamic stress incontinence: efficacy and adverse effects at 10-year follow-up. Eur Urol 61:939–946
van Leijsen SA, Kluivers KB, Mol BW et al (2012) Can preoperative urodynamic investigation be omitted in women with stress urinary incontinence? A non-inferiority randomized controlled trial. Neurourol Urodyn 31:1118–1123
Kim SO, Kim YJ, Yoo DH et al (2011) Clinical factors associated with low valsalva leak point pressure among women with stress urinary incontinence. Int Neurourol J 15:211–215
Cummings JM, Boullier JA, Parra RO et al (1997) Leak point pressures in women with urinary stress incontinence: correlation with patient history. J Urol 157:818–820
Nitti VW, Combs AJ (1996) Correlation of Valsalva leak point pressure with subjective degree of stress urinary incontinence in women. J Urol 155(1):281–285
Kim SO, Jung HS, Jang WS et al (2013) Measurement of the Q-tip angle before and after tension-free vaginal tape-obturator (TVT-O): preoperative urethral mobility may predict surgical outcome. Int Urogynecol J 24:1005–1009
Visco AG, Wei JT, McClure LA et al (2003) Pelvic Floor Disorders Network. Effects of examination technique modifications on pelvic organ prolapse quantification (POP-Q) results. Int Urogynecol J Pelvic Floor Dysfunct 14:136–140
Stamey TA (1980) Endoscopic suspension of the vesical neck for urinary incontinence in females. Report on 203 consecutive patients. Ann Surg 192:465–471
Schäfer W, Abrams P, Liao L et al (2002) Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 21:261–274
Nager CW, Kraus SR, Kenton K et al (2010) Urodynamics, the supine empty bladder stress test, and incontinence severity. Neurourol Urodyn 29:1306–1311
Türker P, Kilic G, Tarcan T (2010) The presence of transurethral cystometry catheter and type of stress test affect the measurement of abdominal leak point pressure (ALPP) in women with stress urinary incontinence (SUI). Neurourol Urodyn 29:536–539
Osborn DJ, Strain M, Gomelsky A et al (2013) Obesity and female stress urinary incontinence. Urology 82:759–763
Wehrberger C, Madersbacher S, Jungwirth S et al (2012) Lower urinary tract symptoms and urinary incontinence in a geriatric cohort—a population-based analysis. BJU Int 110:1516–1521
Kawasaki A, Wu JM, Amundsen CL et al (2012) Do urodynamic parameters predict persistent postoperative stress incontinence after midurethral sling? A systematic review. Int Urogynecol J 23:813–822
McGuire EJ, Lytton B, Kohorn EI et al (1980) The value of urodynamic testing in stress urinary incontinence. J Urol 124:256–258
Mashidori T, Yamanishi T, Yoshida K et al (2007) Continuous urinary incontinence presenting as the initial symptoms demonstrating a contractile detrusor and intrinsic sphincter deficiency in multiple system atrophy. Int J Urol 14:972–974
Hosker G (2009) Is it possible to diagnose intrinsic sphincter deficiency in women? Curr Opin Urol 19(4):342–346
Anger JT, Scott VC, Kiyosaki K et al (2013) Development of quality indicators for women with urinary incontinence. Neurourol Urodyn 32:1058–1063
DeLancey JO (1994) Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 170(6):1713–1723
Ulmsten U, Henriksson L, Johnson P et al (1996) An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 7:81–85
Delorme E (2001) Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 11:1306–1313
Fritel X, Zabak K, Pigne A et al (2002) Predictive value of urethral mobility before suburethral tape procedure for urinary stress incontinence in women. J Urol 168:2472–2475
Karram MM, Bhatia NN (1988) The Q-tip test: standardization of the technique and its interpretation in women with urinary incontinence. Obstet Gynecol 71:807–811
Bergman A, Koonings PP, Ballard CA (1989) Negative Q-tip test as a risk factor for failed incontinence surgery in women. J Reprod Med 34:193–197
Cogan SL, Weber AM, Hammel JP (2002) Is urethral mobility really being assessed by the pelvic organ prolapse quantification (POP-Q) system? Obstet Gynecol 99:473–476
Acknowledgments
We thank Dr. Tian Fang Li at Rush University Medical Center (Chicago, IL, USA) for editing the manuscript.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chen, Y., Wen, J.G., Shen, H. et al. Valsalva leak point pressure-associated Q-tip angle and simple female stress urinary incontinence symptoms. Int Urol Nephrol 46, 2103–2108 (2014). https://doi.org/10.1007/s11255-014-0772-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-014-0772-4