Skip to main content

Advertisement

Log in

Opening vesical pressure: a new test to discriminate urethral sphincter deficiency?

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Urethral sphincter deficiency (USD) is not standardised. Opening vesical pressure could reflect the pressure exerted to overcome urethral resistance during void; thus, we evaluated if it could discriminate USD. Women with urinary symptoms were prospectively assessed with a questionnaire and urodynamics and divided into three groups: urodynamic stress incontinence with USD (group 1), urodynamic stress incontinence related to urethral hypermobility without USD (group 2) and normal urodynamic (group 3). USD was defined as the concomitant presence of severe urodynamic stress incontinence, VLPP <60 cm H2O, MUCP <20 cm H2O and urethral mobility <30°. A total of 145 women were enrolled: 56 in group 1, 50 in group 2 and 39 in group 3. The three groups did not differ for demographics, obstetric and surgical history. The median values for opening vesical pressures were 17.5 (15.6–22.2 95%CI), 30 (27.0–37.3 95%CI) and 30 (30.6–44.2 95% CI) for the groups 1, 2 and 3, respectively. A p value <0.0001 was found when comparing group 1 either with group 2 or 3. Opening vesical pressure is a promising parameter to detect USD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Urinary Incontinence Guideline Panel (1992) Urinary incontinence in adults. Clinical Practice Guideline. AHCPR Pub. No. 92-0038. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Depart ment of Health and Human Services (March)

  2. McGuire EJ, Lytton B, Kohorn EI, Pepe V (1980) The value of urodynamic testing in stress urinary incontinence. J Urol 124:256–258

    PubMed  CAS  Google Scholar 

  3. Bowen LW, Sand PK, Ostergard DR, Franti CE (1989) Unsuccessful Burch retropubic urethropexy: a case-controlled urodynamic study. Am J Obstet Gynecol 160:452–458

    PubMed  CAS  Google Scholar 

  4. Ghezzi F, Serati M, Cromi A, Uccella S, Salvatore S, Triacca P, Bolis P (2006) Tension-free vaginal tape for the treatment of urodynamic stress incontinence with intrinsic sphincteric deficiency. Int Urogynecol J Pelvic Floor Dysfunct 17:335–339

    Article  PubMed  Google Scholar 

  5. Rezapour M, Falconer C, Ulmsten U (2001) Tension-free vaginal tape (TVT) in stress incontinent women with intrinsic sphincter deficiency (ISD)—a long-term follow-up. Int Urogynecol J Suppl 2:S12–S14

    Article  Google Scholar 

  6. Paick JS, Ku JH, Shin JW, Son H, Oh SJ, Kim SW (2004) Tension-free vaginal tape procedure for urinary incontinence with low Valsalva leak point pressure. J Urol 172:1370–1373

    Article  PubMed  Google Scholar 

  7. Liapis A, Bakas P, Salamelekis E, Botsis D, Creatsas G (2004) Tension-free vaginal tape (TVT) in women with low urethral closure pressure. Eur J Obstet Gynecol Reprod Biol 116:67–70

    Article  PubMed  Google Scholar 

  8. Lose G, Griffiths D, Hosker G, Kulseng-Hanssen S, Perucchini D, Schäfer W, Thin dP, Versi E (2002) Standardisation of urethral pressure measurement: report from the standardisation sub-committee Of The International Continence Society. Neurourol Urodyn 21(3):258–260

    Article  PubMed  Google Scholar 

  9. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    Article  PubMed  CAS  Google Scholar 

  10. Ferrari A, Baresi L, Frigerio L, Costa M (1986) A grading model for stress urinary incontinence. Urology 27:76–78

    Article  PubMed  CAS  Google Scholar 

  11. Abrams P, Cardozo L, Fall M et al (2003) The standardization of terminology of lower urinary tract function: report from the standardisation sub-committee of the ICS. Urology 61:37–49

    Article  PubMed  Google Scholar 

  12. DeLancey JOL (1986) Correlative study of paraurethral anatomy. Obstet Gynecol 68(1):91–97

    PubMed  CAS  Google Scholar 

  13. Oelrich TM (1983) The striated urogenital sphincter muscle in the female. Anat Rec 205:223–232

    Article  PubMed  CAS  Google Scholar 

  14. Weber AM (2001) Is urethral pressure profilometry a useful diagnostic test for stress urinary incontinence? Obstet Gynecol Surv 56(11):720–735

    Article  PubMed  CAS  Google Scholar 

  15. Weil A, Reyes H, Bischoff P, Rottenberg RD, Kruer F (1984) Modification of the urethral rest and stress profiles after different types of surgery for urinary stress incontinence. Br J Obstet Gynaecol 91(1):46–55

    PubMed  CAS  Google Scholar 

  16. Bump RC, Coates KW, Cundiff GW, Harris RL, Weidner AC (1997) Diagnosing sphincteric deficiency: comparing urethral closure pressure, urethral axis and Valsalva leak point pressures. Am J Obstet Gynecol 177:303–310

    Article  PubMed  CAS  Google Scholar 

  17. Lose G (1997) Urethral pressure measurement. Acta Obstet Gynecol Scand Suppl 166:39–42

    PubMed  CAS  Google Scholar 

  18. Weber M (2001) Leak point pressure measurement and stress urinary incontinence. Curr Womens Health Rep 1(1):45–52

    PubMed  CAS  Google Scholar 

  19. Digesu GA, Athanasiou S, Chaliha C, Michalas S, Salvatore S, Selvaggi S, Khullar V (2006) Urethral retro-resistance pressure and urodynamic diagnoses in women with lower urinary tract symptoms. BJOG 113:34–38

    Article  PubMed  Google Scholar 

  20. Swift SE, Ostergard DR (1995) A comparison of stress leak-point pressure and maximal urethral closure pressure in patients with genuine stress incontinence. Obstet Gynecol 85:704–708

    Article  PubMed  CAS  Google Scholar 

  21. McGuire EJ, Fitzpatrick CC, Wan J, Bloom D, Sanvordenker J, Ritchey M, Gormley EA (1993) Clinical assessment of urethral sphincter function. J Urol 150:1452–1454

    PubMed  CAS  Google Scholar 

  22. Versi E, Cardozo L, Studd JW, Brincat M, O’Dowd TM, Cooper DJ (1986) Internal urinary sphincter in maintenance of female continence. Br Med J (Clin Res Ed) 292(6514):166–167

    Article  CAS  Google Scholar 

  23. Theofrastous JP, Bump RC, Elser DM (1995) Correlation of Valsalva Leak Point Pressure and urethral pressure profilometry variables with measures of incontinence severity in women with pure genuine stress incontinence. Am J Obstet Gynecol 173:407–414

    Article  PubMed  CAS  Google Scholar 

  24. Petrou SP, Wan J (1999) VLPP in the evaluation of the female with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 10(4):254–259

    Article  PubMed  CAS  Google Scholar 

  25. Bonney V (1923) On diurnal incontinence of urine in women. J Obstet Gynaecol Br Emp 30:324

    Google Scholar 

  26. Slack M, Culligan P, Tracey M, Hunsicker K, Patel B, Sumeray M (2004) Relationship of urethral retro-resistance pressure to urodynamic measurements and incontinence severity. Neurourol Urodyn 23(2):109–114

    Article  PubMed  CAS  Google Scholar 

  27. Slack M, Tracey M, Hunsicker K, Godwin A, Patel B, Sumeray M (2004) Urethral retro-resistance pressure: a new clinical measurements of urethral function. Neurourol Urodyn 23(7):656–661

    Article  PubMed  CAS  Google Scholar 

  28. Athanasiou S, Khullar V, Boos K, Slavatore S, Cardozo L (1999) Imaging the urethral sphincter with three-dimensional ultrasound. Obstet Gynecol 94:295–301

    Article  PubMed  CAS  Google Scholar 

  29. Cucchi A (1999) Sequential changes in voiding dynamics related to the development of detrusor instability in women with stress urinary incontinence. Neurourol Urodyn 18(2):73–80

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Stefano Salvatore.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Salvatore, S., Serati, M., Khullar, V. et al. Opening vesical pressure: a new test to discriminate urethral sphincter deficiency?. Int Urogynecol J 18, 1435–1438 (2007). https://doi.org/10.1007/s00192-007-0379-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-007-0379-8

Keywords

Navigation