Videourodynamic analysis of the relationship of Valsalva and cough leak point pressures in women with stress urinary incontinence.

OBJECTIVES To use videourodynamic assessment to investigate the relationship between Valsalva leak point pressure (VLPP) and cough leak point pressure (CLPP) in women with stress urinary incontinence (SUI). METHODS A total of 116 women with SUI were retrospectively analyzed by videourodynamic results, urethral pressure profilometry, and leak point pressure findings. All women had urine leakage during both coughing and performance of the Valsalva maneuver. The grade of SUI, VLPP, CLPP, maximal urethral closure pressure, and bladder neck descent during the stress test were compared among patients categorized according to three VLPP groups of less than 60 cm H(2)O, 60 or greater but less than 90 cm H(2)O, and 90 cm H(2)O or greater. RESULTS A significant inverse correlation was found between the grade of SUI and VLPP (r = -0.620, P = 0.000) and CLPP (r = -0.506, P = 0.000). The VLPP was less than 60 cm H(2)O in 41 women, 60 or greater but less than 90 cm H(2)O in 36, and 90 cm H(2)O or greater in 39. The CLPP was greater than the VLPP in 101 women (87.1%) and equaled the VLPP in 15 women (12.9%). Of the 41 women with a VLPP less than 60 cm H(2)O, 38 (92.6%) had a CLPP greater than the VLPP and 16 (39%) had greater bladder neck descent. The maximal urethral closure pressure had a weak but significant correlation with the VLPP (r = 0.299, P = 0.011) and CLPP (r = 0.325, P = 0.005). CONCLUSIONS The results of this study have demonstrated that the Valsalva maneuver and cough caused urinary leakage by different activities. A lower leak point pressure was found with VLPP than with CLPP to diagnose intrinsic sphincter deficiency. Complete assessment of urethral function, VLPP, CLPP, and bladder neck descent is essential for diagnosis and treatment of SUI.