Observations on the function of the female urethra: I: Relation between maximum urethral closure pressure at rest and urethral hypermobility

Schick, Erik; Tessier, Jocelyne; Bertrand, Pierre E.; Dupont, C.; Jolivet‐Tremblay, Martine

doi:10.1002/nau.10148

Cited by 19 publications

(20 citation statements)

References 23 publications

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“…In relation to age groups, that decrease occured always in SUI women, in all women in the middle age group and in women with stress or mixed incontinence in the oldest group. The decrease of MUCP during stress profi le (P3) could be related to a urethral hypermobility as it has been demonstrated by Schick et al (26). The difference between the middle age and the oldest group could be the consequence of a more rigid urethra due to oestrogen defi ciency or pelvic surgery or both.…”

Section: Discussionmentioning

confidence: 75%

Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

2012

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Introduction: Our purpose was, applying a strictly defi ned protocol for urethral profi lometry, 1) to test the repeatability of same session rest maximum urethral closure pressure (MUCP) and 2) to search for correlation between women complaint and the changes in MUCP value (rest and dynamic tests). Materials and Methods:A population of 140 consecutive women referred for evaluation of lower urinary tract dysfunction was stratifi ed in 4 groups according with the urinary symptoms: stress, urge, mixed incontinence and continent and in each group in 3 age groups (young, middle age and old). The sequence of tests recorded in supine position was: urethral pressure profi le at rest bladder empty, after bladder fi lling at 250 mL (reference test), stress profi le, fatigability (before (rest) and after 10 successive strong coughs), then in standing position. Results: In all groups, there was no signifi cant difference between the two MUCP values at rest bladder fi lled. In the three incontinent groups, MUCP was higher bladder empty than bladder fi lled (p < 0.05) except in the young sub-group. Stress incontinence led to signifi cant decrease of MUCP during dynamic tests in the young group. MUCP was not modifi ed after fatigability test in women with urge complaint whatever age. Conclusion: When recorded following a strictly defi ned protocol, MUCP at rest bladder fi lled has a good repeatability in individual. However a complex sequence of tests during urethral pressure profi lometry remains discussed in middle-age and old age--groups, it allows specifying the stress component of incontinence in young women and the urgency component in all age-groups. INTRODUCTIONControversies about the role of urethral pressure profi lometry (UPP) in clinical practice (1-3) are mainly based on the reproducibility of the measurements and on the lack of standardization (4).Other main controversies are related to the predictive value of the preoperative maximum urethral closure pressure (MUCP) and the success of the surgery of stress incontinence (5-9) and the postoperative quality of life (10). Conversely, De Lancey (11) found that MUCP was the most characteristic parameter of stress incontinence.In our urodynamic laboratory, we have defi ned a strict protocol for UPP which is routinely applied in order to rule out many causes of variability. It consists of a well-defi ned sequence Vol. 38 (6): 809-817, November -December, 2012 Is a sequence of tests during urethral pressure profi lometry correlated with symptoms assessment in women? ___ _______________________________________________ ____________________________________________

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Section: Discussionmentioning

confidence: 75%

Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

2012

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“…We have already demonstrated that MUCP decreases with statistical signi¢cance when urethral hypermobility appears [Schick et al, 2003a]. This decrease is not in£uenced by the age or number of pregnancies of our patients.…”

Section: Discussion and Overviewmentioning

confidence: 51%

“…In the ¢rst part of this study [Schick et al, 2003a], we explored the relationship between maximum urethral closure pressure and hypermobility of the urethra. We concluded that MUCP drops signi¢cantly with the appearance of hypermobility, but that the ensuing aggravation of this hypermobility has only a marginal e¡ect on MUCP.…”

Section: Introductionmentioning

confidence: 99%

Observations on the function of the female urethra: III: An overview with special reference to the relation between urethral hypermobility and urethral incompetence

Schick¹,

Jolivet‐Tremblay²,

Tessier³

et al. 2003

Neurourology and Urodynamics

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The statistically significant relation between urethral incompetence and hypermobility suggests that urethral incompetence will increase as the degree of urethral hypermobility does. Optimal conditions for urinary continence include a high maximum urethral closure pressure, absence of hypermobility, and a low degree of urethral incompetence. This last factor is assured by a strong support underneath the urethra permitting compression of the latter during straining. Failure of the urethral closure mechanism is highly probable with a diminished maximum closure pressure accompanied by urethral hypermobility often associated with a high degree of urethral incompetence. Clinically significant urinary incontinence may appear in many intermediate circumstances between these two extreme states, but stress urinary incontinence is essentially an activity-related phenomenon.

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“…MUCP and cough LPP evolve ''in tandem'': a decrease in one entails a decrease in the other. In the ¢rst part of our study [Schick et al, 2003] we suggested that the partial denervation of the pelvic £oor muscles was the cause of the decrease in MUCP found with urethral hypermobility. This would imply a strictly neuro-muscular phenomenon.…”

Section: Discussionmentioning

confidence: 98%

“…In a previous study [Schick et al, 2003] we analyzed the relation between maximum urethral closure pressure (MUCP) and the degree of urethral hypermobility. We concluded from that study that MUCP decreases signi¢cantly when urethral hypermobility appears.…”

Section: Introductionmentioning

confidence: 99%

Observations on the function of the female urethra: II: Relation between maximum urethral closure pressure at rest and the degree of urethral incompetence

Schick¹,

Bertrand²,

Jolivet‐Tremblay³

et al. 2003

Neurourology and Urodynamics

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This study demonstrates that there is a highly significant relationship between MUCP and between all grades of urethral incompetence. This supports previous observations that MUCP decreases when abdominal leak point pressure (ALPP) is low and that this might be secondary to some mechanical failure in the pressure transmission from the abdominal cavity to the urethra. Studies should never compare continent to incontinent cohorts without considering their ALPP because in doing so they are comparing groups that are functionally heterogeneous.

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Observations on the function of the female urethra: I: Relation between maximum urethral closure pressure at rest and urethral hypermobility

Cited by 19 publications

References 23 publications

Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

Observations on the function of the female urethra: III: An overview with special reference to the relation between urethral hypermobility and urethral incompetence

Observations on the function of the female urethra: II: Relation between maximum urethral closure pressure at rest and the degree of urethral incompetence

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