Standardisation of urethral pressure measurement: Report from the standardisation sub-committee of the International Continence Society

Lose, Gunnar; Griffiths, Derek; Hosker, G. L.; Kulseng‐Hanssen, Sigurd; Perucchini, Daniele; Schäfer, Werner; Thind, Peter; Versi, Eboo

doi:10.1002/nau.10051.abs

Cited by 38 publications

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“…The conclusion of the ICS standardisation report on urethral pressure measurement (18) is that "the clinical utility of urethral pressure measurement is unclear" and that "there is no doubt that the urethral pressure is of signifi cant importance for the continence mechanism".…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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

2012

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“…A catheter mounted pressure transducer is an advantage for dynamic recordings of urethral pressures during coughing (stress pro¢les) as well as for ambulatory urodynamics in mobile patients. Here only the application of catheter mountedpressure transducers for intravesical and abdominal pressure recordings will be discussed as urethral pressures are dealt with in a separate report [Lose et al, 2002].…”

Section: Pressure Transducersmentioning

confidence: 99%

Good urodynamic practices: Uroflowmetry, filling cystometry, and pressure‐flow studies**

Schäfer¹,

Abrams²,

Liu³

et al. 2002

Neurourology and Urodynamics

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This is the ¢rst report of the International Continence Society (ICS) on the development of comprehensive guidelines for Good Urodynamic Practice for the measurement, quality control, and documentation of urodynamic investigations in both clinical and research environments. This report focuses on the most common urodynamics examinations; uro£owmetry, pressure recording during ¢lling cystometry, and combined pressure^£ow studies. The basic aspects of good urodynamic practice are discussed and a strategy for urodynamic measurement, equipment set-up and con¢guration, signal testing, plausibility controls, pattern recognition, and artifact correction are proposed. The problems of data analysis are mentioned only when they are relevant in the judgment of data quality. In general, recommendations are made for one speci¢c technique. This does not imply that this technique is the only one possible. Rather, it means that this technique is well-established, and gives good results when used with the suggested standards of good urodynamic practice. Neurourol. Urodynam.21: 261^274,2002. ß 2002 Wiley-Liss, Inc.Key words: urodynamics; standardisation; uro£owmetry; cystometry; pressure-£ow studies INTRODUCTIONA Good Urodynamic Practice comprises three main elements:A clear indication for and appropriate selection of, relevant test measurements and procedureŝ Precise measurement with data quality control and complete documentation Accurate analysis and critical reporting of resultsThe aim of clinical urodynamics is to reproduce symptoms whilst making precise measurements in order to identify the underlying causes for the symptoms, and to quantify the related pathophysiological processes. By doing so, it should be possible to establish objectively the presence of a dysfunction and understand its clinical implications. Thus, we may either con¢rm a diagnosis or give a new, speci¢cally urodynamic, diagnosis. The quantitative measurement may be supplemented by imaging (videourodynamics).Urodynamic measurements cannot yet be completely automated, except for the most simple urodynamic procedure, uro£owmetry. This is not an inherent problem of the measurement itself, but is due to the current limitations of urodynamic equipment and the lack of a consensus on the precise method of measurement, signal processing, quanti¢cation, documentation, and interpretation. With the publication of this ICS Standardisation document on good urodynamic practice, it is expected that the necessary technological developments in automation will follow.Urodynamics allows direct assessment of lower urinary tract (LUT) function by the measurement of relevant physiological parameters. The ¢rst step is to formulate the 'urodynamic question or questions' from a careful history, physical examination, and standard urological investigations. The patient's recordings of micturitions and symptoms on a frequency volume chart, and repeated free uro£owmetry with determination of post-void residual volume provide important noninvasive, objective information that helps to ...

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“…Water perfusion catheters measure the urethral resistance to a slow flow of perfused water through a side hole of a small round catheter. This technology meets the description of urethral pressure described by Griffiths and Versi [1] and is recommended by the International Continence Society (ICS) [2]. Water perfusion catheters typically have two or three lumens, are relatively inexpensive, and are disposable.…”

Section: Introductionmentioning

confidence: 80%

A comparative study of water perfusion catheters and microtip transducer catheters for urethral pressure measurements

et al. 2006

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The aim of this study was to compare the maximum urethral closure pressure (MUCP) measures with two different techniques: water perfused catheter and microtip transducer catheters with respect to reproducibility and comparability for urethral pressure measurements. Eighteen women with stress urinary incontinence had repeat static urethral pressure profilometry on a different day using a dual microtip transducer and water perfused catheter (Brown and Wickham). The investigators were blinded to the results of the other. The microtip measurements were taken in the 45°upright sitting position with the patient at rest at a bladder capacity of 250 ml using an 8 Fr Gaeltec® double microtip transducer withdrawn at 1 mm/s, and the transducer was orientated in the three o'clock position. Three different measures were taken for each patient. Three water perfusion measurements were performed with the patient at rest in the 45°upright position at a bladder capacity of 250 ml using an 8 Fr BARD dual lumen catheter withdrawn at 1 mm/s. The mean water perfusion MUCP measure was 26.1 cm H 2 0, significantly lower than the mean microtip measure of 35.7 cm H 2 0. The correlation coefficient comparing each water perfusion measurement with the other water perfusion measures in the same patient was excellent, at 0.95 (p=0.01). Correlation coefficient comparing each microtip measure with the other microtip measure in the same patient was also good, ranging from 0.70 to 0.80. This study confirms that both water perfusion catheters and microtip transducers have excellent or very good reproducibility with an acceptable intraindividual variation for both methods.

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Standardisation of urethral pressure measurement: Report from the standardisation sub-committee of the International Continence Society

Cited by 38 publications

References 0 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?

Good urodynamic practices: Uroflowmetry, filling cystometry, and pressure‐flow studies**

A comparative study of water perfusion catheters and microtip transducer catheters for urethral pressure measurements

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