The Effect of Patient Position on Leak-Point Pressure Measurements in Women with Genuine Stress Incontinence

Abstract

The aim of this study was to determine the quantitative and qualitative effects of patient position on coughing and Valsalva leak-point pressure in women with genunie stress incontinence. Thirty-seven patients with genuine stress incontinence and 4 with mixed incontinence underwent multichannel urodynamics using a standardized protocol. Leak-point pressures were performed using 8 Fr microtip catheters placed in the bladder and vagina at a bladder volume of 250 ml in the supine, semirecumbent and standing positions. Urethral pressure profilometry was performed in the semirecumbent position at a bladder volume of 250 ml. The mean (range) age, and median (range) gravidity, parity, body mass index (BMI), and mean (range) Q-tip deflection angle were 61 years (36-80), 3 (1-8), 3 (1-6), 26 (22-30) and 55.8 degrees (25 degrees-80 degrees), respectively. The mean (+/- standard deviation) Valsalva leak-point pressures in the supine, semirecumbent and standing positions were 82 +/- 23, 73 +/- 24 and 63 +/- 22 cmH2O, respectively (P<0.001). The mean (+/- standard deviation) cough leak-point pressures also decreased as the patients were moved from the supine (98 +/- 29 cmH2O) to the semirecumbent (88 +/- 24 cmH2O) and standing positions (77 +/- 24 cmH2O) (P<0.001). The correlation between leak-point pressure and maximum urethral closure pressure was statistically significant and was dependent upon patient position and the provocative maneuver used.

Impact of patient position on filling phase of urodynamics in women

“…Nguyen et al [3] found a lower leakpoint pressure in standing position as compared to supine position. Grischke et al [2] demonstrated an increase in functional length of the urethra in lithotomy position as compared to upright position with an increase in the maximum urethral closure pressure.…”

“…The functional length of the urethra and maximum urethral closure pressure is known to be affected by patient position [2]. Recently it has been suggested that leak-point pressure and maximum urethral closure pressure is dependent both upon the patient's position and the nature of the provocative manoeuvre used [3]. However, the effect of position on the findings during the filling phase of cystometry has been poorly studied.…”

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

“…Studies comparing VLPP and CLPP in the same patient tend to conclude that VLPP values are systematically lower then CLPP values [Peschers et al, 2000;Zmrhal et al, 2001;Nguyen et al, 2002], presumably due to di¡erent reactions of the pelvic £oor to various stress maneuvers. Zmrhal et al [2001] substantiated this by demonstrating that electromyographic potentials of the pelvic £oor striated muscles were more powerful during CLPPs, compared toVLPPs.…”

“…Patient position also in£uences VLPP and CLPP values [Nguyen et al, 2002]. VLPP in the supine and standing position were 82 AE 23 and 63 AE 22 cm of water.…”

Fluid perfused urethral pressure profilometry and Valsalva leak point pressure: a comparative study in a biophysical model of the urethra

“…It was also found that contraction and relaxation of pelvic Xoor muscles inXuence UPP [16]. Valsalva LPP measurements on the other hand depend on the vesical volume [17,18], catheter size [19] and patient position [20]. Also the time-delay between observation of leakage and pressure recording aVects the LPP.…”