Urethral pressure profile in continent women from childhood to old age

Rud, T.

doi:10.3109/00016348009154090

Cited by 194 publications

(80 citation statements)

References 10 publications

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“…We know that maximum urethral closure pressure decreases with age; however, this decrease becomes significant only after the age of 36 years, with a 2-4% decrease in function up to age 40 years. 17,18 In addition, correlation analysis of maximum urethral closure pressure on age revealed that age explained only 2.4% of the variation in the maximum urethral closure pressure. Linear regression also confirmed an independent effect of race on both the cotton-swab strain angle and the urethral closure pressure during a maximum pelvic muscle contraction.…”

Section: Discussionmentioning

confidence: 99%

Racial differences in the structure and function of the stress urinary continence mechanism

Howard

DeLancey

Tunn

et al. 2000

Obstetrics &Amp; Gynecology

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Objective-To compare the structure and function of the urethral sphincter and the urethral support in nulliparous black and white women.Methods-Eighteen black women (mean age 28.1 years) and 17 white women (mean age 31.3 years) completed this cross-sectional study. The following assessments were made: urethral function using multichannel cystometrics and urethral pressure profilometry, pelvic muscle strength using an instrumented speculum, urethral mobility using the cotton-swab test and perineal ultrasound, and pelvic muscle bulk using magnetic resonance imaging.Results-Black women demonstrated a 29% higher average urethral closure pressure during a maximum pelvic muscle contraction (154 cm H 2 O versus 119 cm H 2 O in the white subjects; P = . 008). Although not statistically significant, black women had a 14% higher maximum urethral closure .23) and pressure at rest (108 cm H 2 O versus 95 cm H 2 O; P = a 21% larger urethral volume (4818 mm 3 versus 3977 mm 3 ; P = .06). In addition, there was a 36% greater vesical neck mobility measured with the cotton-swab test (blacks 49° versus whites 36°; P = .02) and a 42% difference in ultrasonically measured vesical neck mobility during a maximum Valsalva effort (blacks = −17 mm versus whites −12 mm; P = .08).Conclusion-Functional and morphologic differences exist in the urethral sphincteric and support system of nulliparous black and white women.The prevalence of genuine stress urinary incontinence (GSI) is thought to be significantly lower in black women than in white women. This is based on information from cross-sectional studies. Bump 1 examined 200 consecutive patients referred to his urogynecology practice for prolapse or incontinence. Of the 54 blacks in this group, 27% were given a diagnosis of GSI compared with 61% of the white patients. He also found that the black women with GSI had a higher maximum urethral closure pressure and greater urethral mobility with stress than did the white subjects with the same diagnosis. Similarly, Peacock et al 2 retrospectively reviewed 159 black women and found the prevalence of GSI to be 28%. Although these two studies suggested that the prevalence of GSI is lower in black women, additional comparative studies are needed.Stress continence is thought to be provided by two factors: urethral sphincter function and urethral support. 3-5 At present, it is not known whether racial differences exist in either one or both of these factors. Such differences, if they exist, might help explain racial differences in the prevalence of GSI and might help elucidate the pathophysiology of stress urinary Address reprint requests to:

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Section: Discussionmentioning

confidence: 99%

Racial differences in the structure and function of the stress urinary continence mechanism

Howard

DeLancey

Tunn

et al. 2000

Obstetrics &Amp; Gynecology

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“…When we look at the specifi c condition of stress incontinence, resting MUCP value is known to tend to be lower than in continent women and decreases as a function of age (11)(12)(13)(14)(15)(16), but there is no absolute cut-off value with suffi cient sensitivity and specifi city for that diagnosis and the association between MUCP and the severity of incontinence (1,21,22). In our population, MUCP values at rest (P1) tend to be lower in stress incontinent women except in the middle age group where women with mixed incontinence (which however implies a stress component) have lower MUCP.…”

Section: Discussionmentioning

confidence: 99%

“…The main criticism addressed to it is that it is not an absolute measure of the urethral pressure, since it is an evaluation of the sphincter at rest, that does not provide information about the bladder neck or proximal urethra, that can be variable due to involuntary muscular contractions (irritant effect of the catheter), that the pressure varies with size and type of catheter, rate of perfusion, bladder volume and patient position (4), and that there is a wide variation in MUCP among individuals of similar age (16).…”

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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“…Women were excluded for a history of recurrent urinary tract infections, genital anomalies, known neurological disease, claustrophobia, or implanted foreign bodies that would preclude MRI examination. Because age (13) and race (14) affect continence, controls were matched to cases for age and race. To accomplish this, as women were enrolled as cases, control women were recruited to provide the groups of similar age and race.…”

Section: Study Groupmentioning

confidence: 99%