Maniam Prakash, Goldman Howard B
Department of Urology, Case Western Reserve University-University Hospitals of Cleveland, Cleveland, Ohio, USA.
J Urol. 2002 May;167(5):2080-2.
The measurement of Valsalva leak point pressure may have an important role in the treatment algorithm of women with stress urinary incontinence. However, some patients with stress urinary incontinence may not have leakage during standard urodynamic studies and, thus, the Valsalva leak point pressure cannot be determined. We hypothesized that the transurethral catheter may inhibit leakage during urodynamics.
We evaluated 21 consecutive women presenting with complaints of stress urinary incontinence who failed to have leakage on urodynamic studies. Bedside cystometry was performed, followed by urodynamics using a 6Fr transurethral catheter. When stress urinary incontinence was not noted, the catheter was removed and the Valsalva leak point pressure was measured using the intraabdominal pressure catheter.
No woman had leakage on urodynamic studies with the catheter in place, although 11 of 21 had leakage after the catheter was removed and 15 had leakage on bedside cystometry. All 11 patients with leakage at catheter removal showed leakage on bedside stress testing. Mean Valsalva leak point pressure in those with leakage was 67 cm. water.
Patients with a history of stress urinary incontinence and those with a positive bedside stress test who do not have leakage during a Valsalva maneuver on urodynamic studies should repeat the Valsalva maneuver with the catheter out. This technique may unmask stress urinary incontinence and allow the measurement of Valsalva leak point pressure.
瓦尔萨尔瓦漏点压力的测量在压力性尿失禁女性的治疗方案中可能具有重要作用。然而，一些压力性尿失禁患者在标准尿动力学检查期间可能不会出现漏尿，因此无法确定瓦尔萨尔瓦漏点压力。我们推测经尿道导管可能会在尿动力学检查期间抑制漏尿。
我们评估了21例因压力性尿失禁前来就诊且在尿动力学检查中未出现漏尿的连续女性患者。先进行床边膀胱测压，然后使用6Fr经尿道导管进行尿动力学检查。当未观察到压力性尿失禁时，移除导管并使用腹内压导管测量瓦尔萨尔瓦漏点压力。
在留置导管进行尿动力学检查时，所有女性均未出现漏尿，尽管21例中有11例在移除导管后出现漏尿，且15例在床边膀胱测压时有漏尿。所有11例在移除导管时出现漏尿的患者在床边压力测试时均出现漏尿。漏尿患者的平均瓦尔萨尔瓦漏点压力为67cm水柱。
有压力性尿失禁病史且床边压力测试呈阳性但在尿动力学检查的瓦尔萨尔瓦动作期间未出现漏尿的患者，应在移除导管后重复进行瓦尔萨尔瓦动作。该技术可能会揭示压力性尿失禁并允许测量瓦尔萨尔瓦漏点压力。
