Kuo Hann-Chorng
Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Urology. 2003 Mar;61(3):544-8; discussion 548-9. doi: 10.1016/s0090-4295(02)02500-1.
To use videourodynamic assessment to investigate the relationship between Valsalva leak point pressure (VLPP) and cough leak point pressure (CLPP) in women with stress urinary incontinence (SUI).
A total of 116 women with SUI were retrospectively analyzed by videourodynamic results, urethral pressure profilometry, and leak point pressure findings. All women had urine leakage during both coughing and performance of the Valsalva maneuver. The grade of SUI, VLPP, CLPP, maximal urethral closure pressure, and bladder neck descent during the stress test were compared among patients categorized according to three VLPP groups of less than 60 cm H(2)O, 60 or greater but less than 90 cm H(2)O, and 90 cm H(2)O or greater.
A significant inverse correlation was found between the grade of SUI and VLPP (r = -0.620, P = 0.000) and CLPP (r = -0.506, P = 0.000). The VLPP was less than 60 cm H(2)O in 41 women, 60 or greater but less than 90 cm H(2)O in 36, and 90 cm H(2)O or greater in 39. The CLPP was greater than the VLPP in 101 women (87.1%) and equaled the VLPP in 15 women (12.9%). Of the 41 women with a VLPP less than 60 cm H(2)O, 38 (92.6%) had a CLPP greater than the VLPP and 16 (39%) had greater bladder neck descent. The maximal urethral closure pressure had a weak but significant correlation with the VLPP (r = 0.299, P = 0.011) and CLPP (r = 0.325, P = 0.005).
The results of this study have demonstrated that the Valsalva maneuver and cough caused urinary leakage by different activities. A lower leak point pressure was found with VLPP than with CLPP to diagnose intrinsic sphincter deficiency. Complete assessment of urethral function, VLPP, CLPP, and bladder neck descent is essential for diagnosis and treatment of SUI.
采用影像尿动力学评估，研究压力性尿失禁（SUI）女性患者的瓦尔萨尔瓦漏点压（VLPP）与咳嗽漏点压（CLPP）之间的关系。
通过影像尿动力学结果、尿道压力测定法和漏点压结果，对116例SUI女性患者进行回顾性分析。所有女性在咳嗽和进行瓦尔萨尔瓦动作时均有尿液漏出。根据VLPP分为小于60 cm H₂O、60 cm H₂O及以上但小于90 cm H₂O、90 cm H₂O及以上三组，比较各组患者的SUI分级、VLPP、CLPP、最大尿道闭合压及压力测试时膀胱颈下移情况。
SUI分级与VLPP（r = -0.620，P = 0.000）和CLPP（r = -0.506，P = 0.000）之间存在显著负相关。41例女性VLPP小于60 cm H₂O，36例为60 cm H₂O及以上但小于90 cm H₂O，39例为90 cm H₂O及以上。101例女性（87.1%）的CLPP大于VLPP，15例女性（12.9%）的CLPP等于VLPP。在41例VLPP小于60 cm H₂O的女性中，38例（92.6%）的CLPP大于VLPP，16例（39%）有更大的膀胱颈下移。最大尿道闭合压与VLPP（r = 0.299，P = 0.011）和CLPP（r = 0.325，P = 0.005）呈弱但显著的相关性。
本研究结果表明，瓦尔萨尔瓦动作和咳嗽通过不同活动导致尿液漏出。诊断内在括约肌缺陷时，VLPP的漏点压低于CLPP。全面评估尿道功能、VLPP、CLPP和膀胱颈下移对于SUI的诊断和治疗至关重要。
