Korean J Urol.  2010 Aug;51(8):537-543. 10.4111/kju.2010.51.8.537.

Accuracy of Methods for Urinary Detection in Women with Stress Urinary Incontinence

• Jung HD
• Lee HJ
• Chung YG
• Seong DH
• Yoon SM
• Lee T

• KMID: 1997021
• DOI: http://doi.org/10.4111/kju.2010.51.8.537

Abstract

PURPOSE
We assessed the accuracy of urinary detection by visualization compared with a method using the urethral channel of a transurethral, three-channel urodynamic catheter.
MATERIALS AND METHODS
This was a case series of 52 patients presenting with stress urinary incontinence over 2 years. Patients underwent video-urodynamic studies in both the supine and the erect positions by use of two techniques for measuring leak point pressure (LPP) by one examiner. LPP was determined as the intravesical pressure simultaneous to the starting point of urethral pressure changes through the urethral channel of a urodynamic catheter (LPP-ure) and then by visualization (LPP-vis) during different events. We also measured the time related to the provocations and the time to mark the leakage on the urodynamic machine by the examiner.
RESULTS
The LPP-ure values (cough supine: 42.1+/-18.7, cough erect: 42.1+/-21.8, Valsalva supine: 42.2+/-23.3, Valsalva erect: 41.0+/-22.6 cmH2O) were significantly lower than the LPP-vis values (89.9+/-29.4, 97.4+/-30.4, 70.6+/-25.2, and 74.4+/-32.6 cmH2O, respectively, all p<0.001). Whereas the actual leakages happened during the pressure increases, urodynamic recording by visualization was done after those increases had finished.
CONCLUSIONS
The use of visualization as a urinary detection method entails potential errors that cannot be adjusted for on that time scale. Our results emphasize the need to standardize the methodologies used for urinary leakage detection, because this measurement is closely related to the accuracy of measurement of leak point pressure.

Keyword

Diagnosis; Stress urinary incontinence; Urodynamics; Women

MeSH Terms

Catheters
Cough
Female
Humans
Urinary Incontinence
Urodynamics

Figure

• 

  FIG. 1 Representative tracings of urodynamic pressure parameters on an original (left) and enlarged (right) time scale during cough (A) or Valsalva (B) provocations. The cough or Valsalva leak point pressure (LPP) was determined by the urethral channel method (circle: LPP-ure) and by the peak pressure of the spike on which the measurement by the urethral channel was done (dotted circle: LPP-peak). A difference is shown on the spike of 72 cmH2O (cough) or 63 cmH2O (Valsalva) between LPP-peak and LPP-ure. Pves: intravesical pressure, Pura: urethral pressure.

• 

  FIG. 2 Box plot showing the relations among the leak point pressures (LPPs) measured by the urethral channel method (LPP-ure) and the peak values from the same provocation (LPP-peak) and the values checked by visualization with the other provocation (LPP-vis), according to stress type and patient position. The LPP-ure values were lower than the LPP-peak values. The LPP-peak values were not significantly different from the LPP-vis values. The box delineates the interquartile range (25th percentile-75th percentile), with a line at the median. The bars represent the 5% and 95% values.

• 

  FIG. 3 Agreement between stress leak point pressures (LPPs) by the urethral channel (LPP-ure) and the peak pressures of the spike by provocation on which the LPP-ure was measured (LPP-peak) according to the various stress types and patient positions. (A) Cough provocation in supine position. (B) Valsalva provocation in supine position. (C) Cough provocation in upright position. (D) Valsalva provocation in upright position. All LPP-peak values of less than 60 cmH2O proved to be less than 60 cmH2O by LPP-ure with both cough and Valsalva provocations in both positions. By contrast, only a small proportion (15.8%, 17.6%, 22.2%, and 14.3% for cough in supine, Valsalva in supine, cough in upright, and Valsalva in upright, respectively) of LPP-peak values of 60 to 90 cmH2O were shown to be 60 to 90 cmH2O by LPP-ure; the greater proportion (84.2%, 82.4%, 77.8%, and 85.7%) of LPP-peak values of 60 to 90 cmH2O were less than 60 cmH2O by LPP-ure. In addition, only a small proportion (8.7%, 23.0%, 9.4%, and 12.4%) of LPP-peak values higher than 90 cmH2O were shown to be higher than 90 cmH2O by LPP-ure; the greater proportion (91.3%, 77.0%, 90.6%, and 87.6%) of LPP-peak values higher than 90 cmH2O were shown to be less than 90 cmH2O by LPP-ure.

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