The Correlation of Supine Stress Test and Valsalva Leak Point Pressure to Detect Intrinsic Sphincter Dysfunction

Oh, Heui Kyeong; Jeong, Young Beom; Park, Young Kyung

Abstract

PURPOSE
The Valsalva leak point pressure (VLPP) has been suggested to be an objective tool for diagnosing female stress urinary incontinence (SUI) accompanied by intrinsic sphincter dysfunction (ISD). However, measuring the VLPP is difficult, complex and expensive. A new clinical test, supine stress test to measure the VLPP, was compared.
MATERIALS AND METHODS
Fifty-one patients with SUI were evaluated prospectively with a urodynamic study. A supine stress test using cough and Valsalva's maneuvers was performed after bladder filling to 200ml with sterile normal saline by gravity. A urodynamic study, including measuring the VLPP and the maximum urethral closure pressure, was performed. ISD was diagnosed as Blaivas type III and Stamey grade III, and the sensitivity, specificity, positive and negative predictive values of the supine stress test and the VLPP were calculated.
RESULTS
Forty-two patients with SUI were enrolled this study and were evaluated with the VLPP and supine stress test. When the radiological findings were divided into Blaivas type III, and type I and II, the sensitivity, specificity, positive and negative predictive values of the VLPP and supine stress test were 95.0%/90.0%, 86.4%/73.9%, 86.4%/78.3%, 95.0%/89.5%, respectively. When the symptom severity was diagnosed as being Stamey classification grade III, and grade I and II, the sensitivity, specificity, positive and negative predictive values of the VLPP and supine stress test were 94.7%/89.5%, 82.6%/73.9%, 81.8%/73.9%, 95.0%/80.9%, respectively.
CONCLUSIONS
The supine stress test is easy, quick and inexpensive, and is a positive test to reliably predict ISD as precise as the VLPP. This simple, non-invasive supine stress test is recommended as a screening test to detect ISD, especially at an outpatient department.