Factors Predicting Intrinsic Sphincter Deficiency in Female Stress Urinary Incontinence

Choe, Jin Ho; Lee, Kyu Sung

Abstract

PURPOSE
This study was conducted to investigate whether predictive factors are associated with stress urinary incontinence due to intrinsic sphincter deficiency (ISD).
MATERIALS AND METHODS
We reviewed retrospectively the records of 254 women with the diagnosis of genuine stress incontinence. All women had undergone a detailed history by questionnaire and interview, physical examination and multi-channel urodynamic study, including the determination of VLPP. The patients were classified into three groups according to VLPP regardless of the presence of hypermobility; 1) ISD: VLPP<60cmH2O, 2) equivocal: VLPP 61-90cmH2O, 3) anatomical incontinence(AI) : VLPP>90cmH2O. The ISD group was compared with the AI group using 15 clinical factors. Univariate (t-test, chi-square test) and multivariate (logistic regression test) analyses were performed to determine which clinical factors were associated with ISD.
RESULTS
The mean patient age was 51 years (range 25 to 77). Eighty-two women (32%) were in the ISD group and 98 (38%) in the AI group. The results of univariate and multivariate analyses found that women with ISD had a higher symptom grade than women with AI (p=0.001 and 0.0001, respectively). The number of patients in the ISD and AI group in accordance with the symptom grade were 11 (15%) and 61 (85%) in grade I, 53 (62%) and 33 (38%) in grade II, and 18 (82 %) and 4 (18%) in grade III respectively. There was no correlation between VLPP and other clinical factors.
CONCLUSIONS
The only clinical factor that predicted the presence of ISD, as defined by VLPP of 60cmH2O or less, was the symptom grade. Higher grades of stress urinary incontinence have a higher possibility of ISD. One should consider this factor when evaluating patients, especially in the equivocal group.