Valsalva (VLPP) and cough (CLPP) leak point pressures have been used for evaluating urinary incontinence in women. The relationship between these leak point pressures and stress urinary incontinence and detrusor overactivity is not known.

Drs. Singha, Nallaswany and Arunkalaivnan from Birmingham, United Kingdom performed a prospective study to evaluate this relationship.

In this study they examined women with symptoms of urinary incontinence. All women underwent urodynamic evaluation, which included uroflowmetry, sitting cystometry and urethral pressure profile studies. 10 F urethral catheters and 12 F rectal catheters were used for the study. VLPP and CLPP were recorded by asking the patient to perform a Valsalva maneuver and cough at maximum cystometric capacity until incontinence was observed.

A total of 109 women were studied. Mean age was 60 years (range 36-86). 56% (61/109) had stress urinary incontinence, while 19% (21/109) had detrusor overactivity, and 25% (27/109) had mixed urinary incontinence. All the women with stress incontinence demonstrated leakage with cough, but 66% (40/61) did not leak with a Valsalva maneuver. In the women with detrusor overactivity 81% (17/21) leaked with Valsalva while only 24% (5/21) leaked with cough. In the women with mixed incontinence 100% leaked with cough, and 63% (17/27) leaked with Valsalva.

The authors conclude that women with urodynamic stress urinary incontinence are more likely to have leakage with cough than Valsalva, while women with detrusor overactivity were more likely to have incontinence with Valsalva than with cough. In an editorial comment by Dr. Appell, Houston, TX, he notes that these findings may have their greatest impact in women with mixed symptoms in helping to determine whether stress incontinence or urge incontinence is the more severe problem.

By M. Louis Moy, MD