Urethral Closure Pressure at Stress: A Predictive Measure for the Diagnosis and Severity of Urinary Incontinence in Women

Anne-Cécile Pizzoferrato, Arnaud Fauconnier, Xavier Fritel, Georges Bader, Philippe Dompeyre, Anne-Cécile Pizzoferrato, Arnaud Fauconnier, Xavier Fritel, Georges Bader, Philippe Dompeyre

Abstract

Purpose: Maintaining urinary continence at stress requires a competent urethral sphincter and good suburethral support. Sphincter competence is estimated by measuring the maximal urethral closure pressure at rest. We aimed to study the value of a new urodynamic measure, the urethral closure pressure at stress (s-UCP), in the diagnosis and severity of female stress urinary incontinence (SUI).

Methods: A total of 400 women without neurological disorders were included in this observational study. SUI was diagnosed using the International Continence Society definition, and severity was assessed using a validated French questionnaire, the Mesure du Handicap Urinaire. The perineal examination consisted of rating the strength of the levator ani muscle (0-5) and an assessment of bladder neck mobility using point Aa (cm). The urodynamic parameters were maximal urethral closure pressure at rest, s-UCP, Valsalva leak point pressure (cm H2O), and pressure transmission ratio (%).

Results: Of the women, 358 (89.5%) were diagnosed with SUI. The risk of SUI significantly increased as s-UCP decreased (odds ratio [OR], 0.92; 95% confidence interval, 0.88-0.98). The discriminative value of the measure was good for the diagnosis of SUI (area under curve>0.80). s-UCP values less than or equal to 20 cm H2O had a sensitivity of 73.1% and a specificity of 93.0% for predicting SUI. The association between s-UCP and SUI severity was also significant.

Conclusions: s-UCP is the most discriminative measure that has been identified for the diagnosis of SUI. It is strongly inversely correlated with the severity of SUI. It appears to be a specific SUI biomarker reflecting both urethral sphincter competence and urethral support.

Keywords: Bladder Neck Descent; Urethral Pressure; Urinary Incontinence, Stress; Urodynamics.

Conflict of interest statement

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
(A) Method for measuring the urethral closure pressure at stress (s-UCP). (B) Examples of curves. r-MUCP, maximum urethral closure pressure at rest (measured pressure).
Fig. 2.
Fig. 2.
Receiver operating characteristic curves indicative of the degree to which SUI was predicted by each clinical and urodynamic parameter. SUI, stress urinary incontinence; s-UCP, urethral closure pressure at stress (calculated measure); r-MUCP: maximum urethral closure pressure at rest (measured pressure); VLPP, Valsalva leak point pressure.

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