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Reproducibility of a new method to determine cough-induced leak-point pressure in women with stress urinary incontinence

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Abstract

The aim of the study was to test the reproducibility of a new method of determining cough-induced leak-point pressure (CILPP). A cough-induced increase in intra-abdominal pressure was recorded vaginally in 26 women with stress incontinence and urinary leakage was detected electronically. CILPP determinations and short-term pad tests were carried out on two different occasions. Reproducibility is expressed by a coefficient of repeatability as limits of agreement. These indicate that, for 95% of the cases, a repeat measurement of CILPP will be between 0.72 and 1.28 times the first measurement. The coefficient of variation was 11.2%. There was a moderate inverse correlation between padtest data and CILPP. It was concluded that the new method allows for an accurate determination of CILPP, which represents a quantitative and dynamic assessment of urethral function. The reproducibility of the method appears to be better than that of pad tests and standard urodynamic parameters. The correlation with pad-test data gives support to the validity of the method.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Akademiska Hospital, S-75185, Uppsala, Sweden

    H. Siltberg, G. Larsson & A. Victor

  2. Medical Products Agency, Uppsala, Sweden

    A. Victor

Authors
  1. H. Siltberg
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  2. G. Larsson
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  3. A. Victor
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Additional information

Editorial Comment: As healthcare providers for women with urinary incontinence, we are constantly seeking new and better ways to evaluate patients and optimize the outcome of their care. Leak-point pressure measurement has recently been presented as a less cumbersome, less costly and less invasive technique. Its proponents claim it is more physiologic and incremental, thus allowing us to assess improvement with therapy as well as to diagnose incontinence. However, detractors rightfully claim that its use is not supported by any outcome-based data, and that there is little known about many confounding variables, including position, fluid density, loss detection, number and size of catheters, abdominal versus vesical pressure etc. The reproducibility of the technique also needs to be addressed. The leak-point pressure may prove to be a useful addition to the armamentarium of the urodynamic unit. Work like this is a welcome addition to our knowledge base but represents a fraction of what is necessary before leak-point pressure can be widely embraced as a clinical tool.

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Siltberg, H., Larsson, G. & Victor, A. Reproducibility of a new method to determine cough-induced leak-point pressure in women with stress urinary incontinence. Int Urogynecol J 7, 13–19 (1996). https://doi.org/10.1007/BF01895097

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