title: Supine empty stress test as a predictor of low valsalva leak point pressure.
abstract: Our objective was to determine whether a positive supine empty stress test is predictive of a low Valsalva leak point pressure (< or =60 cm of water). Evaluation was carried out on 179 patients with a history of genuine stress incontinence confirmed with urodynamic testing. All patients had a supine stress test performed after voiding. Residual urine determinations were all <100 cc. A vesical Valsalva leak point pressure determination (cough and strain) was performed during multichannel urodynamics with 150 cc in the bladder. Urethral profilometry was performed at maximum capacity. There was a statistically significant relationship between a low leak point pressure and a positive supine empty stress test (P < 0.000). The supine empty stress test had a sensitivity of 79% and a specificity of 62.5% for the detection of a low leak point pressure. The negative predictive value was high at 90%. For the age group 50 years and younger the negative predictive value was 95%. However, there was no significant relationship between a positive supine empty stress test and a low maximal urethral closure pressure. We conclude that the supine empty stress test is a useful screening test for a low leak point pressure but not a low urethral closure pressure. Its high negative predictive value is useful in excluding the presence of a low leak point pressure and may help the clinician to determine which patients with genuine stress incontinence need further assessment of the dynamic function of the urethral sphincter.
authors.affiliation: Department of Gynecology, Greater Baltimore Medical Center, University of Maryland Health Systems, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: McLennan
authors.forename: A E
authors.initials: AE
authors.lastname: Bent
mesh_terms: D005080:Exercise Test; D005544:Forecasting; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011312:Pressure; D012680:Sensitivity and Specificity; D016683:Supine Position; D014521:Urethra / Q000503:physiopathology; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000503:physiopathology; D014636:Valsalva Maneuver