Maximal urethral closure pressure < 20 cm H2O: does it predict intrinsic sphincteric deficiency?
OBJECTIVE
To assess whether the large discrepancy in the literature in the incidence of intrinsic sphincteric deficiency (ISD) is due to different methods by which maximal urethral closure pressure (MUCP) is measured.


METHODS
We compared the measurement of MUCP in the supine position with 300 mL saline in the bladder, according to International Continence Society guidelines, to that in the sitting position (full bladder) in 54 consecutive patients who were diagnosed as having stress urinary incontinence.


RESULTS
In the supine position the mean MUCP was 38.4 +/- 2.85 cm H2O as compared to 22.80 +/- 3.22 cm H2O in the sitting position (p < 0.0001). The mean difference was 15.65 +/- 2.11 cm H2O. MUCP < or = 20 cm H2O was observed in 14 of 54 (25.9%) patients in the sitting position as compared to 1 of 54 (1.8%) in the supine position.


CONCLUSIONS
When MUCP is measured in the supine position, according to International Continence Society guidelines, the cutoff point for diagnosis of ISD should be 35 rather than 20 cm H2O.
Krissi
Haim
H
Department of Obstetrics and Gynecology, Rabin Medical Center, Petah-Tikva, Israel. haimkrissi@hotmail.com
Pansky
Mordechay
M
Halperin
Reuvit
R
Langer
Rami
R
D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D011187:Posture; D011237:Predictive Value of Tests; D011312:Pressure; D012015:Reference Standards; D016683:Supine Position; D014521:Urethra / Q000503:physiopathology*; D001743:Urinary Bladder / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000175:diagnosis*; D014563:Urodynamics