title: Obesity and smoking: are they modulators of cough intravesical peak pressure in stress urinary incontinence?
abstract: OBJECTIVE
  SUI (Stress Urinary Incontinence) results from sudden increases in intravesical peak pressures exceeding urethral resistance leading to involuntary urine loss. Obesity and smoking are well established reversible risk factors for SUI and may alter intravesical peak pressures. BMI, smoking status, and other clinical factors were studied to determine their relationship to CIPP (maximal Intravesical Peak Pressures generated by Cough) in SUI complaining women.
  
  
  METHODS
  Three hundred nineteen women complaining of SUI were evaluated with medical history and urodynamics. Age, parity, comorbidities, previous surgery, BMI and history of smoking were obtained. The maximal intravesical peak pressures generated by cough (CIPP) and cough leak point pressure (CLPP) were acquired. Univariate and multivariate analysis were conducted.
  
  
  RESULTS
  Current smokers and former smokers had similar CIPP (170cmH₂O and 170cmH₂O; p = 0.5, respectively); Those individuals who had never smoked had significantly lower CIPP (140cmH₂O; p = 0.000 and p = 0.009 respectively). BMI was directly related to CIPP (r = 0.41; p = 0.000). Vaginal deliveries (r = -0.15, p = 0.08) and diabetes (r = 0.15, p = 0.016) were also directly related to CIPP on univariate analysis. Only smoking status (p = 0.000) and BMI (p = 0.000) were independently significantly related to CIPP on multivariate analysis.
  
  
  CONCLUSIONS
  Obesity and smoking showed increased CIPP (maximal Intravesical Peak Pressures generated by Cough). While reduced BMI is related to lower CIPP, smoking cessation does not appear to diminish CIPP. These findings suggest that weight loss may reduce incontinence by CIPP modulation. However, the benefits of smoking cessation without additional lifestyle modification, may have no benefit to improve urinary incontinence.
authors: Hospital de Câncer de Londrina, Parana, Brazil. paulo100urologia@hotmail.com
authors: Paulo Emilio
authors: PE
authors: Fuganti
authors: John Michael
authors: JM
authors: Gowdy
authors: Nilton Cesar
authors: NC
authors: Santiago
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D003371:Cough / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011312:Pressure; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D001743:Urinary Bladder / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000209:etiology*; D014563:Urodynamics / Q000502:physiology