title: Posterior vaginal wall pull down maneuver: a clinical test to diagnose intrinsic sphincter deficiency in women suffering from genuine urinary stress incontinence.
abstract: OBJECTIVE
  To assess the predictive value of a simple clinical test (posterior vaginal wall pull down maneuver) in the diagnosis of intrinsic sphincter deficiency.
  
  
  METHODS
  The present prospective study included 62 women suffering from stress urinary incontinence. Every patient underwent a urogynecological examination including multichannel urodynamic testing (cystometry, urethral pressure profile, Valsalva Leak Point Pressure measurement) and a clinical examination including posterior vaginal wall pull down maneuver. Posterior vaginal wall pull down maneuver was carried out with the bladder filled with 400 mL of saline in a supine position, and was obtained by means of a split speculum allowing gentle pull down traction of the posterior vaginal wall. Posterior vaginal wall pull down maneuver was considered as positive when a urine leak was observed during the manoeuvre. Intrinsic sphincter deficiency was urodynamically defined by maximum urethral closure pressure ≤20 cmH2 O. Correlations between positive/negative posterior vaginal wall pull down maneuver and urodynamic intrinsic sphincter deficiency were calculated.
  
  
  RESULTS
  There was a statistical correlation between age and low maximum urethral closure pressure (P < 0.0001), and between low maximum urethral closure pressure and positive posterior vaginal wall pull down maneuver (P < 0.0001). Regarding the intrinsic sphincter deficiency diagnosis, the posterior vaginal wall pull down maneuver positive predictive value was 94.67% and the negative predictive value was 95.4%, with a specificity of 97.6% and sensitivity of 90%.
  
  
  CONCLUSIONS
  Posterior vaginal wall pull down maneuver is a reliable clinical test, easy to carry out, inexpensive and without significant risk. This test allows the diagnosis of intrinsic sphincter deficiency in women suffering from stress urinary incontinence, thus avoiding further invasive urodynamic testing (urethral pressure profile, Valsalva Leak Point Pressure measurement) in women with genuine stress urinary incontinence. Furthermore, it is helpful when choosing the type of sling procedure (retropubic vs transobturator) when a surgery is planned.
authors.affiliation: Neuro-Urology Department of Tenon Hospital, University Pierre and Marie Curie, Paris, France; Group of Clinical Research in Neuro-Urology, University Pierre and Marie Curie, Paris, France; Obstetrics and Gynecology Department, University Paris 11, Clamart, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Thubert
authors.forename: Xavier
authors.initials: X
authors.lastname: Deffieux
authors.forename: Marylène
authors.initials: M
authors.lastname: Jousse
authors.forename: Amandine
authors.initials: A
authors.lastname: Guinet-Lacoste
authors.forename: Samer Sheikh
authors.initials: SS
authors.lastname: Ismael
authors.forename: Gerard
authors.initials: G
authors.lastname: Amarenco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058869:Gynecological Examination / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D014521:Urethra / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult
keywords: empty stress test; intrinsic sphincter deficiency; posterior vaginal wall pull down test; stress urinary incontinence