Cough leak point pressure and beaking sign for diagnosis and assessing the severity in patients with stress urinary incontinence

Abstract

Introduction We assessed the usefulness of cough leak point pressure and beaking sign for diagnosis and assessing the severity in patients with stress urinary incontinence to determine their clinical significance.

Materials and Methods We performed retrospective study of 174 women who underwent TVT-O (Tension free trasvaginal tape-Transobturator system) between March 2006 and December 2009, in urology department. The standard one-hour pad test was performed with some modification just before urodynamic study. The correlation between urodynamic parameter and one-hour pad test was analyzed. On cystography, the quantity of beaking sign was measured.Various clinical parameters were compared between beaking positive group and negative group, and the correlation between quantity of beaking sign and urodynamic parameters was analyzed.

Results Urine leakage was positive in 159 (91.2%) patients with cough maneuver,while 135 (77.5%) patients were positive with Valsalva maneuver. The higher possibility of obtaining CLPP (cough leak point pressure) than VLPP (Valsalva leak point pressure) was demonstrated (p=0.019). Both CLPP (r= -0.29, p=0.005) and VLPP (r= -0.49, p<0.001) were significantly correlated with the pad test results. The beaking sign was positive in 56 patients (32.2%). Urodynamic data revealed that CLPP, VLPP and MUCP (maximal urethral closure pressure) were significantly lower in beaking positive group (p=0.011 for CLPP, p=0.013 for VLPP, p=0.006 for MUCP). The quantity of beaking sign represented significant negative correlation with, CLPP (r= -0.19, p=0.01), VLPP (r= -0.27, p=0.04), and MUCP (r= -0.18, p=0.04).

Conclusions Measurement of CLPP and beaking sign is feasible for diagnosing and assessing the severity of stress urinary incontinence in planning the treatment of stress urinary incontinence patient.