BERKELEY, CA (UroToday Inc.) - Valsalva leak point pressure (VLPP) or abdominal leak point pressure has been used to differentiate the causes of stress urinary incontinence. These pressures are obtained by measuring the intravesical pressure at which leakage occurs during abdominal straining. Stress urinary incontinence (SUI) with low VLPP is supposed to be indicative of intrinsic sphincter deficiency, while SUI with high VLPP is considered to be consistent with hypermobility. VLPP has been used to help recommend the most appropriate treatment for SUI. However, development of the suburethral sling with its technical ease has lead to its use in the treatment of all types of SUI. The value of VLPP in predicting success after suburethral sling has not been evaluated.

In the July 2004 edition of the Journal of Urology, Rodriguez and colleagues from Los Angeles, California and Sao Paulo, Brazil evaluated the use of VLPP in predicting outcome after undergoing the distal urethral polypropylene sling (DUPS) procedure. This operation entails the suburethral placement of a 1x10cm woven polypropylene mesh, with a 1-zero polyglactin suture attached to each end. A double-pronged suture carrier is advanced from a suprapubic incision behind the pubic bone to the vaginal incision. The sutures are then threaded through eyelets in the carrier and transferred to the suprapubic region, where the sutures are tied.

The authors prospectively evaluated 174 patients with SUI who underwent the DUPS procedure. Patients were grouped according to VLPP. Group 1 (60 patients) - no leak on urodynamic studies, Group 2 (27 patients) - VLPP > 80 cm H2O, Group 3 (71 patients) - VLPP 30-80 cm H2O, and Group 4 (16 patients) - VLPP < 30 cm H2O. Patients were evaluated pre and post operatively with patient completed questionnaires, pad use, and quality of life scores.

The mean follow-up was 14.7 months, with a 12-month minimum. Objective cure rates in all the groups were greater than 90%. The number of pads preoperatively was significantly different among the groups, with group 4 having the greatest pad use. After surgery, there was no difference in pad use between the groups. Also, postoperative self-assessment questionnaire scores addressing symptoms, bother and quality of life scores were not statistically different among the groups.

The VLPP does not appear to have an effect on outcomes after the DUPS procedure. Regardless of the preoperative VLPP, all patient groups undergoing the DUPS surgery did equally well.

J Urol 2004; 172:210-214