The effect of patient position on leak-point pressure measurements in women with genuine stress incontinence.

The aim of this study was to determine the quantitative and qualitative effects of patient position on coughing and Valsalva leak-point pressure in women with genunie stress incontinence. Thirty-seven patients with genuine stress incontinence and 4 with mixed incontinence underwent multichannel urodynamics using a standardized protocol. Leak-point pressures were performed using 8 Fr microtip catheters placed in the bladder and vagina at a bladder volume of 250 ml in the supine, semirecumbent and standing positions. Urethral pressure profilometry was performed in the semirecumbent position at a bladder volume of 250 ml. The mean (range) age, and median (range) gravidity, parity, body mass index (BMI), and mean (range) Q-tip deflection angle were 61 years (36-80), 3 (1-8), 3 (1-6), 26 (22-30) and 55.8 degrees (25 degrees-80 degrees), respectively. The mean (+/- standard deviation) Valsalva leak-point pressures in the supine, semirecumbent and standing positions were 82 +/- 23, 73 +/- 24 and 63 +/- 22 cmH2O, respectively (P<0.001). The mean (+/- standard deviation) cough leak-point pressures also decreased as the patients were moved from the supine (98 +/- 29 cmH2O) to the semirecumbent (88 +/- 24 cmH2O) and standing positions (77 +/- 24 cmH2O) (P<0.001). The correlation between leak-point pressure and maximum urethral closure pressure was statistically significant and was dependent upon patient position and the provocative maneuver used.