Leak-point pressures.

The pressure based management of patients with neurogenic vesical dysfunction has led to greatly improved outcomes with respect to upper and lower urinary tract complications. At the heart of this management is detrusor leak-point pressure testing that verifies that a low intravesical pressure is achieved and subsequently maintained. The abdominal (or Valsalva) leak-point pressure that quantifies the degree and type of urethral sphincter dysfunction, is an essential test in selecting the appropriate treatment for stress urinary incontinence. The authors discuss the history, importance, and application of these two very different tests.