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Introduction: Urethral Pressure Profilometry (UPP) assesses the urethral closing function. The literature is scarce regarding the change in the Maximum Urethral Closure Pressure (MUCP) values during Pelvic Floor Muscle Contraction (PFMC). The objective was to evaluate the change in the urethral closure pressure (UCP) at rest and during a PFMC in patients with Stress Urinary Incontinence. Materials and methods: This was a descriptive, comparative, and observational study. The study comprised female patients with either Pure Stress Urinary Incontinence (PSUI) or Complicated Stress Urinary Incontinence (CSUI). The urethral closure pressure was measured at rest and during PFMC using urethral profilometry. The effect of the pelvic musculature contraction was evaluated by comparing the changes in the indicated values. Results: Patients with pure stress urinary incontinence had a mean age of 57.18 ± 10.74 years (p = 0.12), while those with complicated stress urinary incontinence had a mean age of 58.26 ± 14.39 years (p = 0.12). UCP in PSUI was 58.58 ± 26.96 cmH2O at rest compared to 61.26 ± 34.17 cmH2O in CSUI (p = 0.59), with MUCP increasing to 73.93 ± 31.51 and 79.71 ± 36.26 cmH2O during PFMC (p = 0.001). Between the two measurements, there was an average rise of 26.2% (range 26.2%−32.59%) (p = 0.001). MUCP during PFM contractions was found to be inversely associated to age (r = −0.28, p = 0.007). Conclusion: The urethral pressure profile is the same for all types of urinary stress incontinence, whether simple or complicated. When comparing UCP at rest to MUCP during PFMC, there is at least a functional 25% increase. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: TAS-303, which selectively inhibits noradrenaline reuptake, was developed for treating stress urinary incontinence (SUI). The proximal urethra mainly comprises smooth muscle fibers in which α1 adrenergic receptors are abundant. This study was conducted to evaluate the effect of TAS-303 on urethral function and its safety profile in female patients with SUI. Methods: In total, 16 women (age, 20–64 years) with SUI and > 5.0 g of leakage in the 1-h pad test at screening were randomized and administered the assigned treatment in a double-blind manner. The primary end point was change in the maximal urethral closure pressure (MUCP) at 6 h post-dose. The secondary end point was change in the urethral closure pressure of the entire urethra and each urethral region (proximal, middle, and distal) at 6 h post-dose. The results were analyzed using a t-test. Results: The mean change ± standard deviation in MUCP at 6 h post-dose was 3.473 ± 12.154 cmH2O for TAS-303 and 2.615 ± 9.794 cmH2O for placebo (between-group difference: 0.858 cmH2O, P = 0.8047). The mean changes ± standard deviation in urethral closure pressure of the proximal urethra at 6 h after the administration of TAS-303 18 mg and placebo were 3.863 ± 10.941 and 1.634 ± 12.093, respectively (between-group difference: 2.229 cmH2O, P = 0.5976). Conclusions: No significant difference in MUCP and urethral closure pressure was found between TAS-303 and placebo. However, the change in the proximal urethral closure pressure with TAS-303 was larger than that with placebo. This suggests that TAS-303 has pharmacological effects on urethral sphincteric function. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between urodynamic study (UDS) data and recovery of urinary incontinence (UI) in elderly patients who underwent robot-assisted radical prostatectomy (RARP).Materials and Methods: Seventy-five prostate cancer (PCa) patients received UDS before and at 3 months after RARP. They were divided into two groups; a younger group (<70 years old, n = 47) and older group (≥70 years, n = 28), and each was classified according to urinary continence (UC) or UI at 3 months post-RARP. Continence was defined as being pad-free or 1-safety pad usage per day.Results: In the older group, preoperative maximum urethral closure pressure (MUCP) in the UI group was significantly lower than that in the UC group. Detrusor overactivity (DO) rate was significantly higher in the older UI group than in the older UC group at both pre- and 3 months post-RARP. Persistent DO rate pre- and post-RARP was significantly higher in the older group than in the younger group. Regardless of age, postoperative DO was an independent predictor of UI 6 months post-RARP.Conclusions: In elderly patients, low preoperative MUCP and both pre- and postoperative DO are associated with postoperative UI. [ABSTRACT FROM AUTHOR]

The present study evaluated real-time changes in urethral pressure during the storage phase using a rat model with stress urinary incontinence (SUI) induced by simulated multiple birth traumas and investigated the relationship between urethral continence function and dynamic parameters associated with the changes in urethral pressure. Sprague-Dawley rats were divided into the following two groups: the sham group, which underwent three catheterizations of the vagina without distension at 2-wk intervals, and the vaginal distension (VD) group, which underwent three VDs at 2-wk intervals. After transection of the T8-T9 spinal cord, simultaneous bladder and urethral pressure recordings were performed during intravesical pressure elevation. Urodynamic parameters such as leak point pressure (LPP), urethral baseline pressure (UBP), maximum urethral pressure (MUP), the MUP-UBP differential (dUP) during intravesical pressure elevation, the bladder pressure when urethral contraction begins (Puc), and the bladder pressure at bladder neck opening (Pno) were then measured and compared. Compared with the sham group, LPP, UBP, dUP, MUP, Puc, and Pno were significantly decreased in the VD group. Pressure differences between LPP and Pno and between LPP and UBP (LPPUBP) were also significantly different in the two groups. However, difference values of LPP and MUP or Pno and UBP were not altered after VD. Our new methods of simultaneous recordings of dynamic changes in bladder and urethral pressures are useful to fully evaluate the functional alterations in urethral continence function in the SUI model induced by multiple VDs. Moreover, LPP-UBP values, which correspond to the difference between Valsalva LPP and maximum urethral closure pressure in clinical urodynamics, would be useful to evaluate the impaired urethral continence function after simulated birth traumas in animal models. [ABSTRACT FROM AUTHOR]

Aim: The maximum urethral closure pressure (MUCPs) and functional urethral length (FUL) obtained with water‐filled and air‐charged catheters during urethral pressure profile (UPP) determination was compared in a single, blind, randomized, and prospective trial. Methods: Thirty‐three males with spinal cord injuries and neurogenic lower urinary tract dysfunction underwent UPP determinations using water‐filled and air‐charged catheters in random order; the patients were unaware of the catheter sequence. The variability of the same type of catheter and the agreement between the different types of catheters were compared. The Pearson correlation coefficient was used to check the correlation between the catheters and the Bland‐Altman method was used to verify the agreement. Result: The intraclass correlation coefficients for MUCPs and FULs determined using water‐filled and air‐charged catheters were 0.89, 0.75, 0.94, and 0.78, respectively. The interclass correlation coefficients for MUCPs and FULs between the two catheters were 0.43 and 0.28, respectively. Bland‐Altman plots suggested that the values measured by air‐charged catheters were significantly higher than water‐filled catheters (mean difference, 26.0 and 2.4 cmH2O, respectively). There were wide 95% limits of agreement (−54.0 to 106.0 and −0.3 to 5.1 cmH 2O, respectively) that exceeded the clinical range for differences in MUCP and FUL. Conclusion: Air‐charged catheters usually give higher readings than water‐filled catheters for UPP. Agreement between water‐filled and air‐charged catheters was not good. Nevertheless, the catheter type which is more relevant to the disease requires further study. [ABSTRACT FROM AUTHOR]

The molecular mechanism by which 17β-oestradiol (E2) increases urethral tone is unclear. As human tissue is limited in availability, we explored changes in the urethras of ovariectomized (OVX) mice. Twenty-four virgin female mice were randomised into three groups: mice with a sham operation only (control), OVX mice without E2 replacement (OVX), and OVX mice with E2 replacement (OVX + E2). Two weeks after the ovariectomy, mice received either E2 or placebo for 4 weeks. Leak point pressure (LPP) and maximum urethral closure pressure (MUCP) were assessed in these mice at 6 weeks after OVX, under anaesthesia. After measurements were recorded, the animals were sacrificed and the urethras were removed for proteomic and further analyses. LPP and MUCP values were significantly higher in OVX + E2 group than in OVX group. Fourteen differentially expressed proteins within the urethras of mice from OVX and OVX + E2 groups were identified; six proteins were upregulated and eight proteins were down-regulated. Most E2-induced proteins are involved in proteolysis, development, neurophysiological processes, transcription, and the cell cycle. Expression of survival motor neuron (SMN) protein in the urethra was significantly increased in OVX + E2 group compared to OVX group. OVX can impair urethral tone in female mice. E2 supplementation in OVX mice rescued urethral tone. E2-mediated increase in urethral tone in OVX mice involves overexpression of SMN, decreased proteolysis and promotion of development, neurophysiological processes, and transcription in the urethra. The urethra actively undergoes multiple biological processes in response to OVX and OVX with E2 stimuli.Impact statementEstrogens are known to modulate lower urinary tract trophicity. Although treatments with 17β-oestradiol (E2) result in an increase in urethral tone, the mechanism by which E2 increases urethral tone is still not completely understood.Ovariectomy can impair urethral tone in female mice. E2 supplementation in ovariectomized mice rescued urethral tone. E2-mediated increase in urethral tone in ovariectomized mice involves overexpression of survival motor neuron, decreased proteolysis and promotion of development, neurophysiological processes, and transcription in the urethra.This information will offer clues about pathogenesis of stress urinary incontinence after menopause and will open additional avenues for novel research and potential therapies. [ABSTRACT FROM PUBLISHER]

It has not yet been definitively demonstrated that preoperative evaluation of women with stress urinary incontinence with urodynamic testing enhances presurgical counseling, more effectively models patients′ expectations or improves postoperative outcome. Nonetheless, urodynamic testing is frequently utilized in the assessment of women with stress urinary incontinence and clearly accomplishes a number of goals when utilized for this purpose. For example, there are data to suggest that the risk of voiding dysfunction can be mitigated by utilizing data obtained from urodynamic testing to identify women more likely to void ineffectively after conventional stress incontinence procedures. Furthermore, it has been suggested though not proven, that patients with more severe forms of stress incontinence as identified by urodynamic testing, might be less likely to improve after surgery compared to others with more modest degrees of incontinence. Since urodynamic testing is invasive, costly and not always available, it is imperative that the usefulness of such testing be carefully explored and its utility appropriately defined. In this review, we discuss urodynamic techniques to assess stress urinary incontinence, particularly focusing on the ability of leak point pressure testing and urethral pressure profilometry to predict which patients would most likely benefit from surgery and which might be more likely to experience adverse events following surgery.

Introduction and hypothesis: Maximum urethral closure pressure (MUCP) provides an objective assessment of urethral integrity, but its role in predicting outcome after midurethral sling (MUS) placement is debatable and current practice in the UK is variable. The study was carried out to determine if lower preoperative MUCP is associated with poor outcome following MUS. Method: The study was a retrospective review of the British Society of Urogynaecology (BSUG) database and urodynamics (UDS) data. Patients who reported outcome as 'no improvement', 'worse' or 'much worse' on the Patient Global Impression of Improvement (PGII) scale were identified as having a poor outcome. Patients who reported 'a little improvement', 'improved' and 'very much improved' on the PGII were thought to have a good outcome. The preoperative demographics, UDS findings and quality of life (International Consultation of Incontinence questionnaires [ICIQ-SF]) data of the two groups were compared. Result: A total of 236 women were identified for the study. Of these, 24 women (10.2 %) had a poor outcome. Of the remaining women reporting a good outcome, 50 cases were randomly selected. All urodynamic parameters, including mean functional urethral length (FUL), bladder capacity, and Qmax, were similar, except for mean MUCP 37.05 cm HO, which was significantly lower in group 1 (poor outcome 37.05 cm HO) compared with a mean MUCP of 50.6 cm HO in group 2 (good outcome; p = 0.005). Conclusion: We conclude that failure following MUS is associated with preoperatively lower MUCP, which can be used as a predictor of failure. [ABSTRACT FROM AUTHOR]

Purpose: The roles of estrogen receptor α (ERα) in stress urinary incontinence (SUI) remain elusive. This study was conducted to understand the molecular mechanism of ERα against SUI. Methods: Wild-type (ERα) and ACTB-cre ERα knockout (ERα) female mice were generated. Urethral function and protein expression were measured. Leak point pressures (LPP) and maximum urethral closure pressure (MUCP) were assessed in mice under urethane anesthesia. After the measurements, the urethras were removed for proteomic analysis using the two-dimensional differential gel electrophoresis and liquid chromatography-mass spectrometry technology. Interaction between these ERα pathway proteins was further analyzed by using MetaCore. Lastly, Western blot and immunochemistry (IHC) were used to confirm the candidate protein expression levels and locations, respectively. Results: Compared with the ERα group, the LPP and MUCP values of the ERα group were significantly decreased. Additionally, we identified 11 differentially expressed proteins in the urethra of ERα female mice; five proteins were down-regulated and six were up-regulated. The majority of the ERα knockout-modified proteins were involved in muscle development, contraction, and regulation, as well as immune response (amphoterin signaling and phagocytosis), proteolysis, and cell adhesion (platelet aggregation and integrin-mediated cell-matrix adhesion). IHC and Western blot confirmed the down-regulation of tropomyosin and up-regulation of myosin in urethra. Conclusions: This is the first study to estimate protein expression changes in urethras from ERα female mice. These changes could be related to the molecular mechanism of ERα in SUI. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence (SUI) is a common disorder in middle-aged women and the elderly. Although surgical treatment of SUI has progressed, there are no effective pharmacological therapies without a side effect. We studied the effect of ginsenoside Rh2 against SUI. Here, we studied the effect of ginsenoside Rh2 on the contractile force of the urethra and blood vessels in an ex vivo organ bath assay. We further investigated the mechanisms and effects of Rh2 in cell culture and animal models. Ginsenoside Rh2 dose-dependently reduced lipopolysaccharide (LPS)-induced nitric oxide (NO) production and inducible nitric oxide synthase (iNOS) expression in RAW 264.7 cells. In the vaginal distension (VD)-induced SUI mouse model, ginsenoside Rh2 significantly reversed the VD-induced SUI physical signs and reduced blood pressure. The modulation of several SUI-related proteins, including myosin, survival motor neuron (SMN) protein, α-adrenergic receptor 1a (AdR1a), and superoxide dismutase 3 (SOD3), may play some crucial roles in the therapeutic approaches against SUI. In conclusion, the ginsenoside Rh2 may offer therapeutic potential against SUI. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The molecular mechanisms underlying stress urinary incontinence (SUI) are not clear. In light of the limited availability of human tissue for study, we explored the changes in the urethra of C57BL/6 mice with experimentally induced SUI. Study design: Twelve virgin female mice were randomized into two groups: one group undergoing vaginal distension (VD) for 1h with an 8-mm dilator, and a non-instrumented control group. Four days after VD, leak point pressures (LPP) and maximum urethral closure pressure (MUCP) were assessed in these mice under urethane (1g/kg, i.p.) anesthesia. After measuring LPP and MUCP, the animals were sacrificed, and the urethras were removed for proteomic analysis using 2-dimensional differential gel electrophoresis (2D DIGE) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) technology. Lastly, interaction between these proteins was further analyzed using MetaCore. Results: LPP and MUCP values were significantly decreased in the 8-mm VD groups compared with the non-instrumented control group. Sixty-eight differentially expressed proteins of urethra from female mice with and without VD were identified. Of these, 19 proteins were up-regulated and 49 were down-regulated. The majority of the VD-induced proteins were involved in generation of precursor metabolites and energy, oxidation of reduction, regulation of apoptosis, and glycolysis. Myosin expression in the urethra was significantly decreased in the 8-mm VD group as compared with the control group. Conclusions: As a model of simulated birth trauma, VD can induce SUI in female mice. Under-expression of myosin plays a plausible role in the pathogenesis of SUI following vaginal trauma. [Copyright &y& Elsevier]

Objectives: The short-term results for the tension-free vaginal tape procedure (TVT) and the transobturator tape procedure (TOT) for stress urinary incontinence (SUI) were compared using the preoperative maximum urethral closure pressure (MUCP). Methods: A total of 278 patients treated for SUI was considered: 165 who underwent TVT and 113 who underwent TOT retrospectively. The MUCP in a preoperative urodynamic study before and 3 months after surgery were evaluated. Results: At 3 months after TVT, 159 patients (96.4%) were cured and four patients failed. The mean MUCP of the patients who failed was 22.5 ± 5.3 cmH2O, which was significantly lower than that among the cured patients (P < 0.007). At 3 months after TOT, 100 patients (88.5%) were cured and seven patients failed. The mean MUCP of the patients who failed was 27 ± 6.3 cmH2O, which was significantly lower than that among the cured patients (P < 0.001). Furthermore, the mean MUCP among the patients who were cured after TOT was significantly higher than that among the patients who were cured after TVT (P < 0.01). A further analysis using a ROC curve indicated that the MUCP value in the successful patients after TVT was ≧ 24 cmH2O and that in the failures after TOT was ≦ 30 cmH2O with selection sensitivity at 80%. Conclusion: These results suggest that the failure cases after TVT or TOT are often found in SUI with a low MUCP and that TVT might be superior to TOT in SUI with a MUCP ≦ 30 cmH2O. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Our goal was to identify correlates of maximum urethral closure pressure (MUCP) and MUCP as a diagnostic test for stress urinary incontinence (SUI). Methods: This study was a retrospective review of women with non-neurological referrals for urinary incontinence between1995 and 2006. Results: We studied the characteristics of 8,644 women who underwent urodynamics for non-neurological referrals. Mean MUCP was 48 cm HO in urodynamic stress incontinence (USI), 50 cm HO in mixed urinary incontinence (MUI), 65 cm HO in detrusor overactivity incontinence (DOI) and 67 cm HO for continent women . Age and MUCP were negatively correlated in all groups. Multiple regression analysis showed lower levels of MUCP in women with USI who also had previous hysterectomy or anti-incontinence surgery or who were in an older age group. Previous anti-incontinence surgery and older age were risk factors for lower MUCP in women with MUI and DOI. Receiver operator curves did not show MUCP to have utility as a diagnostic test despite age and parity stratification. MUCP < 20 cm HO showed a sensitivity of 5 % and specificity of 98 % in diagnosing USI. Conclusions: MUCP failed to meet the criteria for a diagnostic test. Women with USI and MUI have lower MUCP than women with DOI and continent women in each decade of life. MUCP decreases with age. [ABSTRACT FROM AUTHOR]

The midurethral sling has gained popularity and is the most commonly used treatment of women with stress urinary incontinence (SUI). Whether intrinsic sphincteric deficiency (ISD) still should be used in the preoperative evaluation of patients with SUI and whether it should be considered as a predictor of success in patients undergoing a midurethral sling procedure and as a guide in the choice of surgical approach (retropubic vs transobturator) remain controversial. This article reviews and discusses the definitions of ISD and the latest research into the role of ISD determination in the era of the midurethral sling. [ABSTRACT FROM AUTHOR]

To verify the efficacy and to clarify the mechanism of the tension-free vaginal tape retropubic sling for recurrent stress urinary incontinence after Burch colposuspension failure. A total of 24 women having tension-free vaginal tape retropubic sling placement for recurrent stress urinary incontinence after a previous failed Burch urethropexy were enrolled in the present study. Median follow up was 57 months (range 12-96). Pre- and postoperative urethral mobility and urodynamics were evaluated. Preoperatively, all 24 patients had intrinsic sphincter deficiency and 14 had urethral hypermobility. Postoperatively, 15 patients were completely dry and two had a leakage of urine less than 5 g/h. The overall success rate was 70.8%. There was a significant postoperative increase of maximum urethral closure pressure ( P < 0.001), and a decrease of average flow rate ( P = 0.001) and urethral hypermobility ( P < 0.001). When comparing successful with failure cases, only elevated maximum urethral closure pressure ( P = 0.002) was significantly different. Multivariate logistic regression showed the change of maximum urethral closure pressure ( P = 0.011) was the only independent parameter significantly correlated with the outcome of sling placement. Recurrent stress urinary incontinence with intrinsic sphincter deficiency after Burch colposuspension might be well treated with the tension-free vaginal tape retropubic sling by effectively elevating the maximum urethral closure pressure. [ABSTRACT FROM AUTHOR]

The primary aim of the study was to translate and validate a Polish version of the CONTILIFE, a quality of life questionnaire. The clinical validity of the CONTILIFE was assessed against the number of urinary leaks, Valsalva leak point pressure (VLPP), and maximum urethral closure pressure (MUCP). One hundred women with stress urinary incontinence completed a Polish version of the CONTILIFE twice with a 4-day interval. Internal consistency (Cronbach’s α= 0.94) and test–retest reliability of the instrument (ICC = 0.96) were very good. A significant relationship was found between all the CONTILIFE dimension scores, the CONTILIFE global score, and the number of urinary leaks per week. A less significant relationship was found between VLPP, MUCP, and CONTILIFE dimension and global scores. A Polish version of the CONTILIFE can be a reliable measure of quality of life in stress urinary incontinence patients. [ABSTRACT FROM AUTHOR]

Objective: Maximum urethral closure pressure (MUCP) and Valsalva leak point pressure (VLPP) have been considered objective parameters for studying the urethral integrity and predicting outcome after surgery for stress urinary incontinence (SUI). We test the hypothesis that preoperative MUCP and/or VLPP may predict long-term outcome after out-in transobturator tape (TOT) surgery for female SUI. Methods: 65 patients affected by stress or mixed urinary incontinence were enrolled in a prospective observational descriptive study conducted from May 2002 to November 2005 at a single tertiary urban teaching university urogynecological department. Preoperative MUCP and VLPP, stratified as ≤ or >40 cm H2O and ≤ or >60 cm H2O, respectively, were separately or in combination correlated with primary (continence status: dry or wet) and secondary outcome variables (quality of life questionnaires) after surgery. Results: Out of 65 patients, 6 (9.2%) did not attend the follow-up. The median follow-up was 46 months (mean 52 ± 18; range 36–82). The overall objective cure rates (dry) were 74.4% for patients with VLPP >60 cm H2O and 65% for VLPP ≤60 cm H2O (p < 0.654). The overall objective cure rates (dry) were 75% for patients with MUCP >40 cm H2O and 68.6% for MUCP ≤40 cm H2O (p < 0.808). The overall objective cure rates (dry) were 82.4% for patients with MUCP >40 cm H2O and VLPP >60 cm H2O and 69.2% for MUCP ≤40 cm H2O and VLPP ≤60 cm H2O (p < 0.956). Conclusions: These data seem to cast doubts on the predictive value of MUCP and VLPP in patients who underwent TOT. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Objective: Aim of the study was to correlate urethral retro resistance pressure with the maximum urethral closure pressure (MUCP) and functional urethral length (FUL) in patients with urinary incontinence and healthy individuals. Study design: Two hundred and twenty patients with the complaint of urinary incontinence had a urodynamic examination including urethral pressure profiles and URP. Additionally, 15 healthy individuals without the complaint of any incontinence had their URP and urethral pressure profiles measured. The correlation of MUCP, FUL and URP were calculated using Graph Pad Instat 4.0 for windows. Results: URP correlates well with the diagnosis of urodynamic stress incontinence. Correlation coefficient between URP and MUCP is 0.9262. Healthy individuals have significantly higher values for URP and MUCP. Conclusion: URP is a valuable less invasive test than conventional urethral function tests for the diagnosis of urodynamic incontinence with an excellent correlation of MUCP and URP. [Copyright &y& Elsevier]

In patient studies the correlation between maximum urethral closure pressure (MUCP) and Valsalva leak point pressure (LPP) is meagre at best ( r = 0.22–0.50). We therefore studied the relation between MUCP and LPP in a flexible and extensible model urethra. We applied differently sized pressure zones and different degrees of resistance to a biophysical model urethra by stepwise inflating three types of blood pressure cuff placed around the model. At each degree of resistance we measured detrusor LPP, an in vitro equivalent of Valsalva LPP. Subsequently, we recorded the Urethral Pressure Profile using a water-perfused 5F end-hole catheter at four withdrawal rates and five perfusion rates and calculated MUCP. We tested the dependence of LPP on pressure zone length and MUCP on perfusion rate, withdrawal rate and pressure zone length using analysis of variance. We tested the correlation between LPP and MUCP using Pearson’s correlation coefficient and Linear Regression. LPP did not significantly depend on the pressure zone length ( P = 0.80) and increased linearly with increasing cuff pressure. MUCP also increased with increasing cuff pressure, however, MUCP significantly depended ( P < 0.01) on perfusion rate, withdrawal rate and pressure zone length. MUCP increased with increasing perfusion rate, and decreased with increasing withdrawal rate. In our model urethra MUCP only accurately reflected urethral resistance for a very limited number of combinations of perfusion rate and withdrawal rate. LPP reflected urethral resistance independent of the type of pressure zone. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to compare transobturator tape (MONARC) with tension-free vaginal tape in patients with borderline low maximum urethral closure pressure. Study design: Historical cohort analysis of 3-month outcomes in 145 subjects (MONARC = 85; tension-free vaginal tape = 60). A cut-off point of 42 cm H2O for preoperative maximum urethral closure pressure was identified as predictor of success in the entire cohort. The cohort was stratified by sling type and analyzed. Outcome variables included urodynamic stress incontinence, urethral pressure profiles, subjective stress incontinence symptoms, and complications. Results: The relative risk of postoperative urodynamic stress incontinence 3 months after surgery in patients with a preoperative maximum urethral closure pressure of 42 cm or less H2O was 5.89 (1.02 to 33.90, 95% confidence interval) when we compared MONARC with tension-free vaginal tape. Subjects in the MONARC and tension-free vaginal tape groups did not differ significantly in baseline characteristics. We defined subjects as failures if they demonstrated postoperative objective stress incontinence on multichannel urodynamic testing. Conclusion: In subjects with maximum urethral closure pressure of 42 cm or less H2O, the MONARC was nearly 6 times more likely to fail than tension-free vaginal tape at 3 months after surgery. Long-term follow-up and randomized controlled trials are needed. [ABSTRACT FROM AUTHOR]

In this study 272 patients with genuine stress urinary incontinence (GSUI) were initially considered. Of these, 247 were divided into three groups based on: positive history for GSUI (group 1); positive history and clinical examination for GSUI (group 2); and positive history, clinical examination, and cough urethral pressure profile for GSUI (group 3). When compared with a group of 30 normal women (control group) the values for the urethral functional length (FL) and the maximum urethral closure pressure (MCUP) decreased progressively from group 1 to group 3. The pressure transmission ratio (PTR) was signficantly lower only in group 3. Tonometric values calculated for a group of 25 patients with GSUI recurring afterprevious surgical correction (group 4) were found to be comparable with group 3. These patients with recurrent GSUI had a FL decreased to 70% and a MCUP decreased to 48% of the normal values. The PTR was maintained at a normal value of 97% in patients with degree I recurrence, but was decreased to 68% in patients with degree II-III recurrence having the most severe impairment of the periurethral environment. [ABSTRACT FROM AUTHOR]