At the last year’s ICS meeting we presented a new minimal invasive computerized
Cough Leak Point
(CLP) measurement
system as a
new tool in
the diagnosis
of stress urinary
incontinence
[1]. The measurement
technique does
not use a transurethral
catheter to
avoid the influence
of the catheter on the leak event and is able
to quantify
incontinence
urodynamically
minimal invasive
for the first
time. The aim
of the study
was the investigation
of the diagnostic
accuracy of
the system to
distinguish
between various
incontinence
types (stress,
urge and combined).
Methods
In
80 female patients
with urinary
incontinence
(mean age 58
years) cough
leak point pressure,
leak- Qmax,
leak-volume
(multiple cough
events), cystometry
and urethral
pressure profile
under rest and
stress conditions
(minimal in
duplicate) were
measured. The
conventional
diagnosis were
made by using
all clinical
information
as history,
stress test
and conventional
urodynamics
(reference diagnosis).
Two independent
investigators
without knowledge
of reference
diagnosis were
asked to diagnose
incontinence
type by using
the curves of
CLP alone together
with patients
age and history
(blind diagnosis).
Results
According to reference diagnosis incontinence were defined as stress in
58 females (72,5%),
as urge in 17
females (21,3%)
and as combined
in 5 females
(6,3%). The
diagnosis of
the two independent
investigators
resulted in
93,8% or 87,5%
of correct and
2,4% or 5% incorrect
decisions. The
diagnosis were
half-correct
(stress or urge
as combined
or vice versa)
in 3,8% or 7,5%
of the patients.
In the analysis
of the diagnostic
algorithm the
minimal time
delay between
pressure and
leak flow were
proved to be
most important
(Fig.).
Conclusions
The definition of incontinence type by using CLP-measurement
is possible
with a high
diagnostic accuracy.
The results
show that the
avoidance of
transurethral
catheterization
is no disadvantage
and causes its
minimal invasivity
and optimal
time saving.
Therefore, it
seems to be
an ideal screening
tool in the
diagnosis of
urinary incontinence.
1. Höfner K, Oelke M, Wagner T, Mebert J, Jonas U (1999)
Cough leak point
pressure (CLPP)
- development
of a new method
for routine
use and testing
of clinical
reliability.
Neurourol Urodyn
18: 249-250
