Valsalva leak point pressure and bladder volume

Twenty-nine females with stress urinary incontinence (SUI) were evaluated with fluoro-urodynamics, including Valsalva leak point pressure (VLLP) determinations. VLPP was determined at bladder volumes of 150 ml, 300 ml, and total bladder capacity. The VLPP determinations were analyzed using the signed rank and sign tests. Fluoroscopy was used to analyze change in type of SUI based on bladder volume. No significant difference in VLPP determinations was noted at various bladder volumes. No change in type of SUI was noted at various bladder volumes. We believe the volume in the bladder does not alter the category of SUI or statistically change the VLPP determination. Neurourol. Urodynam. 17:3–7, 1998. © 1998 Wiley-Liss, Inc.     

Excitatory effect of propiverine hydrochloride on urethral activity in rats

Objectives: To investigate the effects of the antimuscarinic agent, propiverine, on the bladder and urethra in rats. Methods: A total of 54 female rats were given propiverine, imidafenacin (an antimuscarinic agent), or distilled water by gavage once or twice daily. After 2 weeks, bladder and urethral activity were recorded under urethane anesthesia. In the propiverine group, the changes of bladder and urethral activity before and after intravenous injection of α₁‐adrenergic antagonists (prazosin, silodosin and naftopidil) were also recorded. Furthermore, the leak point pressure after electrical stimulation of abdominal wall muscles was measured in rats with vaginal distension from the control and propiverine groups. Results: Intravesical baseline pressure was significantly lower in the propiverine and imidafenacin groups compared with the control group, whereas the urethral baseline pressure was significantly higher in the propiverine group compared with the control or imidafenacin groups. Intravenous injection of prazosin (an α₁‐receptor antagonist) significantly decreased the urethral baseline pressure in both of the propiverine and control groups. Intravenous injection of silodosin and naftopidil (α_1A‐ and α_1D‐receptor antagonists, respectively) significantly decreased the maximum contraction pressure and the urethral baseline pressure in the propiverine group. The leak point pressure of the propiverine group was significantly higher than that of the control group. Conclusions: An increase of catecholamines after propiverine administration might activate smooth muscle of the proximal urethra via α_1A‐ and α_1D‐adrenergic receptors, as well as activating urethral and pelvic floor striated muscle via the spinal motoneurons.     

Longitudinal leak point pressure measurements in rats using a modified port à cath system

Stress urinary incontinence, defined as involuntary loss of urine secondary to an increase in abdominal pressure, represents one of the most significant urological problems. Several animal models to simulate stress urinary incontinence have been presented, including methods to quantify leak point pressure. We have modified an existing leak point pressure procedure to longitudinally quantify stress urinary incontinence in rats by introducing the port à cath system. Reproducible leak point pressure measurements were carried out over a period of more than 40 days at different bladder volumes. Leak point pressure neither showed a significant relationship with the number of times anesthesia was applied nor a significant change over time. The port à cath system provided a reliable, sensitive device for longitudinal urinary bladder pressure measurements in animals with an implanted bladder catheter. This set‐up therefore enables the evaluation of bladder pressure in different models for stress urinary incontinence, such as vaginal distention or pudendal transection over long periods of time within the same animal.     

自制可调TVT吊带术后腹压漏尿点压和最大尿道闭合压变化分析

目的观察自制可调TVT吊带术后腹压漏尿点压(VLPP)和最大尿道闭合压(MCP)变化,探讨自制TVT吊带临床效果。方法女性压力性尿失禁患者134例,术前行尿流动力学检查测定VLPP、MCP,行自制TVT吊带手术治疗后随访患者再次检测VLPP和MCP,分析检查结果。结果按照世界尿控协会(ICS)标准有39例患者未检出VLPP,剩余95例患者VLPP手术前为(77.2±21.6)cm H2O(1cm H2O=0.098 k Pa),手术后为(99.7±26.3)cm H2O,二者比较差异具有统计学意义(P<0.05)。MCP手术前(32.5±14.3)cm H2O,手术后(57.2±13.3)cm H2O,二者差异具有统计学意义(P<0.05)。结论自制TVT吊带术后可以取得较满意的手术效果,并具有灵活的术后调整性,较传统手术具有自身优势。     

Early outcomes of mid-urethral slings for female stress urinary incontinence stratified by valsalva leak point pressure

AIMS: To assess the early results of mid-urethral slings placed via the transobturator approach (TVT-O) for stress urinary incontinence (SUI) in women with high (>60 cm H(2)O) and low (60 cm H(2)O) or low (60. CONCLUSIONS: With limited follow up, TVT-O appears to be a safe and effective surgical treatment for female SUI producing excellent results in patients with VLPP >60 cm/H(2)0. Patients with low VLPP may consider conventional, retropubic mid-urethral slings or other procedures as treatment for SUI.     

Therapeutic effect of propiverine hydrochloride on mixed‐type urinary incontinence in women: The Female Urgency and Stress Urinary Incontinence Study of Propiverine Hydrochloride trial

Objectives

To show the efficacy of propiverine hydrochloride in the management of symptoms of stress urinary incontinence in female patients with mixed‐type urinary incontinence.

Methods

The study was carried out as a multicenter single‐arm clinical trial at 64 institutions in Japan. The participants were female patients aged ≥20 years with mixed‐type urinary incontinence. The frequency of stress urinary incontinence and urgency urinary incontinence was evaluated at baseline and 4, 8 and 12 weeks after treatment with propiverine hydrochloride. Subjective symptoms were evaluated using the Overactive Bladder Symptom Score and the International Consultation on Incontinence Questionnaire‐Short Form. Functional urethral length and maximum urethral closing pressure were also measured at baseline and 12 weeks after treatment at the institutions where the urethral pressure profile was taken.

Results

In total, 49 mixed‐type urinary incontinence patients were enrolled in the present study. The number of cases of urgency urinary incontinence was reduced time‐dependently, which showed statistically significant differences between baseline and 4, 8 and 12 weeks after treatment. A similar statistically different reduction was also observed for stress urinary incontinence. The mean reduction rates of urgency urinary incontinence and stress urinary incontinence at 12 weeks after treatment were 63.9% and 44.3%, respectively. The total scores of International Consultation on Incontinence Questionnaire‐Short Form and Overactive Bladder Symptom Score were gradually reduced, and the differences were statistically significant. Functional urethral length and maximum urethral closing pressure at 12 weeks after treatment did not show any statistical differences compared with those at baseline.

Conclusions

Propiverine hydrochloride can be an effective therapeutic option for stress urinary incontinence in patients with mixed‐type urinary incontinence.     

Correlation of abdominal leak point pressure with objective incontinence severity in men with post-radical prostatectomy stress incontinence

AIMS: To determine if the abdominal leak point pressure (ALPP) correlates with objective incontinence severity in patients suffering from post-prostatectomy stress incontinence. METHODS: Twenty-nine men were evaluated for urinary incontinence after radical prostatectomy with videourodynamics and a 24-hr pad test. ALPP was determined with and without a 7-French urodynamics catheter and the lowest value was accepted. Six patients with urgency incontinence associated with detrusor overactivity or decreased bladder compliance were excluded leaving 23 patients for analysis. The relationship between the variables of ALPP, 24-hr pad weight, age and time from prostatectomy were examined with Pearson correlation. RESULTS: The mean age was 66.4 years (SD +/- 7.9, range: 45-81) and the median time from radical prostatectomy was 23 months (IQR = 14-64, range: 9-204). The mean ALPP was 92.8 cm H(2)O (SD +/- 42.4 cm H(2)O) and the mean pad weight was 279.1 g (SD +/- 238.3 g). There was only a weak inverse correlation between ALPP and 24-hr pad weight which was not statistically significant (r = - 0.191, P = 0.38). Age and time from prostatectomy did not significantly correlate with ALPP (r = - 0.122, P = 0.58 and r = - 0.23, P = 0.29, respectively). CONCLUSIONS: ALPP did not correlate significantly with the 24-hr pad test in patients with post-prostatectomy stress incontinence. This suggests that in this patient subset, the ALPP is a relatively poor predictor of incontinence severity and, therefore, has limited clinical value in the urodynamic evaluation of post-prostatectomy incontinence. The urodynamic assessment of these patients should focus on the presence or absence of stress incontinence and on the presence of associated bladder dysfunction.     

Relationship of urethral retro-resistance pressure to urodynamic measurements and incontinence severity

AIMS: The urethral retro-resistance pressure (URP) is a retrograde urethral pressure profile measured by a new urodynamic measurement system.1GYNECARE MoniTorr Urodynamic Measurement System (ETHICON, Inc., Somerville, NJ). URP is the pressure required to achieve and maintain an open sphincter. This clinical investigation focused on a comparison of URP to standard urodynamic measurements and an examination of their relationship to incontinence severity. METHODS: Twenty-two centers enrolled 258 stress incontinent women in a randomized, crossover study of two groups: (1) test procedure followed by multichannel urodynamics, (2) multichannel urodynamics followed by test procedure. We defined incontinence severity categories using 24 hr urine loss and assessed these categories using incontinence quality of life (I-QOL), urinary incontinence severity score (UISS), incontinence visual analogue score (VAS), URP, maximum urethral closure pressure (MUCP), and leak point pressure (LPP). RESULTS: The mean age was 56.2 (+/-12) years. No order effect was present. The correlation coefficient between URP and MUCP was 0.31 (95% CI 0.19-1, P < 0.0001); between URP and LPP was 0.28 (95% CI 0.12-1, P = 0.003); and between MUCP and LPP was 0.14 (95% CI-0.04-1, P = 0.101). The mean values for URP across symptom severity categories were significantly different (P = 0.028) and decreased with increasing severity. The mean values for MUCP and LPP did not decrease with increasing severity. CONCLUSIONS: The study demonstrated that URP had a consistent relationship with incontinence severity. The data suggested that URP is a physiological measure of urethral function and may have clinical utility as a diagnostic tool. Future outcomes-based research is necessary to establish the predictive value of URP, MUCP, and LPP measurements in terms of incontinence cure rates and diagnosis of sphincter dysfunction.     

Baseline abdominal pressure and valsalva leak point pressures-correlation with clinical and urodynamic data

AIMS: To characterize the factors contributing to changes in baseline abdominal pressure (P(abd)) and the correlation between DeltaVLPP, VLPP(tot), and other clinical and urodynamic variables. METHODS: Two hundred sixty-four female patients who had undergone an anti-incontinence procedure between February 1994 and October 1999 were retrospectively reviewed. The urodynamics performed for each patient included abdominal and vesical pressures measured in a standardized manner with the patient sitting upright and the pressure sensors maintained at the level of the symphysis pubis. VLPP was determined at bladder volumes of 200 mL during a gradually increasing Valsalva maneuver. RESULTS: Baseline P(abd) varied between 10 and 55 cm H(2)O (mean, 32.7 +/- 8.8) and were significantly correlated with patient weight (P<0.001) and with patient body mass index (P<0.001). Baseline P(abd) was not found to be correlated with patient age, Baden and Walker Classification of the grading of pelvic floor prolapse, degree of incontinence (determined by the number of pads used per day), or prior surgical procedures for stress incontinence. Higher baseline P(abd) were significantly correlated with the peak abdominal pressure reached during the Valsalva maneuver (P<0.0001) and with VLPP(tot) (P<0.0001) but not with DeltaVLPP. Higher VLPP(tot) significantly correlated with decreased age (P=0.004), less severe incontinence (P=0.004), higher peak Valsalva pressure (P<0.0001), and the ability to increase abdominal pressure for a longer period of time (time to peak P(abd) during Valsalva). VLPP(tot) and DeltaVLPP had similar statistical correlation with all the clinical variables examined and neither could predict the outcome of any anti-incontinence surgery. By using a VLPP of 60 cm H(2)O as a cutoff to differentiate severe ISD from GSUI, 211 (67.4%) of the patients would be categorized as having ISD according to their DeltaVLPP compared with only 106 (40.1%) by using the VLPP(tot). CONCLUSIONS: Baseline P(abd) varies considerably among patients, is correlated with patient weight and habitus. In addition, it varies with both the ability to be increased for longer periods of time and with VLPP(tot). Looking at VLPP(tot) and DeltaVLPP will result in a different categorization of the type of incontinence in at least 25% of patients and, thus, affect the physician's selection of an anti-incontinence procedure for an individual patient.     

Comparison of leak point pressure methods in an animal model of stress urinary incontinence

We compared three different methods of testing leak point pressure (LPP) in rats with or without the pudendal nerves and nerves to the iliococcygeus/pubococcygeus muscles transected: (1) sneeze induced with a whisker in the nostril (sneeze LPP), (2) manually increased abdominal pressure (Crede LPP), and (3) increased intravesical pressure using the vertical tilt table method (vertical tilt table LPP). In sham rats, passive intravesical pressure rises in Crede and vertical tilt table methods induced active urethral closure mechanisms that contributed to high LPPs (41.4 and 35.5 cmH₂O, respectively), which were significantly reduced by nerve transection. During sneezing, leakage was observed in nerve-transected rats, but not in sham rats, indicating that sneezing can activate an additional urethral closure mechanism. Measuring LPP during sneezing or passive intravesical pressure rises in the vertical tilt table and Crede method seems to be useful for assessing the continence mechanisms under different stress conditions in rats.     

External urethral sphincter activity in a rat model of pudendal nerve injury

AIMS: Pudendal nerve injury in the rat has been a useful animal model for studying stress urinary incontinence (SUI). However, the effect of pudendal nerve injury on activity of the external urethral sphincter (EUS) is relatively unexplored. The aims of this study were to examine voiding and the EUS electromyogram (EMG) in a durable SUI model in rats with bilateral or unilateral pudendal nerve transections. In addition, the effects of denervation on urethral anatomy were investigated. METHODS: A leak point pressure (LPP) test was first used to demonstrate that pudendal nerve transection induced SUI. Cystometry exhibited changes in voiding function and EUS-EMG measurements provided a quantitative evaluation of EUS activity during voiding. The morphological changes in sections through the mid-urethra were assessed with hematoxylin and eosin (H&E) staining. RESULTS: A significant decrease in average LPP was detected in rats 6 weeks after bilateral pudendal nerve transection (BPNT). Abnormal urodynamic measurements including a decrease in contraction amplitude and voided volume as well as an increase in contraction duration, and residual volume all indicated inefficient voiding. In addition EUS-EMG silent periods were reduced and the frequency of EUS-EMG bursting during voiding was increased. Atrophy of striated muscle in the EUS was also detected in rats with pudendal nerve transection(s). CONCLUSIONS: Our results indicate that pudendal nerve transection in rats decreases urethral outlet resistance and causes striated muscle atrophy in the EUS, EUS-EMG abnormalities and inefficient voiding. The results demonstrate that BPNT is a durable model for SUI.     

Correlation of maximum urethral closure pressure with Valsalva leak point pressure using air-charged urodynamic catheters

Introduction and hypothesis  The objective of this study was to measure the correlation of maximum urethral closure pressure (MUCP) with Valsalva leak point pressure (VLPP) in women with urodynamic stress incontinence using air-charged urodynamic catheters. Methods  Records of all women who underwent urodynamic testing for urinary incontinence using air-charged catheters over a 3-year period were reviewed. Data included scores on the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Results  One hundred ninety-three women met the criteria for urodynamic stress incontinence. There was a modest correlation of MUCP with VLPP at 200 mL (r = 0.46, p < 0.001) and a low correlation of MUCP with VLPP at maximum capacity (r = 0.35, p < 0.001). There was no correlation of UDI-6 or IIQ-7 scores with MUCP or VLPP. Conclusions  The low to modest correlation of VLPP with MUCP with air-charged catheters is similar to what has been reported with water-filled and microtransducer catheters.     

逼尿肌漏尿点压及膀胱安全容量在神经源性膀胱患者间歇性导尿中的应用价值

目的:评估逼尿肌漏尿点压(detrusor leak point pressure,DLPP)及膀胱安全容量(safety bladder capacity,SBC)在神经源性膀胱患者间歇性导尿中的应用价值。方法:选取2015年7月~2016年7月在我院住院治疗接受间歇导尿的脊髓损伤致神经源性膀胱患者40例。根据随机数字表法分为观察组与对照组,各20例。对照组患者予以常规间歇导尿,根据残余尿量确定间歇导尿次数。观察组患者抽血查肾功能并行泌尿系B超及影像尿动力学检查,明确患者的上尿路情况,同时测量其DLPP及SBC,进行间歇导尿时,依据饮水计划及排尿日记找到排尿规律,在接近SBC的时间测量膀胱内的尿量,严格在SBC内实施间歇导尿。40例患者均有漏尿,均进行床旁盆底肌训练。对患者进行为期1年的干预,两组患者于干预前、干预1年时分别进行尿动力学检查[包括DLPP、SBC、残余尿量(residual urine volume,RUV)]、肾功能检查(包括血尿素氮、肌酐),并采用焦虑自评量表(self-rating anxiety scale,SAS)及抑郁自评量表(self-rating depressive scale,SDS)分别评估患者心理状态,采用SF-36生活质量量表(包括饮食、精神、睡眠及心理4个维度)评分评估患者的生活质量。结果:每组患者干预1年时的DLPP、SBC、RUV、血尿素氮和肌酐、SAS和SDS评分及饮食、精神、睡眠、心理评分与干预前比较均明显改善(P0.05)。干预前,上述各指标两组间比较均无统计学差异(P0.05)。干预1年时,观察组患者的DLPP、RUV均显著低于对照组,SBC显著高于对照组,血尿素氮、肌酐均显著低于对照组,SAS、SDS评分均显著低于对照组,饮食、精神、睡眠、心理评分均显著高于对照组,差异均有统计学意义(P0.05)。结论:对脊髓损伤致神经源性膀胱患者依据DLPP及SBC进行个性化的间歇导尿,可有效改善患者的尿动力学指标,促进其肾功能的恢复,同时消除患者心理不良情绪,且能显著提高生活质量。     

Clinical and demographic factors associated with valsalva leak point pressure among women undergoing burch bladder neck suspension or autologous rectus fascial sling procedures

AIMS: Many parameters have been utilized to try to estimate severity of stress urinary incontinence (SUI). Valsalva leak point pressure (VLPP) measurements, have been proposed as a reliable means of gauging the severity of SUI during urodynamic studies (UDS). Certain, non-invasive, measures of incontinence severity have been proposed, but the correlation of these measures with VLPP is not known. In addition, the correlation of other important UDS measures and VLPP has not been evaluated. In this study we sought to define the relationship between demographic characteristics, physical exam findings, and non-sphincteric UDS measures with VLPP in a large multicenter randomized surgical trial comparing Burch urethropexy and fascial sling for the treatment of SUI. MATERIALS AND METHODS: Pre-surgical, standardized urodynamic measures were obtained in all participants in the Stress Incontinence Treatment Efficacy Trial (SISTEr) trial. All UDS were assessed for quality assurance and protocol compliance. VLPP was assessed using a <8 Fr water transducer catheter during graded Valsalva maneuvers at 200 ml, and then at 100 ml intervals and bladder capacity if no SUI was noted earlier. Only data from women who had SUI on at least two of three consecutive valsalva maneuvers was utilized for this analysis. Delta VLPP was determined as the average value, and the baseline vesical pressure was subtracted from the absolute vesical pressure to arrive at the reported VLPP value. Independent variables studied to assess their relationship to VLPP value included demographic characteristics (age, number of pregnancies, # vaginal deliveries, hormone usage, previous hysterectomy, previous SUI surgery), physical exam parameters [body mass index--BMI, Pelvic Organ Prolapse-Quantified POPQ stage, POPQ Aa measurement, Q-tip angle (rest) and Q-tip angle (strain), and change in angle], and other urodynamic parameters (volume of first leakage, volume at first sensation, presence of detrusor overactivity, maximum cystometric capacity--MCC, maximum flow rate--Q(max), and detrusor pressure at maximum flow rate--pdet.Q(max)). RESULTS: Among the 655 women randomized, 424 were found to have evaluable VLPPs. Thirty-four had stage 3 or 4 prolapse and were excluded from the VLPP analysis. The remaining 390 women had a mean VLPP of 81.1 cm H(2)O. On bivariate analysis, there were significant positive associations with VLPP and BMI (P = 0.026), Q-tip straining angle (P = 0.0002) change in Q-tip angle (P = 0.0046), MCC (P < 0.0001) and pdet.Q(max) (P = 0.0003). Age was negatively associated with VLPP (P < 0.0001). For categorical values, lower POPQ stage (0/1), post menopausal status, and use of hormones were all associated with lower VLPP values. For example, patients with stage 2 had, on the average, VLPP values that were more than 10 cm H(2)O greater than those with stage 0/1. On multivariate analysis, however, only lower age, greater BMI, greater MCC, greater pdet.Q(max), and lower Q(max) were found to be independent associated with higher delta VLPP. CONCLUSIONS: Advancing age, lower BMI, higher maximum flow rate, and lower voiding pressures are all independently associated with lower VLPP in women undergoing surgery for SUI. Lower voiding pressures and higher flow rates among women with more severe SUI may reflect the chronic loss of urethral resistance associated with SUI. Interestingly, urethral hypermobility as assessed by Q-tip testing angle does not achieve a statistically significant association with VLPP on multivariate testing when controlling for POP-Q stage. Thus, as clinically suspected, the Q-tip test is not predictive of VLPP in women with urethral hypermobility and SUI.     

Evaluation of minimally invasive analysis system for cough leak point pressure measurement

PURPOSE: Leak point pressure (LPP) measurement has become standard in the diagnosis of stress urinary incontinence. Leak point pressure is determined by increasing abdominal pressure, which can be done with a Valsalva maneuver or coughing, that is Valsalva LPP and cough LPP (CLPP). It may be influenced by catheter size, bladder volume and interobserver variability. A new, computerized LPP measuring technique for routine use in daily urodynamic practice was tested at a female unit urodynamic practice to evaluate female urinary incontinence. MATERIALS AND METHODS: A total of 28 female patients with a mean age of 54.07 years (range 23 to 82) and urinary incontinence underwent a new, minimally invasive measurement of the cough leak point. Measurements are made with the patient standing and repeated 3 times per patient. Additionally, parameters of the corresponding leak were recorded simultaneously. All patients underwent new CLPP measurement and a standard, complete urodynamic investigation, including filling cystometry with abdominal LPP and urethral pressure profile at rest. Statistical evaluation was done by linear regression analysis and the correlation coefficients among CLPP, age, standard abdominal LPP and maximum urethral pressure, and among the 3 measurements for each patient. RESULTS:: The assignment of leakage to the pressure signal presented no problem. All CLPP data were reproducible in the 3 repeated measurements per patient. No correlation was seen between CLPP and abdominal LPP or the urethral pressure profile. CONCLUSIONS: The study confirm that the CLPP is a practicable, consistent and minimally invasive method in routine use. Clinical use is easy and reproducible, and only 1 catheter is required for measurement.     

Sphincteric urinary incontinence: relationship of vesical leak point pressure,urethral mobility and severity of incontinence

PURPOSE: We examined the relationships among urethral hypermobility, intrinsic sphincter deficiency and incontinence in women. MATERIALS AND METHODS: A total of 65 consecutive women with stress urinary incontinence and 28 with lower urinary tract symptoms not associated with stress urinary incontinence were evaluated with videourodynamics, 24-hour voiding diaries and pad tests, vesical leak point pressure measurement and the cotton swab test. RESULTS: A total of 93 patients with a mean age +/- SD of 63 +/- 13 years were studied, including 65 who presented with stress urinary incontinence and 28 who presented with lower urinary tract symptoms without stress urinary incontinence. The incidence of urethral hypermobility was 32% in the stress urinary incontinence group and 36% in the lower urinary tract symptoms group (p = 0.46). When stress urinary incontinence cases were stratified according to a vesical leak point pressure of 0 to 60, 60 to 90 and greater than 90 cm. H2O, urethral hypermobility was noted in 25%, 31% and 41%, respectively, a difference that was not statistically significant (p = 0.6). Overall incontinent patients with and without urethral hypermobility had the same median number of incontinence episodes (5, range 1 to 13 versus 7, range 1 to 15, p = 0.39) and median pad weight (39.5 range 1 to 693 gm. versus 33.5, range 1 to 751, p = 0.19). When patients with intrinsic sphincter deficiency, defined as vesical leak point pressure less than 60 cm. H2O, were divided into those with and without urethral hypermobility, there were no differences in the mean number of incontinence episodes (9.4 +/- 3 versus 6 +/- 3.6, p = 0.17) or median pad weight (90 gm., range 10 to 348 versus 86, range 30 to 81, p = 0.76). The degree of change in the urethral angle did not correlate with vesical leak point pressure (r = 0.16, p = 0.24) or with pad weight (r = -0.23, p = 0.1). CONCLUSIONS: Urethral hypermobility was equally common in this group of women with lower urinary tract symptoms and stress urinary incontinence. Intrinsic sphincteric deficiency and urethral hypermobility may coexist and they do not define discrete classes of patients with stress urinary incontinence. Urethral hypermobility did not appear to have an independent effect on the frequency or severity of incontinence. Patients with stress urinary incontinence can still be characterized by vesical leak point pressure and change in the urethral angle, although these variables do not always define discrete classes.