A 65-year-old multiparous woman presents with stress urinary incontinence (SUI). Urodynamic assessment shows urethral hypermobility with Valsalva leak point pressure (VLPP) of 35 cmH2O. This VLPP value indicates:

• A Intrinsic sphincter deficiency (ISD) — VLPP < 60 cmH2O indicates poor sphincter function ✓
• B Normal urethral function — VLPP > 60 cmH2O is required to diagnose SUI
• C Detrusor overactivity with normal sphincter function — VLPP < 100 suggests bladder cause
• D Genuine stress incontinence with urethral hypermobility — VLPP 40–120 is the typical range for hypermobility-type SUI

Explanation

Valsalva leak point pressure (VLPP) measures the abdominal pressure at which leakage occurs during straining. VLPP < 60 cmH2O (some texts use < 90 cmH2O) indicates intrinsic sphincter deficiency (ISD) — the urethral sphincter cannot maintain urethral closure pressure even at relatively low abdominal pressures, suggesting a poorly functioning sphincter mechanism. VLPP 60–120 cmH2O with urethral hypermobility indicates hypermobility-type SUI. ISD-type SUI with VLPP < 60 may not respond well to midurethral slings alone and may require bulking agents or Burch colposuspension. This distinction guides surgical planning.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.