A 50-year-old woman complains of leaking urine on coughing and sneezing (stress urinary incontinence). Urodynamic studies show urethral pressure profilometry with maximum urethral closure pressure (MUCP) of 10 cmH2O. There is no detrusor overactivity. What does the reduced MUCP indicate, and which surgical procedure has the best long-term outcomes?
- A Detrusor underactivity; sacral neuromodulation is recommended
- B Intrinsic sphincter deficiency (ISD); retropubic mid-urethral sling (TVT) is the gold standard ✓
- C Urethral hypermobility alone; Burch colposuspension is superior to slings for this phenotype
- D Vesicovaginal fistula; surgical fistula repair is required
Explanation
MUCP < 20 cmH2O is diagnostic of intrinsic sphincter deficiency (ISD), which represents impaired urethral sphincter tone rather than simply urethral hypermobility. ISD accounts for a significant proportion of stress UI cases, particularly post-pelvic surgery. The retropubic mid-urethral sling (TVT — tension-free vaginal tape) remains the most evidence-based procedure for SUI including ISD, with long-term cure rates of 81–90% at 11 years (TVT vs. Burch equivalence trials). Bulking agents (e.g., Bulkamid) are alternatives in ISD when surgical risk is high. Detrusor overactivity is absent in this case, excluding overactive bladder.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.