A 58-year-old woman with anterior vaginal wall prolapse to the hymen and stress urinary incontinence undergoes urodynamic evaluation. Cystometry shows first sensation at 120 mL, maximum cystometric capacity 420 mL, no detrusor overactivity, and Valsalva leak point pressure (VLPP) of 52 cmH2O. What does the VLPP value indicate about the mechanism of incontinence?

• A VLPP 52 cmH2O indicates detrusor overactivity as the primary mechanism
• B VLPP 52 cmH2O is within normal range, suggesting no genuine stress incontinence
• C VLPP 52 cmH2O indicates intrinsic sphincter deficiency (ISD) — urethral dysfunction rather than hypermobility ✓
• D VLPP 52 cmH2O indicates normal sphincter with urethral hypermobility as mechanism

Explanation

Valsalva Leak Point Pressure (VLPP) measures the intravesical pressure at which leakage occurs during Valsalva. VLPP < 60 cmH2O indicates intrinsic sphincter deficiency (ISD) — the urethral mechanism is inherently weak. VLPP 60–90 cmH2O indicates a mixed mechanism. VLPP > 90–100 cmH2O indicates urethral hypermobility as the predominant mechanism (intact sphincter, but urethral support is lacking). ISD with VLPP < 60 predicts poorer outcomes with mid-urethral sling procedures compared to colposuspension or urethral bulking agents and may require more compressive procedures like pubovaginal sling or artificial urinary sphincter.

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

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Written and medically reviewed by the StethoPrep medical team.