A 45-year-old woman with stress urinary incontinence undergoes urodynamic assessment. The urethral pressure profile shows a maximum urethral closure pressure of 15 cmH₂O (normal greater than 20 cmH₂O). This finding indicates which condition?

• A Detrusor overactivity
• B Urethral hypermobility
• C Bladder outlet obstruction
• D Intrinsic sphincter deficiency ✓

Explanation

Intrinsic sphincter deficiency (ISD) is defined by a maximum urethral closure pressure of 20 cmH₂O or less on urethral pressure profilometry, combined with a low Valsalva leak point pressure. It indicates poor urethral coaptation. Detrusor overactivity shows involuntary detrusor contractions on cystometry. Urethral hypermobility is diagnosed by Q-tip test or imaging, not by closure pressure. Bladder outlet obstruction shows high voiding pressures with low flow.

Reference: Williams Gynecology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.