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A 55-year-old woman presents reporting two years of bothersome episodes of leaking urine. The episodes of incontinence have become more frequent over that time and now occur daily. The urine loss is provoked by laughing, coughing, and standing from a sitting position. The symptoms are significant enough to require the regular use of sanitary pads. The embarrassment associated with these episodes has caused the patient to limit her normal physical and social activities in recent months. She denies symptoms of urgency or frequency associated with the incontinence episodes, and she denies hematuria, dysuria, or nocturia. She has no other gynecologic complaints. Obstetric history is significant for three term spontaneous vaginal deliveries without complications. She has no past medical or surgical history. She is not taking any medications and has no known drug allergies.
A 45-year-old female is awaiting discharge from the post-anesthesia recovery unit but is unable to void. She is two hours post-completion of a transobturator tension-free vaginal tape procedure for stress urinary incontinence. The procedure was uncomplicated with minimal blood loss. It was performed under spinal anesthesia. Post-procedure cystoscopy was normal. She is in minimal pain after taking ibuprofen and oxycodone. She is tolerating a general diet without nausea. She reports the sensation of a full bladder. She has no significant past medical or surgical history. She is currently taking multivitamins (one tablet PO daily) and has no known drug allergies.
This chapter discusses the tests of urethral function. The International Continence Society (ICS) has suggested standardisation of the performance of the urethral function and defined parameters for measurements. Two tests may be included to assess urethral function specifically during filling cystometry: vesical or detrusor leak-point pressure estimation and abdominal leak-point pressure (ALPP). Tests of urethral function during voiding cystometry measure the relationship between pressure in the bladder and urine flow rate. Urethral pressure profilometry (UPP) provides a graph indicating the intraluminal pressure along the length of the urethra. Urethral retro-resistance pressure (URP) has been defined as the pressure required to achieve and maintain an open urethral sphincter. Urethral pressure reflectometry (UPR) is measured using a 5-mm diameter polyurethane bag and urethral transducer. Tests of urethral function may also be useful in identifying incompetent urethral closure mechanisms before obstructive surgery for stress urinary incontinence.
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