[Contribution of VLPP (Valsalva leak point pressure) in the urodynamic assessment]

The Valsalva leak point pressure (VLPP) is fully part of urologic assessment. Several factors can influence it: the patient's position, the bladder volume, the presence or absence of the urethral catheter, and the way of observing the leakage (direct visualisation or video-urodynamics). Sometimes VLPP is not feasible because patients cannot push strong enough. Nevertheless, a standardisation of the methodology has been suggested by the Société internationale francaphone d'urodynamique (SIFUD). Values below 60 cmH2O should be considered suggestive for sphincter insufficiency. Conversely, the diagnosis of urethral sphincter insufficiency should rely on the tripod: clinical examination (low urethral mobility), low closure pressure and low VLPP.