Initial urethral pressure increase during stress episodes in genuine stress incontinent women

The urethral and bladder pressure increments registered during a cough were investigated in 30 woman with genuine stress incontinence (GSI) and compared with those from 30 previously investigated healthy women. The pressures were measured by means of a double microtip transducer catheter with the bladder sensor uncovered and the urethral sensor covered with a water-filled rubber cylinder and placed at the bladder neck, midurethrally, or distally in the urethra. In GSI women the pressure increment preceding the pressure spike produced by coughing was significantly higher in the bladder compared with the urethra, and the pressure increment seemed to be initiated in the bladder and all along the urethra simultaneously. In healthy women the pressure increment preceding a pressure spike was significantly higher in the midurethra compared with the bladder and it seemed to be initiated in the midurethra. These findings seem to reflect a defective active closure mechanism in GSI which may be a contributing factor in its pathogenesis.