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Decrease in urethral pressure following repeated cough efforts: a new concept for pathophysiology of stress urinary
Xavier Deffieux1, Katelyne Hubeaux, Raphaël Porcher
1Pierre & Marie Curie University; Urodynamics Laboratory, Rothschild Hospital, AP-HOP, 33 boulevard de Picpus, Paris Cedex 12, France. x.deffieux@free.fr
Aims:
To describe the decrease in maximum urethral closure pressure (MUCP) following repeated coughs in women with stress urinary incontinence (SUI).
Methods:
MUCP was recorded at rest and after seven cough efforts in 70 women under age 40 referred for urodynamic investigation (47 women with SUI and 23 women without SUI).
Results:
The intraclass correlation coefficient for repeatability was very good at 400 mL filling volume: 0.94 (95%CI: 0.85-0.98), as compared to the mean and standard-deviations of the MUCP measurements. A decrease in MUCP >20% after seven cough efforts was observed in 18(38%) patients in the SUI group and in just 1(4%) woman in the non-SUI group (P = 0.0069).
Conclusions:
Many women with SUI exhibit a sharp decrease in MUCP after repeated coughs. Many hypotheses may explain this phenomenon, including increased fatigue of the periurethral muscles.
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