The prognostic significance of augmentation of urethral closure pressure and functional length

Sixty-one women with genuine stress incontinence undergoing preoperative and postoperative multichannel urodynamic investigation were tested with augmenting urethral closure pressure profiles during contraction of the pelvic floor muscles to assess voluntary control of the urethral "sphincter." Increases of 20% or more above resting functional length and closure pressure were selected as indicators of augmentation. The presence or absence of augmentation of functional urethral length and/or closure pressure during pelvic floor contraction allowed for the grouping of these patients into six subgroups which were compared for urinary symptoms, prior anti-incontinence procedures and the presence of low urethral pressure, detrusor instability and genuine stress incontinence both pre- and postoperatively. Evaluation of the patient's ability to augment functional length and closure pressure did not affect surgical success nor did its presence or absence correspond to the presence of a low pressure urethra, detrusor instability, or specific urinary symptoms. Evaluation of augmentation of functional length and closure pressure was therefore felt to be of no prognostic value during the performance of multichannel urodynamic testing in incontinent females.