Abdominal Leak Point Pressures During Cough and Valsalva: What Do the Different Maneuvers Hide?

This study analyzes abdominal leak point pressures (ALPP) during Valsalva and cough maneuvers in patients with stress urinary incontinence (SUI) (pure or mixed), with the aim of clarifying the different psychopathological mechanisms of urethral incontinence behind leakage with each. This is a retrospective study of women with stress or mixed incontinence submitted to urodynamic testing with ALPP in 2024. Patients were allocated in mutually exclusive groups: group 1: Valsalva and cough leakage (n=57); group 2: cough leakage (n=20); and group 3: Valsalva leakage (n=10). A comparative analysis using IBM SPSS Statistics for Windows, Version 28.0 (IBM Corp., Armonk, New York, United States) was performed. Average ALPP was higher in group 2 (113.8±44.3 cmH2O). ALPP was below 60 cmH2O in 37%, 10%, and 20% of the patients in groups 1, 2, and 3, respectively (p=0.06). Women in group 3 were significantly younger (p=0.001) and pre-menopausal (p=0.02). In a subgroup analysis in group 1, only 31% of the patients had Valsalva leak point pressure (VLPP) superior to cough leak point pressure (CLPP). Body mass index (BMI) was significantly variable between subgroups, being higher in patients whose VLPP was superior to CLPP (p=0.01). Similarly, in a subgroup analysis in group 2, the pressure generated with Valsalva was superior to CLPP only in 25% of the cases. BMI was significantly higher in patients whose Valsalva-generated pressure was superior to CLPP (p=0.004). Cough and Valsalva maneuver are both equally and individually relevant in the setting of ALPP, but not equivalent. Our findings support that each maneuver might be associated with different underlying mechanisms for SUI and both should be performed during ALPP.