Should Maximum Urethral Closure Pressure Be Measured on Prolapse Reduction?

Area of Science:

• Urogynecology
• Female Pelvic Medicine
• Lower Urinary Tract Dysfunction

Background:

• Maximum urethral closure pressure (MUCP) assesses urethral function and correlates with urodynamic stress incontinence (USI).
• Pelvic organ prolapse (POP) can confound the relationship between MUCP and USI.
• The impact of POP reduction on MUCP and its predictive value for USI requires investigation.

Purpose of the Study:

• To investigate the effect of pelvic organ prolapse reduction on maximum urethral closure pressure (MUCP).
• To assess whether MUCP measured during prolapse reduction improves prediction of urodynamic stress incontinence (USI) grading compared to MUCP at rest.

Main Methods:

• Observational study of 1992 women undergoing urodynamic testing.
• MUCP measured at rest and during POP reduction.
• Pelvic Organ Prolapse Quantification (POPQ) and translabial ultrasound used.
• Nominal regression analyzed associations between MUCP and USI grading.

Main Results:

• Mean MUCP decreased significantly from 39.1 cm H2O at rest to 33.9 cm H2O on prolapse reduction (p < 0.001).
• This reduction was greater in women reporting splinting and weakly associated with prolapse severity.
• Both MUCP at rest and during prolapse reduction predicted USI and its grading (p < 0.001).
• MUCP during prolapse reduction offered no significant improvement in predicting USI grading (Nagelkerke R² = 0.14 vs 0.13).

Conclusions:

• Symptoms of splinting and objective prolapse predict lower MUCP on prolapse reduction.
• However, prolapse reduction does not significantly enhance the prediction of USI grading.
• Measuring MUCP during prolapse reduction is likely unnecessary in routine clinical practice.