Leak Point Pressure

Historically, leak point pressure was introduced by McGuire et al.17 as a method to predict which children with myelodysplasia were at increased risk of upper urinary tract impairment because of chronically increased bladder pressure. The leak point pressure is the bladder pressure at which leakage occurs. The increase in bladder pressure resulting in leakage may originate from either the detrusor or from increased abdominal pressure. Therefore, two leak point pressures have been described: the bladder or detrusor leak point pressure (DLPP) and the abdominal leak point pressure (ALPP). Each measures the closure function of the entire bladder outlet under various circumstances. Abdominal leak point pressure is the intravesical pressure at which urine leakage occurs as a result of increased abdominal pressure in the absence of a detrusor contraction. The increase in abdominal pressure can be produced during the study by asking the patient to cough (CLPP) or perform a Valsalva maneuver (VLPP). Although coughing can produce higher abdominal pressures, a Valsalva maneuver produces a more well-controlled abdominal pressure. If a Valsalva maneuver fails to produce leakage, CLPP can be done. The DLPP is the value of detrusor pressure at which a leak occurs in the absence of an increase in abdominal pressure. Detrusor leak point pressure was introduced in myelodysplastic children as an indicator of the risk of upper tract deterioration. McGuire et al.17 reported that DLPP exceeding 40 cm H2O with low compliance is associated with imminent risk of upper urinary tract damage. Abdominal leak point pressure evaluates stress incontinence and the total outlet resistance including intrinsic sphincter function.18 Low ALPP is associated with a severe degree of incontinence in some reports but is found to be not related to degree of incontinence in others.19-21 Abdominal leak point pressure less than 90 cm H2O suggests intrinsic sphincter deficiency (ISD).22-23

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