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Intrinsic sphincter deficiency: association with historical, physical, and urodynamic findings
after performing diagnostic cystoscopy. During these 2 years 150 cystoscopy procedures had been performed by this group of residents. The mean scores for the degree of difficulty of procedure and surgeon’s comfort level with cystoscopy (scale 1–10, low-high) were 2.9 (SD ⫾2) and 8.4 (SD ⫾2.6), respectively. After four cystoscopy procedures the scores climbed, and after seven cystoscopy procedures there were only three cases where the residents’ scores for the comfort level were below 9 and 10. The average score for the written posttraining test was 10, compared with 6 (P ⬍ .05) for residents in the two programs without an organized urogynecology teaching curriculum. CONCLUSIONS: The competency to perform diagnostic cystoscopy can be reached quickly. When residents are engaged in a formal urogynecology teaching curriculum, they can recognize pathologic diseases of the bladder more easily.
urinary incontinence, or objective positive supine leak test did not correlate with a diagnosis of ISD. CONCLUSIONS: This study identifies increasing age, time since menopause, prior pelvic surgery, and anterior colporrhaphy as risk factors for ISD.
Multicenter Study of Gynecare MoniTorr Urethral Resistance Pressure Versus Standard Urodynamic MEA J. Peters-Gee, MD Women’s Health Specialty Care, Newington, CT
Intrinsic Sphincter Deficiency: Association With Historical, Physical, and Urodynamic Findings William E. Porter, MD University of Tennessee Health Science Science Center, Memphis, TN
Ilana B. Addis, MD, T. Russell Horton, MD, Val Y. Vogt, MD, and Robert L. Summitt, Jr, MD OBJECTIVE: To determine a predictive association between patient history and physical examination and intrinsic sphincter deficiency (ISD). METHODS: Charts of 196 women with stress incontinence (GSI) were reviewed for the presence of ISD, which was defined as a maximum urethral closure pressure (MUCP) of less than 20 cm H2O, a valsalva leak point pressure (VLPP) of less than 60 cm H2O, or both. Associations between demographics and historical and physical findings and the presence of ISD were determined. RESULTS: Women with ISD were statistically older than those without ISD (61.2 versus 51.6 years, P ⬍ .0002). There were no statistical differences in gravidity, parity, or number of vaginal deliveries. The time since menopause was 15.5 versus 10.5 years for those with and without ISD (P ⬍ .02), but there was no difference in length of hormone replacement. The degree of urethral mobility and pelvic organ prolapse quantification (POP-Q) measurements did not significantly differ between groups. Women with ISD, based on MUCP or both criteria, had a statistically higher incidence (P ⬍ .04) of prior pelvic surgery or an anterior colporrhaphy. A history of smoking, COPD, prior pelvic radiation, complaints of constant
114S
WEDNESDAY POSTERS
T. McKinney, MD, M. Rezapour, MD, PhD, M. Mastropietro, MD, V. Lucente, MD, MBA, M. Slack, MBBCh, MMed, and A. Monga, MD OBJECTIVES: To evaluate whether urethral resistance pressure (URP) of Gynecare MoniTorr correlates to both maximum urethral closure pressure (MUCP) and leak point pressure (LPP) of multichannel urodynamics. Sensitivity and specificity analyses were used to determine the critical URP value for intrinsic sphincter deficiency (ISD). METHODS: 150 women with stress incontinence were evaluated at seven centers in a randomized, crossover study of two groups: 1) MoniTorr followed by urodynamics and 2) urodynamics followed by MoniTorr. URP is a measurement of the pressure required to achieve and maintain an open sphincter. URP measurements were obtained rapidly without the need for a catheter. RESULTS: See Table 1. If MUCP is less than or equal to 20 cm H2O or LPP less than or equal to 60 cm H2O defines ISD, a URP of less than or equal to 82 cm H2O likewise defines ISD.
Table 1. Results Measurement Correlation Summary Measurements
n
Corr. coeff.
P
URP vs MUCP (100 cc) URP vs MUCP (MCC) URP vs LPP (250 cc) LPP vs MUCP (100 cc) LPP vs MUCP (MCC)
120 120 69 79 80
.51 .54 .39 .63 .58
⬍.001 ⬍.001 ⬍.001 ⬍.001 ⬍.001
MCC ⫽ maximum cystometric capacity.
CONCLUSIONS: URP is a useful measurement for a quick diagnosis of ISD in any office setting.
OBSTETRICS & GYNECOLOGY
urinary incontinence, or objective positive supine leak test did not correlate with a diagnosis of ISD. CONCLUSIONS: This study identifies increasing age, time since menopause, prior pelvic surgery, and anterior colporrhaphy as risk factors for ISD.
Multicenter Study of Gynecare MoniTorr Urethral Resistance Pressure Versus Standard Urodynamic MEA J. Peters-Gee, MD Women’s Health Specialty Care, Newington, CT
Intrinsic Sphincter Deficiency: Association With Historical, Physical, and Urodynamic Findings William E. Porter, MD University of Tennessee Health Science Science Center, Memphis, TN
Ilana B. Addis, MD, T. Russell Horton, MD, Val Y. Vogt, MD, and Robert L. Summitt, Jr, MD OBJECTIVE: To determine a predictive association between patient history and physical examination and intrinsic sphincter deficiency (ISD). METHODS: Charts of 196 women with stress incontinence (GSI) were reviewed for the presence of ISD, which was defined as a maximum urethral closure pressure (MUCP) of less than 20 cm H2O, a valsalva leak point pressure (VLPP) of less than 60 cm H2O, or both. Associations between demographics and historical and physical findings and the presence of ISD were determined. RESULTS: Women with ISD were statistically older than those without ISD (61.2 versus 51.6 years, P ⬍ .0002). There were no statistical differences in gravidity, parity, or number of vaginal deliveries. The time since menopause was 15.5 versus 10.5 years for those with and without ISD (P ⬍ .02), but there was no difference in length of hormone replacement. The degree of urethral mobility and pelvic organ prolapse quantification (POP-Q) measurements did not significantly differ between groups. Women with ISD, based on MUCP or both criteria, had a statistically higher incidence (P ⬍ .04) of prior pelvic surgery or an anterior colporrhaphy. A history of smoking, COPD, prior pelvic radiation, complaints of constant
114S
WEDNESDAY POSTERS
T. McKinney, MD, M. Rezapour, MD, PhD, M. Mastropietro, MD, V. Lucente, MD, MBA, M. Slack, MBBCh, MMed, and A. Monga, MD OBJECTIVES: To evaluate whether urethral resistance pressure (URP) of Gynecare MoniTorr correlates to both maximum urethral closure pressure (MUCP) and leak point pressure (LPP) of multichannel urodynamics. Sensitivity and specificity analyses were used to determine the critical URP value for intrinsic sphincter deficiency (ISD). METHODS: 150 women with stress incontinence were evaluated at seven centers in a randomized, crossover study of two groups: 1) MoniTorr followed by urodynamics and 2) urodynamics followed by MoniTorr. URP is a measurement of the pressure required to achieve and maintain an open sphincter. URP measurements were obtained rapidly without the need for a catheter. RESULTS: See Table 1. If MUCP is less than or equal to 20 cm H2O or LPP less than or equal to 60 cm H2O defines ISD, a URP of less than or equal to 82 cm H2O likewise defines ISD.
Table 1. Results Measurement Correlation Summary Measurements
n
Corr. coeff.
P
URP vs MUCP (100 cc) URP vs MUCP (MCC) URP vs LPP (250 cc) LPP vs MUCP (100 cc) LPP vs MUCP (MCC)
120 120 69 79 80
.51 .54 .39 .63 .58
⬍.001 ⬍.001 ⬍.001 ⬍.001 ⬍.001
MCC ⫽ maximum cystometric capacity.
CONCLUSIONS: URP is a useful measurement for a quick diagnosis of ISD in any office setting.
OBSTETRICS & GYNECOLOGY