Conference Coverage

Cough harder during stress urinary incontinence testing, study suggests

 

Key clinical point: Urodynamic operators should encourage patients to cough hard enough to exceed about 120-127 cm H2O in abdominal pressure.

Major finding: The median minimum abdominal leak point pressure ranged from 120-127 cm H2O across all bladder volumes.

Data source: A retrospective study of 145 women with stress urinary incontinence based on urodynamic testing.

Disclosures: Dr. Trye reported having no financial disclosures. One coinvestigator reported ties to Kimberly-Clark and Boston Scientific.


 

– Patients often do not cough hard enough during the cough stress test for it to identify urinary incontinence, Sudhi Trye, MD, reported at Pelvic Floor Disorders Week, sponsored by the American Urogynecologic Society.

Dr. Sudhi Trye stands in front of a podium, addressing the crowd during PFD Week. Amy Karon/Frontline Medical News
Dr. Sudhi Trye
There currently is no standard recommendation for minimum coughing effort to diagnose stress urinary incontinence during urodynamic testing, Dr. Trye noted. To explore the question, the researchers retrospectively studied 145 women with stress urinary incontinence who underwent complex urodynamic testing with cough stress tests at multiple bladder volumes. The investigators excluded patients if their urodynamics were negative or their intravesical volume did not exceed 200 mL on filling cystometry.

Patients were asked to cough at least three times with increasing force at volumes of 200 mL, 300 mL, 400 mL, and 500 mL. The median minimum abdominal leak point pressure ranged from 120 to 127 cm H2O, regardless of bladder volume, and did not differ significantly between premenopausal and postmenopausal women, Dr. Trye said. Only 5% had leakage at abdominal pressures of 70 cm of H2O or less. The same was true at the other end of the spectrum – only 5% of women had leakage at abdominal pressures above 200 cm H2O.

A total of 70% of patients were white; mean age was 65 years, with a standard deviation of 13.6 years; and average body mass index was 28.2 kg/m2 with a standard deviation of 5.4 kg/m2.

Although the findings merit replication in a larger and more diverse cohort, they suggest that patients should be encouraged to cough hard enough to achieve abdominal pressures above 120-127 cm H2O, Dr. Trye said. Since many patients have trouble coughing this hard, operators should model it rather than just tell patients to cough, she added.

Dr. Trye reported having no financial disclosures. One coinvestigator reported ties to Kimberly-Clark and Boston Scientific.

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