Clinical and urodynamic features of intrinsic sphincter deficiency.

AIMS: A prospective analysis of 92 patients with genuine stress incontinence was performed to identify the clinical and urodynamic features of intrinsic sphincter deficiency (ISD).

METHODS: We divided the patients into two categories: 50 patients affected by pure ISD as they had severe stress incontinence and no urethral mobility; 42 patients suffering from stress urinary incontinence without ISD as they had mild stress incontinence and marked urethral hypermobility. Cystometry was normal in all patients. The presence/absence of ISD was considered the dependent variable and was correlated against the following independent variables: age, vaginal deliveries, menopause, previous urogynecological surgery and/or hysterectomy, supine stress test, irritative and/or obstructive symptoms, Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), urethral functional length (UFL), and leakage during cystometry.

RESULTS: The statistical analysis showed close correlations between ISD and age (P < 0.001), menopausal status (P < 0.001), previous surgery (P < 0.0001), supine stress test (P < 0.0001), leakage during cystometry (P < 0.001), and UFL (P < 0.01). The VLPP was below the cut-off value (
CONCLUSIONS: ISD is related to the presence of a more severe clinical picture and case history, but the most significant independent variables are the VLPP and MUCP.