Leak Point Pressures: Are they clinically useful?

Iraklis C. Mitsogiannis, Panagiotis Mourmouris

Abstract


Leak Point Pressure tests have been introduced based on the experience acquired after many years of videourodynamic studies performed in a wide variety of medical conditions, such as stress urinary incontinence and incontinence evolving in patients with neurological conditions. There are two tests available for use in the daily practice, the Abdominal Leak Point Pressure (ALPP), which provides information of the extent to which Intrinsic Sphincter Deficiency (ISD) is responsible for the incontinence and the Detrusor Leak Point Pressure (DLPP) which aims to predict the risk of upper urinary tract deterioration in patients with neurogenic bladder dysfunction. The importance of these tests is often questioned mainly because of coexisting substantial confounding factors. We herein review the literature about the role of Leak Point Pressures in the Urologist’s daily practice.  

 

Οι Πιέσεις Διαφυγής (Leak Point Pressures) εισήχθησαν, ως διαγνωστικά εργαλεία, στην κλινική πρακτική του Ουροδυναμικού ελέγχου με σκοπό την πληρέστερη διερεύνηση των ασθενών.  Έχουν περιγραφεί 2 πιέσεις διαφυγής: η Κοιλιακή Πίεση Διαφυγής (Abdominal leak point pressure, ALPP), η οποία παρέχει πληροφορίες για την παθοφυσιολογία της ακράτειας ούρων προσπαθείας και συγκεκριμένα για τον βαθμό συμμετοχής σε αυτή της λεγόμενης ανεπάρκειας του ενδογενούς σφιγκτήρα (Intrinsic sphincter deficiency, ISD), και η Πίεση Διαφυγής του Εξωστήρα (Detrusor Leak Point Pressure, DLPP), η οποία βοηθά στην εκτίμηση του κινδύνου βλάβης του ανώτερου ουροποιητικού στους ασθενείς με νευρογενή δυσλειτουργία της κύστης. Η κλινική σημασία των 2 αυτών διαγνωστικών εργαλείων πολλές φορές αμφισβητείται, κυρίως λόγω των πολλών συγχυτικών παραγόντων που επηρεάζουν τον ακριβή υπολογισμό τους. Στο παρόν άρθρο ανασκοπείται η βιβλιογραφία για τον ρόλο των Πιέσεων Διαφυγής στην καθημερινή κλινική πράξη.


Keywords


Abdominal Leak Point Pressure; Detrusor Leak Point Pressure; stress incontinence; neurogenic bladder; Κοιλιακή πίεση διαφυγής; Πίεση διαφυγής εξωστήρα; Ακράτεια ούρων προσπαθείας; νευρογενής κύστη

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References


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DOI: http://dx.doi.org/10.19264/hj.v28i4.159