الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Urinary incontinence is a common problem among women in all age groups. It may manifest as stress incontinence, urgency incontinence or mixed incontinence. Stress incontinence is caused by urethral hypermobility and/or intrinsic sphincter deficiency. Numerous risk factors for urinary incontinence have been identified; among them are age, parity, obesity, hysterectomy and neurologic disorders.
Treatment of SUI includes conservative management and surgical management. Conservative management includes life style intervention, behavioral therapy, bladder training, mechanical devices and drugs. Surgical treatment includes sub-urethral slings, colposuspension, intra-urethral bulking agents, mid-urethral tapes and mid-urethral flaps including the tension-free vaginal flap (TVF).
The aim of our study is to define the correlation of valsalva leak point pressure (VLPP) with subjective degree of stress urinary incontinence in females, also the role of VLPP in the choice of surgical technique and the subsequent effect on outcome.
The study was conducted on fifty female patients; thirty patients out of them were studied prospectively and retrospective review of data of twenty other patients was carried out.
History taking regarding age, parity status, and clinical degree of stress incontinence was carried out. The patients were assessed clinically pre and post-operatively by cough stress test in supine and standing positions with urethral mobility assessed by Q-tip test. Urodynamic assessment was done pre and post-operatively and included uroflowmetry, cystometry, VLPP estimation in the sitting position (with urodynamic urethral catheter in place and after its removal) and pressure flow study.
Patients were subjected to anti-incontinence surgery (TVT, TOT or TVF) on a random basis and according to the type of surgery; patients were divided into 2 groups: Group A that included 27 patients treated surgically using synthetic tapes whether Tension-Free Vaginal Tape (TVT) or Trans-Obturator Tape (TOT). Seventeen patients out of them were studied prospectively in addition to retrospective review of data of 10 cases. Group B that included 23 patients treated surgically using Tension-Free Vaginal Flap (TVF) operation. Thirteen patients out of them were studied prospectively in addition to retrospective review of data of 10 cases.
According to our results, there was a statistically significant positive correlation between VLPP and the subjective degree of incontinence both with urodynamic catheter in place and after removal of the catheter. Also, VLPP had a role in the choice of the type of anti-incontinence surgery.
Post-operative bladder outlet obstruction (BOO) was documented (according to the urodynamic criteria proposed by Groutz et al.) only in one patient postoperatively but was not clinically significant as the patient was asymptomatic and had no increased residual urine. Diagnosis of BOO in females is not an easy matter. Accordingly, clinical assessment, residual urine volum