Comment on “relationship between urethral and vaginal pressures during pelvic muscle contraction,” neurology and urodynamics (1997):16:553–558

✍ Scribed by M.E. Vierhout; N.T.V.M. van Loenen

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 10 KB
• Volume: 17
• Category: Article
• ISSN: 0733-2467
• DOI: 10.1002/(sici)1520-6777(1998)17:3<283::aid-nau13>3.0.co;2-l

✦ Synopsis

This interesting article deals with the augmented urethral pressure profile and its relationship with the pressures in the vagina in comparable circumstances. It is important because of its search for a reliable and meaningful indicator of pelvic floor contraction.

However, we have several comments.

In contrast to earlier work on this subject by some of the authors [Bump et al., 1991], they now ignore the influence of Valsalva effort at the time of a pelvic floor contraction. In their original article they defined an ideal Kegel effort as ''a significant increase in the force of the urethral closure without an appreciable (15%) Valsalva effort.'' They then found that 25% of the patients had such an appreciable Valsalva effort during a verbal instructed pelvic floor contraction ''as if you were trying to keep from losing time. '' In a similar study we found that only 39% of our patients was able to contract the pelvic floor and increase the MUCP without a Valsalva effort. This percentage was higher in women without (46%) than with (25%) significant anatomical abnormalities [van Loenen and Vierhout, 1997]. Only 26% performed an ideal pelvic floor contraction.

Thus, Valsalva effort is frequently part of a presumed isolated pelvic floor contraction and cannot be ignored in such a study.

Certainly if comparing it with intravaginal pressure increase during a pelvic floor contraction in which it is likely that a Valsalva effort will, also, increase the pressure in the vagina. A pressure increase in the vagina during a presumed pelvic floor contraction could therefore be the consequence of an ideal pelvic floor contraction, a Valsalva effort, or a combination of both.

We therefore suggest that the authors reanalyze their data and stratify the results for patients with and without appreciable Valsalva effort during a pelvic floor contraction.