Rigi10™ Malleable Penile Prosthesis
Also Known As
Valsalva Leak Point Pressure, Abdominal Leak Point Pressure (ALPP), Valsalva LPP, Vesical Leak Point Pressure Test, Bladder Leak Point Pressure
Definition
Vesical Leak Point Pressure (VLPP) is a dynamic urodynamic test that measures the lowest intravesical pressure at which urine leakage occurs during increased abdominal pressure in the absence of a detrusor contraction.1 It specifically evaluates the pressure threshold at which the urethral sphincter mechanism fails to maintain continence when subjected to increased intra-abdominal pressure through a Valsalva maneuver.2 VLPP is a critical parameter for assessing the integrity of the urethral sphincter and quantifying the severity of stress urinary incontinence.3 The test is performed during urodynamic studies by having the patient perform a controlled Valsalva maneuver (forced exhalation against a closed mouth, glottis, and nose) while bladder pressure is simultaneously measured, with the lowest pressure causing visible urine leakage being recorded as the VLPP value.4
Clinical Context
Vesical Leak Point Pressure (VLPP) is primarily used in the clinical evaluation of patients with stress urinary incontinence (SUI) to assess the functional integrity of the urethral sphincter mechanism.1 This diagnostic parameter is particularly valuable in determining the presence and severity of intrinsic sphincter deficiency (ISD), a condition characterized by inadequate urethral coaptation resulting in incontinence.2
The measurement is typically performed during comprehensive urodynamic studies, with the patient in a lithotomy position on an urodynamic table.3 A multichannel urodynamic device records intravesical and abdominal pressures while the patient performs a controlled Valsalva maneuver at specific bladder volumes, commonly between 150-300 mL.3
McGuire’s classification system provides clinical interpretation guidelines: VLPP values below 60 cmH₂O strongly suggest intrinsic sphincter deficiency, values between 60-90 cmH₂O are considered equivocal, and values above 90 cmH₂O generally indicate sphincter competence.2 An abdominal leak point pressure exceeding 150 cmH₂O suggests that incontinence is unlikely to be caused by urethral incompetence.1
VLPP measurements significantly influence treatment planning for stress urinary incontinence, particularly in surgical decision-making.4 Patients with low VLPP values (<60 cmH₂O) may have different surgical outcomes compared to those with higher values, though the predictive value remains controversial.1 Some studies indicate that low preoperative VLPP correlates with higher failure rates following mid-urethral sling procedures, while others show no significant relationship between preoperative VLPP and postoperative cure rates.1
It’s important to note that VLPP measurements can be affected by various factors including bladder volume (values typically decrease with increasing volume), catheter size, patient position, and the presence of pelvic organ prolapse.3 For comprehensive assessment, VLPP is often compared with cough-induced leak point pressure (CLPP), which typically yields higher values in the same patient.3