Ambulatory urethro‐cysto‐rectometry: A new technique

In some patients complaining of urinary incontinence a leakage is not found during sitting simultaneous urethrocystometry (SUCM). In these patients, who often exhibit marked urethral pressure variations, the closure pressure frequently falls close to zero due to a decrease in the maximum urethral pressure without simultaneous detrusor contraction. In order to see what happens to urethral, bladder, and rectal pressures when these patients leak urine in daily‐life situations, a new ambulatory urethro‐cysto‐rectometric technique (AUCRM) has been developed. Twenty‐six female patients who had urethral pressure variations of 20–100 cm H 2 O during SUCM were reinvestigated with this new technique. Urinary leakage was found significantly more often during AUCRM than during SUCM (21 patients of 26, vs. 13 of 26; P < 0.05). Twenty‐one of 26 patients complained of the symptom urge incontinence. In these patients urinary leakage was found to be highly significant more often during AUCRM than during SUCM (16 patients of 21, vs. 4 patients of 21; P < 0.001). Leakage was always due to a combination of urethral pressure decrease and detrusor pressure increase, as in normal micturition. The condition unstable urethra was not found. During SUCM 17 patients were found to have sensory and 4 motor urgency. Performing AUCRM in the same patients, 5 were found to have sensory and 16 motor urgency. By the use of AUCRM the condition sensory urgency has been shown to be less frequent than was previously believed. The new technique of AUCRM used in the present study is compared to supine and sitting SUCM, judged to be superior for detection of the leakage mechanism.