Is pressure transmission quality during cystometry dependent on the type of effort?

Introduction. - The International Continence Society (ICS) recommends a control of the goodpressure transmission by a coughing effort during cystometry. While poor transmission is sometimes observed in routine practice, other maneuvers can also be proposed. The main objective of this study was to determine if there is a better maneuver to evaluate the pressure transmission ratio between the abdominal cavity and the bladder. Methods. - We performed a prospective, consecutive, single-center study in a tertiary neurourology department in 31 subjects. During a cystometry, each patient was asked to perform at 0 ml and 100 ml of bladder filling, a cough effort, an abdominal push and a Valsalva maneuver controlled by a manometer. The value of the bladder pressure to abdominal pressure ratio was collected manually. The average variations were compared between each maneuver for the same volume of replenishment and between the 2 volumes of replenishment studied. Results. - At 0 ml of filling, the difference in pressure variation between the Pves and the Pabdis significantly higher during the cough maneuver compared to the Valsalva (P = 0.015), which is not found at 100 ml of filling. Conclusion. - During bladder filling, the pressure transmission ratios during the 3 maneuvers are equivalent. Coughing or abdominal thrusting, which are easier to perform than the Valsalva maneuver, should be recommended to check the quality of the recording during cystomanometry.