Stress urinary incontinence (SUI) is a common complaint among female urology patients. The primary causes of SUI are pelvic floor muscle (PFM) weakness or sphincter deficiency. Assessing PFM strength is crucial for diagnosing SUI, along with clinical examinations. Pressure perineometery (PP) is a noninvasive technique used to evaluate PFM strength and function. This study aims to investigate the correlation between cough leak point pressure (CLPP) measured during urodynamic studies (UDS)—a standard and invasive quantitative parameter for SUI—and both pressure perineometery and digital vaginal palpation of PFM. The goal is to establish a noninvasive diagnostic approach that enables clinicians to make informed decisions and monitor treatment outcomes effectively.

62 female patients (mean age: 65±10, range: 22-85 years) presenting with SUI or stress-predominant mixed urinary incontinence, who had a positive CLPP in UDS and physical examination, were included in the study from 2022 to 2023. After taking their medical history and performing a urogenital examination, each patient underwent digital palpation and assessment using a pressure perineometer. The perineometer values measured in cm H₂O, and results of digital palpation using Oxford system, were then analyzed for correlation with CLPP.

Based on the urodynamic study, CLPP was reported as less than 60 mmHg in 22 (35.5%) patients, 90-60 mmHg in 13 (21%) patients, and more than 90 mmHg in 27 (43.5%) patients. The average perineal pressure was 42.87 cmH2O (SD: 10.93, range: 19.1-71). The mean score of the ICIQ-short form questionnaire was reported as 13.6 (SD: 3.88, range: 3-21), No correlations were found between age, BMI, menopause, number and method of childbirth, and PP . Additionally, there were no significant correlations found between PP and a history of pelvic surgery, correction of urinary incontinence, or repair of pelvic organ prolapses (P-value > 0.1). According to the linear and significant correlation between PP values and the score of the International Consultation on Incontinence Questionnaire (ICIQ), we find that an increase in the score of this questionnaire, which indicates the severity of stress urinary incontinence, is related to a decrease in the average PP in patients.

The findings showed a strong, positive, and significant correlation between CLPP and PP values (p-value: 0.001). Furthermore, a significant positive correlation was found between CLPP and digital palpation scores (p-value: 0.0001). The optimal PP cutoff for CLPP-positive patients was 51.5 mmH₂O. In the CLPP subgroups (<60, 60–90, >90 mmH₂O), the corresponding PP cutoff values were <35.5, 35.5–43.5, and >43.5 mmH₂O, respectively.

This study suggests that pressure perineometery, as a quantitative, simple, cost-effective, and noninvasive method, can enhance the diagnosis of SUI, determine its severity, guide treatment decisions, and facilitate patient follow-up and outcome evaluation. If future
research confirms the utility of this method in selecting and evaluating treatment plans, it could serve as an alternative to the current invasive and costly methods.

Pereira VS, Hirakawa HS, Oliveira AB, Driusso P. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles. Brazilian journal of physical therapy. 2014;18:428-34.
Aanestad Ø, Flink R. Urinary stress incontinence. A urodynamic and quantitative electromyographic study of the perineal muscles. Acta obstetricia et gynecologica Scandinavica. 1999;78(3):245-53.
Peschers U, Gingelmaier A, Jundt K, Leib B, Dimpfl T. Evaluation of pelvic floor muscle strength using four different techniques. International urogynecology journal. 2001;12:27-30.