Original Article

Is there a correlation between simulated operations, urodynamics (vlpp) and urethral mobility?


Pelviperineology 2016;35(4):99-103


The diagnosis of stress urinary incontinence is based on history and physical examination and, if necessary, could be associated with additional tests especially the urodynamic. The Integral Theory, developed a new way to evaluate patients with stress urinary incontinence, known as ‘Simulated Operations’. These techniques are maneuvers performed during the stress test (cough), to identify the defects of the urethral support elements that cause incontinence.


1. To establish a correlation between simulated operations with the Valsalva leak point pressure (urodynamics); 2. To correlate the simulated operations with the result of the Q-tip test; 3. To correlate intensity of symptoms with simulated operations through the pad test.

Material and Methods:

From May 2012 to February 2015 82 women with stress urinary incontinence were evaluated. All patients underwent simulated operations that consisted of four maneuvers during the cough test observing if there was urinary leakage during the maneuvers. For the maneuver 1, the atraumatic clamp was applied unilaterally at the pubourethral ligament insertion on the inferior border of the pubis (simulating the plication of the pubourethral ligament). In the maneuver 2, a clamp was used to plicate the vaginal mucosa at the level of the midurethra (simulate the plication of the urethropelvic ligament). In the 3rd maneuver, the index finger is placed in the suburethral region without tension. The 4th maneuver is the same maneuver 3 with tension. The Q-tip test has been used for evaluation of urethral mobility and the one-hour pad test to measure the severity of urinary leakage. The simulated operations were compared with the values of Valsalva leak point pressure, Q-tip test and pad test.


When performing the maneuvers 1, 2 and 3, most patients did not have urinary leakage. There was a significant association between Valsalva leak point pressure and the cessation of stress urinary incontinence with the maneuvers 1, 2 e 3 (p = 0.008, OR 0.965; p = 0.0140, OR 0.953; p = 0.0002, OR 0.949, respectivamente às manobras 1, 2 e 3, com IC 95%). During the maneuver 4, no patient presented had leak urine. The Q-tip test was statistically significant with maneuvers 2, 3 and 4. The pad test did not show statistical correlation with the simulated operations.


The simulated operations demonstrated correlation with Valsalva leak point pressure and urethral mobility. Their use in clinical practice is recommended.

Keywords: Stress urinary incontinence; Simulated operations; Urodynamic study; Valsalva leak; Point pressure; Q-tip test; Pad test.