The micturitional urethral pressure profile in the diagnosis of obstruction in patients with neurogenic bladder

Sixteen male patients with neurologically-based dysfunctional voiding were identified as having bladder neck or prostatic obstruction with the micturitional urethral pressure profile (MUPP) during triple lumen videourodynamics. All patients had had at least one urinary tract infection in the preceding 6 months and had residual urine greater than 150 cc. Urinary tract infection was defined as fever > 37.8, leukocytosis > 12,000, or pyuria > 15/HPF in the presence of urine bacterial counts > 100,000/ml. Obstruction was defined as a pressure drop of 15 cm. water or greater across the bladder neck or prostate as identified on fluoroscopy during the MUPP. None of the patients had obstruction due to detrusor-sphincter dyssynergia. Transurethral surgery for obstruction was performed on all patients, and repeat MUPP's were performed one month after surgery. Of the 16 patients with bladder neck or prostatic obstruction on MUPP, 9 were spinal cord injured (SCI), 3 had Parkinson's, and 4 were post strokes. There were 5 patients (all SCI) with obstruction at the bladder neck and 11 patients (3 Parkinson's, 4 post stroke, 4 SCI) with prostatic obstruction. Mean voiding pressure was 98 cm for these 16 patients preoperatively. Drops of pressure (mean) during the MUPP's were as follows: bladder neck: 37; prostate: 40; SCI: 34; Parkinson's: 48; stroke: 35. Mean residual urine volumes (cc) preoperatively were as follows: bladder neck 202; prostate 180; SCI 188; Parkinson's 203; stroke 173. Post operatively, all 16 patients had unobstructed MUPP's (mean pressure drop 4, range 0-10), and the mean voiding pressure was 64. Residual urine volumes (cc) were as follows: bladder neck 73, prostate 91, SCI 83, Parkinson's 103, stroke 61. At 8 months of follow-up, only one patient (with Parkinson's) had developed a urinary tract infection. Utilizing MUPP criteria, transurethral surgery of the bladder neck or prostate significantly reduced obstruction in these patients. Voiding pressures, residual urine volumes and incidence of UTI's were significantly reduced (P<.01). The MUPP appears to be a reliable tool in the diagnosis of obstruction in patients with neurogenic bladders.