External Urethral Sphincter Pressure Measurement: An Accurate Method for the Diagnosis of Detrusor External Sphincter Dyssynergia?

Abstract

BackgroundCombined pelvic floor electromyography (EMG) and videocystourethrography (VCUG) during urodynamic investigation are the most acceptable and widely agreed methods for diagnosing detrusor external sphincter dyssynergia (DESD). Theoretically, external urethral sphincter pressure (EUSP) measurement would provide enough information for the diagnosis of DESD and could simplify the urodynamic investigation replacing combined pelvic floor EMG and VCUG. Thus, we evaluated the diagnostic accuracy of EUSP measurement for DESD.Patients & MethodsA consecutive series of 72 patients (36 women, 36 men) with neurogenic lower urinary tract dysfunction able to void spontaneously was prospectively evaluated at a single university spinal cord injury center. Diagnosis of DESD using EUSP measurement (index test) versus combined pelvic floor EMG and VCUG (reference standard) was assessed according to the recommendations of the Standards for Reporting of Diagnostic Accuracy Initiative.ResultsUsing EUSP measurement (index test) and combined pelvic floor EMG and VCUR (reference standard), DESD was diagnosed in 10 (14%) and in 41 (57%) patients, respectively. More than half of the patients presented discordant diagnosis between the index test and the reference standard. Among 41 patients with DESD diagnosed by combined pelvic floor EMG and VCUR, EUSP measurement identified only 6 patients. EUSP measurement had a sensitivity of 15% (95% CI 5%–25%), specificity of 87% (95% CI 76%–98%), positive predictive value of 60% (95% CI 30%–90%), and negative predictive value of 56% (95% CI 44%–68%) for the diagnosis of DESD.ConclusionsFor diagnosis of DESD, EUSP measurement is inaccurate and cannot replace combined pelvic floor EMG and VCUR.

A novel urodynamic model for lower urinary tract assessment in awake rats

“…The implantation‐induced tissue alterations need to be considered when bladder‐specific processes are assessed. In humans, combined pelvic floor EMG and videocystourethrography (VCUG) during urodynamic investigation are the most acceptable and widely agreed methods for diagnosis of DSD , especially considering that both detrusor internal and external sphincter dyssynergia can be investigated. VCUG is not yet available in rats but we are working on some additional improvements and in the optimal case a video‐urodynamic assessment could be established.…”

Detrusor Acontractility after Acute Spinal Cord Injury—Myth or Reality?

“…Detrusor-sphincter dyssynergia was defined as 1) detrusor contraction concurrent with involuntary contraction of the urethral and/or periurethral striated muscle 6,7 on pelvic floor electromyography in the absence of the Valsalva or Cred e maneuver and/or 2) a dilated posterior urethra obstructed by the external urethral sphincter on fluoroscopy during videourodynamics as described previously. 12 Patients with asymptomatic bacteriuria were not treated and no antibiotic prophylaxis was administered for UDI.…”

Urethral Pressure Measurement as a Tool for the Urodynamic Diagnosis of Detrusor Sphincter Dyssynergia

“…In 2001, Sakakibara et al [13] looked at the reduction in urethral sphincter pressure during voiding for patients with DSD and found that urethral pressure decreased by an average of 6.4 and 5.0 cm H 2 O for men and women, respectively with DSD compared to 39 and 53 for those without [13]. Taking this information, Suzuki et al [8] examined the utility of urethral pressure as an alternative to combined EMG/VCUG for measuring DSD. They defined urethral pressure DSD as any increase, maintenance, or decrease <10 cm H 2 O of urethral pressure during the voiding phase.…”

“…Urethral sphincter pressure measurements during urodynamics may offer an alternative or supplemental method for diagnosing DSD and yield measurement data that can be used to better characterize physiology [6]. Currently, there are few published techniques for using urethral pressure measurements to categorize DSD and these reports have yielded inconsistent data [7,8]. Consequently, using urethral pressures to diagnose DSD is currently considered experimental by the International Continence Society (ICS) [6].…”