Urethral pressure response to cough and voluntary perineal contraction in men without previous pelvic surgery

The aim of this study was to analyze the urethral pressure responses to cou gh in men to better characterize the neurogenic mechanisms of male urethral function. A prospective study was carried out on 41 men referred for urody namic assessment. Urethral pressure profiles at rest and during coughing, a nd urethral pressure response to voluntary perineal contraction were record ed and analyzed in relation to the neurological status of the patients. Vol untary perineal contraction resulted in a urethral pressure increase (Delta pU) of similar to 150 cm H2O in neurologically normal patients. Delta pU c ould be reduced to any degree in patients with either central or peripheral neurological lesions. Urethral pressure response to cough could be easily classified into two main patterns. Pattern I was characterized by a marked increase in urethral closure pressure during the cough (ratio of urethral t o rectal pressure increase: 248 +/- 106%), occurring at the distal part of the posterior urethra. All the neurologically normal patients and the major ity of those with upper motoneuron lesions had a pattern I response. Patter n II was defined by the absence of any significant increase in urethral clo sure pressure at any site of the posterior urethra and was observed in 80% of the patients with signs of lower motoneuron lesions. The pattern of the response to cough was significantly related to the neurological status of t he patients (P < 0.001). It was dissociated from the response to voluntary contraction, as would be expected for a reflex versus a voluntary response in neurological patients. (C) 1999 Wiley-Liss, Inc.