Penile urethral compression-release maneuver as a non-invasive screening test for diagnosing prostatic obstruction

The purpose of this study was to evaluate the feasibility of using a penile urethral compression and quick release maneuver during urination as a pote ntial non-invasive clinical screening tool in the evaluation of patients wi th voiding dysfunction and the diagnosis of prostatic obstruction. The peni le compression-release maneuver was performed in adult men with symptomatic voiding dysfunction and in asymptomatic normal men by compressing the peni le urethra for 2-3 seconds after the initiation of flow and quickly releasi ng the compression. The penile compression-release index, calculated from t he resulting flow rate surge (Q(surge)) and the steady flow rate (Q(surg)-Q (s)/Q(s)), was analyzed with respect to the type of voiding dysfunction. A comprehensive urodynamic study was performed in each patient to determine t he presence and severity of prostatic obstruction and to measure detrusor c ontractility. The penile compression-release indices measured with this man euver in patients with bladder outlet obstruction (183 +/- 76%, n = 43) or detrusor instability (157 +/- 65%, n = 13) were significantly greater than the index observed in non-obstructed patients with normal contractility (67 +/- 378, n = 24) or in non-obstructed patients with impaired detrusor cont ractility (70 +/- 32%, n = 10). In asymptomatic younger men who had normal free flow rates (>15 mL/s), the penile compression-release index (55 +/- 29 %, n = 20) was significantly less than that observed in patients with outle t obstruction or detrusor instability. These findings suggest that the magn itude of the flow rate change generated after the penile compression-releas e maneuver depends on the magnitude of the isometric detrusor contraction d eveloped during penile urethral compression and on the conduit status of th e outlet. In patients determined to have poor urinary flow rates, this non- invasive maneuver has been able to differentiate prostatic obstruction asso ciated with normal detrusor contractility from other causes of low urinary flow rates. Despite these encouraging trends, further studies in a larger c ohort are required to determine its potential clinical utility as a screeni ng tool for diagnosing prostatic obstruction. (C) 2000 Wileg-Liss, Inc.