The clinical utility of urethral pressure profilometry (UPP) in men with suspected voiding dysfunction (VD), defined as Qmax <15ml/s and/or PVR >100ml, is unclear.(1) This is the first clinical study to assess the diagnostic accuracy of UPP and its prognostic value in guiding treatment for men with VD.

We conducted a retrospective cohort study in a single UK tertiary urology centre, including consecutive men with voiding symptoms and/or urinary retention suspicious of VD who underwent UPP between May 2015 and Jan 2025. Patient Global Impression- Improvement (PGI-I) at six months was used to determine treatment outcome of patients with VD. PGI-I score of 1 to 3 was defined as success; 4 to 7, failure. The diagnostic performance of UPP was assessed against urodynamic-proven VD using standard metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A multivariate logistic regression models was fitted to identify predictors of treatment outcome. The Cochran-Armitage trend test was employed to evaluate the association between maximum urethral closure pressure (MUCP) categories (<70, 70-80, >80 H2O) and sacral neuromodulation (SNM) treatment success.

Of 72 men with voiding symptoms and/or urinary retention who underwent UPP, 66 men were diagnosed with urodynamic-proven VD, of which 40 received treatment (27 idiopathic, 13 neurogenic). (Figure 1 and 2) The median follow up was 3.9 years (IQR: 2.3-4.2 years). UPP demonstrated moderate diagnostic performance of 74.6% sensitivity and 40% specificity for VD, with high PPV (94.3%) but low NPV (10.5%). 27 (67.5%) men reported a successful treatment outcome with a median PGI-I of 2. The multivariate logistic regression found no significant associations between treatment outcome and bladder sensation, post-void residual volume, or MUCP (p >0.05 for all). (Figure 3) However, for the 17 men treated with SNM, the Cochran-Armitage trend test demonstrated a statistically significant association between higher maximum urethral closure pressure (MUCP) and successful outcome (dim = 3, p=0.006).

The high PPV (94.3%) of UPP demonstrates its utility in confirming VD in men, though its low specificity limits its standalone diagnostic use. This makes UPP an adjunct instead of an alternative to pressure-flow studies. Prognostically, MUCP >80 cmH2O strongly predicted SNM success (70% success rate vs. 14% in lower MUCP groups).

UPP is a valuable diagnostic adjunct in confirming VD in men. Critically, it also optimises SNM patient selection as men with VD and a raised MUCP (>80 cmH2O) achieved five-fold greater success rate than men with low or normal MUCP.

D’Ancona C, Haylen B, Oelke M, Abranches-Monteiro L, Arnold E, Goldman H, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019 Feb;38(2):433–77.