Noninvasive measurement of intravesical pressure, impulsive flow rate, and localized urethral resistance is achieved by clamping the penis immediately above the glans with a pneumatic cuff and then instructing the patient to initiate voiding. The cuff is then deflated slowly until urinary flow of at least 1 ml/s is detected and is then released rapidly to permit unimpeded flow. Cuff pressure, voided volume, and flow rate are recorded as functions of time. From the resulting tracings it is possible to determine the isovolumetric bladder pressure, the impulsive flow rate, and the flow pattern specific to the test. We studied 53 male patients demonstrating that data thus obtained are reproducible and that the cuff pressure at the initiation of voiding does measure the bladder pressure at this moment. We then modeled the lower urinary tract by an analog electrical circuit which facilitated the analysis of the urodynamic data. This analysis suggests that it is possible to separate the effects of bladder dysfunction from the effects of urethral resistance and to localize the resistance to the proximal or distal urethra without invasive testing. (C) 1995 Wiley-Liss, Inc.
