Static urethral pressure profile (S.U.P.P.) or video-dynamic pressure profile (V.D.P.P.) in the evaluation of multiple sclerosis (M.S.)?
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文摘
MS is known to affect various levels of the central nervous system. All parts of the autonomic (sympathetic and parasympathetic) and the somatic nervous system are taking part in the innervation of the junction of the bladder and the urethra. The function of this area necessitates its anatomical and neurophysiological integrity. Urethral pressure profile (UPP) is a valid method to evaluate the pressure response at various levels of the urethra both at rest and secondary to various stimuli such as change of body position, cough, Valsalva maneuver, Credé maneuver, etc. SUPP records static urethral pressures exerted by the urethral wall upon the side holes of the urethral catheter. The VDPP provides a more accurate way to diagnose characteristics of the urethral function and their correlation with the above stimuli but also the relation of the urethral response to variable intravesical pressure and especially during voiding. Variable information is also gathered in relation of the area of the vesical neck during uninhibited detrusor contractions. The specificity of VDPP was increased by simultaneous measurement of the intraabdominal pressure as well as electromyography of the external urethral sphincter (EUS) and other pelvic floor muscles using a needle electrode. Derangement of the time sequence of various phases of voiding with accentuated spasticity of the EUS or the pelvic floor muscles with variable contractility response of the detrusor has been accurately shown by VDPP. Detrusor internal sphincter dyssynergia or gaping vesical neck without other clinical manifestations of MS was identified as a subtle neurophysiological abnormality by VDPP. We consider VDPP as very helpfull in the evaluation of patients with MS that may result in finding unsuspected pathology.