Neurourology and Urodynamics ICS Teaching Module: Detrusor Leak Point Pressures in Patients With Relevant Neurological Abnormalities Tufan Tarcan, 1 * Oktay Demirkesen, 2 Mauricio Plata, 3 and David Castro-Diaz 4 1 Department of Urology, Marmara University School of Medicine, Istanbul, Turkey 2 Department of Urology, Istanbul University CerrahpaS sa Medical Faculty, Istanbul, Turkey 3 Department of Urology, Hospital Universitario de la Fundaci  on Santa F e de Bogot  a/Universidad de los Andes, Bogot  a, Colombia 4 University Hospital of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain Aims: This manuscript serves as a scientific background review; the evidence base, for the presentation made available on ICS website to summarize current knowledge and recommendations for the measurement and use of the DLPP. Methods: This review has been prepared by a Working Group of The ICS Urodynamics Committee. The methodology used included comprehensive literature review, consensus formation by the members of the Working Group, and review by members of the ICS Urodynamics Committee core panel. Results: DLPP has been recommended and utilized in the urodynamic evaluation of N-LUTD for many years, but it lacks standardization and there are numerous pitfalls in its measurement. EFP and LPP associated with N-DO are frequently and mistakenly reported as DLPP. The information that high DLPP predicts UUTD originates from retrospective cohort studies of a low level of evidence (LoE 3). Existing data confirm that patients with lower DLPP do better than patients with higher DLPP in terms of their upper urinary tract. However, there appears to be no reliable ‘safe/no safe’ cut-off for DLPP since there are other urodynamic factors that influence UUTD such as bladder compliance and more. Conclusion: Although higher DLPP is associated with a greater risk of UUTD, there is no reliable cut-off level to undoubtedly discriminate the risky group, including the traditional cut- off level of 40 cm H 2 O. Therefore, DLPP should not be used as the sole urodynamic parameter. Future research should be directed to standardization of the technique and better classification of DLPP cut-offs in N-LUTD. Neurourol. Urodynam. # 2015 Wiley Periodicals, Inc. Key words: detrusor leak point pressure; neurogenic bladder; urodynamics INTRODUCTION Detrusor leak-point pressure (DLPP) testing originates from observations of videourodynamic studies of children with myelomeningocele (MMC) and urinary incontinence second- ary to impaired bladder compliance. McGuire retrospectively evaluated this group of children with the aim of finding predictors for upper urinary tract deterioration (UUTD). 1–3 This concept has been further applied to different etiologies of neurogenic lower urinary tract dysfunction (N-LUTD) in adults. 4 The International Continence Society (ICS) defines the DLPP as the lowest detrusor pressure at which urine leakage occurs in the absence of either a detrusor contraction or increased abdominal pressure. 5 The value of DLPP to predict UUTD is not known very precisely, and the measure- ment of DLPP lacks standardization and carries pitfalls. For example, although DLPP measurement has been recom- mended in neurological patients with reduced bladder compliance, some authors measure DLPP during involuntary detrusor contractions. 5 The ICS Urodynamics Committee presents the teaching module ‘‘detrusor leak point pressures in patients with relevant neurological abnormalities’’ to serve as a standard education of good urodynamic practice for everyone involved in indicating, performing, and analyzing urodynamic testing in general and more specifically, for those caring for patients with N-LUTD. The teaching module consists of a web-casted presentation, in combination with this manuscript, which is available on the ICS website. The presentation explains testing requirements, clinical workup, and analysis. The presentation and this manuscript contain experts’ opinion where evidence is unavailable, especially for the clinical practice aspects, and is marked with: ‘‘EO’’ (expert’s opinion). This module reviews the value of DLPP measurement in predicting UUTD in N-LUTD in light of the existing literature. Our purpose is to standardize and improve the method of DLPP measurement in patients with N-LUTD to minimize performer- and patient-dependent variations. MATERIALS AND METHODS All the requirements and instructions for the measurement of DLPP described in this section follow the ICS reports on Good Urodynamic Practices (GUP) 6 and urodynamic equipment performance. 7 The International Children’s Continence Society (ICCS) report on the standardization of terminology of lower urinary tract function in children and adolescents has been taken into consideration for the measurement of DLPP in children. 8 DLPP is obtained during a standard cystometry and no specific other equipment or specific patient preparation is needed to determine DLPP. DLPP uses detrusor pressure; Prof. Christopher Chapple led the peer-review process as the Associate Editor responsible for the paper. Potential conflicts of interest: Nothing to disclose.  Correspondence to: Tufan Tarcan, MD, PhD, Professor of Urology, Department of Urology, Marmara University School of Medicine, Fevzi S Cakmak Mah., Muhsin Yazicioglu Cad. No:10 Ust Kaynarca, Pendik, Istanbul, Turkey. E-mail: tufan@marmara.edu.tr Received 25 November 2015; Accepted 25 November 2015 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/nau.22947 # 2015 Wiley Periodicals, Inc.