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Prostaglandin E2 (PGE2) instilled into the bladder generates symptoms of urinary urgency in healthy women and reduces bladder capacity and urethral pressure in both humans and female rats. Systemic capsaicin desensitization, which causes degeneration of C-fibers, prevented PGE2-mediated reductions in bladder capacity, suggesting that PGE2 acts as an irritant (Maggi CA, Giuliani S, Conte B, Furio M, Santicioli P, Meli P, Gragnani L, Meli A. Eur J Pharmacol 145: 105–112, 1988). In the present study, we instilled PGE2 in female rats after capsaicin desensitization but without the hypogastric nerve transection that was conducted in the Maggi et al. study. One week after capsaicin injection (125 mg/kg sc), rats underwent cystometric and urethral perfusion testing under urethane anesthesia with saline and 100 µM PGE2. Similar to naïve rats, capsaicin-desensitized rats exhibited a reduction in bladder capacity from 1.23 ± 0.08 mL to 0.70 ± 0.10 mL ( P = 0.002, n = 9), a reduction in urethral perfusion pressure from 19.3 ± 2.1 cmH2O to 10.9 ± 1.2 cmH2O ( P = 0.004, n = 9), and a reduction in bladder compliance from 0.13 ± 0.020 mL/cmH2O to 0.090 ± 0.014 mL/cmH2O ( P = 0.011, n = 9). Thus, changes in bladder function following the instillation of PGE2 were not dependent on capsaicin-sensitive pathways. Further, these results suggest that urethral relaxation/weakness and/or increased detrusor pressure as a result of decreased compliance may contribute to urinary urgency and highlight potential targets for new therapies for overactive bladder.

OBJECTIVE Previous studies have shown that anterior vaginal wall prolapse (AVWP) results in reduction of pressure in the proximal urethra. However, the effect of severity of AVWP on urethral pressure is controversial. This study aimed to evaluate parameters of the urethral pressure profile in different stages of AVWP. MATERIALS AND METHODS From 2016 to 2017, 286 consecutive patients with urogynecologic complaints who were referred to our urodynamic unit were enrolled in this study to analyze their urethral pressure profiles. Stages of AVWP were regrouped into three groups ranging from mild to severe stages (groups 1-3). Maximal urethral pressure, urethral closure pressure, functional urethral length, length of continence zone, as well as area of continence zone were compared among these three groups. RESULTS Distribution of age, parity, and menopausal women were significantly different among these three groups. Maximal urethral pressure (pressures for groups 1, 2, and 3 were 74.6∼75.9cmH2O, 69.7∼73.4cmH2O, and 58.3∼60.5cmH2O, respectively; all P

Purpose: To confirm feasibility of recording pressure along the length of the urethra using a multi-sensor fibre-optic pressure catheter; to identify the spatial and temporal features of changes in pressure along the urethra at sites related to specific striated pelvic floor muscles; and to investigate the relationship between urethral pressures and activation of individual pelvic floor muscles estimated from ultrasound imaging. Materials and Methods: Proof-of-concept study including one male (47 years old) and one female (33 years old). A multi-sensor fibre optic pressure catheter (10 mm sensor separation) was inserted into the urethra. Pressure data were recorded simultaneously with trans-perineal ultrasound imaging measures of pelvic floor muscle activity during sub-maximal and maximal voluntary contractions and evoked coughs. Results: Pressure changes along the urethra were recorded in all tasks in both participants. Face validity of interpretation of pressure measures with respect to individual muscles was supported by correlation with ultrasound-measured displacements induced by the relevant muscles. Onset of pressure increase occurred in a distal to proximal sequence in the urethra of the male but not the female during voluntary contraction. Peak urethral pressures varied in location, timing and amplitude between tasks. Evoked cough induced in the greatest urethral pressure increase across all tasks for both participants. Conclusions: The high spatial resolution pressure catheter provide viable and valid recordings of urethral pressure in a male and female. Data provide preliminary evidence of sex differences in spatial and temporal distribution of urethral pressure changes.

We performed a systematic review to examine the efficacy and outcomes of Botulinum Toxin A (BoNT-A) as the primary intervention strategy for patients with detrusor external sphincter dyssynergia. Eleven studies were included in the analysis (n = 353; 16% female, 84% male). BoNT-A was effective in 60%-78% of patients for reducing postvoid residual, mean detrusor pressure, detrusor leak point pressure, and mean urethral pressure 1 month after injection. Most patients required reinjection after an average of 4-9 months. BoNT-A was not associated with any significant adverse events, and may improve quality of life, as well as urodynamic parameters for detrusor external sphincter dyssynergia.

INTRODUCTION AND OBJECTIVE:The Artificial Urinary Sphincter (AUS) is currently the standard of care for men with severe Stress Urinary Incontinence (SUI). It’s also a treatment option for SUI in wo...

Aims To determine if the air-charged urethral sensor balloon currently used in urodynamic testing (UDS) significantly impacts Valsalva leak point pressure (VLPP) measurements. Methods This is a prospective cohort study of women undergoing UDS at an academic institution. VLPPs were obtained at 150 mL and urodynamic capacity with and without the urethral pressure sensor in the urethra. VLPP measurements were analyzed using a Wilcoxon signed-rank test. Median and interquartile range are presented. Results Sixty-three patients were enrolled in the study, 53 were included in the primary analysis. The mean age of the subjects was 56.2 ± 12.1 years. Nine patients (16%) solely leaked when the balloon was not present in the urethra either with cough or during VLPP measurement. At both 150 mL and urodynamic capacity, when VLPP testing was performed, there was a significant difference (cmH2 O) between the control and intervention values, (76.2 [55.0, 97.0] vs 68.8 [46.3, 93.3], P = .0012; 79.3 [53, 96.5] vs 72.5 [50.8, 92.3], P = .04). There was also a statistically significant difference between the control and intervention values for the lowest leak value at 150 mL and capacity (70.5 [51, 94.5] vs 60.0 [40, 88] P = .002; 73.5 [49.5, 91.5] vs 61 [45, 88], P = .017). Conclusions The higher VLPPs obtained with the urethral balloon in place indicate that the balloon may be the cause of falsely elevated VLPPs during urodynamic testing. Additionally, the balloon may mask a diagnosis of stress urinary incontinence in some patients.

Aims During filling cystometry, urethral pressure variations (UPV) can be observed. The clinical relevance and a clear definition of this phenomenon are still a matter of debate. For further research and definition of UPV, it is important to determine how this condition can best be demonstrated. The purpose of this study is to compare continuous urethral pressure measurements with a single urethral-sensor catheter and a triple urethral-sensor catheter in demonstrating UPV. Methods Seventy-five adult female patients requiring urodynamic investigation enrolled in this prospective study. All patients underwent two series of filling and voiding cystometry. One series was performed with a dual-air balloon sensor urodynamic catheter, the other series with a triple urethral-sensor catheter. UPV were defined as urethral pressure drop exceeding 30 cmH2O. Results The prevalence of UPV was 37.3% (28 out of 75 patients), more common than detrusor overactivity. The triple urethral-sensor catheter was more sensitive than the single urethral-sensor catheter: In eight patients UPV were demonstrated with both catheters and in 18 patients only in the measurement with the triple urethral-sensor catheter. This difference in detection was significant (P

The present study evaluated real-time changes in urethral pressure during the storage phase using a rat model with stress urinary incontinence (SUI) induced by simulated multiple birth traumas and investigated the relationship between urethral continence function and dynamic parameters associated with the changes in urethral pressure. Sprague-Dawley rats were divided into the following two groups: the sham group, which underwent three catheterizations of the vagina without distension at 2-wk intervals, and the vaginal distension (VD) group, which underwent three VDs at 2-wk intervals. After transection of the T8–T9 spinal cord, simultaneous bladder and urethral pressure recordings were performed during intravesical pressure elevation. Urodynamic parameters such as leak point pressure (LPP), urethral baseline pressure (UBP), maximum urethral pressure (MUP), the MUP-UBP differential (dUP) during intravesical pressure elevation, the bladder pressure when urethral contraction begins (Puc), and the bladder pressure at bladder neck opening (Pno) were then measured and compared. Compared with the sham group, LPP, UBP, dUP, MUP, Puc, and Pno were significantly decreased in the VD group. Pressure differences between LPP and Pno and between LPP and UBP (LPP-UBP) were also significantly different in the two groups. However, difference values of LPP and MUP or Pno and UBP were not altered after VD. Our new methods of simultaneous recordings of dynamic changes in bladder and urethral pressures are useful to fully evaluate the functional alterations in urethral continence function in the SUI model induced by multiple VDs. Moreover, LPP-UBP values, which correspond to the difference between Valsalva LPP and maximum urethral closure pressure in clinical urodynamics, would be useful to evaluate the impaired urethral continence function after simulated birth traumas in animal models.

Background: Urinary incontinence is defined as involuntary urine leakage. The International Consultation on Incontinence (ici) estimates a 25-45% prevalence of urinary incontinence worldwide. Kegel exercises are included in the clinical management of incontinence, to increase the strength of urethral closure. However, reports in the medical literature state that 25% of the population utilizes poor technique in performing those exercises, producing a worse prognosis in relation to the natural history of the disease. The aim of the present study was to evaluate the efficacy of the Kegel exercises in a population with urinary incontinence, measuring urethral pressure response. Materials and methods: An observational and prospective study was conducted on 38 patients with urinary incontinence. The demographic variables of the patients were collected, and they were given a 5 min explanation of the exercises. Maximum urethral closure pressure and urethral pressure were measured to the point of functional pressure of the urethral sphincter. After the performance of the Kegel maneuver, patients were assessed in relation to an increase in the maximum urethral closure pressure. Results: Of the 38 patients, only 52% achieved an increase in urethral pressure with the Kegel exercises. A lack of response to the exercises was found in patients that presented with overweight (p=0.015). Conclusion: The performance of Kegel exercises had a limited response in patients with urinary incontinence and there was a lack of effectiveness on urethral pressure in overweight patients.

Background: To present a new method of urethral pressure examination, and to evaluate diagnostic capabilities of three-dimensional profilometry, as an alternative to classical urethral profile (UPP). Using five channel catheters and dedicated software, a global urethral pressure image is obtained. The method eliminates the main limitation of classical urethral profilometry, where the catheter orientation determines the pressure picture limited to only one point in the urethral circumference, we observed up to 50% differences in pressure measures depending on the point of urethral circumference where the measurement was taken. Methods: This is a preliminary study containing a method presentation and analysis of the use in varied clinical cases of either healthy patients or patients with lower urinary tract symptoms (LUTS). The article includes a technique and equipment description and a full evaluation of selected cases, including three-dimensional urethral pressure distribution graphics. Results and Conclusions: Three-dimensional profilometry compared to the classical technique is comparable regarding the time, cost, technical difficulty and patient discomfort. At the same time, we obtained much more data on the urethral pressure and its distribution. The results are easy to interpret due to the 3D movable graphics created automatically by the dedicated software.

Purpose To describe a technique for urodynamic diagnosis of detrusor sphincter dyssynergia (DSD) using urethral pressure measurements and examine potential associations between urethral pressure and bladder physiology among patients with DSD. Methods Multiple sclerosis (MS) and spinal cord injured (SCI) patients with known DSD diagnosed on videourodynamics (via electromyography or voiding cystourethrography) were retrospectively identified. Data from SCI and MS patients with detrusor overactivity (DO) without DSD were abstracted as control group. Urodynamics tracings were reviewed and urethral pressure DSD was defined based on comparison of DSD and control groups. Results Seventy-two patients with DSD were identified. Sixty-two (86%) had >20 cm H2O urethral pressure amplitude during detrusor contraction. By comparison, 5 of 23 (22%) of control group had amplitude of >20 cm H2O during episode of DO. Mean duration of urethral pressure DSD episode was 66 seconds (range, 10–500 seconds) and mean urethral pressure amplitude was 73 cm H2O (range, 1–256 cm H2O). Longer (>30 seconds) DSD episodes were significantly associated with male sex (81% vs. 50%, P=0.013) and higher bladder capacity (389 mL vs. 219 mL, P=0.0004). Urethral pressure amplitude measurements during DSD were not associated with significant urodynamic variables or neurologic pathology. Conclusions Urethral pressure amplitude of >20 cm H2O during detrusor contraction occurred in 86% of patients with known DSD. Longer DSD episodes were associated with larger bladder capacity. Further studies exploring the relationship between urethral pressure measurements and bladder physiology could phenotype DSD as a measurable variable rather than a categorical observation.

Objectives: To determine whether artificial urethral sphincter filling volume is proportional to peak pressure exerted on the urethra. Materials and Methods: Urethral pressure profilometry was performed in five female, medium-sized, mixed-breed canine cadavers following artificial urethral sphincter placement. Maximum urethral pressure was recorded following sequential incremental inflation of 0.15 mL and compared to baseline pressure and between dogs using two-way analysis of variance. Results: Artificial urethral sphincter placement in cadavers was associated with an increase in urethral pressure, which was significantly correlated with inflation volume. The correlation was non-linear and demonstrated considerable individual variation. Maximum urethral pressures after artificial urethral sphincter placement exceeded those reported in conscious continent dogs within a narrow volume range, in which a 0.15 mL infusion more than doubled maximal urethral pressures. Clinical Significance: Rapid increases in urethral pressure from the artificial urethral sphincter over a small range of filling volumes (0.15 mL increments) might explain why some clinical cases can become suddenly dysuric following incremental inflations. We suggest that smaller increments of filling (0.05 to 0.1 mL) may achieve finer pressure control.

Urodynamics is a method for evaluation of urinary tract function, specially lower urinary tract. Lower urinary tract is a unique functional entity consisted of urinary bladder, sphincteric mechanism and urethra. Their main function is storage of urine, voiding and continence. Urodynamics is used for evaluation of all this functions. Urodynamics is performed as adjunct to the basic clinical evaluation. The most frequently used methods are uroflow, cistometry, and urethral profilometry. Uroflow represent urinary flow during micturation. Cistometry is used for measurement of pressures during storage and expulsion of the urine. Urethral profilometry measured urethral pressure and show data about patient’s continency. In this review article we present basic information about urodynamic tests with clinical examples.

Introduction and hypothesis Urethral instability (URI) has in the past been defined by the International Continence Society (ICS), but was excluded from ICS terminology and definitions shortly after because of a lack of consensus about the clinical importance of this phenomenon. Recently, interest in URI and its possible role in overactive bladder (OAB) increased again. In the last decade, a beta 3 adrenoreceptor agonist (mirabegron) was approved for the treatment of OAB. The effect of mirabegron on urethral pressure during filling cystometry is unknown. The aim of this study was to assess the influence of mirabegron on urethral pressure variations during urodynamic investigation and the association of symptoms and voiding diary data before and during treatment. Methods This prospective study included 51 consecutive adult female patients, referred with OAB. Patients were evaluated using a voiding diary, two validated questionnaires and two urodynamic investigations, one before and one after 6 weeks of treatment with mirabegron. URI was defined as an urethral pressure drop exceeding 30 cmH(2)O during filling cystometry. Results The prevalence of URI was 31% at initial urodynamic investigation, and 19% at second investigation. URI is more common than DO with 18% prevalence at initial evaluation. Treatment with mirabegron resulted in significant changes in symptoms and urodynamic sensory markers in patients with URI. Conclusion Urethral pressure variations are significantly reduced by treatment with mirabegron in patients with URI. URI seems to have a predictive value in treatment choices for OAB. Future research should elucidate this.

Introduction Recently, a new urodynamic method for the assessment of stress urinary incontinence called high definition urethral pressure profilometry (HD-UPP) has been introduced. This method combines a novel microtip catheter with advanced signal processing to enable spatial data location and the reconstruction of a pressure image inside the urethra. In order to assess the reproducibility of HD-UPP data, we statistically evaluate HD-UPP datasets and compare them to data from a double balloon air-charged system. Materials and Methods Both catheters are used on sedated female minipigs. Data from the microtip catheter are processed through a signal reconstruction algorithm, urodynamic features are extracted, and compared to the air-charged system. Reproducibility of HD-UPP data is assessed by statistically evaluating consecutive, intra-individual datasets. Results HD-UPP delivers results in agreement with previous comparisons of microtip and air-charged systems. The average deviation of two consecutive, intra-individual pressure images is very low at 7 cm H2O. Conclusions HD-UPP provides physicians with detailed information on the pressure distribution inside the urethra. Through comparison with an air-charged catheter, it is shown that HD-UPP delivers results in agreement with previous studies on the comparison of microtip and air-charged catheters. It provides excellent reproducibility, as the difference between sequentially measured profiles from the same minipig is significantly lower than the one between profiles from different minipigs.

Objectives To investigate the effects of propofol and isoflurane on urethral pressure profilometry of female dogs and goats, and to identify the method of anesthesia that least influences urethral pressure profilometry and to assess its reproducibility. Methods The effects of premedication with midazolam, propofol sedation and isoflurane anesthesia were assessed in five female dogs. The effects of propofol and isoflurane were compared in seven goats, whereas in another group of 19 goats, the state of deep propofol sedation was compared with the state of recovery from propofol sedation. The coefficient of reproducibility and within-subject coefficient of variation were calculated to evaluate test–retest reproducibility. Results In conscious female dogs, maximal urethral closure pressure and functional area were significantly higher than under propofol or isoflurane (P = 0.04), but not different from the recovery state. In six of seven goats, maximal urethral closure pressure and functional area were higher when measured under propofol sedation than under isoflurane (median maximal urethral closure pressure, 69 vs 47 cmH2O; P = 0.03). Maximal urethral closure pressure was lower under propofol than during recovery from propofol in 17 of 19 goats (median maximal urethral closure pressure, 54 vs 66 cmH2O; P < 0.001). The test–retest coefficient of reproducibility for goats was 28 cmH2O, and the within-subject coefficient of variation was 16%. Conclusions In dogs, urethral pressure profilometry should be measured in conscious animals whenever possible. In goats, urethral pressure profilometry is least affected during recovery from propofol sedation, and it shows acceptable reproducibility under this condition.

Rationale Stress urinary incontinence (SUI) refers to the involuntary leakage of urine when abdominal pressure increases. Midurethral slings (MUS) have become the main surgical method for treating SUI, but no quantitative standard for the degree of sling tightness during operation exists. We achieved this quantitative measurement using ambulatory urodynamic equipment. Patient concerns A 49-year-old woman presented to our hospital with intermittent urine leakage. Five pads were used daily to keep the vulva dry. The preoperative urethral pressure profilometry (UPP) showed that maximum urethral pressure (MUP) was 54 cmH2O and maximum urethral closure pressure (MUCP) was 53 cmH2O. Diagnosis According to the medical history and examination findings, the patient was diagnosed as SUI. Interventions The MUS and UPP were performed. Outcomes The intraoperative UPP showed that MUP was 29 cmH2O and MUCP was 17 cmH2O. Three months after the operation, the patient was followed up by telephone. The amount of urine pad usage decreased from 5 pads/d to 0 pads/d, reaching the social control standard (0-1 pads/d). The patient's international consultation on incontinence questionnaire short form score decreased from 18 to 5, and their incontinence quality of life score increased from 12.5 to 78.4. The effect of urine control was satisfactory, and no complications occurred.Five months after operation, the patient was reexamined in the outpatient department. The UPP showed that the MUP was 98 cmH2O and the MUCP was 72 cmH2O. The patient still uses 1 pad/day. The international consultation on incontinence questionnaire short form score is 6 and incontinence quality of life score is 79.5. The curative effect is stable. Lessons MUS has become an effective surgical method for SUI, and the tightness of the sling directly affects the surgical outcome. We have achieved the measurement of urethral pressure during MUS. However, although we found that there is no obvious clinical significance of urethral pressure measurement in MUS operation, future research will benefit from our findings by improving upon our study design to help standardize the clinical diagnosis and treatment of MUS.

AIMS To explore if adding occlusion training of a thigh (KAATSU) to low-intensity pelvic floor muscle training (PFMT) could increase effect of PFMT in women with stress urinary incontinence (SUI). METHODS Single-blinded randomized controlled pilot study. Women with SUI and an ICIQ-UI-SF (International Consultation on Incontinence Questionnaire-Short form) score of ≥12 were randomized to a low-intensity PFMT program followed by KAATSU (KAATSU + PFMT) or to a low-intensity PFMT program without KAATSU (PFMT group), both performed four times a week for 12 weeks. PRIMARY OUTCOME Change in the ICIQ-UI-SF score at a 12-week follow-up. SECONDARY OUTCOMES a 3-day leakage diary, the PGI-I (Patient Global Index of Improvement scale), bother with KAATSU in a numeric rank scale and change in urethral opening pressure (UOP) measured with urethral pressure reflectometry (UPR) at rest, contraction and straining at the 12-week follow-up. RESULTS Forty-one women with SUI and an ICIQ-UI-SF of 13 (range 12-16) were included. Fourteen in the KAATSU + PFMT and 17 in the PFMT group completed the study. Both groups had a significant and clinically relevant improvement of the ICIQ-UI-SF score and decrease in number of incontinence episodes with no significant between group differences. UOP did not increase significantly in either group. Bother with KAATSU was low but seven of 14 women expressed dislike with KAATSU. CONCLUSIONS The added KAATSU protocol did not increase the effect of low-intensity PFMT and it was not well tolerated. While subjective effect was significant in both intervention groups this was not reflected in the UPR measures.

Author(s): Wasenda, Erika J; Kirby, Anna C; Lukacz, Emily S; Nager, Charles W | Abstract: AIMS:Traditional technology to characterize urethral pressure changes during dynamic conditions is limited by slow response times or artifact-inducing withdrawal maneuvers. The 8F high-resolution manometry (HRM) catheter (ManoScan™ ESO, Covidien) has advantages of fast response times and the ability to measure urethral pressures along the urethral length without withdrawal. Our objective was to determine static and dynamic maximum urethral closure pressures (MUCPs) and resting functional urethral length (FUL) in women using HRM before and after transurethral bulking and compare results to other women who underwent midurethral sling (MUS). METHODS:We recorded rest, cough, and strain MUCPs and FUL in 24 women before and after transurethral bulking with polydimethylsiloxane (Macroplastique®) using the HRM catheter and compared these changes to HRM values from 26 women who had the same measures before and after MUS. RESULTS:At rest, MUCPs increased minimally after both urethral bulking and MUS (3 vs 0.4 cm H2 O respectively, P = 0.4). Under dynamic conditions there were statistically insignificant small increases in MUCP and these increases were markedly less than after MUS (cough: 1.5 vs 63.8 cm H2 O, P l 0.001 and strain: 11.5 vs 57.7 cm H2 O, P l 0.001). FUL increased by 0.5 cm after transurethral bulking (P = 0.003), and decreased by 0.25 cm after MUS placement (P = 0.012). CONCLUSIONS:The mechanism of continence after urethral bulking differs from MUS. While MUS increases dynamic MUCP, bulking may rely on increasing the length of the continence zone.

Objective To assess the chronological changes in urinary incontinence and urethral function before and after radical prostatectomy (RP), and to compare the findings of pelvic magnetic resonance imaging (MRI) before and after RP to evaluate the anatomical changes. Patients and methods In total, 185 patients were evaluated with regard to the position of the distal end of the membranous urethra (DMU) on a mid-sagittal MRI slice and urethral sphincter function using the urethral pressure profilometry. The patients also underwent an abdominal leak point pressure test before RP and at 10 days and 12 months after RP. The results were then compared with the chronological changes in urinary incontinence. Results The MRI results showed that the DMU shifted proximally to an average distance of 4 mm at 10 days after RP and returned to the preoperative position at 12 months after RP. Urethral sphincter function also worsened 10 days after RP, with recovery after 12 months. The residual length of the urethral stump and urinary incontinence were significantly associated with the migration length of the DMU at 10 days after RP. The residual length of the urethral stump was a significant predictor of urinary incontinence after RP. Conclusion This is the first study to elucidate that the slight vertical repositioning of the membranous urethra after RP causes chronological changes in urinary incontinence. A long urethral residual stump reduces urinary incontinence after RP.

The urethral closure mechanism in women is incompletely understood. Measuring closure function in a collapsed urethral tube without distending the tube and changing its natural shape is impossible with conventional methods. Over the last decade, studies with urethral pressure reflectometry (UPR), a method that measures pressure and the corresponding cross-sectional area along the entire length of the urethra continuously by means of acoustic reflectometry, have been performed. The studies have mainly been performed on patients with stress urinary incontinence (SUI). Our aim was to provide an overview of the studies conducted with UPR, establishing whether the method may be used in clinical practice. We reviewed all literature published on UPR. Urethral pressure reflectometry is easily performed with limited bother for the patient. The catheter consists of a 45-cm-long PVC tube connected to a thin and highly flexible polyurethane bag, which is placed in the urethra. When inserted, the bag only occupies 0.4 mm2 of the urethra, respecting the natural shape and orientation of the urethra and, most importantly; respecting the laws of physics when measuring urethral pressure. UPR can discriminate patients with SUI from continent women and separate assessment of the sphincter function and support system is possible. Also, UPR has revealed statistically significant differences in urethral pressures after drug therapy for SUI. We conclude that UPR has a place in clinical practice. The method has shown groundbreaking potential in the understanding of urethral dysfunction in SUI patients.

Introduction: The aim of the study was to analyse the correlation of subjective complaints and urethral pressure profilometry (UPP) data in women with different types of urinary incontinence (UI): stress UI (SUI), urgency UI (UUI), and mixed UI (MixUI). Methods: A study group of 405 women with complaints about UI were surveyed (UDI-6; ICIQ-UI) to determine the subjectively dominant type of UI, and UPP was performed for all these women. The variables analysed by UPP were the maximum urethral closure pressure at rest (MUCPrest), maximum urethral closure pressure at cough stress (MUCPstress), functional urethral length at rest (FULrest), functional urethral length during cough stress (FULstress) test and pressure transmission ratio (PTR). The statistical variation between different groups of UI patients was calculated for all the analysed variables. Results: The value of PTR was statistically and significantly higher in the group of patients with isolated UUI, compared to the SUI and MixUI groups. The MUCPrest and MUCPstress values were consistently lower in women with isolated SUI, compared to isolated UUI. The FULrest and FULstress values showed no statistically significant difference between the groups with different types of UI. Conclusions: The PTR value is a result of UPP test that helps in distinguishing objectively between UUI, SUI, and MixUI. The PTR value can be used to characterise the hypermobility of urethra. The MUCPrest and MUCPstress values are consistently lower in women with isolated SUI, compared to those with isolated UUI. MUCP can be used as an objective criterion for differentiation of these 2 groups of patients.

Severe stress urinary incontinence is a nonnegligible complication that affects men as well as women. When initial therapies are not sufficient, implantation of artificial urinary sphincters (AUS) is considered the gold standard treatment. This hydromechanical device applies constant pressure on the urethra to keep urine inside the bladder. Although recovery from incontinence is full or partial, this approach has certain disadvantages. In addition to the difficulties and discomfort encountered when operating the device, insufficient pressure, urethral atrophy, and erosion from constant pressure on the urethra may necessitate revision surgery. In this study, we present a novel, remote-controlled AUS with variable urethral pressure that improves continence and avoids revision surgery. The proposed design eliminates the manual pump, facilitating implantation in men and women. It is compatible with current AUS. The device requires very little power and its parameters can be monitored and updated post-operatively. It has been tested on pig bladders ex vivo . Different pressure control algorithms have been developed, and expected performances have been achieved. Design challenges and experimentation results are reported.

Aims The clinical relevance of urethral pressure variations (UPV) in the pathophysiology of over active bladder syndrome (OAB) has remained controversial to date. Some studies report an association with OAB and/or detrusor over activity (DO). Recently the International Consultation on Incontinence—Research Society recommended new clinical research to be performed on this subject. We provide a systematic review of the literature to specify this recommendation. Methods Literature search was performed in PubMed, Embase, Web of Science, Cochrane, Central, Cinahl, Academic Science Premier, Science Direct, and Wiley Online using a sensitive search string combination. All authors independently reviewed and scored full text papers and consensus about methodological quality was obtained according to Oxford Level of Evidence (LoE). Results Four hundred eighty seven abstracts were screened, 25 papers met all predefined inclusion selection criteria. Incidence figures of UPV varied between 2% and 95%. Studies are of poor methodological quality with Oxford LoE scores of 3B and 4. Measurement methods and techniques show a large variety. The above mentioned association of DO/OAB with UPV is however frequently reported. Conclusion There exists a phenomenon of UPV, apart from DO, which may be a separate entity within OAB syndrome. Large variation in measurement techniques and patient populations hinders fundamental research as well as clinical progress. Clinical relevance of UPV and consequences for treatment therefore are yet to be established. Future prospective research with well-defined patient population and standardised urodynamic measurement techniques is needed. Results of standardized and objective evaluations should be compared to clinical signs and symptoms by validated questionnaires. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Introduction Urethral pressure profilometry (UPP) is used in the diagnosis of stress urinary incontinence (SUI). SUI is a significant medical, social, and economic problem, affecting about 12.5% of the population. A novel microtip catheter was developed for UPP featuring an inclination sensor and higher angular resolution compared to systems in clinical use today. Therewith, the location of each measured pressure sample can be determined and the spatial pressure distribution inside the urethra reconstructed. In order to assess the performance and plausibility of data from the microtip catheter, we compare it to data from a double balloon air charged system. Materials and Methods Both catheters are used on sedated female minipigs. Data from the microtip catheter are processed through a signal reconstruction algorithm, plotted and compared against data from the air-charged catheter. Results The microtip catheter delivers results in agreement with previous comparisons of microtip and air-charged systems. It additionally provides a new level of detail in the reconstructed UPPs which may lead to new insights into the sphincter mechanism of minipigs. Conclusions The ability of air-charged catheters to measure pressure circumferentially is widely considered a main advantage over microtip catheters. However, directional pressure readings can provide additional information on angular fluctuations in the urethral pressure distribution. It is shown that the novel microtip catheter in combination with a signal reconstruction algorithm delivers plausible data. It offers the opportunity to evaluate urethral structures, especially the sphincter, in context of the correct location within the anatomical location of the pelvic floor. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Objective To examine chronological changes in urethral and bladder functions before, immediately after, and 1 year after robot-assisted radical prostatectomy (RARP), urodynamic studies were prospectively performed. Methods Sixty-three consecutive patients underwent pressure-flow studies, urethral pressure profiles, and abdominal leak point pressure (ALPP) tests 1-2 days before, immediately after, and 1 year after RARP. Results The mean bladder compliance was 28.3 mL/cm H2O before RARP; it worsened to 16.3 mL/cm H2O immediately after RARP and recovered to 27.1 mL/cm H2O at 1 year. The mean detrusor pressure at maximum flow rate was 61.9 cm H2O before RARP; it decreased to 34.3 cm H2O immediately after RARP and remained at 35.6 cm H2O at 1 year. The mean maximum urethral closure pressure was 84.2 cm H2O before RARP; it decreased to 33.4 cm H2O immediately after RARP and recovered to 63.0 cm H2O at 1 year. Intrinsic sphincter deficiency (ISD) evaluated by the ALPP test was observed in 53 patients immediately after RARP, although no patient showed ISD before RARP. ISD remained in 7 patients at 1 year. Both ALPP and maximum urethral closure pressure at 1 year were significant factors for continence in multivariate analysis. Conclusion Urethral sphincter and bladder function worsen immediately after RARP and recover over time. The bladder storage function after RARP returns to almost the same level before RARP, and the voiding function improves compared with the condition before RARP; however, the urethral sphincter function does not return to its preoperative level. Urethral sphincter dysfunction is considered the main factor for urinary incontinence after RARP. © 2015 Elsevier Inc., Embargo Period 12 months

Urodynamic studies encompass several tests to investigate the hydrodynamics of the lower urinary tract during bladder storage/filling and voiding. These tests include bladder diaries, free uroflowmetry, and post-void residuals, filling cystometry, voiding pressure/flow studies, urethral pressure profiles, leak point pressures, videourodynamics, ambulatory urodynamics, and electromyography. The tests are performed after formulating a urodynamics question to objectively observe lower urinary tract function and dysfunction with the idea of choosing an appropriate treatment for the pathology. Invasive urodynamic tests require appropriate training, as per the joint statement on minimum standards for urodynamic practice in the United Kingdom, and should be performed according to the International Continence Society good urodynamics practice guidelines. It is also important to be able to interpret the traces appropriately and troubleshoot any problems occurring during the test.

Pelvic organ prolapse (POP) reduction is often performed in the preoperative assessment of women before POP surgery. Using urethral pressure reflectometry (UPR), we sought to investigate how POP reduction affects the urethral closure mechanism. Women with anterior or posterior vaginal wall prolapse stage ≥II with and without POP reduction were examined with a speculum. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest and during squeezing, and standardized stress tests with 300 ml saline. All examinations were repeated after insertion of a speculum. We included 38 women: 22 with anterior and 16 with posterior vaginal wall prolapse POP-Q stage ≥II. During POP reduction, resting and squeezing urethral pressures decreased by 2.5 cmH2O (p = 0.007) and 5.1 cmH2O (p

Urinary incontinence is described as the involuntary loss of urine and is a common condition in middle-aged and elderly women and men [1]. Urinary incontinence can be generally classified into the following three: (1) stress urinary incontinence, (2) urge urinary incontinence, and (3) a mixed form of (1) and (2) [1]. Stress urinary incontinence occurs when increased intra-abdominal pressure causes bladder pressure to exceed urethral pressure, resulting in involuntary leakage of urine. In stress urinary incontinence, urine leakage can be observed during coughing, sneezing, laughing, lifting, and exercising. Classically stress urinary incontinence often relies on distinguishing between intrinsic sphincter deficiency and urethral malposition or hypermobility [2]. However, this is controversial as each component may contribute in varying proportion to the occurrence of stress urinary incontinence.

Urethral pressure reflectometry (UPR) has proven highly reproducible in women with pelvic organ prolapse. We hypothesized that urethral parameters would decrease after anterior colporrhaphy. A prospective, observational study where women with anterior vaginal wall prolapse ≥stage II were assessed before and after anterior colporrhaphy. Assessments consisted of prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining (at a standardized abdominal pressure of 50 cmH2O, PO-Abd 50), standardized stress tests with 300 ml saline, and answering the International Consultation on Incontinence – Urinary incontinence short form. Stress urinary incontinence (SUI) was defined as a positive stress test and a questionnaire with symptoms of SUI and a bother score > 1. Sample size was 30, power was 100% and the level of significance was 5%. We analyzed data with paired t-tests or non-parametric Wilcoxon signed rank tests; p-values

Studies have suggested that a posterior vaginal wall prolapse might compress the urethra and mask stress urinary incontinence (SUI), much like an anterior vaginal wall prolapse. A recent study with urethral pressure reflectometry (UPR) has shown that the urethral closure mechanism deteriorates after anterior colporrhaphy; this could explain the occurrence of postoperative de novo SUI. We hypothesized that urethral pressure would also decrease after posterior colporrhaphy. This was a prospective, observational study where women with posterior vaginal wall prolapse ≥stage II were examined before and after posterior colporrhaphy. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining, and standardized stress tests with 300 ml saline. The women filled out International Consultation on Incontinence-Urinary incontinence (ICIQ-UI) short forms. The sample size was 18, with a power of 99.9% and a level of significance of 5%. Parameters were compared using paired t tests or Fisher’s exact test, where appropriate; p values

Aims Women with functional voiding dysfunction often experience a “catching” sensation when catheterising and are in general investigated with both urethral pressure profilometry (UPP) and sphincter electromyography (EMG). It is unknown whether the pattern of the UPP trace correlates with this sensation of “catching” or with sphincter EMG findings. Methods We reviewed the database of all women with voiding dysfunction who had undergone both sphincter EMG and UPP to assess for any relationship between pattern of UPP trace and “catching” on catheterization and/or sphincter EMG findings. UPP traces were classified as smooth or pulsatile and the EMG was classified as normal or abnormal. Statistical analysis was by Chi squared test for pulsatile UPP trace as a predictor of abnormal EMG. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a pulsatile UPP trace for predicting abnormal EMG were also determined. These patients were asked to complete a telephone interview assessing discomfort on catheterization, particularly on catheter removal (“catching”). Results A total of 107 women of mean age 35.8 years underwent both sphincter EMG and UPP between 2011 and 2015. There was no significant association between “catching” on catheterization and pattern of UPP. There was a significant association between the presence of a pulsatile UPP and the finding of an abnormal EMG (P

PURPOSE: To evaluate the effect of diabetes mellitus and of sildenafil citrate on female urethral function.METHODS: Twenty nine female rats were divided into four groups: G1 - (n=9), normal rats; G2 - (n=6), normal rats treated with sildenafil citrate; G3 - (n=9) rats with alloxan-induced diabetes; G4 - (n=5) rats with alloxan-induced diabetes treated with sildenafil citrate. Under anesthesia, urodynamic evaluation was performed by cystometry and urethral pressure simultaneously.RESULTS: A significant increase in urethral pressure was observed during micturition.CONCLUSION: Sildenafil citrate can partially reduced urethral pressure in diabetic female rats.

Objective To evaluate continence status and mechanism of urinary incontinence immediately after robot-assisted radical prostatectomy (RARP) by performing urodynamic evaluation. Methods A total of 87 patients with localized prostate cancer who underwent RARP were included. Filling cystometry, urethral pressure profilometry, and abdominal leak point pressure (ALPP) tests were performed before and immediately after RARP. Results The mean urine loss ratio (ULR), calculated by dividing the total urine volume by the weight of urine loss after RARP, was 17.8%. Nerve-sparing (NS) surgery significantly affected ULR compared with non-NS surgery. In the comparison between preoperative and postoperative results, the mean maximal cystometric capacity (MCC) and maximal closure urethral pressure (MUCP) decreased from 341 mL and 84.6 cm H 2O to 250 mL and 35.6 cm H2O, respectively. No urine leakage was observed in ALPP test preoperatively; however, urine leakage was observed postoperatively in 75 patients (86%), with a mean ALPP of 47.7 cm H2O. Multivariate analysis revealed that MCC, MUCP, and ALPP after RARP were predictive factors for ULR. Linear correlations were found between ULR and MUCP and between ULR and ALPP after RARP. NS status and MUCP after RARP (r = 0.247; P =.021) and the ALPP (r = 0.254; P =.018) were significantly correlated. Conclusion In urodynamic evaluation immediately after RARP, MCC, MUCP, and ALPP were found to predictive factors for urinary incontinence. The NS procedure contributed to continence status after RARP. © 2014 Elsevier Inc.

Aim To investigate if the tension-free vaginal tape (TVT) works by increasing the abdominal to urethral pressure impact ratio (APIR). Methods Twenty one women with urodynamically proven stress urinary incontinence (SUI) were assessed by ICIQ-SF, pad-weighing test, incontinence diary and Urethral Pressure Reflectometry (UPR) before and after TVT. UPR was conducted during resting and increased intra-abdominal pressure (PAbd) by straining. Related values of PAbd and urethral opening pressure (Po) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line was found. The slope expresses the ratio of pressure increase in the urethra compared to the pressure increase in the abdomen and was called APIR. Results The urethral opening pressure at rest (Po-rest) was unchanged after TVT, while APIR increased in all women (from 0.7 to 1.4, P

Over 200 million people worldwide suffer from urinary incontinence. Urinary incontinence in women occurs frequently from middle age onward and is associated with a reduced quality of life. Stress urinary incontinence (SUI) is leakage of urine during sneezing, coughing, physical exercise, lifting, bending or even changing positions. These are all events that cause an increase in intra-abdominal pressure. SUI occurs when bladder pressure exceeds urethral pressure, in the setting of sudden increases of intra-abdominal forces. SUI affects upward of 40% of American women. The placement of the midurethral sling theoretically corrects inadequate urethral support. After a thorough understanding of potential complications, a patient may benefit from this safe and effective procedure that can improve a woman’s quality of life.

The present study aimed to report the urodynamic data from 46 male patients who underwent an orthotopic N-shaped neobladder replacement following a radical cystectomy during a 12-month period and to provide urodynamic evidence for the improvement of this technique. A total of 46 consecutive male patients underwent a radical cystectomy and orthotopic N-shaped neobladder substitution due to muscle-invasive bladder cancer. Uroflowmetry, cystometry and urethral pressure profilometry were analyzed at 3–12 months following the surgery. The mean pressure of the neobladders was

Aim to assess the urethral closure function by urethral pressure reflectometry (UPR) during intra-abdominal pressure-increase in SUI and continent women. Methods Twenty-five urodynamically proven SUI women and eight continent volunteer women were assessed by ICIQ-SF, pad-weighing test, incontinence diary, and UPR. UPR was conducted during resting and increased intra-abdominal pressure (PAbd) by straining. Related values of PAbd and urethral opening pressure (Po) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line (“APIR”) and the intercept with the y-axis found. By the equation of the line, Po was calculated for various values of PAbd, for example, 50 cm H2O (Po-Abd 50). Results The resting Po (Po-rest) and APIR, respectively, significantly differed in SUI and continent women but could not separate the two groups. The urethral closure equation (UCE) based on Po-rest and APIR provided a more detailed characterization of a woman's closure function based on the permanent closure forces (primarily generated by the urethral sphincteric unit) and the adjunctive closure forces (primarily generated by the support system). Po-Abd 50 and UCE, respectively, which express the combined permanent and adjunctive closure forces and estimate the efficiency of the closure function, separated SUI and continent women and were highly significantly negatively correlated with ICIQ-SF, pad test, and the number of incontinence episodes. Conclusions New parameters for characterization of the urethral closure function and possible dysfunctions and its efficiency were provided. Po-Abd 50 and UCE may be used as diagnostic tests and severity measures. Neurourol. Urodynam. 32:1103–1108, 2013. © 2013 Wiley Periodicals, Inc.

Objective To explore the method of building a stable urethral stricture (US) model in New Zealand white rabbits. Methods Through 10× magnification optical microscope, a resection of 1.0 cm urethral mucosa was made in 6 male rabbits and other 6 male rabbits were controlled. After 60 days, the rabbits were evaluated with urethrography, urethral pressure profile (UPP) and histology. Result Urethrography demonstrated a stricture with narrow lumen and discontinuous mucosa in the resection group. The urethras of the control animals were all normal. UPP showed that the urethral pressure on operative site in the controlled group was 14.67 ± 2.16 cm H 2 O, and 27.83 ± 3.71 cm H 2 O in the resection group. There was significant statistical difference between the two groups ( p Conclusions We establish the way to build a stable urethral stricture model of New Zealand rabbits by the microsurgical technique, which is a good laboratory model to research all kinds of urethral stricture. Urethrography and histology combined UPP are the reliable methods to identify the urethral stricture.

International audience; Purpose: Maintaining urinary continence at stress requires a competent urethral sphincter and good suburethral support. Sphincter competence is estimated by measuring the maximal urethral closure pressure at rest. We aimed to study the value of a new urodynamic measure, the urethral closure pressure at stress (s-UCP), in the diagnosis and severity of female stress urinary incontinence (SUI). Methods: A total of 400 women without neurological disorders were included in this observational study. SUI was diagnosed using the International Continence Society definition, and severity was assessed using a validated French questionnaire, the Mesure du Handicap Urinaire. The perineal examination consisted of rating the strength of the levator ani muscle (0-5) and an assessment of bladder neck mobility using point Aa (cm). The urodynamic parameters were maximal urethral closure pressure at rest, s-UCP, Valsalva leak point pressure (cm H2O), and pressure transmission ratio (%). Results: Of the women, 358 (89.5%) were diagnosed with SUI. The risk of SUI significantly increased as s-UCP decreased (odds ratio [OR], 0.92; 95% confidence interval, 0.88-0.98). The discriminative value of the measure was good for the diagnosis of SUI (area under curve > 0.80). s-UCP values less than or equal to 20 cm H2O had a sensitivity of 73.1% and a specificity of 93.0% for predicting SUI. The association between s-UCP and SUI severity was also significant. Conclusions: s-UCP is the most discriminative measure that has been identified for the diagnosis of SUI. It is strongly inversely correlated with the severity of SUI. It appears to be a specific SUI biomarker reflecting both urethral sphincter competence and urethral support.

Aims To evaluate the effect on urethral pressure of reference drugs known to reduce stress urinary incontinence symptoms by different effect size and mechanisms of action on urethral musculature under four test conditions in healthy female subjects using urethral pressure reflectometry. Methods Healthy females aged 18-55 years were recruited by advertising for this phase 1, single site, placebo-controlled, randomized, four-period, crossover study. The interventions were single oral doses of 10 mg Midodrine, 80 mg Duloxetine, 12 mg Reboxetine, and placebo. The endpoints were the opening urethral pressure measured in each period at four time points (predose and 2, 5.5, and 9 h after dosing). Results Twenty-nine females were enrolled; 25 randomized and 24 completed the study. The opening urethral pressure was higher in all measurements with filled bladder compared with empty bladder, and during squeezing compared to the resting condition. All three drugs increased the opening urethral pressure during all four conditions with a ranking of their effect on urethral pressure matching their reported clinical effect (difference vs. placebo at their reported time of peak plasma concentrations [Tmax ] during resting with filled bladder: Midodrine 9.3 cmH2 O [95%CI 3.0, 15.5], Duloxetine 24.2 cmH2 O [95%CI 17.9, 30.5], and Reboxetine 44.9 cmH2 O [95% CI 40.2, 52.8] cmH2 O). Conclusions Urethral pressure reflectometry is capable of detecting drug-induced changes in urethral tone in various conditions. The magnitude of drug-induced changes by the test drugs seems to match their clinical profile and differences in mode of action.

The mechanism of continence in women with pelvic organ prolapse (POP) before and after surgery remains unknown. Urethral pressure reflectometry (UPR) separates women with stress urinary incontinence (SUI) from continent women by measuring urethral opening pressure at an abdominal pressure of 50 cmH2O (P O-Abd 50). UPR can help identify women with POP at risk of postoperative de novo SUI. The aim of this study was to investigate the reproducibility of UPR in women with POP. Women with anterior or posterior vaginal wall prolapse were recruited for this prospective, observational study from our outpatient clinic. The women were examined with UPR on two occasions. Measurements were done at rest, and during squeezing and straining. Statistical analyses were performed using SAS 9.4. A Bland-Altman analysis with limits of agreement and coefficients of variation was used to determine the level of agreement between measurements. Paired t tests were used to estimate the difference; a two-tailed P value of

Objective To evaluate the efficacy and safety of vaginal cystocele repair using a pursestring suture technique reinforced with custom-tailored 2-armed mesh. Methods The records of patients who underwent isolated cystocele repair by a single surgeon were retrospectively reviewed. All women were assessed by clinical examination and lower urinary tract symptoms preoperatively and at 3 and 6 months and every year postoperatively. The principal outcome measure was anatomic cure (stage 1 or lower) assessed by the Pelvic Organ Prolapse Quantification system. Results From May 2005 to June 2009, 50 consecutive patients with minimum stage 2 (Aa or Ba 0) cystocele were treated using the procedure. The mean follow-up was 24 months (range 12-54), and the success rate was 96% (48 of 50). No intraoperative complications occurred. Two developed vaginal erosion (4%) and underwent excision of the extruded mesh smoothly. The final 21 consecutive patients underwent urodynamic assessment pre- and postoperatively. Compared with the baseline urodynamic findings, surgery resulted in decreased maximal urethral pressure and maximal urethral closure pressures. However, neither increased de novo incontinence nor reduced cystometric bladder capacity developed. Conclusion The use of the pursestring suture technique reinforced with custom-tailored 2-armed mesh for vaginal cystocele repair is safe, effective, and economic.

Aims To determine and compare reproducibility of urethral pressure profilometry (UPP) in women with urodynamic stress incontinence (USI) alone or together with detrusor overactivity (DO). Methods Women were recruited from a urodynamic clinic diagnosed with USI using dual channel cystometry. UPP was performed with the technique described by Hilton and Stanton [Hilton P, Stanton SL. Br J Obstet Gynaecol 90:919–33,1983]. Different urethral function parameters were obtained. Two weeks later the tests were repeated. The precision and bias of the tests were measured using the Bland and Altman method [Bland JM, Altman DG. Lancet 1:307–10,1986]. The coefficient of variation (CV) value allowed direct comparison of repeatability of each test, with a lower value indicating less variation. Results Thirty-one women completed both visits. Fourteen women had USI, the other 17 diagnosed with USI with DO at the end of two visits. There was no significant difference between visits for all the parameters for all women recruited. The most reproducible parameter was functional urethral length and maximum urethral pressure as demonstrated by lowest CV. The women with USI group had more reproducible UPP parameters than those with mixed USI and DO in all parameters apart from pressure transmission ratio in Quartiles 2, 3, and 4. However, there was no significant difference between the two diagnostic groups. Conclusions Tests of urethral function in urethral pressure profilometry are shown to have poor reproducibility in women with USI, but limit of agreement may be acceptable in some of the tests. The with-in subject CV appears to be higher in women with mixed USI and DO compared to USI only. Neurourol. Urodynam. 30:1356–1360, 2011. © 2010 Wiley-Liss, Inc.

Aim: To investigate changes in urodynamic parameters after tolterodine treatment for female overactive bladder syndrome, especially in patients with voiding dysfunction. Methods: Between January and December 2006, 44 patients were enrolled for six months of treatment with tolterodine. Pre-treatment and post-treatment urodynamic studies were scheduled for the enrolled patients. Results: Among the remaining 33 patients (11 dropped out), bladder capacity (P