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Abstract Purpose One of the most frequent side effects of radical prostatectomy (RP) is urinary incontinence. The primary cause of urine incontinence is usually thought to be impaired urethral sphincter function; nevertheless, the pathophysiology and recovery process of urine incontinence remains unclear. This study aimed to identify potential risk variables, build a risk prediction tool that considers preoperative urodynamic findings, and direct doctors to take necessary action to reduce the likelihood of developing early urinary incontinence. Methods We retrospectively screened patients who underwent radical prostatectomy between January 1, 2020 and December 31, 2023 at the First People ‘s Hospital of Nantong, China. According to nomogram results, patients who developed incontinence within three months were classified as having early incontinence. The training group’s general characteristics were first screened using univariate logistic analysis, and the LASSO method was applied for the best prediction. Multivariate logistic regression analysis was carried out to determine independent risk factors for early postoperative urine incontinence in the training group and to create nomograms that predict the likelihood of developing early urinary incontinence. The model was internally validated by computing the performance of the validation cohort. The nomogram discrimination, correction, and clinical usefulness were assessed using the c-index, receiver operating characteristic curve, correction plot, and clinical decision curve. Results The study involved 142 patients in all. Multivariate logistic regression analysis following RP found seven independent risk variables for early urinary incontinence. A nomogram was constructed based on these independent risk factors. The training and validation groups’ c-indices showed that the model had high accuracy and stability. The calibration curve demonstrates that the corrective effect of the training and verification groups is perfect, and the area under the receiver operating characteristic curve indicates great identification capacity. Using a nomogram, the clinical net benefit was maximised within a probability threshold of 0.01–1, according to decision curve analysis (DCA). Conclusion The nomogram model created in this study can offer a clear, personalised analysis of the risk of early urine incontinence following RP. It is highly discriminatory and accurate, and it can help create efficient preventative measures and identify high-risk populations.

Purpose: One of the most frequent side effects of radical prostatectomy (RP) is urinary incontinence. The primary cause of urine incontinence is usually thought to be impaired urethral sphincter function; nevertheless, the pathophysiology and recovery process of urine incontinence remains unclear. This study aimed to identify potential risk variables, build a risk prediction tool that considers preoperative urodynamic findings, and direct doctors to take necessary action to reduce the likelihood of developing early urinary incontinence. Methods: We retrospectively screened patients who underwent radical prostatectomy between January 1, 2020 and December 31, 2023 at the First People 's Hospital of Nantong, China. According to nomogram results, patients who developed incontinence within three months were classified as having early incontinence. The training group's general characteristics were first screened using univariate logistic analysis, and the LASSO method was applied for the best prediction. Multivariate logistic regression analysis was carried out to determine independent risk factors for early postoperative urine incontinence in the training group and to create nomograms that predict the likelihood of developing early urinary incontinence. The model was internally validated by computing the performance of the validation cohort. The nomogram discrimination, correction, and clinical usefulness were assessed using the c-index, receiver operating characteristic curve, correction plot, and clinical decision curve. Results: The study involved 142 patients in all. Multivariate logistic regression analysis following RP found seven independent risk variables for early urinary incontinence. A nomogram was constructed based on these independent risk factors. The training and validation groups' c-indices showed that the model had high accuracy and stability. The calibration curve demonstrates that the corrective effect of the training and verification groups is perfect, and the area under the receiver operating characteristic curve indicates great identification capacity. Using a nomogram, the clinical net benefit was maximised within a probability threshold of 0.01–1, according to decision curve analysis (DCA). Conclusion: The nomogram model created in this study can offer a clear, personalised analysis of the risk of early urine incontinence following RP. It is highly discriminatory and accurate, and it can help create efficient preventative measures and identify high-risk populations. [ABSTRACT FROM AUTHOR]

Objectives: Alpha-adrenergic antagonists are commonly used to prevent recurrent urethral obstruction in cats with mixed reports of efficacy. No published data on tamsulosin use in cats are available. The objective of this study was to measure changes in urodynamic parameters and blood pressure in five healthy male cats before and after administration of tamsulosin orally for 4 and 10 days. Methods: Five young healthy adult male cats from a research colony were administered tamsulosin at 0.1 mg/cat PO q24h for 10 days. Urethral pressure profile and blood pressure measurements were performed before treatment and approximately 6 h after treatment on days 4 and 10. Maximum urethral closure pressure (MUCP) for the prostatic and penile urethra, functional urethral length (FPL), functional area (FA) and systolic blood pressures were recorded and compared between the time points. Results: Significant changes in blood pressure on day 4 (121.1 mmHg ± 20.2 mmHg) and on day 10 (112.6 mmHg ± 14.9 mmHg) compared with day 0 (141.1 mmHg± 33.4 mmHg) were not detected (P = 0.18) in anesthetized cats. No significant difference in MUCP, FA or FPL measurements were detected among baseline, day 4 and day 10 of treatment. Hematuria and transient pollakiuria were induced in two cats with 3.5 Fr urethral catheters. Conclusions and relevance: Tamsulosin at 0.1 mg/cat PO q24h did not induce hypotension in healthy cats. Urodynamic testing performed 6 h after the tamsulosin pill was administered did not detect consistent decreases in urodynamic functions induced by tamsulosin. Repeated catheterization of tom cats with 3.5 Fr catheters may induce significant urethral trauma. [ABSTRACT FROM AUTHOR]

The aim of this opinion paper is to determine the entities that define the maximal urethral pressure (MUP) during rest and during bladder filling that is needed to guarantee continence in females. For the development of this opinion, the literature was searched for via the Pubmed database and historic sources. Animal studies indicate that the maximal urethral pressure is determined by the smooth muscle activity in the mid-urethra. Additionally, during increased smooth muscle tone development, the largest sympathetic responses are found in the middle part of the urethra. This could be confirmed in human studies that are unable to find striated EMG activity in this area. Moreover, the external urethral striated sphincter is situated at the distal urethra, which is not the area with the highest pressure. The external urethral sphincter only provides additional urethral pressure in situations of exertion and physical activity. From a physics point of view, the phasic pressure of the external striated sphincter at the distal urethra cannot be added to the tonic pressure generated by the smooth muscle in the mid-urethra. The assertion that mid-urethral pressure is the result of different pressure forces around the urethra, including that of the external striated sphincter, is not supported by basic research evidence combined with physical calculation and should therefore be considered a misconception in the field of functional urology. [ABSTRACT FROM AUTHOR]

Objective: Post-prostatectomy incontinence (PPI) is relatively common and of variable degree. Treatment of small-volume persistent PPI with a male sling or an artificial urinary sphincter is overly invasive, and the concept of intraurethral injection is very appealing in this situation. Bulkamid® is a nanoparticulate polyacrylamide and water polymer gel which is being used successfully in female stress urinary incontinence. We assessed the feasibility and effects of a four-point intraurethral technique on maximum urethral pressure (MUP) in male cadavers. Methods: Urethral pressure profile (UPP) was measured twice on two male fresh-frozen cadaver models before and after a four-point injection of 2 mL of Bulkamid® intraurethrally at the level of the sphincter in 0.5 mL aliquots using a 21Ch cystoscope with a 12° telescope and a 23G needle. Results: A clear UPP trace was recordable in both cadavers. The mean MUP at baseline was 38 cm H2O, and the mean MUP following Bulkamid® intraurethral injection increased to 55 cm H2O. Conclusions: Bulkamid® intraurethral injection in male cadavers is a simple technique that increases MUP. This increase in MUP may allow for treatment of low-volume PPI in men following prostate cancer treatment and warrants further study in the clinical situation. Level of evidence: Level 4. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to examine the functional outcomes of ona‐botulinum toxin A (BTX‐A) injection into the external urethral sphincter (EUS) for female patients with nonneurogenic nonrelaxing sphincter as the underlying cause of voiding dysfunction (VD). METHOD: A retrospective analysis was performed for all the patients with the urodynamic findings of higher than expected maximum urethral closure pressure (MUCP) who received their first injection during the study period. All patients were evaluated with preoperative videourodynamic study and urethral pressure profilometry and received 100 U of EUS BTX‐A. Patients aged less than 18 years and those with neurogenic bladder were excluded. All patients were followed up with the free flow, postvoid residuals (PVR), and patient global impression of improvement (PGI‐I) scale at 6 weeks and then at 3 monthly intervals. Result: We identified 35 female patients with a mean age of 37.5 ± 15 years (range 18–72 years) with a mean follow‐up of 20 months. More than 50% of patients had a history of prior surgical intervention and 28 (80%) patients were catheter dependent, a suprapubic catheterization, or clean intermittent self‐catheterization. Mean MUCP was 97.1 ± 22 cm of water. After treatment with BTX‐A, 21 (60%) patients were able to void per urethral (p = 0.02). The mean maximum flow rate (Qmax) improved from 8.8 to 11 mls/s and the mean PVR decreased from 200 to 149 mls (p < 0.05). On multivariate analysis, we identified high preoperative PVR, high preoperative actual MUCP, and previous surgical intervention (urethral dilatation, sacral neuromodulation, and pelvic surgery) as predictors of successful voiding restoration. The mean duration of response was 4.7 months, 46% of patients requested repeat injection, and 29% were established on maintenance injections. On the 5‐point PGI‐I score, 13 (37%), 12 (34%), and 10 (29%) patients reported good, some, and no improvement, respectively. Quality of life was also improved in 60% of patients. Two patients had transient stress urinary incontinence (for <6 weeks) and there were no significant long‐lasting adverse events. Conclusion: EUS BTX‐A is a valid treatment option for VD considering therapeutic options are limited. The patient must be made aware of the need for repeat treatments. [ABSTRACT FROM AUTHOR]

Objective: Urinary incontinence (UI) is one of the most common complications of radical prostatectomy (RP). Impaired urethral sphincter function is generally considered to be the most important contributing factor for UI; however, the mechanism of onset and recovery of urinary continence has not been fully elucidated. The objective of this research was to evaluate preoperative functional urethral length (FUL) and maximum urethral closure pressure (MUCP) as early continence recovery predictors after open retropubic RP (ORRP).Methods: The research was conducted on a group of 43 patients with localized prostate cancer (PCa) in the period from July 2019 to May 2021. The urodynamic method of urethral pressure profile (UPP) was used to assess FUL and MUCP, and correlate with the postprostatectomy continence recovery. The severity of UI and bothersome were assessed using fully validated International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ‐UI SF) and number of pads used in 24 h. Patients were interviewed about the use of urinary pads and asked to fill out the ICIQ‐UI SF before and 2, 8, 16 and 24 weeks after ORRP.Results: The median value of FUL (mm) and MUCP (cmH2O) was 69 (28–94) and 76 (16–223), respectively. Correlation and linear regression showed a statistically significant negative correlation between preoperative values of FUL and MUCP with ICIQ symptom score and the number of pads used per day at the four observed time intervals (p < 0.05). Such a result showed that patients with higher preoperative FUL and MUCP values were more likely to recover urinary continence earlier. A value of 65 mm for FUL and 80 cmH2O for MUCP proved to be the cut‐off values for continence recovery in 24 weeks after ORRP.Conclusion: Preoperatively evaluated FUL and MUCP seem to be valuable prognostic factors for early continence recovery after ORRP. Further investigation on a larger patient cohort is needed to evaluate the role of UPP in the preoperative management of patients with PCa. [ABSTRACT FROM AUTHOR]

Aims: To investigate factors contributing to pre and postoperative urethral function in male patients who underwent robot‐assisted radical prostatectomy (RARP) using the urethral pressure profile (UPP). Methods: Study A A total of 313 patients who underwent RARP between April 2013 and March 2015 were prospectively investigated. UPP was performed preoperatively in all patients. Correlation and multiple regression analyses were performed to investigate predictive factors for low preoperative maximum urethral closure pressure (MUCP). Study B To validate the predictive factors for low preoperative MUCP obtained in Study A, 755 patients who underwent RARP between May 2010 and October 2017 were retrospectively examined. Relationships between the time to pad‐free status and the following factors were investigated: number of predictive factors, nerve‐sparing surgery, and vesicourethral anastomosis (VUA) methods (barbed vs. nonbarbed suture). Results: Study A A total of 187 patients were enrolled. Multivariate analysis revealed that older age, large prostate volume, low erectile function domain scores in International Index Erectile Function 15, and use of calcium channel blockers were significantly associated with low preoperative MUCP. Study B A total of 515 patients were included. Cox proportional hazard regression showed that the number of predictive factors and VUA method were significantly associated with the time to pad‐free status. Conclusions: Our study demonstrated that older age, larger prostate volume, poor erectile function, and calcium channel blocker use could be predictive markers for recovery from postprostatectomy urinary incontinence. [ABSTRACT FROM AUTHOR]

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<.05) and stress urethral closure pressure (pressures for groups 1, 2, and 3 were 69.3cmH2O, 62.3cmH2O, and 52.2cmH2O, respectively; all P<.05) gradually and significantly decreased, consistent with the severity of AVWP. However, the attenuated maximal urethral pressure and stress urethral closure pressure in accordance with severity did not show any significant difference after controlling for age, body mass index, parity, menopause, and stress urinary incontinence symptoms. Conclusion: Our results showed that AVWP significantly attenuated urethral pressure. However, patient age, menopausal status, and number of parities seem to be more influential in compromising urethral function than just AVWP alone. [ABSTRACT FROM AUTHOR]

Aims: The management of recurrent stress urinary incontinence following failed previous continence surgery remains challenging. Whilst the role of urodynamic investigations has been questioned in the management of primary stress incontinence there is a widely held view that women with recurrent symptoms require further investigation although there is no agreement regarding which tests are required. We sought to understand what testing is recommended prior to managing this difficult cohort of patients. Method: This research proposal was presented at the International Consultation on Incontinence Research Society (ICI‐RS) in order to clarify our current knowledge regarding the assessment of urethral function and to set research priorities for the future. Results: Whilst the majority of clinicians would advocate urodynamic evaluation of women with recurrent stress incontinence following previous surgery there is no consensus of opinion as to which tests should be performed, on whom or where. The available evidence to date suggests that urethral function tests do have a role with regard to prognosis following surgery and also in planning the most appropriate surgical intervention. Conclusion: The ICI‐RS developed a list of research questions which may be able to assist in improving the investigation and management of women with recurrent SUI. Questions included whether patients felt the information gained via urethral function tests had an important role in their counseling regarding outcome of repeat SUI surgery. [ABSTRACT FROM AUTHOR]

Aims The aim of this study is to establish an optimized, minimally invasive transurethral catheterization cystometry (TUCC) and a novel urethral pressure profile (UPP) measurement for mice. Methods The optimized TUCC and the UPP measurement were first established. This optimized TUCC was then performed in 16 anesthetized female mice and compared with the suprapubic catheterization cystometry (SCC) in parallel after suprapubic catheters implantation (SCI; on zero, third, and seventh day, respectively). Finally, the optimized TUCC and novel UPP measurement were applied to investigate in another eight mice of partial bladder outlet obstruction (pBOO) model. The urodynamic parameters including micturition pressure (MP), basal pressure (BP), threshold pressure (TP), bladder capacity (BC), micturition volume (MV), residual urine (RV), bladder compliance (COM), maximum urethral pressure (MUP), bladder pressure curve and UPP were recorded. Statistical cross-comparisons of parameters for two kinds of cystometries and pBOO model were performed. Results Compared with the optimized TUCC before SCI, the MV, RV, BC, and MP decreased significantly on the seventh day after SCI (270.4-132.5 µL, 46.13-20.09 µL, 316.4-152.5 µL, 30.01-24.34 cmH20, respectively). After SCI, the BP, MP, TP, MV, RV, BC, and COM showed no significant difference between the TUCC and SCC at the same time point. The MUP increased significantly after pBOO operation (19.1-46.6 cmH20, P < 0.05). Conclusions The minimally invasive TUCC along with UPP measurement could be widely applied to study the bladder function of mice as a feasible, repeatable, and accessible method. [ABSTRACT FROM AUTHOR]

Aim To investigate if injection of cells in the urethral sphincter complex causes unspecific bulking effects. Methods Human mesenchymal stromal cells were isolated, expanded, and characterized. For transurethral injection, cells were labeled with the fluorescent dye PKH26 and in magnetic resonance imaging associated experiments with superparamagnetic particles. Aliquots of cells in 250 µL solvent were injected under vision in the urethral sphincter of immuno-suppressed Göttingen minipigs. Sphincteric closure pressure was recorded by standard and high-definition urethral pressure profilometry prior to and after cell injection. The animals were sacrificed after surgery or after 3 weeks, 3, 6, or 12 months of follow-up. The localisation of the injected cells was explored by histochemistry. Sham-treated animals served as controls. Results PKH26-labeled cells survive injections in sphincter tissue samples by Williams cystoscopic injection needle well. In our animal study, the cellular depots were detected in the submucosa or in deeper zones of the sphincter, depending of the length of the injection needle (4-8 mm). Adverse effects associated with injection of cells or solvent such as a noteworthy bleeding, incontinence, or obstruction, were not recorded ( n = 96 minipigs). However, a transient infiltration of macrophages was detected 3 weeks after cell injection. Changes in the urethral pressure profiles were not observed in cell-treated ( n = 72) compared to sham-treated animals ( n = 24). Conclusions Injection of small aliquots of cells to investigate cell therapies in minipigs is a feasible and safe procedure, and it does not bias the intrinsic urethral wall pressure. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Urinary incontinence or the inability to void spontaneously after ileal orthotopic bladder substitution is a frequent finding in female patients. Objective To evaluate how hysterectomy and nerve sparing affect functional outcomes and whether these relate to pre- and postoperative urethral pressure profile (UPP) results. Design, setting, and participants Prospectively performed pre- and postoperative UPPs of 73 female patients who had undergone cystectomy and bladder substitution were correlated with postoperative voiding and continence status. Outcome measurements and statistical analysis Outcome analyses were performed with the Kruskal-Wallis test, Wilcoxon-Mann-Whitney, or two-group post hoc testing with the Bonferroni correction. Chi-square or Fisher exact tests were applied for the categorical data. Results and limitations Of postoperatively continent or hypercontinent patients, 22 of 43 (51.2%) had the uterus preserved; of incontinent patients, only 4 of 30 (13.3%, p < 0.01) had the uterus preserved. Of postoperatively continent or hypercontinent patients, 27 of 43 patients (62.8%) had bilateral and 15 of 43 (34.9%) had unilateral attempted nerve sparing. In incontinent patients, 11 of 30 (36.7%) had bilateral and 16 of 30 (53.3%) had unilateral attempted nerve sparing ( p = 0.02). When compared with postoperatively incontinent patients, postoperatively continent patients had a longer functional urethral length (median: 32 mm vs 24 mm; p < 0.001), a higher postoperative urethral closing pressure at rest (56 cm H 2 O vs 35 cm H 2 O; p < 0.001) as well as a higher preoperative urethral closing pressure at rest (74 cm H 2 O vs 47.5 cm H 2 O; p = 0.01) . The main limitation was the limited number of patients. Conclusions In female patients undergoing radical cystectomy and bladder substitution, preservation of the uterus and attempted nerve sparing results in better functional outcomes. The preoperative UPPs correlate with postoperative voiding and continence status and may predict which patients are at a higher risk of functional failure after bladder substitution. Patient summary If preservation of the urethra's innervation is not possible during cystectomy, poor functional results with bladder substitutes are likely. [ABSTRACT FROM AUTHOR]

Introduction: The relevant terminology for stress urinary incontinence (SUI) is affected by the context, namely the clinical assessment (the symptom of SUI elicited on history taking and the sign of SUI observed during examination) or diagnostic investigations (urodynamic stress incontinence). In some cases, SUI may only be observed after the reduction in coexistent prolapse (occult SUI). Classifying SUI often relies on distinguishing between intrinsic sphincter deficiency (ISD), and urethral malposition or hypermobility, although this potentially an over-simplification. Review: Classification systems have been derived based on clinical assessment and diagnostic testing, notably videourodynamics. Modern developments in imaging technology may allow other techniques such as ultrasound to offer additional basis for future developments in classification. Other urodynamic approaches include urethral pressure profilometry and Valsalva leak point pressure; these may offer indicators of thresholds below which ISD is more likely to explain SUI, but they are not generally accepted in routine practice. Conclusions: While SUI classification is potentially relevant to treatment selection, evidence for influence on management outcome is limited. Generating a high-quality evidence base for treatment selection on these criteria is problematic, particularly due to the range of confounding factors. In practice, the modern practitioner relies on various tools to form an opinion on some key aspects, using the findings to derive a treatment strategy. Accordingly, there remains a need to confirm how a classification of SUI translates into treatment selection and better outcomes. [ABSTRACT FROM AUTHOR]

Aims We analyzed the impact of radical retropubic prostatectomy (RRP) on the urethral sphincter function as assessed by urethral pressure profilometry (UPP) and its relation to post-radical prostatectomy continence status. Furthermore, we analyzed the effect of intensive pelvic floor muscle exercises (PFME) on the urethral sphincter function. Methods Sixty-six patients were included in the study. UPP was performed before RRP and 26 weeks after catheter removal. All patients were instructed in PFME, however, the intensity of PFME varied between instructions based on an information folder only (F-PFME) and intensive guidance by a physiotherapist, in addition to the folder (PG-PFME). Results In 66 patients, pre- as well as postoperative UPP was evaluable. After surgery, the functional profile length and the maximum urethral closure pressure (MUCP) showed a median decrease of 64% and 41%, respectively. For men who had regained continence after 6 months the median MUCP was significantly higher both before and after operation as compared to men who were still incontinent. In multivariate analysis, non-nerve sparing approach was a prognostic factors for a higher relative decrease of the MUCP after RRP. Comparing the PG-PFME group with the F-PFME group there were no significant differences in changes in UPP parameters. Conclusions A poor preoperative MUCP seems to be an important prognostic factor for persistent incontinence after RRP. Non-nerve sparing approach seems to be an important prognostic factor for impairment of the urethral sphincter function as measured by UPP. More intensive physiotherapy seems to have no additional effect on the postoperative urethral sphincter function as measured by UPP. Neurourol. Urodynam. 31:646-651, 2012. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Aims To explore how baseline demographic, clinical, and urodynamic (UDS) variables correlate with measures of urethral function in women planning midurethral sling surgery. Methods Women with predominant stress urinary incontinence (SUI) as part of the trial of mid-urethral slings (TOMUS) were characterized preoperatively including: demographics, body mass index (BMI), responses to the Medical and Epidemiologic Social Aspects of Aging (MESA) and Urogenital Distress Inventory (UDI) questionnaires, pad weight (PW), incontinence duration, prior SUI surgery, prolapse, strength of pelvic contraction, Q-tip test, uroflow, cystometrogram, and detrusor pressures at maximum flow (Pdet at Qmax). Multivariate regression analysis and modeling confirmed variables with significant correlations with maximal urethral closure pressure (MUCP), functional urethral length (FUL), and Valsalva leak point pressure (VLPP). Results Five-hundred thirty-nine women were included in the analysis. In multivariable analyses, PW ( P = 0.045) and age ( P < 0.0001) were negatively correlated with MUCP (as PW and age increased, MUCP decreased); BMI ( P = 0.02) and Pdet at Qmax ( P < 0.0001) were positively correlated with MUCP (as BMI and Pdet at Qmax increased, MUCP increased). Age ( P = 0.002) was negatively correlated with FUL; Qtip delta ( P = 0.006), pelvic organ prolapse quantification examination (POPQ) stage ( P = 0.002) and strength of pelvic contraction ( P = 0.03) were positively correlated with FUL. Duration of incontinence ( P = 0.01) was negatively correlated with VLPP; Qtip delta ( P = 0.02), BMI ( P = 0.0005) and Pdet at Qmax ( P = 0.0005) were positively correlated with VLPP. Conclusions Age, BMI, Qtip delta, and Pdet at Qmax were variables that correlated with two or more measures of urethral function. These correlations may help direct future research in female urethral function. Neurourol. Urodynam. 31:496-501, 2012. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Complete urodynamic evaluation of a patient with voiding dysfunction should encompass the storage as well as voiding function of the bladder and the continence/flow-controlling zone of the urethra. Filling and voiding cystometry effectively depict the status of detrusor during the respective cycles. However, the status of the urethra cannot be directly measured by cystometry alone; nevertheless, it can provide indirect evidence for predicting incompetence during the stress phase (leak point pressures) and obstruction during the voiding phase (eg, pressure flow relations, Abrams-Griffiths number, detrusor-adjusted passive urethral resistance relation factor, obstruction coefficient) of the outlet. Fluoroscopic surveillance is often added to aid anatomic visualization of the urethra and, thus, the level of abnormality. However, the cost of set-up, radiation exposure, and obscure visualization in certain conditions are likely to limit its use. Urethral pressure profilometry (UPP) is the most direct method to measure urethral pressures during the filling and voiding phases. The concept of UPP is based on sound physical principles and has been well-researched ex vivo and in vivo. The principle is that during flow down a collapsible tube, there is a decrease in hydrostatic pressure across the site of any narrowing. Unlike the set-up of a videofluoroscopy unit, that of UPP is not elaborate, other than a special double/triple lumen urethral pressure catheter and an additional pressure transducer. However, it does have a learning curve that is steeper than that of pressure flow study. Nevertheless, once understood, it is simple, reproducible, and accurate. In the current era, more enthusiasm and research are required in this field lest the technique be written off. [ABSTRACT FROM AUTHOR]

Female urology is a rapidly evolving field supported by growth in both diagnostic and treatment modalities. As this field moves forward, it is imperative that clinicians are able to use a common medical language to communicate their ideas with one another. This paper discusses the current standards in female pelvic floor anatomy, clinical conditions, and urodynamic evaluation. [ABSTRACT FROM AUTHOR]

This article focuses on patient preparation prior to multichannel urodynamics testing and follow-up care related to the testing procedure. Patients may experience anxiety related to urodynamics testing, and individual counseling with patients and the use of educational brochures or online information explaining the study may reduce anxiety. Expert opinion strongly suggests that urodynamics testing should seek to reproduce bothersome lower urinary tract symptoms (LUTS), and therefore, patient preparation for testingoften begins with an assessment of LUTS, either volunteered by the patient or elicited by a written or online form. Completion of a form is strongly encouraged to ensure patients are queried about all potentially relevant LUTS. Antimicrobial prophylaxis should not be routinely administered, but suppressive antibiotics may be beneficial in highly selected patients. Medications prescribed to modulate lower urinary tract function may be discontinued, but some patients should be evaluated while taking these medications depending on the goals of testing. Mechanical cleansing of the bowel on the day of testing is rarely indicated, but management of bowel elimination symptoms is routinely indicated because of the association between lower urinary tract and fecal elimination dysfunction. Instructions and counselingfollowing testing will ensure that the patient has an opportunity to discuss findings. Consumption of additional fluids to reduce transient bacteriuria and taking a warm sitz bath or shower are also encouraged to alleviate any residual discomfort. [ABSTRACT FROM AUTHOR]

Objective. Male stress incontinence is mainly caused by sphincter lesions, representing the majority of incontinent patients after retropubic radical prostatectomy (RRP). Reflecting the sphincter activity, the urethral pressure profile (UPP) was used to evaluate 65 consecutive patients 6 months after retropubic RRP to identify patients with persistent sphincteric incontinence. Material and methods. According to the history of continence, patients were divided into a continent group and three incontinent subgroups. Six months postoperatively, spontaneous flow and two cystometries were performed with a filling rate of 60 ml/min, immediately followed by pressure flow and two UPPs, flow rate 1 ml with a pulling rate of 2 mm/s, focusing on functional length (FL) and maximal urethral closure pressure (MUCP). At 6 and 12 months' follow-up, questionnaires were filled in concerning the present state of continence. Results. After RRP, two-thirds were continent after 6 months, whereas one-third still suffered from incontinence. MUCP and FL in the stress incontinent group had decreased significantly compared with the continent group (66.2±26.4 vs 21.0±13.6 cmH2O, p≤0.001; and 11.4±3.7 and 8.2±3.7 mm, p=0.05), accompanied by a characteristic UPP configuration. After 12 months subgroups of sphincter incontinence and bladder and sphincter combined experienced no change, whereas the group with bladder incontinence achieved satisfactory improvement. Conclusions. Postoperative urodynamics after 6 months may be predictive for persistent incontinence at the bladder, sphincter, and both, suggesting that immediate intervention is more appropriate than watchful waiting. Sphincter incontinence was diagnosed by stress incontinence with MUCP below 30 cmH2O, decreased FL and a distinctive profile. [ABSTRACT FROM AUTHOR]

In patient studies the correlation between maximum urethral closure pressure (MUCP) and Valsalva leak point pressure (LPP) is meagre at best ( r = 0.22–0.50). We therefore studied the relation between MUCP and LPP in a flexible and extensible model urethra. We applied differently sized pressure zones and different degrees of resistance to a biophysical model urethra by stepwise inflating three types of blood pressure cuff placed around the model. At each degree of resistance we measured detrusor LPP, an in vitro equivalent of Valsalva LPP. Subsequently, we recorded the Urethral Pressure Profile using a water-perfused 5F end-hole catheter at four withdrawal rates and five perfusion rates and calculated MUCP. We tested the dependence of LPP on pressure zone length and MUCP on perfusion rate, withdrawal rate and pressure zone length using analysis of variance. We tested the correlation between LPP and MUCP using Pearson’s correlation coefficient and Linear Regression. LPP did not significantly depend on the pressure zone length ( P = 0.80) and increased linearly with increasing cuff pressure. MUCP also increased with increasing cuff pressure, however, MUCP significantly depended ( P < 0.01) on perfusion rate, withdrawal rate and pressure zone length. MUCP increased with increasing perfusion rate, and decreased with increasing withdrawal rate. In our model urethra MUCP only accurately reflected urethral resistance for a very limited number of combinations of perfusion rate and withdrawal rate. LPP reflected urethral resistance independent of the type of pressure zone. [ABSTRACT FROM AUTHOR]

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Abstract: Performing urodynamic investigations in children presents some difficulty due to the lack of any normogram, and due to the results that vary with age. Such investigation is therefore carried out only when clinical examination and radiological assessment fail to explain a voiding dysfunction. The procedure should be performed in a urodynamic unit that has paediatric expertise. A specific paediatric procedure is to be respected when performing uroflowmetry and cystometry in children. Assessing the urethral pressure profile is very difficult since moving a catheter along the urethra causes a reflex activity of the pelvic floor muscles. Main indications are: neuropathic bladders, voiding dysfunctions, urinary infections, anorectal malformations and pelvic tumours. As in adults, urodynamic investigations are useful when selecting a therapeutic strategy. [Copyright &y& Elsevier]

Objective: The purpose of this study was to assess the effect of detrusor overactivity and bladder filling on urethral function with the use of urethral profilometry. Study design: Women with symptoms of urinary incontinence were recruited from our urodynamic clinic. All of the women underwent videocystourethrography and urethral pressure profilometry with the bladder empty and then full. The maximum urethral closure pressure, mean urethral pressure, functional urethral length, and pressure transmission ratios for each quartile were analyzed. Results: Thirty-five women were recruited: 17 women had urodynamic stress incontinence, and 18 women had detrusor overactivity. In women with urodynamic stress incontinence, there was a significant increase in maximum urethral closure pressure and pressure transmission ratios over all quartiles when the bladder was full compared with empty. In women with detrusor overactivity, there was a significant decrease in functional urethral length and pressure transmission ratios in the second and third quartile of the urethral pressure profiles when the bladder was full compared with empty. Conclusion: Decreases in functional urethral length and pressure transmission ratios with bladder filling in those women with detrusor overactivity are at variance with the normal physiologic response to bladder filling, which suggests that urethral function is affected by the presence of abnormal detrusor activity and that the valid assessment of urethral function may not be possible if the detrusor overactivity is not treated. [ABSTRACT FROM AUTHOR]

Aims The urethral retro-resistance pressure (URP) is a new retrograde measurement of urethral function. URP is the pressure required to achieve and maintain an open sphincter. The assessment of any potential diagnostic measure must include an evaluation in individuals both with and without disease. In this study, we examined URP values in women without urinary incontinence. Methods Four centers enrolled 61 women who did not report symptoms of urinary incontinence, and who had negative standing stress tests (SST). Each center was to perform three consecutive URP measurements on each subject. At two centers, 32 subjects returned in 3-7 days for three additional URP measurements. We compared the average URP in this asymptomatic population to the average URP from women symptomatic of stress urinary incontinence (SUI) derived from a previous study. We evaluated the within-subject variation of the URP measurement at a single visit and the within-subject change in URP over time using test and retest values. Results The mean age was 33 ± 9 years and the mean body mass index (BMI) was 24 ± 6. URP values were normally distributed. The mean URP at visit 1 was 112.6 ± 39.2 cm H2O (n = 60). This was statistically significantly different from the mean URP of symptomatic women (69.9 cm H2O, P < 0.0001). The within-subject standard deviation of URP at visit 1 was 12.6 ± 12.6 cm H2O (n = 60) and at retest visit was 9.3 ± 6.2 cm H2O (n = 32). For the retest cases, the mean URP at visit 1 was 113.9 ± 39.9 cm H2O (n = 32) and at retest visit was 125.5 ± 33.9 cm H2O (n = 32) (Wilcoxon Signed Rank test, P = 0.145). Conclusions The mean URP measurement obtained in this study of asymptomatic women showed significantly higher values when compared to our study in women with SUI. The URP measurements were consistent within the same subject. Furthermore, there was no statistically significant difference in the URP measurement from visit 1 to retest visit. The data suggest that URP shows promise as a physiological urethral pressure measurement. © 2004 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Objective Three-dimensional (3 D) ultrasound facilitates assessment of the anatomy of the urethral sphincter, a decrease in sphincter volume being associated with stress incontinence. Urethral pressure profilometry (UPP) is used to assess urethral sphincter function although it is not diagnostic of stress incontinence. The aim of this pilot study was to determine whether 3 D sphincter volume can be correlated with the area under the UPP curve. Methods Primigravid women were recruited antenatally between 32 and 42 weeks' gestation. 3D transvaginal ultrasound scans of the urethra were performed in modified lithotomy position with a comfortably full bladder. Length and cross-sectional area were measured allowing the sphincter volume to be calculated. UPP measurements were performed with a Gaeltec solid-state pressure transducer and the area under the curve mapped out and calculated. All scans and measurements were repeated between 3 and 6 months postpartum. Results Nineteen women participated in the study. Antenatal and postnatal data were available in all cases. There was a statistically significant correlation between antenatal sphincter volumes and area under the UPP curve although this relationship was lost following delivery. Conclusions There appears to be a correlation between structural anatomy and functional anatomy in the antenatal period although following delivery this is lost. [ABSTRACT FROM AUTHOR]

Aims The urethral retro-resistance pressure (URP) is a retrograde urethral pressure profile measured by a new urodynamic measurement system.1 URP is the pressure required to achieve and maintain an open sphincter. This clinical investigation focused on a comparison of URP to standard urodynamic measurements and an examination of their relationship to incontinence severity. Methods Twenty-two centers enrolled 258 stress incontinent women in a randomized, crossover study of two groups: (1) test procedure followed by multichannel urodynamics, (2) multichannel urodynamics followed by test procedure. We defined incontinence severity categories using 24 hr urine loss and assessed these categories using incontinence quality of life (I-QOL), urinary incontinence severity score (UISS), incontinence visual analogue score (VAS), URP, maximum urethral closure pressure (MUCP), and leak point pressure (LPP). Results The mean age was 56.2 (±12) years. No order effect was present. The correlation coefficient between URP and MUCP was 0.31 (95% CI 0.19-1, P < 0.0001); between URP and LPP was 0.28 (95% CI 0.12-1, P = 0.003); and between MUCP and LPP was 0.14 (95% CI−0.04-1, P = 0.101). The mean values for URP across symptom severity categories were significantly different ( P = 0.028) and decreased with increasing severity. The mean values for MUCP and LPP did not decrease with increasing severity. Conclusions The study demonstrated that URP had a consistent relationship with incontinence severity. The data suggested that URP is a physiological measure of urethral function and may have clinical utility as a diagnostic tool. Future outcomes-based research is necessary to establish the predictive value of URP, MUCP, and LPP measurements in terms of incontinence cure rates and diagnosis of sphincter dysfunction. Neurourol. Urodynam. 23:109-114, 2004. © 2004 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

: Objective:To evaluate whether anterior vaginal wall prolapse will cause a decrease in urethral pressure.: Methods:Two hundred ninety-four patients with uterovaginal prolapse served as study cases. In addition, 127 patients without uterovaginal prolapse were included as controls. The urethral pressure profile measurement was performed using a microtransducer and the fluid-bridge method with the patient in the lithotomy position. The parameters of the urethral pressure profile and its associated variables were compared between the control and study groups.: Results:The proximal portion of urethral pressure and the resting and stress urethral closure pressures in women with anterior vaginal wall prolapse were significantly lower than those of the control group. An indentation segment (or a plateau pressure zone) in the proximal portion of the urethral pressure profile curve was noted in patients with anterior vaginal wall prolapse, especially for stage I (64.2%) and stage II (73.0%). Anterior vaginal wall prolapse and genuine stress incontinence had a statistically significant odds ratio for predicting the presence of an indentation segment (or a plateau pressure zone) in the proximal portion of the urethral pressure profile curve (1.58 and 3.19, respectively).: Conclusions:An indentation segment (or a plateau pressure zone) of the proximal portion of the urethral pressure profile curve was observed in most of our patients with anterior vaginal wall prolapse. Defects in the anterior vaginal wall supports may attenuate the proximal urethral support, and these defects will contribute to a reduction in the proximal urethral pressure. [Copyright &y& Elsevier]

A computerized method for urethral pressure measurement along the whole length and at every angle of the urethra is presented. The main advantage is the exact study of physiological versus artificial factors in pressure distribution in the urethra. Details of the technique are presented. [ABSTRACT FROM AUTHOR]

In order to improve the accuracy of bladder and urethral pressure recording, a measurement system has been tested experimentally. It is possible to measure absolute pressure values during withdrawal of the catheter only when the system is constantly perfused. The optimum relationship between catheter diameter, perfusion rate, withdrawal rate, measurement inertia and systemic resistance has been analysed. [ABSTRACT FROM AUTHOR]

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Copyright of Medical & Biological Engineering (0025696X) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)