The promise of urethral pressure reflectometry: an update

Funding information Astellas Pharma EuropeAims: 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

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“…The method has been described in details previously . During the examinations the subjects were lying in the supine position.…”

Section: Methodsmentioning

confidence: 99%

The effect of single oral doses of duloxetine, reboxetine, and midodrine on the urethral pressure in healthy female subjects, using urethral pressure reflectometry

Klarskov¹,

Cerneus

Sawyer

et al. 2017

Neurourology and Urodynamics

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“…The UPR‐technique is based on continuously measurements of pressure and cross‐sectional areas in a very thin and flexible polyurethane‐bag . The subjects were assessed as described previously; in the supine position during both resting (10 measurements) and squeezing (5 measurements) with 150 mL 37°C 0.9% saline in the bladder.…”

Section: Methodsmentioning

confidence: 99%

Effect of a 5‐HT_2c receptor agonist on urethral closure mechanism in healthy women

Klarskov

Till

Sawyer

et al. 2019

Neurourology and Urodynamics

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Aims To evaluate the effect of ASP2205, a selective serotonin 5‐HT2c receptor agonist, and Duloxetine on the urethral pressure in healthy female subjects. Methods Healthy females aged 18 to 55 years were recruited for this phase 1, single site, placebo‐controlled, randomized, four‐period, cross‐over study. The interventions were single oral doses of 10 and 60 mg ASP2205, 80 mg duloxetine, and placebo. As a pharmacodynamics endpoint, opening urethral pressure (OUP), corrected for placebo, was measured using urethral pressure reflectometry under both resting and squeezing condition of the pelvic floor at predose and 3, 6, 12, and 24 hours after dosing. Safety and tolerability of ASP2205 were also compared with duloxetine and placebo. Results Eighteen healthy women signed informed consent, however, one dropped out before dosing and one dropped out after the first period, therefore, 16 subjects completed the study. Duloxetine significantly increased the OUP during both resting and squeezing condition (maximal increase 18.1 and 16.8 cmH2O, respectively). Both doses of ASP2205 did not increase OUP at any time point. During squeezing OUP decreased significantly in the ASP2205 60 mg group from 6 to 24 hours after dosing. All subjects experienced predominantly central nervous system‐related side effects (eg, dizziness and nausea) during ASP2205 treatment, which was most pronounced at 60 mg. Conclusions ASP2205, a serotonin 5‐HT2c receptor agonist, does not increase the urethral pressure and it is therefore unlikely that 5‐HT 2c receptor agonists can be used as a treatment for stress urinary incontinence. ASP2205 was less well tolerated than the high dose of duloxetine.

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“…A digital signal processor produces sound waves, which are transmitted into the bag before being reflected and recorded by a microphone to calculate the CSA. This technique, termed urethral pressure reflectometry, allows for the first time an assessment of the point of initial opening termed the “urethral opening pressure, ”20 which can discriminate between patients with stress urinary incontinence and healthy controls 21 and assess the efficacy of drug therapy for urinary incontinence 22,23 …”

Section: Anal Acoustic Reflectometrymentioning

confidence: 99%

Current and future perspectives on the utility of provocative tests of anal sphincter function: A state‐of‐the‐art summary

O'Connor

Byrne

Vasant

et al. 2022

Neurogastroenterology Motil

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Background:The maintenance of fecal continence depends upon coordinated interactions between the pelvic floor, anorectum, and anal sphincter complex orchestrated by central and peripheral neural activities. The current techniques to objectively measure anorectal function rely on fixed diameter catheters placed inside the anal canal with a rectal balloon to obtain measurements of anal resting and squeeze function, and rectal compliance. Until recently it had not been possible to measure the distensibility of the anal canal, or in other words its ability to resist opening against an increasing pressure, which has been proposed as the main determinant of a biological sphincter's function. Anal acoustic reflectometry (AAR) and the functional lumen imaging probe (FLIP) are two novel, provocative techniques that dynamically assess the anal sphincter complex under volume-controlled distension. In doing so, both provide information on the viscoelastic properties of the anal canal and offer new insights into its function.Purpose: This review details the current and potential future applications of AAR and FLIP and highlights the unanswered questions relevant to these new technologies.

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The promise of urethral pressure reflectometry: an update

Abstract: 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.

Cited by 10 publications

References 47 publications

The effect of single oral doses of duloxetine, reboxetine, and midodrine on the urethral pressure in healthy female subjects, using urethral pressure reflectometry

The effect of single oral doses of duloxetine, reboxetine, and midodrine on the urethral pressure in healthy female subjects, using urethral pressure reflectometry

Effect of a 5‐HT_2c receptor agonist on urethral closure mechanism in healthy women

Current and future perspectives on the utility of provocative tests of anal sphincter function: A state‐of‐the‐art summary

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The promise of urethral pressure reflectometry: an update

Abstract: 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.

Cited by 10 publications

References 47 publications

The effect of single oral doses of duloxetine, reboxetine, and midodrine on the urethral pressure in healthy female subjects, using urethral pressure reflectometry

The effect of single oral doses of duloxetine, reboxetine, and midodrine on the urethral pressure in healthy female subjects, using urethral pressure reflectometry

Effect of a 5‐HT2c receptor agonist on urethral closure mechanism in healthy women

Current and future perspectives on the utility of provocative tests of anal sphincter function: A state‐of‐the‐art summary

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Effect of a 5‐HT_2c receptor agonist on urethral closure mechanism in healthy women