Urethral Instability: Current Pathophysiological Concept

Groenendijk, P.M.; Heesakkers, John; Ouwerkerk, Theo J.; Nijeholt, A.A.B. Lycklama à

doi:10.1159/000230011

Cited by 12 publications

(16 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Six papers were excluded because of mixed gender studies . Six expert opinion reviews were excluded . When multiple papers were published on the basis of a single patient cohort, only one paper of those, with the largest cohort, was included, others were considered duplicate and excluded .…”

Section: Resultsmentioning

confidence: 99%

Continuous urethral pressure measurements; measurement techniques; pressure variations; clinical interpretations; and clinical relevance. A Systematic Literature Analysis

Kummeling

Elzevier

Groenendijk

2015

Neurourology and Urodynamics

View full text Add to dashboard Cite

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. 36:51-56, 2017. © 2015 Wiley Periodicals, Inc.

show abstract

Section: Resultsmentioning

confidence: 99%

Continuous urethral pressure measurements; measurement techniques; pressure variations; clinical interpretations; and clinical relevance. A Systematic Literature Analysis

Kummeling

Elzevier

Groenendijk

2015

Neurourology and Urodynamics

View full text Add to dashboard Cite

show abstract

“…They suggested that one and the same pathophysiological mechanism participates in female stress, urge, and mixed incontinence (17). Moreover in 2009, Groenendijk et al stated that it makes sense to measure and register detrusor and urethral function during filling and voiding (18). Despite the fact that most authors consider urethral pressure variations, exceeding an amplitude of 15cmH 2 O, as an abnormal finding (6-12) the significance of these fluctuations is still unclear, and the terms ‘urethral instability’ or ‘unstable urethra’ lack clarity and are not accurately defined by the ICS today.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that neuronal nitric oxide (NO) synthase, known for its significant role in nociceptive pathways in the bladder has also been found in human female striated urethra sphincter (20). It may be that contraction of the detrusor is caused by a fall in urethral pressure (18). However, looking at the traces, it is very difficult to determine (Figure-1) which came first: detrusor overactivity, then urethral pressure drop or vice versa, or both appeared at the same time.…”

Section: Discussionmentioning

confidence: 99%

Urethral pressure variation: a neglected contributing factor in patients with overactive bladder syndrome?

et al. 2017

View full text Add to dashboard Cite

Objective To study urethral pressure variations during the whole filling phase among different groups of patients.Material and Methods We investigated 79 consecutive patients from January 2011 to June 2012. All patients were recruited within our routine practice in our continence clinic and were evaluated with urodynamic exam according to the standards of the International Continence Society (ICS) with an additional continuous measurement of the urethral pressure profile (cUPP) that was done in a supine position. Patients with genital prolapse >grade I, as well as patients with impaired cognitive function or neurogenic disorders were excluded. Bacteriuria at the time of investigation was excluded by urine analysis. Urethral pressure changes higher than 15cmH2O were considered as ‘urethral instability’.Results From 79 investigated patients, 29 were clinically diagnosed with OAB syndrome, 19 with stress urinary incontinence (SUI) and 31 with mixed (OAB and SUI) incontinence. The prevalence of ‘urethral instability’ as defined in this study was 54.4% (43/79). The mean Δp in patients with OAB (36.5cmH2O) was significantly higher (p<0.05) than in groups with pure stress (14.9cmH2O) and mixed urinary incontinence (19.3cmH2O).Conclusions Etiology of ‘urethral instability’ is unknown, but high prevalence among patients with overactive bladder syndrome, especially concomitant with detrusor activity can raise a fair question and direct further diagnostic as well as treatment efforts.

show abstract

“…The presence of urethral pressure variations during filling cystometry (urethral instability) has been well documented by various investigators, and said to be responsible for the sensation of urgency and for incontinence. 42 Mechanical stimulation of the urethra, especially the flow of urine, may facilitate the micturition reflex as mentioned above, and reflexes between the urethra and bladder play an integral role in the neural control of the lower urinary tract. 25 Studies in animals have demonstrated the basis for an excitatory urethra-to-bladder reflex, showing that sensory nerves in the wall of the urethra fire in response to urethral urine flow and electrical stimulation, and that this activity initiates bladder contractions in the quiescent bladder and augments ongoing contractions in the active bladder.…”

Section: The Proximal Urethral Mucosa As a Possible Initiator Of Overmentioning

confidence: 99%

Urothelial mucosal signaling and the overactive bladder-ICI-RS 2013

Birder

Andersson

Hanna-Mitchell

et al. 2014

Neurourol. Urodynam.

View full text Add to dashboard Cite

There is abundant evidence that the lower urinary tract (LUT) mucosal layer is involved both in mechanosensory functions that regulate bladder contractile activity and in urethral sensation. Changes to the mucosa can be associated with a number of bladder pathologies. For example, alterations of the urothelium and underlying lamina propria at both the molecular and structural levels have been reported in both patients and animals associated with disorders such as bladder pain syndrome and diabetic cystopathy. In contrast to the urinary bladder, much less is known about the urothelium/lamina propria of the bladder neck/proximal urethra. There are important gender differences in the outflow region both anatomically and with respect to innervation, hormonal sensitivity, and location of the external urethral sphincter. There is reasonable evidence to support the view that the mucosal signaling pathway in the proximal urethra is important for normal voiding, but it has also been speculated that the proximal urethra can initiate bladder overactivity. When dysfunctional, the proximal urethra may be an interesting target, for example, botulinum toxin injections aiming at eliminating both urgency and incontinence due to detrusor overactivity.

show abstract

Urethral Instability: Current Pathophysiological Concept

Cited by 12 publications

References 53 publications

Continuous urethral pressure measurements; measurement techniques; pressure variations; clinical interpretations; and clinical relevance. A Systematic Literature Analysis

Continuous urethral pressure measurements; measurement techniques; pressure variations; clinical interpretations; and clinical relevance. A Systematic Literature Analysis

Urethral pressure variation: a neglected contributing factor in patients with overactive bladder syndrome?

Urothelial mucosal signaling and the overactive bladder-ICI-RS 2013

Contact Info

Product

Resources

About