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The promise of urethral pressure reflectometry: an update

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Abstract

Introduction and hypothesis

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).

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Lose LG (1992) Simultaneous recording of pressure and cross-sectional area in the female urethra: a study of urethral closure function in healthy and stress incontinent women. Neurourol Urodyn 11:55–89. doi:10.1002/nau.1930110202

    Article  Google Scholar 

  2. Susset JG, Shoukry I, Schlaeder G et al (1974) Stress incontinence and urethral obstruction in women: value of uroflowmetry and voiding urethrography. J Urol 111:504–513

    CAS  PubMed  Google Scholar 

  3. Harris JH, Therkelsen EE, Zinner NR (1971) Electrical measurement of ureteral flow. In: Boyarsky S, Tanagho EA, Gottschalk CW, Zimskind PD (eds) Urodynamics. Academic Press, London, pp 465–472

    Chapter  Google Scholar 

  4. Rask-Andersen H, Djurhuus JC (1976) Development of a probe for endoureteral investigation of peristalsis by flow velocity and cross section area measurement. Acta Chir Scand Suppl 472:59–65

    CAS  PubMed  Google Scholar 

  5. Colstrup H, Mortensen SO, Kristensen JK (1983) A probe for measurements of related values of cross-sectional area and pressure in the resting female urethra. Urol Res 11:139–143

    Article  CAS  PubMed  Google Scholar 

  6. Lose G, Colstrup H, Saksager K, Kristensen JK (1986) New probe for measurement of related values of cross-sectional area and pressure in a biological tube. Med Biol Eng Comput 24:488–492

    Article  CAS  PubMed  Google Scholar 

  7. Gregersen H, Andersen MB (1991) Impedance measuring system for quantification of cross-sectional area in the gastrointestinal tract. Med Biol Eng Comput 29:108–110

    Article  CAS  PubMed  Google Scholar 

  8. Andersen IS, Gregersen H, Buntzen S et al (2004) New probe for the measurement of dynamic changes in the rectum. Neurogastroenterol Motil 16:99–105

    Article  CAS  PubMed  Google Scholar 

  9. Mortensen S, Djurhuus JC, Rask-Andersen H (1983) A system for measurements of micturition urethral cross-sectional areas and pressures. Med Biol Eng Comput 21:482–488

    Article  CAS  PubMed  Google Scholar 

  10. Colstrup H, Mortensen SO, Kristensen JK (1983) A new method for the investigation of the closure function of the resting female urethra. J Urol 130:507–511

    CAS  PubMed  Google Scholar 

  11. Colstrup H (1984) Rigidity of the resting female urethra. II. Dynamic measurements. J Urol 132:82–86

    CAS  PubMed  Google Scholar 

  12. Thind P (1995) The significance of smooth and striated muscles in the sphincter function of the urethra in healthy women. Neurourol Urodyn 14:585–618

    Article  CAS  PubMed  Google Scholar 

  13. Thind P, Lose G, Colstrup H (1991) How to measure urethral elastance in a simple way. Elastance: definition, determination and implications. Urol Res 19:241–244

    Article  CAS  PubMed  Google Scholar 

  14. Schäfer W (2001) Some biomechanical aspects of continence function. Scand J Urol Nephrol Suppl 35(207):44–60; discussion 106–125

    Article  Google Scholar 

  15. Weber AM (2001) Is urethral pressure profilometry a useful diagnostic test for stress urinary incontinence? Obstet Gynecol Surv 56:720–735

    Article  CAS  PubMed  Google Scholar 

  16. Klarskov N, Lose G (2007) Urethral pressure reflectometry; a novel technique for simultaneous recording of pressure and cross-sectional area in the female urethra. Neurourol Urodyn 26:254–261. doi:10.1002/nau.20283

    Article  PubMed  Google Scholar 

  17. Lose G, Griffiths D, Hosker G et al (2002) Standardisation of urethral pressure measurement: report from the Standardisation Sub-Committee of the International Continence Society. Neurourol Urodyn 21:258–260

    Article  PubMed  Google Scholar 

  18. Saaby M-L, Klarskov N, Lose G (2013) Urethral pressure reflectometry during intra-abdominal pressure increase-an improved technique to characterize the urethral closure function in continent and stress urinary incontinent women. Neurourol Urodyn 32:1103–1108. doi:10.1002/nau.22368

    Article  PubMed  Google Scholar 

  19. Claerbout J (1968) Synthesis of a layered medium from its acoustic transmission response. Geophysics 33:264–269. doi:10.1190/1.1439927

    Article  Google Scholar 

  20. Sondhi MM, Gopinath B (1971) Determination of vocal-tract shape from impulse response at the lips. J Acoust Soc Am 49:1867–1873

    Article  CAS  PubMed  Google Scholar 

  21. Fredberg JJ, Wohl ME, Glass GM, Dorkin HL (1980) Airway area by acoustic reflections measured at the mouth. J Appl Physiol 48:749–758

    CAS  PubMed  Google Scholar 

  22. Klarskov N, Rasmussen SB, Lose G (2005) Pressure reflectometry: in vitro recordings with a new technique for simultaneous measurement of cross-sectional area and pressure in a collapsible tube. Physiol Meas 26:269–280. doi:10.1088/0967-3334/26/3/011

    Article  PubMed  Google Scholar 

  23. Klarskov N, Lose G (2007) Urethral pressure reflectometry vs urethral pressure profilometry in women: a comparative study of reproducibility and accuracy. BJU Int 100:351–356. doi:10.1111/j.1464-410X.2007.06922.x

    Article  PubMed  Google Scholar 

  24. Klarskov N, Saaby M-L, Lose G (2013) A faster urethral pressure reflectometry technique for evaluating the squeezing function. Scand J Urol 47:529–533. doi:10.3109/21681805.2013.776629

    Article  PubMed  Google Scholar 

  25. Klarskov N (2012) Urethral pressure reflectometry. A method for simultaneous measurements of pressure and cross-sectional area in the female urethra. Dan Med J 59:B4412

    PubMed  Google Scholar 

  26. Klarskov N, Lose G (2008) Urethral pressure reflectometry and pressure profilometry in healthy volunteers and stress urinary incontinent women. Neurourol Urodyn 27:807–812. doi:10.1002/nau.20617

    Article  PubMed  Google Scholar 

  27. Chapple CR, Wein AJ, Artibani W et al (2005) A critical review of diagnostic criteria for evaluating patients with symptomatic stress urinary incontinence. BJU Int 95:327–334. doi:10.1111/j.1464-410X.2005.05293.x

    Article  PubMed  Google Scholar 

  28. DeLancey JOL (2010) Why do women have stress urinary incontinence? Neurourol Urodyn 29:S13–S17. doi:10.1002/nau.20888

    Article  PubMed  PubMed Central  Google Scholar 

  29. Saaby M-L, Klarskov N, Lose G (2012) Urethral pressure reflectometry before and after tension-free vaginal tape. Neurourol Urodyn 31:1231–1235. doi:10.1002/nau.22239

    Article  PubMed  Google Scholar 

  30. Saaby M-L, Klarskov N, Lose G (2015) The impact of tension-free vaginal tape on the urethral closure function: mechanism of action. Neurourol Urodyn 34:50–54. doi:10.1002/nau.22513

    Article  PubMed  Google Scholar 

  31. Koelle D, Windisch J, Doerfler D et al (2006) Effect of tension-free vaginal tape operation on urethral closure function. Urology 67:524–528. doi:10.1016/j.urology.2005.09.063; discussion 528–529

    Article  PubMed  Google Scholar 

  32. Lo TS, Wang AC, Horng SG et al (2001) Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT). Acta Obstet Gynecol Scand 80:65–70

    Article  CAS  PubMed  Google Scholar 

  33. Mutone N, Mastropietro M, Brizendine E, Hale D (2001) Effect of tension-free vaginal tape procedure on urodynamic continence indices. Obstet Gynecol 98:638–645

    CAS  PubMed  Google Scholar 

  34. Abrams P, Cardozo L, Khoury S, Wein A (2012) Incontinence—5th International Consultation on Incontinence, Paris, 5 February

  35. Saaby ML, Klarskov N, Lose G (2011) Simultaneous cystometry and urethral pressure reflectometry (UPR)—a new method. Neurourol Urodyn 30:787–1206

    Article  Google Scholar 

  36. Klarskov N, Lose G (2008) Urethral injection therapy: what is the mechanism of action? Neurourol Urodyn 27:789–792. doi:10.1002/nau.20602

    Article  PubMed  Google Scholar 

  37. Bump RC, Benson JT, Yalcin I et al (2004) Biomechanical and electrophysiological effects of duloxetine in women with stress urinary incontinence. J Pelvic Med Surg 10 [Suppl 1]:37–38

    Article  Google Scholar 

  38. Weil EH, Eerdmans PH, Dijkman GA et al (1998) Randomized double-blind placebo-controlled multicenter evaluation of efficacy and dose finding of midodrine hydrochloride in women with mild to moderate stress urinary incontinence: a phase II study. Int Urogynecol J Pelvic Floor Dysfunct 9:145–150

    Article  CAS  PubMed  Google Scholar 

  39. Klarskov N, Scholfield D, Soma K et al (2009) Measurement of urethral closure function in women with stress urinary incontinence. J Urol 181:2628–2633. doi:10.1016/j.juro.2009.01.114, discussion 2633

    Article  CAS  PubMed  Google Scholar 

  40. Klarskov N, Scholfield D, Darekar A et al (2010) Urethral pressure reflectometry is valuable for evaluating pharmacological therapies for stress urinary incontinence. Int Urogynecol J 21:166–168

    Google Scholar 

  41. Klarskov N, Darekar A, Scholfield D et al (2014) Effect of fesoterodine on urethral closure function in women with stress urinary incontinence assessed by urethral pressure reflectometry. Int Urogynecol J 25:755–760. doi:10.1007/s00192-013-2269-6

    Article  PubMed  Google Scholar 

  42. Klarskov N, Cerneus DP, Sawyer AW et al (2015) The effect of single oral doses of duloxetine, reboxetine and midodrine on the urethral pressure in healthy female subjects, using urethral pressure reflectometry in a placebo-controlled, randomized, crossover study. 40th Annual Meeting—Nice, France June 9–13, 2015: oral presentations. Int Urogynecol J 26(1 Suppl):1–21

  43. Aagaard M, Klarskov N, Sønksen J et al (2012) Urethral pressure reflectometry; a novel technique for simultaneous recording of pressure and cross-sectional area: a study of feasibility in the prostatic urethra. BJU Int 110:1178–1183. doi:10.1111/j.1464-410X.2012.10997.x

    Article  PubMed  Google Scholar 

  44. Aagaard M, Klarskov N, Sønksen J et al (2014) Urethral pressure reflectometry, a novel technique for simultaneous recording of pressure and cross-sectional area in the prostatic urethra: testing in men without bothersome lower urinary tract symptoms. Scand J Urol 48:195–202. doi:10.3109/21681805.2013.831946

    Article  PubMed  Google Scholar 

  45. Mitchell PJ, Klarskov N, Hosker G et al (2010) Anal acoustic reflectometry: a new technique for assessing anal sphincter function. Colorectal Dis Off 12:692–697. doi:10.1111/j.1463-1318.2010.02194.x

  46. Mitchell PJ, Klarskov N, Telford KJ et al (2011) Anal acoustic reflectometry: a new reproducible technique providing physiological assessment of anal sphincter function. Dis Colon Rectum 54:1122–1128. doi:10.1097/DCR.0b013e318223fbcb

    Article  PubMed  Google Scholar 

  47. Mitchell PJ, Klarskov N, Telford KJ et al (2012) Viscoelastic assessment of anal canal function using acoustic reflectometry: a clinically useful technique. Dis Colon Rectum 55:211–217. doi:10.1097/DCR.0b013e31823b2499

    Article  PubMed  Google Scholar 

  48. Hornung BR, Mitchell PJ, Carlson GL et al (2012) Comparative study of anal acoustic reflectometry and anal manometry in the assessment of faecal incontinence. Br J Surg 99:1718–1724. doi:10.1002/bjs.8943

    Article  CAS  PubMed  Google Scholar 

  49. Hornung BR, Carlson GL, Mitchell PJ et al (2014) Anal acoustic reflectometry predicts the outcome of percutaneous nerve evaluation for faecal incontinence. Br J Surg 101:1310–1316. doi:10.1002/bjs.9586

    Article  CAS  PubMed  Google Scholar 

  50. Latthe PM, Foon R, Toozs-Hobson P (2008) Prophylactic antibiotics in urodynamics: a systematic review of effectiveness and safety. Neurourol Urodyn 27:167–173. doi:10.1002/nau.20501

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Laborie for the supply of catheters used for urethral pressure reflectometry.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Copenhagen, Herlev Hospital, Herlev, Denmark

    Yasmine Khayyami, Niels Klarskov & Gunnar Lose

  2. Pileskellet 12, 2000, Frederiksberg, Denmark

    Yasmine Khayyami

Authors
  1. Yasmine Khayyami
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  2. Niels Klarskov
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  3. Gunnar Lose
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Corresponding author

Correspondence to Yasmine Khayyami.

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Conflicts of interest

Yasmine Khayyami and Gunnar Lose have received honoraria as investigators from Astellas. Niels Klarskov has received honoraria as a speaker/investigator and travel grants from Astellas.

Glossary

Urethral pressure

The air pressure required to force the urethra open

Cross-sectional area

The area of the opened lumen of the urethra

High-pressure zone (HPZ)

The area with minimal urethral cross-sectional area at a given pressure

Opening pressure

A measurement of the permanent closing forces that enable the urethra to remain closed

Closing pressure

The pressure at which the urethra closes subsequent to dilation

Elastance

Expresses the urethra’s resistance to deformation when exposed to an external force

Hysteresis

Expresses the energy loss in the urethra during stretching

Abdominal to urethral pressure impact ratio (APIR)

Expresses the effect of increasing abdominal pressure on urethral pressure

PO-Abd 50

Opening pressure at an abdominal pressure of 50 cmH2O

PO-Abd 100

Opening pressure at an abdominal pressure of 100 cmH2O

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Khayyami, Y., Klarskov, N. & Lose, G. The promise of urethral pressure reflectometry: an update. Int Urogynecol J 27, 1449–1458 (2016). https://doi.org/10.1007/s00192-016-2964-1

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