title: Fundamentals and clinical perspective of urethral sphincter instability as a contributing factor in patients with lower urinary tract dysfunction--ICI-RS 2014.
abstract: OBJECTIVE
  Urethral pathophysiology is often neglected in discussions of bladder dysfunction. It has been debated whether "urethral sphincter instability," referred to based on observed "urethral pressure variations," is an important aspect of overactive bladder syndrome (OAB). The purpose of this report is to summarize current urethral pathophysiology evidence and outline directions for future research based on a literature review and discussions during the ICI-RS meeting in Bristol in 2014.
  
  
  METHODS
  Urethral pathophysiology with a focus on urethral pressure variation (UPV) was presented and discussed in a multidisciplinary think tank session at the ICI_R meeting in Bristol 2014. This think tank session was based on collaboration between physicians and basic science researchers.
  
  
  RESULTS
  Experimental animal studies or studies performed in clinical series (predominantly symptomatic women) provided insights into UPV, but the findings were inconsistent and incomplete. However, UPV is certainly associated with lower urinary tract symptoms (likely OAB), and thus, future research on this topic is relevant.
  
  
  CONCLUSIONS
  Future research based on adequately defined clinical (and urodynamic) parameters with precisely defined patient groups might shed better light on the cause of OAB symptoms. Further fundamental investigation of urethral epithelial-neural interactions via the release of mediators should enhance our knowledge and improve the management of patients with OAB.
authors.affiliation: Neuro-Urologie, University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Center Godeshoehe, Germany.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kirschner-Hermanns
authors.affiliation: Neuro-Urologie, University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Center Godeshoehe, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Anding
authors.affiliation: Department of Urology, University Medical Centre Utrecht, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Rosier
authors.affiliation: Departments of Medicine and Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Lori
authors.initials: L
authors.lastname: Birder
authors.affiliation: Faculty of Health Sciences, Institut for Klinisk Medicin, Aarhus Universitet, Denmark.|AIAS, Aarhus Institute of Advanced Studies, Aarhus University, Denmark.
authors.forename: Karl Erik
authors.initials: KE
authors.lastname: Andersson
authors.affiliation: Faculty of Health Sciences, Institut for Klinisk Medicin, Aarhus Universitet, Denmark.
authors.forename: Jens Christian
authors.initials: JC
authors.lastname: Djurhuus
mesh_terms: D000818:Animals; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011312:Pressure; D011379:Prognosis; D012307:Risk Factors; D014521:Urethra / Q000294:innervation / Q000503:physiopathology*; D001743:Urinary Bladder / Q000294:innervation / Q000503:physiopathology*; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics
keywords: overactive bladder syndrome; sensation; urethral pressure measurement; urethral pressure variations urethral instability