SUFU 2020: Ode to the Urethra: Uncovering Flaws in Current Continence Theories

Scottsdale, AZ ( Dr. John DeLancey started his presentation discussing the data from the randomized controlled trial on mid-urethral slings led by Dr. Richter and UITN of 592 women. The data demonstrated cure rate and failure rates, and in this presentation, he focused on the failure rate and how these data help us to understand the role of urethral function. He showed that the failure rate of objective symptoms is about 18%, and the failure for subjective symptoms was about 38 %.


He reports that the problem in these patients is MUCP (Maximum urethral closing pressure) and reports that MUCP is 70.2 cmH2O in the continent patient and 40.8 cmH2O or 45 % lower in the incontinent patient.

He reviewed the effect of Clinical Pelvic Floor Measures on SUI (stress urinary incontinence) and reports that urethral function and specifically MUCP play a major role in comparison to other variables (urethral support, BMI, cough pressure). 

He also showed there is a difference in maximal urethral closure pressure based on race (white 55.8 cmH2O, while black 68 cmH2O), where the MUCP is 22% higher in black patients (n<0.0001), where this was adjusted for age, BMI, vaginal parity and DM. MUCP was low in patients with SUI and UUI


MUCP in nullipara: He showed that MUCP dropped 15 cmH2O per decade. He explored the need to improve the way to measure urethral pressure.

He shared a new method for measuring the urethral pressure using high resolution manometry catheter.



He concluded by looking at where will we be in 2030. Hopefully doing a full evaluation of the urethral function to include:

  • Urethral coordination
  • Percentile urethral support
  • Resting urethral closure
  • contracture strength
  • Vascular contribution
  • Sensory function

Presented by: John DeLancey, MD, Professor, Director, Pelvic Floor Research in the Department of Obstetrics and Gynecology, University of Michigan Medical School.

Written by: Bilal Farhan, MD, Assistant Professor, Division of Urology, University of Texas, Medical Branch, Texas; @BilalfarhanMD, at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - February 29, 2020, Scottsdale, Arizona