ICS Educational Module: Urethral Pressure Profilometry

To present an ICS teaching module on urethral pressure profilometry. This teaching module provides a summary of the evidence base on UPP principles, measurements, and potential clinical applications. This module has been prepared by a Working Group commissioned by the ICS Urodynamics Committee. A comprehensive literature review was performed using modified PRISMA methodology, followed by a review by the members of the Working Group and the ICS Urodynamics Committee core panel. The literature review identified 249 publications, of which 81 were accessible, published in English, and involved human subjects. These publications form the evidence base for the preparation of this manuscript. Various UPP technologies have been proposed, each offering distinct advantages and limitations. There is a lack of standardization regarding how UPP is performed and interpreted. Despite these challenges, UPP has demonstrated clinical utility in patients with stress urinary incontinence and dysfunctional voiding. Additionally, UPP has potential research and clinical applications in patients with symptoms that may be secondary to or demonstrate associated “urethral instability” (transient variations to the neural drive to the external sphincter which may result in detrusor overactivity, giggle incontinence, and urethral relaxation incontinence). UPP may also have intra- and peri-operative applications for optimizing urethral closure pressure during or after SUI surgery (e.g. adjustable mid-urethral slings). UPP has demonstrable clinical and research utility in pathologies where urethral closure pressure may be transiently or consistently reduced or increased. Technological advances, standardization of data collection and interpretation would increase clinical uptake of UPP as well as potential consideration as an outcome measure for treatments.