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Authors' response re: Petros, P. 2014, Urethral resistance to flow, not pressure, is the prime determinant of continence. Neurourol Urodyn

We appreciate Doctor Papa Petros’ interest in our studies on Urethral Reflectometry. We have reason to believe that the paper quoted by Doctor Papa Petros should be or since these papers have a reference to Zacharin which the paper referred to in the head line does not. We disagree with Dr. Petros’ statement:‘‘whether a patient leaks urine or not has nothing to do with pressure, it is to do with musculoelastic closure of the urethral tube.’’ The fundamental principle of urine leak is that the bladder pressure exceeds the pressure needed to just open the urethra. The pressure needed to just open the urethra is precisely what is measured with Urethral Pressure Reflectometry. When we measure the urethral opening pressure with increased intraabdominal pressure, for example, Po-Abd50 we have found a parameter which; 1. discriminates continent from incontinent women; 2. provides a measure of the severity of the condition and 3. returns to normal after successful surgery. This indicates that this pressure parameter is relevant for the continence mechanism. Future studies may show if the Urethral Pressure Reflectometry technique can be used as a predictor of postoperative success with or without midurethral anchoring.