Urethral function plays a central role in female stress urinary incontinence (SUI). The urethral pressure profile (UPP) provides additional information to support diagnosis and may help guide treatment decisions. However, the factors influencing urethral pressure measurements remain incompletely understood.

The aim of this study was to evaluate the relationship between clinical and urodynamic parameters affecting urethral function and to identify independent predictors of maximum urethral closure pressure (MUCP).

A retrospective analysis of urethral pressure profile (UPP), performed according to the Brown & Wickham technique using single lumen catheter with two opposite eyeholes, data was performed in women undergoing urodynamics. Patients were classified according to urodynamic diagnosis as normal, urodynamic stress incontinence (USI), detrusor overactivity (DO), detrusor overactivity incontinence (DOI), or unable to void (UV). Patients with mixed symptoms were excluded.

Clinical variables included age, body mass index (BMI), and history of previous anti-incontinence surgery. Urodynamic variables included UPP parameters, including maximum urethral closure pressure (MUCP). Continuous variables were expressed as mean ± standard deviation. Group comparisons were performed using analysis of variance (ANOVA), and correlations were assessed using Pearson’s coefficient. Variables with p<0.20 or deemed clinically relevant were entered into a multivariable linear regression model to identify independent predictors of MUCP. An interaction term between age and previous anti-incontinence surgery was also tested.

A total of 10,306 patients were included: 1,810 normal, 4,787 USI, 1,793 DO, 1,840 DOI, and 76 UV. Patients with USI consistently demonstrated lower MUCP compared with other diagnostic groups (p<0.001), including in younger age groups (Figure 1). Previous anti-incontinence surgery was associated with significantly lower MUCP (mean difference −16.8 cmH₂O; p<0.001).
In multivariable analysis, age was the strongest independent predictor of MUCP decline, with a decrease of 0.83 cmH₂O per year (95% CI −0.87 to −0.80; p<0.001). Compared with the results of patients with normal urodynamics, USI was associated with significantly lower MUCP (β = −14.68; p<0.001), while DO was associated with higher MUCP (β = +4.03; p<0.001) and DOI with slightly lower MUCP (β = −3.83; p<0.001). Previous anti-incontinence surgery remained independently associated with reduced MUCP (β = −10.40; p<0.001). BMI showed a statistically significant but clinically small positive association with MUCP (β = +0.20; p<0.001). A significant interaction between age and previous surgery was observed (β = +0.19; p=0.006), indicating a differential effect of age on MUCP in patients with prior surgery.

MUCP declines significantly with age and is independently reduced in patients with USI and prior anti-incontinence surgery.

These findings reinforce the central role of urethral dysfunction in SUI and support the use of urethral pressure assessment to improve patient stratification and potentially inform management decisions. Although reference values for MUCP have been reported, their clinical applicability remains unproven. This highlights the need for further studies to establish robust and standardised normative ranges.

Continence 19S (2026) 102628
DOI: 10.1016/j.cont.2026.102628