Can we, and do we need to, define bladder neck hypermobility and intrinsic sphincteric deficiency?: ICI-RS 2011


  • Robert Pickard led the review process

  • Conflict of Interest: P.P.S.—consulting/advisory panel to Astellas Pharmaceuticals, not pertinent to this manuscript.



Bladder neck hypermobility (BNH, also called urethral hypermobility), and intrinsic sphincteric deficiency (ISD) are terms frequently used in the clinical evaluation and management of stress urinary incontinence, and as subject qualifiers in clinical research. The terms also infer pathophysiologic concepts, as BNH and ISD appear to represent two different aspects of failure of the continence mechanism. Unfortunately, neither term is well-defined, and the various clinical and urodynamic characterizations of these terms do not correlate well with one another.


The value of these concepts and these specific terms was debated at the ICI-RS meeting, Bristol, UK, June 2011. Two clinicians were asked to take opposing viewpoints, with three weeks lead-time prior to the meeting. Each discussant presented one viewpoint, “for” or “against,” followed by a brief discussion to review the presentations.


The consensus was that, while we currently cannot adequately define these terms, there is a need to develop terminology employing these concepts.


Terminology should permit improved definition of the sphincteric mechanism, allow individual patient characterization and serve as useful waypoints in treatment decisions. Neurourol. Urodynam. 31:309–312, 2012. © 2012 Wiley Periodicals, Inc.