How urodynamics reshaped the goals of urologic reconstruction

The transition from anatomical to functional goals in urology did not happen at a single inflection point—it accumulated gradually as clinicians began recognizing that technically successful operations were not always producing patients who felt better, according to Sasha Vereecken, BScN, RN, whose historical review traces the evolution of functional reconstructive urology from its early 20th-century foundations to its current status as a recognized subspecialty.¹

"Early urology understandably focused on anatomy," Vereecken said. "You can't explore territory without first mapping it, and we can't underestimate how important that foundation was." Structural repair—addressing obstructions, fistulas, and anatomical abnormalities—reflected both the technology available and the prevailing definition of surgical success. That definition began to erode as the field became, in Vereecken's words, better listeners.

"We started recognizing that a technically successful operation didn't always translate into a patient who actually felt better," she said. Restored anatomy coexisted with persistent incontinence, pain, recurrent infections, and ongoing urinary symptoms—outcomes that pushed clinicians to ask a different question: Had function actually been restored?

The historical review, spanning 1914 to 2025, identifies several foundational contributions that enabled that question to be answered objectively. Barrington's neurophysiology work and Von Garrelts' pressure-flow studies in the early decades provided the scientific substrate for functional assessment. Cine and video-urodynamics—pioneered by Turner-Warwick, Whiteside, Caine, and Edwards—introduced routine objective evaluation of lower tract function and laid the groundwork for what Turner-Warwick would later formalize as functional reconstruction of the urinary tract. The International Continence Society, founded in 1971, standardized terminology and embedded functional concepts globally through its incorporation of neurourology.

Organizational recognition followed. The European Association of Urology formally recognized functional urology as a distinct section in 2008—the same year the University of Colorado launched the first fellowship in functional reconstructive urology. In 2016, Sender Herschorn, BSc, MDCM, FRCSC, became Canada's first endowed Chair in Functional Urology. The first International Functional and Reconstructive Urology Update, held in Denver in 2024, further consolidated the subspecialty's global identity.

Vereecken attributed the length of the transition—spanning decades—to the absence of tools capable of measuring what the field was trying to understand.

"We didn't have the tools to objectively measure lower tract dysfunction, nor did we fully appreciate the complexity of bladder and pelvic floor physiology," she said. "We couldn't fully understand function until we understood the systems that created it." The emergence of urodynamics and the expansion of neurourology gave the field the measurement infrastructure that made functional goals achievable rather than aspirational.

"To me, that's a philosophy that defines functional reconstructive urology today," Vereecken said. "It's not about only asking did we fix the problem, but also did we improve this patient's life?"

REFERENCE

1. Vereecken SJ, Moore KJ, Flynn BJ. From form to function: A historical perspective on the emergence of functional & reconstructive urology. J Urol. 2026;215(suppl_5S):e284. doi:10.1097/01.JU.0001191344.82487.eb.11