Patient unawareness rivals diagnostic gaps as a barrier in functional urology

The physiological framework that Barrington and Von Garrelts established more than a century ago remains the conceptual foundation of every urodynamic study performed today—and Turner-Warwick's philosophy of restoring function rather than managing symptoms, although deeply embedded in modern functional urology, still has significant room to grow in both clinical practice and public awareness, according to Sasha Vereecken, BScN, RN, whose historical review of functional reconstructive urology was previously reported.¹

On the continuity between early foundational science and contemporary urodynamics, Vereecken described the connection as direct rather than merely historical.

"Barrington demonstrated that bladder function is controlled by coordinated neural pathways rather than just being a simple mechanical process, and Von Garrelts showed that pressure and urinary flow could be measured objectively," she said. "Modern urodynamics is built directly on these concepts."

The questions a urodynamicist asks when interpreting a study today—is the bladder storing appropriately, contracting effectively, is there obstruction, is there dyssynergia—are the same questions those pioneers were asking decades earlier.

"The equipment has evolved tremendously, but the underlying physiological framework has remained remarkably consistent," Vereecken said.

Turner-Warwick's conceptual departure—prioritizing physiological restoration over symptom relief—is visible across functional urology today, from reconstructive surgery and neuromodulation to continence procedures and individualized treatment planning.

"The common thread is that we're trying to restore how the urinary tract is meant to function, not just help patients live with these symptoms," Vereecken said. But she was equally candid about where the philosophy remains aspirational. Conditions such as overactive bladder, chronic pelvic pain, neurogenic bladder, and many forms of voiding dysfunction still lack complete mechanistic understanding.

"We still need better diagnostics and more personalized therapies that address the underlying physiology," she said.

The gap Vereecken identified as most striking, however, is not primarily scientific—it is one of patient awareness. Many people quietly accept urinary symptoms as an inevitable consequence of aging without knowing that treatable conditions exist, that specialists are available, or that functional restoration is a realistic goal.

"With urinary symptoms, many people don't even realize that there are people out there who can treat these conditions—and that they don't have to simply just live with them," she said. She described the moment of recognition—when a patient understands that help exists—as carrying its own clinical value.

"Sometimes the first step towards restoring function isn't a new operation or a new technology. It's helping someone realize that there are options out there in the first place."

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