International Neurourology Journal最新文献

Purpose: Prostate deobstruction surgery is effective for relieving lower urinary tract symptoms in men with benign prostatic obstruction, yet some patients experience failure of the initial trial without catheter (TWOC) postoperatively and require recatheterization. This study aimed to identify clinical and urodynamic predictors of initial TWOC failure after prostate deobstruction surgery.

Methods: A retrospective single-center study was conducted on 327 men who underwent prostate deobstruction surgery, including transurethral resection of the prostate, GreenLight laser photoselective vaporization, and holmium laser enucleation, at our institution from 2018 to 2024. Clinical characteristics, prostate volume, preoperative and postoperative uroflowmetry, and multichannel urodynamic parameters were evaluated. Initial TWOC failure was defined as recatheterization within 1 week of catheter removal. Logistic regression analysis was performed to identify predictive factors.

Results: Among the 327 patients, 41 (12.5%) experienced initial TWOC failure. Uroflowmetry parameters improved significantly postoperatively. Multivariate analysis identified detrusor underactivity (DU) (odds ratio [OR], 2.773; P=0.012) and low bladder outlet obstruction (BOO) (OR, 2.881; P=0.041) as independent predictors. Patients with both risk factors exhibited a higher likelihood of initial TWOC failure (OR, 4.560; P=0.003), whereas those with high BOO and no DU showed lower risk (OR, 0.321; P=0.003). Notably, even among patients with high preoperative postvoid residual volume (PVR≥300 mL), those with high BOO and preserved detrusor contractility still demonstrated lower TWOC failure risk (OR, 0.154; P=0.018).

Conclusion: Preoperative multichannel urodynamics enhance initial TWOC risk stratification and support individualized postoperative catheter management. Patients with DU and low BOO may require prolonged catheterization. In contrast, early catheter removal appears feasible in patients with high BOO and preserved detrusor function, even when preoperative PVR is elevated.

Purpose: Both laparoscopic sacrocolpopexy (LSC) and transvaginal mesh surgery (TVM) may provide favorable outcomes for patients with pelvic organ prolapse (POP). However, in our experience, LSC tends to be performed for severe POP and TVM for POP of a moderate or earlier stage. This study aimed to examine the postoperative results of the 2 groups including the preoperative parameters as closely as possible.

Methods: We retrospectively evaluated 238 patients with POP who underwent LSC or TVM at National Defense Medical College Hospital between September 2014 and January 2024. In our hospital, 94 patients were treated by LSC, whereas 144 were treated by TVM. After using nearest-neighbor propensity score matching, the surgical outcomes were compared between the matched 76 patients treated with LSC and 76 treated with TVM.

Results: To perform nearest-neighbor propensity score matching, the body mass index (BMI), POP stage, and number of laparotomies were used as explanatory variables. After propensity score matching, no significant differences in BMI, POP stage, and number of previous laparotomies were found between the matched LSC and TVM groups. Significant differences in age, blood loss, and operating time still existed even after propensity score matching. No significant differences in the occurrence of urinary incontinence or mesh exposure or prolapse recurrence were found between the matched LSC and TVM groups in all patients and patients with stage 4 POP. Moreover, no significant differences in the time to prolapse recurrence or urinary incontinence were found between the matched LSC and TVM groups (P=0.627 and P=0.235, respectively).

Conclusion: Based on the analysis using nearest-neighbor propensity score matching, both surgical methods were effective treatment approaches of POP. TVM would be sufficient to treat POP given its shorter operative time and low complication rates.

Purpose: Overactive bladder (OAB) in men with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) represents a major therapeutic challenge, as symptoms often persist even after surgical relief of obstruction. The underlying molecular mechanisms, however, remain poorly defined. The aim of this study was to identify differentially expressed proteins in the urothelial tissues of patients with BOO-related OAB using a proteomic approach.

Methods: Bladder urothelial tissues were obtained via cold-cup biopsy during transurethral resection of the prostate in patients with BPH. Patients were classified into OAB and non-OAB groups. Proteomic profiling was conducted using liquid chromatography-tandem mass spectrometry, followed by functional annotation and pathway enrichment analyses with the Ingenuity Pathway Analysis and Gene Ontology tools.

Results: Proteomic analysis identified 1,510 proteins, of which 133 were differentially expressed proteins in patients with OAB compared with the non-OAB group. Dysregulated pathways included cytoskeletal remodeling, Rho GTPase signaling, serotonergic signaling, and immune responses. Structural proteins such as ACTA2, CFL2, MYLK, and PPP1R12B were markedly downregulated, whereas GNA13 and multiple inflammatory mediators were upregulated. Functional analysis confirmed the enrichment of neurotransmitter catabolic processes, immune responses, and impaired cell-cell contact, suggesting structural disorganization and aberrant epithelial signaling in the OAB group.

Conclusion: BOO-related OAB is associated with distinct molecular disturbances in cytoskeletal organization, neurotransmitter pathways, and immune responses. These proteomic findings provide novel insights into disease pathophysiology and highlight potential molecular targets for biomarker discovery and therapeutic interventions.

Purpose: Stress urinary incontinence (SUI) affects women worldwide, and surgery remains important for those who do not respond to conservative management.

Methods: We retrospectively reviewed the medical records of 533 female patients with mixed urinary incontinence and predominant SUI treated at a medical center. Some patients may have had stage 3 or higher cystocele and underwent concomitant anterior colporrhaphy. Patients were divided into 4 groups: pubovaginal sling (PVS) alone, PVS with colporrhaphy, transobturator suburethral sling (TOT) alone, and TOT with colporrhaphy. The primary outcome was the long-term cumulative success rate in each group, and a successful outcome was defined as being dry or using fewer than 1 pad per day. The secondary outcomes included subjective postoperative lower urinary tract symptoms and various perioperative complications.

Results: The long-term cumulative success rates of the PVS groups, with or without colporrhaphy, were significantly higher than those of the TOT groups, with or without colporrhaphy (P<0.001). The group receiving PVS with concurrent colporrhaphy demonstrated the highest success rate, followed by PVS alone, TOT with colporrhaphy, and TOT alone (P=0.003). In addition, the highest rate of persistent overactive bladder symptoms was observed in the TOT-alone group (P<0.001).

Conclusion: This study suggests that PVS is superior to TOT in controlling incontinence symptoms and achieving long-term success. Concurrent colporrhaphy may also contribute to improved anti-incontinence outcomes.

Purpose: Alpha-blockers and 5-alpha reductase inhibitors (5ARIs) are well-established treatments for symptoms of benign prostatic hyperplasia (BPH). Despite their therapeutic benefits, concerns have been raised regarding a potential association between these medications and an increased risk of dementia. However, current evidence remains inconsistent, highlighting the need for further evaluation. This study aims to assess the potential dementia risk among patients receiving alpha-blockers and 5ARIs.

Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines (PROSPERO CRD42025643431), 7 databases were systematically searched through December 2024 for studies examining the association between alpha-blockers or 5ARIs and dementia risk in patients with BPH. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool. A Bayesian network meta-analysis was performed to estimate risk ratios with 95% credible intervals and to generate surface under the cumulative ranking curve (SUCRA) values.

Results: Five multicenter studies involving 3,650,434 patients (mean age, 71.1 years) and demonstrating an overall low risk of bias were included. The network analysis indicated that neither alpha-blockers nor 5ARIs were significantly associated with an increased risk of dementia compared with no treatment. However, SUCRA values suggested a relatively higher probability of dementia risk for 5ARIs (finasteride and dutasteride), followed by tamsulosin, doxazosin, terazosin, and alfuzosin.

Conclusion: This study found no significant association between the use of alpha-blockers or 5ARIs and increased dementia risk. These findings may assist clinicians in making more informed prescribing decisions, particularly for older male patients with BPH. Further large-scale research with extended follow-up periods is needed to strengthen the evidence across all BPH medications.

Purpose: Limited data exist on factors influencing surgical outcomes in simple cystectomy for refractory neurogenic lower urinary tract dysfunction (NLUTD). We evaluated the impact of alvimopan use, surgical approach (robotic vs. open), and single vs. multiple surgeons on peri- and postoperative outcomes.

Methods: We conducted a retrospective study of patients undergoing simple cystectomy for refractory NLUTD. Patient demographics, surgical details, and postoperative outcomes, including bowel function recovery, postoperative ileus, nasogastric tube use, and total parenteral nutrition use, were analyzed.

Results: A total of 44 patients were included in the study, with 68% being female. The median age was 57 years, and the median body mass index was 28.3 kg/m2. The majority were Caucasian (86%) with spinal cord injury (55%) history. In comparing single-surgeon versus multiple-surgeon procedures, the latter had significantly higher estimated blood loss. Thirty-three patients (73%) received alvimopan, with no significant differences between alvimopan and nonalvimopan groups in operative and postoperative factors.

Conclusion: NLUTD patients undergoing simple cystectomy represent a distinct surgical cohort. While multiple-surgeon procedures resulted in greater blood loss, they did not affect other perioperative outcomes. Additionally, alvimopan did not significantly improve bowel function recovery or reduce postoperative ileus, likely due to underlying neurogenic bowel dysfunction.

Purpose: To compare the accuracy of portable ultrasound bladder scanner (PUBS) for measuring bladder volume (BV) using manual fanning scan (MFS) and traditional motorized scan (TMS) methods.

Methods: Patients with lower urinary tract symptoms who underwent a urodynamic study at the urology outpatient clinic from October to December 2024 were prospectively enrolled. BV was measured using TMS-type (TMS-BV) and MFS-type (MFS-BV) PUBS prior to free uroflowmetry. True BV (T-BV) was defined as the sum of the voided volume and the postvoid residual volume drained through the urethral catheter after voiding. TMS-BV and MFS-BV were compared and analyzed against T-BV.

Results: Data from 39 patients (30 males and 9 females; mean age, 65.3±14.8 years) were analyzed. TMS-BV (230.9±157.9 mL) and MFS-BV (222.6±154.2 mL) did not differ significantly from T-BV (230.6±156.6 mL) (P>0.05). Comparison of the percentage of difference in volume between TMS-BV and MFS-BV across 100-mL BV ranges revealed no significant difference (P>0.05). The mean difference between TMS-BV and T-BV (0.2±50.2) did not differ significantly from the mean difference between MFS-BV and T-BV (-8.0±69.1) (P>0.05). The correlation between TMS-BV and T-BV (R2=0.90) was stronger than that between MFS-BV and T-BV (R2=0.81).

Conclusion: The correlation between MFS-type PUBS and T-BV was lower than that between TMS-type PUBS and T-BV. However, the measurement accuracy of BV was similar using both methods.

Purpose: Nocturia is increasingly recognized as a natural consequence of aging and is commonly observed in the context of systemic dysfunction, with growing evidence linking it to elevated mortality risk. This study aims to elucidate whether serum uric acid (sUA) acts as a mediator in this associative pathway.

Methods: This study used population-based data from 2005 to 2014 to investigate the association between nocturia and mortality, incorporating sUA as a potential mediator. Using data from 12,522 participants, sUA levels were categorized into quartiles (Q1-Q4) to assess dose-response relationships in the context of nocturia and mortality.

Results: Participants in higher sUA quartiles were older and exhibited a greater burden of metabolic risk factors, including higher body mass index, waist circumference, and blood pressure. After adjustment, Cox regression analysis revealed a significant association between nocturia and increased all-cause and cardiovascular mortality. Restricted cubic spline regression indicated a J-shaped association between elevated sUA and increased mortality. Additionally, mediation analysis demonstrated that sUA partly mediated the relationship between nocturia and mortality.

Conclusion: Nocturia independently predicts mortality, irrespective of metabolic status and sUA levels. These findings underscore the pivotal mediating role of sUA, highlighting the necessity of an integrated approach to nocturia management. Future research should prioritize interventional strategies that target metabolic dysfunction as a means to reduce nocturia-associated mortality risk.

Purpose: Clean intermittent catheterization (CIC) is a safe and effective method for bladder emptying under various conditions. However, it is also a delicate daily procedure that requires high-quality education. This study investigated the current status of CIC education in South Korea.

Methods: An online anonymous survey inquiring CIC education circumstances at both outpatient clinic and ward was conducted via Google Forms in March 2023. The URL link was sent 3 times to the clinical practitioners conducting urodynamic tests in each hospital. These practitioners were nurses and members of the Korean Continence Society whose workplaces were either secondary or tertiary hospitals offering urodynamic tests.

Results: The survey questionnaires were administered to 93 clinical practitioners from 60 different hospitals. The overall response rate was 33%. The urodynamic testing room was commonly used for CIC education, and private space solely designated for CIC education was available in less than 3%. The education materials provided by a catheter company were the most widely used (50%), followed by materials provided by each hospital or the urology department (30%). There were no public or formal CIC education materials provided by urological associations. The initially recommended catheter was a single-use catheter from various companies. However, the catheter selection was limited by national health insurance coverage in 14% of the cases. Furthermore, the mean consumed time for a single session of CIC education was 11-30 minutes in 60% of the cases, 31-60 minutes in 20%, and 5-10 minutes in 16.7%. Majority of the respondents complained about limitations in time and place to provide adequate education to improve patients' understanding on CIC.

Conclusion: The clinical practitioners mainly complained about the lack of time and place to provide adequate CIC education to patients. Furthermore, the limited amount of national insurance coverage for single-use catheters hindered the free selection of appropriate catheters.