International Neurourology Journal最新文献

Purpose: Aquaporin-2 (AQP2) and vasopressin V1a receptor (AVP-V1a) are membrane proteins involved in water transport regulation in renal and extrarenal tissues. Their presence in the urinary bladder suggests a role in local water handling. This study aimed to investigate whether pelvic nerve stimulation induces translocation of AQP2 and AVP-V1a in the bladder urothelium of rats, thereby revealing a potential neural regulatory mechanism in water permeability.

Methods: Forty female Sprague-Dawley rats were assigned to either a control (n=20) or electrical stimulation group (n=20). The pelvic nerve was exposed and stimulated at 10 V, 16 Hz, 0.8 msec for 60 seconds. Bladder tissues were harvested immediately and processed for immunohistochemistry and Western blotting to evaluate the localization and expression levels of AQP2 and AVP-V1a in cytosolic and membrane protein fractions.

Results: Immunohistochemistry revealed that AQP2 and AVP-V1a were co-localized in the urothelium. Western blotting showed that pelvic nerve stimulation led to a significant decrease in cytosolic expression and a concurrent increase in membrane- associated expression of both AQP2 and AVP-V1a (P<0.05). These findings are indicative of protein translocation in response to neural stimulation.

Conclusion: Pelvic nerve stimulation may trigger the relocalization of AQP2 and AVP-V1a from the cytosol to the membrane in bladder urothelial cells. This suggests a novel neurophysiological mechanism for modulating bladder water transport, with potential implications for understanding bladder homeostasis and dysfunction suggesting a possible role in regulating bladder water permeability.

Purpose: This study aimed to determine whether urinary secretory immunoglobulin A (sIgA) levels differ between patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and healthy controls, and to assess whether urinary sIgA is linked to mucosal immune mechanisms that may contribute to BPS/IC pathophysiology.

Methods: A single-center, cross-sectional study was conducted between April and June 2020 at the Department of Urology, Ege University Faculty of Medicine. Forty female patients with BPS/IC and 40 healthy controls were enrolled. Symptom severity in the BPS/IC group was evaluated using the O'Leary-Sant Interstitial Cystitis Symptom and Problem Index. Patients with active urogenital infections, a history of bladder cancer, or prior pelvic radiotherapy were excluded. Urine samples were collected in sterile containers, centrifuged, and stored at -80°C before sIgA measurement using a commercial enzyme-linked immunosorbent assay kit. Correlations between continuous variables were examined with Spearman rank correlation coefficients.

Results: Urinary sIgA levels were not significantly different between the BPS/IC group (mean±standard deviation: 0.96±1.5 μg/mL) and healthy controls (0.53±0.7 μg/mL) (P=0.173). Subgroup analyses within the BPS/IC cohort showed that smokers had significantly lower urinary sIgA levels (median [range], 0.001 [0.000-0.082] μg/mL) compared with nonsmokers (median [range], 0.720 [0.000-6.850] μg/mL) (P=0.004). Conversely, patients with cardiac comorbidities had significantly higher urinary sIgA levels (median [range], 0.820 [0.100-6.850] μg/mL) than those without cardiac disease (median [range], 0.213 [0.000-2.300] μg/mL) (P=0.015).

Conclusion: Although no significant differences in urinary sIgA levels were observed between BPS/IC patients and healthy controls, subgroup analyses identified associations with smoking and cardiac comorbidities. These findings suggest that sIgA may be relevant to BPS/IC pathophysiology and highlight the potential of mucosal immune biomarkers. Larger studies are warranted to further clarify the role of sIgA in BPS/IC.

Purpose: To investigate the long-term therapeutic satisfaction after augmentation enterocystoplasty (AE) or non-AE bladder therapy in patients with Hunner interstitial cystitis (HIC).

Methods: From 2013 to 2024, patients with cystoscopically confirmed HIC who received AE or non-AE bladder-preserving therapy were retrospectively analyzed. Treatment outcomes were analyzed using the subjective global assessment response, symptoms, and urodynamic parameters. The patients' symptoms and urodynamic parameters were compared between AE and non-AE groups from baseline to follow-up endpoint.

Results: A total of 54 patients (48 women and 6 men) were included with a mean age of 58.6±11.4 years at diagnosis and a mean follow-up period of 9.4±5.8 years. AE and non-AE therapy was performed in 17 (31.5%) and 37 patients (68.5%), respectively. A final satisfactory outcome was reported in 13 (76.5%) of the 17 HIC patients after AE and in 26 of the 37 patients (70.3%) after non-AE therapy. Compared with patients who had no improvement, patients who had improved outcomes after AE exhibited decreased interstitial cystitis symptom index (P=0.007) and visual analogue scale (P=0.013) scores and increased bladder fullness sensation (P=0.002) and cystometric bladder capacity (P=0.019). Patients who had no improved outcomes after AE did not experience pain relief or increased bladder fullness sensation or bladder capacity. Only 23.4% of the patients treated with AE required repeat surgery or intravesical therapy in the first 1-3 years. By contrast, patients treated with non-AE therapy required repeat intravesical therapy for the recurrence of Hunner lesions or bladder symptoms.

Conclusion: Both AE or non-AE therapy can result in satisfactory outcomes in more than 70% of HIC patients. AE provides early relief of bladder pain and increases bladder capacity, and non-AE therapy can also relieve pain and improve functional bladder capacity, resulting in improved outcomes.

Overactive bladder (OAB) substantially reduces quality of life (QoL), and novel implantable percutaneous tibial nerve stimulation (iPTNS) devices have emerged as promising alternatives to conventional management. This review provides a comprehensive comparative analysis of iPTNS devices for OAB, evaluating clinical outcomes, technical specifications, regulatory status, innovative features, and limitations-key aspects insufficiently addressed in prior studies. A narrative synthesis was conducted by reviewing clinical trials, technical reports, and regulatory documents related to 7 iPTNS devices. The analysis focused on improvements in health-related QoL (HRQoL), reductions in urgency urinary incontinence (UUI), device design variability, and regulatory distinctions. Our review revealed substantial differences among devices in terms of clinical efficacy (HRQoL and UUI reduction), technical design (including power sources and implantation methods), and regulatory status, with some devices approved by the U.S. Food and Drug Administration and others still under development. While iPTNS devices show considerable promise in OAB management, significant gaps remain regarding long-term outcomes and real-world adherence. Future innovations, particularly closed-loop neuromodulation, hold promise for improving efficacy and advancing personalized therapy.

Purpose: Pelvic organ prolapse (POP) and overactive bladder (OAB) symptoms frequently coexist. Most patients with POP may present with at least one OAB symptom of any grade, and OAB symptoms can be alleviated by conservative or surgical treatments for POP. This study investigated data from patients with POP who underwent laparoscopic sacrocolpopexy (LSC) at our institution to determine the factors that led to the emergence of postoperative OAB symptoms or its improvement after LSC.

Methods: This retrospective study enrolled 97 patients who underwent LSC at our institution between June 2016 and October 2023. The Pearson chi-square test and multiple logistic regression analysis were performed to determine the independent factors that contribute to postoperative OAB symptoms or OAB improvement. The OAB symptom score was used to assess the change in OAB symptoms before and after LSC. OAB symptoms were considered improved if the OAB symptom score total score improved compared to the preoperative score.

Results: In the correlation analysis, the presence of preoperative OAB and/or urinary incontinence (UI) was significantly associated with postoperative OAB symptoms (both P<0.05). In addition, both symptoms were significantly associated with postoperative OAB (P=0.010). In another correlation analysis, the presence of preoperative OAB and that of either symptom were significantly associated with postoperative OAB improvement (both P<0.05). In the multiple logistic regression analysis, the presence of both symptoms was an independent factor for postoperative OAB symptoms among the factors including operative time and preoperative postvoid residual urine volume, and the presence of either symptoms could be associated with postoperative OAB improvement besides operative time.

Conclusion: LSC could improve OAB symptoms postoperatively in patients with preoperative OAB or UI, or both better than in those without such symptoms.

Purpose: Overactive bladder (OAB) syndrome is a subset of storage lower urinary tract symptoms that significantly affects health-related quality of life, impacting social, occupational, and psychological well-being. Although the precise pathophysiology of OAB remains unclear, disruption of the neural network that regulates lower urinary tract activity has been suggested. The brain-bladder axis depends on a complex and extensive network of brain regions, with the periaqueductal gray (PAG) playing a pivotal role in mediating bidirectional communication.

Methods: This study investigates whether the functional connectivity-based organization of the PAG in human subjects changes dynamically over time. OAB patients and healthy controls (HC) underwent resting-state functional magnetic resonance imaging at 7 T, beginning with an empty bladder (subsensory threshold bladder filling state). Functional connectivity-based clustering analysis was performed to evaluate time-dependent changes in PAG organization.

Results: Significant group differences in time-dependent PAG functional organization were observed (P=0.017). In HC, functional subdivisions of the PAG reorganized dynamically during the resting-state scan, whereas OAB patients displayed a largely static functional organization, showing minimal change over time.

Conclusion: These findings indicate altered PAG signaling and differences in sensory processing among OAB patients. The absence of dynamic PAG reorganization may contribute to OAB pathophysiology, offering new insight into its neural mechanisms.

Purpose: This study aimed to measure the cumulative anticholinergic burden in older outpatients in South Korea with and without newly started overactive bladder (OAB) medications, and to assess the contribution OAB treatment-related antimuscarinics have on overall anticholinergic exposure.

Methods: This retrospective study utilizing the South Korean National Health Insurance Service database included patients ≥65 years old with ≥1 outpatient visit (any cause) between January 1 and June 30, 2016. The overall cohort included patients with OAB and matched patients without OAB. Outcomes were assessed over a 100-day follow-up period. Primary endpoints were 100-day cumulative anticholinergic cognitive burden score, prevalence of anticholinergic and strong anticholinergic use, and number of anticholinergics per patient. Proportion of anticholinergic cognitive burden score attributable to OAB medication was a secondary endpoint.

Results: The final study cohort included 2,360 patients with OAB and 11,676 patients without OAB. Mean 100-day cumulative anticholinergic cognitive burden score was 15.2 times higher for OAB (320.1) than non-OAB (21.0). Anticholinergics were used widely for OAB patients (2,287 [96.9%] vs. 3,921 [33.6%] non-OAB patients). Prevalence of strong anticholinergic use was almost 4 times higher for OAB (2,234 patients [94.7%]) compared with non-OAB (2,817 patients [24.1%]). On average, 0.9 anticholinergics were dispensed per patient. Anticholinergic cognitive burden score attributable to OAB medications was 66.9% in the antimuscarinic-only group, 64.3% in the antimuscarinic with mirabegron group, and 0% in the mirabegron-only group.

Conclusion: In patients with OAB, 100-day cumulative anticholinergic cognitive burden score was 15 times higher than in patients without OAB, due to anticholinergic medications. In this study, mirabegron did not contribute to anticholinergic burden. As there are unwanted effects associated with this burden, clinicians should consider the anticholinergic burden of each patient when using pharmacotherapy to treat OAB.

Purpose: Parkinson disease (PD) is a common, progressive neurodegenerative disease, affecting approximately 1% of the population over 60. The associated morbidity and mortality are increasing at a faster rate than for any other neurological disorder. Lower urinary tract symptoms (LUTS) are reported in up to 85% of patients and can significantly impair quality of life (QoL). There are few studies to date that utilise the Montreal Cognitive Assessment (MoCA) to assess cognitive performance and compare this to motor symptoms and LUTS severity.

Methods: An observational, cross-sectional study was performed. Data was collected prospectively from patients diagnosed with PD attending a specialist movement disorder clinic using fully validated, detailed questionnaires and scales routinely employed in clinical practice (ICIQ-MLUTS, ICIQ-FLUTS, Unified PD Rating Scale - Motor Examination, modified Hoehn and Yahr, MoCA). Statistical analyses were performed using Stata/MP 17.

Results: Data from 18 patients was collected (15 male and 3 female subjects; median age, 69 years; median disease duration, 4 years; median modified Hoehn and Yahr stage, 2.5; median MoCA score, 24). Urinary incontinence symptoms scores were significantly correlated with worse QoL scores due to LUTS (r=0.76, P<0.001), with total urinary symptoms scores (r=0.82, P<0.001), and negatively correlated with MoCA scores (r=-0.52, P=0.046). No correlation was found between urinary incontinence symptoms and motor symptoms severity scores (r=0.09, P=0.725). The non-drug-naive group (n=12, 66.7%) was found to have higher motor symptoms scores (P=0.065), higher LUTS scores (P=0.239), worse QoL scores due to LUTS (P=0.244), and similar MoCA scores (P=0.785) to the drug-naive group (n=6, 33.3%).

Conclusion: Cognitive impairment in patients with PD appears to be more strongly associated with urinary incontinence severity than motor symptoms. When considering the appropriateness of urological intervention in PD patients, cognitive function should be taken into account as well as motor function.

Purpose: Low bladder compliance (BC) poses a significant clinical challenge. Nevertheless, studies exploring pharmacological mechanisms to improve BC remain limited. We investigated the efficacy of a β3-adrenoceptor agonist, mirabegron, on BC in comparison with anticholinergics.

Methods: This prospective single-arm paired comparison trial included 14 patients with low BC (≤20 mL/cm H2O) despite anticholinergics treatment. After a 2-week anticholinergics-washout period, patients were treated with mirabegron for 8 weeks and then returned to 8 weeks of anticholinergics. Major treatment effect was assessed with urodynamic studies performed at baseline, 8 weeks after mirabegron treatment, and 8 weeks after consecutive anticholinergics treatment (McNemar test, Paired t-test; mean [95% confidence intervals]).

Results: Following mirabegron, 71.43% of patients exhibited a BC of >20 mL/cm H₂O, compared to 54.55% after switching back to anticholinergics (P=0.317). BC improved significantly from 12.02 (9.52-14.52) to 39.67 (21.60-57.73) mL/cm H2O after mirabegron treatment (P=0.007), but subsequently declined to 20.94 (15.78-26.10) mL/cm H₂O after reintroduction of anticholinergics (P=0.075). Maximum cystometric capacity increased from 352.21 (282.78-421.65) to 442.71 (348.95-536.48) mL after mirabegron (P=0.091), but decreased to 402.00 (315.92-488.08) mL after returning to anticholinergics (P=0.218). Notably, detrusor pressure at end-filling decreased significantly with mirabegron, from 30.50 (25.61-35.39) to 14.43 (10.79-18.06) cm H2O (P<0.001), while increasing to 20.36 (16.26-24.46) cm H2O after returning to anticholinergics (P=0.056).

Conclusion: A β3-adrenoceptor agonist, mirabegron, was more effective than anticholinergics in improving BC. Among the two components of improved BC-increased bladder volume and reduced detrusor filling pressure-the β3-adrenoceptor agonist showed a more pronounced effect on lowering detrusor filling pressure, compared to anticholinergics. These findings suggest that β3-adrenoceptor agonists might play an important role in reducing the tension of the bladder wall by controlling detrusor muscle tone, and this may be an important target for future research.