International Neurourology Journal最新文献

Purpose: Urinary incontinence is a problematic complication after surgery for pelvic organ prolapse including transvaginal mesh surgery (TVM). Japan's only mesh product available for TVM, ORIHIME, is known to easily slide off the anchored tissue, which may lead to recurrence and/or urinary incontinence. In this study, we investigated which factors that contribute to urinary incontinence following TVM using ORIHIME.

Methods: The study enrolled 102 patients who underwent TVM at our hospital between July 2019 and March 2023. The Pearson chi-square test, multiple logistic regression analysis, and the Cox proportional hazards model were used to determine independent factors contributing to postsurgical urinary incontinence.

Results: The Pearson chi-square test showed that the presence of diabetes mellitus (DM) and the adjustment of the mesh length beneath the bladder significantly correlated with postoperative urinary incontinence among preoperative and intraoperative factors (both P<0.05). The presence of DM and the adjustment of the mesh length beneath the bladder were also significant factors in both univariate and multivariate analyses of multiple logistic regression analysis (both P<0.05). In addition, these variables acted as independent factors for shorter time to postoperative urinary incontinence in the multivariate analysis of the Cox proportional hazards model (hazard ratio, 4.99 and 6.63, respectively).

Conclusion: The mesh size adjusted to the length from the cervix to the bladder neck should be considered to avoid postoperative urinary incontinence in TVM using ORIHIME.

Digital technologies and social media have fundamentally reshaped healthcare communication and the accessibility of medical information. This review examines the role of social media in urologic care, focusing particularly on its impact on treatment, management, and professional engagement. Patients commonly utilize social media to obtain health information, share experiences, and discuss treatment options, whereas healthcare professionals leverage these platforms for networking, education, and research dissemination. Despite these benefits, concerns persist about content credibility, inconsistent expert oversight, and disparities in social media usage across different demographic groups. While social media enhances patient engagement and expands access to medical information, its long-term effects on clinical outcomes and healthcare decision-making remain unclear. As digital health continues to evolve, ensuring content reliability through expert oversight and technological advancements will be crucial in optimizing the role of social media in urologic care.

Purpose: Urodynamic testing, a minimally invasive procedure commonly performed in urology, often induces preprocedure anxiety due to its invasive nature and insufficient preparatory information. This study investigated whether supplementing traditional verbal and written explanations with video-animated information could help reduce anxiety in patients undergoing urodynamic testing.

Methods: In this randomized, controlled, prospective study, patients were divided into 2 groups: a nonvideo group (n=100), which received only verbal and written explanations, and a video group (n=100), which additionally viewed an animated informational video. Anxiety was assessed using the State-Trait Anxiety Inventory: the trait version (STAI-T) for general anxiety and the state version (STAI-S), administered both before and after information delivery, for situational anxiety.

Results: Median STAI-T scores did not differ significantly between groups (P=0.067). While preinformation STAI-S scores were comparable (P=0.702), postinformation STAI-S scores were significantly higher in the nonvideo group (group 2) compared to the video group (P<0.001). In the video group (group 1), the median STAI-S score decreased from 34 (range, 20-62) preinformation to 26 (range, 20-39) postinformation (P<0.001). In group 2, the median STAI-S score decreased from 35 (range, 20-63) to 28 (range, 22-48) (P<0.001). Patients who received video-animated information exhibited a significantly larger reduction in STAI-S score (median change, 6.5 vs. 5.0; P=0.034), suggesting greater anxiety relief with video supplementation.

Conclusion: Adding video-animated information to conventional verbal and written explanations significantly increases anxiety reduction before urodynamic testing, potentially improving patient comfort and understanding of the procedure.

Purpose: The relationship between lipid accumulation product (LAP) and stress urinary incontinence (SUI) in women remains unclear, and the potential mediating roles of oxidative stress and inflammatory factors in this process have not been extensively studied. This analysis aimed to explore the association between elevated LAP indices and SUI in women, specifically examining the mediating effects of oxidative stress and inflammatory factors.

Methods: Data from 4,292 participants across 6 consecutive cycles of the National Health and Nutrition Examination Survey were analyzed. Logistic regression and subgroup analyses, adjusted for various covariates, were performed to investigate the relationship between LAP and the prevalence of SUI in adult women. Additionally, mediation analysis was conducted to evaluate the contributions of oxidative stress and inflammatory factors to this association.

Results: The prevalence of SUI among women in the United States was 46.02%. After adjustment for confounding factors, the odds ratio for LAP and SUI was 1.003 (95% confidence interval, 1.001-1.004; P=0.002), indicating a positive association. Gamma-glutamyl transferase mediated this relationship, explaining 40.0% of the effect (P=0.036).

Conclusion: This study's findings indicate a positive association between LAP and the prevalence of SUI in women, with oxidative stress potentially acting as a mediator in this relationship.

Purpose: This review evaluates the clinical utility of emerging optical techniques-specifically, near-infrared spectroscopy (NIRS), optical coherence tomography (OCT), photoacoustic imaging (PAI), and fiber-optic sensors (FOSs)-as noninvasive, patient-friendly modalities for diagnosing lower urinary tract dysfunction. We assess their potential integration into wearable systems for personalized urological care and propose a novel clinical pathway for their use.

Methods: We included published studies employing optical modalities to evaluate bladder function or pathology, focusing on diagnostic accuracy, feasibility, and patient-related outcomes. We also examined technical principles, diagnostic performance metrics (e.g., sensitivity, resolution, penetration), and clinical validation across optical modalities. A total of 40 articles met the final inclusion criteria.

Results: NIRS demonstrates >85% sensitivity for detecting detrusor overactivity in small-scale trials, with wearable devices enabling continuous bladder monitoring. OCT has been found to improve the detection of carcinoma in situ by up to 22% compared to white-light cystoscopy, although its shallow penetration (~2 mm) limits evaluation of deeper layers. PAI visualizes microvascular structures to depths of several centimeters, suggesting strong potential for noninvasive bladder tumor diagnosis. FOSs offer continuous intravesical pressure monitoring with reduced discomfort, although semi-invasive placement remains a limitation.

Conclusion: Noninvasive optical diagnostics offer a safer, more patient-friendly alternative to conventional cystoscopy and urodynamic studies. However, larger multicenter trials, cost-effectiveness analyses, and regulatory alignment are needed. Integrating these emerging modalities with telemedicine and artificial intelligence could transform bladder care into a continuous, home-based model.

Purpose: To investigate the effectiveness of acotiamide on lower urinary tract dysfunction by using a rat model of neurogenic underactive bladder induced through pelvic nerve crush (PNC) injury.

Methods: Bilateral PNC injuries were performed on 8-week-old female Sprague-Dawley rats (PNC group); the sham surgery group was used as control (control group). Two weeks after surgery, awake cystometrography (CMG) was performed, and acotiamide (10 or 100 mg/kg) was subcutaneously administered to the control and PNC groups. Subsequently, CMG parameter values obtained before and after treatment were compared.

Results: In baseline CMG, compared to control group, PNC group revealed statistically significant elevations in the intercontraction intervals (ICIs), number of nonvoiding contractions, baseline pressure, threshold pressure, bladder capacity, voided volumes, and postvoid residual. However, contraction amplitudes and voiding efficiency were significantly decreased. In the control group, compared with the baseline values, 10-mg/kg acotiamide resulted in statistically significant elevations in contraction amplitudes. Treatment with 100-mg/kg acotiamide led to statistically significant elevations in contraction amplitudes and decreases in ICI and bladder volume. In the PNC group, there were no statistically significant changes noted in CMG parameters after treatment with 10-mg/kg acotiamide (n=6). Compared with the baseline values, the administration of 100-mg/kg acotiamide significantly decreased ICI (1,025±186 seconds vs. 578±161 seconds; P=0.012), bladder capacity (1,841±323 µL vs. 871±174 µL, respectively; P=0.0059) and postvoid residual (223±46 µL vs. 44±22 µL, respectively; P=0.023), and increased contraction amplitudes (22.09±1.76 cm H2O vs. 43.84±6.87 cm H2O, respectively; P=0.012) and voiding efficiency (0.87±0.02 vs. 0.94±0.03, respectively; P=0.029).

Conclusion: Acotiamide showed effectiveness in the treatment of underactive bladder, possibly through activation of bladder afferent and detrusor activities.

Purpose: Urinary incontinence (UI) is a significant complication following surgery for pelvic organ prolapse (POP), including laparoscopic sacrocolpopexy (LSC). Although the incidence of postoperative UI is lower after LSC than after transvaginal mesh surgery, a subset of patients still experience UI. This study aimed to determine which factors, including mesh-related factors, contribute to UI impairing daily life following LSC.

Methods: The study enrolled 96 patients who underwent LSC at our institution between June 2016 and September 2023. The Pearson chi-square test, multiple logistic regression analysis, and Cox proportional hazards model were used to determine the independent factors contributing to UI after LSC.

Results: The Pearson chi-square test showed that body mass index, POP quantification (POP-Q) stage 4 and the presence of preoperative UI significantly correlated with the postoperative UI among preoperative and intraoperative factors (all P<0.05). POP-Q stage 4 and the presence of preoperative UI were also significant factors in both univariate and multivariate analyses of multiple logistic regression analysis (all P<0.05). However, only preoperative UI remained an independent predictor for shorter time to UI onset in the multivariate Cox proportional hazards model (hazard ratio, 3.56; 95% confidence interval, 1.29-11.58; P=0.0158).

Conclusion: Patients with preoperative UI and stage 4 POP should receive close monitoring for postoperative UI.

Purpose: Urgency urinary incontinence (UUI) is a common finding in patients with a history of stroke or cerebrovascular accident (CVA). UUI is associated with impaired quality of life as well as increased morbidity, mortality, and need for institutionalization. Medical therapy is often limited by side effects and/or cost prohibitiveness. As a result, third-line therapy is often implemented. The objective is to determine the efficacy of sacral neuromodulation (SNM) and onabotulinum toxin (BTX) in the management of post-CVA UUI.

Methods: Retrospective analysis was performed to identify patients with post-CVA UUI who underwent SNM or BTX at a large academic medical center. The primary outcome was patient symptom response to third-line therapy. Treatment response was determined using the global response assessment scale. Patients reporting >50% improvement were categorized as having significant response. Secondary endpoints were proportion of patients achieving total dry and duration of therapy for those achieving significant response.

Results: One hundred seventy-seven patients were identified (95 BTX, 82 SNM). Patients in the BTX group were older (71.9 years vs. 67.4 years, P=0.02) with otherwise similar demographics. Rate of symptom improvement to >50% of baseline was similar between the groups (66% of BTX, 61% of SNM, P=0.46) as was rate of patients experiencing total dryness (24% of BTX, 16% of SNM, P=0.17). Among patients achieving significant improvement there was no difference in continuation of therapy between the BTX and SNM groups. Younger age was identified as a predictor of >50% symptom improvement (odds ratio, 0.96; P=0.04) and treatment discontinuation (hazard ratio, 0.97; P=0.04) in SNM. Most common adverse events were urinary tract infection in BTX (11%) and pain in SNM (4%).

Conclusion: BTX and SNM show roughly equal efficacy in the management of post-CVA UUI with nearly two-thirds of patients achieving significant benefit.

Purpose: Gold-standard urodynamic examination is widely used in the diagnosis and treatment of lower urinary tract dysfunction. The purpose of urodynamic quality control is to standardize urodynamic examination and ensure its clinical reference value. In our study, we attempted to use a deep learning (DL) algorithm model, mainly for the recognition of typical urodynamic signal, to help physicians complete high-quality urodynamic examinations.

Methods: Urodynamic image data from 2 cohorts of adult patients with neurogenic bladder were used: (1) 300 patients with neurogenic bladder in our center from 2012 to 2018 (1,960 images used to train and validate the DL model); and (2) 100 patients with neurogenic bladder from 2020 to 2021 (695 images used to test the performance of the DL model). This resulted in a total of 2,655 images to train, validate and test the DL algorithm to predict the urdynamic signals.

Results: Yolov5l had the best detection performance and the highest comprehensive index score (F1, 0.81; mean average precision, 0.83). Our study is a retrospective single-center study, and the generalization ability of the model has not been verified.

Conclusion: DL algorithms can help operators identify typical urodynamic signals in real time, improve the interpretation and quality of urodynamic examination, and benefit patients.