International Neurourology Journal最新文献

Purpose: This study investigated urinary incontinence (UI) following holmium laser enucleation of the prostate (HoLEP), based on the postoperative period, type of UI, and severity according to prostate volume.

Methods: We analyzed prospectively collected data from patients who underwent HoLEP for benign prostatic hyperplasia at Seoul National University Hospital between January 2010 and June 2022. Patients were followed-up at 2 weeks, 3 months, and 6 months postoperatively. The patients were divided into 3 prostate volume groups: A (30-80 mL), B (81-120 mL), and C (>120 mL). We compared clinical outcomes and UI rates between the groups.

Results: In total, 1,675 patients were included. The preoperative urgency UI (UUI) rate was 16.1%, with no significant difference between the groups (P=0.81). Two weeks postoperatively, the UUI rate was 6.0% (including a de novo UUI rate of 4.2%), with no significant differences between the groups. The stress UI (SUI) rate at 2 weeks postoperatively was 6.3%, and increased with larger prostate volume (P=0.04). The UUI and SUI rates decreased to 0.9% and 1.2%, respectively, 6 months postoperatively. Six months postoperatively, the SUI rate was significantly lower in group A (P=0.02), whereas the UUI rate did not differ between the groups (P=0.69).

Conclusion: Our results demonstrated that the preoperative UUI rate was high at baseline. Both the UUI and SUI rates continuously decreased up to 6 months postoperatively. Although the SUI rates significantly differed according to prostate volume, there was no significant difference in the UUI rate.

Purpose: This study aimed to investigate the potential role of obsessive-compulsive disorder (OCD), altered perception of bodily sensations, and somatization in the etiology of overactive bladder (OAB).

Methods: A total of 124 participants were included in the study. The case group consisted of 63 female patients diagnosed with OAB, and the control group comprised 61 age-matched healthy females. Demographic data were collected from all participants. All participants completed the OAB Questionnaire-V8 (OABQ-V8), Obsessive Beliefs Questionnaire-44 (OBQ-44), Body Sensations Questionnaire (BSQ), and Somatosensory Amplification Scale (SSAS).

Results: There were no statistically significant differences between the groups in terms of age, education, or marital status. The OAB group demonstrated significantly higher scores on the OABQ-V8, OBQ-44, BSQ, and SSAS. Furthermore, the OABQ-V8 score exhibited a significant positive correlation with the OBQ-44, BSQ, and SSAS scores.

Conclusion: This study offers a new perspective on the psychological aspects of OAB, suggesting that OAB symptoms may result from heightened bodily sensations and subsequent somatization associated with OCD.

Purpose: Cystoscopic intravesical onabotulinumtoxinA injection is a safe and effective minimally invasive treatment for refractory overactive bladder. While the procedure can be performed in outpatient clinics under local anesthetic, some clinicians still use sedation or general anesthesia in an operating theatre. Our study aimed to assess acceptability of intravesical onabotulinumtoxinA injection versus widely accepted diagnostic cystoscopy in the outpatient setting via the medium of patient experience.

Methods: A 16-item patient experience survey was administered following diagnostic cystoscopy or intravesical onabotulinumtoxinA injection in an outpatient clinic. Both procedures were performed using a flexible cystoscope with local anesthetic gel. A visual analogue scale (VAS) assessed intraprocedure pain. Dichotomous questions assessed whether significant pain or postprocedure symptoms were experienced and if these required medical attention. A free-text question assessed which symptoms had occurred.

Results: One hundred responses from 188 patients were received (53.2% response rate). Sixty-eight patients underwent cystoscopic intravesical onabotulinumtoxinA injection and 32 diagnostic cystoscopy. Mean VAS scores were higher for onabotulinumtoxinA injection (24 of 100) than diagnostic cystoscopy (11 of 100) (P=0.002). VAS scores were higher among patients reporting preprocedure anxiety (31 of 100 vs. 14 of 100, P=0.0013). Twenty-four percent of onabotulinumtoxinA injection patients experienced symptoms postprocedure versus 41% for cystoscopy. Medical attention was sought more frequently in the diagnostic cystoscopy group (9.4% vs. 1.5%). Common symptoms following both procedures were dysuria, urinary frequency, urgency, abdominal pain and urine discoloration.

Conclusion: Cystoscopic intravesical injection of onabotulinumtoxinA appears more painful than diagnostic cystoscopy. However, as VAS scores were relatively low, this is unlikely to represent clinically significant discomfort burdensome to the patient. There were no significant complications postprocedure. Cystoscopic intravesical onabotulinumtoxinA injection is acceptable in an outpatient setting.

Purpose: We aimed to assess the clinical efficacy and safety of combining silodosin and solifenacin for overactive bladder (OAB) in females.

Methods: A retrospective analysis of 586 females with OAB was conducted. Patients received either combination therapy (silodosin 8 mg + solifenacin 5 mg) or monotherapy (solifenacin 5 mg) for 12 weeks. Baseline and follow-up assessments included the overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), voided volume (VV), and postvoid residual urine volume (PVR).

Results: Overall, 287 and 299 patients received combination therapy and monotherapy respectively. Both groups experienced significant improvements in OABSS and total IPSS after 12 weeks. The combination therapy group demonstrated a greater improvement in QoL compared to the monotherapy group (P=0.031). No significant differences were observed in Qmax or VV between the groups. However, the combination therapy group showed a significant reduction in PVR compared to the monotherapy group (P<0.001).

Conclusion: Combining silodosin with solifenacin significantly improved OAB symptoms and QoL in females. This combination therapy was particularly effective in reducing postvoid residual volume compared to solifenacin alone. These findings suggest that adding an alpha-blocker to antimuscarinic therapy can enhance OAB management and patient satisfaction.

Purpose: Neurogenic lower urinary tract dysfunction (NLUTD) is highly prevalent among patients with neurologic disorders. Some studies have demonstrated that implantable neuromodulation can improve symptoms of NLUTD. We seek to describe our experience with sacral and pudendal neuromodulation in patients with NLUTD.

Methods: A retrospective chart review of patients with "neurogenic bladder" ICD-9/10 (International Classification of Diseases, Ninth Revision/10th Revision) code was performed at a single institution. This included patients from 2008 to 2020 who underwent stage 1 neuromodulation trial. Demographic and clinical information was collected, including neurologic diagnosis, the character of patients' voiding symptoms, the presence or absence of fecal incontinence, the need for intermittent catheterization, and whether patients had sufficient (>50%) improvement in their symptoms to undergo stage 2 implantable pulse generator (IPG) placement.

Results: We identified 82 patients with neurologic diagnoses who underwent stage 1 neuromodulation. The most common diagnoses were diabetic cystopathy (17.07%), spinal surgery (17.07%), and spinal cord injury (12.20%). The most commonly reported symptoms were urinary urgency, and urge urinary incontinence. Overall, 59 patients (71.95%) advanced to stage 2 IPG placement including 72% of patients with sacral leads and 76% with pudendal leads.

Conclusion: Neuromodulation is feasible and effective in the treatment of NLUTD. Further investigation into its utilization is warranted.

Purpose: The aim of the study was to compare the results of radiofrequency (RF) thermotherapy and transurethral resection of the prostate (TURP) in patients who required benign prostatic obstruction (BPO) surgery and had storage symptoms.

Methods: The results of patients who had undergone TURP and RF thermotherapy procedures between December 2019 and 2022 were compared before and after the procedure. Patients' International Prostate Symptom Scores, maximum flow rate (Qmax), postvoiding residues, and overactive bladder validated 8 scores (OAB-V8) at 3 and 6 months were analyzed.

Results: While the preprocedural OAB-V8 in the RF thermotherapy group was 25.85, this score decreased to 18.12 (P<0.001) at the postprocedural 3rd month and 16.42 (P<0.001) at the postprocedural 6th month. While the preprocedural OAB-V8 score in TURP group was 23.26, it decreased to 20.17 (P<0.001) at the postprocedural 3rd month and 19.84 at the postprocedural 6th month, and there was no significant difference between the 3rd-month and 6th-month values (P=0.328). The proportion of de crease in the OAB-V8 scores was 30% at the 3rd month and 36% at the 6th month in the RF thermotherapy group, whereas it was 13% at the 3rd month and 15% at the 6th month in TURP group.

Conclusion: It was determined that RF thermotherapy was 2.35 times more effective than TURP on OAB-V8 scores. In addition to its acceptable effect on Qmax, its continued effect on storage symptoms at 6 months may be a significant advantage over the TURP. As a minimally invasive method, RF thermotherapy can be offered as a suitable option for BPO patients with storage symptoms.

Purpose: To compare voiding parameters in women with and without increased postvoid residual (PVR) volume, to correlate these parameters with PVR volume and PVR percentage, and to describe their ability to predict an increased PVR volume.

Methods: Retrospective cross-sectional study of urodynamics data prospectively acquired from consecutive symptomatic women over a 5-year period. Patients with spinal cord disorders and with abdominal straining during voiding (abdominal pressure ≥10 cm H2O over baseline at maximum flow rate [Qmax]) were excluded. Increased PVR volume was defined as ≥50 mL. Patients with and without increased PVR volume were matched by age, presence of urodynamic stress urinary incontinence and premicturition bladder volume. Female bladder outlet obstruction (BOO) index (female-BOOI), urethral resistance (UR), projected isovolumetric pressure 1 (PIP1), and relative BOO indexes (female-BOOI/PIP1 and UR/PIP1 ratios) were calculated. Linear regression analysis was applied to correlate the voiding indexes with PVR volume and PVR percentage. The area under the curve (AUC) of the receiver operating characteristic (ROC) analysis was calculated to describe diagnostic accuracy of these indexes for increased PVR volume.

Results: One-hundred ten women with mean age 65.9±13.7 (range, 20-87) years were included. All voiding parameters were significantly different between women with and without increased PVR volume, except for PIP1. Female-BOOI showed the best correlation with increased PVR volume (R2=0.2509, P<0.001) and PVR percentage (R2=0.3677, P<0.001). PIP1 showed no correlation. Relative BOOI indexes did not improve these correlations. ROC curve analyzes confirmed that female-BOOI and UR had good ability to predict increased PVR volume (AUC=0.841 and AUC=0.856, respectively).

Conclusion: PVR volume and PVR percentage correlated with BOO but not to detrusor contraction strength parameters in symptomatic women that void without abdominal straining. The results of this study contribute to the understanding of the pathophysiology of increased PVR volume in women.

Purpose: This study aimed to compare and analyze the feasibility and long-term efficacy of prostatic capsule-sparing (PCS) and nerve-sparing (NS) radical cystectomy in the treatment of bladder cancer.

Methods: From June 2004 to December 2021, our institution treated and followed 145 patients who underwent radical cystectomy with neobladder reconstruction for over a year. These patients were divided into 2 groups: PCS (n=74) and NS (n=71). To minimize potential biases, 1:1 propensity score matching was utilized to compare oncological outcomes, functional outcomes, and complications between the groups. Additionally, Kaplan-Meier analysis and the log-rank test were used to evaluate survival differences between the PCS and NS groups.

Results: The median follow-up durations for PCS and NS were 155 and 122 months, respectively. After adjusting for propensity scores, a total of 96 patients (48 in each group) were included for further analysis. Kaplan-Meier curves showed no statistically significant differences in metastasis-free probability (P=0.206), cancer-specific survival (P=0.091), and overall survival (P=0.208). The daytime urinary control (UC) rate at 3, 6, and 12 months postoperatively was 72.9%, 91.7%, and 97.9% in the PCS group and 47.9%, 79.2%, and 91.7% in the NS group, respectively (P=0.012, P=0.083, and P=0.362). The nocturnal UC rate was 54.2%, 85.4%, and 95.8% in the PCS group, and 31.3%, 60.4%, and 83.3% in the NS group, respectively (P=0.023, P=0.006, and P=0.091). Regarding erectile function recovery, 62.5% of patients in the PCS group and 22.9% in the NS group returned to preoperative levels (P<0.001).

Conclusion: PCS outperformed NS in restoring UC and sexual function and did not affect oncological outcomes. However, PCS was associated with a higher risk of complications linked to bladder-neck obstruction.