Journal of Urology最新文献

Objective: To characterize and compare the bacterial urinary microbiome in individuals with and without overactive bladder (OAB), and secondarily compare its composition by phenotype, comorbidities, recent antibiotic exposure, and therapeutic response.

Material and methods: We isolated DNA and metabolites from the urine of females without urologic diagnoses, and with OAB. Bacterial profiles were generated with 16S rRNA sequencing and metabolite profiles were generated with untargeted metabolomics. Alpha- and beta-diversity, relative abundance, and microbe-metabolite co-occurrence interaction networks were identified by OAB status and patient characteristics.

Results: One hundred fifty-two participants were included, and bacteria were identified in all urine samples. Bacilliota was the most abundant phylum and Lactobacillus, Escherichia, and Prevotella the most abundant genera in individuals without urologic conditions. Megasphaera and Scardovia were the primary genera more abundant in individuals without OAB than those with OAB (each: log₂-fold change [FC] -3.7 p<0.001). Escherichia (log₂-FC 5.9), Enterococcus (log₂-FC 3.5), and Proteus (log₂-FC 3.1) were the primary genera significantly more abundant in the urine of individuals with OAB than those without (p<0.001). Beta diversity differed between individuals with and without OAB and by diabetes mellitus status (p<0.05). Relative abundance of bacterial genera differed by OAB phenotype, diabetes mellitus status, recent antibiotic exposure, and response to OAB treatment (p<0.05). Microbe-metabolite interaction networks demonstrated central microbes and metabolites in the healthy and OAB states.

Conclusions: The study provides new understanding regarding the physiological bacterial composition of urine, as well as that in the context of OAB. Further, microbiota differed by patient phenotype, comorbidities, recent antibiotic exposure, and therapeutic response. The results inform strategies of microbiological modulation to augment existing therapeutic strategies.

Purpose: Combining fascial interposition and mucosal cautery while leaving the testicular end open (open-ended vasectomy) is an effective and recommended vasectomy occlusion technique. We compared the effectiveness and complication risks of this technique to performing fascial interposition alone without any mucosal cautery (double open-ended).

Materials and methods: We conducted a retrospective cohort study with historical and concomitant controls using the electronic records of 5,894 vasectomy patients at a private clinic in Vancouver, Canada. Two surgeons performed no-scalpel vasectomies using fascial interposition with a chromic gut suture and needle. The control group received mucosal cautery of the abdominal segment and fascial interposition covering the abdominal end, whereas the intervention group underwent fascial interposition only without any mucosal cautery. Occlusive effectiveness was assessed using the American Urological Association post-vasectomy semen analysis criteria. Complications were defined as in-person visits due to vasectomy-related concerns.

Results: Occlusion successes in patients with at least one post-vasectomy semen analysis were similar: 98.6% (2,092/2,122) with and 98.7% (1,754/1,777) without cautery (risk difference 0.1%, 95% confidence interval [CI] -0.7% to 0.9%, p=0.8). There was no significant difference in overall occlusive failure between the cautery (0.8%) and no cautery (0.4%) groups (adjusted relative risk [RR_adj] 0.52, 95% CI 0.20 to 1.22, p=0.2). Complication risks were comparable: 5.3% (182/3462) with cautery and 5.2% (127/2432) without cautery (RR_adj 0.95, 95% CI 0.76 to 1.19, p=0.7).

Conclusions: Fascial interposition with sutures and needle covering of the abdominal end without mucosal cautery (double open-ended) is an effective and safe vasectomy occlusion technique.

Purpose: Minimal data exist regarding awake cystoscopic injection of botulinum neurotoxin in pediatric patients with neurogenic bladders. We assess the feasibility and tolerability of awake bladder botulinum toxin injections in children with neurogenic bladders in a pediatric clinic.

Materials and methods: Retrospective chart review was conducted from 01/01/2018 to 09/30/2025 for all pediatric patients with neurogenic bladders who received awake bladder botulinum injections. Baseline characteristics, procedural details, patients' tolerability, and subsequent awake injections were collected.

Results: We identified 48 patients (25 male, 23 female) and a total of 174 awake bladder botulinum injection encounters. The median age at first awake injection was 10.5 years (interquartile range 7.4, range 2-21). Thirteen patients had cognitive delay and 6 had behavioral or mental health conditions. Forty-seven patients (98%) tolerated their first awake injection well and proceeded with subsequent injections. The median time between injections was 5 months (range: 3.1-17), with a median of 3 awake injections per patient (range 1-15). Seventeen patients eventually discontinued awake injections due to: anxiety or pain (n=5; median 3 injections, range: 2-6), lack of therapeutic response (n=4), having undergone urinary diversion (n=5), lost to follow-up (n=2), or unrelated death (n=1). One patient (2%) poorly tolerated the initial injection due to anxiety or pain and did not receive subsequent awake injections.

Conclusions: Children with neurogenic bladder can successfully undergo awake bladder botulinum toxin injections. The procedure is well tolerated and can be efficiently integrated into the workflow of the outpatient clinic setting.