Aim of this study was to evaluate the impact of transobturator vaginal tape (TVT-O) implant on Coital Incontinence (CI), using a specific questionnaire for CI, the “International Female Coital Incontinence- Questionnaire” (IFCI-Q).
Methods
TVT-O was performed on sexually active women diagnosed with urodynamic (UD) stress urinary incontinence (SUI), who also experienced CI with penetration and/or orgasm. At baseline patients underwent to medical history, UD, and VAS scale to assess the impact of CI on quality of life. The success rate for CI was assessed by the IFCI-Q. Follow- up evaluations were performed at 3, 6, and 12- months.
Results
Sixty women were enrolled. Mean (±SD) age was 52.8 ± 10.2 years. Patients underwent implantation of TVT-O. At 12-month follow-up, success rate was 91.6%. Comparison of pre- and post-operative IFCI scores revealed a significant improvement of the total IFCI score. At baseline 50/60 (83.3%) women complained of CI at penetration and 10/60 (16.7%) referred both types of CI. According to the IFCI-Q scores, at 3-, 6-, and 12-month follow-up a significant decrease in frequency of CI, an improvement in quality of intercourse, and in the psychological status of patients persisting over time were demonstrated. At 12-month follow-up, five patients complained of persistent mild SUI. VAS score statistically improved at 12 months follow-up.
Conclusion
This study demonstrated that the TVT-O procedure is an effective and secure treatment not only for SUI but also for CI. This is the first time that CI has been evaluated before and after the surgery using a validated questionnaire specifically designed for CI.
{"title":"Efficacy of Transobturator Vaginal Tape in the Treatment of Coital Incontinence: A Prospective Study Using a Condition-Specific Questionnaire","authors":"Marilena Gubbiotti, Chiara Gilli, Stefano Rosadi, Emanuele Rubilotta","doi":"10.1111/luts.70049","DOIUrl":"10.1111/luts.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Aim of this study was to evaluate the impact of transobturator vaginal tape (TVT-O) implant on Coital Incontinence (CI), using a specific questionnaire for CI, the “International Female Coital Incontinence- Questionnaire” (IFCI-Q).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>TVT-O was performed on sexually active women diagnosed with urodynamic (UD) stress urinary incontinence (SUI), who also experienced CI with penetration and/or orgasm. At baseline patients underwent to medical history, UD, and VAS scale to assess the impact of CI on quality of life. The success rate for CI was assessed by the IFCI-Q. Follow- up evaluations were performed at 3, 6, and 12- months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty women were enrolled. Mean (±SD) age was 52.8 ± 10.2 years. Patients underwent implantation of TVT-O. At 12-month follow-up, success rate was 91.6%. Comparison of pre- and post-operative IFCI scores revealed a significant improvement of the total IFCI score. At baseline 50/60 (83.3%) women complained of CI at penetration and 10/60 (16.7%) referred both types of CI. According to the IFCI-Q scores, at 3-, 6-, and 12-month follow-up a significant decrease in frequency of CI, an improvement in quality of intercourse, and in the psychological status of patients persisting over time were demonstrated. At 12-month follow-up, five patients complained of persistent mild SUI. VAS score statistically improved at 12 months follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrated that the TVT-O procedure is an effective and secure treatment not only for SUI but also for CI. This is the first time that CI has been evaluated before and after the surgery using a validated questionnaire specifically designed for CI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To quantitatively evaluate bladder morphological changes induced by fetal head descent during late pregnancy using transperineal ultrasonography (US) and to investigate the association with urinary incontinence (UI). This study aimed to introduce a novel, imaging-based approach for assessing pregnancy-related urinary dysfunction.
Methods
In this study, 14 women with singleton pregnancies beyond 36 weeks of gestation were evaluated. During routine antenatal visits, participants completed a validated questionnaire assessing urinary symptoms, and the bladder descent angle (BDA) was measured using transperineal US. The BDA was defined as the angle between the bladder base and the inferior margin of the pubic symphysis.
Results
UI was reported in 57.1% of participants, with stress urinary incontinence (SUI) being the most common subtype (62.5%). Ultrasonography revealed that BDA increased in late pregnancy. The SUI group exhibited a significantly greater BDA compared with the no-UI group (p = 0.03), whereas the overall UI group showed only a non-significant trend (p = 0.081).
Conclusions
The BDA assessed by transperineal US is considered a practical and simple marker for the evaluation of UI.
{"title":"Association Between Maternal Bladder Descent Angle and Urinary Incontinence in Late Pregnancy: A Transperineal Ultrasonography Study","authors":"Ryoko Minami, Yumiko Tateoka, Akihiro Kawauchi","doi":"10.1111/luts.70050","DOIUrl":"10.1111/luts.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To quantitatively evaluate bladder morphological changes induced by fetal head descent during late pregnancy using transperineal ultrasonography (US) and to investigate the association with urinary incontinence (UI). This study aimed to introduce a novel, imaging-based approach for assessing pregnancy-related urinary dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, 14 women with singleton pregnancies beyond 36 weeks of gestation were evaluated. During routine antenatal visits, participants completed a validated questionnaire assessing urinary symptoms, and the bladder descent angle (BDA) was measured using transperineal US. The BDA was defined as the angle between the bladder base and the inferior margin of the pubic symphysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>UI was reported in 57.1% of participants, with stress urinary incontinence (SUI) being the most common subtype (62.5%). Ultrasonography revealed that BDA increased in late pregnancy. The SUI group exhibited a significantly greater BDA compared with the no-UI group (<i>p</i> = 0.03), whereas the overall UI group showed only a non-significant trend (<i>p</i> = 0.081).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The BDA assessed by transperineal US is considered a practical and simple marker for the evaluation of UI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12866369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to examine the relationship between nocturia and anticholinergic burden.
Methods
The female participants aged ≥ 65 years who presented to the outpatient geriatric clinic between November 2022 and January 2025 were retrospectively reviewed. Nocturia was defined as waking up from bed at night for urination at least twice per night. All participants underwent a comprehensive geriatric assessment (CGA). Demographic characteristics, comorbidities, geriatric syndromes, laboratory findings, and CGA parameters were recorded.
Results
Of 422 total patients, nocturia was present in 65.9% of them. Patients with nocturia were older (p = 0.021) and had higher rates of coronary artery disease (p = 0.036) heart failure (p = 0.002), and chronic lung disease (p = 0.046). Recurrent falls (p = 0.005), polypharmacy (p < 0.001), depression (p < 0.001), and lower gait-balance (p = 0.033) and activities of daily living scores (p < 0.001) were more frequent in the nocturia group. The proportion of patients with a high anticholinergic burden (Anticholinergic Cognitive Burden [ACB] score ≥ 3) was significantly higher in those with nocturia (p = 0.024). There was a significant association between high ACB scores and nocturia, independent of age (OR = 1.69; 95% CI: 1.05–2.69; p = 0.028), comorbidities (OR = 1.60; 95% CI: 1.01–2.60; p = 0.048), and laboratory parameters (OR = 1.63; 95% CI: 1.01–2.60; p = 0.046).
Conclusions
Our findings suggest that a higher anticholinergic burden is independently associated with nocturia in older female adults. Clinicians should be alert to anticholinergic burden as a modifiable factor in the management of nocturia in older female patients and consider deprescribing when appropriate.
{"title":"A High Anticholinergic Burden Is Independently Associated With Nocturia in Turkish Older Women","authors":"Yılmaz Onal, Suleyman Emre Kocyigit","doi":"10.1111/luts.70048","DOIUrl":"10.1111/luts.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to examine the relationship between nocturia and anticholinergic burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The female participants aged ≥ 65 years who presented to the outpatient geriatric clinic between November 2022 and January 2025 were retrospectively reviewed. Nocturia was defined as waking up from bed at night for urination at least twice per night. All participants underwent a comprehensive geriatric assessment (CGA). Demographic characteristics, comorbidities, geriatric syndromes, laboratory findings, and CGA parameters were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 422 total patients, nocturia was present in 65.9% of them. Patients with nocturia were older (<i>p</i> = 0.021) and had higher rates of coronary artery disease (<i>p</i> = 0.036) heart failure (<i>p</i> = 0.002), and chronic lung disease (<i>p</i> = 0.046). Recurrent falls (<i>p</i> = 0.005), polypharmacy (<i>p</i> < 0.001), depression (<i>p</i> < 0.001), and lower gait-balance (<i>p</i> = 0.033) and activities of daily living scores (<i>p</i> < 0.001) were more frequent in the nocturia group. The proportion of patients with a high anticholinergic burden (Anticholinergic Cognitive Burden [ACB] score ≥ 3) was significantly higher in those with nocturia (<i>p</i> = 0.024). There was a significant association between high ACB scores and nocturia, independent of age (OR = 1.69; 95% CI: 1.05–2.69; <i>p</i> = 0.028), comorbidities (OR = 1.60; 95% CI: 1.01–2.60; <i>p</i> = 0.048), and laboratory parameters (OR = 1.63; 95% CI: 1.01–2.60; <i>p</i> = 0.046).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that a higher anticholinergic burden is independently associated with nocturia in older female adults. Clinicians should be alert to anticholinergic burden as a modifiable factor in the management of nocturia in older female patients and consider deprescribing when appropriate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Casper Vrij, John Heesakkers, Evert Jan Van Limbergen, Jan-Erik Palmgren, Mathie Leers, Marc de Jong, Dennis Oerlemans, Harman Maxim Bruins, Tom Marcellissen, Kevin Rademakers, Peter de Vries, Elisabeth J. M. Driessen, Frits van Osch, Franchette van den Berkmortel, Joep van Roermund, Tom Hermans
The effects of prostate radiotherapy (external beam radiation therapy (EBRT) and brachytherapy (BRT)) on urinary adverse events (UAEs), lower urinary tract function, and quality of life were examined in this scoping review. PubMed, Cochrane, and Embase (OVID) were used to identify relevant articles. We discuss the results of 23 studies. Included studies showed that UAEs are common after prostate radiation therapy. Across modalities, approximately one third experience acute events (Grade ≥ 2 median 36% for both EBRT and BRT), while one quarter experience late events (Grade ≥ 2 median 20% for EBRT and 26% for BRT). These estimates vary by UAE grading definitions and study designs. In the long term, patients with mild lower urinary tract symptoms (LUTS) report minimal improvement or worsening of urinary function after radiotherapy. Patients with moderate to severe baseline LUTS experience improvement in general but continue to experience bothersome LUTS. The limited urodynamic data show a similar pattern in which peak flow rate declines and post-void residual increases in the short term but return to baseline after long-term follow-up. These findings underscore the need for additional research to improve patient management and selection, and thereby improve genitourinary toxicity, function, and quality of life with contemporary radiotherapy techniques.
{"title":"Genitourinary Toxicity, Function, and Quality of Life in Patients Undergoing Prostate Radiation Therapy—A Scoping Review","authors":"Casper Vrij, John Heesakkers, Evert Jan Van Limbergen, Jan-Erik Palmgren, Mathie Leers, Marc de Jong, Dennis Oerlemans, Harman Maxim Bruins, Tom Marcellissen, Kevin Rademakers, Peter de Vries, Elisabeth J. M. Driessen, Frits van Osch, Franchette van den Berkmortel, Joep van Roermund, Tom Hermans","doi":"10.1111/luts.70046","DOIUrl":"10.1111/luts.70046","url":null,"abstract":"<p>The effects of prostate radiotherapy (external beam radiation therapy (EBRT) and brachytherapy (BRT)) on urinary adverse events (UAEs), lower urinary tract function, and quality of life were examined in this scoping review. PubMed, Cochrane, and Embase (OVID) were used to identify relevant articles. We discuss the results of 23 studies. Included studies showed that UAEs are common after prostate radiation therapy. Across modalities, approximately one third experience acute events (Grade ≥ 2 median 36% for both EBRT and BRT), while one quarter experience late events (Grade ≥ 2 median 20% for EBRT and 26% for BRT). These estimates vary by UAE grading definitions and study designs. In the long term, patients with mild lower urinary tract symptoms (LUTS) report minimal improvement or worsening of urinary function after radiotherapy. Patients with moderate to severe baseline LUTS experience improvement in general but continue to experience bothersome LUTS. The limited urodynamic data show a similar pattern in which peak flow rate declines and post-void residual increases in the short term but return to baseline after long-term follow-up. These findings underscore the need for additional research to improve patient management and selection, and thereby improve genitourinary toxicity, function, and quality of life with contemporary radiotherapy techniques.</p>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nocturnal polyuria (NP) with urinary incontinence increases the risk of sleep disturbance, incontinence-associated dermatitis, and urinary tract infection. Factors associated with NP in older adults receiving enteral nutrition (EN) have not been clearly identified. This study aimed to evaluate the direct and indirect associations between NP and related factors in older adults receiving EN in medical long-term care hospitals (MLTCHs).
Methods
This cross-sectional observational study enrolled men and women aged 65 years or older, hospitalized at MLTCHs, and receiving EN. Participants underwent 72-h urine monitoring and multiple clinical assessments, including body composition. Structural equation modeling was used to explore associations with nocturnal urinary volume (NUV), with extensive model modifications based on data patterns.
Results
In total, 101 participants (43 men) with a median age of 86 years were included. The NP model showed an excellent fit (CFI = 1.00, RMSEA = 0.00, SRMR = 0.09) and explained 29% of the variance in NUV; however, this was not statistically significant (p = 0.16). Significant direct associations with NUV were observed for fluid and salt intake, sex, serum sodium, fat-free mass, and diuretic use. Estimated glomerular filtration rate, body mass index, age, and the change in extracellular water volume from night to morning also showed non-significant but theoretically relevant direct associations. Indirect associations were observed for nocturnal systolic blood pressure, protein intake, and fasting blood glucose.
Conclusions
NUV in older adults receiving EN in an MLTCH was complexly associated with multiple factors. This study suggests future research directions for comprehensive evaluation indices of NP.
{"title":"Model of Nocturnal Polyuria in Older Japanese Adults Receiving Enteral Nutrition in Medical Long-Term Care Hospitals: An Exploratory Cross-Sectional Study","authors":"Madoka Takimoto, Tamami Taniguchi","doi":"10.1111/luts.70044","DOIUrl":"10.1111/luts.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Nocturnal polyuria (NP) with urinary incontinence increases the risk of sleep disturbance, incontinence-associated dermatitis, and urinary tract infection. Factors associated with NP in older adults receiving enteral nutrition (EN) have not been clearly identified. This study aimed to evaluate the direct and indirect associations between NP and related factors in older adults receiving EN in medical long-term care hospitals (MLTCHs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional observational study enrolled men and women aged 65 years or older, hospitalized at MLTCHs, and receiving EN. Participants underwent 72-h urine monitoring and multiple clinical assessments, including body composition. Structural equation modeling was used to explore associations with nocturnal urinary volume (NUV), with extensive model modifications based on data patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 101 participants (43 men) with a median age of 86 years were included. The NP model showed an excellent fit (CFI = 1.00, RMSEA = 0.00, SRMR = 0.09) and explained 29% of the variance in NUV; however, this was not statistically significant (<i>p</i> = 0.16). Significant direct associations with NUV were observed for fluid and salt intake, sex, serum sodium, fat-free mass, and diuretic use. Estimated glomerular filtration rate, body mass index, age, and the change in extracellular water volume from night to morning also showed non-significant but theoretically relevant direct associations. Indirect associations were observed for nocturnal systolic blood pressure, protein intake, and fasting blood glucose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>NUV in older adults receiving EN in an MLTCH was complexly associated with multiple factors. This study suggests future research directions for comprehensive evaluation indices of NP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/luts.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To explore the independent and combined effects of vitamin D status and physical activity on urinary flow rate (UFR), a key indicator of voiding function.
Methods
We analyzed data from 17 670 participants in the National Health and Nutrition Examination Survey (2009–2016). Physical activity status was assessed via self-reported weekly moderate-to-vigorous recreational activity. Vitamin D status was evaluated by measuring total serum 25-hydroxyvitamin D [25(OH)D] levels. Weighted linear regression models and restricted cubic spline (RCS) regression models were used to examine associations between serum 25(OH)D, physical activity, and UFR. An XGBoost model was applied to assess variable importance. Stratified analyses and interaction tests were performed to assess the combined effects of serum 25(OH)D and physical activity on UFR.
Results
Higher serum 25(OH)D levels were significantly associated with increased UFR. RCS analysis indicated a nonlinear relationship between serum 25(OH)D and UFR (p for nonlinear = 0.0426). Active physical activity was positively associated with UFR (β = 0.085, 95% CI: 0.053–0.116, p < 0.001). XGBoost model confirmed serum 25(OH)D and physical activity as key predictors of UFR. A significant interaction was observed between serum 25(OH)D levels and physical activity status in relation to UFR. Stratified analyses revealed a stronger positive linear association between serum 25(OH)D and UFR in participants with active or vigorous physical activity, while an inverted L-shaped relationship was found in the inactive group.
Conclusions
Higher serum 25(OH)D levels were associated with increased UFR, particularly when combined with active or vigorous physical activity. These findings provide a scientific foundation for developing integrated interventions that combine nutritional supplementation and physical activity to manage lower urinary tract symptoms.
目的探讨维生素D水平和体力活动对尿流率（UFR）的独立和联合影响。UFR是排尿功能的关键指标。方法分析2009-2016年全国健康与营养调查（National Health and Nutrition Examination Survey）中17670名参与者的数据。通过自我报告每周中度至剧烈的娱乐活动来评估身体活动状况。通过测定血清总25-羟基维生素D [25(OH)D]水平来评估维生素D状态。使用加权线性回归模型和限制三次样条（RCS）回归模型来检验血清25(OH)D、身体活动和UFR之间的关系。采用XGBoost模型评估变量重要性。采用分层分析和相互作用试验来评估血清25(OH)D和体力活动对UFR的联合影响。结果血清25(OH)D水平升高与UFR升高有显著相关性。RCS分析显示血清25(OH)D与UFR之间存在非线性关系（非线性p = 0.0426）。积极的体力活动与UFR呈正相关（β = 0.085, 95% CI: 0.053-0.116, p < 0.001）。XGBoost模型证实血清25(OH)D和体力活动是UFR的关键预测因子。血清25(OH)D水平与身体活动状态之间存在显著的相互作用。分层分析显示，在积极或剧烈运动的参与者中，血清25(OH)D与UFR之间存在更强的正线性关联，而在不运动的参与者中，血清25(OH)D与UFR之间存在倒l型关系。结论：较高的血清25(OH)D水平与UFR升高有关，特别是与积极或剧烈的体育锻炼相结合时。这些发现为制定综合干预措施提供了科学基础，将营养补充和身体活动结合起来，以控制下尿路症状。
{"title":"Combined Effect of Vitamin D Status and Physical Activity on Urinary Flow Rate: A Cross-Sectional Study","authors":"Jie Gao, Yunran Wang, Jieqiong Ren, Kefang Wang","doi":"10.1111/luts.70045","DOIUrl":"https://doi.org/10.1111/luts.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To explore the independent and combined effects of vitamin D status and physical activity on urinary flow rate (UFR), a key indicator of voiding function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from 17 670 participants in the National Health and Nutrition Examination Survey (2009–2016). Physical activity status was assessed via self-reported weekly moderate-to-vigorous recreational activity. Vitamin D status was evaluated by measuring total serum 25-hydroxyvitamin D [25(OH)D] levels. Weighted linear regression models and restricted cubic spline (RCS) regression models were used to examine associations between serum 25(OH)D, physical activity, and UFR. An XGBoost model was applied to assess variable importance. Stratified analyses and interaction tests were performed to assess the combined effects of serum 25(OH)D and physical activity on UFR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher serum 25(OH)D levels were significantly associated with increased UFR. RCS analysis indicated a nonlinear relationship between serum 25(OH)D and UFR (<i>p</i> for nonlinear = 0.0426). Active physical activity was positively associated with UFR (<i>β</i> = 0.085, 95% CI: 0.053–0.116, <i>p</i> < 0.001). XGBoost model confirmed serum 25(OH)D and physical activity as key predictors of UFR. A significant interaction was observed between serum 25(OH)D levels and physical activity status in relation to UFR. Stratified analyses revealed a stronger positive linear association between serum 25(OH)D and UFR in participants with active or vigorous physical activity, while an inverted L-shaped relationship was found in the inactive group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher serum 25(OH)D levels were associated with increased UFR, particularly when combined with active or vigorous physical activity. These findings provide a scientific foundation for developing integrated interventions that combine nutritional supplementation and physical activity to manage lower urinary tract symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mario Henrique Bitar Siqueira, Sagi Shprits, Naeem Bhojani, Bilal Chughtai, Kevin C. Zorn, Luca Cindolo, Giovanni Ferrari, Katherine Lajkosz, Dean Elterman
Objectives
Rezūm water vapor thermal therapy is a minimally invasive surgical option with demonstrated efficacy and safety. However, real-world evidence on 2-year outcomes in the population aged above 80 years remains limited.
Methods
A prospective registry was created as part of the International Rezūm Registry database at two high-volume centers. Data were reviewed from patients monitored between April 2019 and August 2024. Men aged ≥ 80 years who underwent Rezūm therapy were included. Baseline and follow-up assessments at 3, 6, 12, and 24 months included International Prostate Symptom Score (IPSS), IPSS Quality of Life (QoL) subscore, peak urinary flow rate (Qmax), and post-void residual volume (PVR). Safety outcomes and adverse events were also recorded.
Results
Fifty-eight patients (mean age 84.4 ± 4.4 years) were included, with a mean prostate volume of 80.1 ± 42.1 cc. The mean IPSS decreased from 19.8 ± 7.4 at baseline to 12.4 ± 7.9 at 24 months. The IPSS quality of life (QoL) score declined from 4.2 ± 1.8 at baseline to 2.6 ± 1.5 at the corresponding follow-up interval. Qmax improved from 8.5 ± 5.8 mL/s at baseline to 15.0 ± 4.0 mL/s at 24 months, respectively. PVR was reduced from 115.5 ± 93.7 mL at baseline to 42.8 ± 29.2 mL over the same period. However, neither Qmax nor PVR demonstrated a statistically significant change at any time point. Adverse events were infrequent, with urinary tract infections (8.6%), epididymitis (5.2%), and acute urinary retention (3.4%). Only one patient required hospitalization.
Conclusion
Rezūm water vapor thermal therapy is a safe and effective treatment for BPH in patients over 80 years of age. It results in durable improvements in urinary symptoms and function with a low rate of complications.
{"title":"Rezūm Therapy in Very Elderly Men With BPH: Two-Year Outcomes From a Multicenter Cohort","authors":"Mario Henrique Bitar Siqueira, Sagi Shprits, Naeem Bhojani, Bilal Chughtai, Kevin C. Zorn, Luca Cindolo, Giovanni Ferrari, Katherine Lajkosz, Dean Elterman","doi":"10.1111/luts.70043","DOIUrl":"10.1111/luts.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Rezūm water vapor thermal therapy is a minimally invasive surgical option with demonstrated efficacy and safety. However, real-world evidence on 2-year outcomes in the population aged above 80 years remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective registry was created as part of the International Rezūm Registry database at two high-volume centers. Data were reviewed from patients monitored between April 2019 and August 2024. Men aged ≥ 80 years who underwent Rezūm therapy were included. Baseline and follow-up assessments at 3, 6, 12, and 24 months included International Prostate Symptom Score (IPSS), IPSS Quality of Life (QoL) subscore, peak urinary flow rate (Qmax), and post-void residual volume (PVR). Safety outcomes and adverse events were also recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-eight patients (mean age 84.4 ± 4.4 years) were included, with a mean prostate volume of 80.1 ± 42.1 cc. The mean IPSS decreased from 19.8 ± 7.4 at baseline to 12.4 ± 7.9 at 24 months. The IPSS quality of life (QoL) score declined from 4.2 ± 1.8 at baseline to 2.6 ± 1.5 at the corresponding follow-up interval. Qmax improved from 8.5 ± 5.8 mL/s at baseline to 15.0 ± 4.0 mL/s at 24 months, respectively. PVR was reduced from 115.5 ± 93.7 mL at baseline to 42.8 ± 29.2 mL over the same period. However, neither Qmax nor PVR demonstrated a statistically significant change at any time point. Adverse events were infrequent, with urinary tract infections (8.6%), epididymitis (5.2%), and acute urinary retention (3.4%). Only one patient required hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Rezūm water vapor thermal therapy is a safe and effective treatment for BPH in patients over 80 years of age. It results in durable improvements in urinary symptoms and function with a low rate of complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"18 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate in detail whether well-controlled diabetes mellitus (DM) without neuropathy, retinopathy, or nephropathy affects lower urinary tract symptoms (LUTS) and function.
Methods
Of treatment-naïve men with LUTS, those with DM but with good glycemic control (hemoglobin A1c [HbA1c] < 7.0%) and no obvious DM-related complications were included in the DM group. The patients matched to the DM group for backgrounds that might affect lower urinary tract function, including age and prostate volume, were set as the non-DM group, and urodynamic parameters were compared between the groups. In addition, clinical factors associated with bladder dysfunction were examined within the DM group.
Results
A total of 139 men were included in each group (DM group: mean age 73.3 years, prostate volume 38.8 mL, HbA1c 6.6%, DM duration 122 months). Although bladder outlet obstruction index did not differ significantly between the two groups, bladder voiding efficiency, maximum flow rate, and bladder contractility index were significantly lower in the DM group. Notably, the proportion of patients with detrusor underactivity (DU) was significantly higher in the DM group (41.7% vs. 25.9%, p = 0.005). Furthermore, in the DM group, a longer duration of DM and smaller prostate size were significant factors associated with the development of DU.
Conclusions
A significant decrease in detrusor contractility was observed in men with DM even with good glucose control. Among men with LUTS, even with well-controlled DM, those with a longer disease duration and smaller prostate size are at a high risk of LUTS due to bladder dysfunction.
Trial Registration
UMIN000056036
目的：详细探讨无神经病变、视网膜病变或肾病的控制良好的糖尿病（DM）是否影响下尿路症状和功能。方法：treatment-naïve合并糖尿病但血糖控制良好的LUTS男性（血红蛋白A1c [HbA1c]）。结果：每组共纳入139例男性（糖尿病组：平均年龄73.3岁，前列腺体积38.8 mL, HbA1c 6.6%，糖尿病持续时间122个月）。两组膀胱出口阻塞指数无显著差异，但DM组膀胱排尿效率、最大流量、膀胱收缩指数明显低于DM组。值得注意的是，DM组患者逼尿肌活动不足（DU）的比例明显高于DM组（41.7% vs. 25.9%, p = 0.005）。此外，在DM组中，DM持续时间较长和前列腺体积较小是DU发生的重要因素。结论：即使血糖控制良好，糖尿病患者的逼尿肌收缩力也明显下降。在LUTS患者中，即使DM控制良好，病程较长且前列腺体积较小的患者由于膀胱功能障碍而发生LUTS的风险较高。试验注册号：UMIN000056036。
{"title":"Hidden Bladder Dysfunction in Well-Controlled Diabetes: A Urodynamic Study of Men With Lower Urinary Tract Symptoms","authors":"Yoshihisa Matsukawa, Shun Takai, Tsuyoshi Majima, Yushi Naito, Shohei Ishida, Tomokazu Kimura, Momokazu Gotoh, Shusuke Akamatsu","doi":"10.1111/luts.70042","DOIUrl":"10.1111/luts.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate in detail whether well-controlled diabetes mellitus (DM) without neuropathy, retinopathy, or nephropathy affects lower urinary tract symptoms (LUTS) and function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Of treatment-naïve men with LUTS, those with DM but with good glycemic control (hemoglobin A1c [HbA1c] < 7.0%) and no obvious DM-related complications were included in the DM group. The patients matched to the DM group for backgrounds that might affect lower urinary tract function, including age and prostate volume, were set as the non-DM group, and urodynamic parameters were compared between the groups. In addition, clinical factors associated with bladder dysfunction were examined within the DM group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 139 men were included in each group (DM group: mean age 73.3 years, prostate volume 38.8 mL, HbA1c 6.6%, DM duration 122 months). Although bladder outlet obstruction index did not differ significantly between the two groups, bladder voiding efficiency, maximum flow rate, and bladder contractility index were significantly lower in the DM group. Notably, the proportion of patients with detrusor underactivity (DU) was significantly higher in the DM group (41.7% vs. 25.9%, <i>p</i> = 0.005). Furthermore, in the DM group, a longer duration of DM and smaller prostate size were significant factors associated with the development of DU.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A significant decrease in detrusor contractility was observed in men with DM even with good glucose control. Among men with LUTS, even with well-controlled DM, those with a longer disease duration and smaller prostate size are at a high risk of LUTS due to bladder dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>UMIN000056036</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ischaemia has been considered a primary cause of lower urinary tract symptoms (LUTS). The existing concept is that ischaemic LUTS develops subsequent to structural narrowing of feeder arteries of the LUT due to atherosclerosis. However, the distribution of blood flow within each LUT organ that is regulated by intramural microvasculature should also be considered. Thus, the blood supply of the mucosal and detrusor smooth muscle (DSM) in the bladder and the blood flow of the mucosal, smooth muscle and striated muscle in the urethra need to be adjusted to meet their differing energy consumption. Sympathetic overdrive that is commonly seen in aged populations and patients with metabolic syndrome enhances arteriolar constrictions resulting in a disturbed intramural flow distribution so that cell populations with a higher energy demand are more readily affected. In addition to endothelial nitric oxide (NO) that plays a pivotal role in regulating vasocontractility, NO released from perivascular parasympathetic nerves appears to counteract sympathetic activity (sympatholysis) in the LUT. Thus, any diminished neuronally released NO would cause sympathetic overactivity. Capillary rarefaction, the reduced density/function of capillaries, the site of blood-tissue exchange, would also be critically involved in the pathogenesis of LUTS. In the bladder, capillary pericytes appear to function as pacemaker cells driving arteriolar vasomotion facilitating capillary perfusion and may also play a role in maintaining suburothelial homeostasis. Considering the fundamental roles of the intramural microvasculature in maintaining LUT functions, enhanced NO-mediated sympatholysis and/or capillary revascularization could have therapeutic and preventive potential for the ischaemic LUT.
{"title":"Intramural Blood Vessels as a Primary Site of Vascular LUTS","authors":"Hikaru Hashitani, Retsu Mitsui","doi":"10.1111/luts.70041","DOIUrl":"10.1111/luts.70041","url":null,"abstract":"<p>Ischaemia has been considered a primary cause of lower urinary tract symptoms (LUTS). The existing concept is that ischaemic LUTS develops subsequent to structural narrowing of feeder arteries of the LUT due to atherosclerosis. However, the distribution of blood flow within each LUT organ that is regulated by intramural microvasculature should also be considered. Thus, the blood supply of the mucosal and detrusor smooth muscle (DSM) in the bladder and the blood flow of the mucosal, smooth muscle and striated muscle in the urethra need to be adjusted to meet their differing energy consumption. Sympathetic overdrive that is commonly seen in aged populations and patients with metabolic syndrome enhances arteriolar constrictions resulting in a disturbed intramural flow distribution so that cell populations with a higher energy demand are more readily affected. In addition to endothelial nitric oxide (NO) that plays a pivotal role in regulating vasocontractility, NO released from perivascular parasympathetic nerves appears to counteract sympathetic activity (sympatholysis) in the LUT. Thus, any diminished neuronally released NO would cause sympathetic overactivity. Capillary rarefaction, the reduced density/function of capillaries, the site of blood-tissue exchange, would also be critically involved in the pathogenesis of LUTS. In the bladder, capillary pericytes appear to function as pacemaker cells driving arteriolar vasomotion facilitating capillary perfusion and may also play a role in maintaining suburothelial homeostasis. Considering the fundamental roles of the intramural microvasculature in maintaining LUT functions, enhanced NO-mediated sympatholysis and/or capillary revascularization could have therapeutic and preventive potential for the ischaemic LUT.</p>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12611186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to evaluate the perioperative safety and functional outcomes of high-power holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and long-term indwelling urinary catheter (IUC) use, with a specific focus on the impact of catheter duration on postoperative outcomes.
Methods
A retrospective analysis was conducted on 380 patients who underwent HoLEP between 2016 and 2022, stratified into two groups based on catheter duration: long-term (≥ 28 days; Group 1) and short-term catheterization (Group 2). Demographic, intraoperative, and follow-up data were collected. Functional outcomes, including International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual (PVR), were assessed preoperatively and during follow-up at 3 and 12 months.
Results
Both groups demonstrated significant and sustained improvement in voiding function and symptom scores following HoLEP. Although perioperative metrics, such as operative time, hospital stay, and catheter removal time, were comparable, Group 1 had longer enucleation times (p = 0.02). No difference in postoperative complication rate was noted. At 3 months, Group 2 exhibited superior symptom relief (IPSS: 10 vs. 12, p = 0.01), though Qmax and PVR were similar. No patients in either group required re-catheterization postoperatively. By 12 months, functional outcomes converged between groups. Multivariate analysis showed that catheter duration predicted poorer symptomatic recovery one year after surgery (OR 0.786, p < 0.001).
Conclusion
HoLEP is effective and safe for patients with BPH and preoperative catheterization. However, prolonged catheterization negatively impacts early symptom recovery. Early surgical intervention should be considered to optimize long-term outcomes and prevent catheter-related complications.
目的：本研究旨在评估高功率钬激光前列腺摘除（HoLEP）治疗良性前列腺增生（BPH）患者长期留置导尿管（IUC）的围手术期安全性和功能结局，特别关注导尿管持续时间对术后预后的影响。方法：回顾性分析2016年至2022年期间380例HoLEP患者，根据导管持续时间分为长期（≥28天）组和短期（2组）组。收集人口统计学、术中及随访资料。术前及随访3个月和12个月时评估功能结局，包括国际前列腺症状评分（IPSS）、最大尿流率（Qmax）和空腔残留（PVR）。结果：两组在HoLEP治疗后，排尿功能和症状评分均有显著且持续的改善。虽然围手术期指标，如手术时间、住院时间和拔管时间具有可比性，但第1组的去核时间更长（p = 0.02）。两组术后并发症发生率无差异。在3个月时，2组表现出更好的症状缓解（IPSS: 10 vs. 12, p = 0.01），尽管Qmax和PVR相似。两组患者均无需术后再置管。到12个月时，两组之间的功能结果趋于一致。多因素分析显示，导管持续时间预测术后1年症状恢复较差（OR 0.786, p）。结论：HoLEP对BPH患者术前置管有效且安全。然而，延长导尿时间会对早期症状的恢复产生负面影响。应考虑早期手术干预以优化长期预后并预防导管相关并发症。
{"title":"Impact of Preoperative Catheter Duration on Perioperative Safety and Functional Outcomes Following Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia: Results From a Single-Center Series","authors":"Carlo Giulioni, Federico Falsetti, Matteo Tallè, Alessio Papaveri, Francesco Mengoni, Roberto Orciani, Valentina Maurizi, Felice Crocetto, Daniele Castellani, Vineet Gauhar, Angelo Cafarelli","doi":"10.1111/luts.70039","DOIUrl":"10.1111/luts.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to evaluate the perioperative safety and functional outcomes of high-power holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and long-term indwelling urinary catheter (IUC) use, with a specific focus on the impact of catheter duration on postoperative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 380 patients who underwent HoLEP between 2016 and 2022, stratified into two groups based on catheter duration: long-term (≥ 28 days; Group 1) and short-term catheterization (Group 2). Demographic, intraoperative, and follow-up data were collected. Functional outcomes, including International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual (PVR), were assessed preoperatively and during follow-up at 3 and 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both groups demonstrated significant and sustained improvement in voiding function and symptom scores following HoLEP. Although perioperative metrics, such as operative time, hospital stay, and catheter removal time, were comparable, Group 1 had longer enucleation times (<i>p</i> = 0.02). No difference in postoperative complication rate was noted. At 3 months, Group 2 exhibited superior symptom relief (IPSS: 10 vs. 12, <i>p</i> = 0.01), though Qmax and PVR were similar. No patients in either group required re-catheterization postoperatively. By 12 months, functional outcomes converged between groups. Multivariate analysis showed that catheter duration predicted poorer symptomatic recovery one year after surgery (OR 0.786, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HoLEP is effective and safe for patients with BPH and preoperative catheterization. However, prolonged catheterization negatively impacts early symptom recovery. Early surgical intervention should be considered to optimize long-term outcomes and prevent catheter-related complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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