LUTS: Lower Urinary Tract Symptoms最新文献

Definition Change and Update of Clinical Guidelines for Interstitial Cystitis and Bladder Pain Syndrome 间质性膀胱炎和膀胱疼痛综合征的定义变更和临床指南更新

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-09-12 DOI: 10.1111/luts.12532

Yukio Homma, Yoshiyuki Akiyama, Jang Hwan Kim, Yao-Chi Chuang, Seong Jin Jeong, En Meng, Takeya Kitta, Jia-Fong Jhang, Akira Furuta, Kyu-Sung Lee, Daichi Maeda

The clinical guidelines for interstitial cystitis (IC) and bladder pain syndrome (BPS) have been revised by updating our previous guidelines. The symptoms of IC and BPS, collectively called as hypersensitive bladder (HSB) symptoms, are virtually indistinguishable between IC and BPS; however, IC and BPS should be considered as a separate entity of disorders. We define IC as a bladder disease with Hunner lesions, usually associated with HSB symptoms and bladder inflammation, and BPS as a condition with HSB symptoms in the absence of Hunner lesions and any confusable diseases. Pathophysiology totally differs between IC and BPS. IC involves immunological inflammation probably resulting from autoimmunity, while BPS is associated with the interaction of multiple factors such as neurogenic inflammation, exogenous substances, urothelial defects, psychological stress, and neural hyperactivity. Histopathology also differs between IC and BPS. IC is associated with severe inflammation of the whole bladder accompanied by plasma cell infiltration and urothelial denudation, while BPS shows little pathological changes. Management should begin with a differential diagnosis of IC or BPS, which would require cystoscopy to determine the presence or absence of Hunner lesions. The patients should be treated differently based on the diagnosis following the algorithm, although pain management would be common to IC and BPS. Clinical studies are also to be designed and analyzed separately for IC and BPS.

间质性膀胱炎（IC）和膀胱疼痛综合征（BPS）的临床指南已经修订，更新了我们之前的指南。间质性膀胱炎和膀胱疼痛综合征的症状统称为高敏感性膀胱（HSB）症状，两者几乎没有区别；但是，间质性膀胱炎和膀胱疼痛综合征应被视为不同的疾病。我们将 IC 定义为伴有 Hunner 病变的膀胱疾病，通常伴有 HSB 症状和膀胱炎症；将 BPS 定义为伴有 HSB 症状但无 Hunner 病变和任何可混淆疾病的情况。IC 和 BPS 的病理生理学完全不同。IC 涉及可能由自身免疫引起的免疫性炎症，而 BPS 则与神经源性炎症、外源性物质、尿道缺陷、心理压力和神经亢进等多种因素的相互作用有关。IC 和 BPS 的组织病理学也有所不同。IC 与整个膀胱的严重炎症有关，伴有浆细胞浸润和尿路上皮变性，而 BPS 几乎没有病理变化。治疗应从鉴别诊断 IC 或 BPS 开始，这需要进行膀胱镜检查以确定是否存在 Hunner 病变。虽然 IC 和 BPS 的疼痛治疗方法相同，但患者应根据诊断结果按照算法进行不同的治疗。临床研究也应针对 IC 和 BPS 分别进行设计和分析。

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引用次数: 0

Androgenic Alopecia Is Associated With More Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia 雄激素性脱发与继发于良性前列腺增生症的更严重下尿路症状有关

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-09-12 DOI: 10.1111/luts.12531

Yasar Pazir, Mustafa Kadihasanoglu

Objectives

To evaluate the possible association between androgenic alopecia (AGA) and lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

Methods

A total of 148 patients aged over 45 with LUTS secondary to BPH were prospectively enrolled in this study. According to the Norwood–Hamilton classification, the patients were divided into two groups: AGA (n = 69) and non-AGA (n = 79). In addition, the cases of AGA were categorized as vertex (n = 39) and frontal baldness (n = 30). The International Prostate Symptom Score (IPSS), uroflowmetry parameters, prostate volume, serum total testosterone (TT), and free and total prostate-specific antigen concentrations of all patients were assessed and compared between the groups. Correlations between the AGA grade and other variables were also investigated.

Results

The serum TT level (354 ± 97.1 vs. 308.6 ± 73.1 ng/dL, p = 0.01), total IPSS (16.1 ± 8.1 vs. 13.4 ± 7.7, p = 0.04), IPSS storage subscore (IPSS-S) (7.1 ± 3.5 vs. 5.8 ± 3.6, p = 0.03), and number of nocturia episodes (2.5 ± 1.4 vs. 1.8 ± 1.4, p < 0.01) were significantly higher in the AGA group than in the non-AGA group. There were no significant differences in any of the parameters between the patients with vertex and frontal baldness. The AGA grade showed a significant positive correlation with the TT level (r = 0.407, p = 0.003), IPSS-S (r = 0.164, p = 0.04), and number of nocturia episodes (r = 0.203, p = 0.015).

Conclusions

This study demonstrated that among patients with LUTS, those with AGA had worse symptoms and higher TT levels compared with those without AGA of similar age. Furthermore, the AGA grade was positively correlated with the TT level and storage symptoms.

目的评估雄激素性脱发（AGA）与继发于良性前列腺增生症（BPH）的下尿路症状（LUTS）之间可能存在的关联。方法本研究前瞻性地纳入了 148 名 45 岁以上、继发于良性前列腺增生症的下尿路症状患者。根据诺伍德-汉密尔顿分类法，患者被分为两组：AGA组（69人）和非AGA组（79人）。此外，AGA病例还分为顶秃病例（39人）和额秃病例（30人）。对所有患者的国际前列腺症状评分（IPSS）、尿流率参数、前列腺体积、血清总睾酮（TT）、游离和总前列腺特异性抗原浓度进行评估，并在各组之间进行比较。此外，还研究了 AGA 分级与其他变量之间的相关性。结果血清 TT 水平（354 ± 97.1 vs. 308.6 ± 73.1 ng/dL，p = 0.01）、总 IPSS（16.1 ± 8.1 vs. 13.4 ± 7.7，p = 0.04）、IPSS 存储子分数（IPSS-S）（7.1 ± 3.5 vs. 5.8 ± 3.6, p = 0.03）和夜尿次数（2.5 ± 1.4 vs. 1.8 ± 1.4, p < 0.01）在 AGA 组明显高于非 AGA 组。顶秃和额秃患者的任何参数均无明显差异。AGA 等级与 TT 水平（r = 0.407，p = 0.003）、IPSS-S（r = 0.164，p = 0.04）和夜尿次数（r = 0.203，p = 0.015）呈显著正相关。结论本研究表明，在 LUTS 患者中，与年龄相仿的非 AGA 患者相比，AGA 患者的症状更严重，TT 水平更高。此外，AGA 等级与 TT 水平和贮积症状呈正相关。

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引用次数: 0

Predictors of Postoperative Urinary Incontinence After Holmium Laser Enucleation of the Prostate (HoLEP) for Surgeons Early in Their Experience 外科医生前列腺钬激光去核术（HoLEP）术后尿失禁的早期预测因素

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-09-12 DOI: 10.1111/luts.12533

Karen M. Doersch, Laena Hines, Timothy D. Campbell, Rajat K. Jain, Scott O. Quarrier

Objectives

To evaluate factors impacting continence recovery following holmium laser enucleation of the prostate (HoLEP) for surgeons early in their HoLEP experience.

Methods

Predefined factors were evaluated from a prospectively maintained database for their impact on the recovery of continence after HoLEP. Both surgeons had performed fewer than 150 HoLEPs as attending physicians. Inclusion criteria were subjects with at least 6 months of incontinence data or documented recovery of continence. One or fewer pads per day was defined as continence. Statistical analyses were performed using R and Prism and included Spearman correlations, linear modeling, and Mantel–Cox log-rank testing as appropriate.

Results

From December 2020 to May 2023, 152 subjects met inclusion criteria with a median age of 70 (range: 51–93). The median case number was 56 (1–146). Within the study period, 144/152 (94.7%) recovered continence at a median of 1.6 months postoperatively. Linear modeling demonstrated that younger age (p = 0.01) and shorter enucleation time (p = 0.001) predicted recovery. Enucleation time less than 100 min predicted earlier continence recovery based on Mantel–Cox testing (p = 0.0004).

Conclusions

During the surgeons' HoLEP learning curve, age, and enucleation time were predictive of the recovery of continence. Enucleation time under 100 min predicted a faster rate of continence recovery. The relationship between enucleation time and continence recovery may be demonstrative of case difficulty or may be a result of pressure on the external urethral sphincter during enucleation. These findings further our understanding of HoLEP outcomes early in a surgeon's learning curve.

目的评估影响前列腺钬激光去核术（Holmium Laser Enucleation of the prostate，HoLEP）术后尿失禁恢复的因素。方法从前瞻性维护的数据库中评估预定义因素对 HoLEP 术后尿失禁恢复的影响。两位外科医生作为主治医师均实施了少于 150 例 HoLEP。纳入标准为至少有 6 个月尿失禁数据或有尿失禁恢复记录的受试者。每天使用一个或更少的尿垫被定义为尿失禁。统计分析使用 R 和 Prism 进行，包括斯皮尔曼相关性、线性建模和 Mantel-Cox 对数秩检验。结果从 2020 年 12 月到 2023 年 5 月，共有 152 名受试者符合纳入标准，中位年龄为 70 岁（范围：51-93 岁）。病例数中位数为 56 例（1-146 例）。在研究期间，144/152（94.7%）例患者在术后中位数 1.6 个月时恢复了大小便失禁。线性建模显示，年龄较小（p = 0.01）和剜除时间较短（p = 0.001）预示着恢复情况。根据 Mantel-Cox 检验（p = 0.0004），剜除时间少于 100 分钟预示着尿失禁恢复更早。结论在外科医生的 HoLEP 学习曲线中，年龄和去核时间可预测尿失禁的恢复情况。去核时间在 100 分钟以下，预示着尿失禁恢复的速度更快。去核时间与尿失禁恢复之间的关系可能是病例难度的体现，也可能是去核过程中尿道外括约肌受压的结果。这些发现进一步加深了我们对外科医生学习曲线早期 HoLEP 结果的理解。

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引用次数: 0

Holmium laser enucleation of the prostate (HoLEP) in short-circuit outpatient care: Is prostatic volume a limiting factor? 短路门诊中的前列腺钬激光去核术（HoLEP）：前列腺体积是限制因素吗？

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-07-16 DOI: 10.1111/luts.12525

Sánchez Rodríguez Maria, Marco Franco, Roger Freixa Sala, Carlos Gasanz Serrano, Mauro Bernardello Ureta, Ramón Bultó Gonzalvo, Jordi Cervera Alcaide, Carla Casanova García, Mireia García Puche, Maria Segura Alabart, Juan José Areal Calama, Fernando Ágreda Castañeda

Introduction and Objectives

Our goals were to study prostatic volume as a limiting factor after HoLEP surgery with short-circuit outpatient care (4 h) and to define other factors that affect the success of the proposed circuit.

Materials and Methods

An observational analysis and review was performed using a prospective database. Preoperative, intraoperative, and postoperative variables were included for patients who were scheduled for short-circuit outpatient care (SCOC) and who underwent HoLEP between 2020 and 2023. We defined SCOC as a postoperative hospital stay of 4 h. Subjects who required more than 4 h in hospital were categorized as conventional hospital admission (CHA). A descriptive populational study was conducted, expressing the mean using a 95% confidence interval and percentages for the continuous variables. In order to analyze them, we used the Student's t-test for the continuous variables and the chi-squared test for the categorical variables.

Results

Sixty-eight patients were included, 54 of which completed SCOC, which represented a success ratio of 79.5%. The mean age and prostatic volume of the whole cohort were 68.9 (±6.8) years and 79.5 (±29.1) mL, respectively. We found no significant differences in age, prostatic volume, antiplatelet drug use, indwelling bladder catheter, or applied energy among the subjects who completed SCOC and those who required CHA. No patient was presented with a complication of Grade 3 (or higher) in the modified Clavien–Dindo classification. At the six-month follow-up, no differences were observed in the uroflowmetry or International Prostate Symptoms Score variables.

Conclusions

Prostatic volume does not seem to be a limiting factor after undergoing HoLEP with short-circuit outpatient care.

简介和目标：我们的目标是研究前列腺体积作为HoLEP手术后短路门诊护理（4小时）的限制因素，并确定影响拟议电路成功的其他因素：使用前瞻性数据库进行观察分析和回顾。纳入了 2020 年至 2023 年期间计划接受短路门诊护理（SCOC）并接受 HoLEP 的患者的术前、术中和术后变量。我们将 SCOC 定义为术后住院时间不超过 4 小时。我们进行了一项描述性人口研究，使用 95% 的置信区间和百分比来表示连续变量的平均值。为了对其进行分析，我们对连续变量采用了学生 t 检验，对分类变量采用了卡方检验：共纳入 68 名患者，其中 54 人完成了 SCOC，成功率为 79.5%。整个组群的平均年龄和前列腺体积分别为 68.9 (±6.8) 岁和 79.5 (±29.1) mL。我们发现，完成 SCOC 和需要 CHA 的受试者在年龄、前列腺体积、抗血小板药物使用、留置膀胱导尿管或应用能量方面没有明显差异。根据修改后的 Clavien-Dindo 分级，没有患者出现 3 级（或以上）并发症。在六个月的随访中，尿流测量或国际前列腺症状评分变量均未出现差异：结论：前列腺体积似乎并不是接受短路门诊治疗的限制因素。

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引用次数: 0

Preoperative factors predicting poor therapeutic efficacy of holmium laser enucleation of the prostate in patients with benign prostatic hyperplasia 良性前列腺增生症患者前列腺钬激光去核术疗效不佳的术前预测因素。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-07-16 DOI: 10.1111/luts.12530

Kyohei Watanabe, Atsushi Otsuka, Yuichi Kitagawa, Asuka Sano, Ryo Sato, Yuto Matsushita, Hiromitsu Watanabe, Keita Tamura, Daisuke Motoyama, Toshiki Ito, Sanki Takada, Hideaki Miyake

Objectives

We assessed preoperative factors predicting the poor therapeutic efficacy of holmium laser enucleation of the prostate (HoLEP) in benign prostatic hyperplasia (BPH) patients.

Methods

The present study included 159 patients who underwent HoLEP between August 2015 and June 2021 at our institution. Overall therapeutic efficacy was divided into good and poor therapeutic efficacies according to changes in the international prostate symptom score (IPSS), IPSS quality of life (IPSS-QOL), and the maximum urinary flow rate. Patients were divided into good and poor therapeutic efficacy groups based on findings obtained 3 months after HoLEP, and comparative assessments were performed between the two groups.

Results

The therapeutic efficacy of HoLEP was poor in 53 (33.3%) out of 159 patients. Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR), and the presence of overactive bladder (OAB) were significantly higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group. A multivariable analysis of several factors identified the preoperative presence of OAB and short IPP as independent risk factors for the poor therapeutic efficacy of HoLEP. When treatment efficacy was divided according to risk factors, poor therapeutic efficacy was observed in only 14% of patients with prolonged IPP and the absence of OAB.

Conclusions

The therapeutic efficacy of HoLEP may be poor in patients with OAB and short IPP, resulting in the significant deterioration of lower urinary tract symptoms. Accordingly, it is important to consider the presence or absence of OAB and IPP measurements when selecting indications for HoLEP.

研究目的我们评估了良性前列腺增生症（BPH）患者接受前列腺钬激光去核术（HoLEP）疗效不佳的术前预测因素：本研究纳入了2015年8月至2021年6月期间在我院接受HoLEP术的159例患者。根据国际前列腺症状评分（IPSS）、IPSS生活质量（IPSS-QOL）和最大尿流率的变化，将总体疗效分为疗效好和疗效差。根据HoLEP术后3个月的结果将患者分为疗效好和疗效差两组，并对两组进行比较评估：结果：159 名患者中有 53 人（33.3%）的 HoLEP 疗效不佳。疗效差组的膀胱内前列腺突出（IPP）、IPSS、IPSS-QOL、排尿后残余尿量（PVR）和膀胱过度活动症（OAB）明显高于疗效好组。对多个因素进行的多变量分析表明，术前存在膀胱过度活动症和IPP短是导致HoLEP疗效不佳的独立风险因素。根据风险因素对疗效进行划分后发现，只有14%的患者IPP时间长且无OAB，疗效较差：结论：对于 OAB 和 IPP 较短的患者，HoLEP 的疗效可能较差，导致下尿路症状明显恶化。因此，在选择 HoLEP 的适应症时，必须考虑是否存在 OAB 和 IPP 测量值。

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引用次数: 0

Efficacy and safety of Vibegron for the treatment of residual overactive bladder symptoms after laser vaporization of the prostate: A single-center prospective randomized controlled trial (VAPOR TRIAL) Vibegron 治疗前列腺激光汽化术后残余膀胱过度活动症状的有效性和安全性：单中心前瞻性随机对照试验（VAPOR TRIAL）。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-07-02 DOI: 10.1111/luts.12529

Narihito Seki, Hiroyuki Masaoka, Yoohyun Song, Takashi Dejima, Yoshiaki Sato, Shotaro Maeda

Objectives

This study aimed to evaluate the efficacy and safety of Vibegron for the treatment of residual overactive bladder (OAB) symptoms after laser vaporization of the prostate (photo-selective vaporization of the prostate, contact laser vaporization of the prostate, and thulium laser vaporization).

Methods

This randomized, open-label, parallel-group, single-center superiority trial with a 12-week observation (jRCTs071190040) enrolled male patients with OAB aged 40 years or older who had undergone laser vaporization of the prostate for not less than 12 weeks and not more than 1 year earlier. Patients were allocated to receive Vibegron 50 mg once daily or follow-up without treatment for 12 weeks.

Results

Forty-seven patients were enrolled between January 2020 and March 2023. The median age (interquartile range) was 75.5 (72.5–78.5) years for the Vibegron group and 76.5 (71.0–81.0) years for the control group. The intergroup difference in the mean change (95% confidence interval) in the 24-hour urinary frequency at 12 weeks after randomization was −3.66 (−4.99, −2.33), with a significant decrease for the Vibegron group. The Overactive Bladder Symptom Score, International Prostate Symptom Score, IPSS storage score, and Overactive Bladder Questionnaire score significantly improved for the Vibegron group. Voided volume per micturition also increased for the Vibegron group.

Conclusions

The administration of 50 mg of Vibegron once daily for 12 weeks showed significant improvement compared with follow-up without treatment in bladder storage (OAB) symptoms after laser vaporization of the prostate for symptomatic benign prostatic hyperplasia.

研究目的本研究旨在评估Vibegron治疗前列腺激光汽化术（光选择性前列腺汽化术、接触式前列腺激光汽化术和铥激光汽化术）后残留膀胱过度活动症（OAB）症状的有效性和安全性：这项随机、开放标签、平行组、单中心优效试验（jRCTs071190040）的观察期为12周，招募了年龄在40岁或40岁以上、接受过不少于12周且不超过1年的前列腺激光汽化术的男性OAB患者。患者被分配接受每天一次、每次 50 毫克的 Vibegron 治疗或为期 12 周的无治疗随访：47名患者于2020年1月至2023年3月期间入组。Vibegron组的中位年龄（四分位数间距）为75.5（72.5-78.5）岁，对照组为76.5（71.0-81.0）岁。随机分组 12 周后，24 小时尿频的平均变化（95% 置信区间）的组间差异为-3.66（-4.99，-2.33），Vibegron 组显著下降。Vibegron组的膀胱过度活动症状评分、国际前列腺症状评分、IPSS贮存评分和膀胱过度活动问卷评分均有显著改善。Vibegron组每次排尿量也有所增加：结论：在对有症状的良性前列腺增生症进行前列腺激光汽化术后，与不进行治疗的随访相比，每天服用一次 50 毫克的维贝琼，持续 12 周后，膀胱储尿（OAB）症状有了明显改善。

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引用次数: 0

Urotherapy and biofeedback resistant dysfunctional voiding: How to deal with? 泌尿系统治疗和生物反馈治疗可缓解排尿功能障碍：如何处理？

IF 1.5 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-06-25 DOI: 10.1111/luts.12528

M. İrfan Dönmez, Ismail Selvi, Tayfun Oktar, Orhan Ziylan

Objectives

To analyze the management strategies in the children who had treatment-resistant dysfunctional voiding (DV).

Methods

Among 75 children with DV who underwent pelvic floor biofeedback therapy (BF) between 2013 and 2020, 16 patients (14 girls, 87.5%) with a mean age of 9.81 ± 2.53 years that showed incomplete clinical response following urotherapy and initial BF sessions were retrospectively reviewed. The demographic and clinical characteristics, DVSS, and uroflowmetry parameters were recorded before and after the initial BF sessions. Subsequent treatments after initial BF and clinical responses of patients were noted.

Results

Clinical success was observed in one patient by addition of an anticholinergic and in three patients with combination of salvage BF sessions and anticholinergics, whom had predominant overactive bladder (OAB) symptoms. The success rate of TENS alone and in combination with other treatment modalities was 88.8% (8/9 patients). In addition, salvage BF sessions (range 2 to 3) enabled clinical success in five (50%) of 10 cases as a combination with anticholinergics or TENS. In case of incomplete emptying without OAB, adequate clinical response to Botulinum-A was observed during an average follow-up of 29 months in two boys who did not respond to alpha-blockers, even though one required repeat injection after 10 months. The total clinical success rate was 87.5% (14/16 patients) after a median follow-up of 24 months. VV-EBC and Qmax increased by a mean of 30.89% and 7.13 mL/min, respectively, whereas DVSS decreased by a mean of 8.88 points and PVR-EBC decreased by a median of 19.04%.

Conclusions

Our findings showed that clinical success in resistant DV was achieved by various combination treatments in the majority of children. However, a small group may still have persistent, bothersome symptoms despite multiple treatment modalities.

目的分析具有治疗耐药性的排尿功能障碍（DV）儿童的治疗策略。方法回顾性分析2013年至2020年间接受盆底生物反馈疗法（BF）治疗的75名排尿功能障碍儿童，其中16名患者（14名女孩，87.5%）在接受尿路治疗和首次BF治疗后出现不完全临床反应，平均年龄为（9.81 ± 2.53）岁。记录了初次 BF 治疗前后的人口统计学和临床特征、DVSS 和尿流测量参数。记录了患者在初次 BF 治疗后的后续治疗情况和临床反应。结果一名患者在使用抗胆碱能药物后取得了临床成功，三名患者在联合使用挽救性膀胱刺激疗法和抗胆碱能药物后取得了临床成功，这些患者均以膀胱过度活动症（OAB）症状为主。单独使用 TENS 或与其他治疗方法联合使用的成功率为 88.8%（8/9 例患者）。此外，在与抗胆碱能药物或 TENS 联合使用的 10 个病例中，有 5 例（50%）患者通过抢救性 BF 治疗（2 至 3 次）取得了临床成功。对于排空不全但无 OAB 的病例，在平均 29 个月的随访期间，观察到两名对阿尔法受体阻滞剂无反应的男孩对 A 型肉毒杆菌产生了充分的临床反应，尽管其中一人在 10 个月后需要再次注射。中位随访 24 个月后，总临床成功率为 87.5%（14/16 名患者）。VV-EBC 和 Qmax 平均分别增加了 30.89% 和 7.13 mL/min，而 DVSS 平均下降了 8.88 点，PVR-EBC 中位下降了 19.04%。结论我们的研究结果表明，通过各种联合治疗，大多数患儿的耐药 DV 临床治疗取得了成功。然而，尽管采用了多种治疗方法，仍有一小部分患儿可能会持续出现令人烦恼的症状。

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引用次数: 0

Stem cell therapy for interstitial cystitis/bladder pain syndrome 干细胞疗法治疗间质性膀胱炎/膀胱疼痛综合征。

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-06-12 DOI: 10.1111/luts.12527

Jung Hyun Shin, Ju Hyun Park, Chae-Min Ryu, Dong-Myung Shin, Myung-Soo Choo

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic disease with limited treatment options. Current multidisciplinary approach targeting bladder inflammation and urothelial dysfunction has limited durable effect that major surgery is ultimately required for both Hunner and non-Hunner type IC. Various investigational attempts are underway to avoid such operations and preserve the urinary bladder. Stem cell therapy is a fascinating option for treating chronic illnesses. Stem cells can self-renew, restore damaged tissue, and have paracrine effects. The therapeutic efficacy and safety of stem cell therapy have been demonstrated in numerous preclinical models, primarily chemically induced cystitis rat models. Only one clinical trial (phase 1 study) has investigated the safety of human embryonic stem cell-derived mesenchymal stem cells in three Hunner-type IC patients. Under general anesthesia, participants underwent cystoscopic submucosal stem cell injection (2.0 × 10⁷ stem cells/5 mL). No safety issues were reported up to 12 months of follow-up and long-term follow-up (up to 3 years). Although there were variations in therapeutic response, all patients reported significant improvement in pain at 1 month postoperatively. One patient underwent fulguration of the Hunner lesion after the trial, but others reported an overall improvement in pain. The analysis on phase 1/2a trial which had several modifications in protocol is currently ongoing. Despite several limitations that need to be overcome, stem cell therapy could be a potential therapeutic option for treating IC/BPS. Clinical outcome on phase 1/2a trial is important and might provide more insight into the clinical application of stem cell therapy for IC/BPS.

间质性膀胱炎/膀胱疼痛综合征（IC/BPS）是一种慢性疾病，治疗方法有限。目前针对膀胱炎症和尿路上皮功能障碍的多学科治疗方法效果有限，无论是亨纳型还是非亨纳型间质性膀胱炎，最终都需要进行大手术。为了避免此类手术并保留膀胱，目前正在进行各种研究尝试。干细胞疗法是治疗慢性疾病的一个令人着迷的选择。干细胞可以自我更新，恢复受损组织，并具有旁分泌效应。干细胞疗法的疗效和安全性已在许多临床前模型中得到证实，主要是化学诱导的膀胱炎大鼠模型。只有一项临床试验（一期研究）在三名Hunner型IC患者中调查了人类胚胎干细胞衍生间充质干细胞的安全性。在全身麻醉的情况下，参与者接受了膀胱镜黏膜下干细胞注射（2.0 × 107 干细胞/5 mL）。在长达12个月的随访和长期随访（长达3年）中，均未发现安全问题。虽然治疗反应存在差异，但所有患者在术后1个月都报告疼痛明显改善。一名患者在试验后接受了亨纳病变的充填术，但其他患者的疼痛总体上有所改善。1/2a期试验的方案曾多次修改，目前正在进行分析。尽管干细胞疗法还存在一些需要克服的局限性，但它可能是治疗IC/BPS的一种潜在疗法。1/2a期试验的临床结果非常重要，可能为干细胞疗法治疗IC/BPS的临床应用提供更多启示。

{"title":"Stem cell therapy for interstitial cystitis/bladder pain syndrome","authors":"Jung Hyun Shin, Ju Hyun Park, Chae-Min Ryu, Dong-Myung Shin, Myung-Soo Choo","doi":"10.1111/luts.12527","DOIUrl":"10.1111/luts.12527","url":null,"abstract":"<p>Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic disease with limited treatment options. Current multidisciplinary approach targeting bladder inflammation and urothelial dysfunction has limited durable effect that major surgery is ultimately required for both Hunner and non-Hunner type IC. Various investigational attempts are underway to avoid such operations and preserve the urinary bladder. Stem cell therapy is a fascinating option for treating chronic illnesses. Stem cells can self-renew, restore damaged tissue, and have paracrine effects. The therapeutic efficacy and safety of stem cell therapy have been demonstrated in numerous preclinical models, primarily chemically induced cystitis rat models. Only one clinical trial (phase 1 study) has investigated the safety of human embryonic stem cell-derived mesenchymal stem cells in three Hunner-type IC patients. Under general anesthesia, participants underwent cystoscopic submucosal stem cell injection (2.0 × 10<sup>7</sup> stem cells/5 mL). No safety issues were reported up to 12 months of follow-up and long-term follow-up (up to 3 years). Although there were variations in therapeutic response, all patients reported significant improvement in pain at 1 month postoperatively. One patient underwent fulguration of the Hunner lesion after the trial, but others reported an overall improvement in pain. The analysis on phase 1/2a trial which had several modifications in protocol is currently ongoing. Despite several limitations that need to be overcome, stem cell therapy could be a potential therapeutic option for treating IC/BPS. Clinical outcome on phase 1/2a trial is important and might provide more insight into the clinical application of stem cell therapy for IC/BPS.</p>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310992","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}

引用次数: 0

Adherence to AUA guidelines for the work-up, medical management, surgical evaluation and treatment of BPH: Work from a quality improvement collaborative 遵守美国前列腺增生协会（AUA）关于良性前列腺增生症的检查、药物治疗、手术评估和治疗指南：质量改进合作组织的工作。

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-06-10 DOI: 10.1111/luts.12526

Eric Wahlstedt, John Lee Graves, John Wahlstedt, Alison D'Alessandro, Will Cranford, Nicholas A. Freidberg, Amul Bhalodi, John R. Bell, Andrew James, Jason Bylund, Stephen E. Strup, Andrew Harris

Introduction

Previous studies noted varied adherence to clinical practice guidelines (CPGs), but studies are yet to quantify adherence to American Urological Association BPH guidelines. We studied guideline adherence in the context of a new quality improvement collaborative (QIC).

Methods

Data were collected as part of a statewide QIC. Medical records for patients undergoing select CPT codes from January 2020 to May 2022 were retrospectively reviewed for adherence to selected BPH guidelines.

Results

Most men were treated with transurethral resection of the prostate. Notably, 53.3% of men completed an IPSS and 52.3% had a urinalysis. 4.7% were counseled on behavioral modifications, 15.0% on medical therapy, and 100% on procedural options. For management, 79.4% were taking alpha-blockers and 59.8% were taking a 5-ARI. For evaluation, 57% had a PVR, 63.6% had prostate size measurement, 37.4% had uroflowmetry, and 12.3% were counseled about treatment failure. Postoperatively, 51.6% completed an IPSS, 57% had a PVR, 6.50% had uroflowmetry, 50.6% stopped their alpha-blocker, and 75.0% stopped their 5-ARI.

Conclusions

There was adherence to preoperative testing recommendations, but patient counseling was lacking in the initial work-up and preoperative evaluation. We will convey the data to key stakeholders, expand data collection to other institutions, and devise an improvement implementation plan.

导言：以往的研究表明，临床实践指南（CPG）的遵守情况各不相同，但尚未有研究对美国泌尿协会良性前列腺增生指南的遵守情况进行量化。我们在一项新的质量改进合作项目（QIC）中对指南的遵循情况进行了研究：方法：数据收集是全州 QIC 的一部分。我们对 2020 年 1 月至 2022 年 5 月接受特定 CPT 编码治疗的患者的医疗记录进行了回顾性审查，以了解其对特定良性前列腺增生症指南的遵守情况：结果：大多数男性接受了经尿道前列腺切除术。值得注意的是，53.3%的男性完成了IPSS，52.3%的男性进行了尿检。4.7%的男性接受了行为矫正指导，15.0%的男性接受了药物治疗，100%的男性接受了手术治疗。在治疗方面，79.4% 的人服用α-受体阻滞剂，59.8% 的人服用 5-ARI 。在评估方面，57%的患者进行了PVR检查，63.6%的患者进行了前列腺大小测量，37.4%的患者进行了尿流测定，12.3%的患者接受了有关治疗失败的咨询。术后，51.6%的患者完成了IPSS检查，57%的患者进行了PVR检查，6.50%的患者进行了尿流测定，50.6%的患者停用了α-受体阻滞剂，75.0%的患者停用了5-ARI：结论：术前检查建议得到了遵守，但在初步检查和术前评估中缺乏对患者的指导。我们将向主要利益相关者传达这些数据，将数据收集工作扩展到其他机构，并制定改进实施计划。

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引用次数: 0

Protective effect of equol intake on bladder dysfunction in a rat model of bladder outlet obstruction 在膀胱出口梗阻大鼠模型中，摄入马勃醇对膀胱功能障碍有保护作用。

IF 1.3 4区医学 Q2 Medicine

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2024-05-22 DOI: 10.1111/luts.12518

Nozomu Miyazaki, Ryota Katsura, Chiaki Ozaki, Tatsuo Suzutani

Objectives

This study evaluates the impact of equol, a metabolite of soy isoflavone, on bladder dysfunction in rats with bladder outlet obstruction (BOO). In addition, we investigate its potential as a neuroprotective agent for the obstructed bladder and discuss its applicability in managing overactive bladder (OAB).

Methods

Eighteen male Sprague–Dawley rats were divided into three groups (six rats per group) during the rearing period. The Sham and C-BOO groups received an equol-free diet, while the E-BOO group received equol supplementation (0.25 g/kg). At 8 weeks old, rats underwent BOO surgery, followed by continuous cystometry after 4 weeks of rearing. The urinary oxidative stress markers (8-hydroxy-2′-deoxyguanosine and malondialdehyde) were measured, and the bladder histology was analyzed using hematoxylin–eosin, Masson's trichrome, and immunohistochemical staining (neurofilament heavy chain for myelinated nerves, peripherin for unmyelinated nerves, and malondialdehyde).

Results

Equol reduced BOO-induced smooth muscle layer fibrosis, significantly prolonged the micturition interval (C-BOO: 193 s, E-BOO: 438 s) and increased the micturition volume (C-BOO: 0.54 mL, E-BOO: 1.02 mL) compared to the C-BOO group. Equol inhibited the increase in urinary and bladder tissue malondialdehyde levels. While the C-BOO group exhibited reduced peripherin alone positive nerve fibers within the smooth muscle layer, equol effectively attenuated this decline.

Conclusions

Equol reduces lipid peroxidation and smooth muscle layer fibrosis in the bladder and exhibited neuroprotective effects on bladder nerves (peripheral nerves) and prevented the development of bladder dysfunction associated with BOO in rats. Consumption of equol is promising for the prevention of OAB associated with BOO.

研究目的本研究评估了大豆异黄酮的代谢产物马兜铃醇对膀胱出口梗阻（BOO）大鼠膀胱功能障碍的影响。此外，我们还研究了其作为膀胱梗阻神经保护剂的潜力，并讨论了其在控制膀胱过度活动症（OAB）方面的适用性：方法：18 只雄性 Sprague-Dawley 大鼠在饲养期间被分为三组（每组 6 只）。Sham 组和 C-BOO 组接受不含 equol 的饮食，而 E-BOO 组则补充 equol（0.25 克/千克）。8周大时，大鼠接受BOO手术，饲养4周后进行连续膀胱测定。测量尿氧化应激标记物（8-羟基-2'-脱氧鸟苷和丙二醛），并使用苏木精-伊红、马森三色素和免疫组化染色法（髓鞘神经的神经丝蛋白重链、非髓鞘神经的外周蛋白和丙二醛）分析膀胱组织学：与 C-BOO 组相比，Equol 减少了 BOO 诱导的平滑肌层纤维化，显著延长了排尿间隔时间（C-BOO：193 秒，E-BOO：438 秒）并增加了排尿量（C-BOO：0.54 毫升，E-BOO：1.02 毫升）。Equol 可抑制尿液和膀胱组织中丙二醛水平的增加。虽然 C-BOO 组显示平滑肌层内的外周素单独阳性神经纤维减少，但 Equol 有效地减轻了这种减少：结论：Equol 可减少脂质过氧化和膀胱平滑肌层纤维化，对膀胱神经（周围神经）具有神经保护作用，并可防止大鼠出现与 BOO 相关的膀胱功能障碍。食用马勃醇有望预防与BOO相关的OAB。

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引用次数: 0