LUTS: Lower Urinary Tract Symptoms最新文献_第2页

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 术前导管时间对钬激光前列腺摘除治疗良性前列腺增生围手术期安全性和功能结局的影响：来自单中心系列研究的结果

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2025-11-12 DOI: 10.1111/luts.70039

Carlo Giulioni, Federico Falsetti, Matteo Tallè, Alessio Papaveri, Francesco Mengoni, Roberto Orciani, Valentina Maurizi, Felice Crocetto, Daniele Castellani, Vineet Gauhar, Angelo Cafarelli

Purpose

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。

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引用次数: 0

Efficacy of Transurethral Resection of the Prostate in Male Patients With Impaired Detrusor Contractile Function and Urinary Retention 经尿道前列腺切除术治疗男性逼尿肌收缩功能受损及尿潴留的疗效观察。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2025-11-11 DOI: 10.1111/luts.70040

Balázs Kenyeres, Alexandra Helmeczi, Ákos Pytel

Objectives

Detrusor underactivity (DUA) increasingly affects aging male patients with voiding symptoms, while its management remains challenging, with less favorable surgical outcomes compared to bladder outlet obstruction. Our aim was to evaluate the efficacy of TURP in male patients with urinary retention and unfavorable urodynamic findings.

Materials and Methods

This retrospective, single-center study included 67 male patients undergoing TURP between September 2021 and September 2024 after a failed trial of voiding. Patients were divided into three groups labeled as detrusor acontractility (DA, n = 18, voided without detrusor contraction), DUA (n = 19, voided with BCI < 100 and BOOI < 20), or non-voiders (n = 30, failed to urinate and lacked measurable detrusor contractions on pressure-flow study). Surgical success was defined as successful voiding with post-void residual (PVR) < 150 mL at 3 months. Baseline parameters (PSA, prostate volume, cystoscopy and urodynamic findings), rate of surgical success, Patient Global Impression of Improvement (PGI-I) score and adverse events (subsequent surgeries and urinary tract infection) were registered and analyzed.

Results

Overall 37 (55.2%) patients became catheter-free within 3 months. The mean follow-up duration was 25.4 ± 9.6 months. Surgical success was achieved in DA, DUA, and non-voider groups in 6 (33%), 13 (68.4%), and 18 (60%) cases, respectively, and a PGI-I score greater than 4 was reported by 35 (52.2%) patients. Multivariate analysis showed higher prostate volume as an independent predictor for failure (OR: 1.7; 95% CI: 1.010–2.940; p = 0.046). Two patients developed stress urinary incontinence, and three required additional surgical intervention due to urethral stricture. Urinary tract infections occurred more frequently in the treatment failure group: Nine patients (30%) were hospitalized, and 16 (53%) required more than two antibiotic prescriptions within a 6-month period. In contrast, among the success group, only two patients (5.4%) were hospitalized, and none required frequent antibiotic therapy.

Conclusion

TURP offers a reasonable chance for catheter discontinuation in case of unfavorable urodynamic parameters. With careful patient selection in mind, surgery remains a viable option even in this patient population.

目的：逼尿肌活动不足（DUA）越来越多地影响有排尿症状的老年男性患者，而其治疗仍然具有挑战性，与膀胱出口梗阻相比，手术效果较差。我们的目的是评估TURP在男性尿潴留和尿动力学表现不佳的患者中的疗效。材料和方法：这项回顾性的单中心研究纳入了67名男性患者，他们在2021年9月至2024年9月期间接受了TURP手术，此前他们的排尿试验失败。患者分为逼尿肌收缩组（DA, n = 18，无逼尿肌收缩）和DUA组（n = 19，无逼尿肌收缩）。结果：37例（55.2%）患者在3个月内无置管。平均随访时间25.4±9.6个月。DA组、DUA组和非voider组分别有6例（33%）、13例（68.4%）和18例（60%）手术成功，其中35例（52.2%）患者的PGI-I评分大于4分。多因素分析显示前列腺体积增大是治疗失败的独立预测因子（OR: 1.7; 95% CI: 1.010-2.940; p = 0.046）。2例患者出现应激性尿失禁，3例因尿道狭窄需要额外的手术干预。治疗失败组尿路感染发生率更高：9名患者（30%）住院，16名患者（53%）在6个月内需要两次以上抗生素处方。相比之下，在成功组中，只有两名患者（5.4%）住院，没有人需要频繁的抗生素治疗。结论：在尿动力学参数不利的情况下，TURP为导管的停置提供了合理的机会。考虑到仔细的病人选择，手术仍然是一个可行的选择，即使在这个病人群体。

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引用次数: 0

Reply to the Letter to the Editor: “Unraveling the Links Between Posture and Urinary Symptoms in Parkinson's Disease: Missing Pieces to Consider” 回复给编辑的信：“揭示帕金森病的姿势和泌尿系统症状之间的联系：需要考虑的缺失部分”。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2025-11-03 DOI: 10.1111/luts.70036

Betül Kuz, Mustafa Ertuğrul Yaşa, Rıza Sonkaya, Selman Aktaş

引用次数: 0

Associations of Dietary Inflammation Index and Composite Dietary Antioxidant Index With Overactive Bladder in Adults: NHANES 2011–2018 膳食炎症指数和复合膳食抗氧化指数与成人膀胱过度活跃的关系：NHANES 2011-2018。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2025-11-02 DOI: 10.1111/luts.70038

Xuexue Hao, Zhunan Xu, Song Li, Chengrui Zhang, Xiaoqiang Liu

Background

Overactive bladder (OAB) is a common urinary condition, with multiple contributing factors. Dietary factors affecting inflammation and oxidative stress are increasingly recognized as significant triggers. This study investigates the associations between the Dietary Inflammatory Index (DII), the Comprehensive Dietary Antioxidant Index (CDAI), and OAB in adults.

Methods

Data from the 2011–2018 National Health and Nutrition Examination Survey (NHANES) was analyzed. The DII and CDAI were calculated based on nutrient intake, and OAB was assessed using the Overactive Bladder Symptom Score (OABSS). Weighted multivariable logistic regression models were applied to evaluate associations, and subgroup analysis and restricted cubic spline (RCS) analysis were used to explore potential interactions and dose–response relationships. Additional analyses were performed to examine the associations of DII and CDAI with dry and wet OAB subtypes.

Results

Patients with OAB exhibited higher DII scores and lower CDAI scores. Increased DII was significantly associated with an elevated risk of OAB, particularly in the highest quartile (OR = 1.55, 95% CI: 1.19–2.02, p = 0.001). In contrast, higher CDAI was associated with a reduced risk of OAB (OR = 0.68, 95% CI: 0.53–0.88, p = 0.004). Subgroup analysis revealed significant interactions with age and alcohol intake. RCS analysis confirmed a positive linear relationship between DII and OAB risk, and a negative linear relationship between CDAI and OAB risk. Further stratified analysis showed that the association between DII and OAB was stronger in wet OAB than in dry OAB, whereas CDAI showed no significant association with either subtype.

Conclusion

A diet with low inflammatory potential and rich in antioxidants may reduce the risk of OAB, particularly in younger individuals and heavy drinkers. Dietary modification presents a practical approach for OAB management, warranting further research to establish causality and inform intervention strategies.

背景：膀胱过动症（OAB）是一种常见的泌尿系统疾病，有多种致病因素。影响炎症和氧化应激的饮食因素越来越被认为是重要的触发因素。本研究探讨了成人膳食炎症指数（DII）、综合膳食抗氧化指数（CDAI）和OAB之间的关系。方法：对2011-2018年全国健康与营养检查调查（NHANES）数据进行分析。根据营养摄入计算DII和CDAI，使用膀胱过度活动症状评分（OABSS）评估OAB。采用加权多变量logistic回归模型评估相关性，并采用亚组分析和限制性三次样条（RCS）分析探索潜在的相互作用和剂量-反应关系。进一步分析了DII和CDAI与干湿OAB亚型的关系。结果：OAB患者具有较高的DII评分和较低的CDAI评分。DII增加与OAB风险升高显著相关，特别是在最高四分位数（OR = 1.55, 95% CI: 1.19-2.02, p = 0.001）。相反，较高的CDAI与OAB风险降低相关（OR = 0.68, 95% CI: 0.53-0.88, p = 0.004）。亚组分析显示与年龄和酒精摄入量有显著的相互作用。RCS分析证实DII与OAB风险呈线性正相关，CDAI与OAB风险呈线性负相关。进一步的分层分析表明，DII与OAB在湿OAB中的相关性强于干OAB，而CDAI与两种亚型均无显著相关性。结论：低炎症潜力和富含抗氧化剂的饮食可以降低OAB的风险，特别是在年轻人和酗酒者中。饮食调整是OAB管理的实用方法，需要进一步研究以确定因果关系并为干预策略提供信息。

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引用次数: 0

Unraveling the Links Between Posture and Urinary Symptoms in Parkinson's Disease: Missing Pieces to Consider 揭示姿势与帕金森病泌尿系统症状之间的联系：需要考虑的缺失部分。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2025-11-02 DOI: 10.1111/luts.70034

Christian Messina

引用次数: 0

Mechanistic Insights From Reduced Bladder Preparations: A Necessary Complement to In Vivo Models 从膀胱减量制剂的机制见解：对体内模型的必要补充。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2025-11-02 DOI: 10.1111/luts.70035

Bin Feng, George A. Kuchel

引用次数: 0

Re: Woon et al. 2025 Pharmacological Targeting of Hyperpolarization-Activated Cyclic Nucleotide-Gated Cation Channels on Bladder Afferent Sensory Transmission Re: Woon等。2025超极化激活环核苷酸门控阳离子通道在膀胱传入感觉传递中的药理作用。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2025-11-02 DOI: 10.1111/luts.70037

Pradeep Tyagi

引用次数: 0

Barriers to Seeking Medical Consultation for Urinary Incontinence: A Nationwide Population-Based Study in Saudi Arabia 寻求尿失禁医疗咨询的障碍：沙特阿拉伯一项基于全国人群的研究

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2025-10-12 DOI: 10.1111/luts.70033

Ebtesam Almajed, Norah Alqntash, Badriyah AlDejain, Noura AlQurashi, Mohammed Alshehri, Ali AbdelRaheem, Nojoud Alamri

Objectives

Urinary incontinence (UI) is prevalent and often underreported due to various barriers affecting healthcare-seeking behavior. This study aimed to identify barriers preventing patients from seeking help for UI, assess the influence of sociodemographic and clinical factors on these barriers, and determine the associations between UI types and barriers in Saudi Arabia.

Methods

A nationwide, cross-sectional study was conducted from June 2024 to April 2025 among individuals aged ≥ 18 years who experienced UI and had not sought medical consultation. Participants completed a questionnaire that comprised sociodemographic data, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and a modified Barriers to Incontinence Care Seeking Questionnaire (BICS-Q). Data were analyzed using descriptive statistics, independent t-tests, ANOVA, and binary logistic regression.

Results

Of 505 eligible participants, 80.6% were female, predominantly aged 31–45 (40.0%), and the most common UI type was mixed UI (37.2%). The most significant barriers were embarrassment (33.3%), logistical inconvenience (appointments scheduled too far in advance, 36.8%), and provider-related issues (lack of available providers, 12.3%). Gender, obesity, residency region, and type of UI significantly influenced barrier perception. Fear-related barriers were notably higher in nocturnal UI, whereas embarrassment and cultural concerns were highest among those with mixed UI.

Conclusion

This study highlights significant embarrassment, inconvenience, and provider-related barriers deterring healthcare-seeking among UI patients in Saudi Arabia. Findings emphasize the need for culturally tailored interventions, improved healthcare accessibility, and targeted public awareness campaigns.

目的尿失禁（UI）是普遍的，往往被低估，由于各种障碍影响就医行为。本研究旨在确定阻碍患者寻求尿失禁帮助的障碍，评估社会人口统计学和临床因素对这些障碍的影响，并确定沙特阿拉伯尿失禁类型与障碍之间的关系。方法在2024年6月至2025年4月期间对年龄≥18岁且未就诊的尿失禁患者进行全国性横断面研究。参与者完成了一份调查问卷，包括社会人口统计数据、国际失禁咨询问卷-尿失禁简短表格（ICIQ-UI SF）和一份修改过的失禁护理寻求障碍问卷（BICS-Q）。数据分析采用描述性统计、独立t检验、方差分析和二元逻辑回归。结果505例符合条件的患者中，女性占80.6%，年龄以31-45岁为主（40.0%），最常见的UI类型为混合型UI（37.2%）。最重要的障碍是尴尬（33.3%）、后勤不便（预约时间提前太长，36.8%）和与提供者相关的问题（缺乏可用的提供者，12.3%）。性别、肥胖、居住地区和UI类型显著影响障碍感知。在夜间尿失禁中，与恐惧相关的障碍明显更高，而在混合尿失禁中，尴尬和文化问题的障碍最高。结论：本研究突出了沙特阿拉伯尿失禁患者寻求医疗保健的重大尴尬、不便和与提供者相关的障碍。研究结果强调需要针对不同文化的干预措施，改善医疗保健可及性，并开展有针对性的公众宣传活动。

{"title":"Barriers to Seeking Medical Consultation for Urinary Incontinence: A Nationwide Population-Based Study in Saudi Arabia","authors":"Ebtesam Almajed, Norah Alqntash, Badriyah AlDejain, Noura AlQurashi, Mohammed Alshehri, Ali AbdelRaheem, Nojoud Alamri","doi":"10.1111/luts.70033","DOIUrl":"https://doi.org/10.1111/luts.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Urinary incontinence (UI) is prevalent and often underreported due to various barriers affecting healthcare-seeking behavior. This study aimed to identify barriers preventing patients from seeking help for UI, assess the influence of sociodemographic and clinical factors on these barriers, and determine the associations between UI types and barriers in Saudi Arabia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A nationwide, cross-sectional study was conducted from June 2024 to April 2025 among individuals aged ≥ 18 years who experienced UI and had not sought medical consultation. Participants completed a questionnaire that comprised sociodemographic data, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and a modified Barriers to Incontinence Care Seeking Questionnaire (BICS-Q). Data were analyzed using descriptive statistics, independent <i>t</i>-tests, ANOVA, and binary logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 505 eligible participants, 80.6% were female, predominantly aged 31–45 (40.0%), and the most common UI type was mixed UI (37.2%). The most significant barriers were embarrassment (33.3%), logistical inconvenience (appointments scheduled too far in advance, 36.8%), and provider-related issues (lack of available providers, 12.3%). Gender, obesity, residency region, and type of UI significantly influenced barrier perception. Fear-related barriers were notably higher in nocturnal UI, whereas embarrassment and cultural concerns were highest among those with mixed UI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights significant embarrassment, inconvenience, and provider-related barriers deterring healthcare-seeking among UI patients in Saudi Arabia. Findings emphasize the need for culturally tailored interventions, improved healthcare accessibility, and targeted public awareness campaigns.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"17 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/luts.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272757","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}

引用次数: 0

Selective Bladder Denervation via Radiofrequency Ablation Versus Intravesical Onabotulinum Toxin A for Refractory Overactive Bladder: The Short-Term Results of A Preliminary Randomized Controlled Trial 射频消融术与膀胱内肉毒杆菌毒素A治疗难治性过度活跃膀胱的选择性膀胱去神经支配：一项初步随机对照试验的短期结果。

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2025-09-24 DOI: 10.1111/luts.70032

Salih Zeki Sönmez, İsmail Ulus, Aykut Çolakerol, Mustafa Zafer Temiz, Enes Pay, Muhammet Murat Dinçer

Introduction

Overactive bladder (OAB) is a prevalent and burdensome condition associated with significant impairments in health-related quality of life and substantial healthcare costs. While third-line therapies such as intravesical onabotulinum toxin A (BTA) and sacral neuromodulation are established treatment options for refractory cases, selective bladder denervation (SBD) via radiofrequency ablation (RFA) has emerged as a novel minimally invasive alternative. This study aimed to prospectively compare the efficacy and safety of SBD versus BTA in women with refractory OAB.

Methods

In this randomized controlled trial, 54 women with refractory OAB were allocated to receive either SBD or BTA. Patients were followed for 12 weeks and assessed for changes in urgency episodes, urgency urinary incontinence (UUI), daily voiding frequency, overactive bladder symptom scores (OAB-V8), quality of life (I-QOL), post-void residual (PVR) volume, and treatment-emergent adverse events.

Results

Both interventions resulted in significant symptom improvement relative to baseline (p < 0.05). However, BTA demonstrated superior therapeutic efficacy, with a significantly higher proportion of patients achieving ≥ 50% reductions in urgency and UUI episodes across all follow-up visits (p < 0.05). Additionally, BTA yielded greater improvements in symptom scores and quality of life indices. Adverse events were infrequent and mild in both groups. The BTA group exhibited a transient increase in PVR at early follow-up, though no cases of acute urinary retention necessitating catheterization were observed. The SBD group showed modest symptom relief with stable objective parameters.

Conclusion

In this prospective randomized trial, intravesical BTA provided superior clinical efficacy compared to SBD across both subjective and objective outcome measures in women with refractory OAB. While SBD may represent a minimally invasive option for select patient populations, BTA remains the more effective third-line intervention. Further large-scale, sham-controlled studies with longer follow-up are warranted to clarify the role of SBD and optimize patient selection.

膀胱过动症（OAB）是一种普遍且负担沉重的疾病，与健康相关的生活质量和大量医疗保健费用显著受损有关。虽然膀胱内肉毒杆菌毒素A （BTA）和骶骨神经调节等三线治疗已成为难治性病例的治疗选择，但通过射频消融（RFA）的选择性膀胱去神经支配（SBD）已成为一种新的微创选择。本研究旨在前瞻性比较SBD与BTA治疗难治性OAB的疗效和安全性。方法：在这项随机对照试验中，54名难治性OAB女性被分配接受SBD或BTA治疗。对患者进行为期12周的随访，评估急症发作、急症尿失禁（UUI）、每日排尿频率、膀胱过度活动症状评分（OAB-V8）、生活质量（I-QOL）、排尿后残留（PVR）体积和治疗后出现的不良事件的变化。结果：与基线相比，两种干预措施均显著改善了症状(p)。结论：在这项前瞻性随机试验中，与SBD相比，膀胱内BTA在难治性OAB女性的主观和客观结果测量中均提供了更好的临床疗效。虽然SBD可能是选择患者群体的微创选择，但BTA仍然是更有效的三线干预。进一步的大规模、长时间随访的假对照研究是有必要的，以阐明SBD的作用并优化患者选择。

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引用次数: 0

Urodynamic Risk Factors for Recurrent Febrile Graft Pyelonephritis in Kidney Transplant Recipients: A Retrospective Study 肾移植受者发热性肾盂肾炎复发的尿动力学危险因素：一项回顾性研究

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2025-09-13 DOI: 10.1111/luts.70031

Jun Kamei, Ei-ichiro Takaoka, Takehiro Ohyama, Sho Nishida, Daiji Watanabe, Aya Niimi, Yuta Yamada, Toru Sugihara, Satoshi Ando, Haruki Kume, Daiki Iwami, Tetsuya Fujimura

Objectives

We aimed to assess lower urinary tract function and morphological changes in kidney transplant recipients with a history of graft pyelonephritis and investigate the association between specific types of lower urinary tract dysfunction and the risk of recurrent graft pyelonephritis.

Methods

We retrospectively reviewed the medical records of kidney transplant recipients hospitalized for febrile graft pyelonephritis more than 1 year after transplantation between April 2019 and October 2023. Patients underwent cystography and urodynamic studies after infection control and were followed up for at least 12 months. They were classified based on urodynamic findings, and recurrence-free survival was analyzed.

Results

Twenty-four patients were included. Vesicoureteral reflux of the grafted kidney was observed in 20 (83.3%) patients. Detrusor overactivity, detrusor underactivity, and low-compliance bladders were diagnosed in 8 (33.3%), 12 (50.0%), and 7 (29.2%) patients, respectively. Based on urodynamic findings, treatment and bladder management were modified in 20 patients. During a median follow-up of 33 months, seven patients developed recurrent graft pyelonephritis. Detrusor overactivity remained an independent risk factor for recurrent graft pyelonephritis (odds ratio, 21.4; p = 0.04). Patients with detrusor overactivity or underactivity but not low-compliance bladder had significantly shorter recurrence-free survival compared with those without these dysfunctions (p = 0.017, 0.038, and 0.38, respectively).

Conclusions

Persistent lower urinary tract dysfunction, particularly detrusor overactivity, is a significant risk factor for recurrent graft pyelonephritis. Comprehensive evaluation of vesicoureteral reflux and lower urinary tract function via urodynamic studies is important to improve posttransplant outcomes in patients with a history of graft pyelonephritis.

目的评估有移植物肾盂肾炎病史的肾移植受者的下尿路功能和形态变化，探讨特定类型的下尿路功能障碍与移植物肾盂肾炎复发风险之间的关系。方法回顾性分析2019年4月至2023年10月肾移植术后1年以上因发热性移植物肾盂肾炎住院的患者病历。患者在感染控制后接受膀胱造影和尿动力学检查，并随访至少12个月。根据尿动力学结果对患者进行分类，并分析无复发生存率。结果共纳入24例患者。20例（83.3%）患者出现移植肾膀胱输尿管反流。分别有8例（33.3%）、12例（50.0%）和7例（29.2%）患者被诊断为逼尿肌过度活动、逼尿肌活动不足和低依从性膀胱。根据尿动力学的发现，对20例患者的治疗和膀胱管理进行了改进。在中位随访33个月期间，7例患者复发移植物肾盂肾炎。逼尿肌过度活动仍然是移植物肾盂肾炎复发的独立危险因素（优势比为21.4;p = 0.04）。膀胱逼尿肌过度活动或活动不足但非低顺应性的患者与无这些功能障碍的患者相比，无复发生存期明显较短（p分别= 0.017、0.038和0.38）。结论持续性下尿路功能障碍，尤其是逼尿肌过度活动是移植物肾盂肾炎复发的重要危险因素。通过尿动力学研究综合评价膀胱输尿管反流和下尿路功能对于改善移植物肾盂肾炎病史患者移植后的预后非常重要。

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引用次数: 0