LUTS: Lower Urinary Tract Symptoms最新文献

Objective

We aimed to study the incidence of de novo and persistent stress urinary incontinence (SUI), urodynamic stress incontinence (USI) for single incision mesh (SIM) using Calistar-S and anterior mesh (A-mesh) using Surelift-A with sacrospinous fixation (SSF).

Methods

Patients with Stage III or IV POP who underwent Surelift-A + SSF (A-mesh + SSF) or Calistar-S (SIM) were evaluated at 1 year post-operative and compared. The primary outcome was the emergence of post-operative de novo and persistent SUI. Secondary outcomes included the rate of POP recurrence, quality of life, sexual function, and complications.

Results

One hundred and seven patients underwent SIM and 122 patients with A-mesh + SSF. 12/58 (20.7%) had de novo USI, 15/58 (25.9%) de novo SUI in SIM, while in the A-mesh + SSF group, de novo USI developed in 3/43 (7%) and de novo SUI in 4/43 (9.3%), significantly higher with p = 0.048 and p = 0.035 respectively. Rates of persistent USI and SUI were comparable between groups. Objective cure was comparable between the two groups (96.3% vs. 97.5%, p = 0.428), subjective cure 99/107 (92%) vs. 114/122 (93.8%) for SIM vs. A-mesh + SSF. Quality-of-life measures improved significantly in both groups, with greater perceived improvement in the A-mesh + SSF group. One case of bladder injury occurred in SIM and one mesh erosion was seen in both groups.

Conclusion

Risk of de novo SUI and de novo USI were three-fold higher in the SIM (Calistar-S), however risk of persistent USI and SUI was similar. Both SIM and A-mesh + SSF confer comparable high objective and subjective cure.

Purpose

This study aims to investigate the potential influence of serum serotonin (5-HT) levels on the development of overactive bladder (OAB) in a community-dwelling population.

Methods

A four-year longitudinal study was conducted involving 615 subjects who participated in the Iwaki Health Promotion Project in Hirosaki, Japan, in both 2015 and 2019. OAB was defined as experiencing urinary urgency at least once a week with an Overactive Bladder Symptom Score (OABSS) of ≥ 3. Baseline data from 2015, including serum 5-HT levels, other laboratory data, and comorbidity information, were used for the analysis. The association between serum 5-HT levels and incident OAB in 2019 (OAB-2019) was examined using multivariate logistic regression analyses.

Results

The study included 250 men and 365 women, of whom 74 individuals (29 men and 45 women) met the diagnostic criteria for OAB in 2019. Significant differences were observed between the OAB-2019 and non-OAB-2019 groups, including age, chronic kidney disease, irritable bowel syndrome, hypertension, glycemic status, mental status, and OAB in 2015. Participants in the OAB-2019 group had significantly lower serum 5-HT levels compared to the non-OAB-2019 group (100 vs. 129 ng/mL, p < 0.001). After adjusting for confounders, multivariable analysis revealed that serum 5-HT levels < 134 ng/mL (odds ratio: 2.48, 95% confidence interval: 1.39–5.83, p = 0.004), age, mental status, and OAB in 2015 independently served as risk factors for OAB-2019.

Conclusions

Low serum 5-HT levels may be associated with an increased risk of OAB. Further research is needed to elucidate the underlying mechanisms responsible for this association.

Background

Overactive bladder (OAB) is a prevalent urological condition often perceived as negligible or non-threatening, leading to its potential links with severe health conditions being overlooked. Notably, the relationship between OAB and cancer remains unexplored. This study endeavors to elucidate the association of OAB with cancer prevalence and mortality risks.

Methods

This study utilized data from the 2007 to 2016 cycles of the National Health and Nutrition Examination Survey (NHANES), incorporating linked mortality data up to December 31, 2019. OAB symptoms were quantified using the modified overactive bladder symptom score (OABSS), with scores ≥ 3 confirming diagnosis. Cancer status was self-reported and further clarified for cancer type. We employed multivariate weighted logistic regression to examine the association between OAB and cancer prevalence, and subgroup analysis to identify variations across demographic and clinical characteristics. Cumulative mortality incidence curves, adjusted via inverse probability weighting, and multivariate Cox regression analysis were utilized to investigate the relationship between OAB and cancer-related mortality.

Results

A total of 20 468 adults aged 20 and older were involved in this study. After adjusting for potential confounders, OAB was positively associated with the risk of cancer (OR = 1.36, 95% CI: 1.18, 1.57). Subgroup analysis revealed significant interactions between OAB and age (P_interaction = 0.001). Survival analysis suggests that OAB was linked to higher all-cause mortality risks exclusively among cancer patients (HR 1.39, 95% CI: 1.17, 1.65) and elevated cancer-specific mortality across the overall population (HR 1.33, 95% CI: 1.03, 1.73).

Conclusion

OAB is associated with the prevalence and mortality of cancer among US adults.

Objective

To evaluate I-Stop-Mini surgery outcomes in urodynamic stress incontinence (USI) patients and its sonographic features at 1 year.

Methods

One hundred one patients with confirmed USI who underwent I-Stop-Mini surgery from March 2019 to February 2023 were recruited. Inclusion criteria include confirmed USI. Pelvic organ prolapse ≥ stage 2, detrusor overactivity, neurogenic bladder, high residual urine, or concomitant prolapse surgery were excluded. Primary outcomes were objective and subjective continence cure. Secondary outcomes were sonography findings of sling mobility (T), bladder neck (BN), sling to urethra percentile, and the presence of dynamic urethral kinking.

Results

Objective cure and subjective cure were 85/92 (92.4%) and 83/92 (90.2%). Significant improvement in UDS diagnosis of USI was seen pre- versus postoperatively 92/92 (100%) versus 7/92 (7.85%) p < 0.001 and change in pad weight from 22.4 ± 29.1 to 1.5 ± 3.8 g, p < 0.001. As for secondary outcome, no change in resting tape position (xt, yt), at 6months and 1 year; (18.2 ± 2.8, 17.3 ± 2.6 mm) versus (18.8 ± 2.2, 17.8 ± 2.8 mm), (p = 0.208, p = 0.237) respectively. During Valsalva (22.4 ± 3.3, 7.0 ± 2.9 mm) versus (22.8 ± 3.7, 7.5 ± 2.4 mm) (p = 0.251, p = 0.135) at 6 months and 1 year. Tape mobility unchanged, 11.3 ± 2.5 versus 11.4 ± 3.0 mm, p = 0.693. Dynamic kinking was maintained at 60% versus 59%, p = 0.877. No major complication was observed.

Conclusion

I-Stop-Mini SIS has high objective and subjective cure. Dynamic kinking, BN position (at rest and Valsalva) and mobility between 6 months and 1 year were maintained, thus promoting its continence effect.

Objectives

The therapeutic effect of saw palmetto extract (SPE) in benign prostatic hyperplasia (BPH) has been evaluated in clinical trials. However, the molecular mechanisms of SPE in BPH development are not fully understood.

Methods

LNCap cell line treated with dihydrotestosterone (DHT) and SD rats induced with testosterone were used, respectively. TUNEL and Muse Cell Analyzer for apoptosis and CCK8 assay for cell viability were performed to investigate the effects of SPE against BPH. Histological changes were examined by HE staining. Protein expression was analyzed for AR, PSA, SRC-1, and 5AR2 by Western blot, and the levels of DHT and testosterone in rat serum were quantified by ELISA.

Results

SPE treatment could accelerate the apoptosis of cells and decrease the expressions of TNF-α, IL-1β and IL-18. TUNEL staining revealed an increase in positive staining after SPE treatment. Rats treated with SPE exhibited a reduction in prostate weight. SPE treatment led to a decrease in serum DHT and testosterone levels. SPE treatment significantly reduced the protein levels of AR, PSA, SRC-1, and 5AR2 in vitro and in vivo.

Conclusions

SPE possesses anti-proliferative and pro-apoptotic effects by inhibiting 5α-reductase and DHT expression in vitro and in vivo, thereby mitigating the progression of BPH.

Objectives

To evaluate outcomes following bladder augmentation in children at a specialized third-level center concerning quality of life (QoL), continence status, and sexual function.

Methods

The study population included bladder augmented patients treated over the last 25 years. We established contact with them and emailed an online survey with three validated questionnaires: QoL (EQ-5D-5L), incontinence (ICIQ-SF) and sexual function (FSH/FSM2).

Results

Twenty-four patients, aged between 9 and 44, answered the questionnaire. Among respondents, 54.2% declared experiencing some problem in one or more of the five evaluated dimensions. The mean EQ-VAS score was 80 out of 100, while the mean EQ-5D-5L index was 0,845 out of 1. Based on the ICIQ-SF questionnaire, 58.3% of patients were classified as incontinent. Regarding the bother scale (0–10), the mean score was 4.7 ± 3. Among the 18 patients old enough to answer the sexual function questionnaire, 11 (61.1%) described a low or nonexistent level of sexual satisfaction. Among the male cluster, the average score on the FSH questionnaire was 10.95 ± 6.78 (scale 2–24), while in the female cohort the average score on the FSM-2 questionnaire was 21.5 ± 9.64 (scale 2–32).

Conclusions

Despite the high complication rate and the presence of some degree of incontinence or sexual dysfunction in nearly 60% of patients undergoing bladder augmentation in childhood, our cohort exhibits relatively good QoL scores when compared to those reported for the general population.

Objectives

Rarely have studies focused on the utilization of urethral pressure profile (UPP) in bladder neck obstruction (BNO). This study aimed to evaluate the parameters of UPP in urodynamic testing (UDS) using air-charged catheters (ACC) and to investigate the value of UPP as a diagnostic tool for female BNO.

Patients and Methods

We retrospectively collected records of 165 female patients with lower urinary tract symptoms (LUTS) who received UDS at our center from September 2020 to September 2022. The whole patient group was divided into BNO group (n = 92) and non-BNO group (n = 73). The urodynamic data were evaluated.

Results

The UPP includes urethral pressures at the bladder neck (b-UP) and urethral sphincter (s-UP). The b-UP was higher in the BNO group than in the non-BNO group [104.50 (40.50) cmH2O vs. 58.00 (33.50) cmH2O, p < 0.001]. According to multivariable logistic regression analysis, b-UP and bladder voiding efficiency (BVE) were independently associated with BNO. The area under the curve (AUC) of the b-UP had the best value for predicting BNO [AUC: 0.878, sensitivity: 88.04%, specificity: 76.71%, 95% confidence interval (CI): 0.819–0.924]; its cut-off value was 72 cmH2O. Meanwhile, Cohen's kappa was 0.65 (95% CI: 0.537–0.770), indicating that UPP as a diagnostic tool was highly consistent with the video-urodynamic study (VUDS).

Conclusions

UPP by air-charged urodynamic catheters can show the pressure of the bladder neck, with predictive value for identifying BNO in women. The predictive method based on UPP and pressure-flow study (PFS) without fluoroscopy will improve the diagnostic accuracy of BNO, which could help urologists in making better clinical decisions.

Objectives

To explore the efficacy and safety of thulium laser vaporization of the prostate (ThuVAP) for benign prostatic hyperplasia (BPH) at Nara Medical University from 2022 to 2024.

Methods

Patients with BPH who underwent ThuVAP at the Department of Urology, Nara Medical University, between January 01, 2022 and April 30, 2024, were enrolled. Patient background, presurgical pressure flow study results, treatment efficacy, and safety were retrospectively evaluated.

Results

The study included 32 patients; the median age was 74.5 years at surgery. The total International Prostate Symptom Score and quality of life were significantly lower at 4 weeks after surgery than at baseline. They continued to decrease at 12 and 24 weeks. The maximum flow rate was significantly higher at 4 weeks after surgery than at baseline; it continued to increase for 12 and 24 weeks. The postvoid residual (PVR) was significantly lower at 4 weeks after surgery than at baseline and continued to decrease at 12 and 24 weeks.

Intravesical prostatic protrusion and prostate volume were positively correlated with the surgery and laser usage times. Two patients experienced temporary urinary retention, and two underwent transurethral electrocoagulation for postoperative bleeding.

Conclusions

Our data confirm ThuVAP as an effective and safe treatment for BPH.

Objective

To determine factors associated with care-seeking in males with urinary incontinence (UI).

Methods

A cross-sectional study was performed using the National Association for Continence (NAFC) sponsored adult patient-reported survey data from November 2018 to January 2019. Descriptive statistics, chi-squared test, and multivariate logistic regression were used to identify factors associated with care-seeking behavior.

Results

Four hundred and forty-six men completed the survey during the study period. 84% of care-seeking men had initiated the discussion with their doctor about their UI, with 57% initially seeing their primary care provider. Statistically significant predictors of care-seeking were greater UI frequency (OR 1.68, CI 1.22–2.33), UI duration (OR 2.91, CI 1.88–4.65), cost of UI management (OR 1.53, CI 1.12–2.10), and comfort discussing UI (OR 2.83, 1.41–5.87). The top reasons cited for not seeking care for UI were embarrassment (29%) and the sentiment that UI is just a normal part of aging (22%). Non-care-seeking men were more likely to have their UI associated with feelings of shame and isolation.

Conclusions

The majority of men who sought care for UI initiated the conversation with their PCP. Men with longer UI duration, higher UI frequency, higher cost expenditure on UI management, and those who felt comfortable discussing their UI were more likely to seek care.

Objectives

This retrospective study aimed to compare the surgical outcomes of holmium laser enucleation of the prostate (HoLEP) and transurethral vaporization techniques between the elderly and nonelderly patients with benign prostatic enlargement (BPE).

Methods

We retrospectively analyzed clinical data from two regional centers that used HoLEP and transurethral vaporization techniques for BPE treatment. The study population consisted of male patients with lower urinary tract symptoms, divided into elderly and nonelderly groups.

Results

Total 477 of 872 patients remained in the study, of which 198 were classified as elderly (age ≥ 75 years) and 279 as non-elderly (age < 75 years). The postoperative decrease in IPSS was significantly lower in the elderly group, and advanced age was associated with less IPSS decline only after vaporization (p = 0.003) but not after HoLEP. In both surgeries, the duration of postoperative catheterization was significantly longer in the elderly group than in the non-elderly group, and hemoglobin drop at 1 day postoperatively showed no age-related difference. The most common complication after HoLEP was intermittent incontinence, which was more frequent in the elderly group (15.0%) than in the non-elderly group (6.2%, p = 0.038). Regardless of age, the overall rate of need for medication at 6 months postoperatively was significantly higher after HoLEP (32/190, 16.8%) than after transurethral vaporization (30/287, 10.5%) (p = 0.042). The need for medication was higher in the elderly for both HoLEP and vaporization than in the non-elderly group with a specific cutoff of age.

Conclusions

Elderly patients with BPE had relatively worse surgical outcomes, including a higher need for postoperative medications and prolonged catheterization. HoLEP demonstrated a reduction in IPSS regardless of age, and transurethral vaporization did not, although it was associated with a higher rate of intermittent incontinence.