Neurourology and Urodynamics最新文献

Objective: This study aimed to explore the association between food insecurity (FI) and lower urinary tract symptoms (LUTS) in middle-aged and older men, and to evaluate the mediating role of depression in this relationship.

Methods: Data were drawn from the National Health and Nutrition Examination Survey (NHANES) 2005-2008, including 2777 men aged 40 years and older. FI was assessed using the Household Food Security Survey Module, depression was measured by the PHQ-9 scale, and LUTS were identified via symptoms such as hesitancy, incomplete bladder emptying, incontinence, and nocturia. Weighted logistic regression and restricted cubic spline models were applied to assess associations. Mediation analysis was conducted using depression as a mediator.

Results: After full adjustment, FI was significantly associated with higher odds of incomplete bladder emptying (OR = 1.94, 95% CI: 1.11-3.36), urinary incontinence (OR = 2.11, 95% CI: 1.44-3.09), nocturia (OR = 1.59, 95% CI: 1.11-2.29), and clinical LUTS (OR = 2.49, 95% CI: 1.63-3.80). Moreover, higher PHQ-9 scores were consistently associated with increased odds of all types of LUTS, including urinary hesitancy, incomplete bladder emptying, urinary incontinence, nocturia, and clinical LUTS, in a dose-dependent manner. Mediation analysis indicated that depression partially mediated the association between FI and LUTS. Specifically, depression accounted for 12.22% of the effect of FI on urinary hesitancy, 8.90% on incomplete bladder emptying, 9.90% on urinary incontinence, 7.74% on nocturia, and 6.69% on clinical LUTS (all p < 0.05). These results demonstrate that depression plays a modest but statistically significant mediating role in the pathway linking FI to LUTS.

Conclusions: FI is significantly associated with multiple LUTS among middle-aged and older men, with depression partially mediating this relationship. Addressing both food access and mental health, particularly depression, may be critical for mitigating LUTS burden in this population.

Clinical trial registration number: Our study does not require a clinical trial registration. The survey data of our study are publicly available on the internet for data users and researchers throughout the world (https://www.cdc.gov/nchs/nhanes/?CDC_AAref_Val=https://www.cdc.gov/nchs/nhanes/index.htm).

Aims: To evaluate the prevalence, clinical course, and risk factors of lower urinary tract symptoms (LUTS) in patients hospitalized with COVID-19, and to assess associations with comorbidities, disease severity, and vaccination status.

Methods: We conducted a prospective cohort study of adult patients hospitalized with confirmed COVID-19, who were not in intensive care at the time of enrollment, between July 2021 and March 2022. LUTS were assessed using the International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB), and ICIQ-Urinary Incontinence Short Form (ICIQ-UI SF) questionnaires during hospitalization and at one and 3 months post-discharge. Moderate to severe LUTS were defined as an IPSS > 7. Overactive bladder symptoms (OAB symptoms) were defined as an ICIQ-OAB Score ≥ 3 plus urgency and/or urgency urinary incontinence (UUI). Associations with sex, comorbidities, COVID-19 severity, and vaccination status were analyzed using multivariable logistic regression.

Results: Among 168 patients (55.4% male, median age 58 years), 31.0% had moderate to severe LUTS during hospitalization, with storage symptoms predominating. Urgency was present in 21.4% of the cohort, and 36.7% met the criteria for OAB symptoms. Urinary incontinence (UI) affected 34.5%, being more frequent among women. At 3 months, moderate to severe LUTS declined to 21.9%, and both OAB symptoms and UI also decreased significantly. No associations were found between LUTS and comorbidities or disease severity. Fully vaccinated patients had higher odds of moderate to severe LUTS during hospitalization (adjusted OR 10.56, 95% CI 4.13-26.9), particularly those vaccinated with inactivated virus vaccines (BBIBP-CorV).

Conclusions: LUTS are prevalent in the acute phase of COVID-19, especially among women, but tend to improve within 3 months. Unexpectedly, full vaccination-especially with inactivated virus vaccines-was associated with increased odds of moderate to severe LUTS during hospitalization. Further studies are warranted to explore the underlying mechanisms and long-term implications.

Trial registration: This study was not registered at ClinicalTrials.gov, as it is an observational study with no clinical intervention.

Aim: Metrics used to evaluate meaningful clinical outcomes have long been a matter of controversy, particularly where there is no defined objective cure and patient-reported metrics (PROMs) are utilised as objective measures of subjective phenomena. The ICI-RS 2025 think tank discussed the relative merits of objective and subjective outcomes in clinical trials.

Methods: A review of medical literature in four key areas; hard metrics versus PROMs assessment of Minimally Invasive Surgical Treatments for Bladder Outflow Obstruction, for Stress Urinary Incontinence, and their use in current registries and databases were debated. Limitations of trial design were highlighted and proposals for further reporting, steering groups and guidance panels suggested.

Results: It is yet to be fully understood how objective data and PROMs weigh bias and variability. Longitudinal study for objective and subjective metrics is required. Qualitative study with benchmarking may allow future studies to allow patients to set their own goals and develop more nuanced, patient-defined PROMs. Databases incorporating core metrics, specialist assessments and regression analysis may have utility to create composite algorithms into unified scoring systems. Artificial intelligence learning may be applied to large datasets.

Conclusions: Both objective and subjective assessments have their limitations. A balanced approach, combining both may provide the most complete and accurate picture.

Background: Nocturia is a prevalent condition with systematic etiologies which require multidisciplinary collaborations during diagnosis and management. Here we evaluate current evidence and present unresolved research questions regarding the three key pathophysiological domains of nocturia with respect to a conceptual brain-kidney-bladder axis, namely sleep enhancement, extra-renal water reabsorption and circadian regulation of bladder tissue.

Methods: A Think Tank was convened at the 12th International Consultation on Incontinence Research Society meeting in June 2025, looking at novel therapeutic targets for nocturia. This article synthesizes key deliberations from this meeting session.

Results: The discussion was mainly focused on idiopathic nocturia with an overactive bladder symptom complex or nocturnal polyuria. Firstly, medications and conservative nondrug measures targeting sleep that could potentially improve nocturia were considered. Secondly, investigation of water reabsorption mechanisms within the bladder and the role of small molecule vasopressin receptor type-2 agonists were examined that may provide novel therapeutic options to rectify nocturnal polyuria. Finally, to address circadian misalignments, organ specific chronotherapies, based on abnormal circadian features of bladder tissues that can be curative for nocturia, were discussed.

Conclusions: The evidence indicates that promising therapeutic modalities targeting the regulation of sleep-wake cycles, intravesical water transport mechanisms, and circadian patterns of detrusor activity may offer alternative strategies for managing nocturnal polyuria. However, further mechanistic investigations and randomized controlled trials are required to advance these approaches toward clinical translation.

Introduction: Refractory neurogenic lower urinary tract dysfunction presents an obstinate clinical problem. For patients who fail nonsurgical measures, we advocate for bladder-sparing, continent urinary diversion as the optimal approach to management.

Methods: The arguments presented herein were informed by a review of the contemporary literature and our longitudinal institutional experience caring for patients with neurogenic lower urinary tract dysfunction.

Results: Bladder-sparing, continent urinary diversion comprises procedures such as bladder augmentation, creation of a continent catheterizable channel, and bladder neck surgeries such as reconstruction, closure, and placement of a compressive sling or artificial sphincter. Such procedures facilitate clean intermittent catheterization, improve continence, and support patients' independent bladder management. These benefits yield quantifiable gains in quality of life, as demonstrated through several contemporary investigations incorporating patient-reported outcomes measures. Moreover, while continent and non-continent diversions are both susceptible to long-term complications, the former can be managed through both surgical and non-surgical means.

Conclusions: Continent urinary diversion prioritizes patients' autonomy and quality of life. It should be considered the primary surgical option for patients with refractory neurogenic lower urinary tract dysfunction.

Introduction: Overactive bladder (OAB) is defined as urinary urgency, usually accompanied by increased daytime frequency and/or nocturia, with urgency urinary incontinence (OAB-wet) or without (OAB-dry), in the absence of urinary tract infection or other detectable disease. The key symptom of OAB, urinary urgency, is defined as a complaint of sudden, compelling desire to pass urine which is difficult to defer. However, patients report a range of individual experiences and sensations associated with urgency and studies have identified different types of urgency. Patients with OAB not only differ in clinical presentation, but also have different urodynamic and radiological findings. These variations may explain why OAB treatments work well for some individuals but not others. This paper investigates how knowledge can be advanced by phenotyping OAB by urgency symptom variation, and clinical, urodynamic measurements and radiological features.

Methods: A Think Tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2025 discussed the question, "Can OAB management be improved by phenotyping if there are different types of urgency?" The group discussed the current literature on this topic and developed a list of research questions to help shape the future of the field.

Results: Clinical, urodynamic and radiological phenotyping of urgency were discussed and research studies to phenotype urgency were proposed.

Conclusion: Further research to phenotype OAB beyond the presence or absence of urgency and urgency urinary incontinence, using clinical, urodynamic measurements and radiological features, is needed. High priority research questions and strategies were defined. Advanced OAB phenotyping may guide tailored management beyond a stepwise approach, with the aim to improve therapeutic outcomes. This would validate phenotyping and is explored in Part 2 of the topic.

Introduction: For women with bothersome stress urinary incontinence (SUI), a urethral sling is the gold-standard surgical treatment. Despite the high efficacy of slings for SUI, up to a 20%-30% rate of complications or adverse effects have been reported, and there can be a period of convalescence postoperatively. Given this, the less invasive approach of urethral bulking may be utilized. A number of bulking agents can be used to improve urethra coaptation. Polyacrylamide hydrogel (PAHG) is a bulking agent that received FDA approval in 2020 and is reported to have longer efficacy for the treatment of SUI compared to prior bulking agents. We sought to assess trends in the usage of surgery and urethral bulking for SUI treatment in women at a single academic medical center before and after the introduction of PAHG.

Methods: This is a retrospective cohort study of all new patients seen with an ICD-10 diagnosis of SUI (N39.3) at an academic tertiary care center from June 2019 to June 2023. Our multidisciplinary clinic was established in May 2019. Patients were included if they underwent an interventional treatment for SUI with urethral bulking, sling (either mesh or autologous fascia), or Burch colposuspension. Patients were stratified to before and after the introduction of PAHG to our clinic in April 2021. The primary endpoint was the percent of new patients seen in clinic with SUI who were treated with urethral bulking compared to surgical treatment.

Results: A total of 478 new patients with SUI were seen and 279 treated with an invasive procedure by 5 URPS trained surgeons. In total, 109 of these patients underwent treatment in the 20 months before PAHG was introduced into the clinic and 170 patients in the 27 months after. Use of urethral bulking for new patients seen for SUI increased from 56% to 69.1% (p = 0.04) of patients with SUI who underwent a procedure. When the total number of new patients presenting with a diagnosis of SUI was analyzed by 12-month period, there was an overall increase in the number of procedures for SUI, which was driven by an increase in the percent of new patients who were treated with bulking.

Conclusions: The introduction of a PAHG resulted in increased utilization of urethral bulking for patients newly presenting with SUI to a tertiary care center.

Purpose: Vibegron was associated with improvements in efficacy versus placebo and was well tolerated in men with overactive bladder (OAB) on pharmacotherapy for benign prostatic hyperplasia (BPH) in the COURAGE trial (NCT03902080). Additional safety, bladder function, and urodynamics data are provided.

Methods: This 24-week, phase 3, double-blind, placebo-controlled trial randomized men ≥ 45 years with OAB and BPH receiving α-blocker ± 5α-reductase inhibitors to once-daily vibegron or placebo (1:1). From the safety analysis set (SAF), postvoid residual urine volume (PVR), maximum urinary flow rate (Uroflow-Q_max), International Prostate Symptom Score (IPSS) total score, and urologic-related adverse events (AEs) were collected throughout the trial. Q_max and detrusor pressure at Q_max (P_detQ_max) were collected at baseline and week 12 in a urodynamics substudy (urodynamics evaluable set [UES]).

Results: In the SAF, differences between vibegron (n = 553) and placebo (n = 551) in PVR and Uroflow-Q_max were minimal at baseline, week 12, and week 24. Mean (SD) change from baseline (CFB) at week 24 in IPSS total score was -7.3 (6.96) with vibegron and -5.7 (7.14) with placebo. Urinary retention was reported as an AE for 5 (0.9%) and 4 (0.7%) participants receiving vibegron and placebo, respectively. In the UES (vibegron, n = 21; placebo, n = 22), least squares mean difference (95% CI) between vibegron and placebo in CFB at week 12 was 2.75 (0.16, 5.34) mL/s in Q_max and 2.86 (-13.52, 19.25) cmH₂O in P_detQ_max.

Conclusions: There were no safety signals related to bladder function identified by urodynamics; risk of protocol-defined AEs of urinary retention or residual urine volume increase was not increased with vibegron compared with placebo in this population.

Clinical trial registration: This study is registered at www.

Clinicaltrials: gov. The registration identification number is NCT03902080.