Neurourology and Urodynamics最新文献

Objectives: Stress urinary incontinence (SUI) has been linked to excessive urethral mobility, yet clinical evaluation has been largely limited to assessing maximal excursion rather than capturing the full dynamics of visible urethral movement. In this study, we hypothesize that an automated, ultrasound-based method can objectively differentiate urethral mobility patterns between women with SUI and continent controls.

Methods: We used a previously validated optical flow-based algorithm to automatically track urethral motion from transperineal ultrasound images during cough, Valsalva maneuver, and pelvic muscle contraction (PMC) in 11 women with SUI and 10 continent controls. Urethral motion was assessed by defining three regions of interest along the urethra (proximal, mid, and distal). Segmental urethral kinematics were computed and statistically compared between groups.

Results: Substantial variability and overlap between groups were observed, with coefficient of variation ranging 25%-90%. On average, women with SUI demonstrated significantly larger urethral displacement compared to controls, particularly at the proximal segment during Valsalva (10.6 ± 1.2 mm vs. 6.0 ± 0.6 mm, p < 0.01), with pronounced inferior-posterior motion. Additionally, displacement between the upper and lower urethra was significantly larger in the SUI group (0.47 ± 0.10 mm/mm vs. 0.13 ± 0.03 mm/mm, p < 0.05), indicating localized hypermobility particularly near the proximal urethra. Maneuver-specific differences were also noted within the SUI group, with Valsalva producing significantly larger and less uniform urethral movements compared to cough (10.6 ± 1.2 mm vs. 6.6 ± 0.5 mm, p < 0.05).

Conclusion: Our results demonstrate that the automated method is capable of capturing urethral mobility characteristics associated with SUI. Significant inter-individual variability in both continent and SUI groups indicates that urethral kinematics are heterogeneous. The detailed kinematic data have the potential to identify distinct sub-types of urethral mobility, facilitating systematic comparisons with underlying structural and neuromuscular defects. This approach can move clinical evaluation from simple group comparisons toward personalized SUI diagnosis and targeted treatment selection. Future studies with larger sample sizes and inclusion of additional pelvic floor conditions will be needed to validate these findings and advance their translation into clinical practice.

Objective: This prospective study evaluated the impact of the "double-hump" deformity-defined by anterior protrusions of the L4-L5 and L5-S1 disks-on L5-S1 angulation and laparoscopic sacrocolpopexy (LSC) outcomes. We hypothesized that this deformity is associated with reduced angulation and impaired sacral promontory visibility.

Methods: The L5-S1 intervertebral angle measured using sagittal computed tomography (CT) was the primary outcome. Intraoperative sacral promontory visibility, postoperative CT findings of mesh malposition, and perioperative surgical measures (operative time, blood loss) were key secondary outcomes. A total of 184 women scheduled to undergo LSC underwent preoperative CT. The double-hump deformity was defined as an L4-L5 angle > 15° and an L5-S1 angle < 50°. CT measurements of disk heights, disk angles, and sacral promontory location were obtained. For double-hump cases (n = 52), intraoperative videos were reviewed by a blinded surgeon who scored sacral promontory visibility. Postoperative CT was performed to assess mesh placement.

Results: Compared with the control group, the double-hump group had a significantly smaller L5-S1 angle and greater L4-L5 angle (primary outcome). In 50% of double-hump cases (secondary outcome), sacral promontory visualization was rated as "difficult." Intervertebral fixation was not identified by postoperative CT. Estimated blood loss in the double-hump group was greater than that in the control group.

Conclusions: The double-hump deformity is associated with reduced L5-S1 angulation, spinal degeneration, and impaired landmark visibility during LSC. Preoperative recognition may facilitate surgical planning and improve intraoperative safety.

Background: The potential relationship between urinary caffeine metabolites and wet overactive bladder (OAB) is not clear. This study aims to investigate the relationship between urinary caffeine with caffeine metabolites and wet OAB prevalence in American population.

Methods: This cross-sectional study included participants from the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2014. Diagnosis of wet OAB, urinary caffeine with caffeine metabolites, and covariates including demographic, dietary, examination, laboratory, and questionnaire data were collected. Weighted univariate analysis, weighted multivariate logistic regression analysis, restricted cubic spline (RCS) analysis, and subgroup analysis were used to investigate the relationship between urinary caffeine with 14 caffeine metabolites and wet OAB. Two sensitivity analyses were performed to test the stability of our results.

Results: Three thousand three hundred and ninety five participants (362 wet OAB and 3033 non-wet OAB) were finally enrolled for analyses. Caffeine intake was not associated with wet OAB (p = 0.455). While multivariate logistic regression analyses and RCS analyses which adjusted all covariates showed that increasing 1,7-dimethyluric acid (odds ratio [OR] = 0.998, 95% confidence interval [CI]: 0.996-0.999, p = 0.015), 1,3,7-trimethyluric acid (OR = 0.954, 95% CI: 0.925-0.984, p = 0.005), paraxanthine (OR = 0.994, 95% CI: 0.989-1.000, p = 0.045), theobromine (OR = 0.994, 95% CI: 0.988-0.999, p = 0.033), and caffeine (OR = 0.974, 95% CI: 0.960-0.989, p = 0.002) were linearly significantly related to decreased risk of wet OAB. Subgroup analyses showed significant negative associations to wet OAB in specific groups of these five metabolites. Sensitivity analyses confirmed the stability. The increased caffeine to 1,3,7-trimethyluric acid, caffeine to 1,7-dimethyluric acid pathway, and caffeine to theobromine pathways might be related to lower risk of wet OAB.

Conclusions: We found no direct link between caffeine intake and wet OAB, but identified linear negative associations of urinary caffeine and several caffeine metabolites with wet OAB, which might be related to the change caffeine metabolic pathway.

The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), has had a successful and productive ten years, accomplishing several major achievements, including over 65 peer-reviewed publications. This multicenter, transdisciplinary Consortium developed the concept of bladder health and studied it systematically in RISE FOR HEALTH (RISE). The resources developed and the data generated will be made available for use through the NIDDK repository, providing the content for many more accomplishments in the field of bladder health. Clinical Trial Registration: NCT05365971.

Introduction: Maintenance of bladder filling and urinary storage at low intravesical pressures is fundamental to minimizing risk to the upper urinary tract. Bladder compliance describes the relationship between the bladder volume and the change in detrusor pressure during the filling phase of urodynamics. Although significant clinical studies were performed 40 years ago, as currently conceived, the concept of bladder compliance and the associated normative values are inexact as an isolated measurement in predicting upper urinary tract deterioration in individual patients. The purpose of this review is to better define some of these limitations and propose potential means of addressing them.

Methods: The ICI-RS meeting was held in Bristol, England in June 2025, and Proposal 4 reviewed the current limitations of measuring bladder compliance as a predictor of upper urinary tract deterioration. Several ideas were discussed regarding the existing shortcomings of this parameter as well as potential methods of improving its measurement and prognostic value. Future research questions were reviewed and prioritized.

Results: The current methods of measurement and normative values for bladder compliance are inadequate for assessing upper urinary tract risk in many patients. The urodynamic technique for assessing compliance is not standardized among investigators resulting in potential variances between patients and centres. In addition, many patients undergoing urodynamics have very abnormal lower urinary tract anatomy. Such differences in structure, if not accounted for, could impact compliance assessment. Finally, the current "gold standard" of assessing compliance, the pressure-flow urodynamic study, involves catheters and is expensive, and itself may not account for a number of other factors which could potentially affect upper urinary tract risk. Alternative methods of assessing bladder compliance and upper urinary tract risk are investigational but may have some improved prognostic value.

Conclusions: Prediciting upper urinary tract deterioration due to abnormalities of bladder compliance remains inexact as an isolated metric. The reasons for the lack of sensitivity and specificity are not well understood. Identifying the limitations of bladder compliance, modifying its assessment or combining it with other clinical or biological measurements may provide better and more precise prognostic information. In the meantime, advice is given on a "common sense" way by which UDS can be modified in relevant patient, in order to provide information that improves management and surveillance of vulnerable patients at risk from renal damage.

Background: Uroflowmetry (UFM) is a simple and widely used first-line investigation for evaluating lower urinary tract symptoms (LUTS). Despite its non-invasive nature, uroflowmetry can provoke anxiety and affect satisfaction, often due to a lack of understanding about the procedure.

Objective: This randomized controlled trial aimed to compare the effects of structured versus verbal education on alleviating anxiety and assessing patient satisfaction in those undergoing UFM.

Methodology: A single-blind, parallel-arm study was conducted with 148 patients who were randomly assigned to either a structured teaching (brochure) group or a verbal counseling group. The modified Amsterdam Preoperative Anxiety and Information Scale (APAIS-M) was used to assess anxiety, while satisfaction was measured using a validated questionnaire. Descriptive statistics, Chi-square, and independent t-tests were employed for data analysis.

Results: The structured education group demonstrated statistically insignificant overall anxiety score in both groups 10.6 ± 1.23 versus 9.61 ± 1.4 (p = 0.49) in verbally counseled versus structured education group respectively, but individual components have significant differences like worry scores (2.87 ± 0.135) in structured education group compared to the verbal education group (3.49 ± 0.142; p = 0.028), and fewer thoughts (2.90 ± 0.150) versus the verbal education group (3.25 ± 0.155; p = 0.044). Satisfaction scores showed that the structured group had a higher satisfaction to the knowledge provided (1.21 ± 0.04 vs. 1.08 ± 0.036, p = 0.035) and ease of using UFM equipment (4.51 ± 0.11 vs. 4.05 ± 0.118, p = 0.047), more satisfied with aspects related to privacy (4.68 ± 0.112 vs. 4.20 ± 0.115, p = 0.04).

Conclusions: Structured education significantly improved patient understanding, comfort, and expectations regarding privacy, while reducing anxiety compared to verbal counseling. Integrating structured education before uroflowmetry could further enhance the patient experience and satisfaction.

Introduction: The use of antibiotic prophylaxis before urodynamic studies has been debated for a long time, with no clear consensus among international guidelines. Based on identified predictors of urinary tract infection after urodynamic studies, this study aims to develop and internally validate a nomogram to predict post-urodynamic study urinary tract infection and assess its clinical net benefit to support selective antibiotic prophylaxis.

Methods: Multivariable logistic regression identified final predictors; coefficients were converted into a user-friendly nomogram. Performance was evaluated using the area under the receiver operating characteristic curve (ROC-AUC), Brier score, calibration (bootstrap-corrected), and precision-recall AUC (average precision). Decision curve analysis was used to evaluate the clinical net-benefit of the nomogram.

Results: The nomogram includes five routinely available variables: hydronephrosis, neurological lower urinary tract dysfunction, post-void residual volume ≥ 200 mL, age ≥ 70, and the use of an indwelling catheter or performing clean intermittent catheterization. Discrimination was fair (ROC AUC 0.7086). Overall accuracy was good (Brier 0.0180). Calibration showed good agreement after bootstrap correction. Average precision was 0.0508, exceeding the base prevalence. Decision curve analysis demonstrated a positive net benefit relative to both the treat-all and treat-none strategies at low clinical thresholds (<5%).

Conclusion: This simple, well-calibrated nomogram provides individualized post-UDS UTI risk estimates and shows decision-analytic benefit in the stewardship-relevant range. It may help target AP to higher-risk patients while safely reducing unnecessary antibiotics. External validation is warranted.

Aims: Nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) and functional constipation (FC) are common functional disorders in childhood, which can persist into adolescence and adulthood. The aim of this paper is to review evidence of risk factors that impede the attainment of bladder/bowel control and contribute towards the persistence of incontinence, and to outline protective factors towards minimizing long-term negative sequelae.

Methods: A think tank group consisting of multidisciplinary experts at the International Consultation on Incontinence Research Society (ICI-RS) in 2025 reviewed evidence of factors influencing the attainment of bladder and bowel control, the continuation of incontinence into adolescence and adulthood and the subsequent negative sequelae. Both prospective and retrospective views were considered. Open questions and future directions were discussed. Recommendations for future research and for the improvement of clinical practice in in children, adolescents and adults were formulated.

Results: Childhood incontinence can continue into adolescence and adulthood and is associated with medical and mental health risks. Genetic and environmental risk factors have been identified, but their interaction with protective factors has not been studied. Potentially important environmental risks that require further research include late toilet training, prolonged use of disposable diapers, excessive use of digital media and lack of transitional care from pediatric to adult services. Studies on prevention on all levels (universal, selective and indicated) are lacking.

Conclusions: As childhood incontinence is a precursor of adult incontinence in many patients, early preventive measures are needed. Future research should focus on identifying risk and protective factors. Improved collaboration and exchange between pediatric services and adult urology is essential.

Objectives: To present a 16-year multinational experience of 1185 female genital fistula (FGF) repairs performed by a single surgical team, emphasizing the integration of classical techniques with adjunctive innovations across diverse clinical settings.

Methods: This structured observational study included 1185 FGF repairs conducted from 2009 to 2025 across 12 countries. Data collected included patient demographics, fistula etiology and type, prior repairs, surgical approach, use of adjuncts, and postoperative outcomes. Primary outcomes were anatomical closure and functional recovery. Secondary outcomes included postoperative complications and psychosocial reintegration of the patients into their families and societies.

Results and limitations: Vesicovaginal fistulas accounted for 64% of cases, followed by urethrovaginal (12%) and rectovaginal (11%). Obstetric trauma and iatrogenic injury were the leading causes (59% and 34%, respectively). Fistulas were classified as simple (36%), recurrent (56%), or complex (8%). Overall closure rate was 82%, highest among simple (91%) and primary (85%) cases. Adjuncts such as platelet-rich plasma (PRP), small intestinal submucosa (SIS), fibrin glue, and buccal grafts were used in 71% of complex/recurrent repairs, with a 72% closure rate in this subgroup. Residual incontinence after successful closure of fistula affected 12% of patients, most of whom improved with bulking agents (72%) or pubovaginal slings (91%). Complication rates included urinary tract and wound infections (5%) and recurrence of fistula (18%). Limitations include retrospective design and heterogeneity in adjunct usage. Another main limitation is our follow-up regimen, which was not done by our surgical team in all countries included. Nevertheless, treatment of residual incontinence was not performed solely by our team, and thus this affected success rate of residual incontinence.

Conclusions: Combining traditional surgical methods with adjunctive techniques enables high closure and functional recovery rates in FGF repair, even in low-resource settings. Selective use of adjuncts supports tissue healing in complex cases and may enhance long-term success.

Patient summary: In this multinational study of 1185 FGF surgeries, integrating traditional and innovative techniques led to high closure rates and improved continence and quality of life even in resource-constrained countries.

Clinical registration: This study does not require clinical trial registration as it is an observational, retrospective analysis of anonymized surgical cases (2009-2025).