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Examining Gender Representation in US News and World Report Top 25 Urology Departments: Female Faculty Hold Lower Professorial Levels and Publication Rates Than Male Counterparts. 研究《美国新闻与世界报道》排名前 25 位的泌尿外科中的性别比例:女教师的教授级别和论文发表率均低于男教师。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-17 DOI: 10.1002/nau.25639
Greeshma Venigalla, Sabika Sadiq, Aaron A Gurayah, Nachiketh Soodana-Prakash, Laura Martin, Katherine A Amin, Raveen Syan

Objectives: To examine female representation in US News and World Report (USNWR) top 25 US Urology departments and identify trends of female representation in institutional roles.

Methods: Using the 2022 USNWR, we collected data from each institution's websites along with a compared geographically local cohort to evaluate the presence of female residents, female attendings, and professorial levels. First or last author faculty publications numbers were found using PubMed and Scopus in fiscal year 2022.

Results: The top 25 institutions averaged ~32.3% female residents and 18.7% female attendings, which was not significantly different from the comparison cohort. Of the total publications of fiscal year 2022, female attendings contributed ~14% (p < 0.001), also not significantly different from the comparison cohort. Only 20.4% of listed female attendings in top 25 programs are full Professors, compared to 41.1% of the listed men (p < 0.05). The most common level of female professorship is Assistant Professor (53.4%). Level of female professorship between cohort was significantly different, with female urologists more likely to hold a title of full Professor in the top 25 cohort compared to the nontop 25 cohort regardless of similar publication output (p < 0.05).

Conclusions: Female faculty in Urology continue to be underrepresented in the top Urology departments, with significant difference in equitable female professorship appointments between top 25 and nontop 25 departments. Future directions include examining the impact of early mentorship and sponsorship on representation over time.

目的:研究美国新闻与世界报道(USNWR)排名前25位的美国泌尿外科部门的女性代表性,并确定女性在机构角色中的代表性趋势。方法:使用2022年USNWR,我们从每个机构的网站收集数据,并比较地理上的本地队列,以评估女性住院医师,女性主治医师和教授水平的存在。在2022财年使用PubMed和Scopus找到了第一或最后一位作者的教师出版物编号。结果:排名前25位的医院中,女性住院医师的平均比例为32.3%,女性主治医师的平均比例为18.7%,与对照组比较差异无统计学意义。结论:泌尿外科女性教师在排名前25位的科室和排名后25位的科室中,女性教授的公平任命存在显著差异。未来的方向包括研究早期指导和赞助对代表的影响。
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引用次数: 0
Systematic Evaluation of Lower Urinary Tract Sensations to Improve Management of LUTS: ICI-RS 2024. 系统评估下尿路感觉,改善下尿路症状管理:ICI-RS 2024。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-16 DOI: 10.1002/nau.25636
Mathijs de Rijk, Claire Hentzen, Caroline Selai, Stefania Musco, Riccardo Lombardo, Gommert van Koeveringe, Christopher Chapple, Paul Abrams, Jean J Wyndaele, Karen McCloskey

Aims: Lower urinary tract (LUT) sensations form an essential part of diagnostic criteria for many LUT symptoms, additionally LUT sensations are used to evaluate the effectivity of therapeutic interventions. The accurate measurement of LUT sensations, however, is severely hampered by the subjective nature of these sensations.

Methods: This paper summarizes the discussions from the 2024 meeting of the International Consultation for Incontinence-Research Society (ICI-RS 2024) regarding systematic evaluations of LUT sensations and the design of more objective tools to measure these.

Results: Here, we discuss factors that influence sensations that are under the control of the caregiver/investigator, the signaling of sensations from the LUT toward the central nervous system, and currently used diagnostic tools to measure LUT sensations. Recent methodological advances to objectively measure factors that correspond with changes in LUT sensations are introduced along with recommendations for future research to optimally enable objective assessment of processes underlying LUT sensations.

Conclusions: Advancing the objective measurement of LUT sensations will require interdisciplinary collaboration, integrating insights from neuroscience, engineering, and clinical practice. Such efforts hold the potential to transform patient care by enabling more precise diagnostics and personalized therapeutic strategies.

目的:下尿路(LUT)感觉是许多下尿路症状诊断标准的重要组成部分,此外,下尿路感觉还可用于评估治疗干预的效果。然而,LUT 感觉的主观性严重影响了 LUT 感觉的准确测量:本文总结了国际尿失禁咨询研究协会 2024 年会议(ICI-RS 2024)上关于系统评估 LUT 感觉和设计更客观的测量工具的讨论:在此,我们讨论了影响护理人员/研究人员控制下的感觉的因素、从 LUT 向中枢神经系统发出的感觉信号以及目前用于测量 LUT 感觉的诊断工具。本文介绍了最近在客观测量与 LUT 感觉变化相对应的因素方面取得的方法学进展,并对未来研究提出了建议,以最佳方式对 LUT 感觉的基本过程进行客观评估:推进 LUT 感觉的客观测量需要跨学科合作,整合神经科学、工程学和临床实践的见解。这些努力有可能通过更精确的诊断和个性化的治疗策略改变对患者的护理。
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引用次数: 0
Do We Need to Re-Focus on Functional Female Urethral Disorders in Lower Urinary Tract Dysfunction? ICI-RS 2024. 下尿路功能障碍是否需要重新关注功能性女性尿道障碍?ICI-RS 2024。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-28 DOI: 10.1002/nau.25633
Christopher J Chermansky, Jeremy L Ockrim, George Bou Kheir, Christopher R Chapple, Rohna Kearney, Bogdan Toia, Roger R Dmochowski, Alan J Wein, Paul Abrams
<p><strong>Aims: </strong>Insights into the role of the urethra in maintaining continence and in normal voiding have been provided with advances in imaging techniques. Also, functional urethral testing is used to understand which treatments are optimal for women with functional bladder outlet obstruction (BOO), but which testing is better for which treatment? This review aims to describe our current understanding of female urethral function and dysfunction and to provide future research directions for treating functional female urethral disorders.</p><p><strong>Materials and methods: </strong>This is a consensus report of the proceedings of a research proposal discussed at the annual International Consultation on Incontinence-Research Society (ICI-RS), 6th-8th June 2024 (Bristol, UK): "Do we need to re-focus on functional female urethral disorders in lower urinary tract dysfunction? ICI-RS 2024".</p><p><strong>Results: </strong>Regarding female urethral nomenclature, it was agreed that the same terminology should be used in the orientation of the female urethra as in the male. Also, functional MRI and computer modeling could aid further understanding of urethral function in women with voiding dysfunction and OAB symptoms. As for functional urethral assessment, options include video-urodynamics with leak point pressure (LPP) testing, urethral pressure profilometry (UPP), and striated urethral sphincter electromyography (EMG). Future testing may include the use of modalities (borrowed from cardiologic assessment of vascular structures such as resistive measures obtained with ultrasound) for the purpose of assessing urethral closure. UPP testing has limitations in measurement and reproducibility in assessing urethral pressure. Urethral sphincter EMG is difficult to perform and reproduce. LPP also has limitations related to testing and to patient effort, in addition to being influenced by factors such as bladder volume and compliance. When performing urethral surgery, it is imperative to dissect in tissue planes that preserve urethral function. Regarding therapeutic modalities for the treatment of functional female urethral dysfunction, conservative management includes pelvic floor muscle training with or without biofeedback, electrical stimulation, and extracorporeal magnetic stimulation. Furthermore, there was a robust discussion on the use of cognitive-behavioral therapy to address psychological comorbidities, thereby improving female LUTD. The evidence supporting long-term pharmacologic treatment of female urethral LUTD remains scarce. As for invasive management options, the evidence supporting the use of botulinum toxin in female LUTD is limited. Finally, the very existence of BNO and the validity of its diagnosis was discussed. Furthermore, bladder neck incision as a treatment of BNO was debated, and the indications for this procedure include a therapeutic decision balancing benefit to complications.</p><p><strong>Conclusion: </strong>Improving
目的:随着影像技术的进步,对尿道在维持尿失禁和正常排尿中的作用有了深入的了解。此外,功能性尿道测试用于了解哪种治疗方法对功能性膀胱出口梗阻(BOO)的女性是最佳的,但哪种测试对哪种治疗更好?本文综述了目前我们对女性尿道功能和功能障碍的认识,并为功能性女性尿道疾病的治疗提供了未来的研究方向。材料和方法:这是在国际失禁研究学会(ICI-RS)年度咨询会议上讨论的一项研究计划的共识报告,2024年6月6日至8日(Bristol, UK):“我们是否需要重新关注下尿路功能障碍中的功能性女性尿道疾病?ICI-RS 2024”。结果:关于女性尿道的命名,一致认为女性尿道的朝向应与男性尿道的朝向使用相同的术语。此外,功能MRI和计算机建模可以帮助进一步了解女性排尿功能障碍和OAB症状的尿道功能。至于功能性尿道评估,选项包括视频尿动力学与泄漏点压力(LPP)测试,尿道压力谱(UPP),和横切面尿道括约肌肌电图(EMG)。未来的测试可能包括使用模式(借鉴血管结构的心脏学评估,如超声获得的电阻测量)来评估尿道闭合。UPP测试在评估尿道压力的测量和可重复性方面存在局限性。尿道括约肌肌电图难以进行和再现。LPP除了受到膀胱容量和依从性等因素的影响外,还存在与检测和患者努力相关的局限性。在进行尿道手术时,必须在保留尿道功能的组织平面上进行解剖。关于功能性女性尿道功能障碍的治疗方式,保守治疗包括盆底肌肉训练,加或不加生物反馈、电刺激和体外磁刺激。此外,关于使用认知行为疗法来解决心理合并症,从而改善女性LUTD的讨论也很激烈。支持女性尿道LUTD长期药物治疗的证据仍然很少。至于侵入性治疗方案,支持在女性LUTD中使用肉毒杆菌毒素的证据有限。最后,讨论了BNO的存在性及其诊断的有效性。此外,膀胱颈部切口作为BNO的治疗方法也有争议,该手术的适应症包括治疗决策平衡并发症的益处。结论:改善女性功能积存和排尿障碍的治疗取决于最佳的尿道功能评估。功能性MRI更好地了解尿道功能,扩大UPP检测、LPP检测的使用,以及在女性尿道手术中维持尿道功能的新方法,在寻求保守和侵入性选择(针对难治性症状)的同时解决心理合并症,这些都是治疗功能性女性尿道疾病的重要考虑因素。
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引用次数: 0
What Is Needed to Determine and Potentially Improve the Clinical Effectiveness and Cost-Effectiveness of Robot-Assisted Reconstructive Urinary Tract and Pelvic Floor Surgery?-ICI-RS 2024. 确定并潜在地提高机器人辅助尿道和盆底重建手术的临床效果和成本效益需要哪些条件?
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-19 DOI: 10.1002/nau.25625
Michel Wyndaele, Arun Sahai, George Bou Kheir, François Hervé, D Carolina Ochoa, Kevin Rademakers, Thomas van Steenbergen, Qi-Xiang Song, Alan Wein, Paul Abrams

Introduction: Robot-assisted (RA) surgery has many advantages for urinary tract and pelvic floor reconstruction (UTPFR) but its application is only slowly increasing. Studies are limited in number, patients and follow-up duration. The low-volume high-complexity nature of UTPFR warrants specific research to evaluate the potential role of the RA approach.

Methods: During its 2024 meeting in Bristol, the International Consultation on Incontinence-Research Society (ICI-RS) reviewed the current literature on RA UTPFR. Priority research questions and strategies were explored in a proposal.

Results: Four different topics were discussed. (1) Large multicentre prospective studies on RA UTPFR are needed to evaluate clinical effectiveness and safety. The RA approach needs to be prioritized in specific procedures and patients, to first improve patient care where gains are highest. (2) Models for cost-utility analysis for RA UTPFR are needed to (re)direct limited resources as efficiently as possible in a quickly changing technological field. (3) A modular curriculum for training UTPFR surgeons to become RA certified needs to be developed, to allow valid interpretation and comparison of outcomes. (4) Technological improvements to address tissue handling, accessibility, efficiency and sustainability are needed. Digitalization can be a gamechanger for RA UTPFR through telesurgery (training and expertize coverage), augmented reality and artificial intelligence providing intra-operative assistance, assessment and feedback.

Conclusions: The proposal discussed the need for studies on clinical and cost effectiveness, safety, and training curriculum development for RA UTPFR. Recent technological developments hold great promise for RA UTPFR. High-priority research questions were identified.

导言:机器人辅助(RA)手术在泌尿道和盆底重建(UTPFR)方面有很多优势,但其应用正在缓慢增加。相关研究的数量、患者人数和随访时间都很有限。UTPFR手术量少、复杂性高,因此有必要进行专门研究,以评估RA方法的潜在作用:方法:在布里斯托尔举行的 2024 年会议期间,国际尿失禁咨询研究学会(ICI-RS)回顾了有关 RA UTPFR 的现有文献。结果:讨论了四个不同的主题:讨论了四个不同的主题。(1) 需要对 RA UTPFR 进行大型多中心前瞻性研究,以评估临床有效性和安全性。(2) 需要建立 RA UTPFR 的成本效用分析模型,以便在快速变化的技术领域尽可能有效地(重新)引导有限的资源。(3) 需要开发培训UTPFR外科医生成为RA认证医生的模块化课程,以便对结果进行有效的解释和比较。(4) 需要改进技术,以解决组织处理、可及性、效率和可持续性等问题。通过远程手术(培训和专家覆盖)、增强现实和人工智能提供术中协助、评估和反馈,数字化可以改变 RA UTPFR 的游戏规则:该提案讨论了对 RA UTPFR 的临床和成本效益、安全性以及培训课程开发进行研究的必要性。最近的技术发展为 RA UTPFR 带来了巨大希望。确定了高度优先的研究问题。
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引用次数: 0
Re: Khullar V, Lemmon B, Acar O, Abrams P, Vahabi B Does COVID-19 Cause or Worsen LUT Dysfunction, What Are the Mechanisms and Possible Treatments? ICI-RS 2023. Neurourol Urodyn 2024 Aug;43(6):1458-1463. doi: 101002/nau25441. Epub 2024 Mar 20. PMID: 38506116. Re:Khullar V、Lemmon B、Acar O、Abrams P、Vahabi B COVID-19 是否会导致或加重 LUT 功能障碍,其机制和可能的治疗方法是什么?ICI-RS 2023.Doi: 101002/nau25441.Epub 2024 Mar 20.PMID: 38506116.
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-13 DOI: 10.1002/nau.25609
Vik Khullar, Bernadette Lemmon, Ömer Acar, Paul Abrams, Bahareh Vahabi
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引用次数: 0
LUTS in Older Adults: Definitions, Comorbidity Impact, Patient Priorities, and Treatment Strategies for Managing Daytime and/or Nighttime Symptoms - ICI-RS 2024. 老年人的 LUTS:日间和/或夜间症状的定义、并发症影响、患者优先事项和治疗策略 - ICI-RS 2024。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-11 DOI: 10.1002/nau.25624
Andries Van Huele, Karel Everaert, William Gibson, Adrian Wagg, Paul Abrams, Alan Wein, Wendy F Bower

Introduction: Lower urinary tract symptoms (LUTS) are prevalent among older adults, a population that faces multiple medical challenges, with frailty being a major concern. Despite the high prevalence of LUTS, current treatment strategies for older adults are often inadequate. This paper aims to address these issues by defining daytime and/or nighttime LUTS and examining the impact of comorbid conditions on these symptoms. We will identify the priorities of older patients regarding LUTS management and propose treatment strategies to improve outcomes in this vulnerable population.

Methods: This review is based on discussions at the ICI-RS 2024 meeting in Bristol, UK, alongside an extensive literature review examining LUTS in older adults. The review explores distinctions between daytime and nighttime symptoms, the impact of frailty, patient priorities, treatment strategies and the role of comorbidities.

Results: LUTS in older adults present a complex and multifaceted challenge, with notable differences between daytime and nighttime manifestations, which may coexist. Clear definitions are needed. There is a lack of evidence that treating associated comorbidities will improve LUTS or urinary incontinence. Personalized care approaches, integrated into broader geriatric health strategies, are essential for addressing these symptoms. An ideal treatment strategy is proposed, focusing on daytime, nighttime or combined day- and nighttime LUTS. Further research is needed to refine treatment pathways and optimize outcomes for this population.

Conclusions: A comprehensive, individualized approach is necessary to address LUTS in older adults. Future research should focus on refining diagnostic definitions, exploring the interplay between comorbidities and LUTS, and developing patient-centered treatment strategies that account for both daytime and nighttime (or combined) symptoms.

导言:下尿路症状(LUTS)在老年人中非常普遍,老年人面临着多种医疗挑战,其中体弱是一个主要问题。尽管下尿路症状的发病率很高,但目前针对老年人的治疗策略往往不足。本文旨在通过定义日间和/或夜间 LUTS 并研究合并症对这些症状的影响来解决这些问题。我们将确定老年患者在 LUTS 治疗方面的优先事项,并提出治疗策略,以改善这一弱势群体的治疗效果:本综述基于在英国布里斯托尔举行的 ICI-RS 2024 会议上的讨论,以及对老年人 LUTS 的大量文献综述。综述探讨了日间和夜间症状的区别、虚弱的影响、患者的优先权、治疗策略以及合并症的作用:结果:老年人的 LUTS 是一项复杂而多方面的挑战,白天和夜间的表现存在明显差异,而且可能同时存在。需要明确的定义。目前尚无证据表明治疗相关合并症可改善尿失禁或尿失禁。将个性化护理方法融入更广泛的老年健康策略中,对于解决这些症状至关重要。我们提出了一种理想的治疗策略,主要针对日间、夜间或日夜结合的 LUTS。需要进一步开展研究,以完善治疗路径,优化这一人群的治疗效果:结论:要解决老年人的 LUTS 问题,必须采取全面、个性化的方法。未来的研究应侧重于完善诊断定义、探索合并症与 LUTS 之间的相互作用,以及制定以患者为中心、同时考虑白天和夜间(或合并)症状的治疗策略。
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引用次数: 0
Can We Better Understand, Diagnose, and Treat Ketamine-Induced Uropathy, and Can It Be Reversed? ICI-RS 2024. 我们能否更好地理解、诊断和治疗氯胺酮诱发的尿病?ICI-RS 2024.
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-11 DOI: 10.1002/nau.25612
François Hervé, Patrik Aronsson, D Carolina Ochoa, Gommert Van Koeveringe, Giovanni Mosiello, Marcio Augusto Averbeck, George Bou Kheir, Michel Wyndaele, Paul Abrams

Introduction: Ketamine, a versatile anesthetic, has seen increased recreational use, leading to significant health issues, including ketamine-induced uropathy (KIU). KIU manifests with lower urinary tract symptoms (LUTS) and can involve the upper urinary tract. This study aims to provide a comprehensive overview of KIU, addressing its pathophysiology, diagnostic strategies, and treatment options; and to define/identify future research priorities.

Methods: During the 2024 meeting of the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, a dedicated Proposal (P) convened to explore KIU. This initiative involved a thorough review of existing literature, expert presentations, and consensus-driven discussions. The methodology ensured a comprehensive exploration of KIU from both clinical and pre-clinical perspectives, leading to actionable research recommendations.

Results: Understanding the mechanisms of KIU is crucial for developing effective treatment options targeting specific pathophysiological pathways. Key findings include bladder fibrosis driven by transforming growth factor-β1 (TGF-β1), elevated purinergic responses and upregulated P2X1 purinoceptor expression, decreased barrier function due to increased expression of antiproliferative factor (APF), and functional loss of the bladder through Cav1.2 channel blockade. Research indicates that fibrosis, typically considered irreversible, may be mitigated. However, the exact timing and extent of fibrosis initiation and its impact on long-term outcomes require further research. LUTS typically improve after ketamine cessation but relapse upon resumption, indicating a hypersensitivity mechanism involving elevated serum IgE levels. Advanced stages of KIU do not always correlate with LUTS severity, shedding light on potential systemic effects and the need for evaluating liver enzymes. Furthermore, psychological dependency on ketamine, due to its positive perceptive and mood-altering effects, complicates cessation efforts. Long-term management requires a holistic approach, integrating medical treatments and supportive measures to help patients navigate life with potentially irreversible complications.

Conclusion: This comprehensive review spans from fundamental pathology to practical clinical management, addressing both urological and systemic complications, and bridging insights from animal models to human applications. Developing effective treatment strategies necessitates addressing both the physical and psychological aspects of ketamine dependency.

简介:氯胺酮是一种用途广泛的麻醉剂,越来越多的人在娱乐中使用氯胺酮,这导致了严重的健康问题,包括氯胺酮诱发的尿病(KIU)。KIU 表现为下尿路症状(LUTS),也可累及上尿路。本研究旨在全面概述 KIU,探讨其病理生理学、诊断策略和治疗方案,并确定/识别未来的研究重点:方法:在 2024 年于布里斯托尔召开的尿失禁研究学会(ICI-RS)国际磋商会议期间,召集了一个专门的提案(P)来探讨 KIU。该倡议包括对现有文献、专家发言和共识驱动型讨论的全面回顾。该方法确保了从临床和临床前角度对 KIU 进行全面探讨,从而提出可操作的研究建议:结果:了解 KIU 的发病机制对于开发针对特定病理生理途径的有效治疗方案至关重要。主要发现包括转化生长因子-β1(TGF-β1)驱动的膀胱纤维化、嘌呤能反应升高和 P2X1 嘌呤受体表达上调、抗增殖因子(APF)表达增加导致的屏障功能下降,以及通过 Cav1.2 通道阻断导致的膀胱功能丧失。研究表明,通常被认为不可逆转的纤维化可能会得到缓解。然而,纤维化开始的确切时间和程度及其对长期疗效的影响还需要进一步研究。氯胺酮停用后,尿路症状通常会有所改善,但复用后又会复发,这表明存在血清 IgE 水平升高的超敏机制。KIU 的晚期并不总是与 LUTS 的严重程度相关,这说明了潜在的全身影响以及评估肝酶的必要性。此外,由于氯胺酮具有积极的感知和情绪改变作用,对氯胺酮的心理依赖也使戒毒工作变得更加复杂。长期管理需要采取综合方法,将医学治疗和支持性措施结合起来,帮助患者在可能出现不可逆并发症的情况下渡过难关:本综述从基础病理学到实际临床管理,涉及泌尿系统和全身并发症,并将动物模型的见解与人体应用相结合。要制定有效的治疗策略,就必须从生理和心理两方面解决氯胺酮依赖问题。
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引用次数: 0
Re: Khullar V, Lemmon B, Acar O, Abrams P, Vahabi B. Does COVID-19 Cause or Worsen LUT Dysfunction, What Are the Mechanisms and Possible Treatments? ICI-RS 2023 Neurourol Urodyn 2024 Aug; 43(6):1458-1463 doi: 101002/nau25441 Epub 2024 Mar 20 PMID: 38506116. 关于Khullar V, Lemmon B, Acar O, Abrams P, Vahabi B. COVID-19 会导致或加重 LUT 功能障碍吗?ICI-RS 2023 Neurourol Urodyn 2024 Aug; 43(6):1458-1463 doi: 101002/nau25441 Epub 2024 Mar 20 PMID: 38506116.
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-11 DOI: 10.1002/nau.25586
Salvatore Butticè, Rosa Pappalardo, Emre T Sener, Emanuele Caldarera
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引用次数: 0
Constrictive versus compressive bladder outflow obstruction in men: Does it matter? 男性收缩性膀胱流出道梗阻与压迫性膀胱流出道梗阻:这重要吗?
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-06-07 DOI: 10.1002/nau.25520
Wouter van Dort, Peter F W M Rosier, Thomas R F van Steenbergen, Bernard J Geurts, Laetitia M O de Kort

Introduction: Bladder outflow obstruction (BOO) is a urethral resistance (UR) at a level above a clinically relevant threshold. UR is currently graded in terms of the existence and severity of the BOO based on maximum flowrate and associated detrusor pressure only. However, the pressure-flow relation throughout the course of voiding includes additional information that may be relevant to identify the type of BOO. This study introduces a new method for the distinction between the provisionally called compressive and constrictive types of BOO and relates this classification to underlying patient and urodynamic differences between those BOO types.

Methods: In total, 593 high-quality urodynamic pressure-flow studies in men were included in this study. Constrictive BOO was identified if the difference Δp between the actual minimal urethral opening pressure (pmuo) and the expected pmuo according to the linearized passive urethral resistance relation (linPURR) nomogram was >25 cmH2O. Compressive BOO is identified in the complementary case where the pressure difference Δp ≤ 25 cmH2O. Differences in urodynamic parameters, patient age, and prostate size were explored.

Results: In 81 (13.7%) of the cases, constrictive BOO was found. In these patients, the prostate size was significantly smaller when compared to patients diagnosed with compressive BOO, while displaying a significantly lower maximum flowrate, higher detrusor pressure at maximal flowrate and more postvoid residual (PVR).

Conclusion: This study is an initial step in the validation of additional subtyping of BOO. We found significant differences in prostate size, severity of BOO, and PVR, between patients with compressive and constrictive BOO. Subtyping of voiding-outflow dynamics may lead to more individualized management in patients with BOO.

导言:膀胱流出道梗阻(BOO)是指尿道阻力(UR)超过临床相关阈值的水平。目前仅根据最大流量和相关的逼尿肌压力对膀胱流出道梗阻的存在和严重程度进行分级。然而,整个排尿过程中的压力-流量关系包含了可能与识别 BOO 类型相关的其他信息。本研究介绍了一种新方法,用于区分暂时称为压迫型和收缩型的 BOO,并将这种分类与这些 BOO 类型之间潜在的患者和尿动力学差异联系起来:本研究共纳入了 593 例高质量男性尿动力压力-流量研究。如果实际最小尿道开口压力(pmuo)与根据线性化被动尿道阻力关系(linPURR)提名图得出的预期pmuo之间的差值Δp>25 cmH2O,则可确定为收缩性BOO。在压力差 Δp ≤ 25 cmH2O 的补充情况下,可确定为压迫性 BOO。研究还探讨了尿动力学参数、患者年龄和前列腺大小的差异:结果:81 例(13.7%)患者发现了收缩性 BOO。这些患者的前列腺体积明显小于压迫性 BOO 患者,同时最大尿流率明显降低,最大尿流率时的逼尿肌压力升高,排尿后残余尿量(PVR)增加:这项研究是验证其他BOO亚型的第一步。我们发现,压迫性和收缩性 BOO 患者在前列腺大小、BOO 严重程度和 PVR 方面存在明显差异。对排空-流出动力学进行亚型分析,可能会为BOO患者提供更个性化的治疗方案。
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引用次数: 0
A theoretical model for brisk walking- and running-induced lower urinary tract symptoms (BRUTS) and the development of the BRUTS-questionnaire (BRUTS-Q): A focus group and Delphi study. 快走和跑步诱发下尿路症状(BRUTS)的理论模型和 BRUTS 问卷(BRUTS-Q)的开发:焦点小组和德尔菲研究。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-20 DOI: 10.1002/nau.25523
Olena Klahsen, Stéphanie Thibault-Gagnon, Linda McLean

Aims: Existing questionnaires provide limited information on the nature, severity and context surrounding lower urinary tract symptoms (LUTS) experienced during running, jogging and brisk walking. The aims of this study were to develop a theoretical model of the experience of LUTS by females participating in gait-based exercise activities and to use this model to generate a questionnaire to evaluate the presence, symptoms and bother associated with LUTS experienced by females during gait-based activities.

Methods: A theoretical model was developed through a review of the literature and refined through a focus group consultation including pelvic health physiotherapists, females who experienced leakage during exercise and academic researchers who studied female LUTS. A draft questionnaire was developed using key constructs identified in the model by the focus group. A new expert panel was recruited, which included physiotherapists, women with self-reported gait-induced LUTS and urogynecologists. This panel followed a DELPHI process to evaluate the relevance and completeness of the constructs within the questionnaire.

Results: Two rounds of consultation were required to reach consensus on the completeness of included constructs as well as the inclusion and wording of questions. The resulting questionnaire contains questions related to five key constructs: physical activity characteristics, symptoms of urgency, urgency urinary incontinence, stress urinary incontinence experienced during exercise and management/mitigation strategies adopted by respondents.

Conclusions: The content validity of the brisk walking- and running-induced lower urinary tracts symptoms questionnaire has been established. The next steps are to ensure that the questionnaire has adequate comprehensibility, followed by adequate measurement properties.

研究目的:现有的调查问卷只能提供跑步、慢跑和快走过程中出现的下尿路症状(LUTS)的性质、严重程度和相关情况的有限信息。本研究的目的是为参与步态运动活动的女性所经历的下尿路症状建立一个理论模型,并利用该模型编制一份问卷,以评估女性在步态活动中经历的下尿路症状的存在、症状和相关困扰:方法:通过查阅文献建立了一个理论模型,并通过焦点小组咨询(包括骨盆健康理疗师、在运动过程中出现漏尿的女性以及研究女性尿失禁的学术研究人员)完善了该模型。利用焦点小组在模型中确定的关键结构,编制了一份问卷草案。我们招募了一个新的专家小组,其中包括物理治疗师、自述有步态引起的 LUTS 的女性和泌尿妇科专家。该专家小组采用 DELPHI 流程对问卷中的构念的相关性和完整性进行评估:结果:需要经过两轮磋商,才能就所包含结构的完整性以及问题的包含和措辞达成共识。最终形成的调查问卷包含与五个关键要素相关的问题:体育锻炼特征、尿急症状、尿急尿失禁、运动过程中出现的压力性尿失禁以及受访者采取的处理/缓解策略:结论:快走和跑步引起的下尿路症状问卷的内容效度已经确定。下一步工作是确保问卷具有足够的可理解性,以及足够的测量特性。
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Neurourology and Urodynamics
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