Neurourology and Urodynamics最新文献

Introduction: Incontinence after prostate treatment (IPT) following radical prostatectomy and/or radiotherapy for prostate cancer significantly impacts quality of life. While the Adjustable Transobturator Male System (ATOMS) is a promising surgical option for IPT, data on outcomes in patients undergoing ATOMS implantation with prior radiotherapy are limited. This study evaluates the influence of prior radiotherapy-and its timing-on outcomes following ATOMS implantation.

Materials and methods: This retrospective single-center study included 131 men treated with ATOMS for IPT between November 2018 and May 2024. Patients were stratified by history of having received radiotherapy and also by timing of radiotherapy ( ≤ 24 vs. > 24 months) before ATOMS implantation. Pre-, peri-, and postoperative variables were recorded. Cross-sectional follow-up was conducted in November 2024 using clinical questionnaires, 24-h-pad-tests, and validated instruments (PGI, ICIQ-UI). Statistical analysis included t-tests, Mann-Whitney U tests, Chi-square tests, Kaplan-Meier curves, and Cox regression.

Results: Forty seven patients (35.9%) received radiotherapy before ATOMS implantation. These patients had higher tumor stages and Gleason scores. Postoperatively, radiated patients demonstrated lower complete continence rates (21% vs. 51%, p = 0.020) and higher median pad use (2.5 vs. 1, p < 0.01). Furthermore, they experienced higher rates of acute urinary retention (8.5% vs. 0%, p = 0.029) and explantation (21% vs. 6%, p = 0.018). No significant differences in satisfaction, long-term continence, or outcomes were found based on the timing of radiotherapy.

Conclusion: ATOMS is an adequate treatment for IPT regardless of radiotherapy history or timing before its implantation. Although significant differences in immediate continence rates were observed (21% vs. 51%), long-term continence rates were comparable. Therefore, ATOMS seems to be a viable option in this patient population.

Aims: This study aimed to investigate the prevalence of urinary incontinence (UI) among Brazilian female triathletes and to identify associated factors, focusing on demographic, obstetric, and sports-related variables.

Methods: A cross-sectional study was conducted with 90 female triathletes. Data on age, body mass index (BMI), pregnancy history, parity, delivery type, training frequency, and weekly training volume were collected through in-person interviews and an online questionnaire. UI severity was assessed using the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Ordinal logistic regression was used to analyze factors associated with UI severity, and multinomial logistic regression examined associations between training volume and UI type.

Results: The prevalence of UI was 43.3%. Stress urinary incontinence (SUI) was the most common type (25.6%). A greater number of deliveries was associated with increased UI severity (OR = 1.577; 95% CI: 1.047-2.374), while higher training frequency was protective against UI (OR = 0.761; 95% CI: 0.607-0.954). Increased running volume was associated with greater odds of presenting mixed UI (OR = 1.004; 95% CI: 1.001-1.006). Weekly training frequency was inversely associated with both stress and mixed UI.

Conclusions: UI was reported by 43.3% of triathletes, with SUI being the most prevalent type at 25.6%. Parity was the only sociodemographic factor significantly associated with UI. Higher weekly frequency in all disciplines appeared to reduce the likelihood of UI, especially SUI. In contrast, running volume showed a minimal or no association with an increased risk of MUI.

Introduction: To compare the efficacy of the β3 agonist vibegron and the anticholinergic agent fesoterodine in the management of neurogenic detrusor overactivity (NDO) in individuals with spinal cord lesion (SCL).

Materials and methods: This was a single-center, prospective, open-label, randomized, crossover study. A total of 41 individuals with SCL undergoing clean intermittent catheterization, who required pharmacological treatment for NDO confirmed by cystometrogram (CMG), were enrolled in the study. Most patients were < 6 months from SCL. Patients were randomly assigned to receive either vibegron (50 mg) or fesoterodine (4 mg) in a crossover design for 4 weeks each, with no washout period between treatments. The efficacy of the two medications was evaluated during the first 4 weeks using CMG parameters and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). At the end of the second 4-week period, participants were surveyed on their preference for the continuation of either drug, based on efficacy, adverse events, and overall satisfaction.

Results: During the first 4 weeks, CMG parameters, including detrusor pressure and cystometric capacity, significantly improved in both groups, with no significant differences observed between the groups. The ICIQ-SF scores also demonstrated significant improvements in almost all items in both groups; however, the improvements in Q3 (Overall impact of UI) and the total score were significantly better in the vibegron group. At the end of the second 4-week period, participant survey results indicated that 58% preferred vibegron, 6% preferred fesoterodine, and 36% rated both as equivalent for future continuation therapy.

Conclusion: Vibegron significantly improved CMG parameters in addition to alleviating UI symptoms, demonstrating efficacy that was not inferior to that of fesoterodine. With a lower incidence of adverse events and high patient satisfaction, vibegron may serve as a useful therapeutic option for the treatment of NDO in individuals with SCL.

Introduction: Many experience incontinence following prostate cancer treatment. Patients suffering from stress incontinence may benefit from an artificial urinary sphincter (AUS) or urethral sling, however, rates of these procedures following radical prostatectomy (RP) and radiotherapy (RT) are not well-defined. We aimed to assess rates of post-RP and post-RT utilization of AUS and urethral sling in a contemporary, national cohort from the large, federated database TriNetX.

Methods: We retrospectively assessed men ≥ 18 years old who were diagnosed with prostate cancer and eventually treated with RP or RT between 2005 and 2015 on TriNetX. Patients with any prior history of AUS or sling before prostate cancer treatment were excluded. Primary outcomes of interest were rates of AUS and sling utilization 6 months to 10 years after RP, RT, or both. We secondarily assessed rates of cystourethroscopy before incontinence procedure and patient factors associated with utilization of AUS or sling.

Results: Between 2005 and 2015, 13 392, 24 173, and 2353 prostate cancer patients were treated with RP, RT, or both treatments, respectively. After RP, within 6 months to 10 years, 244 patients (1.82%) underwent AUS implantation and 234 patients (1.75%) underwent sling placement, compared to 84 patients (0.35%) undergoing AUS implantation and 13 patients (0.05%) undergoing sling placement after RT. Of patients treated with both, 87 (3.70%) patients underwent AUS implantation and 26 (1.10%) underwent sling placement. One-half to three-fourths of these patients underwent cystourethroscopy before AUS/sling placement. RP, receiving care at an academic center, and being 45-69 years old compared to 70+ years old at prostate cancer treatment were significantly associated with AUS/sling utilization. Rates of utilization also varied across race/ethnicity.

Conclusions: AUS and urethral sling utilization amongst post-RP and post-RT prostate cancer survivors is low and variation in utilization exists based on patient characteristics. Our study emphasizes the importance of awareness of guidelines on incontinence after prostate treatment.

Purpose: Uro-Dynamic MRI was used to non-invasively quantify bladder biomechanics, characterizing the fundamental relationship between bladder wall surface area and bladder volume during voiding.

Methods: Differential Subsampling with Cartesian Ordering MRI sequence was used to acquire multiple volumetric bladder images during the voiding in five normal male subjects. Images were imported into MIMICS. Bladder volume and bladder wall surface area were obtained using threshold-based image segmentation and the main axes of bladder wall deformation were measured/tracked throughout voiding. Linear anatomical measurements yielded bladder volume estimation using a generalized ellipsoid approximation and facilitated direct comparison with the metrics obtained from the 3D renderings.

Results: Ellipsoid volume approximation showed high agreement with volume from 3D renderings; however, this agreement does not hold for flow rates derived from both approaches. Analysis of changes in volume and surface area from 3D renderings show bladder deformation that varies throughout voiding, behaving closer to an idealized spherical bladder past the point of maximum flow. Further analysis suggests an asymmetrical and nonconstant change of bladder dimensions in relation to changes in bladder volume, and a generalized concentric contraction of the bladder wall past maximum flow during the voiding event.

Conclusion: Uro-Dynamic MRI allowed time-resolved analysis of the relationship between changes in anatomy-based measurements, volume and surface area of the bladder. This methodology highlights the use of Uro-Dynamic MRI as a powerful tool to comprehensively extract anatomical information of the bladder and correlate this information with novel Noninvasive metrics to evaluate patient specific biomechanics.

Clinical trial registration: The patients recruited for this study and data collected for this manuscript are not part of a clinical trial.

Objectives: To (1) propose standardized terminology for bladder shapes on fluoroscopic images in a pediatric spina bifida population and (2) determine if bladder shape is associated with filling pressures and other measures of bladder dysfunction. We hypothesized that oblong, trabeculated, and "Christmas tree" bladders would have higher filling pressures and worse bladder function (higher filling pressures; higher presence of vesicoureteral reflux, leakage, detrusor-external sphincter dyssynergia, and hydronephrosis) than smooth and round-shaped bladders.

Methods: We conducted a cross-sectional study of pediatric and adolescent patients with spina bifida who underwent video urodynamics (VUDS) at a tertiary center from July 2016 to June 2022. Representative fluoroscopic bladder images from the earliest available VUDS were categorized by unsupervised cluster analysis. Five urologists also determined standardized classifications for bladder shape (round, oblong, and "Christmas tree") and contour (smooth or trabeculated/diverticulated), which were applied to the bladder images. Bladder filling pressures and clinical measures of bladder function were compared among bladder shapes.

Results: Four hundred seventeen patients with a median age of 2.6 years (IQR 0.4-8.0 years) were included. For the machine learning cluster analysis of bladder shape, clusters with more trabeculated-appearing bladders had higher filling pressures. For expert clinician classification, round trabeculated, oblong trabeculated, and "Christmas tree" bladders had higher filling pressures than round smooth and oblong smooth bladders, a difference that was statistically significant. Statistically significant differences were noted among bladder shapes for the presence of vesicoureteral reflux, leakage, detrusor-external sphincter dyssynergia, and hydronephrosis. Moderate and severe bladder dysfunction were present across all bladder shape clusters.

Conclusions: We established a standardized bladder shape nomenclature in children and adolescents with spina bifida. Higher bladder filling pressures are associated with trabeculations and "Christmas tree" appearance versus smooth contour, but not oblong versus round shape. Bladder shape alone does not appear to consistently differentiate the presence of hydronephrosis, vesicoureteral reflux, leakage, detrusor-external sphincter dyssynergia, or bladder dysfunction severity.

Purpose: Previous studies have found significant sex differences in symptoms among patients with interstitial cystitis/bladder pain syndrome (IC/BPS). However, whether this translates into differences in pathology as observed on cystoscopy is unknown. We sought to assess cystoscopic findings in veterans diagnosed with IC/BPS and to identify possible sex differences in cystoscopic findings.

Methods: This was a retrospective study of all hospital visits in the Veteran Health Affairs Hospital System between October 2004 and July 2016. Patients with IC/BPS were identified from the Veteran Informatics and Computing Infrastructure (VINCI) system using appropriate ICD codes. Patients older than 18 years of age with a confirmed diagnosis of IC/BPS who underwent cystoscopy were included. Rates of cystoscopic findings of ulceration, glomerulation, inflammation, trabeculation, and tumors adjusted for patient demographics were analyzed.

Results: A total of 570 patients met inclusion criteria and underwent analysis (57.9% female). The female cohort was of younger age (48.0 vs. 63.0 years). After adjusting for age, men and women had a similar likelihood of presenting with Hunner's lesions (8.2% for men and 3.7% for women, p > 0.05). They also had a similar likelihood of glomerulation (11.4% in men vs. 15.2% in women, p = 0.05) and inflammation (19.6% vs. 15.8%, p > 0.05). Men were significantly more likely to present with trabeculation (15.4% vs. 8.1%, p = 0.03). Urothelial tumors on cystoscopy were rare in both groups.

Conclusion: The proportion of patients with ulceration on cystoscopy in this study is consistent with previously published studies, and our study showed a similar prevalence of Hunner's lesions between men and women. Cystoscopic identification of Hunner's lesions is an important aspect of IC/BPS management given that treatment directed that these lesions is relatively successful compared to other treatments.

Introduction: Pressure-flow study, consisting of flow rate combined with detrusor pressure, is the gold standard to determine bladder outflow obstruction and evaluate the detrusor voiding contraction. In very young children, not able to sit on a uroflowmetry device, the flow rate cannot be measured. This results in an incomplete evaluation of bladder and urethral functions. The aim of this study is to derive the flow rate using standard care video-urodynamic study X-ray images.

Methods: We retrospectively included 50 video urodynamic studies in children able to void on a uroflowmetry toilet, to correlate the outcome with standard uroflowmetry. The X-ray images taken during voiding were manually segmented and algorithmically converted into a flow rate, called "videoflow". This videoflow was compared with the measured (standard) uroflowmetry.

Results: An excellent cross-correlation of 0.98 was found between the videoflow and normal uroflowmetry outcomes. The videoflow maximum flow rate (Q_max) was accurate with a not significant bias of +0.1 mL/s difference with standard uroflowmetry.

Conclusions: In conclusion, the proposed videoflow is found feasible and accurate in children who are able to void in a uroflowmetry toilet. This method paves the way to measure urine flow rate in very young children who cannot yet sit upright. For the first time, this new technique will enable the validation of a pressure-flow-based urethral resistance measurement in this very young age group.

Trial registration: Clinical Registration Number: 23U-0621.