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.
{"title":"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.","authors":"Greeshma Venigalla, Sabika Sadiq, Aaron A Gurayah, Nachiketh Soodana-Prakash, Laura Martin, Katherine A Amin, Raveen Syan","doi":"10.1002/nau.25639","DOIUrl":"https://doi.org/10.1002/nau.25639","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Systematic Evaluation of Lower Urinary Tract Sensations to Improve Management of LUTS: ICI-RS 2024.","authors":"Mathijs de Rijk, Claire Hentzen, Caroline Selai, Stefania Musco, Riccardo Lombardo, Gommert van Koeveringe, Christopher Chapple, Paul Abrams, Jean J Wyndaele, Karen McCloskey","doi":"10.1002/nau.25636","DOIUrl":"https://doi.org/10.1002/nau.25636","url":null,"abstract":"<p><strong>Aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
{"title":"Do We Need to Re-Focus on Functional Female Urethral Disorders in Lower Urinary Tract Dysfunction? ICI-RS 2024.","authors":"Christopher J Chermansky, Jeremy L Ockrim, George Bou Kheir, Christopher R Chapple, Rohna Kearney, Bogdan Toia, Roger R Dmochowski, Alan J Wein, Paul Abrams","doi":"10.1002/nau.25633","DOIUrl":"https://doi.org/10.1002/nau.25633","url":null,"abstract":"<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","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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。
{"title":"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.","authors":"Michel Wyndaele, Arun Sahai, George Bou Kheir, François Hervé, D Carolina Ochoa, Kevin Rademakers, Thomas van Steenbergen, Qi-Xiang Song, Alan Wein, Paul Abrams","doi":"10.1002/nau.25625","DOIUrl":"10.1002/nau.25625","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vik Khullar, Bernadette Lemmon, Ömer Acar, Paul Abrams, Bahareh Vahabi
{"title":"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.","authors":"Vik Khullar, Bernadette Lemmon, Ömer Acar, Paul Abrams, Bahareh Vahabi","doi":"10.1002/nau.25609","DOIUrl":"https://doi.org/10.1002/nau.25609","url":null,"abstract":"","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"LUTS in Older Adults: Definitions, Comorbidity Impact, Patient Priorities, and Treatment Strategies for Managing Daytime and/or Nighttime Symptoms - ICI-RS 2024.","authors":"Andries Van Huele, Karel Everaert, William Gibson, Adrian Wagg, Paul Abrams, Alan Wein, Wendy F Bower","doi":"10.1002/nau.25624","DOIUrl":"https://doi.org/10.1002/nau.25624","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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。
{"title":"Can We Better Understand, Diagnose, and Treat Ketamine-Induced Uropathy, and Can It Be Reversed? ICI-RS 2024.","authors":"François Hervé, Patrik Aronsson, D Carolina Ochoa, Gommert Van Koeveringe, Giovanni Mosiello, Marcio Augusto Averbeck, George Bou Kheir, Michel Wyndaele, Paul Abrams","doi":"10.1002/nau.25612","DOIUrl":"https://doi.org/10.1002/nau.25612","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salvatore Butticè, Rosa Pappalardo, Emre T Sener, Emanuele Caldarera
{"title":"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.","authors":"Salvatore Butticè, Rosa Pappalardo, Emre T Sener, Emanuele Caldarera","doi":"10.1002/nau.25586","DOIUrl":"https://doi.org/10.1002/nau.25586","url":null,"abstract":"","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-06-07DOI: 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.
{"title":"Constrictive versus compressive bladder outflow obstruction in men: Does it matter?","authors":"Wouter van Dort, Peter F W M Rosier, Thomas R F van Steenbergen, Bernard J Geurts, Laetitia M O de Kort","doi":"10.1002/nau.25520","DOIUrl":"10.1002/nau.25520","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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 (p<sub>muo</sub>) and the expected p<sub>muo</sub> according to the linearized passive urethral resistance relation (linPURR) nomogram was >25 cmH<sub>2</sub>O. Compressive BOO is identified in the complementary case where the pressure difference Δp ≤ 25 cmH<sub>2</sub>O. Differences in urodynamic parameters, patient age, and prostate size were explored.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"2178-2184"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-07-20DOI: 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.
{"title":"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.","authors":"Olena Klahsen, Stéphanie Thibault-Gagnon, Linda McLean","doi":"10.1002/nau.25523","DOIUrl":"10.1002/nau.25523","url":null,"abstract":"<p><strong>Aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"2185-2194"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}