Neurourology and Urodynamics最新文献

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Aims: Recurrent urinary tract infections are a common medical problem and current guidelines recommend both antibiotic and non-antibiotic preventative treatments. However, for a significant proportion of patients with this condition these second-line treatments are not effective. As a result, there has been recent focus on more targeted treatment such as intravesical instillations and bladder fulguration procedures. We aim to report discussions regarding these targeted treatments for recurrent urinary tract infections that took place at the International Consultation on Incontinence - Research Society meeting in Bristol 2025.

Methods: We undertook a think-tank session during this multi-disciplinary meeting specifically designated for discussion regarding targeted treatments for UTI prevention. We discussed the incidence and prevalence of recurrent UTIs in the general population and recognise that up to 25% of patients are not adequately treated with currently recommended preventive strategies. We also explored the increasing knowledge base surrounding the urinary microbiome and discussed the concept of chronic urinary tract infection. Finally we outlined the current evidence to support the use of the targeted treatments of intravesical instillation of both antibiotics and glycosaminoglycan (GAG) replacement compounds and the surgical procedure of bladder fulguration. This led to the generation of research ideas which hope to shape future UTI research within this topic area.

Results: We describe the discussions that took place and document the important research questions that were generated during the International Consultation on Incontinence-Research Society meeting in Bristol 2025.

Conclusions: Although the use of targeted treatments is becoming more widespread the evidence base is currently insufficient for strong guideline recommendation. This must be balanced against the significant need for second-line treatments when current guideline recommended treatments are unsuccessful, particularly in the design of clinical pathways for patients with refractory recurrent UTIs.

Aims: Management algorithms for Bladder Pain Syndrome (BPS) have remained stagnant over the past 20 years. Lack of high level evidence has hindered progress. Contributors to this have been the use of confusing and inconsistent terminology and failure to adequately phenotype participants entering clinical trials. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2025 a Think Tank addressed the question of "How can we make progress in the management of Bladder Pain Syndrome," focussing on the non-Hunner lesion group.

Methods: The Think Tank conducted a literature review and expert consensus meeting focusing on the current limitations in terminology and phenotyping, how we can improve identification of bladder-centric BPS, and how we can improve assessment of psychological comorbidity.

Results: Terminology needs to be standardised to enable more homogenous recruitment to clinical trials. Use of the term "interstitial cystitis" may be misleading, and the term is often inappropriately used. Classification based on the European Association of Urology guidelines should be favoured, using the term Primary Bladder Pain Syndrome. Participants entering clinical trials need to undergo thorough investigation to enable accurate phenotyping. The non-Hunner lesion BPS group need to be the focus of future research. Tools to aid identification of a bladder-centric phenotype (through biopsy and other techniques) need to be studied, including investigating the roles of inflammation, ischaemia and oxidative stress in this condition. A psychological assessment tool specific for BPS should be created to ensure earlier psychological intervention for those who would benefit most.

Conclusions: The use of accurate terminology in describing this condition is the first step toward improving the quality of future research. The Think Tank overwhelmingly recommended that the term "Interstitial Cystitis" should not be used. Future studies should be focussed on understanding the BPS group, excluding those with Hunner lesion disease. Studying inflammation, ischaemia and oxidative stress will help to identify a bladder-centric phenotype, whereas improving our understanding of psychological mechanisms will help to direct psychological therapies more effectively.

Introduction: The management and interpretation of big data appears to be an increasingly attractive but challenging issue in functional urology. The International Continence Society (ICS) Global Urodynamics (UDS) Data Repository (GUDRep) project aims to record and analyse UDS data to share research and clinical information about UDS.

Objectives: The aim of this Think Tank was to identify the main research questions and critical issues related to the GUDRep project.

Methods: This article reports and summarises the discussions on the GUDRep from the 2025 meeting of the International Consultation on Incontinence-Research Society (ICI-RS).

Results and conclusions: Several research questions on the GUDRep project need to be considered, including both issues/barriers in building the Repository and economic, clinical and research advantages which could potentially be obtained by the GUDRep itself.

Aims: Dysfunctional voiding (DV) is characterised by fluctuating or intermittent urinary flow during voiding in neurologically normal individuals. Given the different definitions used and heterogeneous pathophysiologies, outcomes following sacral neuromodulation/sacral nerve stimulation (SNM/SNS) are variably reported. The aim was to identify the areas of research required to be able to accurately predict response to SNM/SNS in adults with DV.

Methods: The relevant literature was reviewed by a multidisciplinary panel and the findings were discussed at the ICI-RS meeting held in 2025 in the UK. The outcomes of this discussion are presented.

Results: DV has unique diagnostic features, typically requiring pressure-flow studies and uroflowmetry to establish the diagnosis. Further investigations such as electromyography and urethral pressure profilometry help to better understand the pathophysiology. Phenotyping the lower urinary tract dysfunction helps to identify patterns of abnormalities, and it is likely that certain groups show a better response to SNM/SNS than others, such as in Fowler's syndrome. Older age and change in body weight following implantation are associated with a worse outcome, though not specifically in DV. Studies evaluating the impact of neuropsychiatric co-morbidities on SNM/SNS outcomes show mixed results. Central dysregulation of micturition networks possibly contribute to DV and could represent an additional therapeutic target of SNM.

Conclusion: Precise phenotyping of individuals with DV integrating clinical, urodynamic, neurophysiological, and neuropsychiatric factors is essential to predict which adults respond best to SNM/SNS. Future research should focus on establishing criteria for patient selection and designing comprehensive prospective interventional studies to assess efficacy and complications.

Aims: While many patients with lower urinary tract symptoms (LUTS) improve by treating peripheral causes, a substantial proportion continue to experience symptoms despite apparently successful interventions. Central nervous system (CNS) mechanisms could potentially contribute to persisting symptoms after the initial peripheral cause has been treated. The aim of this paper is to explore how maladaptive CNS processes may underlie refractory LUTS and to consider the therapeutic and research implications.

Methods: The manuscript summarizes discussions from a proposal hosted at the 2025 International Consultation on Incontinence-Research Society (ICI-RS) meeting. Research priorities were formulated into consensus questions.

Results: Evidence indicates that central sensitization and neuroplasticity may sustain urgency, increased frequency, or pain even after resolution of peripheral triggers. Neuroimaging demonstrates structural and functional brain changes in bladder pain syndrome and spinal cord injury, while preclinical studies implicate neurotrophin and nitric oxide pathways in LUT dysfunction. Nerve stimulation, intravesical agents, and behavioral strategies can benefit selected patients, though with variable outcomes. Priority questions focus on causality versus consequence of CNS changes, the development of biomarkers for patient stratification, and the evaluation of novel therapeutic targets.

Conclusions: Refractory LUTS potentially involve peripheral and/or central maladaptation. Advancing diagnosis and treatment will require improved tools to assess LUT-CNS interactions, refined translational models, and multidisciplinary strategies to enable individualized, mechanism-based therapies.

Aims: This report, from the International Consultation on Incontinence-Research Society, aims to evaluate the existing evidence and identify diagnostic and treatment gaps for Lower Urinary Tract Symptoms (LUTS) in post-menopausal women with Genitourinary Syndrome of Menopause (GSM).

Methods: An overview on the current literature, including pathophysiology, diagnosis and management of GSM associated LUTS, including incontinence, overactive bladder, underactive bladder and recurrent urinary tract infections (rUTIs).

Results: Significant gaps in the literature were identified. GSM is underdiagnosed and the interplay between hormonal changes in the postmenopausal period on LUTS remains poorly understood. Diagnostic methods for rUTIs lack sensitivity and the role of the urinary microbiome is emerging. Current treatments, including topical oestrogens and systemic hormone therapy, lack long-term efficacy data on LUTS. Evidence for regenerative medicine techniques remain limited by low-quality studies and short-term follow up.

Conclusion: There is lack of high-quality evidence, which hinders the optimal management of LUTS in post-menopausal women with GSM. The panel proposes targeted research questions, focusing on the hormonal impact on the lower urinary tract, advancing diagnostics and robust clinical trials for existing and novel therapies, to bridge current gaps in the literature and improve patient care.