Neurourology and Urodynamics最新文献

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

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

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

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

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

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

Importance: The role of preoperative urodynamic studies (UDS) in women undergoing pelvic organ prolapse (POP) surgery remains controversial, especially regarding their influence on surgical planning and patient counseling.

Objective: To evaluate the impact of preoperative UDS on changes in surgical management and counseling among women with advanced-stage POP undergoing surgical repair.

Design: Retrospective observational study.

Setting: Tertiary urogynecology center at Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Participants: A total of 118 women with POP-Q stage III or IV who underwent UDS before planned POP surgery between July 2018 and July 2023.

Interventions: All participants underwent standardized multichannel UDS, including POP reduction during testing, based on institutional protocol and international guidelines.

Main outcomes and measures: The primary outcome was the proportion of cases in which UDS findings led to changes in surgical or medical management. Secondary outcomes included the role of UDS in enhancing preoperative counseling and identifying discrepancies between symptoms and objective findings.

Results: The mean age of participants was 69.4 years (SD 7.7), with 97.5% being postmenopausal. UDS altered clinical management in 23 cases (19.5%). Notable changes included the addition or omission of anti-incontinence procedures and initiation of OAB treatment. UDS also enhanced the preoperative counseling process, contributing to informed decision-making in 67 patients (56.8%) and excluding misleading symptoms in 69 cases (58.5%), such as absence of detrusor overactivity in OAB or detrusor underactivity in voiding dysfunction.

Conclusions and relevance: Preoperative UDS led to management changes in approximately one in five patients with advanced POP, particularly those with SUI, occult SUI, or voiding dysfunction. Although major surgical changes were infrequent, UDS provided significant value for patient counseling and risk stratification. These findings support a more selective and context-specific approach to the use of UDS in POP surgical planning.

While overactive bladder (OAB) is a clinical diagnosis, detrusor overactivity is identified through urodynamic testing. UDS is usually considered when primary treatment for OAB fails, because UDS is expensive, time consuming, invasive, and sometimes inaccurate, and it is not considered to influence treatment strategy substantially. On the other hand, UDS helps for diagnosis and treatment among women with OAB symptoms, and plays a key role in diagnosing DO to properly assess bladder function for complex LUTS situations such as nocturnal enuresis, bladder outlet obstruction, detrusor underactivity or after surgical correction of stress urinary incontinence. This article emphasizes the vital role of urodynamics in diagnosing and managing DO, highlighting its significance in treatment planning and the need for further research to refine diagnostic criteria and therapeutic strategies.

Introduction: Urodynamic studies (UDS) are essential for evaluating lower urinary tract function but are limited by patient discomfort, lack of standardization and diagnostic variability. Advances in technology aim to address these challenges and improve diagnostic accuracy and patient comfort.

Ambulatory urodynamic monitoring (aum): AUM offers physiological assessment by allowing natural bladder filling and monitoring during daily activities. Compared to conventional UDS, AUM demonstrates higher sensitivity for detecting detrusor overactivity and underlying pathophysiology. However, it faces challenges like motion artifacts, catheter-related discomfort, and difficulty measuring continuous bladder volume.

Remote monitoring technologies: Emerging devices such as Urodynamics Monitor and UroSound offer more patient-friendly alternatives. These tools have the potential to improve diagnostic accuracy for bladder pressure and voiding metrics but remain limited and still require further validation and testing.

Ultrasonography in uds: Ultrasound-based modalities, including dynamic ultrasonography and shear wave elastography, provide real-time, noninvasive assessment of bladder structure and function. These modalities are promising but will require further development of standardized protocols.

Artificial intelligence in uds: AI and machine learning models enhance diagnostic accuracy and reduce variability in UDS interpretation. Applications include detecting detrusor overactivity and distinguishing bladder outlet obstruction from detrusor underactivity. However, further validation is required for clinical adoption.

Conclusion: Advances in AUM, wearable technologies, ultrasonography, and AI demonstrate potential for transforming UDS into a more accurate, patient-centered tool. Despite significant progress, challenges like technical complexity, standardization, and cost-effectiveness must be addressed to integrate these innovations into routine practice. Nonetheless, these technologies provide the possibility of a future of improved diagnosis and treatment of lower urinary tract dysfunction.

Introduction/background: Obstructive sleep apnea (OSA) has an established association with nocturia, but even when referred, patients presenting with nocturia may not undergo a full evaluation or begin treatment for underlying OSA. At our institution, patients with nocturia (≥ 2 episodes per night) are often referred for at-home sleep studies. This study aims to assess if patients presenting with nocturia undergo evaluation for OSA and the impact of continuous or automatic positive airway pressure (CPAP/APAP) on nocturia severity.

Methods: We conducted a retrospective chart review of patients with nocturia who completed an at-home sleep study for OSA between July 2020 and September 2023. Patients with pre-existing OSA were excluded. Statistical analysis included Wilcoxon signed-rank tests and Kruskal-Wallis tests.

Results: Of 336 nocturia patients referred for sleep studies, 37 completed the study, and all met diagnostic criteria for OSA. Sixteen of those patients (43.2%) initiated CPAP/APAP therapy. In patients receiving nocturia medication, the mean nocturic episodes significantly decreased after CPAP/APAP initiation (p < 0.01). No significant change was observed before CPAP/APAP initiation with medical management alone (p = 0.052). Twelve of the 16 patients reported subjective improvement in lower urinary tract symptoms (LUTS).

Conclusion: All patients with nocturia who completed an at-home sleep study were diagnosed with OSA, yet most did not follow up, indicating potential underdiagnosis and undertreatment. As advancements in OSA treatment continue to be made, evaluation and treatment for OSA in patients presenting with nocturia may lead to improvement in both conditions.

Introduction: This review examines the role of urodynamics (UDS) in evaluating lower urinary tract symptoms (LUTS) following radical prostatectomy. We first present typical urodynamic findings in post-prostatectomy men, then discuss applications of UDS, and finally examine treatment pathways for post-prostatectomy LUTS beyond stress urinary incontinence (SUI) surgery.

Methods: A narrative review was performed focusing on the current primary literature and society guidelines on the role of UDS post-prostatectomy.

Results: LUTS after prostatectomy are common, most frequently storage LUTS, specifically SUI. For the index patient with clinically suspected SUI after prostate treatment, routine UDS before SUI surgery have not been shown to impact postsurgical continence outcomes. In cases where there is diagnostic uncertainty following noninvasive lower urinary tract evaluation, UDS plays an important role. UDS are highly beneficial in complex scenarios, such as severe mixed LUTS, prior radiation therapy, impaired bladder compliance, detrusor underactivity, and/or previous SUI surgery. Fluoroscopy during UDS and cystoscopy can provide additional clarity and confirmation of the diagnosis suggested by UDS.

Conclusion: UDS are useful adjuncts in appropriately selected post-prostatectomy patients with LUTS, typically with complicating factors.