Neurourology and Urodynamics最新文献

Background: Spinal cord injury (SCI) results in a disruption of autonomic function negatively affecting bladder and sexual function. Research suggests that sport participation can improve physiological function and quality of relationships. This study aimed to describe the prevalence of bladder and sexual dysfunction in national level wheelchair rugby (WCR) males with a SCI.

Methods: Sixty-nine male WCR athletes completed a self-reported questionnaire during national competition. Participants provided information on sociodemographic, injury and sport characteristics, and completed the Neurogenic Bladder Symptom Score Short Form (NBSS-SF) and the International Index of Erectile Function (IIEF).

Results: The NBSS-SF depicted an overall score of 9.8 ± 4.2, 3.2 ± 2.4 in incontinence, 4.1 ± 2.0 for storage and voiding, and 2.5 ± 1.2 in the consequence domains. Athletes with > 10-years of experience had significantly better bladder function, compared to those with < 10-years (p = 0.036). The IIEF showed values of 19.3 ± 7.0 for erectile function, 4.6 ± 2.4 in orgasmic function, 8.0 ± 1.8 in sexual desire, 11.8 ± 3.6 for intercourse satisfaction, and 7.7 ± 2.1 for overall satisfaction. Athletes with < 2-years of experience had notably lower scores in some domains.

Conclusions: While injury classification and completeness did not show differences in functional scores, long-term WCR participation was associated with significantly better bladder function, suggesting a rehabilitative benefit of sustained sport engagement.

Objective: To evaluate the impact of demographic parameters, urinary system symptoms in children with spina bifida on their parents' anxiety and depression.

Methods: This prospective clinical trial included children with spina bifida and their primary caregivers. Demographic data, upper urinary tract (UUT) findings, and parental anxiety and depression were recorded between October and December 2024. UUT damage was defined as the presence of renal scarring, hydronephrosis, or vesicoureteral reflux. Caregivers completed the Hospital Anxiety and Depression (HAD) Scale and BECK Anxiety Inventory, with scores categorized into mild, moderate, and severe. Children and parents were stratified into subgroups based on demographics, anxiety and depression levels, UUT damage, febrile urinary tract infection history, incontinence, and motor deficits, and subgroup comparisons were performed.

Results: A total of 64 children (25 [39.1%] boys, 39 [60.9%] girls) with a median age of 7.5 years and their primary caregivers were evaluated. Median HAD anxiety, HAD depression, and Beck Anxiety scores did not differ significantly according to gender, number of siblings, parental or child age, or parental and child educational levels. In the categorical analyses of anxiety and depression scores, younger parental age (<35 years) was significantly associated with higher anxiety levels across both anxiety assessment scales (HADS-A, p = 0.032; Beck Anxiety, p = 0.042). Among clinical parameters, urinary incontinence was linked to higher anxiety and depression scores (respectively, p < 0.045, p < 0.005).

Conclusion: These findings suggest that certain parental and clinical factors, particularly younger parental age and the presence of urinary incontinence in children with spina bifida, may be associated with increased anxiety and depression levels among caregivers.

Clinical trial registration: NCT06802770.

Objective: To systematically evaluate the efficacy of posterior tibial nerve stimulation (TNS) in children with lower urinary tract symptoms (LUTS) and/or lower urinary tract dysfunction (LUTD).

Materials and methods: A systematic review was conducted following PRISMA guidelines. Databases including PubMed, EMBASE, CENTRAL, and Scopus were searched for relevant studies published before May 11, 2023. Studies included pediatric patients (< 18 years old) treated with percutaneous or transcutaneous posterior TNS (PTNS or TTNS, respectively) for LUTS or LUTD. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT), and data were synthesized qualitatively. Studies were categorized as mixed neurogenic (NLUTD) and non-neurogenic (NN LUTD), monosymptomatic nocturnal enuresis (MNE), and NN LUTD.

Results: Of 576 studies, 26 met the inclusion criteria. For mixed NLUTD/NN LUTD, PTNS had variable efficacy (0%-100%) for improving LUTS, and TTNS had at least some urinary symptom improvement for around 80% of patients. For MNE, most studies showed a mild improvement of 1-2 wet nights over 1-2 weeks with TNS. For NN LUTD, TNS led to improvement in LUTS in around 40%-70% of patients, although complete cure rates were variable. Adverse events were minimal, with only transient discomfort reported. The overall quality of evidence was low to moderate, and most studies had small sample sizes and lacked comparison groups. No studies directly compared PTNS and TTNS.

Conclusions: Overall, posterior TNS via either a percutaneous or transcutaneous approach often provides at least a mild benefit to pediatric patients with LUTS and LUTD. However, the variability in study outcomes and low quality of evidence suggest a need for more robust studies with standardized outcomes and comparison groups to better establish the efficacy and role of TNS in children.

Purpose: The impact of asymptomatic bacteriuria and inflammation on response to Onabotulinumtoxin-A for overactive bladder is poorly understood. This work compares baseline differences in asymptomatic bacteriuria status and urinary inflammatory markers between women who respond to Onabotulinumtoxin-A and those who do not.

Materials and methods: Women undergoing intradetrusor Onabotulinumtoxin-A injection for refractory overactive bladder submitted a catheterized urine sample to assess for asymptomatic bacteriuria and quantification of 12 urinary cytokines and chemokines at the time of injection. Clinical responders were defined as meeting a minimal clinical difference of > 11 on the Urinary Distress Inventory Short Form after treatment. The proportion of asymptomatic bacteriuria and concentration of urinary biomarkers in Onabotulinumtoxin-A responders compared to non-responders were analyzed.

Results: Of the 75 participants, 45 (60%) were Onabotulinumtoxin-A responders. Responders did not differ in baseline characteristics apart from age (66.0 ± 14.2 [responders] vs. 74.3 ± 7.8 years [non-responders], p < 0.01). There was no difference in asymptomatic bacteriuria rates in responders (37.8%) versus non-responders (40.7%, p = 0.09). No single inflammatory marker was predictive of treatment response when controlling for age. Decision tree analysis allowed for 80% classification accuracy of responders. MCP1 and IP10 were major features in the decision tree analysis, but their impact varied by age. Adding asymptomatic bacteriuria to the decision tree analysis did not improve classification nor function as an important predictive feature.

Conclusions: Asymptomatic bacteriuria does not affect Onabotulinumtoxin-A response. Older women were less likely to respond to Onabotulinumtoxin-A treatment and experienced a differential impact of inflammatory cytokines.

Aims: To assess the safety and efficacy of intravesical gentamicin in patients with recurrent urinary tract infections (UTI) and/or catheter blockages.

Methods: This prospective, single-center study enrolled adult patients with recurrent UTIs and/or catheter blockages who had been prescribed intravesical gentamicin (once-daily, 30-60 mL, 0.48 mg/mL, held 60 min) from June 1, 2024, to April 1, 2025. Eligible patients had received ≥ 14 days' intravesical gentamicin. Primary outcomes were, for patients with recurrent UTIs, subjective (patient-reported) and objective (positive culture with symptoms) rates of UTI per 12-month-equivalent, before versus during treatment.

Results: Fifty-five patients were prescribed intravesical gentamicin, of whom 42 were eligible. Median age was 58 years, and 26 patients (62%) were female. Thirty-six patients (86%) had neurogenic bladder, and 38 (90%) had pre-existing catheter use (suprapubic: 17; intermittent: 15; indwelling urethral: six). Median follow-up was 6 months. Compared with pre-treatment, patients experienced significantly fewer subjective (median 6.5 vs. 0; p < 0.00001) and objective (median 5.5 vs. 0; p < 0.00001) UTIs per 12-month-equivalent. Regarding secondary outcomes, for patients with recurrent UTIs, gentamicin was associated with decreased rates of UTI-related emergency department presentations per 12-month-equivalent (median 1 vs. 0; p = 0.005) and decreased proportion of patients with ≥ 1 multi-drug-resistant UTI (70% vs. 23%; p = 0.00002). Median ease-of-use was 4/5, and likelihood-to-recommend was 5/5. Complications were reported by 11 patients (26%), all Clavien-Dindo Grade I. Of patients with prior catheter blockages, 47% reported decreased catheter blockages, although duration between catheter changes was unchanged (median 28 vs. 28 days; p = 0.53).

Conclusions: Intravesical gentamicin appears safe and effective prophylaxis for recurrent UTIs and/or catheter blockages.

Trial registration: This study has been registered with the Australian New Zealand Clinical Trials Registry, submission 389972.

Aim: Although TRPV1 is present in detrusor smooth muscle (DSM), interstitial cells of Cajal, and urothelium, its physiological role remains unclear. The present study demonstrated the presence of TRPV1 mRNA in goat DSM, including the physiological effects of the TRPV1 channel and its modulation by nitric oxide.

Methods: Species identity was confirmed by amplification of the mitochondrial 16S rRNA gene from the genomic DNA of the goat (Capra hircus) DSM, and the samples were subjected to RT-PCR for TRPV1 gene expression. For functional studies, DSM strips (2-3 × 4-5 mm) from freshly slaughtered male goats (6-8 months) were mounted in organ baths. Capsaicin (1 nM-10 µM) was applied cumulatively to DSM precontracted with carbachol (CCh, 10 µM) or high K⁺ solution (30 mM), in the absence or presence of BCTC (1 µM), yohimbine (1 µM), glibenclamide (10 µM), sodium nitroprusside (SNP, 10 µM), l-NAME (10 µM), or ODQ (1 µM).

Results: RT-PCR confirmed TRPV1 mRNA expression. Capsaicin produced maximal relaxation (Rmax) of 45.5% (95% CI = 41.9-49.1) and 42.8 (95% CI = 37.1-48.5) in CCh- and high K⁺- contracted DSM, respectively. R_max was reduced to 0% and 3.9% (95% CI = 1.4-6.4) by BCTC; 6.8% (95% CI = 2.7-10.9) and 27.3% (95% CI = 10.1-44.5) by yohimbine, 4.7% (95% CI = 1.8-7.6) and 28.5% (95% CI = 9.7-47.3) by glibenclamide in CCh- and K⁺30-PSS - contracted DSM, respectively. SNP enhanced the capsaicin-evoked R_max to 76.3 (95% CI = 55-97.6) and 85.2% (95% CI = 50.2-120.2), whereas l-NAME decreased it to 26.7% (95% CI = 11.1-42.3) and 11.8% (95% CI 4.8-18.8), and ODQ to 12.4% (95% CI = 4.8-20.0) and 7.7 (95% CI = 3.2-12.2) in CCh-contracted and high K⁺-depolarized DSM, respectively.

Conclusion: The present study demonstrates that goat DSM expresses functional TRPV1 channels and capsaicin elicits relaxation by activating these channels. The NO donor SNP further potentiates the capsaicin-induced relaxation through a NO-cGMP signalling pathway.

Objective: To characterize parental perspectives on nocturnal enuresis (NE), including awareness of therapies, psychosocial impact, and openness to neuromodulation, and to compare survey responses for monosymptomatic (MNE) and nonmonosymptomatic nocturnal enuresis (NMNE).

Materials and methods: An anonymous cross-sectional online survey was distributed to parents and guardians of children with NE. The survey assessed demographics, respondent and child concern, treatment awareness and use, and openness to novel interventions. Descriptive statistics and comparative analyses between MNE and NMNE were performed.

Results: A total of 261 responses were received. Most respondents were parents or guardians of boys (68.2%) aged 5-10 years (56.7%). Respondent concern was high (median 8/10), as was motivation to pursue treatment (median 10/10). Among 184 respondents providing treatment histories, 61.4% reported trying a single modality (41 alarms, 21 medications, 51 behavioral), 32.1% reported two, and 6.5% reported three. Dissatisfaction was common, and free-text responses emphasized psychosocial consequences. NMNE was most common in 5-10-year-olds, whereas MNE predominated among older children (p < 0.001). A greater proportion of NMNE patients were male (72.8% vs. 54.5%, p = 0.010). Perception of the child's concern was significantly lower among NMNE (median 5/10 vs. 7/10, p = 0.039). Awareness of bedwetting solutions was not significantly different between respondents of children with NMNE versus MNE (61.8% vs. 75.2%, p = 0.051).

Conclusions: Parents and guardians of children with NE report high concern and motivation but frequent dissatisfaction with current therapies. Families remain receptive to innovative, technology-based interventions, underscoring opportunities for further clinical adoption and research.

Background: Guidelines recommend initial cystometrography in patients with supra-sacral spinal cord injuries. Contemporary data on cohort composition and related adherence to neurogenic bladder guidelines is limited.

Objectives: To assess treads in cohort composition and the proportion of persons with spinal cord injury who were seen by a urologist and who underwent cystometrography.

Methods: We identified the cohort of veterans with supra-sacral spinal cord injury in whom neurogenic bladder guidelines may apply. Measures included whether the veteran was seen by a urologist and had a cystometrography procedure performed within 2 years of the first SCI/D clinic or hospital encounter. We also examined trends over 20+ year cohort composition and overall survival.

Results: The cohort consisted of 49 347 veterans with a mean follow-up of 10.2 (SD 6.5) years. The number of new patients was more than 3000 in 2000 and has been approximately 1200 from 2020 to 2023. Prevalent patients peaked in 2019 at 25 812, followed by a decline. Eighty percent of veterans had at least one record of lower urinary tract symptoms within 1 year of their first SCI/D encounter, and more than 55% received medication for urinary conditions or urinary supplies. An urologist visit was reported for 14 408 (29%) veterans, and cystometrography (CMG) was performed in 15 512 (31%) veterans. Over 20+ years, from 2000 to 2023, the mean age of new patients increased by almost 9 years, as did the proportion of veterans with baseline comorbidities; for example, the proportion of veterans with diabetes increased from 17% in 2000 to more than 45% in 2022. Median survival was 13.3 (IQR: 6.4-22.4).

Conclusion: The characteristics of veterans with supra-sacral SCI/D have changed to older age and more comorbidities, and most veterans have recorded lower urinary tract symptoms early after the initial SCI/D encounter. Given the study's insights into changing patient demographics, the crucial role of CMG, and the low rates of specialized urological care, there is a pressing need for enhanced awareness, surveillance, and updated treatment strategies tailored for this unique patient population. This paper calls for a concerted effort to improve healthcare delivery for veterans with supra-sacral SCI/D, aiming for early diagnosis and treatment to optimize outcomes and quality of life.

Clinical trial registration statement: The study does not require clinicaltrials. gov trial registration. The reason is that is we did not "prospectively assign people or a group of people to an intervention" (ICMJE, Section I.1). Supplemental materials for the fourth paper in this series includes a STROBE statement (STrengthening the Reporting of OBservational studies in Epidemiology; https://www.strobe-statement.org).

Aims: Cyclophosphamide (CYP) may through its toxic metabolite, acrolein, induce hemorrhagic cystitis and bladder hyperactivity. Previous studies demonstrated intra-iliac arterial administration of adipose derived mesenchymal stem cells (ADSC)-derived microvesicles with less immune response and adverse effects than ADSC itself may confer anti-oxidative stress and anti-inflammatory potential to improve bladder dysfunction. We explored whether ADSC-derived microvesicles may prevent CYP-induced bladder cystitis and overactivity.

Methods: Female Wistar rats were divided into control (Con), CYP (Cy), CYP+microvesicles (CyM), and microvesicles treated control (CoM) groups. Con rats were intraperitoneally treated with saline, while the Cy rats were induced by intraperitoneally administered CYP (100 mg/kg body weight). We injected ADSC-derived microvesicles at the dosage of 15 μg/ml via intra-iliac artery to the rats with or without CYP treatment. We measured the responses of transcystometrogram, pathology, expression of muscarinic receptors (M3) and purinergic receptors (P2X7), pyroptosis related Caspase 1 and IL-1β, xCT/Gpx4 related ferroptosis by western blot in CYP-treated bladders. Wire myography of the urinary bladder was determined.

Results: ADSC-derived microvesicles effectively decreased micturition frequency (overactivity), inflammation and fibrosis in CyM rats versus Cy rats. ADSC-derived microvesicles efficiently downregulated P2X7 and M3 receptor expression, Caspase 1/IL-1β mediated pyroptosis, xCT/Gpx4 regulated ferroptosis and restored Bcl-2/HO-1 mediated antioxidant defense mechanisms in CYP-induced cystitis. The pathologic results also displayed the effective reduction of bladder immune cell infiltration (inflammation) and fibrosis, and the preservation of the integrity in the urothelium by the treatment of ADSC-derived microvesicles.

Conclusion: ADSC-derived microvesicles can ameliorate CYP-induced bladder overactivity, inflammation, fibrosis, ferroptosis and pyroptosis.