Aims: To investigate the association between a standardized ankle fascial manipulation protocol and improvements in symptoms and quality of life for patients with urinary incontinence (UI).
Methods: This retrospective study reviewed the clinical records of 81 patients (aged 30-75) with stress, urgency, or mixed UI who completed a standardized intervention. The protocol consisted of 16 sessions of ankle fascial manipulation over 8 weeks. Primary outcomes included the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score and 24-h pad test volume. Secondary outcomes included the King's Health Questionnaire (KHQ). Assessments were performed at baseline, 8 weeks, and a 3-month follow-up.
Results: Significant improvements were observed. The mean ICIQ-SF score decreased from 14.3 ± 3.2 to 6.8 ± 2.9 (p < 0.001), and the 24-h pad test volume reduced by 63.7% (p < 0.001). Patients with stress UI demonstrated the greatest reduction in leakage (72.4%), compared to urgency (54.8%) and mixed (61.3%) UI (p = 0.023). Quality of life improved significantly, with the mean total KHQ score decreasing from 65.3 to 31.8 (p < 0.001). Improvements were largely maintained at the 3-month follow-up.
Conclusions: Ankle fascial manipulation was associated with significant improvements in urinary incontinence symptoms and quality of life, particularly for stress UI. These findings suggest it may be a promising complementary therapy. Rigorous randomized controlled trials are needed to confirm efficacy and investigate underlying mechanisms.
Purpose: Percutaneous tibial neuromodulation (PTNM) is a standard third line therapy for patients with overactive bladder (OAB). While the therapy has demonstrated efficacy, its exact mechanism of action is unclear. Functional neuroimaging is employed to understand brain activity changes during the micturition cycle in women with OAB. In this study, we measure brain perfusion using functional MRI (fMRI) during bladder filling at discrete bladder volumes in women with OAB pre and post PTNM. We also assess brain perfusion at discrete bladder volumes in healthy women without OAB.
Materials and methods: Women with and without OAB were enrolled. All participants completed validated urinary symptom questionnaires. Subjects underwent an fMRI exam with arterial spin labeling (ASL) fMRI while their bladders were filled through a urethral catheter at discrete bladder volumes. Subjects with OAB underwent a second ASL fMRI after treatment with PTNM.
Results: Twelve women with OAB and 13 women without OAB were enrolled. Patients with OAB had increased bladder filling sensations at lower bladder volumes compared to women without OAB. Anterior cingulate cortex (ACC), insula and supplemental motor area (SMA) perfusion during bladder filling did not increase in a linear fashion in healthy women nor women with OAB; there were changes in ACC, insula, and SMA perfusion during bladder filling at set bladder volumes, which changed after a single session of PTNM.
Conclusions: Perfusion of the ACC, insula, or SMA does not change linearly during bladder filling in women, irrespective of OAB. After a single session of PTNM, perfusion changes during bladder filling in the ACC, Insula, and SMA in a non-linear fashion.
Background: Uroflowmetry (UFM) is a simple and widely used first-line investigation for evaluating lower urinary tract symptoms (LUTS). Despite its non-invasive nature, uroflowmetry can provoke anxiety and affect satisfaction, often due to a lack of understanding about the procedure.
Objective: This randomized controlled trial aimed to compare the effects of structured versus verbal education on alleviating anxiety and assessing patient satisfaction in those undergoing UFM.
Methodology: A single-blind, parallel-arm study was conducted with 148 patients who were randomly assigned to either a structured teaching (brochure) group or a verbal counseling group. The modified Amsterdam Preoperative Anxiety and Information Scale (APAIS-M) was used to assess anxiety, while satisfaction was measured using a validated questionnaire. Descriptive statistics, Chi-square, and independent t-tests were employed for data analysis.
Results: The structured education group demonstrated statistically insignificant overall anxiety score in both groups 10.6 ± 1.23 versus 9.61 ± 1.4 (p = 0.49) in verbally counseled versus structured education group respectively, but individual components have significant differences like worry scores (2.87 ± 0.135) in structured education group compared to the verbal education group (3.49 ± 0.142; p = 0.028), and fewer thoughts (2.90 ± 0.150) versus the verbal education group (3.25 ± 0.155; p = 0.044). Satisfaction scores showed that the structured group had a higher satisfaction to the knowledge provided (1.21 ± 0.04 vs. 1.08 ± 0.036, p = 0.035) and ease of using UFM equipment (4.51 ± 0.11 vs. 4.05 ± 0.118, p = 0.047), more satisfied with aspects related to privacy (4.68 ± 0.112 vs. 4.20 ± 0.115, p = 0.04).
Conclusions: Structured education significantly improved patient understanding, comfort, and expectations regarding privacy, while reducing anxiety compared to verbal counseling. Integrating structured education before uroflowmetry could further enhance the patient experience and satisfaction.
Objectives: Stress urinary incontinence (SUI) has been linked to excessive urethral mobility, yet clinical evaluation has been largely limited to assessing maximal excursion rather than capturing the full dynamics of visible urethral movement. In this study, we hypothesize that an automated, ultrasound-based method can objectively differentiate urethral mobility patterns between women with SUI and continent controls.
Methods: We used a previously validated optical flow-based algorithm to automatically track urethral motion from transperineal ultrasound images during cough, Valsalva maneuver, and pelvic muscle contraction (PMC) in 11 women with SUI and 10 continent controls. Urethral motion was assessed by defining three regions of interest along the urethra (proximal, mid, and distal). Segmental urethral kinematics were computed and statistically compared between groups.
Results: Substantial variability and overlap between groups were observed, with coefficient of variation ranging 25%-90%. On average, women with SUI demonstrated significantly larger urethral displacement compared to controls, particularly at the proximal segment during Valsalva (10.6 ± 1.2 mm vs. 6.0 ± 0.6 mm, p < 0.01), with pronounced inferior-posterior motion. Additionally, displacement between the upper and lower urethra was significantly larger in the SUI group (0.47 ± 0.10 mm/mm vs. 0.13 ± 0.03 mm/mm, p < 0.05), indicating localized hypermobility particularly near the proximal urethra. Maneuver-specific differences were also noted within the SUI group, with Valsalva producing significantly larger and less uniform urethral movements compared to cough (10.6 ± 1.2 mm vs. 6.6 ± 0.5 mm, p < 0.05).
Conclusion: Our results demonstrate that the automated method is capable of capturing urethral mobility characteristics associated with SUI. Significant inter-individual variability in both continent and SUI groups indicates that urethral kinematics are heterogeneous. The detailed kinematic data have the potential to identify distinct sub-types of urethral mobility, facilitating systematic comparisons with underlying structural and neuromuscular defects. This approach can move clinical evaluation from simple group comparisons toward personalized SUI diagnosis and targeted treatment selection. Future studies with larger sample sizes and inclusion of additional pelvic floor conditions will be needed to validate these findings and advance their translation into clinical practice.
Objectives: Chronic painless urine retention (CUR) with > 1 liter of postvoid residual urine (PVR) is a rare but serious complication of benign prostatic obstruction (BPO). This study aims to evaluate the outcomes of HoLEP in men with chronic painless urinary retention and PVR volumes exceeding 1 l.
Methods: We retrospectively reviewed data from men who underwent "en-bloc" HoLEP between July 2017 and May 2024. We identified patients with CUR and PVR > 1 l due to BPO (study group). Excluded were those with acute-on-chronic retention, bladder diverticulum or neurogenic bladder. A matched-pair analysis (1:2) was performed with patients having PVR < 50 ml (control group). We compared demographic, perioperative, and postoperative voiding parameters and complications up to 1 year.
Results: Of 660 patients, 20 had baseline PVR > 1 l. Demographic and preoperative parameters were similar, except for a higher catheterization rate in the study group (50% vs. 17.5%, p < 0.005). The study group had a higher risk of failing a voiding trial on the first postoperative day (20% vs 5.2%) though the difference was not statistically significant. By 1-month post-HoLEP, all patients in the study group were catheter-free and voiding spontaneously. No significant differences were found in postoperative voiding improvements and complications between the groups. Neither group required medical or surgical retreatment within 1 year.
Conclusions: HoLEP is effective and safe for patients with CUR and PVR > 1 l due to BPO, although these patients have a higher risk of failing a voiding trial on the first postoperative day.
Background: The decision on which catheterization method to prescribe should be made on an individual basis, considering each patient's individual needs and circumstances. However, the current decision-making process regarding assisted bladder drainage might not be transparent or standardized.
Objectives: The aim of the present study was to explore and compare the decision-making processes of Dutch healthcare providers regarding the choice of catheterization method and relevant bladder management. This information is crucial in the empowerment of patient involvement and the development of a catheter decision aid.
Design & methods: We conducted a nationwide survey study including urologists, rehabilitation doctors, physician assistants, and specialized (continence)nurses. A 12-question survey was distributed regarding the decision-making process, including questions about treatment options discussed and factors upon which healthcare providers base their decisions.
Results: A total of 108 healthcare providers responded (response rate 36%). The majority were (continence)nurses or urologists and worked in a hospital. (Continence)nurses were least often involved in the decision-making, and when involved, 53% did not discuss potential other treatment options for the underlying causes of impaired bladder emptying. Most healthcare providers base their decision on the patient characteristics.
Conclusion: We observed differences in the decision-making process between the healthcare providers. Implementing shared decision-making can lead to more effective collaboration between the patient and healthcare provider when selecting the most appropriate type of bladder management. This could be achieved through comprehensive training supplemented by a validated decision aid.
Background: Bladder filling rate has the potential to significantly impact the results of a urodynamics study (UDS). The International Continence Society (ICS) recommends two methods to determine the filling rate: Body weight divided by 4 (BW/4) and 10% of maximum voided volume (MVV) (10%MVV) from a bladder diary. However, there is no evidence if one method is superior to the other.
Materials and methods: This prospective study included patients undergoing UDS for non-neurological diseases, and the filling rate was calculated using both formulas. The study cohort consisted predominantly of patients with voiding lower urinary tract symptoms (LUTS). All the patients underwent UDS twice-once with the filling rate calculated by BW/4 method and once with the 10% MVV method. All UDS parameters, including the maximum cystometric capacity (MCC) were recorded and compared between the two methods used to calculate the fill rates. The MCC recorded during the UDS, with both methods, was further compared with the patient's MVV documented on the bladder diary to assess its accuracy.
Results: The study included 31 patients, and the calculated fill rate by the BW/4 method was 16 mL/min, and that with 10%MVV was 33 mL/min. The MCC on the UDS was 323 mL (IQR: 238-422) for the BW/4 method and 348 mL (IQR: 236-430) for the 10% MVV method, with no statistically significant difference from the MVV as recorded on the bladder diary (p = 0.961 and p= 0.549, respectively). Other urodynamic parameters, including first sensation, first desire to void, strong desire, bladder compliance, and detrusor overactivity, also showed no significant variation between the two methods to calculate the filling rate.
Conclusion: Both the BW/4 and 10% MVV formulas provide reliable estimates of MCC and do not significantly alter the urodynamic parameters. While the BW/4 method better aligns with the physiological filling rates, the 10% MVV method can result in faster filling and shorter duration of the urodynamic study, without adversely affecting its quality. These findings, however, may not apply to patients with storage LUTS, and studies in more diverse populations are warranted.
Purpose: To investigate the relationship between age-related white matter hyperintensities (WMHs) and lower urinary tract symptoms (LUTS) in functionally independent older adults by integrating neurological and urological evaluations.
Materials and methods: This observational prospective cohort study (One Step Towards Overactive Bladder Phenotyping [OSTOAP Study]) included 59 community-dwelling individuals aged ≥ 55 years with MRI evidence of cerebral small vessel disease. Participants underwent standardized neurological evaluation, Montreal Cognitive Assessment (MoCA), and WMH classification using the Fazekas scale. WMHs were categorized into mild (Fazekas 1) and moderate-to-severe (Fazekas 2-3). Urological assessment included validated questionnaires, a 3-day bladder diary, uroflowmetry, and post-void residual (PVR) measurement. Multivariable regression models identified predictors of LUT dysfunction.
Results: Participants with moderate-to-severe WMHs had more urgency episodes (median [IQR]: 3 [1-4] vs. 1 [0-2], p = 0.001) and higher PVR volumes (median [IQR]: 50 [0-90] vs. 0 [0-20], p = 0.012). WMH burden independently predicted urgency (OR = 3.51; p = 0.014) and PVR ≥ 50 mL (OR = 3.25; p = 0.014), after adjusting for age, MoCA, and comorbidities. Questionnaire scores and prostate volume did not differ significantly. Increasing age was associated with reduced maximum voided volume (β = -0.516, p < 0.001).
Conclusions: Moderate-to-severe WMHs are independently associated with urgency and impaired bladder emptying. These findings suggest that cerebral small vessel disease may contribute to LUT dysfunction in older adults and support the inclusion of neurological screening in their evaluation, reinforcing the value of integrative phenotyping in future studies.
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