Neurourology and Urodynamics最新文献

Purpose: This study aimed to assess the limitations of the International Prostate Symptom Score (IPSS) in evaluating male lower urinary tract symptoms (LUTS) and to determine whether the International Consultation on Incontinence Questionnaire-Male LUTS (ICIQ-MLUTS) can uncover clinically relevant symptoms overlooked by IPSS.

Methods: A total of 239 Turkish men aged 50-80 with LUTS were prospectively evaluated using the linguistically validated Turkish versions of the IPSS and the short form of the ICIQ-MLUTS questionnaires. Symptoms not assessed by IPSS (urgency incontinence, stress incontinence, unaware leakage, nocturnal enuresis, postvoid dribbling) were identified. Multivariate logistic regression and ROC analyses were conducted to explore predictors of having at least one of these symptoms with a severity score ≥ 2.

Results: While the IPSS categorized patients into mild (18.0%), moderate (47.7%), and severe (34.3%) LUTS groups, 32.6% of all participants reported at least one significant symptom not captured by IPSS. In multivariate analysis, an IPSS question 4 (urgency) score ≥ 3 was independently associated with a 1.5-fold increased risk (p = 0.002), while being classified as severely symptomatic conferred a 7.7-fold increased risk (p = < 0.001) of having overlooked symptoms. ROC analysis showed acceptable predictive performance (AUC = 0.710 for urgency score ≥ 3; AUC = 0.671 for severe IPSS classification).

Conclusion: A considerable proportion of clinically relevant LUTS, especially incontinence and post-micturition symptoms, go undetected when using IPSS alone. Patients with high urgency scores or severe symptom burden may benefit from further evaluation beyond the IPSS, which highlights the potential role of IPSS as a triage test in LUTS assessment.

Clinical trial registration: This study does not require clinical trial registration because it is not a prospective interventional trial involving human participants.

Introduction and objectives: Female urethral strictures remain a challenging clinical entity with limited data on optimal reconstructive techniques. This study presents 12-month clinical and patient-reported outcomes following a novel transurethral approach to dorsal inlay buccal graft urethroplasty.

Methods: We evaluate the outcomes of consecutive female patients with urethral strictures treated via dorsal inlay buccal graft urethroplasty from October 2021 to November 2024. Preoperative evaluation included cystoscopy, uroflowmetry, and/or voiding cystourethrogram. Follow-up at 4 and 12 months included cystoscopy, uroflowmetry, and patient-reported outcomes measured via the Global Response Assessment. Success was defined as absence of recurrence on cystourethroscopy.

Results: Twenty-one patients were included in the study, with 95% having undergone prior treatments (90% dilation/DVIU and 9% urethroplasty). Stricture locations varied across the distal (33%), mid (19%), proximal (19%), and multifocal/pan urethral (19%). The median operative duration was 60 min (IQR: 56-86) and all were discharged on the day of surgery. Nineteen patients (90%) underwent a dorsal inlay procedure, while two (10%) required combined dorsal and ventral inlay due to obliterative stricture. No complications were observed. The median follow-up was 13.2 (IQR: 5.1-23.5) months, during which time 1 patient underwent retreatment for recurrent stricture. Clinical success was 95% at 4 months and 92% at 12 months. Median peak urinary flow rate preoperatively versus 4-month postoperatively was 7.0 cc/s versus 13.0 cc/s (p = 0.20) and at 12-month postoperatively was 13.3 cc/s (p = 0.50). 90% of patients reported improvement on the Global Response Assessment. There were no cases of de novo stress urinary incontinence.

Conclusions: This novel transurethral dorsal inlay buccal graft urethroplasty offers a safe and efficient treatment for female urethral strictures with durable clinical and patient-reported outcomes at 12 months. The technique's minimal urethral mobilization translates into shorter operative times and a low risk of stress incontinence, making it a promising alternative to traditional approaches.

Purpose: This study investigates the correlation between clinical characteristics, ultrasound measurements, and the severity of stress urinary incontinence (SUI) in women, aiming to identify key transperineal ultrasound measurements that can guide clinical management of SUI.

Methods: The study was conducted with 519 women diagnosed with urinary incontinence from three hospitals in Fujian Province, China, who underwent clinical assessment and transperineal ultrasound examination from November 2019 and May 2024. Ultrasound measurements, including temporal and morphological metrics, were analyzed in relation to SUI severity, categorized as slight, moderate, or severe. Statistical analyses included Spearman's rank correlation and logistic regression.

Results: Among the 314 women with SUI, significant correlations were found between ultrasound measurements and SUI severity. The duration of maximum contraction showed the strongest correlation with severity, followed by twitch count during sustained contraction. Logistic regression revealed that age (OR = 1.052, p = 0.018) and larger differences in LHA between Valsalva and rest (OR = 1.227, p = 0.035) were risk factors for moderate-to-severe SUI, while longer the duration of maximum contraction reduced the risk (OR = 0.924, p < 0.001).

Conclusion: Transperineal ultrasound was proved to be a noninvasive, objective method for the evaluation and management of SUI. Key findings underscored the potential of ultrasound in advancing pelvic floor health and guiding personalized pelvic floor muscle training. Further research is needed to standardize these measurements and validate their clinical utlity.

Aims: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition marked by chronic pain and voiding dysfunction, often without a clear cause. Management of which often requires a multidisciplinary approach, as well as multiple therapeutic interventions.

Methods: This review characterizes mechanisms and limitations of currently available treatment modalities for IC/BPS, as well as novel and investigational therapies.

Results: Conservative and supportive therapies include cognitive therapies, dietary and fluid management, pelvic floor exercises and bladder training. Additionally, pelvic floor directed therapies such as physical therapy, injections and nerve blocks should be considered. Cystoscopy with hydrodistension is both a diagnostic and therapeutic intervention. Currently available oral therapies include: pentosan polysulfate, amitriptyline, hydroxyzine, silodosin, and non-opioid medications such as cyclobenzaprine. Immunotherapies include cyclosporine and tacrolimus. Available intravesical therapies include dimethyl sulfoxide, lidocaine, oxybutynin, and glycosaminoglycan substitution treatment. Neuromodulation is also available including sacral and pudendal neuromodulation. Finally, we explore emerging therapies and drug delivery systems.

Conclusions: In this review, we present currently available treatment options for IC/BPS. These include conservative therapies, oral medications, intravesical therapies, and neuromodulation. Novel and investigational therapies are presented as well as promise for future directions.

Introduction: Enterocystoplasty is a procedure that uses the ileum to augment a small bladder reservoir. Because many of the anorexigenic intestinal hormones are produced in the ileum, this study evaluates the incidence of developing metabolic complications in patients undergoing augmentation.

Methods: We retrospectively reviewed all patients who underwent an enterocystoplasty at a large pediatric tertiary center covering seven states. Because a large portion of patients undergoing enterocystoplasty had spina bifida, we included a separate control registry of spina bifida patients without augments. We evaluated both demographic and clinical risk factors for developing overweight, obesity, hypertension, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease.

Results: A total of 112 patients were eligible for analysis, with a median follow up time of 5 years. Approximately 61% of this cohort developed overweight or obesity. We did not find enterocystoplasty to be a risk factor in developing overweight or obesity (HR: 1.3, 95% CI: 0.865-1.982). Notable risk factors were having spina bifida and having an enterocystoplasty before puberty (p = 0.001 and p < 0.001, respectively). The odds of developing overweight in the spina bifida patients was 4.2 (95% CI: 1.8-9.8). After adjusting for mobility, the hazard ratio of developing overweight or obesity was 3.48 (95% CI: 1.72-7.03) if a patient had enterocystoplasty before puberty versus later.

Conclusion: The rates of developing overweight or overweight are high in this cohort. Specific risk factors for developing overweight include having spina bifida and undergoing enterocystoplasty before puberty.

Clinical trial registration number: None, as this is a retrospective study not involved in the study of a new medication or procedure.

Introduction: Overactive bladder (OAB) is a common clinical syndrome known to significantly impact individuals' quality of life and work productivity. This study aimed to determine the prevalence and risk factors of OAB among military healthcare workers in an academic hospital in Thailand, with a focus on its effects on workplace productivity.

Materials and method: A cross-sectional observational study was conducted among military healthcare workers undergoing annual health checks in 2023. The diagnosis of OAB was made using the validated Thai version of the Overactive Bladder Symptoms Score (OABSS-T). Participants with abnormal urine analysis results (RBC ≥ 3/hpf and/or WBC ≥ 3/hpf) were excluded. Data on demographics, symptoms, and relevant risk factors were collected via self-report questionnaires.

Results: Among 923 participants, the overall prevalence of OAB was 15.8%, with no significant difference between sexes. OAB-dry and OAB-wet were identified as 7.1% and 8.7% of participants, respectively. Participants with OAB reported significantly higher bladder discomfort scores than those without OAB (mean score: 2.44 ± 1.18 vs. 1.29 ± 0.61; p < 0.001). After adjusting for multiple risk factors, OAB was associated with a significant reduction in work hours, with affected individuals working an average of 4.20 fewer hours per week (p = 0.037). Multivariable analysis identified several risk factors, including a BMI ≥ 25, lower education, sedentary work, limited restroom access, a history of UTIs, and smoking. Conversely, caffeine consumption is associated with a lower likelihood of OAB, likely due to avoidance by symptomatic individuals.

Conclusion: This study demonstrates a moderate prevalence of OAB among Thai military healthcare workers and reveals its potential negative impact on workplace productivity. Identifying modifiable risk factors presents opportunities for targeted interventions to reduce symptom burden and support occupational well-being in this workforce.

Purpose: The purpose of this article is to establish expert consensus on the rationale for, and components of, a global patient registry for interstitial cystitis/bladder pain syndrome (IC/BPS). Our goal is to highlight what a comprehensive international patient registry can add to the growing body of IC/BPS-focused research and summarize the committee's rationale for inclusion or exclusion of certain patient and diagnostic characteristics to identify sub-groups of patients who will benefit from targeted therapy.

Materials and methods: An expert working group was formed from members of the Global Consensus on IC/BPS meeting. The working group consisted of four Urologists and a Urogynaecologist, and held a series of meetings in 2025 to achieve consensus on the benefits, hurdles and practical aspects of developing a global registry for IC/BPS. Literature search of the PubMed database was also performed where relevant, and all members agreed on the final proposals.

Results: The framework for an IC/BPS global registry was developed inclusive of male and female patients ages 18 years and older, who have symptoms of pain, pressure or discomfort related to the bladder, along with lower urinary tract symptoms, that have persisted for 3 or more months, in the absence of confusable disorders. A comprehensive list of patient data points including demographic, history-related, and comorbid conditions was developed. Additionally, validated questionnaires were identified for inclusion that assess domains of pain, urinary symptoms and quality of life. Consensus was reached regarding collecting data on prior treatment, cystoscopy findings and biopsy results where applicable. Lastly, importance was placed on patient-reported questionnaire data that can be input longitudinally by patients to lessen the burden of data collection by providers. Technical, legal and financial aspects were addressed as potential barriers.

Conclusions: A global registry for IC/BPS would overcome the limitations of current regional registries by including large numbers of patients from varied geographical locations, allowing for more efficient recruitment of patients for clinical trials. Understanding epidemiological trends and global variation in practice would enable optimization of care and quality improvement worldwide.

Aims: The objective of this study was to assess the duration and clinical correlates of positive response in interstitial cystitis/bladder pain syndrome patients undergoing therapeutic bladder hydrodistension (HOD) or HOD with electrofulguration (for those with Hunner lesions).

Methods: One hundred and twenty four women were enrolled in this prospective IRB-approved study. Participants answered a set of validated questionnaires at intake including chronic overlapping pain conditions (COPCs), brief pain index (BPI), and IC/BPS symptomatic questionnaires. These were repeated at 1, 2-, 3-, 6-, and 12-months posttreatment, together with a global response assessment (GRA). The primary outcome measure was the GRA score. A secondary analysis of patients who were strong responders to treatment was used to identify clinical correlates of positive response.

Results: At 1-month post-HOD, 62 patients (53.9%) were responders (i.e., reported persistent positive response to treatment). Further, 21/49 (42.9%) respondents continued to report a positive response at 12 months. Logistic regression analyses identified several correlates of strong response to therapy including absence of Huynner lesions (odds ratio (OR) = 3.629), lack of diagnosis of fibromyalgia (OR = 0.31), lower number of total sites of pain on BPI pain map (OR = 0.91), fewer total number of COPCs (OR = 0.36), and lower complex medical symptom inventory scale (CMSI; OR = 0.91). After false discovery rate correction, only the CMSI remained statistically significant.

Conclusions: Therapeutic hydrodistension results in a clinically meaningful and sustained improvement in associated symptoms and pain for many patients. However, having higher scores on markers of a widespread pain/non-bladder centric phenotype was associated with a lower treatment success rate.

Introduction: Urinary incontinence is a common complication after radical prostatectomy. Several meta-analyses have evaluated the effectiveness of pelvic floor muscle training (PFMT) for continence recovery, but their findings are inconsistent, and not all include all relevant studies. This meta-analysis aims to address these gaps.

Objectives: The study aims to summarize evidence on the effectiveness of preoperative PFMT, with or without biofeedback, on continence recovery post-prostatectomy.

Materials and methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. The PICO framework was used: Patients undergoing radical prostatectomy, Intervention: preoperative PFMT, Comparison: any postoperative intervention or monitoring, Outcome: continence recovery. Studies were sourced from PubMed, CINAHL, Scopus, Web of Science, and PEdro. Quality was assessed using the PEdro scale, and statistical analysis was performed using a random effect model.

Results: Six studies were included. Preoperative PFMT did not significantly improve continence recovery 1 month post-surgery (odds-ratio 2.01, 95% CI [0.94-4.31], p = 0.37). However, a significant improvement was observed 3 months post-surgery (odds-ratio 1.52, 95% CI [1.05-2.20], p = 0.03). No significant differences were found at 6 months (odds-ratio 1.28, 95% CI [0.85-1.94], p = 0.95) and twelve months (odds-ratio 0.73, 95% CI [0.43-1.23], p = 0.32).

Conclusions: Preoperative PFMT may improve continence recovery 3 months post-surgery but not at one, six, or twelve months. The study highlights the need for standardized assessment criteria and further research on robotic-assisted prostatectomy. The innovative aspect of this study lies in its conservative inclusion criteria and focus on preoperative PFMT's potential benefits.

Clinical trial registration: Not applicable. This study did not require clinical trial registration because it is a systematic review and meta-analysis of previously published studies.