Neurourology and Urodynamics最新文献

The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), has had a successful and productive ten years, accomplishing several major achievements, including over 65 peer-reviewed publications. This multicenter, transdisciplinary Consortium developed the concept of bladder health and studied it systematically in RISE FOR HEALTH (RISE). The resources developed and the data generated will be made available for use through the NIDDK repository, providing the content for many more accomplishments in the field of bladder health. Clinical Trial Registration: NCT05365971.

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.

Introduction: The use of antibiotic prophylaxis before urodynamic studies has been debated for a long time, with no clear consensus among international guidelines. Based on identified predictors of urinary tract infection after urodynamic studies, this study aims to develop and internally validate a nomogram to predict post-urodynamic study urinary tract infection and assess its clinical net benefit to support selective antibiotic prophylaxis.

Methods: Multivariable logistic regression identified final predictors; coefficients were converted into a user-friendly nomogram. Performance was evaluated using the area under the receiver operating characteristic curve (ROC-AUC), Brier score, calibration (bootstrap-corrected), and precision-recall AUC (average precision). Decision curve analysis was used to evaluate the clinical net-benefit of the nomogram.

Results: The nomogram includes five routinely available variables: hydronephrosis, neurological lower urinary tract dysfunction, post-void residual volume ≥ 200 mL, age ≥ 70, and the use of an indwelling catheter or performing clean intermittent catheterization. Discrimination was fair (ROC AUC 0.7086). Overall accuracy was good (Brier 0.0180). Calibration showed good agreement after bootstrap correction. Average precision was 0.0508, exceeding the base prevalence. Decision curve analysis demonstrated a positive net benefit relative to both the treat-all and treat-none strategies at low clinical thresholds (<5%).

Conclusion: This simple, well-calibrated nomogram provides individualized post-UDS UTI risk estimates and shows decision-analytic benefit in the stewardship-relevant range. It may help target AP to higher-risk patients while safely reducing unnecessary antibiotics. External validation is warranted.

Aims: Nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) and functional constipation (FC) are common functional disorders in childhood, which can persist into adolescence and adulthood. The aim of this paper is to review evidence of risk factors that impede the attainment of bladder/bowel control and contribute towards the persistence of incontinence, and to outline protective factors towards minimizing long-term negative sequelae.

Methods: A think tank group consisting of multidisciplinary experts at the International Consultation on Incontinence Research Society (ICI-RS) in 2025 reviewed evidence of factors influencing the attainment of bladder and bowel control, the continuation of incontinence into adolescence and adulthood and the subsequent negative sequelae. Both prospective and retrospective views were considered. Open questions and future directions were discussed. Recommendations for future research and for the improvement of clinical practice in in children, adolescents and adults were formulated.

Results: Childhood incontinence can continue into adolescence and adulthood and is associated with medical and mental health risks. Genetic and environmental risk factors have been identified, but their interaction with protective factors has not been studied. Potentially important environmental risks that require further research include late toilet training, prolonged use of disposable diapers, excessive use of digital media and lack of transitional care from pediatric to adult services. Studies on prevention on all levels (universal, selective and indicated) are lacking.

Conclusions: As childhood incontinence is a precursor of adult incontinence in many patients, early preventive measures are needed. Future research should focus on identifying risk and protective factors. Improved collaboration and exchange between pediatric services and adult urology is essential.

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.

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.

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.