Neurourology and Urodynamics最新文献

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.

Objective: To assess the surgical safety, efficacy and quality of life in patients suffering from stress urinary incontinence after desobstructive surgery for benign prostatic enlargement, we analyzed data from patients treated with the Adjustable Transobturator Male System (ATOMS) at our tertiary referral center.

Methods: We retrospectively analyzed 27 patients with stress urinary incontinence (SUI) after desobstructive surgery (transurethral resection of the prostate (TUR-P): n = 17; Holmium laser enucleation of the prostate (HoLEP): n = 10) who underwent ATOMS implantation at our high-volume incontinence-surgery center between 2018 and 2024. Patients with prior prostatectomy or cancer-related surgery were excluded. Pre- and postoperative continence parameters, complications, and patient-reported outcomes were assessed using questionnaires, 24-h pad tests, and standardized instruments. The median follow-up was 32 months.

Results: Baseline demographics were comparable across groups. HoLEP patients had a significantly higher resected tissue weight (95.0 g vs. 26.0 g, p = 0.008) and required greater cushion volume (8.0 ml vs. 7.0 ml, p = 0.035). Complete continence rates were 64.7% (TUR-P) and 80.0% (HoLEP, p = 0.401). Postoperative pad test results (12.0 ml vs. 11.0 ml), complication rates, and satisfaction levels showed no significant differences. Explantation occurred in ~10% of patients, with high patient-reported satisfaction and willingness to recommend the implant across both groups.

Conclusion: ATOMS implantation is a feasible, safe, and effective treatment for SUI following both TUR-P and HoLEP. Importantly, neither the type of prior surgery nor the volume of resected prostate tissue negatively impacted outcomes. These findings support the broader application of ATOMS in patients with post-BPE SUI, including those with large prostate volumes.

Background: Guidelines contain recommendations for monitoring and care of neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury/disorder. Evidence on the level of adherence to these recommendations is limited.

Objectives: To assess treads in proportion of patients with spinal cord injury/disorder receiving commonly recommended processes of care for NLUTD.

Methods: The cohort consisted of 49 326 veterans with supra-sacral spinal cord injury or disorder (SCI/D) within the Veterans Affairs (V.A.) healthcare system first seen from fiscal year 1999-2024. Measures included laboratories, imaging, bladder-care procedures, and whether the veteran was seen by a urologist and had cystometrography (CMG).

Results: The analysis reveals the use of recommended NLUTD monitoring processes, with 41% undergoing renal imaging, 48% having a urology encounter, and 31% receiving cystometrography. A longitudinal view shows a decline in these rates over time. However, CMG rates exhibited some increase in veterans entering the system between 2005 and 2014, indicating a slight improvement in adherence over time.

Conclusions: The study highlights gaps between current practices and recommended processes for NLUTD, which may compromise outcomes for veterans with supra-sacral SCI/D. Further research is necessary to explore the barriers to executing suggested processes and implications for outcomes of this vulnerable population.

Objective: This study aimed to explore the association between food insecurity (FI) and lower urinary tract symptoms (LUTS) in middle-aged and older men, and to evaluate the mediating role of depression in this relationship.

Methods: Data were drawn from the National Health and Nutrition Examination Survey (NHANES) 2005-2008, including 2777 men aged 40 years and older. FI was assessed using the Household Food Security Survey Module, depression was measured by the PHQ-9 scale, and LUTS were identified via symptoms such as hesitancy, incomplete bladder emptying, incontinence, and nocturia. Weighted logistic regression and restricted cubic spline models were applied to assess associations. Mediation analysis was conducted using depression as a mediator.

Results: After full adjustment, FI was significantly associated with higher odds of incomplete bladder emptying (OR = 1.94, 95% CI: 1.11-3.36), urinary incontinence (OR = 2.11, 95% CI: 1.44-3.09), nocturia (OR = 1.59, 95% CI: 1.11-2.29), and clinical LUTS (OR = 2.49, 95% CI: 1.63-3.80). Moreover, higher PHQ-9 scores were consistently associated with increased odds of all types of LUTS, including urinary hesitancy, incomplete bladder emptying, urinary incontinence, nocturia, and clinical LUTS, in a dose-dependent manner. Mediation analysis indicated that depression partially mediated the association between FI and LUTS. Specifically, depression accounted for 12.22% of the effect of FI on urinary hesitancy, 8.90% on incomplete bladder emptying, 9.90% on urinary incontinence, 7.74% on nocturia, and 6.69% on clinical LUTS (all p < 0.05). These results demonstrate that depression plays a modest but statistically significant mediating role in the pathway linking FI to LUTS.

Conclusions: FI is significantly associated with multiple LUTS among middle-aged and older men, with depression partially mediating this relationship. Addressing both food access and mental health, particularly depression, may be critical for mitigating LUTS burden in this population.

Clinical trial registration number: Our study does not require a clinical trial registration. The survey data of our study are publicly available on the internet for data users and researchers throughout the world (https://www.cdc.gov/nchs/nhanes/?CDC_AAref_Val=https://www.cdc.gov/nchs/nhanes/index.htm).