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).
Aims: Provide urologists with a comprehensive understanding to guide the optimal and evidence-based utilization of VUDS in contemporary practice.
Methods: We performed a literature review of VUDS use in modern-day urologic practice, as well as innovative technological advancements and research endeavors to improve VUDS.
Results: VUDS offers enhanced diagnostic precision, which directly influences treatment planning and can lead to more tailored and effective therapies. The increased resource intensity of VUDS underscores the critical need for appropriate patient selection. Contrast-enhanced voiding ultrasonography (ceVUS), using microbubble contrast agents, shows promise for eliminating the need for radiation through fluoroscopy in the identification of vesicoureteral reflux. Further, artificial intelligence holds considerable potential to transform various aspects of VUDS.
Conclusions: VUDS is a diagnostic tool for complex lower urinary tract dysfunction (LUTD) where UDS findings are insufficient or where detailed anatomical information is paramount for safe and effective treatment planning.
Introduction: Pelvic organ prolapse (POP) is a prevalent condition among older women, often linked to weakened pelvic floor muscles. Sarcopenia, characterized by age-related loss of muscle mass and function, may contribute to the pathophysiology of POP. However, the association between sarcopenia and POP remains unclear. This study aims to investigate the relationship between sarcopenia and POP using the psoas-lumbar vertebral index (PLVI) as an objective, practical, imaging-based assessment.
Materials and methods: A retrospective analysis was conducted on patients who presented to the functional urology outpatient clinic between March 2022 and March 2024. Patients were categorized into two groups: those with severe POP requiring surgical intervention and those without POP. PLVI was measured using computed tomography (CT) scans at the L4 vertebral level. Demographic data, and clinical characteristics results were compared between groups. Logistic regression models assessed predictors of POP, testing linearity of PLVI using restricted cubic splines. Model discrimination, calibration, and clinical utility were evaluated by receiver operating characteristic (ROC) analysis, Hosmer-Lemeshow test, and decision-curve analysis. A sensitivity analysis restricted to CTs ≤ 3 months was also performed.
Results: A total of 112 patients were analyzed (64 with POP, 48 controls). PLVI values were significantly lower in the POP group (p = 0.021). In multivariable analysis, previous pelvic surgery (OR 0.53, p = 0.011), positive provocative stress test (OR: 4.73, p < 0.001), and lower PLVI (OR: 0.18, p = 0.032) were independently associated with POP. The model showed acceptable calibration (Hosmer-Lemeshow χ² = 15.97, p = 0.06) and moderate discrimination (AUC = 0.627, 95% CI: 0.522-0.733). Sensitivity analysis yielded consistent results.
Conclusion: This study highlights a significant association between sarcopenia, as measured by PLVI, and POP. PLVI offers an objective, easily accessible, imaging-based metric for sarcopenia evaluation in patients with POP. Given these findings, incorporating sarcopenia assessment into POP management may enhance clinical decision-making and optimize patient outcomes with multidisciplinary approach.
Clinical trial registration: Since our study is a retrospective data analysis, clinical trial registration is not required.
Introduction: Fibromyalgia (FM) is a chronic pain disorder frequently accompanied by lower urinary tract symptoms (LUTS), yet the prevalence and clinical relevance of overactive bladder (OAB) in this population remain poorly defined. This study aimed to evaluate the prevalence of OAB among women with FM and to compare their clinical features with non-FM controls presenting with similar urinary complaints.
Methods: This cross-sectional controlled study included 232 women aged 18-65 years: 192 diagnosed with FM and 40 age- and symptom-matched controls. OAB was diagnosed based on International Continence Society (ICS) criteria using the Overactive Bladder Awareness Tool Version 8 (OAB-V8; cut-off ≥ 8) and a 3-day bladder diary. FM symptom burden was assessed using the Widespread Pain Index (WPI), Symptom Severity Scale (SSS), and General Symptom Score (GSS). Psychiatric comorbidities and irritable bowel syndrome (IBS) were also recorded.
Results: OAB was identified in 62.0% of FM patients and 28.6% of controls (p < 0.001). FM + OAB patients were significantly older and had longer disease duration than FM-OAB patients (p < 0.001). WPI, SSS, and GSS scores were significantly higher in FM + OAB compared to both FM-OAB and control+OAB groups (p < 0.001). Psychiatric comorbidities, IBS, and obesity were also more frequent in FM + OAB. Moderate correlations were observed between OAB and FM symptom severity (ρ = 0.33-0.42, p < 0.01).
Conclusions: OAB is highly prevalent and clinically relevant among women with FM. Its presence is associated with greater symptom severity and comorbid burden, supporting the hypothesis that OAB in FM may represent a manifestation of central sensitization.
Introduction: For women with bothersome stress urinary incontinence (SUI), a urethral sling is the gold-standard surgical treatment. Despite the high efficacy of slings for SUI, up to a 20%-30% rate of complications or adverse effects have been reported, and there can be a period of convalescence postoperatively. Given this, the less invasive approach of urethral bulking may be utilized. A number of bulking agents can be used to improve urethra coaptation. Polyacrylamide hydrogel (PAHG) is a bulking agent that received FDA approval in 2020 and is reported to have longer efficacy for the treatment of SUI compared to prior bulking agents. We sought to assess trends in the usage of surgery and urethral bulking for SUI treatment in women at a single academic medical center before and after the introduction of PAHG.
Methods: This is a retrospective cohort study of all new patients seen with an ICD-10 diagnosis of SUI (N39.3) at an academic tertiary care center from June 2019 to June 2023. Our multidisciplinary clinic was established in May 2019. Patients were included if they underwent an interventional treatment for SUI with urethral bulking, sling (either mesh or autologous fascia), or Burch colposuspension. Patients were stratified to before and after the introduction of PAHG to our clinic in April 2021. The primary endpoint was the percent of new patients seen in clinic with SUI who were treated with urethral bulking compared to surgical treatment.
Results: A total of 478 new patients with SUI were seen and 279 treated with an invasive procedure by 5 URPS trained surgeons. In total, 109 of these patients underwent treatment in the 20 months before PAHG was introduced into the clinic and 170 patients in the 27 months after. Use of urethral bulking for new patients seen for SUI increased from 56% to 69.1% (p = 0.04) of patients with SUI who underwent a procedure. When the total number of new patients presenting with a diagnosis of SUI was analyzed by 12-month period, there was an overall increase in the number of procedures for SUI, which was driven by an increase in the percent of new patients who were treated with bulking.
Conclusions: The introduction of a PAHG resulted in increased utilization of urethral bulking for patients newly presenting with SUI to a tertiary care center.
Purpose: Vibegron was associated with improvements in efficacy versus placebo and was well tolerated in men with overactive bladder (OAB) on pharmacotherapy for benign prostatic hyperplasia (BPH) in the COURAGE trial (NCT03902080). Additional safety, bladder function, and urodynamics data are provided.
Methods: This 24-week, phase 3, double-blind, placebo-controlled trial randomized men ≥ 45 years with OAB and BPH receiving α-blocker ± 5α-reductase inhibitors to once-daily vibegron or placebo (1:1). From the safety analysis set (SAF), postvoid residual urine volume (PVR), maximum urinary flow rate (Uroflow-Qmax), International Prostate Symptom Score (IPSS) total score, and urologic-related adverse events (AEs) were collected throughout the trial. Qmax and detrusor pressure at Qmax (PdetQmax) were collected at baseline and week 12 in a urodynamics substudy (urodynamics evaluable set [UES]).
Results: In the SAF, differences between vibegron (n = 553) and placebo (n = 551) in PVR and Uroflow-Qmax were minimal at baseline, week 12, and week 24. Mean (SD) change from baseline (CFB) at week 24 in IPSS total score was -7.3 (6.96) with vibegron and -5.7 (7.14) with placebo. Urinary retention was reported as an AE for 5 (0.9%) and 4 (0.7%) participants receiving vibegron and placebo, respectively. In the UES (vibegron, n = 21; placebo, n = 22), least squares mean difference (95% CI) between vibegron and placebo in CFB at week 12 was 2.75 (0.16, 5.34) mL/s in Qmax and 2.86 (-13.52, 19.25) cmH2O in PdetQmax.
Conclusions: There were no safety signals related to bladder function identified by urodynamics; risk of protocol-defined AEs of urinary retention or residual urine volume increase was not increased with vibegron compared with placebo in this population.
Clinical trial registration: This study is registered at www.
Clinicaltrials: gov. The registration identification number is NCT03902080.
Aims: To discuss the use of urodynamic testing for female stress urinary incontinence and provide a narrative review of the current evidence regarding the utility of urodynamics across the spectrum of clinical presentations.
Methods: A nonsystemic, extensive literature review via PubMed was performed on the use of urodynamics for female stress urinary incontinence.
Results: Findings from several large multicenter trials and subsequent secondary analyses have significantly influenced treatment patterns away from the routine use of urodynamics in female patients with uncomplicated stress urinary incontinence. Much of the current literature focuses on selected patients with uncomplicated stress urinary incontinence that are subsequently treated with midurethral sling placement. These studies comprise the foundational evidence supporting multiple national and international guidelines on the topic. In uncomplicated patients, these guidelines do not support the routine use of urodynamics. However, in more complicated presentations, urodynamic studies are more often valuable for diagnosis and management.
Conclusions: Routine use of urodynamic testing is not currently recommended in guidelines for evaluating uncomplicated female stress urinary incontinence. It is important to recognize that much of the evidence supporting these recommendations is derived from a select population of uncomplicated patients, which may limit generalizability to more complex cases. In such cases, urodynamic testing may be more useful to guide diagnosis and management, though further research is needed to identify which findings have the greatest impact on clinical outcomes.
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