Neurourology and Urodynamics最新文献

Objectives: To automatically identify and diagnose bladder outflow obstruction (BOO) and detrusor underactivity (DUA) in male patients with lower urinary tract symptoms through urodynamics exam.

Patients and methods: We performed a retrospective review of 1949 male patients who underwent a urodynamic study at two institutions. Deep Convolutional Neural Networks scheme combined with a short-time Fourier transform algorithm was trained to perform an accurate diagnosis of BOO and DUA, utilizing five-channel urodynamic data (consisting of uroflowmetry, urine volume, intravesical pressure, abdominal pressure, and detrusor pressure). We used fivefold cross-validation, constructing training and internal test sets from 1725 patients from Renmin Hospital of Wuhan University (RHWU) at a 4:1 ratio, and used an independent external validation set consisting of 224 patients from The Central Hospital of Wuhan (TCHO) to build and evaluate the DI model. We further conducted subgroup analyses to provide a more detailed description of the AI model's interpretability regarding urodynamics.

Results: The AUC scores of BOO and DUA, which were measured through the STFT-based deep learning method, were 0.945 ± 0.020 and 0.929 ± 0.039 in RHWU and 0.881 and 0.850 in TCHO, respectively. The diagnostic efficiency of other subgroup analyses and indicators was also effective.

Conclusion: In this study, the proposed deep neural network combined with the short-time Fourier transform method is robust and feasible for interpreting the results of urodynamics in men and has the potential for application to assist clinicians in real clinical settings.

Background: Nocturia is among the most common and bothersome urinary tract symptoms in older adults. While sleep quality is key to nocturia management, there is little information on the impact of nocturia itself on sleep quality. We investigated the impacts of nocturia on sleep quality and quality of life and explored factors contributing to reduced sleep quality.

Methods: A total of 186 men, aged 42-88 years (patients with nocturia and a control group), were evaluated using the Pittsburgh Sleep Quality Index, the Nocturia Quality-of-Life questionnaire, a visual analog scale measurement of dry mouth, and the Overactive Bladder Symptom Score, among other tools. Patients were graded into four categories of nocturia severity based on 3-day frequency volume charts. Factors associated with reduced subjective and comprehensive sleep quality were investigated using multiple regression analysis.

Results: Initial undisturbed sleep duration was negatively associated with nocturia frequency. Subjective and comprehensive sleep quality, overactive bladder scores, sleep efficiency and oral dryness were significantly associated with nocturia-related quality of life, when controlled for both age and nocturia severity. Sleep efficiency was a major predictor of reduced subjective and comprehensive sleep quality; overactive bladder scores and oral dryness were also independently significantly associated with reduced subjective and comprehensive sleep quality on multiple regression analysis, although nocturia frequency and initial undisturbed sleep duration were not.

Conclusions: It may be beneficial to conduct a comprehensive assessment for overactive bladder and dry mouth when managing nocturia in older adults with poor sleep quality.

Aim: To investigate urinary incontinence prevalence and its association with neurodevelopmental disorders among children in Japan.

Methods: A web-based survey was conducted on children aged 5-15 years in Japan. Information on daytime and nocturnal incontinence and neurodevelopmental disorders, such as attention deficit hyperactivity disorder, autism spectrum disorder, and intellectual disability, was collected.

Results: Responses from 5186 questionnaires (2619 boys, 2517 girls) were evaluated. In total, 505 children had neurodevelopmental disorders. Furthermore, 148 children had daytime urinary incontinence. The incidence of daytime urinary incontinence did not differ significantly according to sex. Daytime urinary incontinence was associated with neurodevelopmental disorders in 33.1% of children. Moreover, 220 children had nocturnal enuresis. Boys had a significantly higher prevalence of nocturnal enuresis than girls in the overall cohort and early elementary school age group. Nocturnal enuresis was associated with neurodevelopmental disorders in 29.1% of children. Children with daytime urinary incontinence or nocturnal enuresis had a significantly higher incidence of neurodevelopmental disorders.

Conclusions: The prevalence of concomitant daytime and nocturnal urinary incontinence and neurodevelopmental disorders in children is significant.

Aims: To assess the effectiveness of intravesical gentamicin in managing recurrent urinary tract infections (rUTIs) refractory to first- and second-line treatments.

Methods and materials: This single-centre prospective cohort study included 41 patients treated with intravesical gentamicin over a 24-month period from 2021 to 2023. A multidisciplinary team comprising functional urologists, microbiologists, and specialist nurses was involved in the decision-making process and in designing the treatment protocol. Patients self-administered gentamicin instillations into the bladder according to a 6-month instillation schedule. Patients were followed up during and after the treatment period to assess the treatment response.

Results: A total of 41 patients with rUTIs were treated using the 6-month intravesical gentamicin regimen. Of these, 10 were male and 31 were female, with a mean age of 53 years. E. coli was isolated from urine cultures in 19 patients (46%), while 19 patients had multiple organisms. Serum gentamicin levels were undetectable in all patients 1 week after treatment initiation. The mean follow-up period was 15 months with minimum follow up of 6 months for all patients. Following gentamicin administration, hospital admission rates due to urosepsis decreased from 46% to 5%, and the prevalence of multidrug-resistant organisms in urine cultures decreased from 44% to 10%. A significant reduction in UTI frequency was observed in 80.5% of patients, with 71% reporting good to excellent Patient Global Impression of Improvement (PGI-I) scores. Additionally, 76% of patients reported a significant improvement in Quality of Life (QoL).

Conclusion: In our cohort of patients with recurrent and refractory UTIs, intravesical gentamicin instillations has shown to be both safe and effective, leading to notable improvements in patients' symptoms and QoL.

Background: The association between different anthropometric indices, including body mass index (BMI), a body shape index (ABSI), lipid accumulation product (LAP), visceral adiposity index (VAI), waist circumference-triglyceride index (WTI), weight-adjusted waist index (WWI), body roundness index (BRI) and the prevalence of overactive bladder (OAB) is unclear. This investigation aims to explore the association among different anthropometric indices and overactive bladder as well as confounding variables.

Methods: Data were obtained from the USA National Health and Nutrition Examination Survey (NHANES) data set between 2005 and 2018, and 15231 participants were included in the study. Multivariable logistic regression was used to investigate the correlation among anthropometric indices mentioned in our study and overactive bladder. Subgroup analyses, smooth curve fitting and area under curve (AUC curve) were also performed.

Results: There was a positive correlation between BMI, LAP, WTI, WWI, BRI and overactive bladder. The results were significant even after taking into account every covariate (p < 0.05). Fitting smooth curves demonstrated that when anthropometric indices were used as a predictor to predict the occurrence of OAB, the probability of female patients suffering from OAB was higher than that of male patients. Additionally, WWI had better predictive power (AUC = 0.6780) and VAI had the worst predictive power (AUC = 0.5558).

Conclusion: Our results suggest a substantial positive relationship between some of the anthropometric indices, including BMI, LAP, WTI, WWI, BRI, and overactive bladder.

Introduction and objective: Observable autonomous rhythmic changes in intravesical pressure, termed bladder wall micromotion, is a phenomenon that has been linked to urinary urgency, the key symptom in overactive bladder (OAB). However, the mechanism through which micromotion drives urinary urgency is poorly understood. In addition, micromotion is inherently difficult to study in human urodynamics due to challenges distinguishing it from normal cyclic physiologic processes such as pulse rate, breathing, rectal contractions, and ureteral jetting. Therefore, the goal of this study was to create a reproducible model of micromotion using an ex-vivo perfused porcine bladder, as well as to describe the relationship between micromotion and afferent nerve signaling.

Methods: Porcine bladders were reanimated using ex-vivo perfusion with a physiologic buffer. The pelvic nerve adjacent to the bladder was dissected, grasped with micro-hook electrodes and electroneurogram (ENG) signals were recorded at 20 kHz. Bladders were catheterized and intravesical pressure measurements were taken using a Laborie XT Urodynamics system. Bladders were filled to a fixed volume of 300 mL and control measurements were recorded. The bladders were then washed with 0.001 M carbachol (CCh) solution and refilled to 300 mL to induce micromotion, which was detected as rhythmic changes in intravesical pressure. ENG amplitude was calculated in μV, and nerve firing rate was calculated as number of spikes above baseline threshold per minute.

Results: Micromotion was induced by carbachol in 12/25 (48.4%) of trials as rhythmic changes in intravesical pressure after the instillation of carbachol but not in any control period. A fast Fourier transform (FFT) algorithm showed average peak dominant frequency component amplitude was significantly higher during the carbachol period when compared to the control period (0.47 vs. 0.01 cm-H₂O, p < 0.0001). Peak waveform frequency (1.13 vs. 1.54 cycles/min, p > 0.05) did not differ between control and carbachol periods. With regard to afferent nerve signaling, normalized average amplitude (0.66 ± 0.24 vs. 0.05 ± 0.08 μV) and firing rate (0.68 ± 0.28 vs. 0.18 ± 0.22 spike/min) for all bladders was significantly greater in the carbachol period when compared to the control period (p < 0.001).

Conclusions: Micromotion can be induced using instillation of carbachol in a perfused ex-vivo porcine bladder. Increased afferent nerve firing is observed during periods of micromotion. Thus, micromotion may drive afferent nerve signaling and may potentially contribute to urinary urgency, detrusor overactivity, and OAB. The development of an experimental ex-vivo porcine model for micromotion provides a reproducible method to study bladder micromotion and its potential role in the pathophysiology of urinary urgency and voiding dysfunction.

Background: Following the severe complications widely reported in some women following polypropylene suburethral mesh implantation for the treatment of stress urinary incontinence, it has become clear that careful preclinical study in an appropriate animal model is essential. The preclinical model described here allows the postoperative clinical and histochemical assessment of material implanted in the sheep vagina and represents a model that allows prediction of the potential vaginal tissue responses to suburethral mesh implantation before implantation into humans.

Objectives: To develop and evaluate a relevant preclinical animal model to mimic suburethral implantation of support materials for stress urinary incontinence.

Material: Fourteen parous ewes of 30-40 kg were used. Under general anesthetic, animals were placed in the lithotomy position. A 12-French Foley catheter was inserted. The ventral vaginal wall was longitudinally incised. The space between the vaginal wall and the urethra was developed, with lateral retropubic dissection. Either a standard transvaginal polypropylene tape (seven animals) or a fascia mimetic microfibre spun polyurethane tape (seven animals) were inserted using an introducer either via a suprapubic (seven animals) or a transvaginal approach (seven animals) into the suburethral and retropubic space. The incisions were closed, and the catheter was removed. A betadine vaginal pack was placed and removed after 24 h. Postoperatively, the animals were observed carefully for pain and complications and allowed access to water and food under continuous veterinary supervision adhering to USA-approved protocols.

Results: On the second postoperative day, all the animals passed urine freely and had regular bowel motions. No procedure related complications were observed.

Conclusion: This is the first large animal model which has been designed for suburethral implantation. and which can be effectively used for the preoperative evaluation of novel materials designed for suburethral implantation. We believe that this technique in this large animal model accurately reproduces the surgical technique used to treat stress urinary incontinence in women. It provides a new and effective in vivo model for the objective evaluation of new materials to treat female stress incontinence.

Introduction: Urinary incontinence (UI) is an uncontrollable expulsion of urine at a time. UI is obviously not life-threatening, but its impact on the patient's quality of life (QoL) is often devastating. Many treatments method to address this problem but all these methods have limitations. Recently, a brand-new noninvasive treatment for pelvic floor muscles (PFM) using a high-intensity focused electromagnetic (HIFEM) field was unveiled. HIFEM therapy may provide better results thus in this study, we aim to summarize the existing evidence and assess the efficacy and safety of HIFEM.

Method: The databases used were Pubmed, Cochrane, EMBASE, and SCOPUS. The literature search was performed using strategic keywords (women) AND ((High Intensity Electromagnetic Field) OR (Electromagnetic Stimulation)) AND ((urinary incontinence) OR (overactive bladder) OR (pelvic floor dysfunction)). Articles that meet the inclusion and exclusion criteria are then analyzed.

Results: Seven studies were included in this review, most of the studies concluded that the usage of HIFEM can reduce the symptoms related to UI significantly and improve QoL. There was higher decrease of UI episodes (MD: -4.10, 95% CI: -7.34 to -0.85, p = 0.01) and improvement of ICIQ-UI SF score (MD: -3.03, 95% CI: -3.27 to -2.79, p = < 0.00001) in HIFEM group compared to control. Subgroup analyses showed better QoL parameter (MD -3.40; p = 0.01, MD -0.70; p = 0.04) compared to control, albeit statistically comparable overall (p = 0.09). However, both pooled analyses for contraction and resting tone changes revealed that there were no significant differences between both groups (SMD: 0.98, 95% CI: -0.70 to 2.660, p = 0.25 and SMD: 0.20, 95% CI: -0.18 to 0.58, p = 0.30, respectively). Finally, there was no safety issue highlighted in most of the studies included.

Conclusion: Current published studies suggest that HIFEM may be an effective and safe noninvasive treatment for female UI by promoting QoL. However, due to being high in heterogeneity and possible bias, future high-quality trials with proper blinding and standardized outcomes are necessary to conclude the applicability of HIFEM for UI.