Neurourology and Urodynamics最新文献

Introduction: Despite their utility, urodynamics (UDS) are associated with medical risks and patient discomfort. Therefore, it is crucial to select patients for UDS where the results are likely to change clinical decision-making or solidify diagnostic confidence. This narrative review aims to assess the indications, benefits and limitations of UDS in men with a prostate who have refractory lower urinary tract symptoms.

Methods: A comprehensive review of the literature was conducted, focusing on studies evaluating the utility, patient perspectives, and clinical guidelines related to the use of UDS.

Results: UDS are beneficial in specific clinical scenarios, such as in patients with neurogenic lower urinary tract dysfunction (NLUTD) or when the likelihood of successful intervention is uncertain. For men with suspected BPH, routine UDS before surgical intervention may not be necessary unless there are comorbid conditions such as frailty or a history of radiation that exacerbate risk of surgery or in the presence of significant diagnostic uncertainty, such as in men with suspected neurogenic lower urinary tract dysfunction.

Conclusions: UDS should be selectively utilized in clinical practice to maximize their diagnostic and therapeutic benefits while minimizing patient discomfort and risks. In men with suspected BPH, UDS should be considered in cases with diagnostic uncertainty or in the presence of significant comorbidities. Further research is needed to refine the indications for UDS and to develop noninvasive alternatives that can provide similar diagnostic insights.

Aim: Previous investigations indicated a higher prevalence of overactive bladder (OAB) in diabetic patients compared to healthy individuals, with growing evidence supporting this association. The present study conducted a systematic review and meta-analysis to determine the pooled prevalence and potential risk factors of OAB in diabetic patients.

Methods: A systematic search was conducted across PubMed (MEDLINE), Embase, and Web of Science. We reported the overall and subgroup prevalence of OAB in diabetic patients, including 95% confidence intervals (CIs). Fixed-effect or random-effect models were employed to synthesize the odds ratios (ORs) and derive an overall OR for analyzing relevant risk factors, including age, diabetes duration, HbA1c level, neuropathy, nephropathy, retinopathy, sex, BMI, hypertension, and stroke history. Meta-regression was used to investigate sources of heterogeneity.

Results: The pooled prevalence of OAB among patients with diabetes was 30.3% (95% CI: 21.3%-39.3%). Patients with diabetes had significantly higher odds of OAB compared to healthy controls (OR = 3.566, 95% CI: 2.639-4.819, p < 0.05). Age (OR = 1.03, 95% CI: 1.02-1.05, p < 0.05), diabetes duration (OR = 1.57, 95% CI: 1.17-2.10, p < 0.05), hypertension (OR = 1.66, 95% CI: 1.09-2.55, p < 0.05), and neuropathy (OR = 2.42, 95% CI: 1.94-3.00, p < 0.05) were identified as significant risk factors for OAB in diabetic patients.

Conclusion: This systematic review and meta-analysis indicated a high prevalence of OAB among diabetic patients. In addition, we found that age, diabetes duration, hypertension, and neuropathy were significant risk factors for OAB among patients with diabetes. These findings are crucial for public health, guiding effective interventions to mitigate OAB risk in diabetic patients.

Background: Urinary incontinence (UI) is a prevalent condition among women, yet many do not seek care due to limited knowledge and stigma.

Objective: To evaluate the effectiveness of a culturally tailored educational animation video in improving UI-related knowledge, health-seeking behavior, and quality of life.

Methods: A randomized controlled trial was conducted among 354 community-dwelling women with UI in Sing Buri, Thailand. Participants were randomized to receive a 4.5 min UI animation video or a control health education session. The primary outcome was UI knowledge proficiency (PIKQ-UI), assessed immediately and at 2-month follow-up. Secondary outcomes included quality of life (IIQ-7) and health-seeking behavior.

Results: The intervention group demonstrated significantly higher UI knowledge proficiency post-intervention (89% vs. 13%, RR 6.67, p < 0.001) and at 2 months (42% vs. 13%, RR 3.18, p < 0.001). They also reported improved health-seeking behavior (mean score 40.16 vs. 36.33, p < 0.001) and better quality of life (IIQ-7 score 25.67 vs. 31.20, p = 0.002).

Conclusion: A brief, culturally adapted animation video significantly improved UI knowledge and health-seeking behavior, and was associated with better quality of life compared with controls, although no significant within-group improvement was observed from baseline. This low-cost, scalable intervention may be valuable in resource-limited settings.

Trial registration: Thai Clinical Trials Registry TCTR20220601002 (retrospectively registered).

Background: The decision on which catheterization method to prescribe should be made on an individual basis, considering each patient's individual needs and circumstances. However, the current decision-making process regarding assisted bladder drainage might not be transparent or standardized.

Objectives: The aim of the present study was to explore and compare the decision-making processes of Dutch healthcare providers regarding the choice of catheterization method and relevant bladder management. This information is crucial in the empowerment of patient involvement and the development of a catheter decision aid.

Design & methods: We conducted a nationwide survey study including urologists, rehabilitation doctors, physician assistants, and specialized (continence)nurses. A 12-question survey was distributed regarding the decision-making process, including questions about treatment options discussed and factors upon which healthcare providers base their decisions.

Results: A total of 108 healthcare providers responded (response rate 36%). The majority were (continence)nurses or urologists and worked in a hospital. (Continence)nurses were least often involved in the decision-making, and when involved, 53% did not discuss potential other treatment options for the underlying causes of impaired bladder emptying. Most healthcare providers base their decision on the patient characteristics.

Conclusion: We observed differences in the decision-making process between the healthcare providers. Implementing shared decision-making can lead to more effective collaboration between the patient and healthcare provider when selecting the most appropriate type of bladder management. This could be achieved through comprehensive training supplemented by a validated decision aid.

Objectives: Neurogenic lower urinary tract dysfunction (NLUTD) severely impairs patient quality of life (QoL). While oral medications are often first-line treatments, their high failure rates and side effects limit their effectiveness. Thus, we argue for the use of intravesical botulinum toxin A (BoNT-A) injections as a first-line alternative.

Materials and methods: A PubMed search identified 81 studies on NLUTD and BoNT-A, 26 of which were analyzed for the efficacy of BoNT-A as a first-line treatment.

Results: BoNT-A significantly improved renal function and urinary continence, as indicated by significant reductions in maximum detrusor pressure and increases in maximum cystometric capacity, respectively. Mechanisms for which BoNT-A treatment also improved urinary urgency were found to include sensory pathway modulation and neurotransmitter inhibition. Finally, QoL was found to significantly improve across multiple criteria, including sexual function such as lubrication and orgasm. Importantly, early initiation of BoNT-A treatment yielded better outcomes, emphasizing its value as a first-line treatment. Although side effects include increased post-void residual (PVR), pain, muscle weakness, and reduced efficacy over time, studies have shown that these effects are manageable with dose adjustments and anesthetics.

Conclusion: BoNT-A offers substantial therapeutic benefits for NLUTD and demonstrates greater effectiveness when used early; thus, it should be considered a first-line treatment option.

Background: A prior study of a large cohort of veterans with supra-sacral spinal cord injury or disorder (SCI/D) showed, as seen in other cohorts, substantial variation in application of bladder care processes and, specifically in the proportion of patients undergoing cystometrography (CMG). The next step in a systematic evaluation such as this is to assess the association CMG on outcomes related to the urinary system.

Objectives: To assess the association of CMG being performed with changes in bladder management, urinary tract infections, urinary stones, renal deterioration, and dialysis care.

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 to 2024. Multivariable regression models were used to assess factors, including CMG, that affected changes in bladder management (e.g., intermittent catheterization), annual probabilities of urinary tract infections, urinary stones and time to renal deterioration and to dialysis care.

Results: Having a CMG was associated with a significantly lowered annual probabilities of febrile urinary tract infections and urinary stones. CMG also was associated with delay in the time to renal deterioration (measured as more than 25% year-to-year drop in estimated glomerular filtration rate; hazard ratio 0.74; 95% CI: 0.70-0.78, p < 0.001), and delay in time to initiation of dialysis for end-stage renal failure (hazard ratio 0.76 (95% CI: 0.60-0.96, p < 0.05).

Conclusions: After adjusting for observable confounding factors, a veteran not having a CMG was associated with significantly more adverse urinary system outcomes (urinary tract infection, stone, renal insufficiency). These findings indicate a need to reexamine systemwide policies to increase the use of CMG for this cohort, as recommended in many global guidelines.

Background: Bladder filling rate has the potential to significantly impact the results of a urodynamics study (UDS). The International Continence Society (ICS) recommends two methods to determine the filling rate: Body weight divided by 4 (BW/4) and 10% of maximum voided volume (MVV) (10%MVV) from a bladder diary. However, there is no evidence if one method is superior to the other.

Materials and methods: This prospective study included patients undergoing UDS for non-neurological diseases, and the filling rate was calculated using both formulas. The study cohort consisted predominantly of patients with voiding lower urinary tract symptoms (LUTS). All the patients underwent UDS twice-once with the filling rate calculated by BW/4 method and once with the 10% MVV method. All UDS parameters, including the maximum cystometric capacity (MCC) were recorded and compared between the two methods used to calculate the fill rates. The MCC recorded during the UDS, with both methods, was further compared with the patient's MVV documented on the bladder diary to assess its accuracy.

Results: The study included 31 patients, and the calculated fill rate by the BW/4 method was 16 mL/min, and that with 10%MVV was 33 mL/min. The MCC on the UDS was 323 mL (IQR: 238-422) for the BW/4 method and 348 mL (IQR: 236-430) for the 10% MVV method, with no statistically significant difference from the MVV as recorded on the bladder diary (p = 0.961 and p= 0.549, respectively). Other urodynamic parameters, including first sensation, first desire to void, strong desire, bladder compliance, and detrusor overactivity, also showed no significant variation between the two methods to calculate the filling rate.

Conclusion: Both the BW/4 and 10% MVV formulas provide reliable estimates of MCC and do not significantly alter the urodynamic parameters. While the BW/4 method better aligns with the physiological filling rates, the 10% MVV method can result in faster filling and shorter duration of the urodynamic study, without adversely affecting its quality. These findings, however, may not apply to patients with storage LUTS, and studies in more diverse populations are warranted.

Introduction: This review highlights NIDDK-funded clinical research studies focused on interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Methods: Since 1987, the NIDDK has funded numerous cohort studies, epidemiologic studies, and clinical trials for these conditions.

Results: While the majority of clinical trials have not demonstrated positive results, these research efforts have provided essential information about these conditions, which have informed clinical practice guidelines and enhanced the clinical care of patients.

Conclusions: The data from these studies are a valuable resource that is available via the NIDDK Data Repository for future analysis.

Purpose: Hemorrhagic radiation cystitis (HRC), a complication of pelvic radiation therapy, results from hypoxic and ischemic injury and causes urinary symptoms like hematuria, dysuria, frequency, urgency, and retention. Hyperbaric Oxygen Therapy (HBOT), where patients breathe 100% oxygen at increased atmospheric pressure, enhances tissue oxygenation, promoting neovascularization and reducing inflammation. The optimal pressure remains unclear, though pressures above 1.41 ATA are efficacious, with higher pressures increasing side effect risks. This study compares the efficacy and side effects of 2.0 versus 2.5 ATA therapy at two sites.

Materials and methods: A retrospective chart review of 93 patients treated for HRC at two sites was conducted. Data on demographics, efficacy (symptom reduction), and side effects were analyzed using GraphPad Prism. Chi-squared and Mann-Whitney tests were used for statistical analysis. Mixed effects logistic regression models were used.

Results and conclusions: Fewer patients treated at 2.5 ATA experienced gross hematuria within 1-year post-therapy compared to those treated at 2.0 ATA (p < 0.05). However, time to hematuria recurrence showed no difference between the groups (10.2 vs. 9.6 months). No difference was observed in other urinary symptoms. Adverse events were increased at 2.5 ATA when analyzed with a mixed effects logistic regression model. Other treatment parameters, including treatment number and duration, were similar across groups. These findings suggest an association between 2.5 ATA treatment and lower rates of hematuria recurrence, but further randomized studies are necessary to determine causality. Future studies should also assess quality of life and explore variations in treatment protocol for efficacy and safety.

Clinical trial registration: As this is a retrospective study, no clinical trial registration is necessary.