Neurourology and Urodynamics最新文献

Purpose: To investigate the relationship between age-related white matter hyperintensities (WMHs) and lower urinary tract symptoms (LUTS) in functionally independent older adults by integrating neurological and urological evaluations.

Materials and methods: This observational prospective cohort study (One Step Towards Overactive Bladder Phenotyping [OSTOAP Study]) included 59 community-dwelling individuals aged ≥ 55 years with MRI evidence of cerebral small vessel disease. Participants underwent standardized neurological evaluation, Montreal Cognitive Assessment (MoCA), and WMH classification using the Fazekas scale. WMHs were categorized into mild (Fazekas 1) and moderate-to-severe (Fazekas 2-3). Urological assessment included validated questionnaires, a 3-day bladder diary, uroflowmetry, and post-void residual (PVR) measurement. Multivariable regression models identified predictors of LUT dysfunction.

Results: Participants with moderate-to-severe WMHs had more urgency episodes (median [IQR]: 3 [1-4] vs. 1 [0-2], p = 0.001) and higher PVR volumes (median [IQR]: 50 [0-90] vs. 0 [0-20], p = 0.012). WMH burden independently predicted urgency (OR = 3.51; p = 0.014) and PVR ≥ 50 mL (OR = 3.25; p = 0.014), after adjusting for age, MoCA, and comorbidities. Questionnaire scores and prostate volume did not differ significantly. Increasing age was associated with reduced maximum voided volume (β = -0.516, p < 0.001).

Conclusions: Moderate-to-severe WMHs are independently associated with urgency and impaired bladder emptying. These findings suggest that cerebral small vessel disease may contribute to LUT dysfunction in older adults and support the inclusion of neurological screening in their evaluation, reinforcing the value of integrative phenotyping in future studies.

Background: Frailty has been associated with numerous chronic diseases. However, the relationship between frailty and overactive bladder (OAB) has not been thoroughly examined. This study aims to explore the association between frailty and OAB in a large-scale population.

Methods: Data from 11 888 participants aged 20 years or older, who were part of the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018, were analyzed. The frailty index was calculated using a validated 49-item deficit accumulation model, with a cutoff value of 0.21 or higher indicating frailty. OAB was diagnosed based on self-reported urgency incontinence, nocturia, and an OAB Symptom Score of 3 or higher. Multivariable logistic regression models were employed, adjusting for demographic factors, lifestyle characteristics, comorbidities, and biochemical markers. Subgroup analyses and restricted cubic splines (RCS) were utilized to evaluate effect modification and potential nonlinear relationships.

Results: A significant positive association was found between frailty and OAB. In the multivariable-adjusted model, the odds ratio (OR) was 2.74 (95% confidence interval [CI]: 2.39-3.13, p < 0.001). The RCS analysis confirmed a nonlinear dose-response relationship (overall p < 0.001). Subgroup analyses demonstrated the consistency of this association across different populations. The association was stronger in non-diabetic individuals (OR = 2.961) and those who engaged in vigorous physical activity (OR = 3.442).

Conclusions: In this study, a robust association between frailty and OAB has been identified. Nevertheless, additional research is necessary to confirm this correlation and to investigate the underlying mechanisms.

Aims: To describe why ileal conduit is the best option for the poorly compliant bladder in the neurogenic lower urinary tract dysfunction patient refractory to minimally invasive treatment.

Methods: Evidence from prior studies evaluating this patient population were reviewed.

Results: There are few options that can address the urinary incontinence that often accompanies this scenario while also eliminating the elevated storage pressures placing the patients' renal function at risk. Once less invasive options such as oral therapy and intradetrusor high-dose botulinum toxin have failed then surgical options should be considered. Construction of an ileal conduit removes the concern for elevated bladder pressures negatively impacting future renal function, is easy to care for without the need for intermittent catheterization and has demonstrated improved quality of life in patients with neurogenic lower urinary tract dysfunction. In addition, an ileal conduit does not have some of the risks that can be seen with bladder augmentation (with or without continent urinary stoma construction) such as the need for lifelong mucus irrigation, bladder stones, bladder cancer and the need for surgical revision related to the stoma.

Conclusions: Construction of an ileal conduit is an excellent option for the poorly compliant bladder in the neurogenic lower urinary tract dysfunction patient refractory to minimally invasive treatment. Patient satisfaction rates are high and the risk of damage to the upper urinary tracts are minimized with acceptable short- and long-term morbidity.

Background: Clean intermittent catheterization (CIC) is the standard of care for patients with chronic retention of urine, particularly those with spinal cord injury, multiple sclerosis, and other causes of neurogenic lower urinary tract dysfunction, as well as in cases of idiopathic and non-neurogenic bladder dysfunction. The aim of this literature scoping review was to analyze the functional, practical, and psychological barriers to successful adoption and continuation of CIC among eligible patients. It also considers key principles of education on CIC for patients and healthcare professionals and the potential value of specific educational interventions.

Materials & methods: We conducted a literature scoping search on PubMed and Embase. The findings have been classified into the following four main categories: (A) functional ability as a driver of success or failure; (B) practical and psychological barriers; (C) guiding principles for designing patient education and training the trainers; (D) value of specific educational interventions.

Results: (A) Physical challenges can fundamentally affect ability to implement CIC. A number of studies focus specifically on degree of functional ability as a driver of success or failure. (B) As for practical and psychological barriers, specific numbers of common themes emerged from the studies, including education and support, access to choice of products, urinary tract infections and other medical complications, planning timings and opportunities for catheterization, and emotional adjustment. (C) Several studies highlight the need for evidence-based care and a structured, consistent approach, along with the need of verbal explanation, practical instruction, and written information. It has been noted that clinical staff who teach CIC should themselves be trained in a standardized way. (D) Relatively few studies have investigated specific educational interventions like web-based support, a centralized education system, or a simulator.

Conclusion: Despite CIC is a widely recognized and accepted tool, its acceptance and long-term integration into patients' daily lives is often challenging. Functional, practical and psychological barriers may affect patients' adherence. Further studies are needed to gain a more in-depth knowledge of this specific issue.

Clinical trial registration: Not applicable.

Aims: In April of 2025, the Wake Forest Institute for Regenerative Medicine hosted a Global Consensus meeting on IC/BPS in Winston-Salem, NC. The goal of this meeting was to establish global consensus regarding diagnostic criteria, phenotyping, treatment outcome assessment, and etiopathology in interstitial cystitis/bladder pain syndrome (IC/BPS). Our sub-committee was tasked with developing a consensus document on patient phenotyping in IC/BPS.

Methods: Narrative review.

Results: Patients with IC/BPS populate broad groups that have been characterized as having a bladder-focused disease phenotype (bladder-centric), a widespread pain and symptoms phenotype (systemic), or by other variable phenotypes including those with myofascial pelvic pain. In this review, we discuss the published evidence supporting each of these patient phenotypic groups.

Conclusions: Future clinical trials and treatment development in IC/BPS should include patient phenotyping efforts with, at minimum, a focus on stratification into bladder-centric vs systemic and efforts to refine discriminative thresholds (cut-off points) that may influence differential treatment outcomes. It is important to continue to investigate the importance of patient phenotypes on treatment strategy selection, outcomes, and our understanding of the underlying pathophysiology for this disease spectrum.

Clinical trial registration: N/A.

Aim: Treating multiple sclerosis (MS)-related adult neurogenic lower urinary tract dysfunction (ANLUTD) is challenging because conservative treatments are often ineffective. Sacral neuromodulation (SNM) is a promising minimally invasive treatment of ANLUTD. This review assesses the efficacy and safety of SNM for MS-related ANLUTD.

Methods: Studies were identified through electronic searches of PubMed and Scopus from inception to August 9, 2024, supplemented by backward and forward manual searches. All studies included were original articles investigating the impact of SNM on urinary symptoms in patients with MS and ANLUTD. Three independent reviewers assessed the quality of evidence using the Oxford Centre for Evidence-Based Medicine criteria and the ROBINS-I tool.

Results: Seventeen studies involving 192 patients with MS undergoing SNM were included. The analysis revealed overall success rates of 80% (95% CI, 76%-91%) and 74% (95% CI, 62%-86%) for the test phase (stage I) and permanent SNM (stage II), respectively. Subgroup analyses explored limitations and potential sources of heterogeneity, including gender and type of urinary dysfunction, offering deeper insight into the effectiveness of SNM. With respect to safety, the pooled incidence of complications was approximately 7%, the majority of which were minor and manageable.

Conclusions: This systematic review highlights the potential of SNM to improve urinary symptoms in patients with MS-related ANLUTD, although the quality of evidence remains low. Further adequately powered randomized clinical trials are needed to clarify long-term efficacy and safety.

Aims: This narrative expert review aims to elucidate the role of biomarkers in the diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS), highlighting their potential to enhance patient care by enabling more precise and individualized therapeutic strategies.

Methods and results: We performed a comprehensive review of literature focused on biomarkers relevant to IC/BPS, including bladder capacity, symptom intensity, bladder wall thickness, as well as serum and urinary inflammatory cytokines and other biomarkers of inflammation, oxidative stress, and urothelial and extracellular matrix remodeling. Evidence indicates that biomarkers such as TNF-α, IL-8, and bladder capacity can differentiate between Hunner lesion and non-Hunner lesion IC subtypes, predict treatment responses, and guide effective interventions. Furthermore, advanced statistical methods and machine learning applications show promise in improving diagnostic accuracy and treatment outcome predictions through clustering of the biomarker data.

Conclusions: Reliable biomarkers are vital for improving diagnostic precision and tailoring therapies for IC/BPS patients. Ongoing research and validation of these biomarkers are essential for advancing understanding, guiding treatment decisions, and enhancing the quality of life for individuals affected by this complex syndrome. The need for integrated biomarker profiles and multipronged research approaches is crucial for the future of IC/BPS management.

Introduction: To investigate whether the volume of the prostate tissue resected on TURP influences on short and medium term follow up.

Methods: It was developed a prospective study between May 2020 and August 2022, embracing patients with severe LUTS due to BPO, including clinical and urodynamic parameters meeting obstruction criteria (BOOI > 40), and good detrusor function (BCI > 100). Patients were assessed at 1, 6 and 12 months follow up. The primary endpoint was to compare whether the amount of resected tissue after TURP influences uroflowmetry at 12 months follow up (Qmax, ml/sec). The secondary endpoint was to compare different percentages of resected tissue (RPT) and its relation to the outcomes.

Results: Ninety-six patients with mean age of 70,4 ± 7.96 years. At baseline, prostate volume was 78.5 ± 51.8 cc³, Qmax was 6.03 ± 3.09 ml/sec and post void residual (PVR) was 113 ± 132 ml, IPSS of 24.9 ± 6.75. All of them were urodinamically obstructed (BOOI 86.7 ± 35.6) and good detrusor function (BCI 130 ± 28.6). The general RPT was 45.5 ± 27.7%. The higher the RTP, the lower the PSA at 1 month follow up (p < 0.001, R = 0.521). Nevertheless, it was not found correlation between the RTP and Qmax, IPSS or PVR.

Conclusion: TURP improves clinical and urodynamic parameters at 1 year follow up, independent of the amount of resected prostate tissue, in patients with bladder outlet obstruction and good detrusor function, since the surgery is effective.