Neurourology and Urodynamics最新文献

Background: Detrusor underactivity (DUA) is a lower urinary tract (LUT) diagnosis that is diagnosed with multichannel urodynamic studies (UDS). The effect of voiding position and DUA detection is unclear.

Objectives: We investigated whether moving individuals from the UDS chair to their typical voiding position would more accurately assess detrusor function in cases of absent or nonrepresentative voiding. We hypothesized that patients unable to achieve a representative void while on the UDS chair may be misdiagnosed with DUA, and that changing position may reveal intact detrusor function.

Methods: We retrospectively studied patients who underwent UDS with a single provider over 2 years. Studies were included if a patient was moved to a new position after unsuccessful or unrepresentative void attempts on the UDS chair. Two neurourologists reanalyzed the studies and recorded: time spent attempting to void on UDS chair and after moving position, whether a bladder contraction occurred on UDS chair, pdet Q max and Q max when voiding occurred, presence of a bladder contraction in new position, and pdet Q max and Q max in new position, and Valsalva effort.

Results: 503 patients underwent UDS; 94/503 patients were moved to a new position and 81/94 studies were interpretable. 71% of patients without a bladder contraction on the UDS chair demonstrated contraction in new position.

Conclusion: UDS voiding position and surface can impact whether patients produce a bladder contraction and representative void during urodynamic testing. Positional change to more natural voiding positions and surfaces improves detection of intact detrusor function.

Aims: To investigate the relationship between nocturia and values measured using a novel multifunctional portable urine-measuring device.

Methods: Thirty-five older men with nocturia and/or high-normal or high blood pressure were enrolled to record measurements on one full day (24 h) and two nights using the portable device during urination. Participants used a semi-conical cup with a small hole equipped with a conductivity sensor, temperature sensor, and timer to measure urine volume, salt content, urine temperature, and urination speed.

Results: Two participants were excluded owing to oliguria. The mean age of 33 participants was 75.2 ± 7.4 years (range: 55-85 years). The mean nocturnal urination frequency, including the first urination after waking, was 2.1 ± 0.6 times. Simple correlation analysis revealed that nocturnal urine frequency significantly increased with nocturnal urine volume (r = 0.65, p < 0.001) and salt content (r = 0.57, p < 0.001) but not with 24-h urine volume and salt content. Furthermore, the frequency significantly decreased with nocturnal urine temperature (r = -0.37, p < 0.05). No significant relationship was observed between morning blood pressure and nocturnal urination frequency. A high correlation was observed between nighttime urine volume and salt content (r = 0.73, p < 0.001).

Conclusions: Nocturnal urine volume, salt content, and urine temperature are significantly correlated with nocturia. The portable urine-measuring device could guide nocturia reduction through facilitation of the reduction of nocturnal urine volume and salt content, in addition to urine temperature monitoring.

Aims: To discuss the role of screening and treatment of affective symptoms, like anxiety and depression in patients with LUTD. A review of the literature regarding the bidirectional association and multidisciplinary approaches integrating psychometric assessments with personalized treatment plans to improve diagnostic accuracy and therapeutic outcomes of LUTD.

Methods: This review summarizes discussions and a narrative review of (recent) literature during an International Consultation on Incontinence-Research Society 2024 research proposal with respect to the role of screening for anxiety and depression, effect of mental health symptoms on treatment outcomes and future implications.

Results: Consensus recognized the importance to incorporate attention to anxiety and depression in relation to LUTD. The awareness of this association can lead to better outcomes. Future research projects are proposed to evaluate the bidirectional relationship.

Conclusion: The relationship between affective symptoms and LUTD underscores the need for integrated treatment approaches that address both psychological and urological dimensions. Further research is required to identify specific patient subgroups that would benefit most from these interventions, to develop standardized screening tools, and to refine treatment protocols. Multidisciplinary care, incorporating psychological assessment and personalized treatment strategies, could enhance outcomes for LUTD patients.

Context: Improved continence outcomes are reliant on identification of unmet need, education delivery, and shared decision-making. The evidence base on which to derive innovative approaches in these areas was unclear.

Methods: A debate held at the International Consultation on Incontinence-Research Society meeting, held in Bristol in June 2024, considered ways to improve research requirements to advance these areas.

Results and conclusion: Artificial intelligence solutions and digital approaches to healthcare are emerging at pace and offer possibilities to improve these three key areas but this must be driven by person-centered approaches. Care must be taken to avoid increasing inequality through digital exclusion and language barriers. Research questions are highlighted to derive innovation in these three key areas.

Introduction: The efficacy of unilateral versus bilateral Transcutaneous Tibial Nerve Stimulation (TTNS) for women with Overactive Bladder Syndrome (OAB) remains uncertain.

Objective: To compare the efficacy of unilateral and bilateral TTNS in the tibial region in women with OAB.

Methods: This randomized, controlled, triple-blind clinical trial included women with OAB or urgency-predominant urinary incontinence (UUI). Participants were randomized (1:1) into the Unilateral Tibial Group or Bilateral Tibial Group. Before treatment, they underwent a pre-assessment including peripheral sensitivity examination and completion of sociodemographic data and seven validated questionnaires on urinary symptoms, quality of life, sleep, and psycho-emotional aspects. TTNS interventions were administered twice weekly (12 sessions, 30 min each). Posttreatment, participants underwent another physical examination and completed the same questionnaires, with a 30-day follow-up. Categorical variables were analyzed using Chi-square or Fisher's Exact Test, while numerical variables were assessed with the Mann-Whitney test. Group comparisons over time utilized intention-to-treat ANOVA (p < 0.05).

Results: Thirty-five women participated: 17 in the unilateral group and 18 in the bilateral group. Mean ages were 55.1 (±14.7) years and 52.7 (±12.6) years, respectively (p = 0.680). Initial OAB severity (ICIQ-OAB) did not differ significantly between groups (p = 0.561). Both groups showed significant improvement in ICIQ-OAB scores: unilateral group from 10.1 (±3.4) to 5.8 (±3.4) (p < 0.001), bilateral group from 9.3 (±3.3) to 5.1 (±4) (p < 0.001), with no intergroup difference (p = 0.395). Improvement in UUI symptoms was observed: unilateral group from 2.2 (±1.4) to 0.7 (±1.5), bilateral group from 1.5 (±1.9) to 0.2 (±0.5), without significant intergroup difference (p = 0.645). Quality of life scores improved similarly between groups (p = 0.055).

Conclusion: TTNS appears to be effective in improving bladder storage and UUI symptoms in women with OAB, with no difference between unilateral and bilateral applications.

Clinical trial registration: Brazilian Registry of Clinical Trials (REBEC) (RBR: 96f2fgkn).

Aim: This study aimed to assess the predictive value of the Bladder Deformity Index (BDI) in determining upper urinary tract (UUT) damage among patients with neurogenic bladder (NB).

Methods: Clinical data of 132 NB patients admitted to the China Rehabilitation Research Center between January 2018 and December 2023 were retrospectively analyzed. Patients were categorized into UUT damage and normal UUT function groups based on the MRU and ultrasound grading systems for hydronephrosis, patients with the grade greater than or equal to I degree were considered to have UUTD. Patient demographics, biochemical parameters, and video-urodynamics (VUDS) findings were collected, and BDI was calculated. Independent sample t tests were employed to compare general characteristics and VUDS parameters between groups. Receiver operating characteristic (ROC) curves were utilized to evaluate the predictive capability of UUT damage.

Results: The study comprised 132 patients (86 males and 46 females) with an average NB duration of 7.37 ± 9.37 years (range: 0.2-44 years). UUT damage was present in 40.91% (n = 54) of patients. Significant differences (p < 0.05) were observed between the UUT damage and normal groups in terms of the duration of LUTS (9.98 ± 10.52 vs. 4.83 ± 7.32 years), creatinine levels (135.58 ± 110.51 vs. 57.66 ± 12.26 μmol/L), and BDI (103.28 ± 71.6 vs. 19.23 ± 15.03%). No significant differences were noted in age, bladder volume, or residual urine between the groups (p > 0.05). The AUC for the duration of LUTS, creatinine, and BDI were 0.691, 0.786, and 0.908, respectively, with a BDI Yoden index of 77%.

Conclusion: Long-term LUTS, elevated creatinine levels, and high BDI are associated with UUT damage. BDI demonstrates high sensitivity and specificity in diagnosing UUT damage, outperforming creatinine levels and NB duration. Patients with BDI values exceeding 77% are at a heightened risk of UUT damage. BDI facilitates quantitative evaluation of cystography and preliminary evaluation upper and lower urinary tract function in NB patients. Further research is warranted to validate BDI's feasibility in quantifying cystography and diagnosing UUT damage.

Trial registration: This study is retrospective and does not require clinical trial registration.

Introduction: Giggle incontinence (GI) is characterized by the sudden and involuntary expulsion of urine coinciding with episodes of laughter. The underlying pathophysiology of this condition remains unclear, and various treatment approaches are employed. The objective of this study is to assess the effectiveness of biofeedback (BF) therapy in treating GI and ascertain the requisite number of therapy sessions needed for efficacy.

Methods: Medical records of children treated with BF therapy for GI between November 2022 and November 2023 were retrospectively analyzed. The success of treatment was assessed after four and eight sessions, as well as following three maintenance sessions. Treatment outcomes were evaluated using the scoring system recommended by the International Children's Continence Society (ICCS), which categorizes responses into three levels: no response (Score 0), partial response (Score 1), and complete response (Score 2).

Results: Thirteen patients were initially diagnosed with GI. Of these, 10 patients were included in the study as three discontinued treatments. The cohort comprised an equal gender distribution with five females (50.0%) and five males (50.0%). The mean age of patients was 8.9 ± 3.3 (range 5-16) years. Two out of ten patients had a history of previous treatment for overactive bladder, while three had received treatment for primary monosymptomatic nocturnal enuresis. Following the completion of all BF sessions, the rate of complete response was observed at 80.0% (n = 8), while the partial response rate accounted for 10.0% (n = 1). Statistical analysis revealed significant differences in response scores after four and eight sessions (p < 0.01) as well as between the results after eight sessions and the completion of maintenance sessions (p < 0.01).

Conclusion: BF therapy demonstrates a high success rate in managing GI. Completion of at least eight BF therapy sessions enhances the probability of a successful outcome in the treatment of GI. Additionally, it has been observed that maintenance sessions contribute to the increased efficacy of the treatment.

Purpose: The study aimed to investigate the association between urinary incontinence (UI) severity, pelvic pain, and sensory-motor function in older women with stroke.

Methods: A cross-sectional prospective study was carried out with 102 older women individuals with stroke. Barthel Index (BI), Incontinence Impact Questionnaire Short Form (IIQ-7), Urogenital Distress Inventory (UDI-6), Pelvic Pain Impact Questionnaire (PPIQ), Somatosensory Amplification Scale (SASS), and Somatic Sensitivity Scale (SeSS) were used for clinical measurements.

Results: Partial correlational analyses with age, stroke duration, and BMI as covariates revealed a moderate positive correlation between SASS and IIQ-7 (r = 0.315, p < 0.001) and UDI-6 (r = 0.376, p < 0.001). On the other hand, there was a strong positive correlation between SASS and PPIQ (r = 0.522, p < 0.001). SeSS had a low positive correlation with IIQ-7 (r = 0.198, p < 0.05) and UDI-6 (r = 0.203, p < 0.05). In addition, there was a positive and moderate correlation between SeSS and PPIQ (r = 0.384, p < 0.001). Multivariate linear regression analysis revealed causality of SASS (R² = 0.381, p < 0.001) and SeSS (R² = 0.167, p < 0.001) with PPIQ.

Conclusions: Increased abnormal sensory sensitivity is associated with increased pelvic pain levels in women with stroke. Clinicians should consider sensory abnormalities, especially pain, within the scope of UI in women with stroke. Our results provide preliminary essential data for sensory and pain awareness during pelvic rehabilitation in stroke patients.