Neurourology and Urodynamics最新文献

Introduction: Overactive bladder (OAB) is defined as urinary urgency, usually accompanied by increased daytime frequency and/or nocturia, with urgency urinary incontinence (OAB-wet) or without (OAB-dry), in the absence of urinary tract infection or other detectable disease. The key symptom of OAB, urinary urgency, is defined as a complaint of sudden, compelling desire to pass urine which is difficult to defer. However, patients report a range of individual experiences and sensations associated with urgency and studies have identified different types of urgency. Patients with OAB not only differ in clinical presentation, but also have different urodynamic and radiological findings. These variations may explain why OAB treatments work well for some individuals but not others. This paper investigates how knowledge can be advanced by phenotyping OAB by urgency symptom variation, and clinical, urodynamic measurements and radiological features.

Methods: A Think Tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2025 discussed the question, "Can OAB management be improved by phenotyping if there are different types of urgency?" The group discussed the current literature on this topic and developed a list of research questions to help shape the future of the field.

Results: Clinical, urodynamic and radiological phenotyping of urgency were discussed and research studies to phenotype urgency were proposed.

Conclusion: Further research to phenotype OAB beyond the presence or absence of urgency and urgency urinary incontinence, using clinical, urodynamic measurements and radiological features, is needed. High priority research questions and strategies were defined. Advanced OAB phenotyping may guide tailored management beyond a stepwise approach, with the aim to improve therapeutic outcomes. This would validate phenotyping and is explored in Part 2 of the topic.

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-Q_max), International Prostate Symptom Score (IPSS) total score, and urologic-related adverse events (AEs) were collected throughout the trial. Q_max and detrusor pressure at Q_max (P_detQ_max) 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-Q_max 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 Q_max and 2.86 (-13.52, 19.25) cmH₂O in P_detQ_max.

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: Recurrent urinary tract infections are a common medical problem and current guidelines recommend both antibiotic and non-antibiotic preventative treatments. However, for a significant proportion of patients with this condition these second-line treatments are not effective. As a result, there has been recent focus on more targeted treatment such as intravesical instillations and bladder fulguration procedures. We aim to report discussions regarding these targeted treatments for recurrent urinary tract infections that took place at the International Consultation on Incontinence - Research Society meeting in Bristol 2025.

Methods: We undertook a think-tank session during this multi-disciplinary meeting specifically designated for discussion regarding targeted treatments for UTI prevention. We discussed the incidence and prevalence of recurrent UTIs in the general population and recognise that up to 25% of patients are not adequately treated with currently recommended preventive strategies. We also explored the increasing knowledge base surrounding the urinary microbiome and discussed the concept of chronic urinary tract infection. Finally we outlined the current evidence to support the use of the targeted treatments of intravesical instillation of both antibiotics and glycosaminoglycan (GAG) replacement compounds and the surgical procedure of bladder fulguration. This led to the generation of research ideas which hope to shape future UTI research within this topic area.

Results: We describe the discussions that took place and document the important research questions that were generated during the International Consultation on Incontinence-Research Society meeting in Bristol 2025.

Conclusions: Although the use of targeted treatments is becoming more widespread the evidence base is currently insufficient for strong guideline recommendation. This must be balanced against the significant need for second-line treatments when current guideline recommended treatments are unsuccessful, particularly in the design of clinical pathways for patients with refractory recurrent UTIs.

Introduction/background: Obstructive sleep apnea (OSA) has an established association with nocturia, but even when referred, patients presenting with nocturia may not undergo a full evaluation or begin treatment for underlying OSA. At our institution, patients with nocturia (≥ 2 episodes per night) are often referred for at-home sleep studies. This study aims to assess if patients presenting with nocturia undergo evaluation for OSA and the impact of continuous or automatic positive airway pressure (CPAP/APAP) on nocturia severity.

Methods: We conducted a retrospective chart review of patients with nocturia who completed an at-home sleep study for OSA between July 2020 and September 2023. Patients with pre-existing OSA were excluded. Statistical analysis included Wilcoxon signed-rank tests and Kruskal-Wallis tests.

Results: Of 336 nocturia patients referred for sleep studies, 37 completed the study, and all met diagnostic criteria for OSA. Sixteen of those patients (43.2%) initiated CPAP/APAP therapy. In patients receiving nocturia medication, the mean nocturic episodes significantly decreased after CPAP/APAP initiation (p < 0.01). No significant change was observed before CPAP/APAP initiation with medical management alone (p = 0.052). Twelve of the 16 patients reported subjective improvement in lower urinary tract symptoms (LUTS).

Conclusion: All patients with nocturia who completed an at-home sleep study were diagnosed with OSA, yet most did not follow up, indicating potential underdiagnosis and undertreatment. As advancements in OSA treatment continue to be made, evaluation and treatment for OSA in patients presenting with nocturia may lead to improvement in both conditions.

Aims: Management algorithms for Bladder Pain Syndrome (BPS) have remained stagnant over the past 20 years. Lack of high level evidence has hindered progress. Contributors to this have been the use of confusing and inconsistent terminology and failure to adequately phenotype participants entering clinical trials. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2025 a Think Tank addressed the question of "How can we make progress in the management of Bladder Pain Syndrome," focussing on the non-Hunner lesion group.

Methods: The Think Tank conducted a literature review and expert consensus meeting focusing on the current limitations in terminology and phenotyping, how we can improve identification of bladder-centric BPS, and how we can improve assessment of psychological comorbidity.

Results: Terminology needs to be standardised to enable more homogenous recruitment to clinical trials. Use of the term "interstitial cystitis" may be misleading, and the term is often inappropriately used. Classification based on the European Association of Urology guidelines should be favoured, using the term Primary Bladder Pain Syndrome. Participants entering clinical trials need to undergo thorough investigation to enable accurate phenotyping. The non-Hunner lesion BPS group need to be the focus of future research. Tools to aid identification of a bladder-centric phenotype (through biopsy and other techniques) need to be studied, including investigating the roles of inflammation, ischaemia and oxidative stress in this condition. A psychological assessment tool specific for BPS should be created to ensure earlier psychological intervention for those who would benefit most.

Conclusions: The use of accurate terminology in describing this condition is the first step toward improving the quality of future research. The Think Tank overwhelmingly recommended that the term "Interstitial Cystitis" should not be used. Future studies should be focussed on understanding the BPS group, excluding those with Hunner lesion disease. Studying inflammation, ischaemia and oxidative stress will help to identify a bladder-centric phenotype, whereas improving our understanding of psychological mechanisms will help to direct psychological therapies more effectively.

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.