Neurourology and Urodynamics最新文献

Purpose: Pelvic organ prolapse (POP) in women after cystectomy or anterior pelvic exenteration is a rare yet complicated condition that presents a technical challenge. Limited data exists on the management of this condition. This study aims to review the vaginal approach to management of POP after cystectomy or anterior pelvic exenteration.

Materials and methods: Patients undergoing vaginal repair of POP after cystectomy or anterior pelvic exenteration at a single institution from 1/1/2010 to 9/1/2018 were identified and retrospective data was extracted. Only patients with urologic indications for cystectomy or anterior exenteration were included.

Results: Ten patients who underwent vaginal POP were identified. Median time to prolapse diagnosis after cystectomy/anterior exenteration was 5.5 months (0-42). All patients reported bulge symptoms, five (50%) had vaginal discharge, and three (30%) had irritation/pain at presentation. Four patients had sacrospinous ligament repair, three had biologic graft augmented repairs, two had suture-based repairs, and one had a colpocleisis. Complications were reported in three patients (30%)-vaginal bleeding, vaginal pain and biologic extrusion, and enterotomy. At a median follow-up of 12 months (1-58) six (60%) patients did not have recurrent bulge symptoms. Two patients (20%) had or planned for repeat repair.

Conclusions: Transvaginal repair of POP after cystectomy or anterior pelvic exenteration is a feasible and effective treatment option, with 60% reporting durable resolution of bulge symptoms. Eighty percent of patients will not need additional surgery. There is a 30% complication rate due to the complexity of the procedure, and patients should be counseled accordingly.

Aims: Urodynamics (UDS) is critical for patients with neurogenic bladder but remains artificial given retrograde filling and voiding around a catheter in an uncomfortable setting. We have developed a wireless device for catheter-free real-time measurement of intravesical pressure during natural filling. Women with neurogenic bladder secondary to multiple sclerosis (MS) may experience discomfort, detrusor overactivity, or inability to urinate while observed during UDS which might belie true voiding patterns. The aim of this study was to test the wireless device in women with neurogenic bladder due to MS.

Methods: Ten female participants with neurogenic bladder secondary to MS underwent standard UDS, after which the device was inserted and a second UDS study performed. Patients then ambulated with only the device in place for an additional void.

Results: There were no significant differences in UDS results, pain or discomfort between the first and second cycle. The device captured 98% of UDS events, including 100% of detrusor overactivity. Post void residual volume after UDS (160 ± 179 mL [Range 0-454]) was significantly greater than after ambulation with the wireless device alone (19 ± 18 mL [Range 0-46]; p = 0.01), demonstrating greater voiding efficiency with the wireless device alone than with the UDS catheter in place.

Conclusions: The device was well tolerated without complications, captured urodynamic data with a high degree of fidelity, and demonstrated additional utility in patients with borderline obstruction or inability to urinate while observed who cannot void during standard UDS. This device offers a promising alternative to the critical information provided by UDS in a less-invasive, more physiologic manner.

Aims: Minimally invasive overactive bladder (OAB) therapies (percutaneous tibial nerve stimulation [PTNS], onabotulinumtoxinA [BTX], sacral neuromodulation [SNM]) are commonly used in older adults, however little is known regarding utilization of more than one minimally invasive OAB therapy within 2 years of initiating such treatment.

Methods: This retrospective cohort study included 100% of fee-for-service Medicare beneficiaries who underwent minimally invasive OAB therapy (MIT) from 2015 to 2020. The primary outcome was initiation of a different MIT within 2 years of the index therapy. A Sankey diagram was created to visualize the sequence and flow of therapies. Multivariable modified Poisson regression was performed to identify patient-factors associated with initiating different MIT.

Results: Among the 111,939 beneficiaries undergoing first-time MIT, 18,444 (16.5%) initiated different MIT within 2 years. The most common pattern was PTNS followed by BTX (29.1%), then BTX followed by SNM (20.9%) and SNM followed by BTX (20.0%). Factors associated with increased likelihood of initiating different MIT were: PTNS as the index therapy (aRR 1.43, 95% CI 1.38-1.48 vs. SNM), female sex (aRR 1.12, 95% CI 1.09-1.16), and higher frailty levels (pre-frail aRR 1.09, 95% CI 1.06-1.13; mild-to-severe frailty aRR 1.08, 95% CI 1.03-1.14 vs. not frail). Older age (75-84 aRR 0.88, 95% CI 0.86-0.91; ≥ 85 aRR 0.60, 95% CI 0.57-0.63 vs. 65-74 years) and non-White race (aRR 0.79, 95% CI 0.75-0.84) were associated with lower likelihood of initiating different MIT.

Conclusion: Among Medicare beneficiaries receiving MIT, 16.5% initiated different therapy within 2 years. These high rates of more than one MIT within a short time endorse the need for expectation-setting and close follow-up.

Objective: To develop a consensus on diagnostic criteria for interstitial cystitis/bladder pain syndrome (IC/BPS).

Materials and methods: A subcommittee was identified based on expertise in IC/BPS diagnostic criteria. An outline was generated and iteratively modified until it was found to be acceptable by subcommittee members as the basis for manuscript generation. The manuscript was presented and revised in two iterations according to feedback from international key opinion leaders at the Global Consensus on IC/BPS and the AUA Annual Meeting, respectively.

Results: The patient history and physical examination are necessary components in the diagnosis of IC/BPS. Urinalysis and urine culture are necessary laboratory tests to rule out exclusionary conditions including active infection. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) criteria, which were established in 1988 for research purposes, pose several limitations and result in the exclusion of a large proportion of IC/BPS patients when applied clinically. Thus, we put forth a pragmatic and streamlined definition that is aligned with existing clinical guidance and standard diagnostic workup.

Conclusions: The clinical diagnosis of IC/BPS is based on history, physical examination, and urine studies. IC/BPS is clinically defined as an unpleasant sensation (e.g. pain, discomfort, pressure, burning) that worsens with bladder filling and improves with bladder emptying, of 3 or more months duration, in the absence of exclusionary diagnoses that would likely account for the symptomatology. A substantial number of IC/BPS patients have comorbid pelvic disorders (e.g., pelvic floor dysfunction, vulvodynia, endometriosis) which require separate treatment.

Trial registration: This study is not a clinical trial and thus does not warrant registration as such.

Objective: To evaluate the effects of prostatic urethral lift (PUL) and water vapor energy therapy (WAVE) on bladder outlet obstruction (BOO) using pressure flow studies (PFS) in real-world clinical practice among patients with benign prostatic hyperplasia (BPH), particularly those who are elderly or in poor general health.

Methods: This retrospective study included 128 men who underwent PUL (n = 43), WAVE (n = 38), or photoselective vaporization (PVP, n = 47) for BPH. Surgical procedure selection was based on a department-specific proprietary algorithm. In elderly patients or those with systemic comorbidities, either PUL or WAVE was selected, and the choice between the two procedures was made based on prostate morphology. The primary endpoint was the change in bladder outlet obstruction index (BOOI) from baseline to 6 months after each surgical procedure.

Results: The BOOI (mean ± SD) significantly decreased from 59.5 ± 26.2 to 14.8 ± 16.7 after PVP, 39.7 ± 21.8 to 25.8 ± 17.7 after PUL, and 52.5 ± 23.9 to 21.9 ± 19.2 after WAVE (all p < 0.01). The International Prostate Symptom Score (IPSS) improved from 17.0 ± 8.8 to 7.0 ± 6.2 (PVP), 16.7 ± 9.0 to 11.5 ± 7.9 (PUL), and 14.7 ± 8.0 to 8.2 ± 6.3 (WAVE) (all p < 0.01). Maximum flow rate (Qmax) increased from 8.6 ± 5.0 to 17.3 ± 7.5 mL/s (PVP), 9.3 ± 5.9 to 12.5 ± 5.8 mL/s (PUL), and 9.2 ± 3.7 to 12.4 ± 6.0 mL/s (WAVE) (all p < 0.01). Despite improvements, residual BOO (Schafer grade ≥ III) remained in 6.4% of PVP, 16.3% of PUL, and 15.8% of WAVE patients.

Conclusion: In elderly patients or those with poor general health, both PUL and WAVE significantly improved the BOOI at 6 months postoperatively. However, in PUL and WAVE, persistent BOO exceeded 15%, suggesting that more appropriate patient selection will be necessary in the future.

Aim: Recent studies have highlighted the relationship between biomarkers and overactive bladder (OAB). Detrusor overactivity has been linked to increased Adenosine Triphosphate (ATP) secretion from urothelium and cholinergic nerve endings. This study aimed to evaluate urinary ATP as a diagnostic and follow-up biomarker for children with OAB, previously studied only in adults and children with neurogenic bladders.

Materials and methods: Fifty-eight children with OAB and 28 healthy controls were prospectively included. Two midstream urine samples were collected from the OAB group: one pretreatment and one at the first month of anticholinergic treatment. Urine samples were centrifuged, stored at -80°C, and ATP levels were measured via ELISA. Comparisons were made between the groups and pre-/posttreatment ATP levels in the OAB group. Correlation analysis was conducted between ATP levels and lower urinary system (LUS) parameters.

Results: Of the OAB group, 29 (50%) were male, with a median age of 7 years (5-15), compared to 10 years (5-16) in controls. Median urinary ATP was significantly higher in the OAB group [12.15 (2.48-170.62) ng/mg Cr] than in controls [9.92 (3.09-29.95); p = 0.04]. No significant difference was found between pre- and posttreatment ATP levels in the OAB group (p = 0.84), nor was there a correlation between ATP levels and LUS parameters.

Conclusion: This prospective trial is the first to document that urinary ATP levels are higher in children with OAB. Consequently, urinary ATP could serve as a diagnostic biomarker for OAB in children. Larger studies with varying symptom levels and invasive urodynamic testing are needed to further evaluate its clinical utility, particularly in monitoring treatment response.

Clinical trial registration: NCT06785558.

Introduction: Urethral instrumentation (UI) in patients with artificial urinary sphincters (AUS) requires specific technical considerations due to the risk of urethral erosion, which can lead to serious clinical and legal consequences. Many urologists report limited preparedness for performing UI in AUS patients, particularly in emergency scenarios. This study evaluated the impact of a brief training session (TS) on urologists' self-reported confidence in managing UI in this context.

Methods: Urologists and residents attending a national urology meeting in Brazil (November 2023) were invited to participate in a structured TS. The intervention included a theoretical overview of AUS components and mechanisms, device activation and deactivation, and safe catheterization techniques, followed by supervised hands-on practice using a simplified catheterization model. Confidence levels were assessed via pre- and post-training questionnaires.

Results: A total of 135 participants (100 urologists and 35 residents) took part, with a median age of 35.0 ± 10.2 years; 76.3% were men. The mean duration of the TS, including evaluations, was 15 min. Before training, only 34.1% felt capable to independently perform UI in AUS patients during emergencies. Post-training, this proportion rose to 88.8% (p < 0.001). Significant improvements were observed across all assessed competencies, including AUS deactivation, catheter selection, duration of catheterization, and device reactivation.

Conclusions: A brief, focused training session significantly improved participants' confidence in performing UI in patients with AUS. These findings support the integration of targeted educational interventions into urologic training programs. Further studies are warranted to evaluate long-term retention and clinical outcomes.

Aims: Underactive bladder and bowel function are common in the elderly. Neurokinin 2 receptor (NK2R) agonists induce voiding in young adult animals; however, these effects have not been sufficiently examined in aged animals. Most NK2R agonists also have activity at neurokinin 1 receptors, which produces off target effects, such as transient hypotension. Hypotension is problematic in the elderly due to increased injury risk when falling. Therefore, the aims of this study were to (1) test the ability of NK2R agonists to increase bladder and colorectal pressure without affecting blood pressure and (2) determine if daily administration of a NK2R agonist consistently induces urination and defecation in aged rats.

Methods: Voiding cystometry and manometry were used to evaluate effects of [Arg⁵, MeLeu⁹, Nle¹⁰]-NKA_(4-10) (AMN-NKA) and GR64349 on bladder and colorectal physiology, respectively, while recording blood pressure in anesthetized adult and aged F344 rats. The rapid voiding detection assay was used to test the efficacy of repeated intramuscular GR64349 dosing to induce urination and defecation in aged rats.

Results: Intravenous AMN-NKA or GR64349 both increased bladder and colorectal pressure in anesthetized young adult and aged rats, but AMN-NKA produced transient hypotension. Intramuscular GR64349 produced rapid increases in bladder and colorectal pressures in aged and adult rats (10-300 µg/kg) and consistently induced defecation and urination in awake aged rats across a 2 week period of dosing (100 μg/kg/2 times/day).

Conclusions: The results show that GR64349 could be a promising therapeutic for inducing urination and defecation in the elderly without side effects such as hypotension.

Objective: To evaluate the role of gynecologic findings in Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) by reviewing current international guidelines and identifying relevant gynecologic co-morbidities.

Methods: This consensus statement was developed through a systematic four-phase process: (1) comprehensive literature review across PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases (inception-January 2025) using predefined search terms related to IC/BPS and gynecologic conditions; (2) assembly of a 6-member multidisciplinary expert panel including urologists, urogynecologists, gynecologists and pain specialists; (3) consensus development via modified Delphi technique comprising several electronic rating rounds and a face-to-face meeting, with consensus defined as ≥ 80% agreement; and (4) manuscript preparation with iterative review.

Results: A number of associated gynecologic disorders may overlap with IC/BPS, our consensus committee identified five main co-morbid disorders: Endometriosis/Adenomyosis, Genito-Pelvic Pain Penetration Disorder/Sexual Dysfunction, Overactive Pelvic Floor Muscles, Hormone- Associated Genitourinary Changes, Vulvodynia/Vestibulodynia.

Conclusion: While not exhaustive, this consensus highlights the most prevalent gynecologic co-morbidities supported by current literature. Clinical evaluation should prioritize a detailed medical history and pelvic examination to identify these overlapping conditions. Future directions include developing a multidisciplinary diagnostic and treatment algorithm to guide clinicians-including urologists, gynecologists, urogynecologists, physical therapists-in comprehensive IC/BPS care.