Neurourology and Urodynamics最新文献

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.

Objectives: To assess the applicability of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations and Chinese eGFR Investigation Collaboration (C-eGFR) equations in estimating glomerular filtration rate (GFR) in patients with neurogenic lower urinary tract dysfunction (NLUTD). These equations are based on serum creatinine, cystatin C, or combined creatinine and cystatin C.

Methods: This prospective study enrolled 142 adult patients with NLUTD. GFR was measured using the dual plasma ⁹⁹mTc-DTPA plasma clearance method. We compared the bias, precision, accuracy and correct classification percentage of six estimated glomerular filtration rate (eGFR) equations, including CKD-EPI creatinine equation (CKD-EPIcr), C-eGFR creatinine equation (C-eGFRcr), CKD-EPI creatinine-cystatin C equation (CKD-EPIcr-cys), C-eGFR creatinine-cystatin C equation (C-eGFRcr-cys), CKD-EPI cystatin C equation (CKD-EPIcys), and C-eGFR cystatin C equation (C-eGFRcys).

Results: The median (interquartile range [IQR]) of measured GFR (mGFR) was 60.54 (34.66-86.28) mL/min/1.73 m². Both CKD-EPIcr and C-eGFRcr significantly overestimated GFR (median differences of 17.20 and 13.60 mL/min/1.73 m², respectively; both p < 0.01), and P₃₀ values (percentage of estimated GFR within 30% of mGFR) were 51% and 57%, respectively. CKD-EPIcr-cys demonstrated superior performance than C-eGFRcr-cys (median difference: 2.07 vs 9.13 mL/min/1.73 m²; both p < 0.01; P₃₀: 84% vs 69%). CKD-EPIcys achieved the highest P₃₀ (88%), while C-eGFRcys showed minimal bias (median difference: 0.42 mL/min/1.73 m²; p = 0.69). CKD-EPIcr-cys, CKD-EPIcys, and C-eGFRcys all achieved acceptable P₃₀ values and correct classification percentage. CKD-EPIcr-cys performed optimally at mGFR ≥ 60 mL/min/1.73 m², whereas CKD-EPIcys was superior at mGFR < 60 mL/min/1.73 m².

Conclusion: Creatinine-based equations systematically overestimate GFR in NLUTD patients and should be used with caution. In contrast, cystatin C-based equations-whether used alone (e.g., CKD-EPIcys, C-eGFRcys) or combined with creatinine (e.g., CKD-EPIcr-cys)-demonstrate superior accuracy and should be preferred for GFR estimation in NLUTD patients.

Clinical trial registration: The Chinese clinical trial registration number is ChiCTR2100054934.

Purpose: This study aimed to assess the limitations of the International Prostate Symptom Score (IPSS) in evaluating male lower urinary tract symptoms (LUTS) and to determine whether the International Consultation on Incontinence Questionnaire-Male LUTS (ICIQ-MLUTS) can uncover clinically relevant symptoms overlooked by IPSS.

Methods: A total of 239 Turkish men aged 50-80 with LUTS were prospectively evaluated using the linguistically validated Turkish versions of the IPSS and the short form of the ICIQ-MLUTS questionnaires. Symptoms not assessed by IPSS (urgency incontinence, stress incontinence, unaware leakage, nocturnal enuresis, postvoid dribbling) were identified. Multivariate logistic regression and ROC analyses were conducted to explore predictors of having at least one of these symptoms with a severity score ≥ 2.

Results: While the IPSS categorized patients into mild (18.0%), moderate (47.7%), and severe (34.3%) LUTS groups, 32.6% of all participants reported at least one significant symptom not captured by IPSS. In multivariate analysis, an IPSS question 4 (urgency) score ≥ 3 was independently associated with a 1.5-fold increased risk (p = 0.002), while being classified as severely symptomatic conferred a 7.7-fold increased risk (p = < 0.001) of having overlooked symptoms. ROC analysis showed acceptable predictive performance (AUC = 0.710 for urgency score ≥ 3; AUC = 0.671 for severe IPSS classification).

Conclusion: A considerable proportion of clinically relevant LUTS, especially incontinence and post-micturition symptoms, go undetected when using IPSS alone. Patients with high urgency scores or severe symptom burden may benefit from further evaluation beyond the IPSS, which highlights the potential role of IPSS as a triage test in LUTS assessment.

Clinical trial registration: This study does not require clinical trial registration because it is not a prospective interventional trial involving human participants.

Introduction and objectives: Female urethral strictures remain a challenging clinical entity with limited data on optimal reconstructive techniques. This study presents 12-month clinical and patient-reported outcomes following a novel transurethral approach to dorsal inlay buccal graft urethroplasty.

Methods: We evaluate the outcomes of consecutive female patients with urethral strictures treated via dorsal inlay buccal graft urethroplasty from October 2021 to November 2024. Preoperative evaluation included cystoscopy, uroflowmetry, and/or voiding cystourethrogram. Follow-up at 4 and 12 months included cystoscopy, uroflowmetry, and patient-reported outcomes measured via the Global Response Assessment. Success was defined as absence of recurrence on cystourethroscopy.

Results: Twenty-one patients were included in the study, with 95% having undergone prior treatments (90% dilation/DVIU and 9% urethroplasty). Stricture locations varied across the distal (33%), mid (19%), proximal (19%), and multifocal/pan urethral (19%). The median operative duration was 60 min (IQR: 56-86) and all were discharged on the day of surgery. Nineteen patients (90%) underwent a dorsal inlay procedure, while two (10%) required combined dorsal and ventral inlay due to obliterative stricture. No complications were observed. The median follow-up was 13.2 (IQR: 5.1-23.5) months, during which time 1 patient underwent retreatment for recurrent stricture. Clinical success was 95% at 4 months and 92% at 12 months. Median peak urinary flow rate preoperatively versus 4-month postoperatively was 7.0 cc/s versus 13.0 cc/s (p = 0.20) and at 12-month postoperatively was 13.3 cc/s (p = 0.50). 90% of patients reported improvement on the Global Response Assessment. There were no cases of de novo stress urinary incontinence.

Conclusions: This novel transurethral dorsal inlay buccal graft urethroplasty offers a safe and efficient treatment for female urethral strictures with durable clinical and patient-reported outcomes at 12 months. The technique's minimal urethral mobilization translates into shorter operative times and a low risk of stress incontinence, making it a promising alternative to traditional approaches.

Purpose: This study investigates the correlation between clinical characteristics, ultrasound measurements, and the severity of stress urinary incontinence (SUI) in women, aiming to identify key transperineal ultrasound measurements that can guide clinical management of SUI.

Methods: The study was conducted with 519 women diagnosed with urinary incontinence from three hospitals in Fujian Province, China, who underwent clinical assessment and transperineal ultrasound examination from November 2019 and May 2024. Ultrasound measurements, including temporal and morphological metrics, were analyzed in relation to SUI severity, categorized as slight, moderate, or severe. Statistical analyses included Spearman's rank correlation and logistic regression.

Results: Among the 314 women with SUI, significant correlations were found between ultrasound measurements and SUI severity. The duration of maximum contraction showed the strongest correlation with severity, followed by twitch count during sustained contraction. Logistic regression revealed that age (OR = 1.052, p = 0.018) and larger differences in LHA between Valsalva and rest (OR = 1.227, p = 0.035) were risk factors for moderate-to-severe SUI, while longer the duration of maximum contraction reduced the risk (OR = 0.924, p < 0.001).

Conclusion: Transperineal ultrasound was proved to be a noninvasive, objective method for the evaluation and management of SUI. Key findings underscored the potential of ultrasound in advancing pelvic floor health and guiding personalized pelvic floor muscle training. Further research is needed to standardize these measurements and validate their clinical utlity.

Aims: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition marked by chronic pain and voiding dysfunction, often without a clear cause. Management of which often requires a multidisciplinary approach, as well as multiple therapeutic interventions.

Methods: This review characterizes mechanisms and limitations of currently available treatment modalities for IC/BPS, as well as novel and investigational therapies.

Results: Conservative and supportive therapies include cognitive therapies, dietary and fluid management, pelvic floor exercises and bladder training. Additionally, pelvic floor directed therapies such as physical therapy, injections and nerve blocks should be considered. Cystoscopy with hydrodistension is both a diagnostic and therapeutic intervention. Currently available oral therapies include: pentosan polysulfate, amitriptyline, hydroxyzine, silodosin, and non-opioid medications such as cyclobenzaprine. Immunotherapies include cyclosporine and tacrolimus. Available intravesical therapies include dimethyl sulfoxide, lidocaine, oxybutynin, and glycosaminoglycan substitution treatment. Neuromodulation is also available including sacral and pudendal neuromodulation. Finally, we explore emerging therapies and drug delivery systems.

Conclusions: In this review, we present currently available treatment options for IC/BPS. These include conservative therapies, oral medications, intravesical therapies, and neuromodulation. Novel and investigational therapies are presented as well as promise for future directions.