Neurourology and Urodynamics最新文献

Purpose: To evaluate the efficacy of specific antibiotic regimens in preventing infection following sacral neuromodulation.

Materials and methods: This is a retrospective cohort study utilizing the Premier Healthcare Database. Patients who underwent sacral neuromodulation placement between January 2016 and March 2020. The patients were grouped by those who received dual antibiotic therapy per 2019 AUA guidelines (Gram positive + broad Gram negative coverage), first- or second-generation cephalosporins or any other regimen. Comparison between groups was performed using Kruskal-Wallis and χ² tests for continuous and categorical variables, respectively. Inverse probability of treatment weighted (IPTW) analysis was used to estimate the average treatment effect of AUA guidelines regimens versus the use the first- or second-generation cephalosporins alone.

Results: The sample included 14 179 patients, with 2211 patients receiving prophylaxis that followed the AUA guideline recommendations. There was no significant difference in surgical site infection rates within 3 months (p = 0.28) or within 12 months (p = 0.53) between the groups. On IPTW, the probability of an infection at 3 months was lower with the AUA guideline regimens compared to those who received first- or second-generation cephalosporins alone, but this difference was not statistically significant (OR = 0.73, 95% CI: [0.43, 1.24]).

Conclusions: In the absence of allergies to cephalosporins or penicillin, first- or second-generation cephalosporins alone may be a sufficient preoperative antibiotic regimen for prevention of infection at the time of sacral neuromodulation.

Trial registration: Not applicable due to being a database study.

Aim: In the present study, we wanted to check whether TCS OX2 29 (TCS), a potent selective antagonist of OX2 receptors, would have positive effects in an animal model of detrusor overactivity co-existed with the depression-like state in Wistar male rats.

Methods: The forced swim test with the measurement of spontaneous locomotor activity, conscious cystometry, determination of c-Fos expression in central micturition areas, and a set of biochemical analyses (with the use of urine, hippocampus, bladder urothelium, and detrusor muscle of tested animals) were carried out.

Results: The outcomes showed that a 7-day administration of TCS (3 mg/kg/day, subcutaneously) normalizes the cystometric parameters corresponding to overactivity of the detrusor and reverses the pro-depressive response. Furthermore, the antagonism of OX₂ receptors restored the abnormal levels of overactive bladder markers (i.e., ATP, CGRP, OCT3, TRPV1, ROCK1, and VAChT), diminished neuronal overactivity in central micturition areas (i.e., pontine micturition center, ventrolateral periaqueductal gray, and medial preoptic area) as well as restored the altered hippocampal levels of CRF, cytokines (IL-1β, IL-6, IL-10, and TNF-α), and growth factors (BDNF and NGF) that reflected biochemical disturbances detected in depressed people.

Conclusions: It seems that our findings open new perspectives regarding the implication of the orexin system in the functioning of the urinary bladder and in the pathophysiology of depression.

Introduction: The prevalence, formal definition, and diagnostic criteria of bladder outlet obstruction in owmen have not been clearly defined.

Methods: This is a literature review of the definition of BOO in women, its prevalence, as well as its differential diagnosis.

Results: The main causes of BOO in women are divided into functional and anatomic conditions. Functional etiologies include detrusor external sphincter dyssynergia, dysfunctional voiding, Fowler's syndrome, and primary bladder neck obstruction. Anatomic causes can be further divided into extrinsinc and intrinsic conditions. Intrinsic etiologies include urethral stricture and urethral diverticula, whereas extrinsic causes comprise pelvic organ prolapse, post anti-incontinence surgery, and Skene's gland cyst or abscess.

Conclusions: There are multiple etiologies to BOO in women, and this condition is most probably underdiagnosed, owing to a lack of consensus for a standard definition.

Aim: Current guidelines on surgical treatment of stress urinary incontinence (SUI) recommend an informed decision making process between the physicians and patients reviewing all available surgical options with and without mesh. However, there is a lack of synthesized clinical evidence on some of the comparisons that can feed into patient counseling processes. The aim of this study was to review the available studies comparing clinical outcomes of an autologous fascial sling (AFS) and a retropubic (RP) synthetic sling for women undergoing a primary surgery for SUI.

Methods: We conducted a literature search from 1990 to 2024 following international guidelines. We have included studies reporting on comparative outcomes of AFS and RP synthetic sling surgeries as a primary procedure.

Results: Three randomized studies were included with follow-up durations ranging from 24 months to 10 years. The mean percentage change in symptom scores ranged from 27.7% to 44.9%, with no significant difference between the two sling types. There was no difference between groups with regard to objective cure rates, subjective cure rates and length of hospital stay between AFS and RP slings. AFS surgeries had longer operative times. There were concerns about bias, particularly related to allocation, blinding, and missing outcome data.

Conclusion: Overall, both types of slings had similar cure rates but AFSs were associated with longer operative times. The study highlights the need for more research on the comparative effectiveness of AFS and synthetic slings for SUI surgery to guide decision-making for SUI surgical treatments.

Background: Neurogenic dysfunction of the lower urinary tract is one of the challenging diseases with high burdens in urology. Our study aims to evaluate the efficacy of a 4-week treatment with Solifenacin and Trospium chloride and assess their safety and impact on quality of life.

Methods: Following the selection of 206 stroke patients from two centers who met specific eligibility criteria, including a clinical diagnosis of stroke, normal cognitive function, and the presence of lower urinary tract symptoms (LUTS), participants were randomly assigned to receive oral Solifenacin, Trospium chloride, or a placebo. Under the supervision of the Ethics Committee, the baseline characteristics, compliance with medication, and outcomes were monitored, gathered, and analyzed.

Results: The majority of participants were male, with a mean age of 67.3, and most had ischemic stroke. The groups had no significant difference in urinary symptoms after stroke. All of the symptoms in the study groups, according to the NBSS questionnaire, were decreased following treatment compared to the baseline (p < 0.05). After treatment, ICIQ-OAB, and ICIQ-LUTS-QOL total scores and bothersome scores decreased significantly compared to baseline (p < 0.001). When compared to the placebo, both Trospium chloride and Solifenacin alleviated symptoms according to the NBSS questionnaire and ICIQ-LUTS-QOL, total ICIQ-OAB, and the total score of ICIQ-OAB-Bothersome. However, the total LUTS-QOL-Bothersome score did not change in the active treatment groups compared to the placebo. While comparing the two drugs, these values were similar except for the total score of LUTS-QOL-Bothersome, ICIQ-OAB, and ICIQ-OAB-Bothersome in favor of the Solifenacin group. Moreover, Solifenacin had fewer side effects compared to Trospium chloride or placebo.

Conclusion: The study analyzed 206 stroke patients in two international centers and found both drug arms effective in treating overactive bladder. However, inconsistencies were found in efficacy and safety, necessitating further studies with larger populations.

Trial registration: This triple-blind, multicenter, randomized controlled trial was done on 206 stroke patients after getting Ethical Committee approval and registering the project on IRCT (IRCT20160606028304N2).

Introduction: Recovery of lower urinary tract (LUT) and lower gastrointestinal tract (LGIT) is a high priority for people with lived experience following spinal cord injury (SCI). A universally accepted validated patient-reported outcome (PRO) measure of the individual sensory and motor components of LGIT and LUT function, which allows tracking of recovery is lacking. To address this literature gap, the SCI Bladder and Bowel Control Questionnaire (SCI-BBC-Q) was developed.

Methods: The SCI-BBC-Q was developed as a direct assessment of the micturition and defecation experiences of an individual with SCI with possible neurogenic LUT and LGIT dysfunction. The SCI-BBC-Q development process consisted of two phases, measure development and evaluation. Measure development was guided by a conceptual framework, review of existing instruments and literature, and an iterative process of item incorporation, review, feedback, and consensus revision. Evaluation included cognitive interviewing, and assessments of feasibility, reliability, and content validity.

Results: The final 6-item SCI-BBC-Q is a PRO, which assesses motor and sensory function related to micturition and defecation, requiring ~5 min to complete. Assessments of clarity of the instrument components with regard to understanding of what is being asked in the questionnaire, feasibility of administration, reliability, internal consistency, and agreement with proxy measures have demonstrated that the SCI-BBC-Q provides consistent, stable, and reproducible data. Significant correlations were found between SCI-BBC-Q scores and the anorectal motor and sensory components of the International Standards for the Neurological Classification of SCI.

Conclusion: The SCI-BBC-Q is a practical and reliable method for baseline and ongoing evaluation of patients with neurogenic LUT and LGIT dysfunction, especially in the acute and subacute period when function is changing due to neurological plasticity. It is also appropriate for use in monitoring response to treatments related to neurological recovery.

Aim: Female bladder outflow obstruction is an underdiagnosed and undermanaged condition. This review article aims to illustrate the basic and clinical evaluation of patients who might have this condition.

Review: Clinical evaluation includes clinical history, examination, and basic investigations, including uroflowmetry and postvoid residual, urinalysis and culture, renal function assessment, ultrasound of kidneys and bladder, voiding cystourethrography, and magnetic resonance imaging. Based on the initial evaluation, if the concern of obstruction is high, the clinician might undergo further advanced evaluation.

Conclusion: Basic evaluation is the initial step in the diagnosis of female bladder outflow obstruction, the clinician need to have a high index of suspicion and often further advanced evaluation is needed to confirm the diagnosis.

Objective: Young adults with spina bifida (and other congenital neurologic diseases) have their own aspirations that may include education, employment, relationships and having children. As they move from pediatric to adult care, they must eventually transition to an adult healthcare team. The objective of this paper is to review the challenges and controversies in the transitional and adult care of people with congenital neurourological diseases.

Methods: The Research Group convened a meeting of its members and invited guests to better understand the healthcare challenges faced by these patients as they become adults. The group examined potential research opportunities focused on people with these diagnoses and themes related to their healthcare.

Results: Trust and clear communication are essential for effective patient transition. Ideally parents are involved in the transition to help reinforce independent self-care and responsibility. Adolescents require education about sexual health and independence, which may not be part of the core skillset of a urologist. The healthcare team must promote self-management and autonomy as early as practical. One of the major limitations is that adult care lacks the coordination of pediatric care, and patients may not have a "medical home." Multidisciplinary clinics are ideal but face logistical barriers in adult medicine. Additional barriers include limited physicians with the required specialized training. In the adult system, financial constraints are a key challenge for patients and providers.

Conclusion: Collaboration, supported by institutions and new research, is vital for improving the neurourological care of young adults with complex diseases.

Trial registration: This study reports on the proceedings of a meeting, and therefore clinical trial registration was not necessary.

Background: Enuresis refers to urinary incontinence during sleep in children over 5 years of age. The pathogenesis of enuresis is complex. It is related to low functional bladder capacity, nocturnal bladder overactivity, and high arousal threshold, and it is also related to the immaturity of the central nervous system. Also, it was related to nocturnal polyuria and decreased nocturnal urine osmolality. There are many clinical observations that link nocturnal enuresis with developmental delay in language and physical growth. Vitamin D is important for the critical biological actions involving neural function and development. It is involved in the regulation of nerve growth factor synthesis. It also has a neuroprotective effect. It not only plays a vital role in skeletal growth but also has other critical biological actions in neural development and function. Furthermore, Vitamin D deficiency was linked to increased urinary output, which raised the question of whether Vitamin D levels are linked to nocturnal polyuria and decreased nocturnal urine osmolality. It was observed in the mice model study that Vitamin D is a negative regulator of the renin-angiotensin system, and its deficiency leads to abnormal thirst and increased water intake by mice with Vitamin D deficiency and as much as twice urinary output than normal mice.

Aim of the study: To evaluate the relationship between Vitamin D deficiency and nocturnal enuresis and to study the correlation between Vitamin D deficiency and urine osmolality, which is an indirect indicator of ADH deficiency.

Patients and methods: This is a case-control study that started in February 2020 and ended in August 2020 in our tertiary hospital. The study included 60 children with primary monosymptomatic nocturnal enuresis selected randomly and 60 healthy children as a control group. We compared Vitamin D levels, nocturnal polyuria, and nocturnal urine osmolality among both groups.

Results: In our study, there was a statistically significant difference between both groups regarding serum Vitamin D values. The results of the serum Vitamin D level showed that 63.3% of cases with nocturnal enuresis had low Vitamin D levels with a mean range (18.8 ± 7.1) compared with 41.7% in the control group with a higher mean range (23.7 ± 9.6), and a p value of 0.002.

Conclusion: Our study indicates that there is a significant relationship between primary monosymptomatic nocturnal enuresis and serum Vitamin D deficiency in children. We also proved that Vitamin D level is correlated positively with nocturnal urine osmolality.

Trial registration: Clinical trials registration number: NCT06243042.