Neurourology and Urodynamics最新文献

Context: Lower Urinary Tract Symptoms (LUTS) are defined by their distressing effect on patients' day-to-day life. Given the pressures on secondary care resources, LUTS may be overlooked or inadequately assessed and therefore patients may be burdened for an extended period before treatment.

Methods: In a debate held at the International Consultation on Incontinence Research Society (ICI-RS) meeting in Bristol in June 2024, we considered how new technologies might contribute to an expedited, dignified and effective investigation of LUTS.

Results: We describe three broad areas where technology has a role to play: streamlining of existing investigations through mobile and miniaturized technology; entirely new investigations made possible by the technology; and advanced analytics to provide better insights from the data available.

Conclusion: We describe key research questions that will signpost us toward answering the question raised in the title.

Aims: Urinary tract infections are one of the most common reasons for antibiotic prescription. The widespread use of antibiotic treatments contributes to the global health problem of antimicrobial resistance development. To slow down the progression of antimicrobial resistance, it is essential that we explore nonantibiotic preventive treatments for this common condition. We aim to report discussions regarding nonantibiotic preventive strategies for recurrent urinary tract infections in both catheterized and non-catheterized patients that took place at the International Consultation on Incontinence-Research Society meeting in Bristol in 2024.

Methods: We undertook a think-tank session during this multidisciplinary meeting specifically designated for discussion regarding both established and emerging nonantibiotic treatments for UTI prevention in both catheterized and non-catheterized patients. This led to the generation of pertinent research questions, which hope to shape future UTI research.

Results: We describe the discussions that took place and document the important research questions that were proposed during the International Consultation on Incontinence-Research Society meeting in Bristol in 2024.

Conclusions: There is a range of established UTI preventative strategies for UTI prevention in both catheterized and non-catheterized patients. Emerging UTI prevention treatments have varying levels of evidence to support their use, and in many areas, further research is needed to establish their place in clinical pathways.

Introduction: Pelvic organ prolapse (POP) is a common condition, affecting women worldwide and is known to have a significant impact on Health Related Quality of Life (HRQoL). Although there are various treatment options available, including pelvic floor muscle training and support pessaries, many women opt for or require surgery, with a lifetime risk of needing surgery of 12%-19%. As with any operation, this does not come without its complications and the reoperation rate following POP surgery is up to 36%. This International Consultation on Incontinence-Research Society (ICI-RS) report aims to look at the different factors which may play a role in objective and subjective outcomes following pelvic floor surgery and to summarize the evidence and uncertainties regarding prediction of POP surgical outcomes, how to optimize them and the tools available to predict them. Research question proposals to further this field have been highlighted.

Methods: At ICI-RS 2024, the evidence for predicting the outcomes from POP surgery and methods to optimize outcomes were discussed and presented in this paper.

Results: There are many reasons why POP surgery may fail, such as variations in lifestyle and occupation, persistent constipation, failure in the perineal body, connective tissue types or the shape of the pelvis. There may also be inherent conditions of the vagina, such as hormonal or microbial features. The literature lacks evidence about the potential use of advanced statistical modeling or supervised machine learning in the development of management plans for patients with POP. Furthermore, future research is needed to determine the role of UDS in the preoperative evaluation of POP patients.

Conclusions: High-quality powered studies are required to assess optimization for long-term outcomes of pelvic surgery and then, once these are well established, and possible interventions are elucidated, prediction modeling can have a real impact clinically.

Aims: To answer the question of whether the bladder itself can to any extent control or modulate the initiation of voiding.

Methods: This subject was discussed at the International Consultation on Incontinence-Research Society (ICI-RS) 2024 conference in Bristol, UK in a proposal session.

Results: Cells in the bladder wall sense the local environment via a diverse array of ion channels and receptors which together provide input to motor-sensory and signal transduction mechanisms. A purinergic signal transduction system provides a high-gain mucosal chemosensitive transduction pathway between bladder wall stretch during filling and graded afferent activation. Recent studies established cross-species similarities in the regulation of urine storage which include the upregulation of aquaporin (water) channels during bladder filling/wall stretch, in the bladder. In addition to the endocrine hypothalamus/pituitary axis production, urothelial production of arginine vasopressin acts on urothelial vasopressin receptors in a paracrine manner causing aquaporin channel upregulation, reducing the bladder volume and delaying sensation of fullness. Bladder shape influences the sensory systems involved in the perception of bladder volume; moreover irregular bladder shapes may correlate with overactive bladder.

Conclusions: Volume measuring and signaling threshold-determining mechanisms in the bladder along with shape and permeability act to influence the timing and type of signaling to the CNS; although this is not always followed by a consecutive action. The hierarchical grading of the signals originating from the bladder among other peripheral bodily or central signals are crucial factors that determine whether the bladder is "allowed" to initiate voiding.

Objectives: To examine female representation in US News and World Report (USNWR) top 25 US Urology departments and identify trends of female representation in institutional roles.

Methods: Using the 2022 USNWR, we collected data from each institution's websites along with a compared geographically local cohort to evaluate the presence of female residents, female attendings, and professorial levels. First or last author faculty publications numbers were found using PubMed and Scopus in fiscal year 2022.

Results: The top 25 institutions averaged ~32.3% female residents and 18.7% female attendings, which was not significantly different from the comparison cohort. Of the total publications of fiscal year 2022, female attendings contributed ~14% (p < 0.001), also not significantly different from the comparison cohort. Only 20.4% of listed female attendings in top 25 programs are full Professors, compared to 41.1% of the listed men (p < 0.05). The most common level of female professorship is Assistant Professor (53.4%). Level of female professorship between cohort was significantly different, with female urologists more likely to hold a title of full Professor in the top 25 cohort compared to the nontop 25 cohort regardless of similar publication output (p < 0.05).

Conclusions: Female faculty in Urology continue to be underrepresented in the top Urology departments, with significant difference in equitable female professorship appointments between top 25 and nontop 25 departments. Future directions include examining the impact of early mentorship and sponsorship on representation over time.

Aims: Lower urinary tract (LUT) sensations form an essential part of diagnostic criteria for many LUT symptoms, additionally LUT sensations are used to evaluate the effectivity of therapeutic interventions. The accurate measurement of LUT sensations, however, is severely hampered by the subjective nature of these sensations.

Methods: This paper summarizes the discussions from the 2024 meeting of the International Consultation for Incontinence-Research Society (ICI-RS 2024) regarding systematic evaluations of LUT sensations and the design of more objective tools to measure these.

Results: Here, we discuss factors that influence sensations that are under the control of the caregiver/investigator, the signaling of sensations from the LUT toward the central nervous system, and currently used diagnostic tools to measure LUT sensations. Recent methodological advances to objectively measure factors that correspond with changes in LUT sensations are introduced along with recommendations for future research to optimally enable objective assessment of processes underlying LUT sensations.

Conclusions: Advancing the objective measurement of LUT sensations will require interdisciplinary collaboration, integrating insights from neuroscience, engineering, and clinical practice. Such efforts hold the potential to transform patient care by enabling more precise diagnostics and personalized therapeutic strategies.

Introduction: Robot-assisted (RA) surgery has many advantages for urinary tract and pelvic floor reconstruction (UTPFR) but its application is only slowly increasing. Studies are limited in number, patients and follow-up duration. The low-volume high-complexity nature of UTPFR warrants specific research to evaluate the potential role of the RA approach.

Methods: During its 2024 meeting in Bristol, the International Consultation on Incontinence-Research Society (ICI-RS) reviewed the current literature on RA UTPFR. Priority research questions and strategies were explored in a proposal.

Results: Four different topics were discussed. (1) Large multicentre prospective studies on RA UTPFR are needed to evaluate clinical effectiveness and safety. The RA approach needs to be prioritized in specific procedures and patients, to first improve patient care where gains are highest. (2) Models for cost-utility analysis for RA UTPFR are needed to (re)direct limited resources as efficiently as possible in a quickly changing technological field. (3) A modular curriculum for training UTPFR surgeons to become RA certified needs to be developed, to allow valid interpretation and comparison of outcomes. (4) Technological improvements to address tissue handling, accessibility, efficiency and sustainability are needed. Digitalization can be a gamechanger for RA UTPFR through telesurgery (training and expertize coverage), augmented reality and artificial intelligence providing intra-operative assistance, assessment and feedback.

Conclusions: The proposal discussed the need for studies on clinical and cost effectiveness, safety, and training curriculum development for RA UTPFR. Recent technological developments hold great promise for RA UTPFR. High-priority research questions were identified.