Neurourology and Urodynamics最新文献

Purpose: The purpose of this article is to establish expert consensus on the rationale for, and components of, a global patient registry for interstitial cystitis/bladder pain syndrome (IC/BPS). Our goal is to highlight what a comprehensive international patient registry can add to the growing body of IC/BPS-focused research and summarize the committee's rationale for inclusion or exclusion of certain patient and diagnostic characteristics to identify sub-groups of patients who will benefit from targeted therapy.

Materials and methods: An expert working group was formed from members of the Global Consensus on IC/BPS meeting. The working group consisted of four Urologists and a Urogynaecologist, and held a series of meetings in 2025 to achieve consensus on the benefits, hurdles and practical aspects of developing a global registry for IC/BPS. Literature search of the PubMed database was also performed where relevant, and all members agreed on the final proposals.

Results: The framework for an IC/BPS global registry was developed inclusive of male and female patients ages 18 years and older, who have symptoms of pain, pressure or discomfort related to the bladder, along with lower urinary tract symptoms, that have persisted for 3 or more months, in the absence of confusable disorders. A comprehensive list of patient data points including demographic, history-related, and comorbid conditions was developed. Additionally, validated questionnaires were identified for inclusion that assess domains of pain, urinary symptoms and quality of life. Consensus was reached regarding collecting data on prior treatment, cystoscopy findings and biopsy results where applicable. Lastly, importance was placed on patient-reported questionnaire data that can be input longitudinally by patients to lessen the burden of data collection by providers. Technical, legal and financial aspects were addressed as potential barriers.

Conclusions: A global registry for IC/BPS would overcome the limitations of current regional registries by including large numbers of patients from varied geographical locations, allowing for more efficient recruitment of patients for clinical trials. Understanding epidemiological trends and global variation in practice would enable optimization of care and quality improvement worldwide.

Aims: The objective of this study was to assess the duration and clinical correlates of positive response in interstitial cystitis/bladder pain syndrome patients undergoing therapeutic bladder hydrodistension (HOD) or HOD with electrofulguration (for those with Hunner lesions).

Methods: One hundred and twenty four women were enrolled in this prospective IRB-approved study. Participants answered a set of validated questionnaires at intake including chronic overlapping pain conditions (COPCs), brief pain index (BPI), and IC/BPS symptomatic questionnaires. These were repeated at 1, 2-, 3-, 6-, and 12-months posttreatment, together with a global response assessment (GRA). The primary outcome measure was the GRA score. A secondary analysis of patients who were strong responders to treatment was used to identify clinical correlates of positive response.

Results: At 1-month post-HOD, 62 patients (53.9%) were responders (i.e., reported persistent positive response to treatment). Further, 21/49 (42.9%) respondents continued to report a positive response at 12 months. Logistic regression analyses identified several correlates of strong response to therapy including absence of Huynner lesions (odds ratio (OR) = 3.629), lack of diagnosis of fibromyalgia (OR = 0.31), lower number of total sites of pain on BPI pain map (OR = 0.91), fewer total number of COPCs (OR = 0.36), and lower complex medical symptom inventory scale (CMSI; OR = 0.91). After false discovery rate correction, only the CMSI remained statistically significant.

Conclusions: Therapeutic hydrodistension results in a clinically meaningful and sustained improvement in associated symptoms and pain for many patients. However, having higher scores on markers of a widespread pain/non-bladder centric phenotype was associated with a lower treatment success rate.

Aims: In April 2025, the Wake Forest Institute for Regenerative Medicine hosted a Global Consensus meeting on interstitial cystitis/bladder pain syndrome (IC/BPS) in Winston-Salem, NC. The goal of this meeting was to establish attainable targets in phenotyping, diagnosis, and biomarkers for IC/BPS. Our subcommittee focused on developing a consensus document addressing IC/BPS in men.

Methods: Narrative review.

Results: Within this document, we discuss prevalence, clinical characteristics, evaluation/investigation, and treatment of IC/BPS in men. The is limited literature specifically addressing IC/BPS within the male population, as IC/BPS has traditionally been considered a disease of women. Thus, prevalence data varies widely. Diagnosis of IC/BPS in men is fraught with difficulty, as there is much overlap with other chronic pelvic pain syndrome, specifically chronic prostatitis. Key clinical features specific to IC/BPS are pain with bladder filling and relief with voiding. Painful ejaculation may be indicative of pelvic floor dysfunction. Physical exam, including extensive pelvic exam with analysis of pelvic floor tenderness, is critical in correct diagnosis. Ultrasound +/- urodynamics may be used to rule out obstructive disease, and urinalysis +/- culture must be used to rule out infection. There are no treatments specific to men with IC/BPS.

Conclusions: We have described the prevalence, clinical characteristics, evaluation, and treatment of IC/BPS in men. There is a significant need for more sex-specific research of IC/BPS with consideration for hormonal and anatomical factors that may differentiate the disease in men.

Clinical trial registration: No new data were generated for this manuscript; no clinical trial was conducted.

Aims: In April of 2025, a Global Consensus meeting on IC/BPS was held in Winston-Salem, NC. The goal of this meeting was to establish global consensus in diagnostic criteria, phenotyping, treatment outcome assessment, and possible etiopathology in interstitial cystitis/bladder pain syndrome (IC/BPS). Our sub-committee focused on developing a consensus document on histopathology in IC/BPS.

Methods: Narrative review.

Results: Herein we discuss histological and molecular distinctions of Hunner lesion disease (HLD) and non-Hunner lesion disease (non-HLD) in IC/BPS, including urothelial alterations, inflammatory changes, vascularization and fibrosis, and neurophysiological dysfunction. The molecular and histological characteristics of HLD make it distinct from non-HLD. HLD is histologically characterized by urothelial denudation and subepithelial chronic inflammation featured by B-cell dominant lymphoplasmacytic infiltration, while non-HLD shows subtle inflammatory changes with preserved urothelial layers. Some cases of non-HLD reflect a component of multi-systemic pain syndrome driven by altered neurophysiological networks within the central or peripheral nervous system.

Conclusions: Molecular and histological characteristics revealed that HLD and non-HLD are distinct disease entities as the former is an inflammatory disease of the urinary bladder and the latter may be represented by systemic neurophysiological disorder, rather than pathology that is limited to the bladder. This concept could be useful in phenotyping, diagnosis, and development of biomarkers for IC/BPS.

Trial registration: No new data were generated for this manuscript; no clinical trial was conducted.

Introduction: Urinary incontinence is a common complication after radical prostatectomy. Several meta-analyses have evaluated the effectiveness of pelvic floor muscle training (PFMT) for continence recovery, but their findings are inconsistent, and not all include all relevant studies. This meta-analysis aims to address these gaps.

Objectives: The study aims to summarize evidence on the effectiveness of preoperative PFMT, with or without biofeedback, on continence recovery post-prostatectomy.

Materials and methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. The PICO framework was used: Patients undergoing radical prostatectomy, Intervention: preoperative PFMT, Comparison: any postoperative intervention or monitoring, Outcome: continence recovery. Studies were sourced from PubMed, CINAHL, Scopus, Web of Science, and PEdro. Quality was assessed using the PEdro scale, and statistical analysis was performed using a random effect model.

Results: Six studies were included. Preoperative PFMT did not significantly improve continence recovery 1 month post-surgery (odds-ratio 2.01, 95% CI [0.94-4.31], p = 0.37). However, a significant improvement was observed 3 months post-surgery (odds-ratio 1.52, 95% CI [1.05-2.20], p = 0.03). No significant differences were found at 6 months (odds-ratio 1.28, 95% CI [0.85-1.94], p = 0.95) and twelve months (odds-ratio 0.73, 95% CI [0.43-1.23], p = 0.32).

Conclusions: Preoperative PFMT may improve continence recovery 3 months post-surgery but not at one, six, or twelve months. The study highlights the need for standardized assessment criteria and further research on robotic-assisted prostatectomy. The innovative aspect of this study lies in its conservative inclusion criteria and focus on preoperative PFMT's potential benefits.

Clinical trial registration: Not applicable. This study did not require clinical trial registration because it is a systematic review and meta-analysis of previously published studies.

Aims: The aim of this manuscript was to provide a narrative review of the etiopathology of three different interstitial cystitis/bladder pain syndrome (IC/BPS) phenotypes: Hunner lesion, widespread pain, and low bladder capacity.

Methods: IC/BPS literature was reviewed by the authors specific to the three phenotypes, focusing on etiopathology. Evidence was condensed and summarized on the different causes of each phenotype, emphasizing papers and abstracts dealing with basic science research, symptoms, and treatment options for patients afflicted with the three different IC/BPS phenotypes.

Results: Hunner lesion patients are marked by a distinct, visible inflammatory lesion in the bladder, inflammatory serum and urinary biomarkers, and respond well to bladder-centric treatments targeted specifically at the Hunner lesions. Widespread pain patients have diffuse pain attributed to central nervous system changes manifesting in the bladder, often with co-occurring non-bladder chronic pain conditions such as fibromyalgia and seem to respond better to systemic therapies. Low bladder capacity patients have a marked decrease in anesthetic bladder capacity during therapeutic hydrodistension of the bladder. They also tend to have higher pain scores, symptoms specifically concentrated at the bladder, and respond to localized treatments, constituting another bladder centric phenotype.

Conclusions: IC/BPS should not be thought to represent one unique type or pathophysiology, but rather a diverse group of patients, each with their own etiopathology and phenotypic manifestations.

Clinical trial registration: This was a narrative review and did not involve any direct intervention on patients nor direct patient contact and was not a clinical trial.

Aims: To evaluate the prevalence, clinical course, and risk factors of lower urinary tract symptoms (LUTS) in patients hospitalized with COVID-19, and to assess associations with comorbidities, disease severity, and vaccination status.

Methods: We conducted a prospective cohort study of adult patients hospitalized with confirmed COVID-19, who were not in intensive care at the time of enrollment, between July 2021 and March 2022. LUTS were assessed using the International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB), and ICIQ-Urinary Incontinence Short Form (ICIQ-UI SF) questionnaires during hospitalization and at one and 3 months post-discharge. Moderate to severe LUTS were defined as an IPSS > 7. Overactive bladder symptoms (OAB symptoms) were defined as an ICIQ-OAB Score ≥ 3 plus urgency and/or urgency urinary incontinence (UUI). Associations with sex, comorbidities, COVID-19 severity, and vaccination status were analyzed using multivariable logistic regression.

Results: Among 168 patients (55.4% male, median age 58 years), 31.0% had moderate to severe LUTS during hospitalization, with storage symptoms predominating. Urgency was present in 21.4% of the cohort, and 36.7% met the criteria for OAB symptoms. Urinary incontinence (UI) affected 34.5%, being more frequent among women. At 3 months, moderate to severe LUTS declined to 21.9%, and both OAB symptoms and UI also decreased significantly. No associations were found between LUTS and comorbidities or disease severity. Fully vaccinated patients had higher odds of moderate to severe LUTS during hospitalization (adjusted OR 10.56, 95% CI 4.13-26.9), particularly those vaccinated with inactivated virus vaccines (BBIBP-CorV).

Conclusions: LUTS are prevalent in the acute phase of COVID-19, especially among women, but tend to improve within 3 months. Unexpectedly, full vaccination-especially with inactivated virus vaccines-was associated with increased odds of moderate to severe LUTS during hospitalization. Further studies are warranted to explore the underlying mechanisms and long-term implications.

Trial registration: This study was not registered at ClinicalTrials.gov, as it is an observational study with no clinical intervention.

Aim: Metrics used to evaluate meaningful clinical outcomes have long been a matter of controversy, particularly where there is no defined objective cure and patient-reported metrics (PROMs) are utilised as objective measures of subjective phenomena. The ICI-RS 2025 think tank discussed the relative merits of objective and subjective outcomes in clinical trials.

Methods: A review of medical literature in four key areas; hard metrics versus PROMs assessment of Minimally Invasive Surgical Treatments for Bladder Outflow Obstruction, for Stress Urinary Incontinence, and their use in current registries and databases were debated. Limitations of trial design were highlighted and proposals for further reporting, steering groups and guidance panels suggested.

Results: It is yet to be fully understood how objective data and PROMs weigh bias and variability. Longitudinal study for objective and subjective metrics is required. Qualitative study with benchmarking may allow future studies to allow patients to set their own goals and develop more nuanced, patient-defined PROMs. Databases incorporating core metrics, specialist assessments and regression analysis may have utility to create composite algorithms into unified scoring systems. Artificial intelligence learning may be applied to large datasets.

Conclusions: Both objective and subjective assessments have their limitations. A balanced approach, combining both may provide the most complete and accurate picture.

Background: Nocturia is a prevalent condition with systematic etiologies which require multidisciplinary collaborations during diagnosis and management. Here we evaluate current evidence and present unresolved research questions regarding the three key pathophysiological domains of nocturia with respect to a conceptual brain-kidney-bladder axis, namely sleep enhancement, extra-renal water reabsorption and circadian regulation of bladder tissue.

Methods: A Think Tank was convened at the 12th International Consultation on Incontinence Research Society meeting in June 2025, looking at novel therapeutic targets for nocturia. This article synthesizes key deliberations from this meeting session.

Results: The discussion was mainly focused on idiopathic nocturia with an overactive bladder symptom complex or nocturnal polyuria. Firstly, medications and conservative nondrug measures targeting sleep that could potentially improve nocturia were considered. Secondly, investigation of water reabsorption mechanisms within the bladder and the role of small molecule vasopressin receptor type-2 agonists were examined that may provide novel therapeutic options to rectify nocturnal polyuria. Finally, to address circadian misalignments, organ specific chronotherapies, based on abnormal circadian features of bladder tissues that can be curative for nocturia, were discussed.

Conclusions: The evidence indicates that promising therapeutic modalities targeting the regulation of sleep-wake cycles, intravesical water transport mechanisms, and circadian patterns of detrusor activity may offer alternative strategies for managing nocturnal polyuria. However, further mechanistic investigations and randomized controlled trials are required to advance these approaches toward clinical translation.