Current Urology最新文献

Intravesical injections of botulinum toxin type A (BTX-A) are effective for treating refractory overactive bladder (OAB) in women. However, the adverse effects linked to the injections, such as hematuria, pain, and infection, and need for repeated injections can lower patient compliance and make the treatment inconvenient. Hence, urologists are actively pursuing less invasive and more convenient methods for the intravesical delivery of BTX-A. Advances in nanotechnology have facilitated noninvasive intravesical drug delivery. Currently, liposomes, hydrogels, nanoparticles, and many other forms of carriers can be used to enhance bladder wall permeability. This facilitates the entry of BTX-A into the bladder wall, allowing it to exert its effects. In this review, the feasibility and efficacy of liposomes, thermosensitive hydrogels, and hyaluronic acid-phosphatidylethanolamine for the treatment of OAB in women are discussed along with recent animal experiments on the use of nanotechnology-delivered BTX-A for the treatment of OAB in female rat models. Although the clinical efficacy of nanocarrier-encapsulated BTX-A for the treatment of OAB in women has not yet matched that of direct urethral muscle injection of BTX-A, improvements in certain symptoms indicate the potential of bladder instillation of nanocarrier-encapsulated BTX-A for future clinical applications. Consequently, further research on nanomaterials is warranted to advance the development of nanocarriers for the noninvasive delivery of BTX-A in the bladder.

Objectives: The aim of this study was to evaluate the effects of the combination of bacteriophage therapy with antibiotics and bacteriophage treatment alone on relieving clinical symptoms of chronic recurrent cystitis caused by multidrug-resistant bacteria.

Materials and methods: This clinical trial compared the treatment methods of 217 female patients with chronic recurrent cystitis caused by multidrug-resistant bacteria, who were investigated from June 2020 to May 2023. Patients were allocated into 4 groups: group I: received bacteriophage (Sextaphage) therapy alone; group II: received a combination of bacteriophages (Sextaphage) and furazidin; group III: received a combination of bacteriophage (Sextaphage) and furazidin with cefixime; and group IV: received furazidin and cefixime (without bacteriophage). The primary outcome included changes in the acute cystitis symptom scale and the pain visual analog scale, which were completed on days 7 and 14 following treatment. Secondary outcome measures included bladder diary records of urinary symptoms, median voided volumes, level of bacteriuria, and degree of leukocyturia.

Results: Initially, 217 female patients were presented during baseline visits. Those who did not meet the criteria inclusions were excluded, and 178 female patients were included in the final analysis. Statistically significant improvements from baseline in acute cystitis symptom scale scores for differential, typical symptoms, and quality of life domains were observed after 14 days of treatment in groups II, III, and IV. The pain level measured on the 14th day with the visual analog scale significantly decreased in groups II, III, and IV compared with group I. The patients of group I had a reduction of mean level bacteriuria of Escherichia coli from 10⁶ to 10² CFU/mL at 14 days of therapy. Significant improvement of voided volume from baseline was observed in groups II, III, and IV. Episodes of urinary frequency, both daytime and night-time, reduced significantly from baseline in all 4 groups only at 14 days of treatment.

Conclusions: Bacteriophage cocktail alone or with antibiotics may improve clinical symptoms in women with chronic recurrent cystitis caused by multidrug-resistant bacterial pathogens. In addition to improving clinical symptoms, the therapy with a phage cocktail may restore antibiotic sensitivity and increase the efficacy of antimicrobial agents.

This article reported the diagnosis and treatment of cystitis glandularis (CG) co-occurring with bladder neck leiomyomas. We retrospectively analyzed the clinical data of a single case of CG with bladder neck leiomyoma. A 31-year-old Chinese woman was given a diagnosis of CG and bladder neck leiomyoma. The mass and surrounding bladder mucosal lesions were entirely excised via transurethral resection, leaving a clean margin of healthy tissue. Histopathological analyses confirmed the diagnosis of CG and bladder neck leiomyoma. The patient remained asymptomatic throughout the follow-up period, with no indication of recurrence. Cystitis glandularis co-occurring with bladder neck leiomyoma requires careful examination, and surgery remains the best treatment option for these diseases.

Objectives: The aim of this study was to observe the clinical effectiveness of simultaneous electroacupuncture stimulation on the tibial nerve (TN) and ilioinguinal-iliohypogastric nerve (IIN/IHN) in the treatment of refractory overactive bladder (OAB) in women.

Materials and methods: A prospective study was conducted involving 94 female patients with a diagnosis of OAB in the Urology Department of our hospital from September 2022 to October 2023. The patients were randomly divided into a TN-IIN/IHN group and a control group, each comprising 47 cases. All patients in both groups had received anticholinergic muscarinic receptor antagonists (tolterodine/solifenacin), β3 receptor agonists, flupentixol/melitracen, and other basic treatment regimens with poor results. The TN-IIN/IHN group received simultaneous electroacupuncture on the TN and IIN/IHN, whereas the control group received pelvic floor muscle biofeedback electrical stimulation. Both groups underwent treatment 3 times a week for a total of 4 weeks. Bladder symptoms (24-hour voiding diary), OAB Symptom Score, OAB-Quality of Life Questionnaire, and anxiety and depression scores were compared and analyzed before treatment, after treatment, and at a 3-month follow-up. Clinical efficacy was also assessed.

Results: Both groups showed significant improvement in voiding frequency, nocturia, urgency, OAB Symptom Score, and average voiding volume after treatment and at follow-up (p < 0.01). The TN-IIN/IHN group showed significantly superior results compared with the control group (p < 0.01). Quality of life scores and anxiety and depression scores significantly decreased (p < 0.01), with the TN-IIN/IHN group scores significantly lower than those of the control group (p < 0.01). The treatment success rate in the TN-IIN/IHN group was 84.78%, whereas that in the control group was 28.89%, showing a statistically significant difference (p < 0.01). No significant adverse reactions occurred in either group during the treatment period.

Conclusions: Simultaneous electroacupuncture on the TN and IIN/IHN is effective in treating refractory OAB in women and has good long-term efficacy. This therapy is safe, convenient, and free of significant adverse reactions, providing a new approach for the clinical treatment of refractory OAB in these patients. It significantly improves bladder symptoms and alleviates anxiety and depression, thereby markedly enhancing the patients' quality of life.

Background: Ureteral stent removal is one of the most common procedures performed in urology. Herein, we describe a novel technique for stent removal using transurethral guidewire loop for manipulation and extraction of stents method. We aimed to evaluate the role, feasibility, cost, operative time, and complications of the method. A review of the literature outlining the innovations in ureteral stent removal was also performed.

Materials and methods: Cystoscopic stent removal was performed using transurethral guidewire loop for manipulation and extraction of stents in all sequential cases. Variables including sex, age, stent type, duration, reason for stent insertion, type of anesthesia (general/local), cystoscopic stent removal time, and documentation of postprocedural complications were tabulated. In addition, using the search term "novel innovation in ureteral stent removal," various databases (PubMed, EMBASE, Cochrane Library, SCOPUS, and Web of Science) were searched.

Results: Transurethral guidewire loop for manipulation and extraction of stents was successfully performed in all patients assessed on the first attempt. The patients comprised both sexes. The procedure was well tolerated under local anesthesia (4 of 5 cases), whereas general anesthesia was used in 1 case as the patient was booked for subsequent ureteroscopy under the same anesthetic. The procedure time was <27 seconds in all the cases assessed. No significant complications were noted. Fifteen studies involving novel innovations were included in the critical appraisal.

Conclusions: Transurethral guidewire loop for manipulation and extraction of stents is a simple, cost-effective, and innovative alternative for removing ureteral stents. It may be easily applied instead of a conventional ureteral stent grasper. Published innovative trends in ureteral stent removal have evolved over time, including advancements in stent design, retrieval devices, and the use of fluoroscope-free and cystoscope-free techniques.

Pelvic floor dysfunction poses a significant challenge to women worldwide. Female urinary incontinence is one of the most prevalent types of pelvic floor dysfunctions, affecting at least 50% of females, particularly those who are pregnant or menopausal. Among the various urinary incontinence subtypes, stress urinary incontinence takes the lead, characterized by involuntary urine leakage during activities that increase intra-abdominal pressure, such as sneezing, coughing, laughing, or exercising. This comprehensive review explores the latest advancements and critical insights into conservative treatments for stress urinary incontinence. Stress urinary incontinence symptoms result in profound physical and psychological consequences for individuals and impose a substantial medical and economic burden on society; however, only 5%-10% seek professional help. This narrative review meticulously examines a spectrum of interventions, ranging from lifestyle modifications to emerging modalities, such as laser treatment and electroacupuncture.

Recurrent uncomplicated lower urinary tract infections (RULUTIs) are common among women without anatomical or physiological abnormalities and affect women of all age groups, races, and ethnicities. Herein, we summarized the sources of epidemiology, etiology, diagnosis, treatment, prophylaxis, and follow-up evaluations in cases of RULUTIs. Patients' medical histories, symptoms, and signs were recorded. The review showed that urinalysis, culture, and sensitivity should be tested before empiric treatment. A first-line therapeutic strategy should be applied based on the results of the urine culture and sensitivity tests. Therefore, estrogen should be used as an ancillary therapy. After the successful treatment of acute infections, intermittent or continuous prophylaxis can be administered. Patients may benefit from follow-up evaluations to avoid recurrent infections. We expect that clinicians will pay more attention to RULUTIs.

[This corrects the article DOI: 10.1097/CU9.0000000000000259.].

Background: Bipolar transurethral enucleation of the prostate (B-TUEP) is a well-established surgical treatment for benign prostatic hyperplasia (BPH); however, its efficacy may vary depending on patient characteristics. Magnetic resonance imaging (MRI) with radiomics analysis can offer comprehensive and quantitative information about prostate characteristics that may relate to surgical outcomes. This study aimed to explore the value of MRI and radiomics analysis in predicting the short-term efficacy of B-TUEP for BPH.

Materials and methods: A total of 137 patients with BPH who underwent B-TUEP at 2 institutions were included. Radiological features were measured in the MRIs, and the radiomics score was developed from 1702 radiomics features extracted from the prostate and transitional zone regions of interest. Three prediction models were developed and validated based on clinical-radiological features, radiomic features, and their combinations. The models were evaluated using the area under the receiver operating characteristic curve, calibration curve, and decision curve analysis.

Results: The combination model exhibited the highest area under curve in both the training set (0.838) and the external validation set (0.802), indicating superior predictive performance and robustness. Furthermore, the combination model demonstrated good calibration (p > 0.05) and optimal clinical utility. The combination model indicated that a higher maximum urine flow rate, lower transitional zone index, and higher radiomics score were associated with an increased risk of poor efficacy.

Conclusions: Magnetic resonance imaging with radiomic analysis can offer valuable insights for predicting the short-term efficacy of B-TUEP in patients with BPH. A combination model based on clinical and radiomics features can assist urologists in making more precise clinical decisions.

Objectives: Spinal cord injury (SCI) is one of the most debilitating and expensive traumatic conditions. Chronic complications after SCI have a particularly negative impact on patients' functional independence and quality of life. Urodynamic study (UDS) provides a quantitative assessment of lower urinary tract function in these patients. In many fields, animal models are considered a precursor to clinical trials, so research using laboratory animals play a major role in knowledge acquisition.

Materials and methods: Twelve female Wistar rats (13 weeks old, 220-270 g) were divided randomly into 2 groups: sham or SCI. The sham-operated group underwent a laminectomy at T9-T10 without any spinal cord damage, while the SCI group underwent a complete transection at the T9-T10 vertebral level. We performed cystometry in all animals at the end of the fourth week. In this article, we visualize all procedures for catheter implementation and UDS in animals for the first time at Tabriz University of Medical Sciences, Iran, using a locally developed animal UDS device.

Results: The UDS results showed that the bladders in the SCI group were overactive and that peak and baseline pressures increased significantly in rats with SCI when compared with the sham group (p < 0.05 for all). Conversely, significant reductions in bladder compliance and intercontraction interval were observed in the SCI group (p < 0.05 for both).

Conclusions: This comprehensive visual report will be very useful to all researchers in the field of urology. Furthermore, the measurable variables of the UDS device have been described in this study.