Pub Date : 2025-11-17DOI: 10.1016/j.cont.2025.102304
Adrian Wagg
The use of antimuscarinics for overactive bladder in older adults has been affected by the results of epidemiological cross-sectional studies which have found an association between their use and the risk of an incident dementia diagnosis. Since the publication of earlier studies with high media exposure, later reports have resulted in conflicting findings, some shedding doubt upon initial results. This expert update reviews some of these conflicts and the results of studies which have assessed cognition in older adults, both with and without cognitive impairment. There is a need for a re-evaluation of current clinical guidelines in the light of these newer, and in some cases older, but ignored, studies.
{"title":"Bladder antimuscarinics in older adults: as bad as portrayed?","authors":"Adrian Wagg","doi":"10.1016/j.cont.2025.102304","DOIUrl":"10.1016/j.cont.2025.102304","url":null,"abstract":"<div><div>The use of antimuscarinics for overactive bladder in older adults has been affected by the results of epidemiological cross-sectional studies which have found an association between their use and the risk of an incident dementia diagnosis. Since the publication of earlier studies with high media exposure, later reports have resulted in conflicting findings, some shedding doubt upon initial results. This expert update reviews some of these conflicts and the results of studies which have assessed cognition in older adults, both with and without cognitive impairment. There is a need for a re-evaluation of current clinical guidelines in the light of these newer, and in some cases older, but ignored, studies.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"16 ","pages":"Article 102304"},"PeriodicalIF":1.2,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-10DOI: 10.1016/j.cont.2025.102303
Glenn T. Werneburg , Marcus J. Drake , Ryuji Sakakibara , Mikolaj Przydacz , Tatsuya Yamamoto , Sanjay Sinha , Members of the Neuro-urology Promotion Committee of the International Continence Society
Background and objective
Parkinson's disease and other Parkinsonian disorders, including multiple system atrophy, dementia with Lewy Bodies, progressive supranuclear palsy, and corticobasal degeneration, are commonly associated with lower urinary tract symptoms, which contribute to morbidity and reduced quality of life.
Methods
The Neuro-urology Promotion Committee of the International Continence Society provides an update in the form of a scoping review, which includes literature since 2014. We focus on the pathophysiology of urinary dysfunction in the Parkinsonian disorders, as well as current and emerging treatment regimens.
Key findings and limitations
Data supporting the use of beta-3-agonists as well as botulinum toxin in the population with Parkinsonian disorders have accumulated rapidly, and support the safety and efficacy of these modalities in the population. Growing evidence suggests that deep brain stimulation (DBS), which is used primarily for motor symptoms, may have therapeutic potential for lower urinary tract dysfunction. However, further studies regarding patient selection and brain target selection for such therapy along with clinical trials to assess efficacy of DBS for lower urinary tract dysfunction in the Parkinsonian disorders are warranted.
Conclusions and clinical implications
Over the past decade, there has been meaningful progress in the understanding of lower urinary tract symptoms in Parkinsonian disorders. Further investigation and clinical trials are essential to further refine therapeutic strategies and improve quality of life for affected individuals.
{"title":"Pathophysiology and management of lower urinary tract dysfunction in parkinsonian Disorders: Update from the Neuro-Urology Promotion Committee of the ICS","authors":"Glenn T. Werneburg , Marcus J. Drake , Ryuji Sakakibara , Mikolaj Przydacz , Tatsuya Yamamoto , Sanjay Sinha , Members of the Neuro-urology Promotion Committee of the International Continence Society","doi":"10.1016/j.cont.2025.102303","DOIUrl":"10.1016/j.cont.2025.102303","url":null,"abstract":"<div><h3>Background and objective</h3><div>Parkinson's disease and other Parkinsonian disorders, including multiple system atrophy, dementia with Lewy Bodies, progressive supranuclear palsy, and corticobasal degeneration, are commonly associated with lower urinary tract symptoms, which contribute to morbidity and reduced quality of life.</div></div><div><h3>Methods</h3><div>The Neuro-urology Promotion Committee of the International Continence Society provides an update in the form of a scoping review, which includes literature since 2014. We focus on the pathophysiology of urinary dysfunction in the Parkinsonian disorders, as well as current and emerging treatment regimens.</div></div><div><h3>Key findings and limitations</h3><div>Data supporting the use of beta-3-agonists as well as botulinum toxin in the population with Parkinsonian disorders have accumulated rapidly, and support the safety and efficacy of these modalities in the population. Growing evidence suggests that deep brain stimulation (DBS), which is used primarily for motor symptoms, may have therapeutic potential for lower urinary tract dysfunction. However, further studies regarding patient selection and brain target selection for such therapy along with clinical trials to assess efficacy of DBS for lower urinary tract dysfunction in the Parkinsonian disorders are warranted.</div></div><div><h3>Conclusions and clinical implications</h3><div>Over the past decade, there has been meaningful progress in the understanding of lower urinary tract symptoms in Parkinsonian disorders. Further investigation and clinical trials are essential to further refine therapeutic strategies and improve quality of life for affected individuals.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"16 ","pages":"Article 102303"},"PeriodicalIF":1.2,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urinary incontinence (UI) is a highly prevalent condition with profound physical, psychological and social implications. In sub-Saharan Africa, structured pathways for vesicovaginal fistula management exist, however, services for non-fistulae related UI are almost entirely absent. Malawi is a low-income country with severe surgical workforce shortages and therefore lacks basic routine continence services.
Methods
This article reports on a Urolink, Meditech and Cambridge Global Health Partnership programme to Kamuzu Central Hospital in Lilongwe in February 2025. The initiative delivered consultant surgical training, urodynamic assessments, outpatient clinics, equipment provision and teaching sessions to urology and gynaecology doctors in training. A mixed methods prospective service implementation and feasibility study was conducted over a one-week programme. Data on procedures, patient assessments, operative outcomes and teaching outcomes were collected.
Results
Clinical activity included both major reconstructive surgeries, such clam enterocystoplasty, complex fistulae repair, urethral diverticulectomy, rectus fascial sling and minor procedures including, urethral bulking, cystoscopy assessments, bladder Botox injections and urodynamic studies. Sixteen patients with UI were assessed in urogynecology clinics. Twelve registrars participated in lectures, viva sessions and live surgical teaching. Self-reported confidence improved significantly in all domains including the management of, stress UI, urodynamic assessments, neuropathic bladder and urinary diversion. Collaborative dual consultant operating reinforced the independence of the local consultants.
Discussion
Major challenges included theatre inefficiency, sterilisation limitations, shortages of nursing and anaesthetic staff, sociocultural stigma and late patient presentations. Despite these barriers, the program demonstrated the feasibility of introducing basic and advanced continence procedures, sustainable training models and national teaching platforms in a resource-limited setting.
Conclusions
Progress in continence surgery in Malawi requires long-term mentorship, infrastructure strengthening, culturally adapted awareness campaigns and national policy support. Global partnerships can act as facilitators for sustainable, context-specific solutions. Short, intensive partnership can build local capacity and initiate a subspecialty service, but long-term outcomes remain unknown.
{"title":"Challenges and advances in offering urinary continence care in Malawi","authors":"Brendan Berry , Mayur Gami , Nikesh Thiruchelvam , Tamsin Greenwell , Suzie Venn","doi":"10.1016/j.cont.2025.102302","DOIUrl":"10.1016/j.cont.2025.102302","url":null,"abstract":"<div><h3>Background</h3><div>Urinary incontinence (UI) is a highly prevalent condition with profound physical, psychological and social implications. In sub-Saharan Africa, structured pathways for vesicovaginal fistula management exist, however, services for non-fistulae related UI are almost entirely absent. Malawi is a low-income country with severe surgical workforce shortages and therefore lacks basic routine continence services.</div></div><div><h3>Methods</h3><div>This article reports on a Urolink, Meditech and Cambridge Global Health Partnership programme to Kamuzu Central Hospital in Lilongwe in February 2025. The initiative delivered consultant surgical training, urodynamic assessments, outpatient clinics, equipment provision and teaching sessions to urology and gynaecology doctors in training. A mixed methods prospective service implementation and feasibility study was conducted over a one-week programme. Data on procedures, patient assessments, operative outcomes and teaching outcomes were collected.</div></div><div><h3>Results</h3><div>Clinical activity included both major reconstructive surgeries, such clam enterocystoplasty, complex fistulae repair, urethral diverticulectomy, rectus fascial sling and minor procedures including, urethral bulking, cystoscopy assessments, bladder Botox injections and urodynamic studies. Sixteen patients with UI were assessed in urogynecology clinics. Twelve registrars participated in lectures, viva sessions and live surgical teaching. Self-reported confidence improved significantly in all domains including the management of, stress UI, urodynamic assessments, neuropathic bladder and urinary diversion. Collaborative dual consultant operating reinforced the independence of the local consultants.</div></div><div><h3>Discussion</h3><div>Major challenges included theatre inefficiency, sterilisation limitations, shortages of nursing and anaesthetic staff, sociocultural stigma and late patient presentations. Despite these barriers, the program demonstrated the feasibility of introducing basic and advanced continence procedures, sustainable training models and national teaching platforms in a resource-limited setting.</div></div><div><h3>Conclusions</h3><div>Progress in continence surgery in Malawi requires long-term mentorship, infrastructure strengthening, culturally adapted awareness campaigns and national policy support. Global partnerships can act as facilitators for sustainable, context-specific solutions. Short, intensive partnership can build local capacity and initiate a subspecialty service, but long-term outcomes remain unknown.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"16 ","pages":"Article 102302"},"PeriodicalIF":1.2,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-30DOI: 10.1016/j.cont.2025.102295
Nadine Arina Maria van Merode , P.Y. Hermans , T. de Jong , B.M.A. Schout , C. Cobussen , J.P.A. van Basten , R. de Jongh , S. Mekke , H. Roshani , M.M. Nijenhuis , J.I.M. van Uhm , R.R. Kikkert , S. Tilli , J.F.A. Heesakkers , M. Duijn , E.P. van Haarst , A.M. Tijans , A. Noordzij , L. van Eerten-Koops , I. Bleumer , L.P.W. Witte
Background and objective
This study aimed to assess practice variation in the timing and management of trial without catheter (TWOC) following acute urinary retention (AUR) in Dutch hospitals. Secondary objectives were to identify clinical predictors of TWOC success and evaluate catheter-related complications.
Methods
We conducted a retrospective cross-sectional observational study across multiple Dutch hospitals. Male patients aged ≥18 years with a single episode of spontaneous AUR were identified using electronic health record queries. Data collected included catheter duration, alpha-blocker use, TWOC outcomes, predictors of success, and complications. TWOC success was defined as spontaneous voiding with acceptable post-void residual, as judged by the local clinician. Predictors were determined with multivariable binomial logistic regression.
Key findings and limitations
A total of 299 men (mean age 73.1 ± 9.4 years) were included from January 2022 to June 2022. Median drained volume was 1000 mL (IQR 750–1500 mL), and median catheter duration was 15 days (IQR 6–23 days). TWOC success varied across hospitals (14–55 %). Catheter duration and alpha-blocker were not significant predictors. Older age (OR 0.93, p = 0.001) and larger drained volume (OR 0.99, p < 0.001) were associated with lower success, while alcohol consumption increased success odds (OR 3.54, p = 0.016). The study is limited by the retrospective design, lack of standard definition for TWOC success, and observational nature.
Conclusion
Substantial variation exists in catheter duration and TWOC management across Dutch hospitals. Age, drained volume, and alcohol use were significant predictors of TWOC outcome. However, the association with alcohol should be interpreted as an indication that non-BOO causes of AUR may resolve spontaneously. Findings highlight the need for standardised protocols and support future multicenter randomized trials to optimize care, reduce complications, and improve patient quality of life.
背景和目的本研究旨在评估荷兰医院急性尿潴留（AUR）后无导管试验（TWOC）的时间和管理的实践差异。次要目的是确定TWOC成功的临床预测因素并评估导管相关并发症。方法对荷兰多家医院进行回顾性横断面观察性研究。年龄≥18岁且有一次自发性AUR发作的男性患者通过电子健康记录查询被确定。收集的数据包括导管时间、α -阻滞剂使用、TWOC结果、成功预测因素和并发症。TWOC成功被定义为自发排尿，并有可接受的空后残留，由当地临床医生判断。采用多变量二项逻辑回归确定预测因子。从2022年1月至2022年6月，共纳入299名男性（平均年龄73.1±9.4岁）。中位引流量为1000 mL (IQR 750 ~ 1500 mL)，中位置管时间为15天（IQR 6 ~ 23天）。TWOC的成功率因医院而异（14 - 55%）。导管时间和阻断剂不是显著的预测因素。年龄越大（OR 0.93, p = 0.001）和排气量越大（OR 0.99, p < 0.001）与成功率较低相关，而饮酒增加了成功率（OR 3.54, p = 0.016）。该研究受到回顾性设计、缺乏TWOC成功的标准定义和观察性的限制。结论荷兰各医院在导管使用时间和TWOC管理方面存在很大差异。年龄、排气量和酒精使用是TWOC结果的重要预测因素。然而，与酒精的关联应被解释为非boo引起的AUR可能会自发消退。研究结果强调了标准化方案的必要性，并支持未来的多中心随机试验，以优化护理，减少并发症，提高患者的生活质量。
{"title":"Variation in catheter management and predictors of trial without catheter success in men with AUR: results from the AUR-SNAPSHOT study","authors":"Nadine Arina Maria van Merode , P.Y. Hermans , T. de Jong , B.M.A. Schout , C. Cobussen , J.P.A. van Basten , R. de Jongh , S. Mekke , H. Roshani , M.M. Nijenhuis , J.I.M. van Uhm , R.R. Kikkert , S. Tilli , J.F.A. Heesakkers , M. Duijn , E.P. van Haarst , A.M. Tijans , A. Noordzij , L. van Eerten-Koops , I. Bleumer , L.P.W. Witte","doi":"10.1016/j.cont.2025.102295","DOIUrl":"10.1016/j.cont.2025.102295","url":null,"abstract":"<div><h3>Background and objective</h3><div>This study aimed to assess practice variation in the timing and management of trial without catheter (TWOC) following acute urinary retention (AUR) in Dutch hospitals. Secondary objectives were to identify clinical predictors of TWOC success and evaluate catheter-related complications.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional observational study across multiple Dutch hospitals. Male patients aged ≥18 years with a single episode of spontaneous AUR were identified using electronic health record queries. Data collected included catheter duration, alpha-blocker use, TWOC outcomes, predictors of success, and complications. TWOC success was defined as spontaneous voiding with acceptable post-void residual, as judged by the local clinician. Predictors were determined with multivariable binomial logistic regression.</div></div><div><h3>Key findings and limitations</h3><div>A total of 299 men (mean age 73.1 ± 9.4 years) were included from January 2022 to June 2022. Median drained volume was 1000 mL (IQR 750–1500 mL), and median catheter duration was 15 days (IQR 6–23 days). TWOC success varied across hospitals (14–55 %). Catheter duration and alpha-blocker were not significant predictors. Older age (OR 0.93, <em>p</em> = 0.001) and larger drained volume (OR 0.99, <em>p</em> < 0.001) were associated with lower success, while alcohol consumption increased success odds (OR 3.54, <em>p</em> = 0.016). The study is limited by the retrospective design, lack of standard definition for TWOC success, and observational nature.</div></div><div><h3>Conclusion</h3><div>Substantial variation exists in catheter duration and TWOC management across Dutch hospitals. Age, drained volume, and alcohol use were significant predictors of TWOC outcome. However, the association with alcohol should be interpreted as an indication that non-BOO causes of AUR may resolve spontaneously. Findings highlight the need for standardised protocols and support future multicenter randomized trials to optimize care, reduce complications, and improve patient quality of life.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"16 ","pages":"Article 102295"},"PeriodicalIF":1.2,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-30DOI: 10.1016/j.cont.2025.102299
Matthew Antonellis , Robert Adler , Michael Kozlov , Jason Lazar , Jeffrey P. Weiss
Background
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are widely used in patients with diabetes, heart failure, and chronic kidney disease, all of whom are at elevated risk for nocturia. These agents affect renal glucose and sodium handling, potentially influencing nocturnal urine production. However, their overall impact on nocturia remains poorly defined.
Methods
A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Embase, and Web of Science were searched through May 2025 for studies reporting nocturia-related outcomes among SGLT2 inhibitor users. Eligible study designs included randomized controlled trials, observational studies, and post-marketing analyses. Additionally, disproportionality analysis using the FDA Adverse Event Reporting System (FAERS) was performed to assess urinary adverse event signals across individual agents.
Results
Forty-six studies met inclusion criteria. Trial data suggest a modest increase in urinary frequency and nocturia, though few studies employed validated symptom measures. Pharmacovigilance analysis revealed elevated reporting rates of nocturia, particularly with canagliflozin. In contrast, shorter half-life agents such as tofogliflozin demonstrated lower nocturia prevalence. Morning dosing and individualized agent selection may mitigate symptom burden.
Conclusions
SGLT2 inhibitors are associated with a small but clinically meaningful increase in nocturia, especially during early treatment. The effect varies by agent pharmacokinetics and patient characteristics. Prospective studies using standardized outcome measures are needed to guide personalized prescribing and symptom management.
背景：钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂广泛用于糖尿病、心力衰竭和慢性肾脏疾病患者，这些患者夜尿的风险都很高。这些药物影响肾脏葡萄糖和钠的处理，可能影响夜间尿的产生。然而，它们对夜尿症的总体影响仍不明确。方法根据PRISMA 2020指南进行系统评价。PubMed、Embase和Web of Science检索了截至2025年5月报告SGLT2抑制剂使用者夜尿相关结果的研究。符合条件的研究设计包括随机对照试验、观察性研究和上市后分析。此外，使用FDA不良事件报告系统（FAERS）进行歧化分析，以评估单个药物的泌尿不良事件信号。结果46项研究符合纳入标准。试验数据显示尿频和夜尿适度增加，尽管很少有研究采用有效的症状测量。药物警戒分析显示夜尿报告率升高，特别是卡格列净组。相反，半衰期较短的药物如tofogliflozin显示夜尿率较低。早晨给药和个体化用药可减轻症状负担。结论ssglt2抑制剂与夜尿症的小幅但有临床意义的增加有关，特别是在早期治疗期间。效果因药物的药代动力学和患者特征而异。需要使用标准化结果测量的前瞻性研究来指导个性化处方和症状管理。
{"title":"Nocturia and SGLT2 inhibitors: A review of pathophysiology, clinical evidence, and therapeutic implications","authors":"Matthew Antonellis , Robert Adler , Michael Kozlov , Jason Lazar , Jeffrey P. Weiss","doi":"10.1016/j.cont.2025.102299","DOIUrl":"10.1016/j.cont.2025.102299","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose cotransporter-2 (SGLT2) inhibitors are widely used in patients with diabetes, heart failure, and chronic kidney disease, all of whom are at elevated risk for nocturia. These agents affect renal glucose and sodium handling, potentially influencing nocturnal urine production. However, their overall impact on nocturia remains poorly defined.</div></div><div><h3>Methods</h3><div>A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Embase, and Web of Science were searched through May 2025 for studies reporting nocturia-related outcomes among SGLT2 inhibitor users. Eligible study designs included randomized controlled trials, observational studies, and post-marketing analyses. Additionally, disproportionality analysis using the FDA Adverse Event Reporting System (FAERS) was performed to assess urinary adverse event signals across individual agents.</div></div><div><h3>Results</h3><div>Forty-six studies met inclusion criteria. Trial data suggest a modest increase in urinary frequency and nocturia, though few studies employed validated symptom measures. Pharmacovigilance analysis revealed elevated reporting rates of nocturia, particularly with canagliflozin. In contrast, shorter half-life agents such as tofogliflozin demonstrated lower nocturia prevalence. Morning dosing and individualized agent selection may mitigate symptom burden.</div></div><div><h3>Conclusions</h3><div>SGLT2 inhibitors are associated with a small but clinically meaningful increase in nocturia, especially during early treatment. The effect varies by agent pharmacokinetics and patient characteristics. Prospective studies using standardized outcome measures are needed to guide personalized prescribing and symptom management.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"16 ","pages":"Article 102299"},"PeriodicalIF":1.2,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-29DOI: 10.1016/j.cont.2025.102298
Anna E. Kohler , Tone Prosch-Bilden , Stig Norderval
Purpose
The purpose of this study was to assess outcome after 1 and 5 years in patients who had undergone sphincteroplasty for anal incontinence (AI) in Norway.
Methods
The study was conducted as a retrospective cohort study based on prospectively recorded data from the Norwegian Registry of Anal Incontinence. AI was quantified using the St. Mark's score. Quality of life (QoL) was assessed with a simple visual analog scale with range 0–10. Primary endpoints were reduction in St. Mark's score and QoL score at follow-up.
Results
Some 75 patients had available results at year 1 follow-up, and 34 patients at year 5. Between baseline and year 1 there was a mean decrease in St. Mark's score of 3.9 points (p < 0.001) and an increase in QoL-score of 0.4 points (p = 0.282). Between year 1 and year 5 mean St. Mark's score increased by 1.0 points (p = 0.359), while the QoL decreased by 1.7 points (p = 0.020). Comparing baseline with year 5, there was still a mean decrease in the St. Mark's score (p < 0.001). A low St. Mark's score at baseline was statistically significantly associated with less reduction in St. Mark's score at year 1 (p < 0.001), and patients with a baseline St. Mark's score of 9 or less experienced a mean St Mark's score increase of 0.25 point (p = 0.901). Neither age, menopause or ultrasonographic extent of sphincter defect prior to surgery affected outcome.
Conclusion
Patients with a baseline St. Mark's score of 9 or less have little to no benefit from sphincteroplasty for AI.
{"title":"Short- and long-term outcome of sphincteroplasty for anal incontinence: Results from the Norwegian Registry of Anal Incontinence","authors":"Anna E. Kohler , Tone Prosch-Bilden , Stig Norderval","doi":"10.1016/j.cont.2025.102298","DOIUrl":"10.1016/j.cont.2025.102298","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to assess outcome after 1 and 5 years in patients who had undergone sphincteroplasty for anal incontinence (AI) in Norway.</div></div><div><h3>Methods</h3><div>The study was conducted as a retrospective cohort study based on prospectively recorded data from the Norwegian Registry of Anal Incontinence. AI was quantified using the St. Mark's score. Quality of life (QoL) was assessed with a simple visual analog scale with range 0–10. Primary endpoints were reduction in St. Mark's score and QoL score at follow-up.</div></div><div><h3>Results</h3><div>Some 75 patients had available results at year 1 follow-up, and 34 patients at year 5. Between baseline and year 1 there was a mean decrease in St. Mark's score of 3.9 points (p < 0.001) and an increase in QoL-score of 0.4 points (p = 0.282). Between year 1 and year 5 mean St. Mark's score increased by 1.0 points (p = 0.359), while the QoL decreased by 1.7 points (p = 0.020). Comparing baseline with year 5, there was still a mean decrease in the St. Mark's score (p < 0.001). A low St. Mark's score at baseline was statistically significantly associated with less reduction in St. Mark's score at year 1 (p < 0.001), and patients with a baseline St. Mark's score of 9 or less experienced a mean St Mark's score increase of 0.25 point (p = 0.901). Neither age, menopause or ultrasonographic extent of sphincter defect prior to surgery affected outcome.</div></div><div><h3>Conclusion</h3><div>Patients with a baseline St. Mark's score of 9 or less have little to no benefit from sphincteroplasty for AI.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"16 ","pages":"Article 102298"},"PeriodicalIF":1.2,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.cont.2025.102297
James Fox , Silje Ekroll Jahren , Marcus J. Drake , Francesco Clavica
Introduction
Indwelling urinary catheters, particularly Foley catheters, are commonly used in clinical care but remain associated with several complications, including bladder tissue damage, risk of infection, poor emptying speeds and urethral trauma. Despite ongoing design innovations, objective comparisons between catheter types are limited. This study aimed to develop a computational framework to quantitatively assess and compare the performance of three urinary catheter designs (Foley, Optitip, and Flume) across metrics linked to patient outcomes.
Methods
A female lower urinary tract (LUT) model was constructed using standard anatomical dimensions. Each catheter was assessed using geometrical analysis, computational fluid dynamics (CFD), and finite element analysis (FEA). Simulations were performed at two catheter positions (bladder centre and bladder neck) and under two bladder pressures (4 and 20 cmH2O). Quantified metrics include residual urine volume, catheter height (protrusion into the bladder), immersed surface area, wall shear stress, urine flow rate, and von Mises stress in bladder tissue.
Results
The Foley catheter consistently underperformed across all metrics, showing high residual volumes, low shear stress near the side holes, and high von Mises stress in the bladder tissue (factors linked to infection, blockage, and trauma). In contrast, the Flume and Optitip catheters demonstrated improved flow dynamics, reduced catheter height, and lower immersed surface area.
Conclusions
This study presents a novel modelling approach to assess urinary catheter design. Findings support the clinical need to move beyond traditional Foley designs and adopt better-performing alternatives to reduce complications and improve patient safety and comfort.
{"title":"Choosing the optimal urethral Catheter: A computational comparison","authors":"James Fox , Silje Ekroll Jahren , Marcus J. Drake , Francesco Clavica","doi":"10.1016/j.cont.2025.102297","DOIUrl":"10.1016/j.cont.2025.102297","url":null,"abstract":"<div><h3>Introduction</h3><div>Indwelling urinary catheters, particularly Foley catheters, are commonly used in clinical care but remain associated with several complications, including bladder tissue damage, risk of infection, poor emptying speeds and urethral trauma. Despite ongoing design innovations, objective comparisons between catheter types are limited. This study aimed to develop a computational framework to quantitatively assess and compare the performance of three urinary catheter designs (Foley, Optitip, and Flume) across metrics linked to patient outcomes.</div></div><div><h3>Methods</h3><div>A female lower urinary tract (LUT) model was constructed using standard anatomical dimensions. Each catheter was assessed using geometrical analysis, computational fluid dynamics (CFD), and finite element analysis (FEA). Simulations were performed at two catheter positions (bladder centre and bladder neck) and under two bladder pressures (4 and 20 cmH<sub>2</sub>O). Quantified metrics include residual urine volume, catheter height (protrusion into the bladder), immersed surface area, wall shear stress, urine flow rate, and von Mises stress in bladder tissue.</div></div><div><h3>Results</h3><div>The Foley catheter consistently underperformed across all metrics, showing high residual volumes, low shear stress near the side holes, and high von Mises stress in the bladder tissue (factors linked to infection, blockage, and trauma). In contrast, the Flume and Optitip catheters demonstrated improved flow dynamics, reduced catheter height, and lower immersed surface area.</div></div><div><h3>Conclusions</h3><div>This study presents a novel modelling approach to assess urinary catheter design. Findings support the clinical need to move beyond traditional Foley designs and adopt better-performing alternatives to reduce complications and improve patient safety and comfort.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"16 ","pages":"Article 102297"},"PeriodicalIF":1.2,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.cont.2025.102296
Stephanie Kotes , Danielle Delaney , Marcus John Drake , Ashani Couchman , Thomas Milton , Kadir Onem , Katie Brodie , Sanjay Sinha
Neurogenic lower urinary tract dysfunction (NLUTD) is a frequent but under-recognized complication in children with rare neurological disorders. These conditions often interfere with central or peripheral pathways involved in micturition, leading to various clinical presentations including urinary incontinence, urinary retention, and risk to upper tract deterioration. The objective of this joint report by the Neurourology Promotion Committee (NUPC) and the Children and Young Adults Committee (CYAC) of the International Continence Society (ICS) is to describe and summarise rare paediatric neurological conditions associated with NLUTD, with a focus on their pathophysiology, urological sequelae, and implications for clinical management. Included conditions have been categorised into complex anatomical, genetic, neurodevelopmental, metabolic disorders and malignancies. The complex interplay of neurological, anatomical and developmental factors highlights the need for timely, multidisciplinary, and personalized care to protect kidney function, support continence, and enhance quality of life (QoL) in children with complex neurological and developmental conditions.
{"title":"Lower urinary tract dysfunction in rare paediatric neurological conditions: A joint report by the neurourology promotion committee and children and young adults committee of the International Continence Society","authors":"Stephanie Kotes , Danielle Delaney , Marcus John Drake , Ashani Couchman , Thomas Milton , Kadir Onem , Katie Brodie , Sanjay Sinha","doi":"10.1016/j.cont.2025.102296","DOIUrl":"10.1016/j.cont.2025.102296","url":null,"abstract":"<div><div>Neurogenic lower urinary tract dysfunction (NLUTD) is a frequent but under-recognized complication in children with rare neurological disorders. These conditions often interfere with central or peripheral pathways involved in micturition, leading to various clinical presentations including urinary incontinence, urinary retention, and risk to upper tract deterioration. The objective of this joint report by the Neurourology Promotion Committee (NUPC) and the Children and Young Adults Committee (CYAC) of the International Continence Society (ICS) is to describe and summarise rare paediatric neurological conditions associated with NLUTD, with a focus on their pathophysiology, urological sequelae, and implications for clinical management. Included conditions have been categorised into complex anatomical, genetic, neurodevelopmental, metabolic disorders and malignancies. The complex interplay of neurological, anatomical and developmental factors highlights the need for timely, multidisciplinary, and personalized care to protect kidney function, support continence, and enhance quality of life (QoL) in children with complex neurological and developmental conditions.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"16 ","pages":"Article 102296"},"PeriodicalIF":1.2,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
AIMS OF STUDY: To evaluate the therapeutic potential and safety of platelet-rich plasma (PRP) therapy in patients with mild to moderate erectile dysfunction, with a prospective observational follow-up of two years.
STUDY DESIGN, MATERIALS AND METHODS: Thirty-five patients with mild to moderate erectile dysfunction, based on the IIEF-EF score, received three injections of autologous PRP (3 mL per corpus), administered two weeks apart. Patients were evaluated at 1, 3, and 6 months, and then every 6 months for two years. After six months, the PRP group (18 patients) continued to receive maintenance PRP injections every six months, while the saline group (17 patients) received placebo injections at the same intervals.
Results
A total of 35 patients were categorized into two groups: 18 received PRP treatment, while 17 were assigned to the saline group.
As we were conducting a 2-year follow up of the patients who have achieved satisfactory results upon receiving 3 doses of PRP. During the first 6 months following the initial three injections, no significant differences were observed between the two groups. However, after 6 months, the PRP group showed continuous improvement in all parameters regarding cavernousal artery diameter, peak systolic velocity, end diastolic velocity, IIEF-EF, SEP Q3, IIEF intercourse satisfaction Q6, 7,8 and IIEF overall satisfaction Q13, 14 up to 2 years of follow up, while the saline group exhibited a gradual decline in all parameters, although still better than baseline. None of the patients exhibited plaque formation, subcutaneous bruising, or any other significant adverse effects.
Conclusion
CONCLUDING MESSAGE: Platelet-Rich Plasma appears to be a reliable long-term treatment option for improving erectile dysfunction, with satisfactory outcomes and no serious adverse events. However, larger multicenter studies with extended follow-up are needed to confirm these findings.
{"title":"Is platelet rich plasma a promising treatment for erectile dysfunction? the first 2-year follow up randomized controlled study","authors":"Hussein Shaher, Tamer Diab, Mahmoud Farag, Kareem Noah","doi":"10.1016/j.cont.2025.102294","DOIUrl":"10.1016/j.cont.2025.102294","url":null,"abstract":"<div><h3>Background</h3><div>AIMS OF STUDY: To evaluate the therapeutic potential and safety of platelet-rich plasma (PRP) therapy in patients with mild to moderate erectile dysfunction, with a prospective observational follow-up of two years.</div><div>STUDY DESIGN, MATERIALS AND METHODS: Thirty-five patients with mild to moderate erectile dysfunction, based on the IIEF-EF score, received three injections of autologous PRP (3 mL per corpus), administered two weeks apart. Patients were evaluated at 1, 3, and 6 months, and then every 6 months for two years. After six months, the PRP group (18 patients) continued to receive maintenance PRP injections every six months, while the saline group (17 patients) received placebo injections at the same intervals.</div></div><div><h3>Results</h3><div>A total of 35 patients were categorized into two groups: 18 received PRP treatment, while 17 were assigned to the saline group.</div><div>As we were conducting a 2-year follow up of the patients who have achieved satisfactory results upon receiving 3 doses of PRP. During the first 6 months following the initial three injections, no significant differences were observed between the two groups. However, after 6 months, the PRP group showed continuous improvement in all parameters regarding cavernousal artery diameter, peak systolic velocity, end diastolic velocity, IIEF-EF, SEP Q3, IIEF intercourse satisfaction Q6, 7,8 and IIEF overall satisfaction Q13, 14 up to 2 years of follow up, while the saline group exhibited a gradual decline in all parameters, although still better than baseline. None of the patients exhibited plaque formation, subcutaneous bruising, or any other significant adverse effects.</div></div><div><h3>Conclusion</h3><div>CONCLUDING MESSAGE: Platelet-Rich Plasma appears to be a reliable long-term treatment option for improving erectile dysfunction, with satisfactory outcomes and no serious adverse events. However, larger multicenter studies with extended follow-up are needed to confirm these findings.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"16 ","pages":"Article 102294"},"PeriodicalIF":1.2,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-11DOI: 10.1016/j.cont.2025.102292
Irina Zabbarova , Pradeep Tyagi , Youko Ikeda , Xiangyu Yan , Visishta Ginjupally , Sophia Percy , Amanda Wolf-Johnson , Shachi Tyagi , Marcus Drake , Karl-Erik Andersson , Alan Wein , Christopher Fry , Anthony Kanai
Introduction
Nocturia, the urge to wake from sleep to void, is targeted sub-optimally by existing drugs that modulate circadian dysregulation of urine production in kidney without alleviating detrusor overactivity, a key aspect in the multifactorial etiology of nocturia. This study reports age-related upregulation of arginine vasopressin (AVP) synthesis in mouse urinary bladder to counter the concurrent decline in the kidneys’ ability to concentrate urine, another prevalent symptom of nocturia.
Methods
Adult/aged C57Bl/6 mice of both sexes were anesthetized with isoflurane for bladder permeability experiments and used awake for cystometries with saline and soybean oil. Bladder overactivity was induced by chronic acrolein instillation. AVP and VR expression was examined by western blot and immunofluorescence.
Results
Aged mice showed lower urine osmolality relative to adults that coincided with upregulation of urothelial pre-pro AVP synthesis and VR2 expression that would complement the endocrine action of AVP in promoting bladder reabsorption of free water from stored urine. This was evident from the amplified systemic uptake of tritiated water following bladder instillation of AVP or vasopressin receptor 2 (VR2) agonist, desmopressin (dAVP). Fedovapagon, a small molecule VR2 agonist, exerted anti-diuretic action in kidney, surpassing the efficacy of AVP or dAVP in free water reabsorption from stored urine in bladder and dampened detrusor overactivity.
Conclusion
Fedovapagon, with its anti-diuretic actions on kidney, augments the therapeutic benefit activating VR2 receptors in urothelium to promote water reabsorption and relax the detrusor. Therefore, bladder VR2 activation by fedovapagon exemplifies a mechanistic paradigm for addressing the multifactorial etiology of nocturia.
{"title":"Endogenous Vasopressin and Vasopressin Receptor 2 in Bladder as Anti-diuretic / Anti-spasmodic Targets for the Treatment of Multifactorial Nocturia","authors":"Irina Zabbarova , Pradeep Tyagi , Youko Ikeda , Xiangyu Yan , Visishta Ginjupally , Sophia Percy , Amanda Wolf-Johnson , Shachi Tyagi , Marcus Drake , Karl-Erik Andersson , Alan Wein , Christopher Fry , Anthony Kanai","doi":"10.1016/j.cont.2025.102292","DOIUrl":"10.1016/j.cont.2025.102292","url":null,"abstract":"<div><h3>Introduction</h3><div>Nocturia, the urge to wake from sleep to void, is targeted sub-optimally by existing drugs that modulate circadian dysregulation of urine production in kidney without alleviating detrusor overactivity, a key aspect in the multifactorial etiology of nocturia. This study reports age-related upregulation of arginine vasopressin (AVP) synthesis in mouse urinary bladder to counter the concurrent decline in the kidneys’ ability to concentrate urine, another prevalent symptom of nocturia.</div></div><div><h3>Methods</h3><div>Adult/aged C57Bl/6 mice of both sexes were anesthetized with isoflurane for bladder permeability experiments and used awake for cystometries with saline and soybean oil. Bladder overactivity was induced by chronic acrolein instillation. AVP and VR expression was examined by western blot and immunofluorescence.</div></div><div><h3>Results</h3><div>Aged mice showed lower urine osmolality relative to adults that coincided with upregulation of urothelial pre-pro AVP synthesis and VR2 expression that would complement the endocrine action of AVP in promoting bladder reabsorption of free water from stored urine. This was evident from the amplified systemic uptake of tritiated water following bladder instillation of AVP or vasopressin receptor 2 (VR2) agonist, desmopressin (dAVP). Fedovapagon, a small molecule VR2 agonist, exerted anti-diuretic action in kidney, surpassing the efficacy of AVP or dAVP in free water reabsorption from stored urine in bladder and dampened detrusor overactivity.</div></div><div><h3>Conclusion</h3><div>Fedovapagon, with its anti-diuretic actions on kidney, augments the therapeutic benefit activating VR2 receptors in urothelium to promote water reabsorption and relax the detrusor. Therefore, bladder VR2 activation by fedovapagon exemplifies a mechanistic paradigm for addressing the multifactorial etiology of nocturia.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"16 ","pages":"Article 102292"},"PeriodicalIF":1.2,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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