Think Tank 2: How Do We Precisely Define the "High Risk Bladder" and What Are the Interrelationships Between Inflammation, Blood Flow, Fibrosis, and Loss of Bladder Compliance?

IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY
Neurourology and Urodynamics Pub Date : 2025-03-01 Epub Date: 2024-10-30 DOI:10.1002/nau.25604
Salvador Arlandis, Christopher Fry, Michel Wyndaele, Apostolos Apostolidis, Enrico Finazzi-Agró, Pradeep Tyagi, Michael Winder, Hikaru Hashitani, Giovanni Mosiello, Marcio Augusto Averbeck, Alan Wein, Paul Abrams
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引用次数: 0

Abstract

Introduction: Defining "high-risk bladder" or "high-pressure bladder" involves recognizing the potential for an unsafe lower urinary tract, where dysfunction in storage and micturition can threaten upper urinary tract health, leading to unfavorable outcomes like dialysis, recurrent infections, systemic impact, or mortality.

Methods: ICI-RS was held in Bristol in June 2024, and Think Tank 2 aimed to define research priorities including identifying clinical predictors and developing prevention and monitoring strategies.

Results: Risk factors encompass both congenital and neurogenic lower urinary tract dysfunction, bladder outlet obstruction, vascular diseases, and inflammatory disorders, but a validated stratification risk is lacking. Reduced compliance and detrusor overactivity lead to high filling pressures and raised detrusor leak point pressure, playing urodynamic studies a crucial role in risk assessment, though further research is needed for different neurogenic populations. Congenital conditions such as spina bifida, posterior urethral valves, and bladder exstrophy also contribute to a high-risk bladder through fibrosis and reduced compliance. Inflammation and ischemia are key factors, with inflammation leading to fibrosis and impaired bladder storage and voiding function. Novel treatments, including sGC activators, PDE5 inhibitors, and regenerative therapies like stem cell injections and extracorporeal shock wave treatment, show promise in mitigating fibrosis and improving bladder compliance.

Conclusions: Identifying and validating clinical risk stratification models, precise biomarkers and therapeutic windows remains essential for effective management and reversal of bladder fibrosis and dysfunction.

智囊团 2:如何准确定义 "高危膀胱",炎症、血流、纤维化和膀胱顺应性丧失之间的相互关系是什么?
导言:定义 "高危膀胱 "或 "高压膀胱 "需要认识到下尿路不安全的潜在危险,储尿和排尿功能障碍会威胁上尿路健康,导致透析、反复感染、全身影响或死亡等不良后果:方法:2024 年 6 月在布里斯托尔举行了 ICI-RS,智囊团 2 旨在确定研究重点,包括确定临床预测因素以及制定预防和监测策略:风险因素包括先天性和神经源性下尿路功能障碍、膀胱出口梗阻、血管疾病和炎症性疾病,但缺乏有效的风险分层。顺应性降低和逼尿肌过度活动会导致充盈压升高和逼尿肌漏尿点压力升高,因此尿动力研究在风险评估中起着至关重要的作用,但针对不同的神经源性人群还需要进一步研究。脊柱裂、后尿道瓣膜和膀胱外翻等先天性疾病也会通过纤维化和顺应性降低导致膀胱高危。炎症和缺血是关键因素,炎症会导致纤维化,损害膀胱储存和排尿功能。包括sGC激活剂、PDE5抑制剂以及干细胞注射和体外冲击波治疗等再生疗法在内的新型治疗方法有望减轻纤维化并改善膀胱顺应性:确定和验证临床风险分层模型、精确的生物标志物和治疗窗口对于有效管理和逆转膀胱纤维化和功能障碍仍然至关重要。
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来源期刊
Neurourology and Urodynamics
Neurourology and Urodynamics 医学-泌尿学与肾脏学
CiteScore
4.30
自引率
10.00%
发文量
231
审稿时长
4-8 weeks
期刊介绍: Neurourology and Urodynamics welcomes original scientific contributions from all parts of the world on topics related to urinary tract function, urinary and fecal continence and pelvic floor function.
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