Neurourology and Urodynamics最新文献

{"title":"Transurethral Fulguration of Hunner Lesion Was Effective for Primary Management of Pelvic Pain in Patients With Interstitial Cystitis: A Long-Term Follow-Up Study.","authors":"Hyun Ju Jeong, Yu Jin Kang, Min Soo Choo, Seong Jin Jeong, Seung-June Oh","doi":"10.1002/nau.70051","DOIUrl":"https://doi.org/10.1002/nau.70051","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to analyze the outcomes of clinical management of patients with interstitial cystitis (IC).</p><p><strong>Patients and methods: </strong>We retrospectively analyzed the electronic medical records of patients with IC who visited outpatient clinics with pelvic pain between October 2005 and December 2019. Pain was managed with cystoscopic surgery based on transurethral fulguration (TUF) for bladder ulcers. Cystectomy was performed for intractable pelvic pain. Patients were regularly followed and clinical outcomes were analyzed.</p><p><strong>Results: </strong>Of the 275 patients, 240 patients (57 men, 23.7% and 183 women, 76.3%) underwent initial cystoscopic surgery. Overall median follow-up duration was 21.0 months and mean number of TUF was 1.0 (±0.8). Of these 240 patients, 71 (29.6%) did not require further surgical treatment, whereas 64 (26.7%) required a second TUF for recurrent pelvic pain. The median recurrence interval was 12.0 (interquartile range: 6.0-25.0) months. Of the 64 patients who received a second TUF, 15 (23.4%) underwent a third TUF after a median of 12.0 (interquartile range: 12.0-32.0) months. Of the 15 patients who received a third TUF, five patients required a fourth TUF because of recurrence of pain. One patient received until a seventh TUF. Overall, 168 of 240 patients (70.0%) achieved pain control with TUF. Eighteen patients (7.5%) underwent cystectomy (six patients with urinary diversion and 12 patients with cystectomy with bladder replacement).</p><p><strong>Conclusion: </strong>TUF-based cystoscopic surgery is an effective basic treatment for pelvic pain management in patients with IC.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Appraisal of Guidelines for Daytime Urinary Incontinence in Children: Evaluation of Quality and Recommendations on Diagnostics.","authors":"J Marleen Linde, Ilse Hofmeester, Martijn G Steffens, Francis J Kloosterman-Eijgenraam, Rien J M Nijman, Marco H Blanker","doi":"10.1002/nau.70047","DOIUrl":"https://doi.org/10.1002/nau.70047","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to evaluate the quality of currently available guidelines on non-neurogenic daytime urinary incontinence (DUI) in children and compare their content regarding the assessment of a child with DUI.</p><p><strong>Methods: </strong>We conducted a systematic search for guidelines on non-neurogenic DUI in children. A multidisciplinary team assessed the quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE) instrument, which contains 23 items organized into six domains. Besides, each member evaluated if they would recommend using the guidelines. We extracted diagnostic recommendations from all guidelines for a descriptive comparison.</p><p><strong>Results: </strong>Eight guidelines were included. Overall quality scores ranged from 2.6 to 5.8 on a 7-point scale, (1 for lowest and 7 for highest quality). Three guidelines were rated as good, four as moderate, and one as low quality. The AGREE-II domain Clarity and Presentation received high scores across all guidelines, while Rigour of Development and Applicability received the lowest scores. Recommendations for diagnostics were generally similar, with variations observed in guidelines targeting primary and secondary healthcare.</p><p><strong>Conclusions: </strong>This study is the first to assess the quality of guidelines on non-neurogenic DUI in children. The quality varies, only two out of eight guidelines were recommended by the review team without adjustments. Guideline developers could improve the quality of their guidelines by using tools like AGREE II. Clinicians should consider the findings of our study when selecting a guideline to use in their daily practice.</p><p><strong>Clinical trial registration: </strong>As this is a review, no clinical trial registration was conducted. The review protocol has been registered in PROSPERO (CRD42021149059).</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Appraisal of Guidelines for Daytime Urinary Incontinence in Children: Comparison of Recommendations on Treatment.","authors":"J Marleen Linde, Ilse Hofmeester, Martijn G Steffens, Francis J Kloosterman-Eijgenraam, Rien J M Nijman, Marco H Blanker","doi":"10.1002/nau.70046","DOIUrl":"https://doi.org/10.1002/nau.70046","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to compare the recommendations on therapy from currently available guidelines on non-neurogenic daytime urinary incontinence (DUI) in children.</p><p><strong>Methods: </strong>We conducted a systematic search for guidelines on non-neurogenic DUI in children. We extracted the therapy recommendations from all the guidelines for a descriptive comparison.</p><p><strong>Results: </strong>Eight guidelines were included. All guidelines advise urotherapy as the first step of treatment in children with DUI. They all agree on the importance of addressing co-existing bowel dysfunction and urinary tract infections. Neuromodulation was recommended as an early treatment modality in three guidelines, while the others reserve it for special cases (n = 2) or do not mention it at all (n = 3). Pharmacotherapy with anticholinergics is often recommended, sometimes when urotherapy is insufficient, and by some guidelines simultaneously. The use of newer beta-3-agonists was only mentioned by recently (2019 and 2021) published guidelines. Only half of the guidelines mentioned the level of evidence with their recommendations, and when mentioned, the quality of the evidence is generally low.</p><p><strong>Conclusion: </strong>Overall, the recommendations for treating non-neurogenic DUI in children are generally consistent, with all the guidelines endorsing urotherapy as the initial treatment. However, differences exist regarding additional treatments such as neuromodulation and pharmacotherapy, both areas of active research with evolving insights. The observed differences can be explained by the publication date of the guidelines and the target audience. The evidence supporting the recommendations is generally of low quality, indicating a need for further research in the field of DUI in children.</p><p><strong>Trial registration: </strong>As this is a review, no clinical trial registration was conducted. The review protocol has been registered in PROSPERO (CRD42021149059).</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Vision Augmentation to Detect Detrusor Overactivity in Overactive Bladder: A Frontier of Artificial Intelligence Application in Functional Urology-Proof of Concept Clinical Study.","authors":"Shauna J Q Woo, Yu Guang Tan, Mark K F Wong, Jin Yong, Ajith Joseph, Eric C M Loh, Lay Guat Ng","doi":"10.1002/nau.70040","DOIUrl":"https://doi.org/10.1002/nau.70040","url":null,"abstract":"<p><strong>Introduction: </strong>Overactive bladder (OAB) is a common urological condition with increasing prevalence, especially in an aging population. Diagnosing and treating OAB can be challenging. While urodynamic study (UDS) is useful to confirm involuntary detrusor overactivity (DO), it is invasive, time-consuming, and requires good patient coordination, which limits its clinical utility. In this proof-of-concept clinical trial, we propose a novel method in which cystoscopic images can be augmented by machine vision to identify DO and detect OAB based on differences in vascular network motion over time.</p><p><strong>Materials and methods: </strong>We prospectively extracted 30-second clips from 112 videos that were relatively artifact-free. This cohort consisted of 34 UDS confirmed DO and 78 non-OAB videos. Over 85 000 frames were then processed in the following manner: (A) De-noised to remove artifacts, (B) Super-resolution enhancement, (C) Segmentation and identification of keypoints along the vascular network, (D) Mosaic stitching of frames to reconstitute a 3D bladder map after accounting for geometric distortions, (E) Tracking of keypoint motion differences over time as a surrogate for areas for DO.</p><p><strong>Results: </strong>The structure-from-motion pipeline demonstrated satisfactory 3D reconstructions of processed cystoscopy videos. Videos from OAB patients showed a mean of 113.9 pixel-deviations per time frame (SD 32.8). This is 324.5% of those in the non-OAB group, which had an average of 35.1 pixel-deviations (SD 31.3) (p < 0.001). The heatmap generated provided a topographical representation of the cystoscopic views, thus helping to identify key areas of increased focal detrusor contractions.</p><p><strong>Conclusion: </strong>We describe a novel model leveraging AI machine vision to demonstrate statistically increased keypoint deviations on the detrusor vascular network of OAB patients as compared to non-OAB patients. This technology may potentially streamline the diagnosis of OAB and identify localized areas of increased DO for targeted treatment.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"β₃-Adrenoceptor Agonist Effects on the Urinary Bladder Beyond Detrusor Relaxation.","authors":"Martin C Michel, Ebru Arioglu-Inan, Martin Hennenberg","doi":"10.1002/nau.70043","DOIUrl":"https://doi.org/10.1002/nau.70043","url":null,"abstract":"<p><strong>Aims: </strong>β₃-Adrenoceptor agonists such as mirabegron or vibegron reach pharmacokinetic steady-state within a few days. However, maximum improvements in symptoms of the overactive bladder syndrome are reached at time points later than 4 weeks, that is, detrusor smooth muscle relaxation cannot fully explain clinical effects. Therefore, we review mechanistic studies that have administered such drugs for longer periods of time.</p><p><strong>Methods: </strong>Narrative review.</p><p><strong>Results: </strong>The limited data indicates that β₃-adrenoceptor agonists reduce bladder fibrosis and hypertrophy and may induce cell proliferation, and normalize increased apoptosis and ferroptosis. On the other hand, limited data also indicate that detrusor relaxation responses can partly desensitize with prolonged agonist exposure, possibly off-setting effects on fibrosis and hypertrophy.</p><p><strong>Conclusions: </strong>Further long-term studies with β₃-adrenoceptor agonists are needed to clarify the role of such processes in clinical improvement of patients with overactive bladder syndrome occurring at time points later than 4 weeks after initiation of treatment.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanded Physiological Testing of the Lower Urinary Tract In Asymptomatic Women and Those With Urgency Urinary Incontinence: Findings From the LURN-Organ Study.","authors":"James A Hokanson, John O L DeLancey, Anna C Kirby, Brenda Gillespie, H Henry Lai, Karl J Kreder, C Emi Bretschneider, Nick Slavik, Calvin Andrews, Victor Andreev, Linda Black, Sarah Richardson, Kimberly Kenton, Ziya Kirkali, Claire C Yang","doi":"10.1002/nau.70038","DOIUrl":"https://doi.org/10.1002/nau.70038","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate sensory and motor function of the bladder and urethra in women with and without urgency urinary incontinence (UUI).</p><p><strong>Materials and methods: </strong>Treatment-seeking women with UUI and healthy, asymptomatic, nontreatment seeking controls enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network Organ-Based study (LURN-Organ) and underwent a single session of physiological testing. Testing included rapid-fill cystometry before and after lidocaine administration, urethral pressure profiles, pelvic floor contraction (Kegel) testing, and tuning fork sensation testing at the urethral meatus.</p><p><strong>Results: </strong>Data were collected from 31 asymptomatic controls and 56 women with UUI. Women with UUI were more likely to demonstrate detrusor overactivity (DO) (32% vs. 10% in controls, p = 0.019). In addition, women with UUI on average generated 25% lower active urethral closure pressures during maximal contraction (p = 0.0016) and reported sensations at lower volumes during cystometry (34% lower for first desire to void, p = 0.028; 34% lower for strong desire to void, p = 0.0017; and 32% lower for maximum cystometric capacity, p = 0.0047). Women with UUI demonstrated diminished urethral sensation on the tuning fork test (median of 7 vs. 8 in controls) though the difference was not significant (p = 0.054). Considerable overlap in all findings occurred between cases and controls in each parameter. While individual component comparisons revealed some differences, additional multivariable analysis demonstrated prominently the physiological heterogeneity of women with UUI.</p><p><strong>Conclusions: </strong>Women with UUI demonstrated varying amounts of bladder sensory dysfunction, urethral motor dysfunction and bladder motor dysfunction. Considering the function of lower urinary tract components in combination may reveal UUI phenotypes, highlighting the need to study UUI from a multifactorial perspective.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov Identifier:NCT04557748.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transvaginal Electrical Stimulation for Treatment of Overactive Bladder Without Incontinence: A Pilot Cross-Over Clinical Trial.","authors":"Michele Torosis, Lynn Stothers, Crystal Cisneros, Georgina Dominique, A Lenore Ackerman","doi":"10.1002/nau.70034","DOIUrl":"https://doi.org/10.1002/nau.70034","url":null,"abstract":"<p><strong>Objectives: </strong>Few studies look at therapeutic efficacy specifically in the OAB population that lacks urgency incontinence (OAB-dry). Transvaginal electrical stimulation (TES) improves urgency incontinence in OAB-wet by targeting the detrusor muscle by reflex inhibition but has not yet been trialed for the improvement of urgency and frequency symptoms alone without incontinence. This study sought to measure the efficacy of an at-home TES program on urgency and frequency symptoms alone in OAB-dry.</p><p><strong>Methods: </strong>This was a prospective, randomized, cross-over, controlled trial of women > 18 years old presenting to a urogynecology clinic with urinary urgency and frequency without incontinence. Participants were randomized to receive 4 weeks of sham, followed by a 3-week washout period, and then 4 weeks of intervention (Arm 1), or the reverse (Arm 2). Intervention included 15 min/day of TES using a TENS unit and transvaginal probe with stimulation width of 100 µs, rate of 12 Hz, and amplitude set by participant based on sensation. Baseline bladder symptoms were captured with voiding diaries and standardized questionnaires. Standardized pelvic floor muscle exam was performed at the beginning and end of treatment. Participants were categorized as responders if the participants stated they planned to continue the TES as their primary treatment after study completion. Outcomes were compared using t-tests, χ², and Fisher exact tests.</p><p><strong>Results: </strong>In total, 19 enrolled and 15 (79%) completed the study and had primary outcomes data available for analysis. There were no demographic differences between arms. Mean OAB-q scores for all at baseline was 25.1, post-sham was 22.9, and post-TES was 17.60, for a mean change of -7.73 points (95% CI, -21.5 to 5.9), p = 0.007). There was a reduction in voids per 24 h from 11.3 (± 3.7) to 9.0 (± 3.6) posttreatment (p = 0.048). Response, defined as continuation of therapy, had a significant association with lack of pelvic floor tenderness on baseline standardized exam (OR 0.96, CI 0.94-0.99).</p><p><strong>Conclusions: </strong>These data suggest there are two phenotypes within OAB-dry, those with pelvic floor myofascial dysfunction that do not respond to bladder directive therapy, and those who represent a population of less severe OAB-wet with detrusor overactivity, which respond to bladder directive therapy. TES is a viable treatment option for this population, resulting in clinically significant improvements in urinary symptoms and patient-reported disease severity.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT04957524.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medium-Term Outcomes of Total Autologous Fascia Lata Anterior and Apical Pelvic Organ Prolapse Repair.","authors":"Ava A Delu, Joel T Funk, Christian O Twiss","doi":"10.1002/nau.70042","DOIUrl":"https://doi.org/10.1002/nau.70042","url":null,"abstract":"<p><strong>Purpose: </strong>The recognition of synthetic vaginal mesh as a high-risk device in pelvic organ prolapse (POP) repair has led to a resurgence in the utilization of autologous graft and emphasizes the need for long-term studies into the use of autologous materials. In a 33-patient cohort, we highlighted our earliest results of a transvaginal repair for apical and anterior prolapse using a graft harvest of autologous fascia lata. In an updated cohort of 63 patients with up to 5 years of follow-up, we report our current findings.</p><p><strong>Methods: </strong>The Autologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair begins with a solitary, lateral 7-10 cm thigh incision, through which, a 4 × 14 cm segment of fascia lata is harvested. Transvaginal reconfiguration of the graft results in apical fixation to the sacrospinous ligaments and distal fixation to the obturator fascia. Concurrent procedures, including autologous pubovaginal sling, were performed as indicated. Several patient parameters were monitored including medical history, Visual Analog Pain (VAP) Score, SEAPI scores, POP-Q scores, and Baden-Walker grading. We defined a successful repair as absent symptomatic apical or anterior POP.</p><p><strong>Results: </strong>A total of 63 patients with an average age of 64 years underwent AAA-POP repair. Mean follow-up was 17 months (range 1-65); 18 patients had 24 months or more of follow-up. Complete POP symptom resolution was reported in 49 (78%) patients. In total, 11 patients (17%) experienced treatment failure; 5 of this subgroup (45%) underwent a uterine sparing procedure. Urinary retention postoperatively occurred in 20 patients and pubovaginal sling was concurrently performed in 18 of the patients in this subgroup (90%). Minor harvest site issues occurred and were managed expectantly. Nonbothersome thigh bulges occurred in 15 patients. Nine patients experienced a seroma at the harvest site, and five underwent aspiration. Mild paresthesia was reported by 37 patients. Mean VAP score of the fascia lata harvest site was 0.37.</p><p><strong>Conclusion: </strong>The AAA-POP repair medium-term follow-up results reaffirm the procedure's efficacy as a transvaginal and nonmesh repair of POP. Patients should be advised of several precautions including the higher frequency of treatment failure with the uterine sparing approach, potential for urinary retention if pubovaginal sling placement is performed concurrently, and morbidities associated with the harvest site. Our results continue to uphold the AAA-POP repair and its role as a treatment option for patients desiring a nonmesh approach to POP repair.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Predictive Tool for Midterm Success of Sacral Neuromodulation in Non-Neurogenic Overactive Bladder Syndrome.","authors":"Samy Hafez, Morgane Pere, Louise Olivier, Benjamin Carolus, Marie-Liesse De Guerry, Jérôme Rigaud, Xavier Biardeau, Marie-Aimée Perrouin-Verbe","doi":"10.1002/nau.70041","DOIUrl":"https://doi.org/10.1002/nau.70041","url":null,"abstract":"<p><strong>Objectives: </strong>To identify factors that can predict both test phase and midterm success of sacral neuromodulation (SNM) in refractory non-neurogenic overactive bladder syndrome (nnOAB) based on preoperative clinical and urodynamic data.</p><p><strong>Materials and methods: </strong>We conducted a two-center retrospective study and included all individuals with nnOAB who underwent a test phase between 2005 and 2021, with or without subsequent implantation of an SNM device. Only those with preoperative urodynamic assessment data were included. SNM success was defined as <math> <semantics> <mrow><mrow><mo>≥</mo></mrow> </mrow> <annotation>$ge $</annotation></semantics> </math>  50% improvement in one of the bladder diary parameters, associated with <math> <semantics> <mrow><mrow><mo>≥</mo></mrow> </mrow> <annotation>$ge $</annotation></semantics> </math>  50% symptom improvement. Individuals underwent follow-up evaluation at 2 years.</p><p><strong>Results: </strong>In total, 191 individuals were included (163 women), 69% of whom underwent SNM device implantation. At the preoperative urodynamic exam, 115 individuals had detrusor overactivity (DO). Test phase success was associated with younger age (p = 0.009). 24-month SNM success was associated with lower maximal detrusor pressure at DO (Pdet max DO) at baseline (p = 0.045). Other predictive factors for success at 2 years were female (p = 0.03), a history of stress incontinence surgery (p = 0.01), a low maximum urethral closure pressure (MUCP) (p = 0.04), a low volume at first DO (VFDO) (p = 0.03), and a high maximum cystometric capacity (MCC) (p = 0.03). We developed a tool to predict success at 2 years. The following threshold values were significantly associated with treatment success: MUCP < 58 cmH₂O, VFDO < 170 mL, and MCC > 254 mL.</p><p><strong>Conclusion: </strong>Age predicted test phase success. Pdet max DO, gender, history of incontinence surgery, high MUCP, MCC, and VFDO predicted midterm success of SNM in people with nnOAB.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravesical Botulinum Toxin Injection for Treating Detrusor Overactivity and Poor Compliance in Posterior Urethral Valves-A Preliminary Experience.","authors":"Sharon Mohan Kunnath, Eskinder Solomon, Pankaj Mishra, Anne J Wright, Joanna Clothier, Massimo Garriboli","doi":"10.1002/nau.70039","DOIUrl":"https://doi.org/10.1002/nau.70039","url":null,"abstract":"<p><strong>Purpose: </strong>To report our preliminary experience on the use of Botulinum toxin A in boys with posterior urethral valves for treating detrusor overactivity and/or reduced bladder compliance not responsive to medical treatment.</p><p><strong>Material and methods: </strong>Primary outcome measures studied were change in baseline end fill pressure (pDet), compliance, maximum Detrusor overactivity pressure (DO), fractional bladder capacity (FBC), vesicoureteric reflux (VUR) grade/resolution. Secondary outcome measures were serum creatinine and estimated glomerular filtration rate (eGFR). Low compliance group was defined as rise in baseline pDet > 20 cmH₂O. High pressure DO was defined as maximum pDet > 40 cmH₂0.</p><p><strong>Results: </strong>A total of 15 children were included in the analysis. The median decrease in end fill pDet in the whole cohort was from 20 cmH₂O (14.5-30) to 16 cmH₂O (10.5-22) (p = 0.065). By analyzing the patients with low compliance, we identified a median decrease in end fill pDet from 32 cmH₂O (26.5-44.5) to 19 cmH₂O (16.5-25.5) (p = 0.028). The median change in compliance for all the boys was from 6 mL/cmH₂O (4.51-7.3) to 12.1 mL/cmH₂O (7.44-17.3) (p < 0.001). The median change in compliance in the low compliance group was from 5.5 mL/cmH₂O (4.42-7.1) to 8.8 mL/cmH₂O (7.39-13.3) (p = 0.018). The median change in fractional bladder capacity for all the boys was from 0.70 (0.55-0.92) to 0.98 (0.79-1.42) (p = 0.061). A complete resolution of DO was observed in 7 out of 11 patients. Complete resolution of VUR was observed in 5 out of 8 renal units.</p><p><strong>Conclusion: </strong>Botulinum toxin A can be considered in the treatment strategy for reduced bladder compliance and detrusor overactivity in boys with PUV.</p><p><strong>Trial registration: </strong>15894.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}