Neurourology and Urodynamics最新文献

{"title":"Widespread Pain Moderates the Response to Centrally-Acting Therapies in an Observational Cohort of Patients With Urologic Chronic Pelvic Pain Syndrome: A MAPP Research Network Study.","authors":"Andrew Schrepf, Kenneth Locke, Robert Moldwin, David A Williams, Sara Till, John Farrar, J Richard Landis, Frank Tu, Larissa Rodriguez, Henry Lai, Bruce Naliboff, Jason Kutch, Steven E Harte, Richard E Harris, Karl J Kreder, Tracy Spitznagle, Lindsey McKernan, Claire Yang, J Quentin Clemens, Chris Mullins, Daniel J Clauw","doi":"10.1002/nau.70068","DOIUrl":"https://doi.org/10.1002/nau.70068","url":null,"abstract":"<p><strong>Purpose: </strong>Urologic Chronic Pelvic Pain Syndrome (UCPPS) impacts millions of people in the United States but treatment options remain largely unsatisfying. A large number of neurobiological studies from the Multidisciplinary Approach to the study of chronic Pelvic Pain (MAPP) research network and others point to aberrant pain mechanisms in patients with UCPPS and widespread pain, but the clinical significance of widespread pain has been speculative.</p><p><strong>Materials and methods: </strong>In the current exploratory study we investigated whether pain and urologic symptoms responded to centrally-directed therapies (tricyclic antidepressants/gabapentinoids) versus peripherally-directed (pelvic floor physical therapy/hydrodistension) therapies depending on the presence or absence of widespread pain when the new treatment was initiated.</p><p><strong>Results and conclusions: </strong>Forty UCPPS patients (n = 19 widespread) underwent an evaluation of UCPPS symptoms before and after twelve weeks of either centrally-directed (n = 16) or peripherally-directed therapy. Participants were stratified post hoc into widespread (two or more non-pelvic pain sites + pelvic pain) and localized pain categories. General linear models were used to test the group X treatment interaction effect, adjusting for age, sex, and baseline outcome levels. On average, patients with widespread pain receiving centrally-directed therapies improved more than six points on the 0-28 Pelvic Pain Severity scale, while those with localized pain showed no average improvement (interaction p = 0.005). Similar effects were observed for the bladder symptom impact score (interaction p = 0.011) but not urologic symptom severity (interaction p = 0.72). While these findings are exploratory, they provide preliminary evidence for phenotype X treatment interactions in UCPPS and should be followed by confirmatory studies.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02514265-MAPP Research Network: Trans-MAPP Study of Urologic Chronic Pelvic Pain: Symptom Patterns Study (SPS).</p><p><strong>Clinicaltrials: </strong>gov Identifier: NCT02898220-Trans-MAPP Study of Urologic Chronic Pelvic Pain: Control Study Protocol.xs.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143080","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":"Diagnostic Performances of Patient's Interview, Uroflowmetry Alone and Uroflowmetry Paired With Electromyography as Screening Tools to Identify Straining to Void.","authors":"Sami Lasri, Pierre-Luc Dequirez, Émeline Caillau, Laurence Queval, Marie-Aimée Perrouin-Verbe, Xavier Biardeau","doi":"10.1002/nau.70083","DOIUrl":"https://doi.org/10.1002/nau.70083","url":null,"abstract":"<p><strong>Aims: </strong>To assess the diagnostic performances of patient's interview, final uroflowmetry alone and final uroflowmetry paired with rectus abdominis muscle electromyography (EMG) as screening tools to identify straining to void.</p><p><strong>Methods: </strong>All consecutive patients who underwent a multi-channel urodynamic study to explore filling phase disorders - including final uroflowmetry associated with intrarectal pressure monitoring - between 2020 and 2021 in our department of urology were considered eligible. Intrarectal pressure curves (gold-standard) were examined by two senior urologists and a continence nurse to determine by consensus the presence of straining to void. The final uroflowmetry curves and final uroflowmetry paired with EMG curves were retrospectively submitted for interpretation to 3 groups of urologists with different levels of experience (residents, fellows, seniors). Each group was composed of 3 independent examiners blinded to intrarectal pressure. The diagnostic performances of patient's interview, and the diagnostic performances as well as the inter- and the intra-examiner correlation of final uroflowmetry alone and final uroflowmetry paired with EMG were assessed.</p><p><strong>Results: </strong>Overall, 282 neurogenic and non-neurogenic patients were included in the present study. The patient's impression to identify straining to void was associated with a sensitivity, a specificity, a predictive positive value (PPV) and a negative predictive value (NPV) of 68.4%, 63.9%, 68.0% and 64.3%, respectively. Final uroflowmetry alone was associated with a sensitivity, a specificity, a PPV and a NPV of 60.4%, 75.1%, 73.1% and 62.8%, respectively. Final uroflowmetry paired with EMG was associated with a sensitivity, a specificity, a PPV and a NPV of 61.3%, 84.9%, 81.6% and 66.8%, respectively. The inter- and intra-examiner agreement of final uroflowmetry alone was reported as moderate to poor, ranging between 0.17 and 0.72 and 0.58-0.79, respectively. The inter- and intra-examiner agreement of final uroflowmetry paired with electromyography was reported as moderate to poor, ranging between 0.26 and 0.73 and 0.59-0.81, respectively.</p><p><strong>Conclusion: </strong>Patient's interview, final uroflowmetry alone and paired with rectus abdominis muscle EMG, are not reliable enough to be considered as screening tools for straining to void.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143076","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":"Adenosine Receptor Mechanisms Underlying Bladder Dysfunction in Male Rats With Bladder Outlet Obstruction.","authors":"Ei-Ichiro Takaoka, Masahiro Kurobe, Kanako Matsuoka, Tadanobu Kamijo, Shingo Kimura, Paul N Watton, Anne M Robertson, Naoki Yoshimura","doi":"10.1002/nau.70080","DOIUrl":"https://doi.org/10.1002/nau.70080","url":null,"abstract":"<p><strong>Aims: </strong>We examined the role of subtypes of adenosine receptors in bladder dysfunction and changes in the adenosine receptor expression in the bladder using male rats with partial bladder outlet obstruction (BOO).</p><p><strong>Methods: </strong>In Sprague-Dawley rats (male 8-weeks old), BOO was produced by a partial ligation of the urethra along a metal rod of a 1.2 mm outer diameter. Control rats underwent sham operation. Awake cystometrograms (CMG) were first recorded during saline instillation, and then an adenosine A1 receptor agonist (CCPA, 4.1 μM), an adenosine A2A antagonist (ZM241385, 15 μM), or inosine (1 mM) were applied intravesically in sham and BOO rats. In addition, mRNA levels of adenosine receptor subtypes in the bladder wall were measured using RT-PCR. Histological studies of bladder specimen were also performed.</p><p><strong>Results: </strong>Weights of BOO bladders were significantly (p < 0.0001) larger compared with sham bladders. In CMG, a number of non-voiding contractions (NVCs), bladder contraction amplitudes during voiding, bladder capacity, and post-void residual (PVR) were significantly (p < 0.001) increased compared with sham rats. Voiding efficiency (VE) was significantly (p < 0.001) reduced in BOO versus sham rats. Intravesical application of CCPA or inosine did not induce statistically significant effects on CMG parameters in BOO rats. Yet, ZM241385 induced a significant (p = 0.040) reduction in NVCs of BOO rats. mRNA levels of adenosine A2A and A3 receptors were significantly (p < 0.0001 and p = 0.0145, respectively) upregulated in the BOO bladder mucosa, whereas adenosine A2B receptors showed a significant (p < 0.0001) reduction in the BOO bladder mucosa compared with sham bladders. Histologically, we found the thickened detrusor muscle layer in BOO versus sham rats.</p><p><strong>Conclusions: </strong>The male rat model of BOO seems to be suitable for exploring urethral obstruction-related bladder dysfunction at the compensated phase. In addition, the adenosine A2A receptor subtype would be a potential target for the treatment of male BOO patients with bladder overactivity.</p><p><strong>Clinical trial registration: </strong>A clinical trial registration is not required as this study reported the basic research data using animal models.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120387","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":"Effectiveness of Extracorporeal Magnetic Stimulation in the Treatment of Pelvic Floor Dysfunction: A Systematic Review and Meta-Analysis.","authors":"Zhen Yang, Jiaquan Liao, Shangang Zhang, Minyan Zhang, Linru Qiao","doi":"10.1002/nau.70082","DOIUrl":"https://doi.org/10.1002/nau.70082","url":null,"abstract":"<p><strong>Objectives: </strong>This study employs systematic review and meta-analysis methodologies to investigate the efficacy and safety of extracorporeal magnetic stimulation in treating pelvic floor dysfunction, based on published randomized clinical trials. The aim is to provide high-level evidence in evidence-based medicine for clinical decision-making and treatment interventions.</p><p><strong>Data sources: </strong>Study were conducted to include randomized clinical trials from the inception of databases until March 2024 in four databases: PubMed, the Cochrane Library, Web of Science, and EMBASE.</p><p><strong>Review methods: </strong>Eligible studies were selected by two independent investigators. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Meta-analysis was performed using the RevMan 5.3 software. The review protocol was registered on PROSPERO (CRD42024526565).</p><p><strong>Results: </strong>A systematic review incorporating 24 studies and a meta-analysis involving 14 studies demonstrated significant differences in the improvement of patients with urinary incontinence when subjected to extracorporeal magnetic stimulation compared to control groups, as evidenced by the changes in ICIQ-SF and QOL scores (Standardized Mean Difference [SMD] = -0.73, 95% Confidence Interval [CI] [-1.05, -0.41], and SMD = -0.43, 95% CI [-0.82, -0.04], respectively). However, no substantial therapeutic effects were observed in improving functional impairments among patients with overactive bladder (OAB) or chronic pelvic pain (CPP).</p><p><strong>Conclusion: </strong>There is considerable evidence supporting the efficacy of magnetic stimulation for treating urinary incontinence. However, further high-quality, large sample randomized controlled trials are necessary to strengthen the evidence for its effectiveness in addressing other pelvic floor dysfunctions.</p><p><strong>Clinical trial registration: </strong>This study does not involve a real-world clinical trial. The data used are from published clinical trials for secondary analysis. Therefore, clinical trial registration is not applicable. However, the review protocol was registered on PROSPERO (CRD42024526565).</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120389","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":"Correlates of Nocturia With ≥ 2 Nighttime Voids in Older Adults: Associations With Dry Mouth and Sleep Quality.","authors":"Osamu Natsume, Nobutaka Nishimura, Kiyohide Fujimoto","doi":"10.1002/nau.70081","DOIUrl":"https://doi.org/10.1002/nau.70081","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to identify potential predictive factors of nocturia with ≥ 2 nightly voids, with a particular focus on nocturnal polyuria (NP).</p><p><strong>Methods: </strong>A total of 154 men aged 42-88 years were enrolled. Participants were categorized into two groups based on the number of nighttime voids: Group A (< 2 voids/night, n = 79) and Group B (≥ 2 voids/night, n = 75), including a subgroup with NP (n = 61). All participants completed 3-day frequency-volume charts and self-administered questionnaires assessing oral dryness using a visual analog scale and subjective sleep quality. Multivariable logistic regression analysis was performed to identify predictors of nocturia with ≥ 2 voids.</p><p><strong>Results: </strong>Compared with Group A, Group B demonstrated significantly lower total scores on the Nocturia-Specific Quality of Life Questionnaire (p < 0.001), higher Overactive Bladder Symptom Scores (OABSS) (p < 0.001), shorter time to first nocturnal void (u-HUS; p < 0.001), greater nocturnal oral dryness (p = 0.004), and poorer subjective sleep quality (p = 0.006). There were no significant differences in the number of medications taken between groups. Among participants with NP, those with ≥ 2 voids exhibited significantly poorer sleep quality (p = 0.007), increased nocturnal oral dryness (p = 0.030), and shorter u-HUS (p < 0.001) compared with those with < 2 voids. Multivariable analysis identified nocturnal oral dryness (p = 0.015), shortened u-HUS (p < 0.001), and elevated OABSS (p = 0.045) as independent predictors of nocturia with ≥ 2 voids.</p><p><strong>Conclusions: </strong>Increased nocturnal oral dryness and shortened u-HUS are associated with nocturia involving ≥ 2 nighttime voids and may negatively impact quality of life, particularly in patients with NP. These findings highlight the clinical importance of addressing dry mouth as a significant comorbidity in older adults with nocturia.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120388","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":"Commentary on \"Transvaginal Electrical Stimulation for Treatment of Overactive Bladder Without Incontinence: A Pilot Cross-Over Clinical Trial\".","authors":"Venkata Dileep Kumar Veldi, Rachana Mehta, Ranjana Sah","doi":"10.1002/nau.70062","DOIUrl":"https://doi.org/10.1002/nau.70062","url":null,"abstract":"","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111148","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":"Dysfunctional Urinary Incontinence Strategies: A Mediation Model to Explain Why Urinary Incontinence Symptoms Are Associated With Social Isolation Among Women.","authors":"Marta G Porto, João Marôco, Teresa Mascarenhas, Filipa Pimenta","doi":"10.1002/nau.70079","DOIUrl":"https://doi.org/10.1002/nau.70079","url":null,"abstract":"<p><strong>Objective: </strong>Female urinary incontinence (UI) can lead to social isolation (SI). To reduce UI's probable impact, women tend to self-manage their symptoms and employ coping strategies which can sometimes be dysfunctional and exacerbate SI. UI dysfunctional coping strategies are primarily employed as a means of self-management, with women failing to engage in efforts to seek treatment. Literature regarding the mediating role of dysfunctional UI strategies in the relationship between UI severity and SI is scarce. Therefore, this study investigated the mediating role of dysfunctional UI hiding and defensive coping strategies in explaining the relationship between UI severity and SI, among middle-aged women experiencing stress, urgency, and mixed UI.</p><p><strong>Study design: </strong>The study adopted a cross-sectional, observational, descriptive, and correlational design, and recruited 1090 women online (social media) aged 40-65 years, who reported occasional or frequent urine loss and were not receiving any treatment for UI.</p><p><strong>Main outcome measures: </strong>The predictor was symptom severity; the mediator outcome was dysfunctional UI strategies, and the main outcome measure was SI.</p><p><strong>Results: </strong>Mediation analysis with structural equation modeling indicated that dysfunctional coping strategies significantly mediated the relationship between UI severity and SI, explaining a variability of 0.45 in SI. The direct effect between UI severity and SI was nonsignificant when indirect paths were included. Multigroup analysis indicated that the mediation model was consistent across different UI types, showing that the influence of dysfunctional strategies on SI was similar, regardless of the UI type.</p><p><strong>Conclusions: </strong>UI severity influences social isolation through coping behaviors focused on defensive and hiding behaviors in women who have not sought treatment for UI and across the different UI types, highlighting the importance of addressing these strategies in healthcare interventions. Tailoring interventions to modify maladaptive coping strategies is crucial for reducing SI, and enhancing the quality of life of women experiencing UI.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094439","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":"A Novel Scoring System to Assess Continence Quality Outcomes of Orthotopic Ileal Neobladders After Open and Robot-Assisted Radical Cystectomy: The Urodynamic Trifecta.","authors":"Umberto Anceschi, Fabrizio Di Maida, Giuseppe Chiacchio, Riccardo Mastroianni, Gabriele Tuderti, Luca Lambertini, Simone Albisinni, Manuela Mattioli, Anna Cadenar, Simone Flammia Rocco, Samuele Nardoni, Francesco Prata, Eleonora Rosato, Francesca Valastro, Aldo Brassetti, Mara Bacchiani, Anastasios Asimakopoulos, Vincenzo Salamone, Salvatore Basile, Sofia Giudici, Giulia D'Ippolito, Andrea Grosso Antonio, Antonio Tufano, Leslie Licari, Eugenio Bologna, Andrea Mari, Agostino Tuccio, Enrico Finazzi Agrò, Cosimo De Nunzio, Rocco Papalia, Costantino Leonardo, Andrea Minervini, Giuseppe Simone","doi":"10.1002/nau.70078","DOIUrl":"10.1002/nau.70078","url":null,"abstract":"<p><strong>Introduction: </strong>A comprehensive scoring system for standardizing quality of functional outcomes of orthotopic ileal neobladders (OINs) is still unavailable. In this study we propose a novel trifecta for both open and robot-assisted radical cystectomy conceived on urodynamic parameters that summarize OINs functional outcomes regardless of the surgical technique used and predicts continence status.</p><p><strong>Materials & methods: </strong>Between June 2017 and May 2023 two prospective, institutional review board approved, radical cystectomy datasets were matched and queried for \"OINs\" \"and \"urodynamic evaluation\" (n = 149). Urodynamic assessment was performed between 6 and 9 months after surgery. Baseline data and complete urodynamic profile including uroflowmetry, cystometry, compliance, presence of residual peristaltic activity, abdominal leak point pressures (ALPP) and daytime and night-time continence were reported. Descriptive analyses were used. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQRs) were reported for continuously coded variables. Trifecta was defined as the coexistence of: cystometric capacity ≥ 250 cc; neobladder compliance ≥ 35 cmH₂0; negative Valsalva and abdominal leak point pressure testing. Simultaneous achievement of only two of the presented criteria was considered a suboptimal result. Logistic regression analyses were built to identify predictors of daytime and night-time urinary continence. For all analyses, a two-sided p < 0.05 was considered significant.</p><p><strong>Results: </strong>Overall, at a median follow-up of 25 months (IQR 16-37), 149 patients achieved a complete urodynamic evaluation. In the current series, the complete trifecta rate was 40.2% while a suboptimal trifecta achievement was observed in 35.6% of patients. On multivariable analysis, complete trifecta achievement was the only independent predictor of daytime (OR 7.29, 95% CI 2.05-25.9) and night-time (OR 8.13; 95% CI 2.94-22.4) urinary continence, respectively (each p < 0.003). A complete UDM-T at urodynamic testing was associated with a day-time continence, night-time continence, and complete dry status rates of 93.2%, 83.1%, and 79.7%, respectively.</p><p><strong>Conclusion: </strong>This novel urodynamic trifecta for OINs is based on standardized parameters and seems to be predictor of either daytime or night-time urinary continence at a midterm follow-up. Satisfactory continence outcomes may be also expected when a suboptimal trifecta rate is achieved.</p><p><strong>Clinical trial registration: </strong>Not applicable.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094435","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":"Portable Ultrasound Bladder Volume Measurement Over Entire Volume Range Using a Deep Learning Artificial Intelligence Model in a Selected Cohort: A Proof of Principle Study.","authors":"Hyun Ju Jeong, Aeran Seol, Seungjun Lee, Hyunji Lim, Maria Lee, Seung-June Oh","doi":"10.1002/nau.70057","DOIUrl":"https://doi.org/10.1002/nau.70057","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to prospectively investigate whether bladder volume measured using deep learning artificial intelligence (AI) algorithms (AI-BV) is more accurate than that measured using conventional methods (C-BV) if using a portable ultrasound bladder scanner (PUBS).</p><p><strong>Patients and methods: </strong>Patients who underwent filling cystometry because of lower urinary tract symptoms between January 2021 and July 2022 were enrolled. Every time the bladder was filled serially with normal saline from 0 mL to maximum cystometric capacity in 50 mL increments, C-BV was measured using PUBS. Ultrasound images obtained during this process were manually annotated to define the bladder contour, which was used to build a deep learning AI model. The true bladder volume (T-BV) for each bladder volume range was compared with C-BV and AI-BV for analysis.</p><p><strong>Results: </strong>We enrolled 250 patients (213 men and 37 women), and a deep learning AI model was established using 1912 bladder images. There was a significant difference between C-BV (205.5 ± 170.8 mL) and T-BV (190.5 ± 165.7 mL) (p = 0.001), but no significant difference between AI-BV (197.0 ± 161.1 mL) and T-BV (190.5 ± 165.7 mL) (p = 0.081). In bladder volume ranges of 101-150, 151-200, and 201-300 mL, there were significant differences in the percentage of volume differences between [C-BV and T-BV] and [AI-BV and T-BV] (p < 0.05), but no significant difference if converted to absolute values (p > 0.05). C-BV (R² = 0.91, p < 0.001) and AI-BV (R² = 0.90, p < 0.001) were highly correlated with T-BV. The mean difference between AI-BV and T-BV (6.5 ± 50.4) was significantly smaller than that between C-BV and T-BV (15.0 ± 50.9) (p = 0.001).</p><p><strong>Conclusion: </strong>Following image pre-processing, deep learning AI-BV more accurately estimated true BV than conventional methods in this selected cohort on internal validation. Determination of the clinical relevance of these findings and performance in external cohorts requires further study.</p><p><strong>Trial registration: </strong>The clinical trial was conducted using an approved product for its approved indication, so approval from the Ministry of Food and Drug Safety (MFDS) was not required. Therefore, there is no clinical trial registration number.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094444","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":"The Future of Urodynamics: Innovations, Challenges, and Possibilities.","authors":"Lauren E Chew, Jessica H Hannick, Lynn L Woo, John K Weaver, Margot S Damaser","doi":"10.1002/nau.70074","DOIUrl":"https://doi.org/10.1002/nau.70074","url":null,"abstract":"<p><strong>Introduction: </strong>Urodynamic studies (UDS) are essential for evaluating lower urinary tract function but are limited by patient discomfort, lack of standardization and diagnostic variability. Advances in technology aim to address these challenges and improve diagnostic accuracy and patient comfort.</p><p><strong>Ambulatory urodynamic monitoring (aum): </strong>AUM offers physiological assessment by allowing natural bladder filling and monitoring during daily activities. Compared to conventional UDS, AUM demonstrates higher sensitivity for detecting detrusor overactivity and underlying pathophysiology. However, it faces challenges like motion artifacts, catheter-related discomfort, and difficulty measuring continuous bladder volume.</p><p><strong>Remote monitoring technologies: </strong>Emerging devices such as Urodynamics Monitor and UroSound offer more patient-friendly alternatives. These tools have the potential to improve diagnostic accuracy for bladder pressure and voiding metrics but remain limited and still require further validation and testing.</p><p><strong>Ultrasonography in uds: </strong>Ultrasound-based modalities, including dynamic ultrasonography and shear wave elastography, provide real-time, noninvasive assessment of bladder structure and function. These modalities are promising but will require further development of standardized protocols.</p><p><strong>Artificial intelligence in uds: </strong>AI and machine learning models enhance diagnostic accuracy and reduce variability in UDS interpretation. Applications include detecting detrusor overactivity and distinguishing bladder outlet obstruction from detrusor underactivity. However, further validation is required for clinical adoption.</p><p><strong>Conclusion: </strong>Advances in AUM, wearable technologies, ultrasonography, and AI demonstrate potential for transforming UDS into a more accurate, patient-centered tool. Despite significant progress, challenges like technical complexity, standardization, and cost-effectiveness must be addressed to integrate these innovations into routine practice. Nonetheless, these technologies provide the possibility of a future of improved diagnosis and treatment of lower urinary tract dysfunction.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009098","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}