Neurourology and Urodynamics最新文献

{"title":"The Role of Urodynamics in Assessing Lower Urinary Tract Symptoms Post-Radical Prostatectomy: A Review.","authors":"Dora Jericevic Schwartz, Suditi Rahematpura, Benjamin Brucker","doi":"10.1002/nau.70157","DOIUrl":"https://doi.org/10.1002/nau.70157","url":null,"abstract":"<p><strong>Introduction: </strong>This review examines the role of urodynamics (UDS) in evaluating lower urinary tract symptoms (LUTS) following radical prostatectomy. We first present typical urodynamic findings in post-prostatectomy men, then discuss applications of UDS, and finally examine treatment pathways for post-prostatectomy LUTS beyond stress urinary incontinence (SUI) surgery.</p><p><strong>Methods: </strong>A narrative review was performed focusing on the current primary literature and society guidelines on the role of UDS post-prostatectomy.</p><p><strong>Results: </strong>LUTS after prostatectomy are common, most frequently storage LUTS, specifically SUI. For the index patient with clinically suspected SUI after prostate treatment, routine UDS before SUI surgery have not been shown to impact postsurgical continence outcomes. In cases where there is diagnostic uncertainty following noninvasive lower urinary tract evaluation, UDS plays an important role. UDS are highly beneficial in complex scenarios, such as severe mixed LUTS, prior radiation therapy, impaired bladder compliance, detrusor underactivity, and/or previous SUI surgery. Fluoroscopy during UDS and cystoscopy can provide additional clarity and confirmation of the diagnosis suggested by UDS.</p><p><strong>Conclusion: </strong>UDS are useful adjuncts in appropriately selected post-prostatectomy patients with LUTS, typically with complicating factors.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258592","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":"Adhering to Clinical Advice: The Level of Alignment of Care Processes With Global Bladder Guidelines in Veterans With Spinal Cord Injuries or Diseases.","authors":"John Lavelle, John Hornberger","doi":"10.1002/nau.70146","DOIUrl":"https://doi.org/10.1002/nau.70146","url":null,"abstract":"<p><strong>Background: </strong>Guidelines contain recommendations for monitoring and care of neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury/disorder. Evidence on the level of adherence to these recommendations is limited.</p><p><strong>Objectives: </strong>To assess treads in proportion of patients with spinal cord injury/disorder receiving commonly recommended processes of care for NLUTD.</p><p><strong>Methods: </strong>The cohort consisted of 49 326 veterans with supra-sacral spinal cord injury or disorder (SCI/D) within the Veterans Affairs (V.A.) healthcare system first seen from fiscal year 1999-2024. Measures included laboratories, imaging, bladder-care procedures, and whether the veteran was seen by a urologist and had cystometrography (CMG).</p><p><strong>Results: </strong>The analysis reveals the use of recommended NLUTD monitoring processes, with 41% undergoing renal imaging, 48% having a urology encounter, and 31% receiving cystometrography. A longitudinal view shows a decline in these rates over time. However, CMG rates exhibited some increase in veterans entering the system between 2005 and 2014, indicating a slight improvement in adherence over time.</p><p><strong>Conclusions: </strong>The study highlights gaps between current practices and recommended processes for NLUTD, which may compromise outcomes for veterans with supra-sacral SCI/D. Further research is necessary to explore the barriers to executing suggested processes and implications for outcomes of this vulnerable population.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239373","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 Repair of Pelvic Organ Prolapse After Cystectomy/Anterior Pelvic Exenteration.","authors":"Iryna Crescenze, Erin Jaquillard, Megan O Schimpf, Priyanka Gupta, Pamela Fairchild, Dee Fenner, John O DeLancey, Daniel Morgan","doi":"10.1002/nau.70159","DOIUrl":"https://doi.org/10.1002/nau.70159","url":null,"abstract":"<p><strong>Purpose: </strong>Pelvic organ prolapse (POP) in women after cystectomy or anterior pelvic exenteration is a rare yet complicated condition that presents a technical challenge. Limited data exists on the management of this condition. This study aims to review the vaginal approach to management of POP after cystectomy or anterior pelvic exenteration.</p><p><strong>Materials and methods: </strong>Patients undergoing vaginal repair of POP after cystectomy or anterior pelvic exenteration at a single institution from 1/1/2010 to 9/1/2018 were identified and retrospective data was extracted. Only patients with urologic indications for cystectomy or anterior exenteration were included.</p><p><strong>Results: </strong>Ten patients who underwent vaginal POP were identified. Median time to prolapse diagnosis after cystectomy/anterior exenteration was 5.5 months (0-42). All patients reported bulge symptoms, five (50%) had vaginal discharge, and three (30%) had irritation/pain at presentation. Four patients had sacrospinous ligament repair, three had biologic graft augmented repairs, two had suture-based repairs, and one had a colpocleisis. Complications were reported in three patients (30%)-vaginal bleeding, vaginal pain and biologic extrusion, and enterotomy. At a median follow-up of 12 months (1-58) six (60%) patients did not have recurrent bulge symptoms. Two patients (20%) had or planned for repeat repair.</p><p><strong>Conclusions: </strong>Transvaginal repair of POP after cystectomy or anterior pelvic exenteration is a feasible and effective treatment option, with 60% reporting durable resolution of bulge symptoms. Eighty percent of patients will not need additional surgery. There is a 30% complication rate due to the complexity of the procedure, and patients should be counseled accordingly.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213243","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":"Sex Differences in Cystoscopic Findings Among Veterans With Interstitial Cystitis.","authors":"Isabella Dolendo, Andrew Chen, Catherine Bresee, Jose A Cordero Pacheco, Amanda De Hoedt, Jayoung Kim, Stephen Freedland, Jennifer T Anger","doi":"10.1002/nau.70142","DOIUrl":"https://doi.org/10.1002/nau.70142","url":null,"abstract":"<p><strong>Purpose: </strong>Previous studies have found significant sex differences in symptoms among patients with interstitial cystitis/bladder pain syndrome (IC/BPS). However, whether this translates into differences in pathology as observed on cystoscopy is unknown. We sought to assess cystoscopic findings in veterans diagnosed with IC/BPS and to identify possible sex differences in cystoscopic findings.</p><p><strong>Methods: </strong>This was a retrospective study of all hospital visits in the Veteran Health Affairs Hospital System between October 2004 and July 2016. Patients with IC/BPS were identified from the Veteran Informatics and Computing Infrastructure (VINCI) system using appropriate ICD codes. Patients older than 18 years of age with a confirmed diagnosis of IC/BPS who underwent cystoscopy were included. Rates of cystoscopic findings of ulceration, glomerulation, inflammation, trabeculation, and tumors adjusted for patient demographics were analyzed.</p><p><strong>Results: </strong>A total of 570 patients met inclusion criteria and underwent analysis (57.9% female). The female cohort was of younger age (48.0 vs. 63.0 years). After adjusting for age, men and women had a similar likelihood of presenting with Hunner's lesions (8.2% for men and 3.7% for women, p > 0.05). They also had a similar likelihood of glomerulation (11.4% in men vs. 15.2% in women, p = 0.05) and inflammation (19.6% vs. 15.8%, p > 0.05). Men were significantly more likely to present with trabeculation (15.4% vs. 8.1%, p = 0.03). Urothelial tumors on cystoscopy were rare in both groups.</p><p><strong>Conclusion: </strong>The proportion of patients with ulceration on cystoscopy in this study is consistent with previously published studies, and our study showed a similar prevalence of Hunner's lesions between men and women. Cystoscopic identification of Hunner's lesions is an important aspect of IC/BPS management given that treatment directed that these lesions is relatively successful compared to other treatments.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186259","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":"Adjustable TransObturator Male System (ATOMS) After Radiotherapy: Is Timing Everything? A Single-Center Experience.","authors":"Marc Kidess, Elisa Lederer, Nikolaos Pyrgidis, Troya Georgieva, Julian Hermans, Leo Stadelmeier, Marina Hoffmann, Benedikt Ebner, Patrick Keller, Michael Chaloupka, Julian Marcon, Philipp Weinhold, Ricarda Bauer, Christian G Stief, Yannic Volz","doi":"10.1002/nau.70158","DOIUrl":"https://doi.org/10.1002/nau.70158","url":null,"abstract":"<p><strong>Introduction: </strong>Incontinence after prostate treatment (IPT) following radical prostatectomy and/or radiotherapy for prostate cancer significantly impacts quality of life. While the Adjustable Transobturator Male System (ATOMS) is a promising surgical option for IPT, data on outcomes in patients undergoing ATOMS implantation with prior radiotherapy are limited. This study evaluates the influence of prior radiotherapy-and its timing-on outcomes following ATOMS implantation.</p><p><strong>Materials and methods: </strong>This retrospective single-center study included 131 men treated with ATOMS for IPT between November 2018 and May 2024. Patients were stratified by history of having received radiotherapy and also by timing of radiotherapy ( ≤ 24 vs. > 24 months) before ATOMS implantation. Pre-, peri-, and postoperative variables were recorded. Cross-sectional follow-up was conducted in November 2024 using clinical questionnaires, 24-h-pad-tests, and validated instruments (PGI, ICIQ-UI). Statistical analysis included t-tests, Mann-Whitney U tests, Chi-square tests, Kaplan-Meier curves, and Cox regression.</p><p><strong>Results: </strong>Forty seven patients (35.9%) received radiotherapy before ATOMS implantation. These patients had higher tumor stages and Gleason scores. Postoperatively, radiated patients demonstrated lower complete continence rates (21% vs. 51%, p = 0.020) and higher median pad use (2.5 vs. 1, p < 0.01). Furthermore, they experienced higher rates of acute urinary retention (8.5% vs. 0%, p = 0.029) and explantation (21% vs. 6%, p = 0.018). No significant differences in satisfaction, long-term continence, or outcomes were found based on the timing of radiotherapy.</p><p><strong>Conclusion: </strong>ATOMS is an adequate treatment for IPT regardless of radiotherapy history or timing before its implantation. Although significant differences in immediate continence rates were observed (21% vs. 51%), long-term continence rates were comparable. Therefore, ATOMS seems to be a viable option in this patient population.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150075","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":"Complementary Artificial Intelligence Strategies for Standardizing Pediatric Uroflowmetry Interpretation.","authors":"Ömer Barış Yücel","doi":"10.1002/nau.70155","DOIUrl":"https://doi.org/10.1002/nau.70155","url":null,"abstract":"","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137977","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":"Pascal's Law has no Role in Intraurethral Pressure Transmission or Urethral Closure.","authors":"P E P Petros","doi":"10.1002/nau.70154","DOIUrl":"https://doi.org/10.1002/nau.70154","url":null,"abstract":"","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137926","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":"Is It Necessary to Remove the Maximum Prostate Tissue in All Patients? the Percentage of Resected Prostate Tissue and the Influence on Surgery Outcomes: A One-Year Follow Up Study.","authors":"Bruno Rodrigues Lebani, André Barcelos da Silva, Luciano Teixeira Silva, Marcia Eli Girotti, Eduardo Remaile Pinto, Milton Skaff, Fernando Gonçalves Almeida","doi":"10.1002/nau.70152","DOIUrl":"https://doi.org/10.1002/nau.70152","url":null,"abstract":"<p><strong>Introduction: </strong>To investigate whether the volume of the prostate tissue resected on TURP influences on short and medium term follow up.</p><p><strong>Methods: </strong>It was developed a prospective study between May 2020 and August 2022, embracing patients with severe LUTS due to BPO, including clinical and urodynamic parameters meeting obstruction criteria (BOOI > 40), and good detrusor function (BCI > 100). Patients were assessed at 1, 6 and 12 months follow up. The primary endpoint was to compare whether the amount of resected tissue after TURP influences uroflowmetry at 12 months follow up (Qmax, ml/sec). The secondary endpoint was to compare different percentages of resected tissue (RPT) and its relation to the outcomes.</p><p><strong>Results: </strong>Ninety-six patients with mean age of 70,4 ± 7.96 years. At baseline, prostate volume was 78.5 ± 51.8 cc³, Qmax was 6.03 ± 3.09 ml/sec and post void residual (PVR) was 113 ± 132 ml, IPSS of 24.9 ± 6.75. All of them were urodinamically obstructed (BOOI 86.7 ± 35.6) and good detrusor function (BCI 130 ± 28.6). The general RPT was 45.5 ± 27.7%. The higher the RTP, the lower the PSA at 1 month follow up (p < 0.001, R = 0.521). Nevertheless, it was not found correlation between the RTP and Qmax, IPSS or PVR.</p><p><strong>Conclusion: </strong>TURP improves clinical and urodynamic parameters at 1 year follow up, independent of the amount of resected prostate tissue, in patients with bladder outlet obstruction and good detrusor function, since the surgery is effective.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131426","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":"Impact of Prostatic Urethral Lift and Water Vapor Energy Therapy on Bladder Outlet Obstruction in Elderly or Comorbid Patients With Benign Prostatic Hyperplasia in Real-World Clinical Practice.","authors":"Yuki Kyoda, Yoko Saito, Nodoka Kozen, Tetsuya Shindo, Kohei Hashimoto, Ko Kobayashi, Toshiaki Tanaka, Naoya Masumori","doi":"10.1002/nau.70149","DOIUrl":"https://doi.org/10.1002/nau.70149","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effects of prostatic urethral lift (PUL) and water vapor energy therapy (WAVE) on bladder outlet obstruction (BOO) using pressure flow studies (PFS) in real-world clinical practice among patients with benign prostatic hyperplasia (BPH), particularly those who are elderly or in poor general health.</p><p><strong>Methods: </strong>This retrospective study included 128 men who underwent PUL (n = 43), WAVE (n = 38), or photoselective vaporization (PVP, n = 47) for BPH. Surgical procedure selection was based on a department-specific proprietary algorithm. In elderly patients or those with systemic comorbidities, either PUL or WAVE was selected, and the choice between the two procedures was made based on prostate morphology. The primary endpoint was the change in bladder outlet obstruction index (BOOI) from baseline to 6 months after each surgical procedure.</p><p><strong>Results: </strong>The BOOI (mean ± SD) significantly decreased from 59.5 ± 26.2 to 14.8 ± 16.7 after PVP, 39.7 ± 21.8 to 25.8 ± 17.7 after PUL, and 52.5 ± 23.9 to 21.9 ± 19.2 after WAVE (all p < 0.01). The International Prostate Symptom Score (IPSS) improved from 17.0 ± 8.8 to 7.0 ± 6.2 (PVP), 16.7 ± 9.0 to 11.5 ± 7.9 (PUL), and 14.7 ± 8.0 to 8.2 ± 6.3 (WAVE) (all p < 0.01). Maximum flow rate (Qmax) increased from 8.6 ± 5.0 to 17.3 ± 7.5 mL/s (PVP), 9.3 ± 5.9 to 12.5 ± 5.8 mL/s (PUL), and 9.2 ± 3.7 to 12.4 ± 6.0 mL/s (WAVE) (all p < 0.01). Despite improvements, residual BOO (Schafer grade ≥ III) remained in 6.4% of PVP, 16.3% of PUL, and 15.8% of WAVE patients.</p><p><strong>Conclusion: </strong>In elderly patients or those with poor general health, both PUL and WAVE significantly improved the BOOI at 6 months postoperatively. However, in PUL and WAVE, persistent BOO exceeded 15%, suggesting that more appropriate patient selection will be necessary in the future.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131392","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":"IPSS May Not Tell the Whole Story: Integrating ICIQ-MLUTS for Comprehensive LUTS Assessment.","authors":"Muhammet Guzelsoy, Anil Erkan","doi":"10.1002/nau.70156","DOIUrl":"https://doi.org/10.1002/nau.70156","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the limitations of the International Prostate Symptom Score (IPSS) in evaluating male lower urinary tract symptoms (LUTS) and to determine whether the International Consultation on Incontinence Questionnaire-Male LUTS (ICIQ-MLUTS) can uncover clinically relevant symptoms overlooked by IPSS.</p><p><strong>Methods: </strong>A total of 239 Turkish men aged 50-80 with LUTS were prospectively evaluated using the linguistically validated Turkish versions of the IPSS and the short form of the ICIQ-MLUTS questionnaires. Symptoms not assessed by IPSS (urgency incontinence, stress incontinence, unaware leakage, nocturnal enuresis, postvoid dribbling) were identified. Multivariate logistic regression and ROC analyses were conducted to explore predictors of having at least one of these symptoms with a severity score ≥ 2.</p><p><strong>Results: </strong>While the IPSS categorized patients into mild (18.0%), moderate (47.7%), and severe (34.3%) LUTS groups, 32.6% of all participants reported at least one significant symptom not captured by IPSS. In multivariate analysis, an IPSS question 4 (urgency) score ≥ 3 was independently associated with a 1.5-fold increased risk (p = 0.002), while being classified as severely symptomatic conferred a 7.7-fold increased risk (p = < 0.001) of having overlooked symptoms. ROC analysis showed acceptable predictive performance (AUC = 0.710 for urgency score ≥ 3; AUC = 0.671 for severe IPSS classification).</p><p><strong>Conclusion: </strong>A considerable proportion of clinically relevant LUTS, especially incontinence and post-micturition symptoms, go undetected when using IPSS alone. Patients with high urgency scores or severe symptom burden may benefit from further evaluation beyond the IPSS, which highlights the potential role of IPSS as a triage test in LUTS assessment.</p><p><strong>Clinical trial registration: </strong>This study does not require clinical trial registration because it is not a prospective interventional trial involving human participants.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131405","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}