Neurourology and Urodynamics最新文献

{"title":"Systematic Evaluation of Lower Urinary Tract Sensations to Improve Management of LUTS: ICI-RS 2024.","authors":"Mathijs de Rijk, Claire Hentzen, Caroline Selai, Stefania Musco, Riccardo Lombardo, Gommert van Koeveringe, Christopher Chapple, Paul Abrams, Jean J Wyndaele, Karen McCloskey","doi":"10.1002/nau.25636","DOIUrl":"10.1002/nau.25636","url":null,"abstract":"<p><strong>Aims: </strong>Lower urinary tract (LUT) sensations form an essential part of diagnostic criteria for many LUT symptoms, additionally LUT sensations are used to evaluate the effectivity of therapeutic interventions. The accurate measurement of LUT sensations, however, is severely hampered by the subjective nature of these sensations.</p><p><strong>Methods: </strong>This paper summarizes the discussions from the 2024 meeting of the International Consultation for Incontinence-Research Society (ICI-RS 2024) regarding systematic evaluations of LUT sensations and the design of more objective tools to measure these.</p><p><strong>Results: </strong>Here, we discuss factors that influence sensations that are under the control of the caregiver/investigator, the signaling of sensations from the LUT toward the central nervous system, and currently used diagnostic tools to measure LUT sensations. Recent methodological advances to objectively measure factors that correspond with changes in LUT sensations are introduced along with recommendations for future research to optimally enable objective assessment of processes underlying LUT sensations.</p><p><strong>Conclusions: </strong>Advancing the objective measurement of LUT sensations will require interdisciplinary collaboration, integrating insights from neuroscience, engineering, and clinical practice. Such efforts hold the potential to transform patient care by enabling more precise diagnostics and personalized therapeutic strategies.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"622-630"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eleventh International Consultation on Incontinence Research Society 2024: Introduction.","authors":"Paul Abrams, Alan Wein","doi":"10.1002/nau.70027","DOIUrl":"https://doi.org/10.1002/nau.70027","url":null,"abstract":"","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":"44 3","pages":"537-538"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657169","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 Our Limited Understanding of the Effects of Nerve Stimulation Resulting in Poor Outcomes and the Need for Better \"Rescue Programming\" in SNM and PTNS, and Lost Opportunities for New Sites of Stimulation? ICI-RS 2024.","authors":"Marcio Augusto Averbeck, Jerzy B Gajewski, Enrico Finazzi-Agrò, Christopher John Chermansky, Arun Sahai, Michał Późniak, Sanjay Sinha, Giovanni Mosiello, Christopher Harding, Hashim Hashim, Roger Dmochowski, Mohammed Belal, Paul Abrams","doi":"10.1002/nau.25600","DOIUrl":"10.1002/nau.25600","url":null,"abstract":"<p><strong>Aims: </strong>Sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) are strongly recommended by international guidelines bodies for complex lower urinary tract dysfunctions. However, treatment failure and the need for rescue programming still represent a significant need for long-term follow-up. This review aimed to describe current strategies and future directions in patients undergoing such therapies.</p><p><strong>Materials and methods: </strong>This is a consensus report of a Think Tank discussed at the Annual Meeting of the International Consultation on Incontinence - Research Society (ICI-RS), June 6-8, 2024 (Bristol, UK): \"Is our limited understanding of the effects of nerve stimulation resulting in poor outcomes and the need for better 'rescue programming' in SNM and PTNS, and lost opportunities for new sites of stimulation?\"</p><p><strong>Results: </strong>Rescue programming is important from two different perspectives: to improve patient outcomes and to enhance device longevity (for implantable devices). Standard SNM parameters have remained unchanged since its inception for the treatment of OAB, nonobstructive urinary retention, and voiding dysfunction. SNM rescue programming includes intermittent stimulation (cycling on), increased frequency and changes in pulse width (PW). The effect of PW setting on SNM outcomes remains unclear. Monopolar configurations stimulate more motor nerve fibers at lower stimulation voltage; hence, this could be an option in patients who failed bipolar stimulation in the long term. Unfortunately, there is little evidence for rescue programming for PTNS. However, the development of implantable devices for intermittent stimulation of the tibial nerve may increase long-term adherence to therapy and increase interest in alternative programming. There has been recent promising neurostimulation targeting the pudendal nerve (PNS), especially in BPS/IC. More recently, preliminary data addressed the benefits of high-frequency bilateral pudendal nerve block for DESD and adaptive PNS on both urgency and stress UI in women.</p><p><strong>Conclusion: </strong>The exploration of rescue programming and new stimulation sites remains underutilized, and there are opportunities that could potentially expand the therapeutic applications of nerve stimulation. By broadening the range of target sites, clinicians may be able to tailor treatments according to individual patient needs and underlying conditions, thereby improving overall outcomes. However, further studies are still needed to increase the level of evidence, potentially allowing for an individualized treatment both in patients who are candidates for electrostimulation and in those who have already received surgical implants but seek a better outcome.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"676-682"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400850","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":"Can We Better Understand, Diagnose, and Treat Ketamine-Induced Uropathy, and Can It Be Reversed? ICI-RS 2024.","authors":"François Hervé, Patrik Aronsson, D Carolina Ochoa, Gommert Van Koeveringe, Giovanni Mosiello, Marcio Augusto Averbeck, George Bou Kheir, Michel Wyndaele, Paul Abrams","doi":"10.1002/nau.25612","DOIUrl":"10.1002/nau.25612","url":null,"abstract":"<p><strong>Introduction: </strong>Ketamine, a versatile anesthetic, has seen increased recreational use, leading to significant health issues, including ketamine-induced uropathy (KIU). KIU manifests with lower urinary tract symptoms (LUTS) and can involve the upper urinary tract. This study aims to provide a comprehensive overview of KIU, addressing its pathophysiology, diagnostic strategies, and treatment options; and to define/identify future research priorities.</p><p><strong>Methods: </strong>During the 2024 meeting of the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, a dedicated Proposal (P) convened to explore KIU. This initiative involved a thorough review of existing literature, expert presentations, and consensus-driven discussions. The methodology ensured a comprehensive exploration of KIU from both clinical and pre-clinical perspectives, leading to actionable research recommendations.</p><p><strong>Results: </strong>Understanding the mechanisms of KIU is crucial for developing effective treatment options targeting specific pathophysiological pathways. Key findings include bladder fibrosis driven by transforming growth factor-β1 (TGF-β1), elevated purinergic responses and upregulated P2X1 purinoceptor expression, decreased barrier function due to increased expression of antiproliferative factor (APF), and functional loss of the bladder through Cav1.2 channel blockade. Research indicates that fibrosis, typically considered irreversible, may be mitigated. However, the exact timing and extent of fibrosis initiation and its impact on long-term outcomes require further research. LUTS typically improve after ketamine cessation but relapse upon resumption, indicating a hypersensitivity mechanism involving elevated serum IgE levels. Advanced stages of KIU do not always correlate with LUTS severity, shedding light on potential systemic effects and the need for evaluating liver enzymes. Furthermore, psychological dependency on ketamine, due to its positive perceptive and mood-altering effects, complicates cessation efforts. Long-term management requires a holistic approach, integrating medical treatments and supportive measures to help patients navigate life with potentially irreversible complications.</p><p><strong>Conclusion: </strong>This comprehensive review spans from fundamental pathology to practical clinical management, addressing both urological and systemic complications, and bridging insights from animal models to human applications. Developing effective treatment strategies necessitates addressing both the physical and psychological aspects of ketamine dependency.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"548-557"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624877","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":"Do We Need to Re-Focus on Functional Female Urethral Disorders in Lower Urinary Tract Dysfunction? ICI-RS 2024.","authors":"Christopher J Chermansky, Jeremy L Ockrim, George Bou Kheir, Christopher R Chapple, Rohna Kearney, Bogdan Toia, Roger R Dmochowski, Alan J Wein, Paul Abrams","doi":"10.1002/nau.25633","DOIUrl":"10.1002/nau.25633","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;Insights into the role of the urethra in maintaining continence and in normal voiding have been provided with advances in imaging techniques. Also, functional urethral testing is used to understand which treatments are optimal for women with functional bladder outlet obstruction (BOO), but which testing is better for which treatment? This review aims to describe our current understanding of female urethral function and dysfunction and to provide future research directions for treating functional female urethral disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This is a consensus report of the proceedings of a research proposal discussed at the annual International Consultation on Incontinence-Research Society (ICI-RS), 6th-8th June 2024 (Bristol, UK): \"Do we need to re-focus on functional female urethral disorders in lower urinary tract dysfunction? ICI-RS 2024\".&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Regarding female urethral nomenclature, it was agreed that the same terminology should be used in the orientation of the female urethra as in the male. Also, functional MRI and computer modeling could aid further understanding of urethral function in women with voiding dysfunction and OAB symptoms. As for functional urethral assessment, options include video-urodynamics with leak point pressure (LPP) testing, urethral pressure profilometry (UPP), and striated urethral sphincter electromyography (EMG). Future testing may include the use of modalities (borrowed from cardiologic assessment of vascular structures such as resistive measures obtained with ultrasound) for the purpose of assessing urethral closure. UPP testing has limitations in measurement and reproducibility in assessing urethral pressure. Urethral sphincter EMG is difficult to perform and reproduce. LPP also has limitations related to testing and to patient effort, in addition to being influenced by factors such as bladder volume and compliance. When performing urethral surgery, it is imperative to dissect in tissue planes that preserve urethral function. Regarding therapeutic modalities for the treatment of functional female urethral dysfunction, conservative management includes pelvic floor muscle training with or without biofeedback, electrical stimulation, and extracorporeal magnetic stimulation. Furthermore, there was a robust discussion on the use of cognitive-behavioral therapy to address psychological comorbidities, thereby improving female LUTD. The evidence supporting long-term pharmacologic treatment of female urethral LUTD remains scarce. As for invasive management options, the evidence supporting the use of botulinum toxin in female LUTD is limited. Finally, the very existence of BNO and the validity of its diagnosis was discussed. Furthermore, bladder neck incision as a treatment of BNO was debated, and the indications for this procedure include a therapeutic decision balancing benefit to complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Improving","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"558-567"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751409","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":"What Is Needed to Determine and Potentially Improve the Clinical Effectiveness and Cost-Effectiveness of Robot-Assisted Reconstructive Urinary Tract and Pelvic Floor Surgery?-ICI-RS 2024.","authors":"Michel Wyndaele, Arun Sahai, George Bou Kheir, François Hervé, D Carolina Ochoa, Kevin Rademakers, Thomas van Steenbergen, Qi-Xiang Song, Alan Wein, Paul Abrams","doi":"10.1002/nau.25625","DOIUrl":"10.1002/nau.25625","url":null,"abstract":"<p><strong>Introduction: </strong>Robot-assisted (RA) surgery has many advantages for urinary tract and pelvic floor reconstruction (UTPFR) but its application is only slowly increasing. Studies are limited in number, patients and follow-up duration. The low-volume high-complexity nature of UTPFR warrants specific research to evaluate the potential role of the RA approach.</p><p><strong>Methods: </strong>During its 2024 meeting in Bristol, the International Consultation on Incontinence-Research Society (ICI-RS) reviewed the current literature on RA UTPFR. Priority research questions and strategies were explored in a proposal.</p><p><strong>Results: </strong>Four different topics were discussed. (1) Large multicentre prospective studies on RA UTPFR are needed to evaluate clinical effectiveness and safety. The RA approach needs to be prioritized in specific procedures and patients, to first improve patient care where gains are highest. (2) Models for cost-utility analysis for RA UTPFR are needed to (re)direct limited resources as efficiently as possible in a quickly changing technological field. (3) A modular curriculum for training UTPFR surgeons to become RA certified needs to be developed, to allow valid interpretation and comparison of outcomes. (4) Technological improvements to address tissue handling, accessibility, efficiency and sustainability are needed. Digitalization can be a gamechanger for RA UTPFR through telesurgery (training and expertize coverage), augmented reality and artificial intelligence providing intra-operative assistance, assessment and feedback.</p><p><strong>Conclusions: </strong>The proposal discussed the need for studies on clinical and cost effectiveness, safety, and training curriculum development for RA UTPFR. Recent technological developments hold great promise for RA UTPFR. High-priority research questions were identified.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"683-690"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can We Prevent Recurrent UTIs Without Antibiotics, in Both Those Who Do and Do Not Use Catheters? ICI-RS 2024.","authors":"Christopher Harding, Francesco Clavica, Marcio Augusto Averbeck, Anasofia Da Silva, Marcus John Drake, Jerzy Bogdan Gajewski, Vik Khullar, Michael Pozniak, Angie Marie Rantell, Tufan Tarcan, Glenn Thomas Werneburg, Ilias Giarenis","doi":"10.1002/nau.25641","DOIUrl":"10.1002/nau.25641","url":null,"abstract":"<p><strong>Aims: </strong>Urinary tract infections are one of the most common reasons for antibiotic prescription. The widespread use of antibiotic treatments contributes to the global health problem of antimicrobial resistance development. To slow down the progression of antimicrobial resistance, it is essential that we explore nonantibiotic preventive treatments for this common condition. We aim to report discussions regarding nonantibiotic preventive strategies for recurrent urinary tract infections in both catheterized and non-catheterized patients that took place at the International Consultation on Incontinence-Research Society meeting in Bristol in 2024.</p><p><strong>Methods: </strong>We undertook a think-tank session during this multidisciplinary meeting specifically designated for discussion regarding both established and emerging nonantibiotic treatments for UTI prevention in both catheterized and non-catheterized patients. This led to the generation of pertinent research questions, which hope to shape future UTI research.</p><p><strong>Results: </strong>We describe the discussions that took place and document the important research questions that were proposed during the International Consultation on Incontinence-Research Society meeting in Bristol in 2024.</p><p><strong>Conclusions: </strong>There is a range of established UTI preventative strategies for UTI prevention in both catheterized and non-catheterized patients. Emerging UTI prevention treatments have varying levels of evidence to support their use, and in many areas, further research is needed to establish their place in clinical pathways.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"637-643"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882249","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":"Do We Have Sufficient Evidence to Derive Innovative Approaches to Assessing Unmet Need, Delivering Education on Bladder and Bowel Continence Health, and Providing a Better Environment for Joint Decision-Making? ICI-RS 2024.","authors":"Nikki Cotterill, Michael Samarinas, Angie Rantell, Caroline Selai, Salvador Arlandis, Kathryn Jones, Paul Abrams, D Robinson, Adrian Wagg","doi":"10.1002/nau.25654","DOIUrl":"10.1002/nau.25654","url":null,"abstract":"<p><strong>Context: </strong>Improved continence outcomes are reliant on identification of unmet need, education delivery, and shared decision-making. The evidence base on which to derive innovative approaches in these areas was unclear.</p><p><strong>Methods: </strong>A debate held at the International Consultation on Incontinence-Research Society meeting, held in Bristol in June 2024, considered ways to improve research requirements to advance these areas.</p><p><strong>Results and conclusion: </strong>Artificial intelligence solutions and digital approaches to healthcare are emerging at pace and offer possibilities to improve these three key areas but this must be driven by person-centered approaches. Care must be taken to avoid increasing inequality through digital exclusion and language barriers. Research questions are highlighted to derive innovation in these three key areas.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"644-650"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do We Have the Evidence to Produce Tools to Enable the Identification and Personalization of Management of Women's Pelvic Floor Health Disorders Through the Perinatal and Perimenopausal Periods? ICI-RS 2024.","authors":"Rohna Kearney, Stefano Salvatore, Vik Khullar, Christopher Chapple, Annika Taithongchai, Alan Uren, Paul Abrams, Alan Wein","doi":"10.1002/nau.70019","DOIUrl":"10.1002/nau.70019","url":null,"abstract":"<p><strong>Introduction: </strong>There is an increasing recognition of the impact of ageing on pelvic floor health and the consequences in populations with rising proportions of women over the age of 65 years. A think tank was held at the ICI-RS 2024 to discuss the evidence to support the personalisation of women's pelvic floor health during the perinatal and perimenopausal period.</p><p><strong>Methods: </strong>Data was collected and presented on the evidence to support the development of tools to personalise pelvic floor health care. Epidemiological, imaging, patient-reported outcomes, and evidence of tool development questionnaires were discussed. The current evidence and research gaps for potential intervention to prevent the pelvic floor disorders of pelvic organ prolapse, overactive bladder, urinary incontinence and faecal incontinence during the perinatal and perimenopasual time periods were discussed and identified.</p><p><strong>Results: </strong>Epidemiological studies highlight that vaginal delivery and in particular operative vaginal delivery is the single biggest modifiable risk factor for the future development of pelvic floor dysfunction. The oestrogen depletion resulting from the perimenopause and menopause can lead to the development of Genitourinary syndrome of menopause (GSM) which is associated with the risk of developing pelvic floor dysfunction. Ultrasound is a useful technique for assessing the pelvic floor and has been used to assess bladder neck mobility, distensibility of the puborectalis muscle and the striated urethral sphincter volume antenatally with some studies reporting a correlation between these measurements and the need for Caesarean section and development of postpartum stress urinary incontinence. Further studies are needed to standardise these measurements. There are no patient reported outcome questionnaires validated for use in the perinatal and postmenopausal period. The UR- choice tool has been developed to counsel women on the risk of postpartum pelvic floor disorders occurring. However, further evaluation in larger numbers is required.</p><p><strong>Conclusion: </strong>There is significant interest in developing tools to counsel women on the risks of developing pelvic floor dysfunction post partum and after the menopause. Further evaluation of the UR-choice tool was considered a research priority. The timepoint of cervical screening for research into interventions such as pelvic floor health education, lifestyle optimisation and perimenopausal vaginal oestrogen supplementation was identified.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"651-660"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can the Bladder Itself \"Measure\" Volume, and Thereby Help to Determine When Initiation of Voiding Should Occur? ICI-RS 2024.","authors":"Gommert Van Koeveringe, Karen D McCloskey, Anthony J Kanai, Mathijs M de Rijk, Pradeep Tyagi, John E Speich, Christopher H Fry, Alan J Wein","doi":"10.1002/nau.25638","DOIUrl":"10.1002/nau.25638","url":null,"abstract":"<p><strong>Aims: </strong>To answer the question of whether the bladder itself can to any extent control or modulate the initiation of voiding.</p><p><strong>Methods: </strong>This subject was discussed at the International Consultation on Incontinence-Research Society (ICI-RS) 2024 conference in Bristol, UK in a proposal session.</p><p><strong>Results: </strong>Cells in the bladder wall sense the local environment via a diverse array of ion channels and receptors which together provide input to motor-sensory and signal transduction mechanisms. A purinergic signal transduction system provides a high-gain mucosal chemosensitive transduction pathway between bladder wall stretch during filling and graded afferent activation. Recent studies established cross-species similarities in the regulation of urine storage which include the upregulation of aquaporin (water) channels during bladder filling/wall stretch, in the bladder. In addition to the endocrine hypothalamus/pituitary axis production, urothelial production of arginine vasopressin acts on urothelial vasopressin receptors in a paracrine manner causing aquaporin channel upregulation, reducing the bladder volume and delaying sensation of fullness. Bladder shape influences the sensory systems involved in the perception of bladder volume; moreover irregular bladder shapes may correlate with overactive bladder.</p><p><strong>Conclusions: </strong>Volume measuring and signaling threshold-determining mechanisms in the bladder along with shape and permeability act to influence the timing and type of signaling to the CNS; although this is not always followed by a consecutive action. The hierarchical grading of the signals originating from the bladder among other peripheral bodily or central signals are crucial factors that determine whether the bladder is \"allowed\" to initiate voiding.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"568-576"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}