Neurourology and Urodynamics最新文献

Aims: To investigate the association between a standardized ankle fascial manipulation protocol and improvements in symptoms and quality of life for patients with urinary incontinence (UI).

Methods: This retrospective study reviewed the clinical records of 81 patients (aged 30-75) with stress, urgency, or mixed UI who completed a standardized intervention. The protocol consisted of 16 sessions of ankle fascial manipulation over 8 weeks. Primary outcomes included the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score and 24-h pad test volume. Secondary outcomes included the King's Health Questionnaire (KHQ). Assessments were performed at baseline, 8 weeks, and a 3-month follow-up.

Results: Significant improvements were observed. The mean ICIQ-SF score decreased from 14.3 ± 3.2 to 6.8 ± 2.9 (p < 0.001), and the 24-h pad test volume reduced by 63.7% (p < 0.001). Patients with stress UI demonstrated the greatest reduction in leakage (72.4%), compared to urgency (54.8%) and mixed (61.3%) UI (p = 0.023). Quality of life improved significantly, with the mean total KHQ score decreasing from 65.3 to 31.8 (p < 0.001). Improvements were largely maintained at the 3-month follow-up.

Conclusions: Ankle fascial manipulation was associated with significant improvements in urinary incontinence symptoms and quality of life, particularly for stress UI. These findings suggest it may be a promising complementary therapy. Rigorous randomized controlled trials are needed to confirm efficacy and investigate underlying mechanisms.

Purpose: Percutaneous tibial neuromodulation (PTNM) is a standard third line therapy for patients with overactive bladder (OAB). While the therapy has demonstrated efficacy, its exact mechanism of action is unclear. Functional neuroimaging is employed to understand brain activity changes during the micturition cycle in women with OAB. In this study, we measure brain perfusion using functional MRI (fMRI) during bladder filling at discrete bladder volumes in women with OAB pre and post PTNM. We also assess brain perfusion at discrete bladder volumes in healthy women without OAB.

Materials and methods: Women with and without OAB were enrolled. All participants completed validated urinary symptom questionnaires. Subjects underwent an fMRI exam with arterial spin labeling (ASL) fMRI while their bladders were filled through a urethral catheter at discrete bladder volumes. Subjects with OAB underwent a second ASL fMRI after treatment with PTNM.

Results: Twelve women with OAB and 13 women without OAB were enrolled. Patients with OAB had increased bladder filling sensations at lower bladder volumes compared to women without OAB. Anterior cingulate cortex (ACC), insula and supplemental motor area (SMA) perfusion during bladder filling did not increase in a linear fashion in healthy women nor women with OAB; there were changes in ACC, insula, and SMA perfusion during bladder filling at set bladder volumes, which changed after a single session of PTNM.

Conclusions: Perfusion of the ACC, insula, or SMA does not change linearly during bladder filling in women, irrespective of OAB. After a single session of PTNM, perfusion changes during bladder filling in the ACC, Insula, and SMA in a non-linear fashion.

Background: Uroflowmetry (UFM) is a simple and widely used first-line investigation for evaluating lower urinary tract symptoms (LUTS). Despite its non-invasive nature, uroflowmetry can provoke anxiety and affect satisfaction, often due to a lack of understanding about the procedure.

Objective: This randomized controlled trial aimed to compare the effects of structured versus verbal education on alleviating anxiety and assessing patient satisfaction in those undergoing UFM.

Methodology: A single-blind, parallel-arm study was conducted with 148 patients who were randomly assigned to either a structured teaching (brochure) group or a verbal counseling group. The modified Amsterdam Preoperative Anxiety and Information Scale (APAIS-M) was used to assess anxiety, while satisfaction was measured using a validated questionnaire. Descriptive statistics, Chi-square, and independent t-tests were employed for data analysis.

Results: The structured education group demonstrated statistically insignificant overall anxiety score in both groups 10.6 ± 1.23 versus 9.61 ± 1.4 (p = 0.49) in verbally counseled versus structured education group respectively, but individual components have significant differences like worry scores (2.87 ± 0.135) in structured education group compared to the verbal education group (3.49 ± 0.142; p = 0.028), and fewer thoughts (2.90 ± 0.150) versus the verbal education group (3.25 ± 0.155; p = 0.044). Satisfaction scores showed that the structured group had a higher satisfaction to the knowledge provided (1.21 ± 0.04 vs. 1.08 ± 0.036, p = 0.035) and ease of using UFM equipment (4.51 ± 0.11 vs. 4.05 ± 0.118, p = 0.047), more satisfied with aspects related to privacy (4.68 ± 0.112 vs. 4.20 ± 0.115, p = 0.04).

Conclusions: Structured education significantly improved patient understanding, comfort, and expectations regarding privacy, while reducing anxiety compared to verbal counseling. Integrating structured education before uroflowmetry could further enhance the patient experience and satisfaction.

Objectives: Stress urinary incontinence (SUI) has been linked to excessive urethral mobility, yet clinical evaluation has been largely limited to assessing maximal excursion rather than capturing the full dynamics of visible urethral movement. In this study, we hypothesize that an automated, ultrasound-based method can objectively differentiate urethral mobility patterns between women with SUI and continent controls.

Methods: We used a previously validated optical flow-based algorithm to automatically track urethral motion from transperineal ultrasound images during cough, Valsalva maneuver, and pelvic muscle contraction (PMC) in 11 women with SUI and 10 continent controls. Urethral motion was assessed by defining three regions of interest along the urethra (proximal, mid, and distal). Segmental urethral kinematics were computed and statistically compared between groups.

Results: Substantial variability and overlap between groups were observed, with coefficient of variation ranging 25%-90%. On average, women with SUI demonstrated significantly larger urethral displacement compared to controls, particularly at the proximal segment during Valsalva (10.6 ± 1.2 mm vs. 6.0 ± 0.6 mm, p < 0.01), with pronounced inferior-posterior motion. Additionally, displacement between the upper and lower urethra was significantly larger in the SUI group (0.47 ± 0.10 mm/mm vs. 0.13 ± 0.03 mm/mm, p < 0.05), indicating localized hypermobility particularly near the proximal urethra. Maneuver-specific differences were also noted within the SUI group, with Valsalva producing significantly larger and less uniform urethral movements compared to cough (10.6 ± 1.2 mm vs. 6.6 ± 0.5 mm, p < 0.05).

Conclusion: Our results demonstrate that the automated method is capable of capturing urethral mobility characteristics associated with SUI. Significant inter-individual variability in both continent and SUI groups indicates that urethral kinematics are heterogeneous. The detailed kinematic data have the potential to identify distinct sub-types of urethral mobility, facilitating systematic comparisons with underlying structural and neuromuscular defects. This approach can move clinical evaluation from simple group comparisons toward personalized SUI diagnosis and targeted treatment selection. Future studies with larger sample sizes and inclusion of additional pelvic floor conditions will be needed to validate these findings and advance their translation into clinical practice.

Objectives: Chronic painless urine retention (CUR) with > 1 liter of postvoid residual urine (PVR) is a rare but serious complication of benign prostatic obstruction (BPO). This study aims to evaluate the outcomes of HoLEP in men with chronic painless urinary retention and PVR volumes exceeding 1 l.

Methods: We retrospectively reviewed data from men who underwent "en-bloc" HoLEP between July 2017 and May 2024. We identified patients with CUR and PVR > 1 l due to BPO (study group). Excluded were those with acute-on-chronic retention, bladder diverticulum or neurogenic bladder. A matched-pair analysis (1:2) was performed with patients having PVR < 50 ml (control group). We compared demographic, perioperative, and postoperative voiding parameters and complications up to 1 year.

Results: Of 660 patients, 20 had baseline PVR > 1 l. Demographic and preoperative parameters were similar, except for a higher catheterization rate in the study group (50% vs. 17.5%, p < 0.005). The study group had a higher risk of failing a voiding trial on the first postoperative day (20% vs 5.2%) though the difference was not statistically significant. By 1-month post-HoLEP, all patients in the study group were catheter-free and voiding spontaneously. No significant differences were found in postoperative voiding improvements and complications between the groups. Neither group required medical or surgical retreatment within 1 year.

Conclusions: HoLEP is effective and safe for patients with CUR and PVR > 1 l due to BPO, although these patients have a higher risk of failing a voiding trial on the first postoperative day.

Background: The decision on which catheterization method to prescribe should be made on an individual basis, considering each patient's individual needs and circumstances. However, the current decision-making process regarding assisted bladder drainage might not be transparent or standardized.

Objectives: The aim of the present study was to explore and compare the decision-making processes of Dutch healthcare providers regarding the choice of catheterization method and relevant bladder management. This information is crucial in the empowerment of patient involvement and the development of a catheter decision aid.

Design & methods: We conducted a nationwide survey study including urologists, rehabilitation doctors, physician assistants, and specialized (continence)nurses. A 12-question survey was distributed regarding the decision-making process, including questions about treatment options discussed and factors upon which healthcare providers base their decisions.

Results: A total of 108 healthcare providers responded (response rate 36%). The majority were (continence)nurses or urologists and worked in a hospital. (Continence)nurses were least often involved in the decision-making, and when involved, 53% did not discuss potential other treatment options for the underlying causes of impaired bladder emptying. Most healthcare providers base their decision on the patient characteristics.

Conclusion: We observed differences in the decision-making process between the healthcare providers. Implementing shared decision-making can lead to more effective collaboration between the patient and healthcare provider when selecting the most appropriate type of bladder management. This could be achieved through comprehensive training supplemented by a validated decision aid.