Lower Urinary Tract Dysfunction Research Articles

Urological Outcomes of 5-Year Old Patients After Open Prenatal Spina Bifida Aperta Repair

Abstract Background Neurogenic lower urinary tract dysfunction (NLUTD) is a severe and frequent burden in patients with spina bifida aperta (SBA). Less than 10% of patients with postnatal SBA repair achieve normal bladder function (NBF) by the typical toilet training age. Aims This study aimed to assess if open prenatal spina bifida aperta repair (OPSBAR) improves urological outcome at age five, when most healthy children have bladder control. Methods Patients undergoing OPSBAR at our institution are followed prospectively in a standardized way, with data collected in a REDCap registry. We reviewed urological outcome data at age five, including bladder diary, urodynamic and ultrasound findings, need for clean intermittent catheterization (CIC) and anticholinergics. NBF was defined as age-appropriate voiding patterns in a bladder diary, age-appropriate bladder capacity, absence of detrusor overactivity, leakage or pressure increase during filling, normal detrusor contractility, absence of detrusor-sphincter-dyssynergia, and voiding without significant residual urine. Results 22% (20/91) of patients showed a NBF, all exhibited spontaneous micturition. 60% (12/20) were fully continent, 30% (6/20) required night-time diapers, and 10% (2/20) were not yet fully toilet trained and used diapers during the day. 78% (71/91) had NLUTD, with 19% (17/91) developing NLUTD related to inclusion cysts. CIC was performed by 70% of patients (64/91), and 45% (41/91) required anticholinergic therapy, all of whom also performed CIC. A subgroup analysis showed a higher percentage of NBF in patients operated on after 2017 (35% vs. 12%, p<0.05), correlating with a significant decreased incidence of inclusion cysts. Conclusion After OPSBAR, 22% of patients exhibit NBF by age five, increasing to 35% for those operated on after 2017. Compared to postnatal SBA repair, this represents a significant improvement in urological outcome.

The Future of Urodynamics: Innovations, Challenges, and Possibilities.

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. 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. 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. 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. 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. 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.

Urodynamics in the Evaluation and Management of Bothersome Lower Urinary Tract Symptoms in Men With a Prostate.

Despite their utility, urodynamics (UDS) are associated with medical risks and patient discomfort. Therefore, it is crucial to select patients for UDS where the results are likely to change clinical decision-making or solidify diagnostic confidence. This narrative review aims to assess the indications, benefits and limitations of UDS in men with a prostate who have refractory lower urinary tract symptoms. A comprehensive review of the literature was conducted, focusing on studies evaluating the utility, patient perspectives, and clinical guidelines related to the use of UDS. UDS are beneficial in specific clinical scenarios, such as in patients with neurogenic lower urinary tract dysfunction (NLUTD) or when the likelihood of successful intervention is uncertain. For men with suspected BPH, routine UDS before surgical intervention may not be necessary unless there are comorbid conditions such as frailty or a history of radiation that exacerbate risk of surgery or in the presence of significant diagnostic uncertainty, such as in men with suspected neurogenic lower urinary tract dysfunction. UDS should be selectively utilized in clinical practice to maximize their diagnostic and therapeutic benefits while minimizing patient discomfort and risks. In men with suspected BPH, UDS should be considered in cases with diagnostic uncertainty or in the presence of significant comorbidities. Further research is needed to refine the indications for UDS and to develop noninvasive alternatives that can provide similar diagnostic insights.

Bladder and bowel dysfunction in children with sleep bruxism.

There is little evidence of a direct relationship between sleep bruxism and enuresis nocturna, and whether this enuresis is monosymptomatic or non-monosymptomatic nocturnal enuresis (MNE or NMNE) is unknown. The aim of the study is to investigate the type and frequency of nocturnal enuresis and other lower urinary tract symptoms (LUTS) in children with sleep bruxism. The children who applied consecutively to the Department of Pediatric Dentistry were included in this study. Sleep bruxism was determined by history and confirmed by clinical examination by pedodontist. LUTS were evaluated using the Dysfunctional Voiding and Incontinence Symptom Scale (DVISS). Patients with total DVISS score above 8.5 were accepted as having lower urinary tract dysfunction (LUTD). The relationship between bruxism and the presence of LUTD and LUTS was investigated. Patients with and without sleep bruxism were compared using the Mann-Whitney U test and Crosstab on SPSS 16.0. A total of 184 consecutive children were included in the study. Sleep bruxism was present in 77 (41.8%) children and absent in 107 (58.2%) (control group). LUTD was detected in 19 (24.7%) children with bruxism and 11 (10.3%) without bruxism. The mean total score of DVISS, which was 5.43 in bruxers vs. 2.67 in non-bruxers, was significantly higher in the bruxism group (p = 0.012). NMNE, pain during voiding, intermittent urination, urination after voiding, urge incontinence, and constipation were significantly more common in children with bruxism (p values were 0.005, 0.025, 0.002, 0.0001, and 0.002, respectively). LUTD with enuresis nocturna and daytime symptoms (NMNE) is more common in children with sleep bruxism and LUTS can be easily questioned with a simple validated questionnaire.

Research on complications and bladder management of the chronic phase spinal cord injury in China

This study aimed to investigate common complications during the chronic phase of spinal cord injury (SCI) and to assess bladder management methods and their associated complications in patients with neurogenic lower urinary tract dysfunction (NLUTD). A retrospective analysis was performed using clinical data from chronic-phase SCI patients across multiple centers in China. The study population included individuals diagnosed with SCI and admitted between January 1, 2017, and December 31, 2022. Chi-square tests were used to evaluate differences in the distribution of complications, disease duration, bladder management methods, and urinary complications. Univariate and multivariate analyses were conducted to identify risk factors for urinary complications. A total of 849 SCI patients from 28 provinces in China were included, showing significant demographic and clinical differences between traumatic SCI (TSCI) and non-traumatic SCI (NTSCI). Urinary tract infection (59.95%) and bowel-related complications, such as constipation (62.17%), were the most frequently reported complications. Additionally, the incidences of osteoporosis (38.50%), neuropathic pain (29.99%), bowel incontinence (12.06%), and hydronephrosis (11.91%) were also high. NLUTD was present in 90.58% of SCI patients. Among these, intermittent catheterization was associated with significantly lower rates of urological complications compared to indwelling catheterization (p = 0.025). Multivariate analysis identified bladder management method as a significant risk factor for urinary complications, with indwelling catheterization associated with a higher risk of urinary stones (p < 0.001) compared to intermittent catheterization. The high prevalence of bowel- and urological-related complications among Chinese SCI patients highlights the need for increased societal attention. In terms of bladder management, intermittent catheterization may provide greater benefits compared to indwelling catheterization. Further research and education are necessary to promote intermittent catheterization as a standardized bladder management approach for SCI patients.

The Feasibility and Safety of the Glean Urodynamics System: The Modern Urodynamics System Efficacy Study.

Purpose: Urodynamics is used to diagnose lower urinary tract dysfunction; however, conventional urodynamics results often poorly correlate to patient symptoms because of the nonphysiological nature of the test. The GleanTM Urodynamics System is a novel, wireless, catheter-free ambulatory urodynamics system that allows clinicians to study lower urinary tract dysfunction in a more physiological manner. The objective of this study was to evaluate the feasibility, efficacy, and safety of the Glean Urodynamics System for use in clinic. Materials and Methods: This prospective, single-arm, multicenter interventional trial enrolled adults with lower urinary tract dysfunction. Participants underwent conventional urodynamics per standard of care followed by ambulatory urodynamics using the intravesical Glean bladder sensor. After the removal of the Glean sensor, participants completed comfort and preference questionnaires. Participants were followed up within 7-14 days to assess the incidence of adverse events. Results: Thirty-eight participants were enrolled. Glean sensor insertion was attempted in 33 participants and successful in 32 (97.0%). The median sensor insertion time was 33.62 seconds (range: 12.32-256). The Glean Urodynamics System recorded vesical pressure, and all 32 participants were able to void with the sensor indwelling. Median sensor removal time was 5.71 seconds (range: 0.79-22.15). There were 14 adverse events in 12 participants, of which 7 events (in 7 participants) were attributed to the Glean Urodynamics System. There were no serious adverse events. Overall participant feedback on the Glean Urodynamics System was positive, and clinicians reported it was easy to use. Conclusions: The Glean Urodynamics System is a feasible, efficacious, safe, and well-tolerated device that enables ambulatory urodynamics with physiological bladder filling and without catheters impeding lower urinary tract function.

Long-Term Decision Regret and Associated Factors After Urinary Reconstruction in Underserved Patients With Spinal Cord Injury.

Long-Term Decision Regret and Associated Factors After Urinary Reconstruction in Underserved Patients With Spinal Cord Injury.

Real-Life Monitoring: Precise Onset of Action after BotulinumtoxinA Injection

Purpose: OnabotulinumtoxinA detrusor injection (Onabot-A DI) has been an established therapy for idiopathic overactive bladder and neurogenic lower urinary tract dysfunction for over a decade. However, the exact onset of its effect on symptoms, such as frequency, urgency, and urinary incontinence (UI), remains unclear. Materials and Methods: Female patients undergoing Onabot-A DI completed an automated bladder diary using an app-connected measuring cup (Diary Pod; Minze). The device automatically recorded voided volumes and micturition frequency, while urgency and UI episodes were manually registered in the accompanied app (Minze Flow). Data were collected 3 days preprocedure and up to 3 weeks postprocedure, securely stored, and analyzed through a cloud-based clinician portal. Results: Of the 62 patients, 27 (44%) had well-documented bladder diaries according to the protocol. The mean age of the patients was 63 years (range, 36-81 years). Despite the use of digital technology, the elderly patients also complied with the study protocol. The micturition frequency decreased significantly after 7 days (−2.7; P &lt; .05), and the voided volume increased by 19.3 mL after 5 days (P &lt; .05). Urgency voids significantly decreased by 21% after 1 day (P &lt; .01), whereas UI episodes showed the first significant reduction (−2.4; P &lt; .001) after 2 days. Forty-two percent of participants were completely dry. Conclusions: Onabot-A DI begins to act within 1 week postinjection, with urgency and UI improving first, followed by reductions in micturition frequency and increased voided volume. These real-world findings offer valuable insights for clinicians and patients, helping set realistic expectations for therapy progression.

Bladder Diary Feasibility and Reliability in Neurogenic Lower Urinary Tract Dysfunction Patients.

Bladder diary (BD) is an important tool to understand patients' lower urinary tract symptoms. But few data exist on adult neurogenic lower urinary tract dysfunction (ANLUTD) patients. The aim was to assess in real-life practice the feasibility, reliability and influencing factors of BD completion in patients with ANLUTD. All patients with ANLUTD who had a first neuro-urologic consultation between January 2022 and April 2023 were included. No patients underwent intermittent self-catheterization. We collected demographic data, validated questionnaires about symptoms and quality of life, the presence and analysis of the 3-day BD. BD was classified as feasible if patients returned it nonempty and was deemed reliable if patients had completed at least 2 consecutive days, if it did not have an intake-output imbalance, and if it were consistent with the USP questionnaire. We investigated influencing factors of feasibility and reliability with a general linear regression. One hundred and nighty-nine patients were included (mean age 56 ± 14; 111 (55.7%) women). Eighty-four (42.2%) had demyelinating disease, 55 (27.6%) Parkinson's disease, 51 (25.6%) neuro-genetic disorder and 7 (4.5%) spinal cord injury or cauda equina syndrome. BD were classified as feasible for 128 (64%) patients and 45 (40.5%) were deemed reliable. In a generalized linear model, no factor was associated with BD feasibility or reliability. In a ANLUTD population, the BD is a feasible tool, but its interpretation should be met with caution due to its limited reliability. No factor was associated with the feasibility or reliability of the BD.

Sexual function in women with bothersome lower urinary tract symptoms: findings from the symptoms of lower urinary tract dysfunction research network (LURN) cohort study.

Bothersome lower urinary tract symptoms (LUTS) can negatively affect the quality of life in women, including sexual function. The primary aim of the study was to explore the association between LUTS severity and sexual functioning among women with LUTS. Female participants enrolled in the Symptoms of the first Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN-I) observational cohort study with a frequency rating of at least "sometimes" and a bother rating of at least "somewhat" on at least one LUTS Tool question. LUTS and sexual function were quantified by patient questionnaires at baseline, 3months, and 12months after study enrollment. LUTS were assessed via the LUTS Tool, while sexual function was assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, International Urogynecological Association-Revised (PISQ-IR). Longitudinal analyses were restricted to females with completed baseline and 12-month (or 3-month, if missing) questionnaires. Associations between baseline sexual function, clinical characteristics, and LUTS were analyzed using linear regression. The primary outcomes were bothersome LUTS, defined by the LUTS Tool, and sexual function, defined by the PISQ-IR. Female participants (n = 528) were identified. At baseline, 245 participants were not sexually active (NSA), while 283 were sexually active (SA). Baseline characteristics of the cohort are described in Table 1; compared with NSA, SA was younger (49 vs 63years) and more likely to be married/civil union (67% vs 43%). Less severe LUTS (10 points lower) was associated with higher (better) PISQ-IR summary and subscale scores (condition-specific, condition-impact, global quality, and arousal/orgasm subscales) for SA participants. For NSA participants, less severe LUTS was associated with higher condition-specific and condition-impact subscale scores. A subset of participants (n= 406) had follow-up data at 12months. Longitudinally, LUTS Tool scores improved on average from baseline to 12months by seven points, while PISQ-IR scores generally remained stable. As LUTS improves, overall sexual function in SA and NSA women remains stable. Strengths of the study include the use of a validated sexual function questionnaire, PISQ-IR, which captures sexual function in women who are not SA. Limitations of the study include the fact that participants presented to tertiary academic centers for care, which may limit the study's generalizability. In a large cohort of women with prospectively collected data on LUTS and sexual function, sexual function largely remained stable over time even as LUTS bother improved.

Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN II) Urinary Urgency Phenotyping Study: Methods and Baseline Urinary Symptoms by Age and Sex.

To present the methods and baseline findings from a prospective, longitudinal cohort study of treatment seeking adults with urinary urgency (URG) with or without urgency urinary incontinence (UUI). Adults seeking treatment for URG and/or UUI and controls were enrolled. Participants completed physical examination, urine and serum studies, post-void residual, and validated questionnaires. Data from 809 participants were analyzed. Cases and controls were both predominantly white. The mean overall age of the cases was older (62 vs. 59 years) as was the mean BMI and functional comorbidity index scores. Higher proportions of controls were never smokers. Among cases, bivariate analysis found higher proportions of women reporting URG, URG with fear of leaking, any UI and UUI. Men had higher proportions of often or almost always reporting nocturia. Higher proportions of men reported URG alone and UUI without stress UI. Mixed UI was prevalent among women but rare among men. In logistic regression models, women had higher odds of SUI, UUI, and dysuria compared to men. Men had higher odds of nocturia, intermittency, splitting/spraying, and hesitancy. Older participants had higher odds of UUI, nocturia, any UI, and URG with fear of leakage whereas younger participants had higher odds of stress UI, irritative symptoms. Treatment-seeking adults with URG and/or UUI were older, had higher BMI, worse functional comorbidity index and higher proportions of prior smoking history compared to controls. Among cases, sex and age differences were seen in within the spectrum of URG and UUI.

Adult Manifestation of Lower Urinary Tract Dysfunction as Daytime Urinary Incontinence and Nocturnal Enuresis in a Case With Spinal Lipoma

Adult Manifestation of Lower Urinary Tract Dysfunction as Daytime Urinary Incontinence and Nocturnal Enuresis in a Case With Spinal Lipoma

The Effects of Botulinum Toxin A Injections on Patients with Radiogenic Lower Urinary Tract Symptoms.

Botulinum toxin A (BTX-A) injection into the detrusor vesicae is an established therapy for neurogenic lower urinary tract dysfunction as well as idiopathic overactive bladder. Pelvic radiotherapy causes comparable lower urinary tract symptoms (LUTS) in a third of radiated patients. Little is known about the effects of BTX-A injections into the detrusor vesicae in the management of radiogenic LUTS. Our aim was to assess the effect of BTX A injections on these symptoms and related quality of life. Material and Methods: In total, 28 patients with BTX-A injections for radiogenic LUTS were assessed retrospectively. We analyzed symptoms recorded in bladder diaries, the results of quality-of-life questionnaires (ICIQ-LUTSqol), and urodynamic studies (UDS) before and after BTX-A injections. Results: A significant reduction in daily micturition frequency, nocturia, and pad consumption was demonstrated in the overall cohort and in gender-related subgroup analysis. There was a significant decrease in the ICIQ-LUTSqol independent of gender or BTX-A units. For UDS maximum cystometric bladder capacity (188.0 vs. 258.2 mL, p = 0.043), micturition volume (138.2 vs. 216.7 mL, p = 0.018), and first desire to void (98.2 vs. 171.2 mL, p = 0.042) was significantly improved. No side effects of the toxin injection or urinary retention were observed. Conclusions: Intradetrusor injection therapy with BTX-A could represent a safe and effective therapeutic option for radiogenic LUTS with increasing quality of life, reductions in symptoms, and the improvement of urodynamic parameters.

Sacral Neuromodulation for Neurogenic Lower Urinary Tract, Bowel and Sexual Dysfunction in Patients With Multiple Sclerosis: A Pilot Trial.

We present results of a two-arm pilot study assessing the feasibility of conducting a double-blind randomized controlled trial (RCT) to evaluate the efficacy of sacral neuromodulation (SNM) in patients with multiple sclerosis (MS) suffering from neurogenic lower urinary tract dysfunction (NLUTD). Eligible subjects with refractory NLUTD and EDSS < 5 underwent SNM test phase. Those showing more than a 50% improvement of bladder variables, received implantable pulse generators (IPG) and were randomized to either treatment group (IPG ON) or to sham group (IPG OFF) for 1 month. During second month, all patients had the IPG ON until the end of the trial. The primary endpoints were trial feasibility, recruitment potential, and response rate at the end of SNM test phase. Secondary endpoint was safety. Changes in key bladder diary-derived variables and patient reported outcomes were recorded as well. Thirty-two patients were screened, 17 were eligible and 13 were included in the SNM test phase. Eleven were considered responders and were implanted with IPG. Subsequently, six patients were randomized to the treatment group and five to the sham group. No serious adverse events were reported. In the intervention phase, both objective and subjective improvements were seen in the treatment group, while the symptoms in the sham group remained mostly unchanged. At study completion, six patients reported being completely satisfied, three were mostly satisfied, and two were indifferent to the treatment. This pilot trial demonstrated feasibility of double-blind RCT assessing safety and efficacy of SNM in MS patients. ClinicalTrials. gov NCT05380856.

Evaluation of transcutaneous electrical tibial nerve stimulation in lower urinary tract dysfunction secondary to a parkinsonian syndrome: Uroparktens-a multicenter randomized placebo-controlled study.

Lower urinary tract dysfunction (LUTD) is common in parkinsonian syndromes (PS) and requires special treatment due to limitations in the use of certain drugs and the progression of the disease. Tibial nerve stimulation by transcutaneous electrical nerve stimulation (TENS) is a simple, well-tolerated treatment with proven effectiveness in LUTD. The aim of our study was to evaluate the efficacy on urinary symptoms in patients with a parkinsonian syndrome. A prospective, double-blind, multicenter, randomized study to compare the effects of TENS 20min a day for 3months with sham stimulation using the 3-month Patient Global Impression of Improvement (PGI-I) score in adults with PS and LUTD for whom conventional treatments had failed. The secondary endpoints studied were 3-month changes in PGI-S (Severity), Urinary Symptom Profile (USP), Qualiveen questionnaire, voiding diary (VD), post-void residue and the rate of complications. Between 2015 and 2020, 100 patients with a mean age of 68.6 ± 8.4years were randomized and included in the intention to treat analysis population (ITT). Among them were 71 men and 85 patients with idiopathic Parkinson's disease. Initially, the PGI-S was moderate to severe (score of 3-4) in 80 patients: 38 (83%) in the TENS group and 42 (82%) in the sham group. After 3months of treatment, 68 patients felt an improvement (PGI-I 1-3): 30 (64%) in the TENS group and 38 (72%) in the sham-stimulation group (p = 0.399). There was no statistically significant difference between the 2 groups regardless of the endpoint considered. The effect of tibial neuromodulation by TENS on urinary disorders in patients with parkinsonian syndrome after 3months of stimulation was not significantly different from the placebo effect obtained with sham stimulation.

Urodynamic assessment and proteomic analysis of lower urinary tract dysfunction following nerve-sparing radical hysterectomy

This study aimed to evaluate lower urinary tract dysfunction after radical hysterectomy using urodynamic studies and to identify urinary biomarkers for detrusor underactivity via proteomic analysis. This prospective single-center study included women who underwent nerve-sparing radical hysterectomy for cervical carcinoma. Preoperative and postoperative assessments (at 1 and 6 months) included the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, urethral pressure profiling, and pressure flow studies. Detrusor contractility was assessed using the projected isovolumetric pressure (PIP1). Proteomic analysis was performed to identify urinary biomarkers associated with postoperative detrusor underactivity. Twenty-five patients were included. The total IPSS increased significantly at 1 and 6 months postoperatively. The maximum urethral closure pressure decreased significantly at 1 month and stabilized thereafter. PIP1 and voiding efficiency decreased significantly at 1 month, but improved by 6 months. Proteomic analysis revealed significant correlations between the changes in urinary ezrin, moesin, transthyretin, and PIP1 levels. Receiver operating characteristic analysis identified the optimal cutoff values for these biomarkers in diagnosing detrusor underactivity (PIP1 < 30). It was concluded that nerve-sparing radical hysterectomy impairs detrusor contractility and urethral function. Additionally, urinary ezrin, moesin, and transthyretin levels may be valuable biomarkers for diagnosing detrusor underactivity.

Transitional Outcomes of Adults Who Underwent Cohen Ureteroneocystostomy for the Treatment of Vesicoureteral Reflux as Children.

Transitional Outcomes of Adults Who Underwent Cohen Ureteroneocystostomy for the Treatment of Vesicoureteral Reflux as Children.

Pathophysiology and potential treatment modalities in women with recurrent urinary tract infection.

Urinary tract infection (UTI) of the urinary bladder is a common bacterial infection that predominantly affects women, with many experiencing recurrent episodes. Recurrent UTIs (rUTIs) are associated with significant physical, psychological, and social difficulties. Further, they are closely related to lower urinary tract dysfunction (LUTD). LUTD affects bladder function and structure, thereby contributing to urinary urgency, frequency, and incontinence, which, in turn, increases the risk of recurrent infections due to impaired urothelial defense mechanisms. The current study explored the pathophysiology of LUTD in women with rUTIs. Potential treatments for rUTIs include long-term prophylactic antibiotics, probiotics, D-mannose, vaccines, small molecule inhibitors, and stem cell therapy. Moreover, it evaluated the use of platelet-rich plasma (PRP) therapy as a treatment modality for LUTD. PRP has regenerative and anti-inflammatory properties. Hence, it can be a promising option for enhancing urothelial barrier integrity and reducing infection recurrence. Repeated intravesical PRP injections are effective in improving bladder symptoms and decreasing UTI recurrences by enhancing the proliferative ability of the urothelium in patients with rUTIs. Further, this review examined the potential predictors of successful PRP treatment outcomes such as cytokine and urothelial biomarker levels, which provided insights into patient selection and individualized treatment strategies. Identifying the predictive biomarkers of treatment responsiveness is essential for optimizing PRP therapy. Hence, to improve the clinical outcomes and quality of life of patients with rUTIs, future research should focus on refining the use of PRP, exploring combination therapies, and validating biomarkers.

Efficiency and Safety of Noninvasive and Intravesical Therapy for Adult Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.

Neurogenic lower urinary tract dysfunction (NLUTD), a complex abnormality caused by multiple neurologic disorders, is aserious threat to patients' prognosis and quality of life. However, benefit and safety for various treatments are inconsistent. The aim of the current study was to investigate the available trials of adult NLUTD treatments and provide valuable insights for clinical practice. The data sources were Medline, Embase, and Cochrane databases up to 31 December 2023. A Bayesian network meta-analysis was conducted with randomized controlled trials in patients whowere diagnosed with NLUTD, reporting clinical symptoms and urodynamic data. The main outcomes were incontinence episodes frequency (IEF) and maximum cystometric capacity (MCC). Secondary outcomes included frequency, maximum detrusor pressure, bladder compliance, volume of involuntary detrusor contraction, voided volume, incontinence, quality of life, and adverse events. A total of 54 articles were eligible, evaluating 28 treatments and 4478 patients for efficacy and safety. Compared with the control group, the oxybutynin instillation demonstrated a mean reduction in IEF of -2.65 episodes (95% confidence interval [CI]: -4.64 to -0.67), with a surface under the cumulative ranking curve (SUCRA) value of 85.8%. Botulinum toxin trigone-combined injection resulted in a reduction of -2.30 episodes (95% CI: -3.23 to - 1.44; SUCRA 84.2%). Additionally, intravesical therapies significantly increased MCC: oxybutynin instillation (mean 227.75mL, 95% CI 147.00 to 311.42, SUCRA 99.1%) and BTX300U (mean 147.88mL, 95% CI 100.45-190.32, SUCRA 83.2%). Botulinum toxin injection emerged as the preferred option for improving most urodynamic outcomes and quality of life. However, the incidence of adverse events associated with intravesical injections was higher compared with oral medications and other noninvasive therapies. The three types of botulinum toxins (onabotulinum toxin, abobotulinum toxin, and incobotulinum toxin) demonstrated consistent efficacy in treating both IEF and MCC. Individual studies were sequentially excluded for analysis of network stability. Most results from the alternative networks were consistent with the original analysis, although specific trials influenced certain therapy rankings. Overall, oxybutynin instillation and intravesical botulinum toxin injection demonstrated significant advantages in improving symptoms and urodynamic parameters. Our findings support intravesical treatment as a safe and effective option, provided that patients are fully informed about their treatment choices. Clinically, intravesical therapies, oral medications, nerve stimulation, and other treatments should be integrated into shared decision-making processes, while some options require further research to bolster the supporting evidence.

Evaluating the Benefits of Pelvic Floor Muscles Exercises Combined With Biofeedback Therapy for Improving Functional Urinary Incontinence in Children.

Pelvic floor muscles training (PFMT), with or without biofeedback (BF), is widely utilized as an alternative treatment for various refractory lower urinary tract dysfunctions in adults and children. This study aimed to compare the efficacy of PFMT alone versus in combination with BF on functional urinary incontinence (UI) in children. Medical records of children who had undergone pelvic floor rehabilitation for non-neuropathic intermittent UI from 2018 to 2022 were retrieved. Patients were categorized based on their treatment regimen. Group I had undergone standard urotherapy and PFMT, twice weekly for 5 weeks. Group II had undergone a similar 5-week treatment with addition of 10 BF sessions conducted at the end of each appointment. All children had been evaluated with kidney and bladder ultrasounds, uroflowmetry/EMG, and a 7-day voiding and bowel diary before and after treatment. Response to treatment was defined according to International Children's Continence Society (ICCS) protocols. A total of 32 patients (71.9% female) with a mean age of 8.4 ± 2.1 (range: 5-13) years were included in the analyses (each group N = 16). In group I, nine (56.2%) and two (12.5%) patients demonstrated complete (100% reduction in UI episodes) and partial (50%-100% reduction in UI episodes) clinical response, respectively. In group II, 11 (68.7%) and 3 (18.8%) patients showed complete and partial response, respectively. The two groups were not significantly different with regard to clinical response (p = 0.430). No significant difference was observed between the two groups in terms of enuresis, urgency, constipation, and uroflowmetry parameters. PFMT under the supervision of an expert physical therapist appears to be as effective as combined PFMT and BF in improving UI in children without underlying neurologic disease.