Overactive Bladder Symptom Score Research Articles

Impact of Covid-19 Infection on Incidence and Exacerbation of Overactive Bladder Symptoms: A Systematic Review

Background The COVID-19 pandemic continues to be a major global health concern. A key factor is the presence of angiotensin-converting enzyme 2 (ACE2) receptors in various organs, including the lungs, heart, bladder, and testicles. These receptors allow the SARS-CoV-2 virus to enter cells, making these organs vulnerable to damage. This vulnerability may explain why some patients experience non-respiratory symptoms. Notably, overactive bladder (OAB) symptoms and a condition called COVID-associated cystitis (CAC) have been reported to negatively affect the quality of life of COVID-19 patients. A systematic review is needed to summarize the current understanding of these urological aspects of SARS-CoV-2 infection, considering both short- and long-term effects. Methods We conducted a systematic review in accordance with PRISMA guidelines to investigate urological complications of COVID-19, with a specific focus on OAB symptoms and CAC (characterized by frequent urination, urgency, and nocturia). We searched databases, including Medline (PubMed), Embase, and Scopus. Two reviewers independently screened the studies, and the quality of each study was assessed using the Newcastle-Ottawa Scale (NOS). Results Our search identified 343 articles published up to March 2024, of which 12 were included in this review. Many of the studies utilized scoring systems such as the International Prostate Symptom Score (IPSS) and OAB symptom scores. The evidence suggests that COVID-19 may trigger or worsen lower urinary tract symptoms, OAB, and cystitis in some patients, regardless of gender or age. However, these effects appear to be uncommon. Several studies reported an increase in IPSS scores, though it remains unclear whether this increase is temporary or long-lasting. A few studies found that symptoms resolved over several months. Conclusion This systematic review suggests that COVID-19 may affect the urinary system, leading to symptoms such as frequent urination, urgency, and nocturia. These symptoms can negatively impact the quality of life in COVID-19 patients.

Safety and Effectiveness of Vibegron in Japanese Patients With Overactive Bladder: A Japanese Postmarketing Survey.

To evaluate the safety and effectiveness of vibegron, a highly selective β3-adrenoceptor agonist, in Japanese patients with overactive bladder (OAB) in a real-world clinical setting. This prospective survey was conducted from August 2019 to July 2023 using a central registration method. Patients newly treated with vibegron for OAB were followed for 12 weeks, and those who continued treatment were observed for up to 52 weeks. Adverse drug reactions (ADRs) and the overall improvement level were assessed, and overactive bladder symptom score (OABSS) and International Prostate Symptom Score-Quality of Life (IPSS QOL) score were collected. Of the 1848 patients in the safety analysis set, 154 ADRs were reported in 141 patients (7.63%). Common ADRs were increased residual urine volume (1.30%), constipation (1.14%), dysuria and urinary retention (0.97% each), cystitis (0.65%), and dry mouth (0.32%). The incidence of urinary retention-related adverse events (AEs) was higher in male patients, patients ≥ 65 years old, and patients with benign prostatic hyperplasia. The effectiveness rate was 88.8% among the 1561 patients in the effectiveness analysis set. Significant improvement in both OABSS and IPSS QOL scores was observed at all observation periods. The rate of achieving the minimal clinically important change in OABSS total score at the final evaluation was 75.35%. OABSS scores were also significantly reduced in all subgroup analyses. This survey found no major concerns regarding the safety and effectiveness of vibegron in Japanese OAB patients, except for urinary retention-related AEs. Vibegron is considered to represent a useful drug for treating OAB symptoms in a real-world clinical setting.

The association between different levels of depression and overactive bladder: A cross-sectional study of the 2005-2018 National Health and Nutrition Examination Survey.

There is growing evidence of a possible correlation between depression and overactive bladder (OAB). However, few studies have classified depression according to its severity. Whether there is an association between different levels of depression and OAB symptoms remains unclear. Participants with complete information about depression, OAB, and covariates in the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were included in this study. Depression symptoms were assessed by the Patient Health Questionnaire-9. OAB symptoms were evaluated by the Overactive Bladder Symptom Score. Weighted multivariate logistic regression models were applied to analyze the relationship between depression and OAB. A total of 30 359 participants were included in this study, consisting of 6245 OAB patients and 24 114 non-OAB participants. The multivariate logistic regression suggested depression independently correlated with OAB (odds ratio [OR] = 2.764, 95% confidence interval [CI] = 2.429-3.146, p < 0.001). Further, mild (OR = 2.355, 95% CI = 2.111-2.627, p < 0.001), moderate (OR = 3.262, 95% CI = 2.770-3.841, p < 0.001), and moderately severe to severe depression (OR = 3.927, 95% CI = 3.246-4.752, p < 0.001) were all associated with OAB. Additionally, depression was also correlated with urgency urinary incontinence (OR = 2.249, 95% CI = 1.986-2.548, p < 0.001) and nocturia (OR = 2.166, 95% CI = 1.919-2.446, p < 0.001). This study indicated different levels of depression, even mild depression, were independent risk factors for OAB. Given the frequent coexistence and potential interactions between depression and OAB, clinicians should be aware of the importance of assessing both physical and psychological symptoms in these patients. Early diagnosis and holistic treatment may improve the treatment outcomes, particularly for those suffering from both conditions.

Risk factors associated with overactive bladder severity in patients with type 2 diabetes.

The prevalence of overactive bladder (OAB) is known to be higher in patients with type 2 diabetes (T2DM) however there are not many studies about specific risk factors contributing to its progression among diabetes mellitus (DM) patients, so this study aimed to investigate the risk factors specific to DM that influence the progression of OAB in Syrian population. This cross-sectional study was carried out at five endocrinology centers situated in four Syrian provinces: Damascus, Aleppo, Homs, Hama, and Latakia. The study comprised patients who were diagnosed with both T2DM and OAB and had visited these centers from March 2020 and February 2024. The Arabic version of the OAB Symptom Score (OABSS) scale was used to categorize the participants based on the severity score into two groups: the mild OAB group and the moderate-severe OAB group. A logistic analysis was conducted to assess the risk factors associated with the progression of OAB among patients with diabetes. Among the 186 patients diagnosed with both DM and OAB, significant distinctions were found between the two groups concerning the severity of OAB, age, duration of diabetes, symptomatic diabetic peripheral neuropathy (DPN), and ankle reflex (p < 0.05). Furthermore, a multivariate analysis revealed that age (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.68-1.58), duration of diabetes (OR 2.14, 95% CI 1.75-3.74), and symptomatic DPN (OR 2.47, 95% CI 1.17-3.54) independently acted as risk factors for the advancement of OAB. The progression of OAB in Syrian patients with diabetes is closely associated with the severity of DM. Factors such as age, duration of diabetes, and symptomatic DPN are independent predictors of the severity of OAB. Patients who experience symptomatic DPN are at an increased risk of developing OAB.

Association of Workplace Toilet Access with Urinary Tract Symptoms and Productivity Loss among Female

Abstract Purpose Lower urinary tract symptoms (LUTS) are prevalent among women, affecting not only their physical well-being but also their quality of working life. We investigate workplace toilet access related to LUTS among women in the Korean workforce. Materials and methods An online survey was conducted to determine the demographic characteristics, occupational risk factors, and urinary tract symptoms among employed Korean women. Occupational risk factors included three survey questions on access to toilets at work: A) enduring urinary symptoms at work; B) capability to use the toilet at will during work, and C) needing to use the toilet during work but were unable to. The LUTS were assessed using the overactive bladder symptom score (OABSS) and international consultation on incontinence questionnaire-urinary incontinence short form (ICIQ-SF). Health-related productivity losses (HRPL) were estimated using the work productivity and activity impairment (WPAI) questionnaire for urinary symptoms. Multiple logistic regression was used to determined the association between workplace toilet access and LUTS. In addition, generalised linear regression analysis was performed to assess HRPL according to workplace toilet access. Results Of the 1057 participants, 260 (24.6%) and 294 (27.81%) had overactive bladder and urinary incontinence, respectively. More than 50% reported poor access to toilet. Multiple logistic regression analysis showed that the lower the access to toilets in the workplace, the higher the incidence of LUTS and the higher HRPL. Conclusions Restricted access to toilets at work are associated with poor urinary health and loss of productivity. The results highlight the need for interventions to improve the workplace environment. Key messages • Restricted access to toilets at work are associated with poor urinary health and loss of productivity. • The results highlight the need for interventions to improve the workplace environment.

Blood cadmium levels and overactive bladder in middle-aged and older adults in the United States: Insights from NHANES 2007–2020 data

Cadmium is a common environmental pollutant associated with various health risks. Its neurotoxic, muscle-damaging, and pro-inflammatory properties may be related to overactive bladder (OAB), though few studies have assessed its impact on urinary function. This study aimed to examine the potential link between cadmium exposure and OAB. Using data from the 2007–2020 National Health and Nutrition Examination Survey (NHANES), we analyzed adults aged 40 and older (n = 15,467) in a cross-sectional design. OAB was defined by the refined Overactive Bladder Symptom Score (OABSS). Weighted multivariate logistic regression examined the associations between blood cadmium levels and OAB and its components. Age and gender stratifications were performed, and restricted cubic splines (RCS) were used to explore non-linear associations between blood cadmium and OAB. Sensitivity analyses and co-exposure analyses with other pollutants were conducted to assess OAB definition stability, subgroup differences, and exposure collinearity. The prevalence of OAB was 26.2%. While blood cadmium showed a small, non-significant positive association with overall OAB, it was inversely associated with nocturia severity (OR = 0.85, 95% CI 0.74–0.98, p < 0.05). Blood cadmium was also linked to more severe urinary incontinence in the 50–59 age group and among non-Hispanic Black adults. A non-linear association between blood cadmium and OAB was observed (p for nonlinearity = 0.016, p < 0.05). In co-exposure analyses, cadmium remained a dominant and independent factor. These findings suggest that cadmium exposure may have a complex association with OAB and may relate differently to its various components. Further research is needed to explore these relationships.

Screening tool for sarcopenia (SARC-F) predicts unsatisfactory medical treatment of lower urinary tract symptoms in elderly men aged 75years or older: a preliminary observational study.

We investigated the influence of sarcopenia on treatment outcomes in elderly patients receiving medical therapy for lower urinary tract symptoms (LUTS). We included male patients with LUTS aged ≥ 75years who had not changed their medication for 1year. Current conditions were estimated using IPSS, overactive bladder symptoms score (OABSS), and screening tool for sarcopenia (SARC-F). We also evaluated prostatic volume (PV), serum testosterone level, grip strength, and nutrition status. SARC-F score of ≧4 was defined as sarcopenia. We included 59 patients in this study, including 16 patients (27.1%) with sarcopenia. The mean grip strength was significantly lower in the sarcopenia group than the non-sarcopenia group (25.5 vs. 30kg, p < 0.01). IPSS total score, voiding symptom score of IPSS, and IPSS-QOL were significantly higher in the sarcopenia group than the non-sarcopenia group. The non-sarcopenia group had significantly larger PV (40 vs. 20ml, p < 0.01) and higher testosterone levels (497.5 vs. 369ng/ml, p = 0.03) compared with the sarcopenia group, whereas the percentage of patients taking dutasteride tended to be higher in the non-sarcopenia group than the sarcopenia group (58.1% vs. 31.3%, p = 0.07). Moderate and severe LUTS (IPSS total ≥ 8) persisted in 34 patients (57.6%) after medical treatment. Multivariate analysis showed that only SARC-F was a significant factor affecting the IPSS total ≥ 8 despite medical treatment for 1year (OR 1.67, 95%CI: 1.13-2.46, p = 0.01). Sarcopenia defined by using SARC-F is a significant factor for unsatisfactory medical treatment of LUTS in elderly men aged ≥ 75years.

The Therapeutic Effect of Monopolar Radiofrequency Therapy on Urinary Symptoms and Sexual Function.

Objectives: Stress urinary incontinence (SUI) negatively affects the quality of life and sexual function in women. This study aimed to evaluate the efficacy of radiofrequency (RF) therapy in reducing SUI symptoms and its impact on sexual function. Methods: Thirty-four women with SUI were enrolled and underwent a single RF treatment session using the Viveve® System (Viveve Medical Inc., USA) with parameters of 90 J/cm2 and 220 pulses per hour. Assessments at baseline and 6 months post treatment included perineal ultrasound and personal interviews to evaluate lower urinary tract symptoms and sexual function. Urodynamic studies, voiding diaries, and questionnaires such as the Female Sexual Function Index (FSFI), Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) measured outcomes. Results: RF therapy significantly improved sexual function, with higher FSFI scores in all domains except pain at 6 months. SUI symptoms were significantly reduced, as indicated by improved scores on OABSS, UDI-6, IIQ-7, and ICIQ-SF, alongside better voiding diary results. Anatomical changes included reduced bladder neck mobility, decreased vaginal width, and a reduced rotation angle of the proximal urethra. Conclusions: RF therapy is effective and safe for treating mild to moderate SUI and enhances sexual function, potentially due to changes in vaginal topography. These results suggest RF therapy as a viable non-surgical option for managing SUI and improving sexual health.

Urodynamic study and its correlation with cardiac meta-iodobenzylguanidine (MIBG) in body-first and brain-first subtypes of Parkinson's disease.

Lower urinary tract symptoms (LUTS) are frequently observed in patients with Parkinson's disease (PD), but the underlying mechanism remains elusive. The concept of "body-first" and "brain-first" subtypes in PD has been proposed, but the correlation of PD subtype with LUTS remains unclear. We aimed to investigate the disparities in urological dysfunctions between body-first and brain-first subtypes of PD using urodynamic studies (UDS). We reviewed patients with PD (disease duration <3 years) who had undergone UDS and completed urological questionnaires (Overactive Bladder Symptom Score [OABSS] and International Prostate Symptom Score [IPSS]) and a voiding diary. Patients were categorized as having body-first or brain-first PD based on cardiac sympathetic denervation (CSD) using cardiac meta-iodobenzylguanidine (MIBG) uptake and the presence of rapid eye movement sleep behavior disorder (RBD), assessed using a questionnaire (PD with CSD and RBD indicating the body-first subtype). A total of 55 patients with PD were categorized into body-first PD (n = 37) and brain-first PD (n = 18) groups. The body-first PD group exhibited smaller voiding volume and first desire volume (FDV) than the brain-first PD group (p < 0.05 in both). Also, the body-first PD group had higher OABSS and IPSS scores, and higher prevalence of overactive bladder diagnosed by OABSS, compared to the brain-first PD group. In multiple linear regression, cardiac MIBG uptake was positively correlated with FDV and voiding volume andnegatively correlated with OABSS and IPSS (p < 0.05 in all). Patients with the body-first PD subtype exhibited more pronounced overactive bladder symptoms and impaired storage function in the early stage of disease. Additionally, cardiac MIBG was significantly associated with urological dysfunction.

White Matter Magnetic Resonance Diffusion Measures in Multiple Sclerosis with Overactive Bladder.

Lower urinary tract (LUT) symptoms are reported in more than 80% of patients with multiple sclerosis (MS), most commonly an overactive bladder (OAB). The relationship between brain white matter (WM) changes in MS and OAB symptoms is poorly understood. We aim to evaluate (i) microstructural WM differences across MS patients (pwMS) with OAB symptoms, patients without LUT symptoms, and healthy subjects using diffusion tensor imaging (DTI), and (ii) associations between clinical OAB symptom scores and DTI indices. Twenty-nine female pwMS [mean age (SD) 43.3 years (9.4)], including seventeen with OAB [mean age (SD) 46.1 years (8.6)] and nine without LUT symptoms [mean age (SD) 37.5 years (8.9)], and fourteen healthy controls (HCs) [mean age (SD) 48.5 years (20)] were scanned in a 3T MRI with a DTI protocol. Additionally, clinical scans were performed for WM lesion segmentation. Group differences in fractional anisotropy (FA) were evaluated using tract-based spatial statistics. The Urinary Symptom Profile questionnaire assessed OAB severity. A statistically significant reduction in FA (p = 0.004) was identified in microstructural WM in pwMS, compared with HCs. An inverse correlation was found between FA in frontal and parietal WM lobes and OAB scores (p = 0.021) in pwMS. Areas of lower FA, although this did not reach statistical significance, were found in both frontal lobes and the rest of the non-dominant hemisphere in pwMS with OAB compared with pwMS without LUT symptoms (p = 0.072). This study identified that lesions affecting different WM tracts in MS can result in OAB symptoms and demonstrated the role of the WM in the neural control of LUT functions. By using DTI, the association between OAB symptom severity and WM changes were identified, adding knowledge to the current LUT working model. As MS is predominantly a WM disease, these findings suggest that regional WM involvement, including of the anterior corona radiata, anterior thalamic radiation, superior longitudinal fasciculus, and superior frontal-occipital fasciculus and a non-dominant prevalence in WM, can result in OAB symptoms. OAB symptoms in MS correlate with anisotropy changes in different white matter tracts as demonstrated by DTI. Structural impairment in WM tracts plays an important role in LUT symptoms in MS.

Electroacupuncture versus solifenacin succinate for female overactive bladder: study protocol for a multicentre, randomised, controlled, double-dummy, non-inferiority trial

IntroductionOveractive bladder (OAB) affects approximately 500 million people worldwide, with a higher prevalence in women than in men, significantly impacting the quality of life of female patients. Treatment options for...

Association between weight-adjusted waist index and overactive bladder: a cross-sectional study based on 2009-2018 NHANES.

The weight-adjusted waist index (WWI) is a novel obesity indicator that appears to outperform the body mass index (BMI) and waist circumference (WC) in assessing both overweight and obesity. Studies have demonstrated the relationship between obesity and overactive bladder (OAB). The purpose of this study is to examine the correlation between WWI and OAB. This research utilizes data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018. Each participant's WWI was calculated as their WC in centimeters by the square root of weight in kilograms. The Overactive Bladder Symptom Score (OABSS) questionnaire is used to determine whether a participant has OAB. Multivariate logistic regression and generalized additive model analysis were employed to investigate the relationship between WWI and OAB. We used smoothing curve fitting to explore non-linear relationships. Additionally, subgroup analysis and interaction tests are conducted. In this cross-sectional study involving 35,950 subjects, we found that individuals with a higher WWI have a higher risk of OAB (OR = 1.41, 95% CI: 1.02-1.74). Subgroup analysis and interaction testing showed that the relationship between WWI and OAB is consistent across various population characteristics. Smoothing curve fitting reveals a positive non-linear relationship between WWI and OAB. Furthermore, the association between WWI and OAB is stronger than that of other obesity-related indicators. Weight-adjusted waist index may be able to predict the incidence of OAB and that WWI-based obesity management may help to reduce the risk of OAB.

Effectiveness of Electrical Stimulation Combined with Pelvic Floor Muscle Training on Female Sexual Dysfunction with Overactive Bladder: A Randomized Controlled Clinical Trial.

(1) Background: Female sexual dysfunction (FSD) and overactive bladder (OAB) are prevalent disorders that significantly impair women's quality of life. While pelvic floor muscle training (PFMT) is a well-established treatment for OAB, its effectiveness for FSD remains uncertain. Recent studies suggest that intravaginal electrical stimulation (IVES) may enhance the effects of PFMT. Therefore, this study aimed to evaluate the efficacy of combining IVES with PFMT to improve sexual function and bladder control in women with OAB and FSD. (2) Methods: A total of 40 women with FSD and OAB as determined by the Female Sexual Function Index (FSFI) and Overactive Bladder Symptom Score (OABSS) were randomized into two groups: group 1, the intravaginal electrical stimulation group (IVESG) (n = 20), and group 2, the placebo control group (CG) (n = 20). Patients in both groups received PFMT during the trial, and the IVESG underwent 10 weeks of electrical stimulation. The primary outcome was the change in the FSFI score from baseline to week 4 and week 10. The secondary outcome was a comparison of the OABSS values at week 4 and week 10 of the trial. (3) Results: After treatment, the IVESG scores for the total FSFI, sexual arousal and orgasm, increased significantly (p < 0.05). After 10 weeks of treatment, the OABSS values for IVESG were significantly lower (p < 0.01). After 10 weeks of treatment, the percentage of patients with mild OAB in the IVESG and CG increased by 53.33% and 60%, respectively, while the percentage of patients with both moderate and severe OAB decreased, especially in the IVESG, where patients with severe OAB were non-existent after 10 weeks of treatment. (4) Conclusions: IVES combined with PFMT improved objective and subjective measures of FSD and OAB. There was a significant improvement in FSD (including arousal and orgasmic domain scores). This study concludes that IVES is an effective conservative treatment.

Utilizing Bladder Diaries to Prevent Unnecessary Treatment in Patients With Storage Dysfunction: A Retrospective Study.

Introduction A frequency volume chart (FVC) or bladder diary (BD) is used to diagnose lower urinary tract symptoms and to determine the effectiveness of treatment. In outpatient practice, patients who use an FVC or BD may experience improvement in storage symptoms and not desire further treatment. The aim of this study was to determine the characteristics of patients who did not desire treatment after BD recording and to assess the changes in storage symptoms after BD recording. Methods This was a retrospective study. Patients who completed a three-day BD record were included. The patients were divided into two groups: those whose symptoms improved after using a BD and no longer desired treatment, and those who desired treatment. We compared endpoints including patient background, BD, Overactive Bladder Symptom Score (OABSS), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score. Results We recruited 79 patients. Four patients were excluded (two were minors and two due to cognitive impairment). Thus, 75 patients were included in the analysis. Of these, 27 (36.0%) did not desire treatment for storage symptoms after BD recording. Compared with the group of patients who desired treatment, those who did not desire treatment had significantly lower daytime and nighttime frequency and number of leaks recorded in their BD, and there were fewer patients with nocturia and habitual caffeine consumption. Baseline OABSSand ICIQ-UI SFscores were lower and there were no significant changes in storage symptoms after BD recording. The cut-off value for the baseline total score of OABSSthat did not desire treatment for storage symptoms after BD recording was 6 points. Conclusion In this study, 36.0% of patients no longer desired treatment for storage symptoms after using a BD. These patients initially exhibited a normal daily urinary frequency and mild storage symptoms. These findings suggest that among patients presenting to the outpatient clinic with storage symptoms, those with mild symptom severity and a total OABSSof 6 points or less may be able to avoid unnecessary treatment through BD recording.

Prevalence and risk factors for overactive bladder symptoms in patients with artificial urinary sphincter

To demonstrate the prevalence and risk factors for overactive bladder symptoms associated with artificial urinary sphincter implantation, we investigated the patients who underwent primary artificial urinary sphincter implantation with severe urinary stress incontinence. Forty-eight patients who completely answered the questionnaires of the overactive bladder symptom score before surgery were included. Patient characteristics, urinary status at pre and 1, 3, 6, and 12 months post-device activation, and predictive factors for overactive bladder symptoms were examined. Sixty percent of the patients had preoperative overactive bladder symptoms. Until 12 months after device activation, 35–40% of all patients had overactive bladder symptoms. The rate of persistent and de novo postoperative overactive bladder symptoms was 44.8% and 26.3%, respectively. Daily pad use was not different between patients w/wo overactive bladder symptoms. The only risk factor for postoperative overactive bladder symptoms was a max cystometoric capacity < 200 mL measured by a preoperative urodynamic study. Attention must be given to both persistent and de novo overactive bladder symptoms associated with artificial urinary sphincter implantation for patients with stress incontinence. Counsel should equally be provided for preoperative overactive bladder symptoms, especially in cases with a cystometric capacity < 200 mL.

Discrete Mathematics in Dynamic Network Analysis: Long-Term Efficacy Evaluation of Fotona Laser Therapy for Overactive Bladder Syndrome Using Clustering-Based Patient Subgroup Identification.

Dynamic network analysis, a state-of-the-art application of discrete mathematics, offers unprecedented insight into complex, time-evolving clinical data. This technical report demonstrates the value of evaluating the long-term efficacy of Fotona laser therapy (Fotona d.o.o., Ljubljana, Slovenia) in overactive bladder (OAB) syndrome. We analyzed data from 101 female patients aged ≥60 years who underwent Fotona laser treatment, including Vaginal Erbium Laser (VEL) and Urethral Erbium Laser (UEL), between 2020 and 2022. OAB symptom scores (OABSS) were collected at baseline (T0) and at six, 12, 18, and 24 months post treatment. Network graphs were constructed, representing patients as nodes, and symptom similarities as edges. Clustering techniques identify patient subgroups, whereas principal component analysis reduces dimensionality. The dynamic evolution of patient clusters was visualized through changes in average degree centrality over time. This approach revealed three distinct patient clusters with unique treatment response patterns. The results showed a progressive reduction in OABSS, with the total score decreasing by 2.82 ± 3.03 at 24 months. Our method provides novel visualization and analysis of complex longitudinal clinical data, offering insights into personalized treatment strategies for OAB. This report presents one of the first applications of discrete mathematics and dynamic network analysis to evaluate the long-term outcomes of Fotona laser therapy for OAB and introduces an innovative perspective for clinical decision-making in urogynecology.

Acupuncture for overactive bladder in adults: Study protocol for a randomized controlled trial

BackgroundOveractive bladder (OAB) is a prevalent condition that substantially degrades patient quality of life. Acupuncture is recognized as an effective therapeutic approach for various urological diseases. However, there is limited evidence validating the effectiveness and safety of acupuncture for OABs. ObjectiveTo assess the therapeutic efficacy of acupuncture for OAB and to investigate the potential mechanisms by analyzing its effects on relevant urinary biomarkers. MethodsThis is a randomized, participants and outcome assessors blinded, sham acupuncture controlled trial. A total of 110 patients with OABs will be randomly divided in a 1:1 ratio between the acupuncture and sham acupuncture groups. Participants in the acupuncture group will undergo 30-min authentic acupuncture, while their counterparts in the sham acupuncture group will undergo sham acupuncture needling non-acupoints superficially three times weekly for a duration of 8 weeks. The two co-primary outcomes will be the change in the mean number of micturitions per 24 h from baseline to the end of the 8-week treatment and 20-week follow-up. The secondary outcomes will encompass the change in Overactive Bladder Symptom Score, Overactive Bladder Questionnaire Short Form, and average 24 h values of urgency, daytime micturition, nocturia, and mean volume voided per micturition from baseline to weeks 8 and 20. Urinary nerve growth factor, brain-derived neurotrophic factor, and monocyte chemoattractant protein-1 levels will be measured at baseline and week 8. Adverse events will also be documented. DiscussionThe results of this trial provide evidence for the effectiveness and safety of acupuncture in the management of OAB.

Duration of α-1 adrenergic antagonist administration after low-dose-rate brachytherapy for prostate cancer.

Urinary dysfunction is an adverse event of low-dose-rate brachytherapy (LDR-BT) in patients with prostate cancer. We aimed to examine the time to α-1 adrenergic antagonist withdrawal after LDR-BT initiation. We retrospectively evaluated 1663 patients who underwent LDR-BT at our hospital during 2004-2022. Overall, 1485/1663 (89.3%) patients were able to stop using α-1 adrenergic antagonists, 1111 (66.8%) of them within 1year of LDR-BT. Risk factors for prolonged time to withdrawal were age ≥70years, taking agents for lower urinary tract symptoms prior to LDR-BT, an International Prostate Symptom Score≥8, an Overactive Bladder Symptom Score≥3 and a residual urine volume≥20ml. Of the patients who were able to stop taking α-1 adrenergic antagonists, 357/1485 (24.0%) required resumption, 218 (61.1%) of whom did so between 1 and 3years after LDR-BT. This period matched the period of transient worsening of the urinary symptom score. Finally, multivariable analysis identified supplemental external beam radiotherapy and an Overactive Bladder Symptom Score≥3 as independent risk factors for α-1 adrenergic antagonist resumption. Withdrawal of α-1 adrenergic antagonists was possible in 66.8% of patients within 1year of LDR-BT. Our results suggest that patients who are older or have pre-treatment LUTS may have prolonged deterioration of urinary dysfunction after treatment. Resumption of α-1 adrenergic antagonists 1-3years after treatment may be associated with urinary symptom flares, and close attention is necessary for patients with supplemental external beam radiotherapy and a high pretreatment Overactive Bladder Symptom Score.

Association Between Frailty and Pelvic Organ Prolapse in Elderly Women: A Retrospective Study

Introduction and HypothesisThis study evaluated the association between pelvic organ prolapse (POP), frailty, and sarcopenia to explore how POP treatment can extend healthy life expectancy in elderly women.MethodsWe conducted a retrospective study of prospectively collected data, comparing women with mild POP (stages 0–II) with those with advanced POP (stages III and IV). The inclusion criteria for this study were women who visited the clinic with at least one symptom of pelvic floor dysfunction and underwent imaging studies between April 2020 and November 2022. Initially, 119 patients met these inclusion criteria. Patients were excluded if they had a history of previous POP treatment, did not respond to the study survey, or were lost to follow-up. After applying these exclusion criteria, 82 patients were included in the final analysis, of whom 65 underwent surgery (laparoscopic sacrocolpopexy, colpocleisis, tension-free vaginal tape, and native tissue repair). Assessments included POP Quantification, Kihon Checklist, Pelvic Organ Prolapse Quality of Life (P-QOL) questionnaire, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Incontinence Symptom Questionnaire (ICIQ-SF). Pelvic muscles were measured using MRI or CT. Immunohistochemical analysis of estrogen receptor alpha (ERα), estrogen receptor beta , and androgen receptor was performed on surgical specimens from 43 patients.ResultsThe median age of participants was 75 years. Of the 82 patients, 48 (58.5%) were classified as frail or pre-frail, and 22 (26.8%) exhibited motor impairment. Advanced POP (stages 3 and 4) was seen in 41 patients. These patients had more motor function impairments (advanced, 16; mild, 6; p = 0.01). Patients with advanced POP had poorer P-QOL, ICIQ-SF (median: 9.5 vs 4, p = 0.006) and OABSS (7 vs 4, p = 0.008) scores, and smaller pubococcygeus muscle diameter (2.5 vs 3 cm, p = 0.017). Postoperatively, significant improvements were seen in P-QOL (all domains except personal relationships: p < 0.001), total IPSS (11 vs 4, p < 0.001), OABSS (6 vs 5, p = 0.033), and ICIQ-SF scores (6 vs 2, p < 0.001). ERα expression was associated with preoperative frailty (r = −0.37, p = 0.014).ConclusionsAdvanced POP correlates with poorer QOL, worse urinary symptoms, and reduced pubococcygeus muscle diameter, consistent with sarcopenia, compared with mild POP.

One hundred cases of Rezum water vapor thermal therapy for benign prostatic hyperplasia: Real-world data at a single institution in Japan.

The objective of our study was to assess the efficacy of Rezum, a minimally invasive surgical treatment, for patients with lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) in real-world clinical practice at a single institution in Japan. We conducted a prospective study involving 100 patients who underwent the Rezum procedure between October 2022 and February 2024. We analyzed patient backgrounds that are compliant with Japanese regulations and assessed descriptive outcomes such as symptom scores, peak flow in uroflowmetry, post-void residual (PVR) volume, and prostate volume (PVol). These data were collected at 1 and/or 3 months postoperatively. On average, 4.7 water vapor injections were administered during the Rezum procedures, with a mean operative time of 6.3 min. Patients experienced significant relief in symptoms, with reductions of 55% in International Prostate Symptom Score, 53% in quality of life score, and 30% in Overactive Bladder Symptom Score. There was also a significant decrease in mean PVR volume (50% reduction) and PVol (27% reduction). Among the subgroup of 23 pre-interventional catheter-dependent patients, 91% achieved catheter independence. Our single-center analysis demonstrates that Rezum is an effective and safe minimally invasive therapeutic option for patients with BPH. This promising novel technique can be particularly beneficial for patients at an augmented risk of bleeding or those considered high risk for anesthesia.