Lower Urinary Tract Symptoms Research Articles

Robotic bladder diverticulectomy with concurrent management of bladder outlet obstruction: A choice to consider.

Acquired bladder diverticula (BD) are associated with bladder outlet obstruction. The aim of our study is to analyse the improvement in lower urinary tract symptoms (LUTS) in patients who underwent robot-assisted bladder diverticulectomy (RABD) combined with transurethral prostatectomy (TURP). A prospectively single-centre, single surgeon cohort of four patients with posterolateral BD due to bladder outlet obstruction (BOO) undergoing RABD combined with TURP between 2018 and 2023 was analysed. Median age and maximum BD diameter were 73.5 years and 16 cm, respectively. All patients had severe LUTS and elevated postvoid residual (PVR). Preliminary uroflowmetry revealed bladder outlet obstruction with a median of maximum urine flow rate of 8.5 ml/s. The median operative time and blood loss were 212 min and 100 ml, respectively. No intraoperative complications were recorded. The median length of stay was 4 days. The International Prostate Symptom Score (IPSS) and PVR were compared between baseline, 1 month and 6 months after surgery. IPSS significantly decreased from 24 (IQR 24-25) preoperatively compared to the postoperative, at 1 month follow up 7 (IQR 6-8) (p < 0.0001). PVR significantly decreased too from 165 (IQR 150-187) to 35 ml (IQR 25-42) (p < 0.0001). In transitioning from the 1-month follow-up to the 6-month follow-up, no substantial statistical improvement was observed. Concomitant performance of TURP with RABD is feasible and safe. Diverticulectomy in addiction at the endoscopic procedure should be discussed with patients who have obstructive lower urinary tract symptoms as viable alternative to single procedure individually performed.

Management of Benign Prostatic Hyperplasia in 2024

Benign prostatic hyperplasia (BPH) is a condition involving the proliferation of smooth muscle and epithelial cells within the transition zone of the prostate. The process by which this takes place is not precisely known. It does require that testosterone and 5-alpha reductase convert it to dihydrotestosterone (DHT) which is the active androgen within the prostate. The growth of the prostate results from an imbalance between cell growth and cell death. Obstruction occurs via compression of the urethra by the resulting hyperplastic nodules, as well as increased smooth muscle tone and resistance within the enlarged gland. It is an almost universal process in men beginning in their 40’s; it increases to a prevalence of 60% by age 60 and 80% by age 80.1 This results in progressive bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTs). Patients can range from being asymptomatic to severely symptomatic. In the most extreme cases, it can result in complete urinary retention and renal dysfunction. The annual economic impact of BPH has been estimated at nearly $4 billion in the Unites States.

Long-term outcomes after treatment with Optilume BPH Four-year results from the EVEREST study.

The purpose of this study was to gather initial safety and efficacy data with the Optilume® BPH Catheter System for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). A total of 80 men with moderate-to-severe LUTS secondary to BPH were enrolled and treated with the Optilume BPH Catheter System. Symptoms were evaluated using the International Prostate Symptom Score (IPSS) and Benign Prostatic Hyperplasia-Impact Index (BPH-II). Improvement in urinary flow and relief of obstruction was evaluated by way of peak urinary flow rate (Qmax) and postvoid residual urine volume (PVR). Subjects were prospectively queried for adverse events at each study visit, and relatedness to the study device was evaluated by the investigators, as well as centrally adjudicated by the study principal investigator. Previous reports of symptom improvement in this cohort were maintained through four-year followup, with a significant reduction in IPSS and IPSS quality of life maintained through four years (-12.1, -2.8, respectively). Clinically meaningful improvement in Qmax was maintained in the majority of subjects, with an average improvement from baseline of +5.6 mL/sec. No treatment-related adverse events were reported in the long-term followup period. Long-term followup through four years for subjects treated with the Optilume BPH Catheter System indicates durable outcomes in symptom improvement and functional improvement in flow rate. These results indicate the unique mechanism of action for Optilume BPH successfully achieves an immediate mechanical effect that is maintained long-term through incorporation of paclitaxel to maintain patency.

In-depth microbiological characterization of urine from subjects with type 2 diabetes.

Lower urinary tract symptoms (LUTS) are common in type 2 diabetes (T2D), affecting quality of life and potentially leading to medication discontinuation. Among various factors contributing to LUTS, recent observations suggest a critical role of the urinary microbiota. Research on urinary dysbiosis in T2D remains underexplored. We conducted a pilot study to investigate differences in the urinary microbiota between T2D patients and healthy individuals and its potential indirect association with LUTS risk. This case-control study included 50 patients with T2D and no LUTS, and 25 healthy controls. Microbial DNAs were extracted from urinary sediments and bacterial populations quantified by Real-Time qPCR and qualitatively investigated by 16S rRNA gene sequencing. Validation experiments with Digital PCR were also performed. In T2D patients a higher total bacterial load and an increased abundance of Bacillota were found. After stratification by gender, these results were observed only in women. However, no significant quantitative differences were observed at the genus level. Alpha diversity analysis showed no significant differences between T2D and control groups, or by gender. At the species level, a substantial qualitative and often gender-dependent shift was present in T2D individuals. The urinary microbiome of subjects with T2D was found to be different from that of healthy controls. Specifically, T2D patients displayed higher total bacterial load and Bacillota levels, as well as qualitative changes in bacterial species. These changes suggested a dysbiotic condition of the urinary microbiota of T2D subjects, with some gender-related differences. Although causality cannot be inferred, these findings highlight the impact of T2D on the urinary microbiota and its potential relevance in developing LUTS and, from a broader perspective, metabolic abnormalities.

MRI-based radiomic features of the urinary bladder wall identify patients with moderate-to-severe international prostate symptom score

BackgroundThe International Prostate Symptom Score (IPSS) is a patient-reported measurement to assess the lower urinary tract symptoms of bladder outlet obstruction. Bladder outlet obstruction induces molecular and morphological alterations in the urothelium, suburothelium, detrusor smooth muscle cells, detrusor extracellular matrix, and nerves. We sought to analyze MRI-based radiomics features of the urinary bladder wall and their association with IPSS.MethodIn this retrospective study, 87 patients who had pelvic MRI scans were identified. A biomarker discovery approach based on the optimal biomarker (OBM) method was used to extract features of the bladder wall from MR images, including morphological, intensity-based, and texture-based features, along with clinical variables. Mathematical models were created using subsets of features and evaluated based on their ability to discriminate between low and moderate-to-severe IPSS (less than 8 vs. equal to or greater than 8).ResultsOf the 7,666 features per patient, four highest-ranking optimal features were derived (all texture-based features), which provided a classification accuracy of 0.80 with a sensitivity, specificity, and area under the receiver operating characteristic curve of 0.81, 0.81, and 0.87, respectively.ConclusionA highly independent set of urinary bladder wall features derived from MRI scans were able to discriminate between patients with low vs. moderate-to-severe IPSS with accuracy of 80%. Such differences in MRI-based properties of the bladder wall in patients with varying IPSS’s might reflect differences in underlying molecular and morphological alterations that occur in the setting of chronic bladder outlet obstruction.

Exploring women's bladder self-care practices: A qualitative secondary analysis.

To describe women's experiences with a range of bladder self-care practices. We conducted a secondary, directed content analysis of qualitative data from the Study of Habits, Attitudes, Realities and Experiences, a multisite focus group study designed to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviours related to bladder health. This study was conducted by the National Institute of Diabetes and Digestive and Kidney Diseases' Prevention of Lower Urinary Tract Symptoms Research Consortium. Study methods were informed by the Consortium's conceptual framework, based on a social ecological model adapted from Glass and McAtee's Society-Behavior-Biology Nexus. Participants were recruited at seven geographically diverse United States research centres between July 2017 and April 2018. Data for the current analysis were collected using a semi-structured discussion group with 36 focus groups involving 316 community-dwelling adult women aged 18-93 years. Coded text was re-examined according to eight self-care behavioural domains identified through literature review and expert opinion as potentially influencing bladder health. Participants described many self-care practices they had adopted to prevent bladder problems or manage existing symptoms and conditions. Eight themes were identified: 'Choosing fluids, foods and medications'; 'Dressing for bladder health'; 'Promoting bodily cleanliness'; 'Managing toileting environments'; 'Timing when to void'; 'Exercising pelvic floor muscles for bladder control'; 'Limiting physical activities that challenge the bladder' and 'Staying home and navigating when away'. Thirteen subthemes were derived from five of the eight themes. Women use a broad array of self-care practices related to their bladder health. Research is needed to examine the efficacy of self-care behaviours for preventing or managing bladder symptoms and conditions, and to discern potential risks. Results have important implications for development of bladder health promotion interventions and public health messaging around women's bladder health. This study provides a comprehensive framework for understanding women's bladder self-care practices, which can be used by clinicians and public health professionals in designing interventions to promote bladder health and function. Women with and without lower urinary tract symptoms use a broad range of self-care practices that may affect their bladder health, including some that may be harmful. Because of the high prevalence of bladder symptoms in women, this study may help patient assessment and counselling regarding self-care practices. This study was reported according to the Standards for Reporting Qualitative Research (SRQR). No patient or public contribution.

Cognitive function and bladder health among midlife adult women in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

The aim of this study was to examine whether different aspects of women's cognitive function are associated with lower urinary tract symptoms (LUTS) and their impact. In 2010-2011, women aged 42 to 57 years in the Coronary Artery Risk Development in Young Adults study completed different tests of cognitive function, including the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop test. Two years later, data on LUTS and their impact were collected. LUTS/impact, a four-level composite variable ranging from bladder health to mild, moderate, and severe LUTS/impact, was regressed on each cognitive test separately, as well as a cognitive function composite variable. The analytic sample was composed of 1,021 women with complete data. When adjusting for sociodemographic variables (age, race, education) and gynecologic/obstetric variables (parity, menopausal status, hysterectomy, hormonal use), better performance on the cognitive function composite and Digit Symbol Substitution Test were both associated with lower odds of membership to a more severe LUTS/impact category (odds ratio, 0.90 [95% confidence interval, 0.83-0.98] and 0.89 [95% confidence interval, 0.82-0.97], respectively). These associations became nonsignificant when additionally adjusting for mechanisms that might explain an association between cognitive function and LUTS/impact, including health behaviors and health conditions that may covary with cerebral and peripheral vascular health and cognitive function. In this sample of midlife adult women, a modest association was found between better cognitive function and lower likelihood of LUTS/impact. Longitudinal studies are needed to further investigate the association between cognitive function and LUTS/impact, as well as potential explanatory mechanisms, particularly as women age and cognitive function varies to a greater degree.

Efficacy and durability of holmium laser enucleation of the prostate in the management of acute and chronic urinary retention A retrospective study.

Our study aimed to assess the efficacy and durability of holmium laser enucleation of the prostate (HoLEP) in managing acute urinary retention (AUR), neurogenic chronic urinary retention (NCUR), and non-neurogenic chronic urinary retention (NNCUR). We also sought to compare outcomes in patients with preoperative urinary retention (UR) to those without. We conducted a retrospective analysis using prospectively gathered data from men who underwent HoLEP at our institution between October 2017 and July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure, median urinary volume drained, or median postvoid residual urine volume (PVR) before catheterization or HoLEP. Chronic urinary retention (CUR) was defined as PVR >300 mL in males able to void; and initial catheter drainage >1000 mL in males unable to void, in the absence of pain. NCUR and NNCUR were differentiated based on the presence of any significant illness or injury with a neurologic impact on the bladder. All patients had postoperative followup visits at one, three, six, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS), quality of life (QoL) assessment, maximum urinary flow rate (Qmax), PVR, and catheter-free status. Three hundred sixty-eight males who underwent HoLEP were included in our study. The UR group consisted of 189 patients (70 AUR, 42 NCUR, and 77 NNCUR), and the lower urinary tract symptoms (LUTS) group was comprised of 179 individuals. There were no statistically significant differences between the NCUR and NNCUR subgroups regarding demographics and outcomes. At 12 months postoperative, the AUR group had a higher catheter-free rate than the CUR group (p=0.04), and other outcome variables were comparable between the two cohorts. The UR group had a significantly lower QoL score at one month (p=0.01) and a significantly lower IPSS score at one and 12 months (p=0.034 and p=0.018, respectively) than the LUTS cohort. During all followup visits, the UR group had a significantly higher PVR than the LUTS cohort. The successful first trial of void (TOV) rate for the UR and LUTS groups was 81% and 83.2%, respectively. At 12 months postoperative, the catheter-free rate for the UR and LUTS cohorts was 96.3% and 99.4%, respectively. HoLEP is an effective and durable treatment for UR with a high catheter-free rate and comparable outcomes when performed to manage LUTS.

Urologic care of nonagenarians A retrospective chart review.

Nonagenarians represent a rapidly growing patient population in Canada and have unique health concerns. With the goal of preparing urologists to manage this complicated patient population in the future, we sought to characterize referral patterns, diagnoses, investigations, treatments, and associated complications in a cohort of nonagenarians. Our second goal was to review anticholinergic burden (ACB) and rates of anticoagulation in this patient population and to assess the risk of hematuria in those who were anticoagulated. This was a single-center, retrospective chart review of a sample of nonagenarians referred to our tertiary care center between 2009 and 2017. Demographic information, referral patterns, investigations, treatment plans, and outcomes were assessed. We assessed medication lists to calculate ACB scores at the time of referral, in addition to rates of anticoagulation use. Data was collected for 154 nonagenarians. Hematuria was the most common reason for referral (n=43, 27.9%). Urinary retention and lower urinary tract symptoms (LUTS) were seen in 22 and 36 patients, respectively. The majority of patients underwent routine investigations; however, treatment decisions were frequently based on age and frailty. Mild, moderate and severe ACB scores were seen in 76.6%, 9.33%, and 14.0% of patients, respectively. Of those referred for hematuria, 78.1% were on anticoagulation therapy. The most common reasons for urologic referral of nonagenarians include hematuria and LUTS. Most nonagenarians are offered routine investigations, and many are offered minor interventions for common benign and malignant urologic diagnoses. When treating nonagenarians, an individualized patient-centered care approach is likely most appropriate.

Lower Urinary Tract Symptoms in Patients with COVID-19: Results of a Cross-sectional Study

Lower Urinary Tract Symptoms in Patients with COVID-19: Results of a Cross-sectional Study

Prostate Artery Embolization (PAE) with Small Beads for the Treatment of Benign Prostatic Hyperplasia (BPH).

Benign Prostatic Hyperplasia (BPH) is the most frequent cause of Lower Urinary Tract Symptoms (LUTSs) in elderly populations. Minimally invasive treatments of BPH are safe and effective and are gaining popularity among both professionals and patients. Prostate Artery Embolization (PAE) has proven to be effective in Trans-Urethral Resection of the Prostate (TURP) in terms of prostate volume reduction and LUTS relief. PAE entails the selective catheterization of the prostatic artery and later embolization of distal vessels with beads of various calibers. Universal consensus regarding the ideal particle size is yet to be defined. We retrospectively evaluated 24 consecutive patients (median age: 75 years; range: 59-86 years) treated with PAE at our institution from October 2015 to November 2022. Particles of different sizes were employed; 12 patients were treated with 40-120 µm particles, 5 with 100 µm, 5 with 100-300 µm and 2 with 250 µm. Technical success, defined as selective prostate artery catheterization and controlled release of embolizing beads, was achieved in all patients. Removal vs. retention of the urinary catheter at the first post-procedural urological visit was the main clinical objective. No major peri-procedural complications were recorded, with 56% of patients successfully removing the urinary catheter.

Self-Assessment of Lower Urinary Tract Condition in Female Competitive Cyclists.

During cycling, prolonged compression by the bicycle saddle on the anatomical structures located in the perineum area occurs. An additional factor that may have a negative impact on organs located in the pelvic area may be a prolonged sitting position resulting in increased intraabdominal pressure. This situation has the potential to adversely affect pelvic floor function. Therefore, the aim of this study was to assess the incidence of lower urinary tract symptoms (LUTSs) in female competitive road cyclists and cross-country cyclists. The study included 76 female competitive road cyclists and cross-country cyclists and 76 women not practising competitive sport. The Core Lower Urinary Tract Symptom Score (CLSS) questionnaire was used to assess the lower urinary tract condition. Female competitive cyclists had a statistically significantly higher LUTSs score (95% CI: 3.12-4.2 vs. 2.31-3.16; p < 0.05) compared to women not practising competitive sports. Female cyclists had a statistically significantly higher overall CLSS score (95% CI: 3.99-5.61 vs. 2.79-3.97; p < 0.05). Female cyclists had a statistically significantly higher incidence and severity of urinary frequency (p < 0.05 and p < 0.02), urge (p < 0.001 and p < 0.02) and stress incontinence (p < 0.001 and p < 0.001), and pain in the bladder (p < 0.01 and p < 0.01), while physically inactive women recorded a statistically higher incidence of slow urinary stream (p < 0.01 and p < 0.04). A statistically significant association was recorded between the years of cycling and the number of hours per week spent on training and the number of symptoms and their severity. The number of natural births experienced by women involved in competitive cycling significantly affects the severity of LUT symptoms. Compared to women not practising competitive sports, competitive female cyclists are found to have a higher prevalence of LUTSs and a greater degree of severity. LUTSs in competitive female cyclists are negatively influenced by years of competitive career and weekly number of training hours and the number of natural births experienced.

Sarcomatoid carcinoma of the urinary bladder: a case report

Background: Sarcomatoid carcinoma of the urinary bladder (SCUB) is a rare and aggressive malignancy with limited clinical data due to its infrequency. This case report contributes to the existing knowledge by presenting a patient with SCUB and highlighting the diagnostic workup, treatment course, and clinical outcomes. Case presentation: A 57-year-old man presented with lower urinary tract symptoms and hematuria. Imaging revealed a 4 cm bladder tumor. Transurethral resection of bladder tumor (TURBT) confirmed pT2 sarcomatoid carcinoma. Radical cystoprostatectomy with bilateral pelvic lymphadenectomy and urinary diversion was performed. Pathological examination confirmed SCUB with no lymph node involvement. The patient remains disease-free at two years follow-up. Conclusion: SCUB is an uncommon malignancy with a poor prognosis. Radical cystectomy is the preferred treatment; however, outcomes remain poor. A multimodal approach may offer improved outcomes for locally advanced diseases. Further research is needed to establish more effective treatment strategies.

Nocturia and frailty in older adults: a scoping review

BackgroundMore than one in two older people wake up several times a night to urinate. Far from being a minor inconvenience, nocturia is associated with poor health outcomes. Given the importance of sleep as a foundation for resilience and healthy ageing, nocturia may promote the development of frailty, which is inextricably linked to physical decline, disability, and mortality.The aim of this scoping review was to collate published evidence on the relationship between nocturia and frailty, using the methodological framework of Arksey and O'Malley, together with the Joanna Briggs Institute methodology as guidance (OSF registration: osf.io/d5ct7).MethodsRelevant publications were retrieved via PubMed, Embase, the Cochrane Library and Google Scholar. The Rayyan tool was used to facilitate the screening process. Data were extracted by two independent reviewers. 250 publications were initially identified, of which 87 met the eligibility criteria.ResultsMost of the evidence came from cross-sectional studies, most of which had been published within the last 5 years. The researchers were diverse, with 27% having a geriatric background. Only few publications established a clear association between nocturia and frailty. Other topics included: the association between nocturia and poor sleep quality and duration; the association between sleep and frailty; the association between frailty, multimorbidity, and age-related changes in the lower urinary tract.Conclusion The findings emphasize the increasing interest and interdisciplinary nature of research into the relationship between frailty, nocturia, lower urinary tract symptoms, and sleep disturbances. Further research is required to enhance understanding, establish causality, and identify potential therapeutic approaches.

Comparative efficacy of commercial oral poly-herbal traditional Chinese medicine formulations combined with western medicine in benign prostatic hyperplasia management: a systematic review and network meta-analysis.

Background: Benign prostatic hyperplasia (BPH) is prevalent among the aging male population and often presents with distressing lower urinary tract symptoms. There is emerging evidence that commercial oral poly-herbal traditional Chinese medicine (TCM) formulation combined with Western medicine (WM) may offer enhanced therapeutic effects compared to WM alone in BPH treatment. Nevertheless, determining the optimal formulations for BPH remains controversial. We aimed to employ a network meta-analysis to compare and assess differences among commonly used and recommended poly-herbal TCM formulations outlined in the Chinese guidelines for BPH treatment, providing clinical medication recommendations and guidance. Methods: We extensively searched for RCTs of BPH patients that had oral poly-herbal TCM formulations and WM treatment, covering both English and Chinese databases up to 31 October 2023. The quality of the included studies was evaluated using the Cochrane risk-of-bias tool Version 2 (ROB2). A Bayesian network meta-analysis was performed to assess the effectiveness of various formulations, followed by sensitivity and subgroup analyses. Results: Our meta-analysis included 107 RCTs involving 11,037 patients across 16 oral poly-herbal TCM formulations. The quality of the selected studies was assessed as "Some concerns". Most formulations combined with WM demonstrated superior therapeutic efficacy compared to WM alone. For clinical effective rate, Jingui Shenqi pill (JGSQ) + WM had the highest-ranking probability (87.38%). Concerning International Prostate Symptom Score (IPSS) and maximum flow rate of urine, Guizhi Fuling capsule (GZFL) + WM was most effective (91.10% and 98.55%). Regarding the quality of life score and postvoid residual urine, Pulean tablet (PLA) + WM ranked first (86.71% and 91.81%). In controlling prostate volume, Huange capsule (HE) + WM demonstrated the highest efficacy (95.65%). Additionally, among the interventions, Lingze (LZ) + WM capsule exhibited the lowest incidence of adverse drug reactions (2.32%). Conclusion: Combining oral poly-herbal TCM formulations with WM may provide greater therapeutic benefits in BPH treatment compared to WM alone. JGSQ, GZFL, PLA, and HE emerged as promising treatment options. However, further rigorous empirical studies are essential to substantiate these findings. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=459651, CRD 42023459651.

INTERNATIONAL PROSTATE SYMPTOM SCORE (IPSS) CORRELATION WITH SONOGRAPHIC PROSTATE SIZE

The International Prostate Symptom Score (IPSS) is a broadly used questionnaire designed to assess the severity of lower urinary tract symptoms (LUTS) in men, particularly those related to harmless prostatic hyperplasia (BPH). Objectives: The primary aim of this study is to find the International Prostate Symptom Score (IPSS) and its correlation with sonography and prostate size. Methods: This cross-sectional study was conducted at CMH Lahore February 17, 2024, to May 16, 2024. Data were collected from 250 patients. Male patients aged&gt;40 years who presented with LUTS were included in the study. Patients with a history of prostate cancer, bladder dysfunction and prostate surgery were excluded from the study. Data were collected through a systematically designed questionnaire. All the study participants completed the IPSS questionnaire to find the severity and urinary symptoms. Results: Data were collected from 250 patients according to the study's inclusion criteria. The mean age of the patients was 62.4 ± 8.6 years, and the mean BMI was 27.1 ± 3.2 kg/m2. The mean PSA was 6.8 ± 2.5 ng/mL, and the mean IPSS score was 19.5 ± 6.8. there, 140 (56%) patients were smokers, and 125 (50%) also suffering from hypertension. Patients with IPSS scores ranging from 0-7 exhibited a mean PV of 32.5 ± 5.6 mL, with a Pearson correlation coefficient (r) of 0.25 (p = 0.038). As IPSS scores increased to the 22-35 range, the mean PV rose to 54.3 ± 9.2 mL, with a more robust correlation coefficient of 0.75 (p &lt; 0.001). Conclusion: It is concluded that there is a significant positive correlation between the International Prostate Symptom Score (IPSS) and prostate volume (PV) in patients with benign prostatic hyperplasia (BPH).

A new technique for the treatment of ureteric stricture after kidney transplantation.

To evaluate the safety and effectiveness of endoscopic treatments with Allium® metal ureteric stent (AMUS) for ureteric strictures after kidney transplantation (KT). In a prospective manner, we gathered clinical data from 68 patients who underwent endoscopic treatments with AMUS for ureteric strictures after KT between January 2019 and March 2022. The definition of surgical success was the unobstructed drainage of the AMUS, or in cases where there was AMUS migration, occlusion or encrustation and subsequently removed, there is no worsening of renal hydronephrosis in the patient during the follow-up period. Based on the specific circumstances of the ureteric strictures, three distinct types of surgery were selected for treatment. The overall success rate of endoscopic treatments for ureteric strictures following KT was 90% (61/68) during a follow-up period of 1 year. Surgical complications included haematuria (18%), pain (10%), urinary tract infections (7.4%), and lower urinary tract symptoms (7.4%). The incidences of stent migration, occlusion, and encrustation were 10%, 2.9%, and 1.5%, respectively. Postoperatively, significant improvements were observed in various parameters. At 1 month after surgery, there was a notable decrease in blood creatinine levels (105.5 vs 90.4 mol/L), urea nitrogen levels (6.6 vs 5.4 mmol/L), and hydronephrosis volume (64.4 vs 43.9 mL). Additionally, the serum estimated glomerular filtration rate increased from 49.5 to 64.4 mL/min/1.73 m2. The follow-up results of patients at 1 year after surgery were similar to those observed at 1 month after surgery. Systemic endoscopic treatments with AMUS were found to be safe and effective for ureteric strictures after KT with short-term follow-ups. This technique offers a novel option for the treatment of post-KT strictures.

Applications of machine learning in urodynamics: A narrative review.

Machine learning algorithms as a research tool, including traditional machine learning and deep learning, are increasingly applied to the field of urodynamics. However, no studies have evaluated how to select appropriate algorithm models for different urodynamic research tasks. We undertook a narrative review evaluating how the published literature reports the applications of machine learning in urodynamics. We searched PubMed up to December 2023, limited to the English language. We selected the following search terms: artificial intelligence, machine learning, deep learning, urodynamics, and lower urinary tract symptoms. We identified three domains for assessment in advance of commencing the review. These were the applications of urodynamic studies examination, applications of diagnoses of dysfunction related to urodynamics, and applications of prognosis prediction. The machine learning algorithm applied in the field of urodynamics can be mainly divided into three aspects, which are urodynamic examination, diagnosis of urinary tract dysfunction and prediction of the efficacy of various treatment methods. Most of these studies were single-center retrospective studies, lacking external validation, requiring further validation of model generalization ability, and insufficient sample size. The relevant research in this field is still in the preliminary exploration stage; there are few high-quality multi-center clinical studies, and the performance of various models still needs to be further optimized, and there is still a distance from clinical application. At present, there is no research to summarize and analyze the machine learning algorithms applied in the field of urodynamics. The purpose of this review is to summarize and classify the machine learning algorithms applied in this field and to guide researchers to select the appropriate algorithm model for different task requirements to achieve the best results.

Systematic Review of the Global Use of Validated Questionnaires in the Management of Stress Urinary Incontinence in Women.

Our goal was to systematically review the most commonly used validated questionnaires in recent global literature on stress urinary incontinence (SUI) treatment. PubMed, Embase, and Ovid databases were queried for manuscripts containing "female stress urinary incontinence" AND "diagnosis" AND "treatment" AND "questionnaire." Two independent reviewers screened studies for randomized controlled trials, prospective, and retrospective studies between 2018 and 2023. Exclusion criteria included male participants, non-SUI incontinence, and articles not originally written in English. The review was registered in PROSPERO [465721] and conformed to PRISMA guidelines. In 117 manuscripts meeting study criteria, the median of the mean ages was 52 years, with a median of 164 participants per study. Most studies originated in Europe (59/117). The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form was the most frequently used (52%), followed by the Patient Global Impression of Improvement (31%), the Urinary Distress Inventory 6 Short Form (25%), the Incontinence Quality of Life (20%), and the Incontinence Impact Questionnaire-Short Form (19%). These leading questionnaires were short, translated into several languages, and globally addressed important SUI-related domains, including the presence and severity of SUI, additional lower urinary tract symptoms, and the impact of SUI on quality of life, as well as changes perceived after treatment. This systematic review of the validated questionnaires used in contemporary SUI management literature could help guide recommendations for incorporating these favored instruments into future SUI treatment outcome documents.

Early Results after Thulium Laser Enucleation of the Prostate in Patients with Urodynamically Proven Detrusor Underactivity

Objectives: Benign prostatic hyperplasia is one of the most common urological diseases. Among these patients, the presence of detrusor underactivity or acontractility represents a challenging condition since no medical treatment is available. Our objective is to evaluate early term outcomes following transurethral anatomical enucleation of the prostate with Tm:YAG support. Methods: In a retrospective analysis of 115 patients who underwent this procedure between January 2019 and March 2022 due to lower urinary tract symptoms, 8 patients with urodynamic evidence of detrusor underactivity secondary to a non-neurogenic aetiology were identified. Detrusor underactivity was defined as a bladder contractility index of &lt;100. Results: Median age, prostate volume and bladder contractility index were 73.2 years, 78.5 cm3 and 63.9, respectively. Median International Prostate Symptom Score/quality of life, Qmax and post-void residual volume were 15/3.5 points, 4.4 mL/s and 189 mL, respectively. Postoperatively, immediate catheter-removal success rate was 87.5% (7/8), at 2 months all patients were catheter-free and remained so at 1-year follow-up. Significant improvements for quality of life, Qmax and post-void residual volume were detected. Median postoperative International Prostate Symptom Score/Quality of life, Qmax and post-void residual volume were 7/2, 21.6 mL/s and 0 mL, respectively. Conclusions: This surgical approach offers high catheter-free rates, significantly improves functional voiding parameters and increases patient satisfaction in patients with benign prostatic hyperplasia and concomitant detrusor underactivity. Therefore, it can be regarded as an effective approach for such patients.