Detrusor Underactivity Research Articles

MP74-15 COMPARISON OF REMOTE MONITORING (HOME) VERSUS IN OFFICE UROFLOWS IN WOMEN: ACCURACY AND CLINICAL RELEVANCE

You have accessJournal of UrologyCME1 Apr 2023MP74-15 COMPARISON OF REMOTE MONITORING (HOME) VERSUS IN OFFICE UROFLOWS IN WOMEN: ACCURACY AND CLINICAL RELEVANCE Michael Huaman, Yat Ching Fung, and Jerry Blaivas Michael HuamanMichael Huaman More articles by this author , Yat Ching FungYat Ching Fung More articles by this author , and Jerry BlaivasJerry Blaivas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Maximum uroflow (Qmax) is considered to be the gold standard to screen for bladder outlet obstruction (BOO) or detrusor underactivity (DU), but little attention has been paid to the accuracy of uroflowmeters. The aim of this study is to compare the accuracy of two different methods of measuring uroflow (Q). METHODS: This was a retrospective IRB approved, single-center study that compared Q measurements between office and home uroflows. Home Qs utilized a sound based mobile app+; office Qs were obtained by a gravimetric method.++ A database was searched for women who underwent Q on both UFMs as part of their diagnostic evaluation. There were no exclusion criteria. The extracted data is listed in the Table 1. Each UFM generated an automated printout of the Q data. The printout Qmax was compared to corrected Qmax, defined as the highest point of the Q curve that lasted ≥2 S. A 3 mL/S difference between the printout and corrected Qmax was considered clinically relevant. Q’s were excluded if no segment of the curve lasted ≥2 S or the curve did not begin and/or end at zero. RESULTS: (see Table 1). CONCLUSIONS: In this study, the printout, uncorrected best Qmax overestimated Qmax by 3-4 mL/S and overestimated the Qmax by ≥3 mL/S in 29-86% of women. Further, Q’s and voided volumes were higher in the office than at home. These findings, if corroborated, are highly relevant because those with a falsely elevated Qmax may be excluded from further workup for BOO or DU and those with falsely lower Q’s, recorded in the office, might relegate women to an unnecessary workup. The printout errors could be easily solved by changing the software Qmax criteria. The ability of remote UFMs to record multiple samples appears to allow for more accurate data analysis. +Home Uroflow (ProudP from Soundable Health); ++Office Uroflow (Urocap IV from Laborie Medical Technologies, Inc.). Source of Funding: Institute for Bladder and Prostate Research (IBPR) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1076 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Huaman More articles by this author Yat Ching Fung More articles by this author Jerry Blaivas More articles by this author Expand All Advertisement PDF downloadLoading ...

MP03-07 THE LACK OF MECHANOSENSITIVE TREK-1 CHANNEL MIMICS THE DEVELOPMENT OF AGING-RELATED BLADDER PHENOTYPES IN MICE

You have accessJournal of UrologyCME1 Apr 2023MP03-07 THE LACK OF MECHANOSENSITIVE TREK-1 CHANNEL MIMICS THE DEVELOPMENT OF AGING-RELATED BLADDER PHENOTYPES IN MICE Alison Xiaoqiao Xie, Nao Iguchi, and Anna Malykhina Alison Xiaoqiao XieAlison Xiaoqiao Xie More articles by this author , Nao IguchiNao Iguchi More articles by this author , and Anna MalykhinaAnna Malykhina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003214.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous animal and human studies have confirmed that the potassium channel subfamily K member 2 (TREK-1), a member of two-pore domain mechanosensitive K+ channels (K2P), acts as a mechanosensor in the urinary bladder. We reported that TREK-1 is a predominantly expressed K2P channel in the human detrusor, and its expression and function are altered in patients with idiopathic detrusor overactivity (DO). TREK-1 expression in the peripheral organs and in the nervous system also declines during aging. This study aimed to investigate the role of TREK-1-related mechanosensitivity in the detrusor in aging mice. METHODS: Bladder histology, detrusor contractility, and voiding function were investigated in adult (3, 6, 9 and 12 months old) TREK-1 KO mice of both sexes and age-matched wildtype controls. Bladder weight, detrusor smooth muscle (DSM) thickness, and collagen content were compared between the groups using paraffin-embedded bladder samples. Bladder strip assay was used to evaluate detrusor muscle contractility and nerve-induced bladder contractions. Voiding spot assay (VSA) and awake cystometry recordings were performed to assess micturition patterns in vivo. RESULTS: Increased bladder weight and bladder wall thickness were observed in TREK-1 KO mice of both sexes, starting as early as at 6-month-old. and threshold volume in cystometry recordings. In comparison to age- and sex-matched controls, bladder strips isolated from TREK-1 KO mice showed significantly decreased DSM contractility including contractile responses to electric field stimulation and cholinergic receptor activation. Interestingly, while the peak forces of evoked DSM contractions decreased with aging in control mice, TREK-1 KO animals at 6-12 month-old displayed DSM contractility that was lower than in 12-month-old control animals. Increased numbers of non-voiding contractions were observed in both sexes of TREK-1 KO mice, whereas the bladder capacity, intermicturition interval, and micturition threshold volume were significantly increased in comparison to age-matched controls. CONCLUSIONS: In summary, the lack of TREK-1 expression in adult mice significantly increased a number of functional changes typically observed in underactive bladders with detrusor overactivity, including increases in bladder size, weight, capacity, and a significant decrease in DSM contractility. Our findings suggest that decreased TREK-1 expression may mimic the development of age-related voiding phenotypes in mice. Source of Funding: DK095817 (Malykhina), DK116648 (Malykhina) and Department of Surgery Academic Enrichment Fund (Xie) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e23 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alison Xiaoqiao Xie More articles by this author Nao Iguchi More articles by this author Anna Malykhina More articles by this author Expand All Advertisement PDF downloadLoading ...

PD23-01 EFFECT OF OPIOID RECEPTOR ANTAGONIST ON BLADDER UNDERACTIVITY INDUCED BY PROLONGED PUDENDAL AFFERENT STIMULATION

You have accessJournal of UrologyCME1 Apr 2023PD23-01 EFFECT OF OPIOID RECEPTOR ANTAGONIST ON BLADDER UNDERACTIVITY INDUCED BY PROLONGED PUDENDAL AFFERENT STIMULATION Michael Pintauro, Jianan Jian, Jicheng Wang, Bing Shen, Zhijun Shen, Khari Goosby, Joseph Scolieri, Avanish Madhavaram, Jonathan Beckel, William De Groat, Christopher Chermansky, and Changfeng Tai Michael PintauroMichael Pintauro More articles by this author , Jianan JianJianan Jian More articles by this author , Jicheng WangJicheng Wang More articles by this author , Bing ShenBing Shen More articles by this author , Zhijun ShenZhijun Shen More articles by this author , Khari GoosbyKhari Goosby More articles by this author , Joseph ScolieriJoseph Scolieri More articles by this author , Avanish MadhavaramAvanish Madhavaram More articles by this author , Jonathan BeckelJonathan Beckel More articles by this author , William De GroatWilliam De Groat More articles by this author , Christopher ChermanskyChristopher Chermansky More articles by this author , and Changfeng TaiChangfeng Tai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003296.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fowler Syndrome, or non-obstructive urinary retention, is seen in young female patients. Although the cause is unknown, it is theorized that aberrant sensory nerves from the urethral sphincter cause inhibition of the central nervous system, thereby leading to urinary retention. Prior studies have suggested that the opioid receptor may be implicated in bladder overactivity and underactivity. We aimed to evaluate opioid receptor inhibition on bladder function in a feline model of Fowler’s Syndrome. METHODS: A total of 10 cats were anesthetized, ureters externalized via laparotomy, and urethral catheter placed. A tripolar cuff electrode was placed on the pudendal nerve. Multiple cystometrograms (CMGs) were performed to determine baseline bladder function (Control). Multiple pudendal nerve stimulations (PNS) were performed at 30-minute cycles (5 Hz, 0.2 ms) were applied at 4-6 times the intensity required to elicit anal contraction for 2-5 hours. The result was a stable, underactive bladder state (Post-PNS 1). Next, naloxone (1mg/kg IV) was administered, and CMGs obtained (Post-NX). A single 30-minute PNS was then performed to evaluate the combined effect of naloxone and PNS (Post-PNS 2). Lastly, a CMG was performed to examine any recovery (Post-Control). Primary outcomes were bladder capacity and contraction amplitude (contractility). RESULTS: Application of PNS produced a significant increase in bladder capacity and decrease in bladder amplitude, indicative of a state of bladder underactivity (Figure 1, * denotes significance p<0.05). Administration of naloxone significantly reduced the bladder capacity and increased contraction amplitude. Re-application of PNS led fully overcame the naloxone effect on capacity; however, the amplitude is a combined effect. This effect of re-stimulation lasted only for a short period (15-20 minutes) and Post-Control demonstrate a reduction in capacity indicating effects of the still present naloxone overcoming the PNS. CONCLUSIONS: Pharmacologic opioid receptor antagonism increased bladder contractility and reduced bladder capacity to baseline in our feline model of non-obstructive urinary retention. This is a new target for possible pharmacotherapy in the treatment of patients with Fowler's Syndrome. Source of Funding: 5R01DK121698-02 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e670 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Pintauro More articles by this author Jianan Jian More articles by this author Jicheng Wang More articles by this author Bing Shen More articles by this author Zhijun Shen More articles by this author Khari Goosby More articles by this author Joseph Scolieri More articles by this author Avanish Madhavaram More articles by this author Jonathan Beckel More articles by this author William De Groat More articles by this author Christopher Chermansky More articles by this author Changfeng Tai More articles by this author Expand All Advertisement PDF downloadLoading ...

PD19-11 DIABETES CAUSES TEMPORAL CHANGES IN CHOLINERGIC-MEDIATED BLADDER CONTRACTILITY DUE TO INFLAMMATION VIA THE NLRP3 INFLAMMASOME IN FEMALE AKITA MICE

You have accessJournal of UrologyCME1 Apr 2023PD19-11 DIABETES CAUSES TEMPORAL CHANGES IN CHOLINERGIC-MEDIATED BLADDER CONTRACTILITY DUE TO INFLAMMATION VIA THE NLRP3 INFLAMMASOME IN FEMALE AKITA MICE Michael Odom, Francis Hughes, Huixia Jin, and J. Todd Purves Michael OdomMichael Odom More articles by this author , Francis HughesFrancis Hughes More articles by this author , Huixia JinHuixia Jin More articles by this author , and J. Todd PurvesJ. Todd Purves More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003285.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The most common complication of diabetes is bladder dysfunction which is driven in the female Akita type 1 diabetic mouse by inflammation mediated by the NLRP3 inflammasome. It is unclear how diabetes affects signaling pathways responsible for bladder contractility and if this is mediated by NLRP3. Using a female Akita model that develops a temporal progression from bladder overactivity to underactivity, we investigated effects on the cholinergic signaling pathways. To accomplish this we utilized ex vivo myography to determine how neurotransmitter release from efferent nerve terminals and muscarinic receptor activation is impacted in bladders of non-diabetic and diabetic mice±the NLRP3 gene. METHODS: Akita mice were crossbred with NLRP3-/- mice to yield non-diabetics and diabetics±NLRP3 gene. Females were aged to 15 and 30 weeks when respective overactive and underactive bladder phenotypes are evident. For ex vivo myography, bladder strips with intact mucosa were used. Efferent neurotransmitter-mediated contractions were assessed using electric field stimulation (EFS)±the muscarinic receptor antagonist atropine. Contractility to carbachol, a muscarinic receptor agonist, was also assessed (n=5-10 per group). RESULTS: At 15 weeks, diabetic NLRP3+/+ mice have increased EFS contractility (p<0.05) but NLRP3 gene deletion prevented this pathology in diabetics. At 30 weeks, EFS contractions were no longer dysregulated. EFS was repeated in the presence of atropine to determine the cholinergic contribution. In the presence of atropine, no significant differences were noted in diabetic animals – indicating the increase in contractility at 15 weeks was due to upregulated cholinergic mechanisms. No changes in contractions to carbachol were noted at either time point. This indicates the increased contractility to EFS was not due to increased muscarinic receptor activity but rather an increase in acetylcholine release. CONCLUSIONS: Diabetes increases cholinergic neurotransmitter release and bladder contractility in mice with an overactive bladder as a consequence of inflammation driven by NLRP3. This suggests an NLRP3 inhibitor may be an effective therapy to prevent overactive bladder and eliminate the need for conventional anti-cholinergic treatments. Source of Funding: NIH-K12 DK100024; NIH-RO1 DK117890 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e581 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Odom More articles by this author Francis Hughes More articles by this author Huixia Jin More articles by this author J. Todd Purves More articles by this author Expand All Advertisement PDF downloadLoading ...

Urodynamics in the evaluation of lower urinary tract symptoms in young adult men: A systematic review.

This review aims to systematically evaluate the available evidence on the different urodynamic diagnoses of lower urinary tract symptoms (LUTS) in young adult men aged 18-50 years and to summarize the various urodynamic parameters based on these diagnoses. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement and the search was performed in PubMed, Embase, and Cochrane library from inception till September 2021. A total of 295 records were identified using a combination of keywords such as LUTS, urodynamics (UDS), and young males. The review was registered in PROSPERO (CRD42021214045). All the ten studies, which were included in this analysis, categorised the patients into either of the four primary diagnoses after the UDS - primary bladder neck obstruction (PBNO), dysfunctional voiding, detrusor underactivity (DU), or detrusor overactivity. Five of these studies used the conventional UDS, and in the other five a video UDS was performed. The most common abnormality on the conventional UDS was DU with a pooled estimate of 0.24 (95% confidence interval [CI] - 0.104-0.463, I2-95.35, (τ2-1.07). The most common abnormality on the video UDS was PBNO with a pooled estimate of 0.49 (95% CI - 0.413-0.580, I2-66.59, 2-0.09). The point estimates of various UDS parameters were also recorded. A urodynamic diagnosis was possible in 79% and 98% of the young men who underwent a conventional UDS or a video UDS, respectively. However, the men subjected to the conventional UDS and the video UDS had significant differences in their primary urodynamic diagnostic label. These results will help to plan future trials for the evaluation and management of LUTS in young men.

A Velocity-Based Approach to Noninvasive Methodology for Urodynamic Analysis.

To date, invasive urodynamic investigations have been used to define most terms and conditions relating to lower urinary tract symptoms. This invasiveness is almost totally due to the urethral catheter. In order to remove this source of discomfort for patients, the present study investigated a noninvasive methodology able to provide diagnostic information on bladder outlet obstruction or detrusor underactivity without any contact with the human body. The proposed approach is based on simultaneous measurements of flow rate and jet exit velocity. In particular, the jet exit kinetic energy appears to be strongly related to bladder pressure, providing useful information on the lower urinary tract functionality. We developed a new experimental apparatus to simulate the male lower urinary tract, thus allowing extensive laboratory activities. A large amount of data was collected regarding different functional statuses. Experimental results were compared successfully with data in the literature in terms of peak flow rate and jet exit velocity. A new diagram based on the kinetic energy of the exit jet is proposed herein. Using the same notation as a Schäfer diagram, it is possible to perform noninvasive urodynamic studies. A new noninvasive approach based on the measurement of jet exit kinetic energy has been proposed to replace current invasive urodynamic studies. A preliminary assessment of this approach was carried out in healthy men, with a specificity of 91.5%. An additional comparison using a small sample of available pressure-flow studies also confirmed the validity of the proposed approach.

The role of transurethral resection of prostate (TURP) in patients with underactive bladder: 12 months follow‐up in different grades of detrusor contractility

Male detrusor underactivity (DUA) definition remains controversial and no effective treatment is consolidated. Transurethral resection of the prostate (TURP) is one of the cornerstones surgical treatments recommended in bladder outlet obstruction (BOO). However, the role of prostatic surgery in male DUA is not clear. The primary endpoint was the clinical and voiding improvement based on IPSS and the maximum flow rate in uroflowmetry (Qmax) within 12 months. We analyzed an ongoing prospective database that embraces benign prostata hyperplasia (BPH) male patients with lower urinary tract symptoms who have undergone to TURP. All patients were evaluated pre and postoperatively based on IPSS questionnaires, prostate volume measured by ultrasound, postvoid residual urine volume (PVR), Prostate Specific Antigen measurement and urodynamic study (UDS) before the procedure. After surgery, all patients were evaluated at 1-, 3-, 6- and 12-months. Patients were categorized in 3 groups: Group 1-Detrusor Underactive (Bladder Contractility Index (BCI) [BCI] < 100 and BOO index [BOOI] < 40); Group 2-Detrusor Underactive and BOO (BCI < 100 and BOOI ≥ 40); Group 3-BOO (BCI ≥ 100 and BOOI ≥ 0). It was included 158 patients underwent monopolar or bipolar TURP since November 2015 to March 2021. According to UDS, patients were categorized in: group 1 (n = 39 patients); group 2 (n = 41 patients); group 3 (n = 77 patients). Preoperative IPSS was similar between groups (group 1-24.9 ± 6.33; group 2-24.8 ± 7.33; group 3-24.5 ± 6.23). Qmax was statistically lower in the group 2 (group 1-5.43 ± 3.69; group 2-3.91 ± 2.08; group 3-6.3 ± 3.18) as well as greater PVR. The 3 groups presented similar outcomes regard to IPSS score during the follow-up. There was a significant increase in Qmax in the 3 groups. However, group 1 presented the lowest Qmax improvement. There were different objective outcomes depending on the degree of DUA at 12 months follow-up. Patients with DUA had similar IPSS improvement. However, DUA patients had worst Qmax improvement than men with normal bladder contraction.

Current and Emerging Pharmacological Targets and Treatments of Urinary Incontinence and Related Disorders.

Overactive bladder syndrome with and without urinary incontinence and related conditions, signs, and disorders such as detrusor overactivity, neurogenic lower urinary tract dysfunction, underactive bladder, stress urinary incontinence, and nocturia are common in the general population and have a major impact on the quality of life of the affected patients and their partners. Based on the deliberations of the subcommittee on pharmacological treatments of the 7th International Consultation on Incontinence, we present a comprehensive review of established drug targets in the treatment of overactive bladder syndrome and the aforementioned related conditions and the approved drugs used in its treatment. Investigational drug targets and compounds are also reviewed. We conclude that, despite a range of available medical treatment options, a considerable medical need continues to exist. This is largely because the existing treatments are symptomatic and have limited efficacy and/or tolerability, which leads to poor long-term adherence. SIGNIFICANCE STATEMENT: Urinary incontinence and related disorders are prevalent in the general population. While many treatments have been approved, few patients stay on long-term treatment despite none of them being curative. This paper provides a comprehensive discussion of existing and emerging treatment options for various types of incontinence and related disorders.

Evaluation of urodynamic pattern in short and long-standing diabetic patients

To address the pattern of urodynamic findings in diabetic patients with lower urinary tract symptoms (LUTS), comparing short-standing and long-standing type 2 diabetes mellitus (T2DM). A prospective study was conducted on 50 patients presenting with LUTS and a concurrent diagnosis of T2DM, between February 2016 and May 2018. Patients were classified and evaluated according to the duration of diabetes into two groups: short-standing DM (< 15 years, n = 31), and long-standing DM (≥ 15 years, n = 19) groups. The impact of LUTS and quality of life were assessed in female patients using ICIQ-FLUTS and male patients using ICIQ-MLUTS. A total of 50 patients were included in the study. The mean duration of T2DM was 10 ± 0.7 years. The mean age was 56.3 ± 1.2 years, and the mean HbA1c was 7.5 ± 1.2%. Urodynamic evaluation detected significantly higher detrusor overactivity (DO) and increased bladder sensation with the short-standing DM group (35.5 vs. 15.8%, p = 0.01 and 32.3 vs. 5.3%, p = 0.01, respectively). Comparatively, weak, or absent detrusor contractility were more frequent in patients with long-standing DM (52% and 26% respectively p = 0.01). As expected, overflow incontinence and straining during voiding were significantly higher in the long-standing DM group (p = 0.04 and p = 0.03, respectively). Surprisingly, there was no significant correlation between patients presenting with urgency in their voiding diary (subjective) and urodynamic detection of DO (p = 0.07). There are different patterns in urodynamic characterizations of T2DM. Patients with short-standing DM present more commonly with storage symptoms and detrusor overactivity on urodynamics. Contrastingly, patients with long-standing DM present more frequently with voiding symptoms and detrusor underactivity on urodynamics. Thus, screening for an underactive bladder is advisable in patients with long-standing T2DM.

The Efficacy of Transvaginal Ultrasound-Guided BoNT-A External Sphincter Injection in Female Patients with Underactive Bladder.

Owing to the diverse treatment outcomes after a botulinum toxin A (BoNT-A) injection to the external sphincter, this study aimed to develop a new technique: an ultrasound-guided BoNT-A external sphincter injection. This single-center prospective cohort study was conducted at a tertiary medical center in Taichung, Taiwan. From December 2020 to September 2022, 12 women were enrolled. The patients were evaluated for lower urinary tract syndrome using patient perception of bladder condition (PPBC), international prostate symptom score (IPSS), uroflowmetry, post-void residual volume (PVR), cystometry, and external sphincter electromyography. We evaluated the patients the day before surgery and 1 week after the BoNT-A injection. For the patients requiring self-catheterization, we recorded the number of times they required clean intermittent catheterization (CIC) per day before the procedure and 1 month after the procedure. The IPSS, PPBC, and PVR were significantly better after the transvaginal ultrasound-guided BoNT-A external sphincter injection. The number of times the patients required daily CIC was also reduced after the injection. Only one patient developed de novo urge urinary incontinence. Our results demonstrated that a transvaginal ultrasound-guided BoNT-A injection was efficacious and safe in the treatment of underactive bladder.

International Survey on Urodynamic Investigations in Women Undergoing Stress Urinary Incontinence Surgery

To evaluate the role of invasive urodynamics (UD) in women candidates for stress urinary incontinence (SUI) surgery. This was a worldwide survey on current trends in use of preoperative invasive UD in women undergoing SUI surgery. Demographic respondents' data, whether routine invasive UD is performed before surgery and its diagnostic role were investigated. The survey was completed by 504 respondents: urologists 83.1%, gynecologists 16.8%. UD findings were reported influencing the surgical decision in 84.3% of the cases and may change planned surgery in 72.4%, may discourage it in 43.6%, may change surgical expectations in 55.5%, and are useful for preoperative counselling in 96.6%. We found a very low rate of routine performance of UD for uncomplicated SUI. The most impactful UD findings were related to the conditions of detrusor contractility, overactivity and underactivity. Among voiding disorders, dyssynergia was considered the most relevant dysfunction. Valsalva Leak Point Pressure was the most reported tool to investigate urethral function. The surgical management was influenced by UD findings in the vast majority of the cases, although about 60% reported that a relevant impact of the UD occurred in less than 40% of the investigations. The crucial effect of UD on surgical management was high. This finding showed that for many respondents UD still has a pivotal role before SUI surgery. This survey showed a worldwide picture on preoperative UD in SUI surgery highlighting the crucial role of UD. UD investigation influences surgical management, but whether it influences outcomes is unclear.

Adiponectin can be a good predictor of urodynamic detrusor underactivity: a prospective study in men with lower urinary tract symptoms.

To investigate whether circulating adiponectin, which is considered a possible marker of anti-atherogenic effects, is a useful predictor of bladder function, especially detrusor underactivity (DU), in men with lower urinary tract symptoms (LUTS). A total of 130 treatment-naïve men with non-neurogenic LUTS were prospectively stratified into two groups (the DU and non-DU groups) based on the presence or absence of DU, where DU is defined as a bladder contractility index < 100 and bladder outlet obstruction index (BOOI) < 40. The impact of serum adiponectin levels on urodynamic function, including DU, was assessed using univariate, binomial logistic regression, and receiver operating characteristic (ROC) curve analyses. In total, data from 118 men were analyzed; 39 (33.0%) had DU (DU group) and 79 (67.0%) did not have DU (non-DU group). The median serum adiponectin in the DU group was significantly lower than in the non-DU group (6.2 vs 12.6µg/mL, p < 0.001). In the binomial logistic regression analysis, lower adiponectin, smaller intravesical prostatic protrusion, and lower bladder voiding efficiency were significant factors related to DU. In the ROC analyses, serum adiponectin had the highest area under the curve value for DU diagnosis (0.849). Additionally, a cutoff value of 7.9µg/mL for serum adiponectin level was identified for DU, which yielded a sensitivity and specificity of 79% and 90%, respectively. The serum adiponectin level was significantly associated with bladder function and may be a useful marker for predicting DU in men with LUTS.

Detrusor underactivity is behind persistent LUTS after TURP

Detrusor underactivity is behind persistent LUTS after TURP

The role of the bladder diary in phenotyping men with LUTS.

The aim of this study was to compare the clinical characteristics of men with lower urinary tract symptoms(LUTS) grouped by 24-hurine output determined from a bladder voiding diary. An online database was queried to identify men who completed a 24-hour bladder diary (24HBD), and the Lower Urinary Tract Symptom Score (LUTSS) questionnaire from 2015 to 2019 using a mobile app. Data from the bladder diary and questionnaire were contemporaneously matched within a 2-week period. Additional data, including maximum uroflow (Qmax ) and postvoid residual urine (PVR), were obtained from the electronic medical record (EMR). The cohort was divided into three groups: normal, oliguria, and polyuria based on their 24-hour voided volume (24HVV). The LUTSS, 24HVV, maximum voided volume (MVV), maximum flow rate (Qmax ), and PVRwere compared between those with oliguria and polyuria. A total of 327 men (mean age 62, SD: 19) completed the LUTSS questionnaire and contemporaneous 24HBD. Of these, 61% had a normal 24HVV, 13% had oliguria, and 26% had polyuria. A total of 147 patients from the study cohort had contemporaneous Qmax and PVR abstracted from the EMR. There was no difference in symptom severity, bother, or PVR among the three patient groups. However, several objective metrics were significantly correlated with urine output. Men with oliguria, as compared to men with polyuria were older (65 vs. 55years) and had lower MVV (260vs.470 mL), fewer voids/24 h (8 vs. 13),and lower Qmax (8.5vs. 18.3 mL/s). These observations suggest that men with oliguria or polyuria and LUTS constitute easily distinguished phenotypes that might require different diagnostic and therapeutic algorithms. Those with oliguria were older, and had lower MVVs and much lower uroflows, suggesting that they are more likely to have underlying disorders such as bladder outlet obstruction and detrusor underactivity or may be patients with overactive bladder who reduced fluid intake to improve symptoms.

NEFL-Related Charcot-Marie Tooth Disease due to P440L Mutation in Two Italian Families: Expanding the Phenotype and Defining Modulating Factors

Introduction: Mutations in the neurofilament polypeptide light chain (NEFL) gene account for <1% of all forms of Charcot-Marie-Tooth (CMT) diseases and present with different phenotypes, including demyelinating, axonal and intermediate neuropathies, and with diverse pattern of transmission, with dominant and recessive inheritance being described. Methods: Here, we present clinical and molecular data in two new unrelated Italian families, affected with CMT. Results: We studied fifteen subjects (11 women, 4 men), age range 23–62 year. Onset of symptoms was mainly in childhood, with running/walking difficulties; some patients were pauci-asymptomatic; almost all shared variably distributed features of absent/reduced deep tendon reflexes, impaired gait, reduced sensation, and distal weakness in the legs. Skeletal deformities were seldom documented and were of mild degree. Additional features included sensorineural hearing loss in 3 patients, underactive bladder in 2 patients, and cardiac conduction abnormalities, requiring pacemaker implantation, in one child. Central nervous system (CNS) impairment was not documented in any subject. Neurophysiological investigation disclosed feature suggestive of demyelinating sensory-motor polyneuropathy in one family and resembling an intermediate form in the other. Multigene panel analysis of all known CMT genes revealed two heterozygous variants in NEFL: p.E488K and p.P440L. While the latter change segregated with the phenotype, the p.E488K variant appeared to act as a modifier factor being associated with axonal nerve damage. Conclusions: CMT related to P440L mutation in NEFL is associated with a mild, childhood-onset phenotype, showing prevalently sensory distal limbs involving and with motor impairment predominantly involving anterolateral leg muscles, in the absence of CNS involvement. Additional findings, never reported so far in patients with NEFL mutation, are cardiological and urinary dysfunctions. Our study expands the array of clinical features associated with NEFL-related CMT.

Diagnosing and Managing Bladder Outlet Obstruction with Detrusor Underactivity in Males

Diagnosing and Managing Bladder Outlet Obstruction with Detrusor Underactivity in Males

Transurethral Incision of the Bladder Neck with or without Additional Procedure Resumes Spontaneous Voiding in Female Voiding Dysfunction-A Long-Term Retrospective Follow-Up.

This study evaluated the long-term effectiveness of transurethral incision of the bladder neck (TUI-BN) with or without an additional procedure for female voiding dysfunction. Women with voiding difficulty who underwent TUI-BN in the last 12 years were included. All patients underwent a videourodynamics study (VUDS) at baseline and after TUI-BN. A successful outcome was defined as having a voiding efficiency (VE) increase by ≥50% after treatment. Patients with insufficient improvement were chosen for repeated TUI-BN, urethral onabotulinumtoxinA injection, or transurethral external sphincter incision (TUI-ES). The current voiding status, surgical complications, and additional surgeries were evaluated. A total of 102 women with VUDS evidence of a narrow bladder neck during voiding were enrolled. The long-term success rate of the first TUI-BN was 29.4% (30/102) and increased to 66.7% (34/51) after combining TUI-BN and an additional procedure. The overall long-term success rates were 74.6% in women with detrusor underactivity (DU), 52.0% in detrusor overactivity and low contractility, 50.0% in bladder neck obstruction, 20.0% in hypersensitive bladder, and 75% in stable bladder (p = 0.022). Patients with a lower maximum flow rate (Qmax), (p = 0.002), lower voided volume (p < 0.001), lower corrected Qmax (p < 0.001), lower ladder contractility index (p = 0.003), lower voiding efficiency (p < 0.001), but larger post-void residual volume (p < 0.001) had a satisfactory surgical outcome. Spontaneous voiding was achieved in 66 (64.7%) patients, de novo urinary incontinence in 21 (20.6%), and vesicovaginal fistula in 4 (3.9%), all were repaired. TUI-BN alone or in combination with an additional procedure was safe, effective, and durable in patients with DU to resume spontaneous voiding.

Mechanosensitive ion channel PIEZO1 and rare genetic disorders.

Lower urinary tract symptoms (incontinence, urgency, frequency) cost the US $10 billion annually. Detrusor underactivity (DU) is a weak bladder contraction with slow, incomplete bladder emptying that often requires bladder emptying by catheter ± surgeries since drug therapies are ineffective. DU affects all ages by myogenic or neurogenic etiologies, leading to UTIs, stones, hydronephrosis ± vesicoureteral reflux, renal insufficiency/failure. Barriers exist to progress in treatment, with poor genetics and mechanistic understanding, and few animal models of disease.

Validation and clinical utility of the Nagoya diagnostic criteria for detrusor underactivity in men

Validation and clinical utility of the Nagoya diagnostic criteria for detrusor underactivity in men

Adiponectin predicts urodynamic detrusor underactivity: A prospective study of elderly men with lower urinary tract symptoms

Adiponectin predicts urodynamic detrusor underactivity: A prospective study of elderly men with lower urinary tract symptoms