Maternal and perinatal risk factors of hypospadias: A case-control study.

Low-intensity extracorporeal shock wave therapy (LiESWT) is a promising noninvasive therapy for stress urinary incontinence (SUI). We assessed whether LiESWT restores urethral function in a vaginal distension (VD)-induced rat model of SUI, focusing on pelvic floor tissue remodeling and endoplasmic reticulum stress pathway as potential mechanisms. Eighty-one female Sprague-Dawley rats underwent functional and tissue analyses. Sneezing was induced to assess urethral pressure responses. Leak point pressure (LPP) was measured with or without hypogastric and pudendal nerve transections. Tissue remodeling and molecular pathways were assessed using histological and molecular expression analyses. In VD rats, baseline urethral pressure (9.9 ± 4.3 vs 17.6 ± 3.1 cmH2O) and LPP (27.4 ± 4.7 vs 37.0 ± 7.0 cmH2O) were lower than in normal rats (both p < 0.05). LiESWT restored the baseline urethral pressure (16.3 ± 4.7 cmH2O) and LPP (37.5 ± 4.9 cmH2O) in VD rats (p < 0.05). Notably, LPP enhancement persisted after bilateral hypogastric and pudendal nerve transections. Additionally, LiESWT tended to reduce VD-induced vaginal smooth muscle fibrosis histologically, whereas collagen type I alpha and elastin mRNA expression remained elevated in both groups. Western blotting revealed no sustained activation of protein kinase R-like endoplasmic reticulum kinase (PERK) at 96h after the final LiESWT. LiESWT enhanced urethral function in the VD-induced SUI model by potentially facilitating pelvic floor tissue remodeling, thereby restoring passive urethral closure. The absence of sustained PERK activation in the late phase indicates the safety of LiESWT for SUI.

Postpartum stress urinary incontinence (PSUI) commonly impairs quality of life in postpartum women. Pelvic floor muscle training (PFMT), as a primary foundational treatment, faces challenges such as inadequate adherence and significant individual differences in efficacy. Electrical stimulation (ES) and magnetic stimulation (MS), as passive pelvic floor rehabilitation techniques, are often used in conjunction with PFMT in clinical settings. However, there is a lack of systematic retrospective cohort study evidence comparing the efficacy, safety, and adherence of these three methods. Compare the effects of the three intervention strategies: PFMT, PFMT combined with ES, and PFMT combined with MS, on the recovery of pelvic floor function and the improvement of clinical symptoms in patients with PSUI. This retrospective study enrolled patients with PSUI who received systematic treatment at our hospital's plastic surgery department between June 2020 and June 2025. Patients were divided based on their treatment regimens: PF (receiving PFMT guidance), ES (receiving PFMT combined with outpatient ES therapy), and MS (receiving PFMT combined with outpatient MS therapy). A total of 102 patients (n = 34) were ultimately included. All patients received a 12-week course of systematic rehabilitation treatment. Primary indicators were objective measures: the amount of urine leakage during a 1-hour pad test, pelvic floor muscle strength (modified Oxford grading), and urodynamic parameters (maximum urethral closure pressure [MUCP], abdominal pressure leak point pressure [LPP]). Secondary indicators included the overall clinical response rate, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores, Incontinence Quality of Life Questionnaire (I-QOL) scores, and the incidence of adverse events. Baseline characteristics were balanced among the three groups (P > 0.05). After 12 weeks of treatment, the urine leakage volume in all three groups decreased compared to the baseline (P < 0.001). Specifically, the urine leakage volume after MS and ES treatments was lower than after PF treatment (P < 0.01). In terms of pelvic floor muscle strength, both MS and ES treatments resulted in higher Oxford grades compared to PF (P < 0.001). Regarding urodynamic parameters, both MS and ES treatments showed higher MUCP and LPP values than PF (P < 0.001) with MS higher than ES (P < 0.05). In terms of clinical overall effectiveness, PF had a rate of 73.5% (25/34), ES had a rate of 91.2% (31/34), and MS had a rate of 94.1% (32/34). Both ES and MS had higher rates compared to PF (P < 0.05). Both MS and ES showed lower ICIQ-SF scores (P < 0.01) and higher I-QOL scores (P < 0.001) than PF. Moreover, MS had higher I-QOL scores than ES (P = 0.008). In this non-randomized study, PFMT combined with ES or MS was associated with greater improvements than PFMT alone, and MS showed more favorable urodynamic and quality-of-life changes. Causal superiority cannot be determined.

A male patient in his 60s presented with painful penile swelling, sepsis and incomplete bladder emptying. Further questioning revealed a decade-old retained urethral foreign body, later confirmed to be a cable segment. CT confirmed a large linear urethral foreign body in the distal penile urethra with a metallic core with suspected surrounding calcification. Endoscopic extraction was not deemed possible, and a suprapubic catheter was inserted to enable bladder emptying and divert urine away from the infected tissues. A delayed surgical removal of the foreign body was favoured to enable tissue preservation and optimal reconstructive surgery. A ventral urethrotomy with foreign body removal and excision of the fistula tract was performed, followed by delayed urethral closure. This case highlights the importance of recognising risks associated with chronically retained, colonised foreign bodies and the value of perioperative multidisciplinary planning involving Andrology and Genito-Urethral Surgery experts.

To elucidate the urethral closure mechanism during abdominal pressure in men, we investigated changes in pelvic anatomy during abdominal pressure using dynamic Magnetic Resonance Imaging (MRI). This study retrospectively analyzed data from 145 patients scheduled for robot-assisted radical prostatectomy at Kanazawa University Hospital from 2016 to 2022. Preoperative dynamic MRI was used to take measurements at several anatomical points to assess changes in pelvic anatomy during abdominal pressure. Dynamic MRI measurements during abdominal pressure revealed that the prostate apex rotates anteriorly at an average of 5.6°, and the internal urethral orifice shifts dorsally. Additionally, the prostate apex moves 1.2 mm toward the pubic bone. Conversely, the distal end of the membranous urethra shifts 0.9 mm dorsally during abdominal pressure. Consequently, a misalignment between the prostate apex and the membranous urethra is observed, resulting in the closure of the anterior-posterior direction of the proximal membranous urethra that may contribute to urethral closure during abdominal pressure. These results may suggest that prostate rotation during abdominal pressure creates a step-like displacement at the proximal membranous urethra, which could contribute to urethral closure in men with an intact prostate. Dynamic MRI provides anatomical evidence supporting a complementary role of prostate motion in this mechanism. Not applicable. This study was conducted prospectively with written informed consent and institutional ethical approval; however, it was not designed as a clinical trial because it was a non-interventional observational study in which a specialized MRI protocol was added to standard clinical imaging without any therapeutic intervention or treatment allocation.

BackgroundIn order to improve the diagnostic accuracy of anatomical/intrinsic sphincter deficiency (ISD) in female patients with stress urinary incontinence (SUI) and to provide a reference for surgical approaches, we developed a nomogram model based on urodynamic parameters.MethodsClinical data from 1150 women with complicated SUI treated at the Department of Urology, Third Xiangya Hospital, Central South University (01/01/2017–10/30/2023) were retrospectively analyzed. Patients were randomly divided into a training cohort (805 cases, 70%) and a validation cohort (345 cases, 30%). ISD was diagnosed by maximum urethral closure pressure (MUCP <30 cmH2O) or Valsalva leak point pressure (VLPP ≤60 cmH2O). Independent predictors of ISD were identified in the training cohort using binary logistic regression to construct the nomogram, validated using the validation cohort.ResultsMultivariate analysis identified abdominal pressure to urinate, IBPM, voiding time, urethral closure pressure, MUCP, and VLPP as independent predictors of ISD. The nomogram demonstrated good discrimination: training cohort AUC = 0.8308 (95% CI: 0.8022–0.8604); validation cohort AUC = 0.8408 (95% CI: 0.7964–0.8844). Decision curve analysis (DCA) indicated significant clinical benefit for both cohorts.ConclusionThis urodynamic parameter-based nomogram (incorporating abdominal pressure to urinate, IBPM, voiding time, urethral closure pressure, MUCP, and VLPP) provides higher diagnostic accuracy for identifying anatomical/structural differences (ISD) in women with complicated SUI compared to traditional criteria (MUCP <30 cmH2O or VLPP ≤60 cmH2O), providing important references for the selection of surgical approaches.

Integrated traditional Chinese medicine (TCM) and Western medicine for perimenopausal urinary incontinence combines the holistic regulatory concepts of TCM with the targeted therapeutic approaches of Western medicine, aiming to synergistically improve patients'incontinence symptoms and overall quality of life. Whilst effective, conventional Western therapies, such as pharmacotherapy and pelvic floor muscle training, can be limited by side effects (e.g., dry mouth from anticholinergics) and suboptimal long-term compliance. Conversely, the advantages of TCM interventions, including acupuncture and herbal formulations, have often been constrained by a reliance on subjective symptom scores, lacking robust objective metrics in efficacy evaluation. Quantitative urodynamic parameters, such as maximum cystometric capacity, detrusor pressure at end filling, abdominal leak point pressure and maximum urethral closure pressure, provide a critical and objective toolset for quantifying lower urinary tract function and therapeutic outcomes. In recent years, alongside the broadened clinical adoption of urodynamic studies, research has increasingly focused on evaluating the specific effects of combined therapies (e.g., acupuncture or herbal medicine integrated with pelvic floor rehabilitation or pharmacotherapy) on these objective parameters. This article reviews the clinical research progress in evaluating integrated TCM and Western medicine treatment for perimenopausal urinary incontinence, using urinary function parameters as the core assessment tool. Key findings, mechanistic insights and prevalent methodological limitations within the existing literature are synthesised. The review aims to provide a scientific reference to inform clinical decision-making and future research directions in treatment strategy selection for this prevalent condition.

Minimally Invasive Single-Incision Sling Surgery for Stress Urinary Incontinence: Age-Related Outcomes and Predictors of Failure.

The aim of this study was to evaluate the therapeutic effect of electroacupuncture (EA) in a rat model of stress urinary incontinence (SUI) induced by vaginal distension (VD). The potential mechanisms underlying this process were also explored. Virgin Sprague-Dawley rats underwent VD (to model SUI) or a sham operation, followed by EA or no treatment. Cystometry and leak point pressure (LPP) testing were employed to demonstrate the impact of EA on the micturition reflex and urethral closure function. mRNA expression of α1A and α1D adrenoceptors and 5-hydroxytryptamine (5-HT)2C and 5-HT2A receptors were examined in spinal segments using real-time qRT-PCR, Western blotting and immunohistochemistry (IHC). The individual role of 5-HT2A and 5-HT2C receptors were distinguished with selective antagonists (MDL 100907 and SB 242084, respectively). EA treatment successfully reversed the decrease of LPP induced by VD without any significant effect on the micturition reflex in this rat model of SUI. VD did not change bladder basic pressure (BP), voided volume or bladder contraction. Multiple approaches including qRT-PCR, Western blotting and IHC revealed over-expression of 5-HT2C and 5-HT2A receptors but not α1A or α1D adrenoceptors in the L6-S2 spinal cord of these rats. Administration of the 5-HT2C antagonist (SB 242084) largely eliminated EA-mediated mitigation of the decrease in LLP caused by VD, while the 5-HT2A antagonist (MDL 100907) had no effect under these conditions. EA improves impaired urethral closure capacity induced by VD in female rats, and it appears that the 5-HT2C receptor plays a critical role in this effect. It is reasonable to speculate that EA represents a promising treatment for SUI caused by childbirth trauma.

BackgroundEctopic ureters (EU) are the main cause of urinary incontinence in juvenile dogs with a continence rate ranging from 22 to 72% reported after surgical correction. The objective of this retrospective preliminary study was to evaluate the usefulness of pre- and postoperative urethral pressure profiles (UPP) in predicting long-term continence in dogs with EU.ResultsUPP were performed in 16 female dogs prior to surgical correction of EU, as well as postoperatively, between 2012 and 2022. Urodynamic parameters included maximal urethral pressure (MUP), maximal urethral closure pressure (MUCP), anatomical profile length (APL), functional profile length (FPL) and integrated pressure (IP). A continence score (CS), defined as 1 = incontinent, 2 = continent with sporadic episodes of incontinence, 3 = continent, was given at the time of pre- and postoperative UPP. Neoureterostomy with dissection of the intramural portion (23 EU) or neoureterocystostomy (3 extramural EU) were performed. Seven dogs were neutered before or during surgical correction. Median preoperative CS was 1 (min 1, max 2). All dogs were continent with a CS of 3 in the immediate postoperative period. Long-term median follow-up time was 24 [8.5–42] months. Recurrence of incontinence occurred in 9 dogs (56.3%). Median time duration without recurrence was 5 months. In the 16 dogs, postoperative FPL values (median 70.5 [56-82.5] mm) were significantly increased compared to preoperative values (median 56.5 [41-72.3] mm) (P = 0.034). In the group of 7 dogs without recurrence of incontinence, IP increased significantly from a preoperative median value of 102 [19–171] cm.cmH2O to a postoperative median value of 132 [67–225] cm.cmH2O (P = 0.016). In dogs without recurrence, ranges of variation between pre- and postoperative MUP and IP values, as well as postoperative MUCP values (median 47.3 [24.5–52] cmH2O, P = 0.026) were significantly higher (P = 0.017 and P = 0.039 respectively). Recurrence hazard of incontinence was neither significantly associated with age, breed, preoperative urodynamic measurements, CS, neutering, or the type of EU.ConclusionsIn our population, preoperative UPP could not be considered as a diagnostic procedure predictive for incontinence recurrence after surgical correction of EU. Our urodynamic findings support potential improvement in urethral tone in female dogs without recurrence of incontinence.

The evaluation of surgical outcomes for mid-urethral sling (MUS) procedures in treating stress urinary incontinence (SUI) is critical for optimizing patient care. This study is aimed at evaluating the association between empty cough stress test (CST) results and surgical outcomes in MUS procedures, and its role in detecting intrinsic sphincter deficiency (ISD). This was a retrospective cohort study of women who underwent MUS procedures at a single academic center between 2017 and 2023.Patient information including demographics, perioperative factors, urodynamic parameters, and postoperative outcomes were extracted from electronic medical records. A total of 1215 women underwent MUS procedures, with 347 (28.6%) testing positive on the empty CST. The median follow-up period was 12months (range 8 to 16). Empty CST-positive women were younger (median age 53 vs 57years, p < 0.001) and more likely premenopausal. No significant differences were observed between the groups in SUI recurrence after MUS procedures (3.2% vs 4.8%, p = 0.477) or in reoperation rates for persistent SUI. The empty CST showed high specificity for leak point pressure ≤ 60cm H20 (86.5%) and low maximum urethral closure pressure ≤ 20cm H20 (85.3%), but limited sensitivity (17.7% and 3.7% respectively). CST positivity was initially associated with lower point Aa values (55.3% vs 74.0%, p < 0.001), but this lost significance after adjustment for confounders. Empty CST is not predictive of MUS success outcomes and shows high specificity with low sensitivity for detecting ISD, making it a useful yet limited diagnostic tool.

The primary aim was to evaluate the impact of body mass index (BMI) category on objective and subjective cure following single incision sling (SIS) surgery for stress urinary incontinence (SUI). The secondary aim was to compare outcomes among different SIS types within and across BMI categories. This retrospective study included 636 women (mean age 57.4 ± 10.4years) with urodynamic SUI who underwent SIS using the Ophira, Solyx, or I-stop mini between 2015 and 2023. Patients were stratified into BMI categories: normal (< 25kg/m2), overweight (25-29.9kg/m2), and obese (≥ 30kg/m2). Objective cure was defined as no leak on urodynamic testing and the 1-h pad test < 2g, while subjective cure was based on patient-reported outcomes using the UDI-6. Objective and subjective cure rates differed across BMI categories, with the highest rates observed in patients with normal BMI (93.1% and 90.5%) and the lowest in obese patients (77.8% and 75%). Within each BMI category, cure rates did not differ significantly by sling type. However, when outcomes were examined across BMI categories for individual sling types, fixed-length SIS (Ophira and Solyx) showed a significant decline in cure rates with increasing BMI, whereas the adjustable length I-stop mini maintained more consistent outcomes. Independent risk factors for failure included age ≥ 66, menopause, intrinsic sphincter deficiency (ISD), and maximal urethral closure pressure (MUCP) < 40cm H2O. BMI category is associated with SIS outcomes, with obese patients demonstrating lower cure rates compared with normal BMI patients. While sling type does not influence outcomes within BMI groups, preoperative counseling is essential for high-risk patients.

The novel long non-coding RNA (lncRNA) Leat1 is extraordinarily conserved in both its location (syntenic with EfnB2, an essential gene in anogenital patterning) and sequence. Here we show that Leat1 is upregulated following the production of testosterone from the developing testis in mice and interacts with EfnB2, positively regulating its expression. Leat1 expression is suppressed by estrogen, which in turn suppresses the expression of EfnB2. Moreover, the loss of Leat1 leads to reduced EfnB2, resulting in a severe hypospadias phenotype. The human LEAT1 gene is also co-expressed with EFNB2 in the developing human penis, suggesting a conserved function for this gene in urethral closure. Together our data identify Leat1 as a novel molecular regulator of urethral closure and implicate it as a target of endocrine disruption in the etiology of hypospadias.

Stress urinary incontinence (SUI) is the predominant form of urinary incontinence in women. While not life-threatening, this condition significantly affects quality of life through social embarrassment, withdrawal, and anxiety. Magnetic stimulation, a non-invasive and convenient intervention, has gained considerable attention. However, its efficacy in SUI is still controversial. Hence, its clinical value needs to be further explored through systematic reviews and meta-analyses. To clarify the efficacy of magnetic stimulation therapy for SUI in women. Chinese and English studies were searched in PubMed, EMbase, Cochrane Library, Web of Science, CNKI, and Wanfang Databases up to August 2024. Randomized controlled trials of female SUI were included, focusing on urinary incontinence status, quality of life, urine pad test, urodynamics, pelvic floor muscle strength, and poor pelvic floor electromyographic signal. Information, such as author, study period, study type, age, intervention measures, intervention time, intervention frequency, and outcome indicators was extracted. Review Manager 5.4 and StataSE15.0 were adopted for data analyses. Sensitivity analyses and subgroup analyses were also implemented. In total, 17 studies with 1389 patients were included. The results demonstrated that magnetic stimulation-centered treatment significantly improved urinary incontinence, quality of life, 1-hour pad test results, maximum urethral closure pressure, and fast-twitch contraction potential difference of the pelvic floor muscles. However, the therapy did not show a statistical difference in the 24-hour pad test and pelvic floor muscle strength compared with the control measure. Magnetic stimulation-based therapeutic strategy can be used to improve SUI in women. However, it could not significantly improve pelvic floor muscle strength. In addition, the limited number and high heterogeneity of some research indicators may undermine the accuracy of the results. Therefore, caution is needed when translating the conclusions into clinical practice. These findings can be further corroborated through large-scale, high-quality multicenter randomized controlled trials.

Background/Objectives: Pelvic organ prolapse (POP) surgery can lead to postoperative stress urinary incontinence (SUI) in previously continent women, termed de novo SUI. This study assessed the incidence and risk factors of de novo SUI after apical POP repair, hypothesizing that reduced bladder neck elasticity—particularly within the zone of critical elasticity (ZCE) described by the Integral Theory—contributes to its development. Methods: A retrospective single-center analysis was performed in 206 postmenopausal women (≥60 years) who underwent apical POP surgery without concomitant anti-incontinence procedures. Patients were classified by surgical approach as laparoscopic sacrocolpopexy (SCP) or vaginal native tissue repair. Results: The overall incidence of de novo SUI was 8.7%. Laparoscopic SCP for vaginal vault prolapse was significantly associated with a higher risk of postoperative SUI (OR 10.37, 95% CI 2.70–39.79, p = 0.001), whereas other procedures showed no significant association. Neither prior hysterectomy nor cystocele stage was an independent predictor of de novo SUI. Conclusions: These results suggest that surgical alteration of the ZCE—particularly excessive tension or reduced elasticity near the bladder neck—may impair urethral closure. Therefore, preserving ZCE integrity and carefully adjusting mesh tension during apical POP repair may reduce the risk of de novo SUI.

IntroductionWomen with spina bifida often experience neurological impairments leading to pelvic organ dysfunction, including difficulties with bladder and bowel emptying that necessitate frequent Valsalva manoeuvres. These factors, combined with pelvic floor weakness, may increase the risk of pelvic organ prolapse (POP). This study aimed to assess the prevalence of POP in women with spina bifida, identify associated risk factors and evaluate outcomes of surgical management.MethodsWe retrospectively analysed a prospectively maintained database of women with spina bifida seen at a French referral centre from 2007 to 2024. Age under 18 and congenital perineal abnormality were exclusion criteria. The primary outcome was the presence of POP grade 2 or higher (Baden‐Walker classification). Secondary outcomes included symptomatic POP requiring surgery, recurrence after surgery, use of vaginal pessaries and related symptoms.ResultsPOP grade ≥2 was present in 14.8% of patients. Women with POP were older (median 44 vs. 31 years; p < 0.0001) and more frequently parous (58.5% vs. 18.3%; p < 0.0001), although 41.5% of POP cases occurred in nulliparous women. Apical prolapse was predominant (64.3%). Among 11 patients who underwent POP surgery, 54.5% experienced recurrence. Multivariate analysis identified parity (OR 5.33; p = 0.005) and lower maximum urethral closure pressure (OR 0.97; p = 0.02) as independent risk factors.ConclusionsPOP is highly prevalent in young adult women with spina bifida, including many nulliparous patients. The parity status and a low maximum urethral closure pressure could be associated with an increased risk of POP in this population. High recurrence after surgery highlights the need for information, routine screening and tailored management in this population.

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

Numerous anatomical theories have been developed to explain women stress urinary incontinence (SUI) and improve its management. The transperineal ultrasound is an efficient and non-invasive exam that perfectly studies the bladder neck movement and the urethral anatomy. The measurement of the static portion of the distal urethral length, considered as the functional urethral length (FUL), and of the posterior urethral closure angle (PUCA) have not been studied before and could be of interest. This prospective case control study compared incontinent and continent patients. Bladder neck descent, FUL and the PUCA were measured at rest and then during Valsalva maneuvers. The correlation between these perineal sonographic criteria and the severity of incontinence was then evaluated. Fifty patients were included in the study. Bladder neck descent during Valsalva maneuvers was higher in the incontinence group (22.8mm versus 13.5mm, P=0.001). There was not any significant difference in the two groups concerning the FUL and PUCA. Bladder neck descent (ρ=0.36, P<0.05) and urethral funneling during Valsalva maneuvers (ρ=0.37, P<0.05) were significantly correlated to the severity of SUI whereas FUL and the PUCA were not. Bladder neck descent had the best area under the ROC curve (0.7685) for the diagnosis of SUI. There was no significant correlation between the FUL or the PUCA and the severity of SUI. Bladder neck descent seemed to be the most reliable criteria for the diagnosis of SUI. Several factors may be responsible for a variation in the ultrasound measurements.

To investigate sensory and motor function of the bladder and urethra in women with and without urgency urinary incontinence (UUI). Treatment-seeking women with UUI and healthy, asymptomatic, nontreatment seeking controls enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network Organ-Based study (LURN-Organ) and underwent a single session of physiological testing. Testing included rapid-fill cystometry before and after lidocaine administration, urethral pressure profiles, pelvic floor contraction (Kegel) testing, and tuning fork sensation testing at the urethral meatus. Data were collected from 31 asymptomatic controls and 56 women with UUI. Women with UUI were more likely to demonstrate detrusor overactivity (DO) (32% vs. 10% in controls, p = 0.019). In addition, women with UUI on average generated 25% lower active urethral closure pressures during maximal contraction (p = 0.0016) and reported sensations at lower volumes during cystometry (34% lower for first desire to void, p = 0.028; 34% lower for strong desire to void, p = 0.0017; and 32% lower for maximum cystometric capacity, p = 0.0047). Women with UUI demonstrated diminished urethral sensation on the tuning fork test (median of 7 vs. 8 in controls) though the difference was not significant (p = 0.054). Considerable overlap in all findings occurred between cases and controls in each parameter. While individual component comparisons revealed some differences, additional multivariable analysis demonstrated prominently the physiological heterogeneity of women with UUI. Women with UUI demonstrated varying amounts of bladder sensory dysfunction, urethral motor dysfunction and bladder motor dysfunction. Considering the function of lower urinary tract components in combination may reveal UUI phenotypes, highlighting the need to study UUI from a multifactorial perspective. ClinicalTrials.gov Identifier: NCT04557748.

To identify factors that can predict both test phase and midterm success of sacral neuromodulation (SNM) in refractory non-neurogenic overactive bladder syndrome (nnOAB) based on preoperative clinical and urodynamic data. We conducted a two-center retrospective study and included all individuals with nnOAB who underwent a test phase between 2005 and 2021, with or without subsequent implantation of an SNM device. Only those with preoperative urodynamic assessment data were included. SNM success was defined as 50% improvement in one of the bladder diary parameters, associated with 50% symptom improvement. Individuals underwent follow-up evaluation at 2 years. In total, 191 individuals were included (163 women), 69% of whom underwent SNM device implantation. At the preoperative urodynamic exam, 115 individuals had detrusor overactivity (DO). Test phase success was associated with younger age (p = 0.009). 24-month SNM success was associated with lower maximal detrusor pressure at DO (Pdet max DO) at baseline (p = 0.045). Other predictive factors for success at 2 years were female (p = 0.03), a history of stress incontinence surgery (p = 0.01), a low maximum urethral closure pressure (MUCP) (p = 0.04), a low volume at first DO (VFDO) (p = 0.03), and a high maximum cystometric capacity (MCC) (p = 0.03). We developed a tool to predict success at 2 years. The following threshold values were significantly associated with treatment success: MUCP < 58 cmH2O, VFDO < 170 mL, and MCC > 254 mL. Age predicted test phase success. Pdet max DO, gender, history of incontinence surgery, high MUCP, MCC, and VFDO predicted midterm success of SNM in people with nnOAB.