Urge Incontinence Research Articles

Perineal wound breakdown is a rare but important complication following childbirth-related perineal trauma. Though many providers manage wound breakdown via expectant management, the optimal strategy remains debated. In this review, we systematically compile a comprehensive overview of existing data on management of perineal wound dehiscence with emphasis on timing, surgical technique and personnel, outcomes, and considerations to obstetric anal sphincter injuries (OASIS). Our literature search utilized PubMed, SCOPUS, and EMBase databases. Thirteen relevant articles were included in our review. The majority of studies reported resuturing within 2 weeks of diagnosis (11/13), utilizing intraoperative antibiotics (10/13) and polyglactin suture (13/13). Repairs were largely completed in the operating room by an Ob/Gyn; Urogynecology and Reconstructive Pelvic Surgery (URPS) subspecialists were specified in two studies. Complete healing occurred in 57.1-92.9% of patients, typically by 3 months postoperatively, but also reported up to 1 year after repair. Dyspareunia was the most common complication (5.6-27.8%). Minor complications included superficial separation (14.3%) and surgical site infection (9.5%). Four studies focused on OASIS, and repair in these settings often required an URPS consultation and was associated with fecal urgency, flatal and/or fecal incontinence (13.6-37.0%). Evidence supports early resuturing within 2 weeks of perineal wound breakdown, demonstrating good short-term outcomes. Optimal management includes intraoperative cephalosporin administration, polyglactin sutures, and URPS consultation, especially if breakdown of OASIS is suspected. Future studies should examine long-term outcomes, such as rates of persistent anal incontinence, and overall patient satisfaction regarding the timing and techniques of perineal laceration repair revision.

Abstract Background and Aims Mirabegron is a beta 3-receptor agonist used to treat overactive bladder symptoms including Urinary frequency, urgency, and urge incontinence. The medication is contraindicated in severe hypertension, as most of the patients who use it are old and need long-term uses for this drug, its effect on blood pressure, and kidney function tests should be evaluated. Aim: Assessment of the impact of Mirabegron on systolic and diastolic blood pressure and kidney function tests over 1 year post initiation of the drug. Method The study included randomly selected 20 patients divided into 11 females and 9 males who started Mirabegron from 2020–2023 in Oak Vale Medical Centre-Liverpool –UK, after obtaining consent from all participants .Blood pressure and kidney function test including urea, creatinine and GFR were monitored before starting drug use, after 6 months and one year of drug initiation. Result Regarding study population, age ranged from 43 to 88 years with mean ± SD of 75.95 ± 11.86. With female predominance with a percentage of 55%. There was a statistically significant positive correlation between age “years” with Systolic BP and blood urea at baseline before the start of Mirabegron and after start. There is no statistically significant difference between males and females according to Systolic BP, Diastolic BP, Serum Creatinine, Blood urea and eGFR. In all patients Regarding Systolic and Diastolic BP there was a highly statistically significant highest mean value of blood pressure at 6 months and one year after Mirabegron compared to baseline before Mirabegron initiation. Regarding Serum creatinine and blood urea there was a statistically significant highest mean value at 6 months and one year after Mirabegron compared to baseline before Mirabegron. Regarding eGFR: there is no statistically significant difference between before and after Mirabegron intake. Conclusion Blood pressure and kidney function tests should be monitored before starting treatment with Mirabegron and regularly during treatment, especially in patients with pre-existing hypertension or renal impairment. In addition, Mirabegron should be avoided if systolic BP is above 180 and better not to be given until control Bp.

Abstract Objective(s)To estimate the incidence of urinary incontinence, pelvic organ prolapse, and sexual dysfunction in a cohort of patients who had undergone hysterectomy for placenta accreta spectrum (PAS). Additionally, to understand whether certain surgical factors contributed to these outcomes.MethodsThis was a retrospective cohort study of patients who underwent a cesarean hysterectomy for PAS between January 2018 and August 2023 at a single urban academic institution. Patients were recruited 6 months or more following surgery performed by the dedicated accreta team. The survey consisted of validated questionnaires (Pelvic Floor Distress Inventory and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), and clinical data were abstracted from the medical record. Patients who reported pre‐existing incontinence or who were not sexually active were excluded from these respective outcomes. Two‐sided tests of significance were used with an alpha level of 0.05. There was no adjustment for multiple comparisons.ResultsDuring the study period, 100 patients underwent a hysterectomy for PAS of which 64 completed the survey. Participants had a median age of 36 at the time of surgery and a median of 2 prior cesarean deliveries. The majority of cases were scheduled (n = 44, 68.8%) and underwent a supracervical hysterectomy (n = 40, 62.5%). Cystotomy occurred in 12.5% (n = 8/64) of cases. Following hysterectomy, approximately 31% (n = 20/64) of participants had at least one symptom of prolapse, 39.3% (n = 24/61) had symptoms of stress urinary incontinence, and 23.0% (n = 14/61) had symptoms of urge incontinence. Twenty percent of patients (n = 13/64) reported chronic pelvic pain, while 48.0% (n = 25/52) reported at least occasional dyspareunia. Rates of stress incontinence (p = 0.048) and pelvic pain (p = 0.047) were reported more frequently in patients who had experienced cystotomy. There was no difference in outcomes when comparing the type of hysterectomy (i.e., total vs. supracervical) or the urgency of the surgical case.ConclusionIn this cohort of patients who underwent hysterectomy for placenta accreta, there was a high rate of symptoms of prolapse, urinary incontinence, pelvic pain, and dyspareunia, especially in those with intraoperative bladder injury. These results should be used to counsel patients prior to surgery. Placenta accreta centers of excellence should consider offering referral to urogynecology postoperatively for all patients, and especially for those with intraoperative bladder injury.

Simple hysterectomy is one of the most common gynaecological surgical procedures worldwide; however, its association as a possible aetiological factor for urinary dysfunction remains controversial. To evaluate the clinical impact of different types of non-radical hysterectomy on lower urinary tract symptoms (LUTS). A structured search was conducted across scientific sources through December 1989 to March 2025, using terms including: 'urodynamics', 'urinary incontinence', 'stress incontinence', 'urge incontinence', 'urinary urgency', 'urinary frequency', 'urinary nocturia' and 'urinary retention', 'lower urinary tract symptoms', 'hysterectomy'. Randomised controlled trials and prospective observational studies assessing patients undergoing simple hysterectomy with pre- and post-operative evaluation by validated questionnaires. Exclusion criteria included case reports, reviews, editorials, short communications, radical hysterectomy, post-operative assessment only, non-English publications and studies on pelvic organ prolapse surgery. Ten studies, encompassing 1769 patients, were included in the analysis. Five outcomes were selected: changes in urinary frequency; occurrence of stress urinary incontinence; occurrence of urge urinary incontinence; changes in nocturia; changes in incomplete bladder emptying. Changes from baseline to last follow-up available in urinary frequency (OR 0.48, 95% CI 0.36-0.66; p < 0.00001); stress urinary incontinence (OR = 0.54, 95% CI 0.44-0.68; p < 0.00001); urge urinary incontinence (OR = 0.76, 95% CI 0.72-0.94; p = 0.01); nocturia (OR 0.55, 95% CI 0.36-0.84; p = 0.005); incomplete bladder (OR = 0.95, 95% CI 0.66-1.36; p = 0.77). The present meta-analysis suggests that simple hysterectomy is associated with a reduction in the prevalence of urinary symptoms postoperatively. PROSPERO: CRD42024575574.

To assess the long-term urinary and sexual function outcomes for men undergoing robotic-assisted simple prostatectomy (RASP) with circumferential mucosal anastomosis performed at a single, high-volume robotics center. RASP cases performed by a single surgeon from June 2013 through June 2024 using the da Vinci® Xi robotic system were analyzed. Indications for surgery were bothersome lower urinary tract symptoms (LUTS) refractory to medical management and prostate volume ≥ 80g. Urinary function and sexual function parameters were assessed by the American Urologic Association Symptoms Score (AUASS) and Sexual Health Inventory for Men (SHIM), respectively at routine 6-month postoperative visits. A uniform phone survey was conducted in September 2024, which assessed long-term functional outcomes by combining AUASS with questions on incontinence, erectile function, and orgasm. A Wilcoxon signed rank test was utilized to compare pre- and postoperative IPSS and SHIM scores with p < 0.05 considered significant. 292 patients underwent RASP during the query interval and were included in the perioperative analysis with a mean follow-up time of 22.6months (SD ± 15.2). Mean preoperative AUASS was 17.9 (SD ± 7.9). Mean postoperative AUASS was 5.7 (SD ± 5.2); W-statistic 352.0 (p < 0.001). Bother scores preoperative mean was 4.3 (SD ± 1.5), with postoperative values of 1.1 ± 1.4; W-statistic 395.0 (p < 0.001). Sexual Health Inventory for Men (SHIM) scores demonstrated a preoperative mean of 12.8 (SD ± 8.1). Postoperatively, the SHIM mean was 12.6 (SD ± 8.5); W-statistic: 4462.0 (p = 0.57). No patients required reoperation for LUTS, although one patient underwent completion prostatectomy for malignancy identified on RASP pathology. No patients developed bladder neck contracture. Calls were placed to 288 patients (98.6% of total cohort) at a mean follow up of 66 (SD ± 34.7) months postoperatively, of which 198 (68.8%) answered and consented to survey participation. At the time of the follow-up survey, mean IPSS was 2.1 (SD ± 1.9), mean quality of life score was 0.7 (SD ± 0.8). With respect to continence, 196/198 (98.9%) patients experienced no stress incontinence. Two patients (1%) experienced urge incontinence and one patient (0.5%) utilized an incontinence pad. Regarding sexual activity, 157 (79.3%) patients were sexually active at the time of survey compared to 159 (80.3%) prior to surgery. Of those who remained sexually active, 152 (96.8%) were satisfied with postoperative orgasm, and 149 (94.9%) were satisfied with postoperative erectile function. Notably, 11 (7.0%) of men endorsed a "bothersome or distressing" orgasm change. RASP has a low complication rate, low risk of urinary incontinence, no significant impact on erectile function, and provides durable improvements in lower urinary tract symptoms. A small portion of men do experience sustained, bothersome orgasm change following RASP.

Abstract Background Chronic recreational use of maras powder (minced Nicotiana rustica leaves), endemic in Southeastern Turkey and characterized by very high nicotine and alkaloid content, may induce bladder dysfunction analogous to ketamine-induced cystitis. This study investigates the urological impact of chronic maras powder use. Methods We retrospectively analyzed 400 patients with lower urinary tract symptoms (LUTS) at Osmaniye State Hospital (2024–2025). The case group included 20 chronic Maras Powder users, while 30 age-matched controls had no exposure. Evaluations included urodynamics, cystoscopy, and histopathologic examination. Maras powder exposure was quantified as pack-years (daily frequency × duration). Results Maras powder users demonstrated significant urodynamic impairments compared to controls: reduced cystoscopic bladder capacity (median 200 mL vs. controls, p &lt; 0.001), lower voided volume (79.3 mL vs. controls, p &lt; 0.001) on the initial uroflowmetry test, diminished maximum flow rate (Qmax: 5.5 mL/s, p = 0.007), and decreased detrusor compliance (11 mL/cmH₂O, p = 0.007). Dose-dependent correlations linked higher pack-years to reduced bladder capacity (Pearson’s r = − 0.45, p &lt; 0.05). Urge incontinence (p &lt; 0.05) and nocturia (p &lt; 0.05) were more prevalent in users. Histopathology revealed eosinophilic cystitis, lymphocytic inflammation, lamina propria edema, and vascular dilation. Conclusions Chronic maras powder use is associated with a ketamine-like bladder syndrome, characterized by contracture, inflammation, and impaired flow. Public health measures and clinician awareness are critical to address this emerging etiology of LUTS.

Urinary incontinence (UI) is a significant health concern among women in the USA and is often underdiagnosed. Prevalence has increased over recent decades. The COVID-19 pandemic disrupted national survey data collection, creating a gap in updated prevalence estimates. We analyzed publicly available data from the 2021-2023 National Health and Nutrition Examination Survey. Our study included women aged ≥ 20 years who completed incontinence-related survey items (n = 2834). Outcomes included stress (SUI), urgency (UUI), and mixed incontinence (MUI). Analyses were weighted to provide nationally representative estimates. Multivariable logistic regression stratified by age (<50 vs ≥50 years) was used to identify independent risk factors. The crude prevalence of UI was 63%, representing approximately 79.6 million US women. Age-adjusted prevalence was 47.6%. Over 40% of women with each UI subtype reported "moderate" to "very severe" UI symptoms. Functional dependence was a consistent predictor of all subtypes across age groups. Among younger women, SUI was associated with current pregnancy, multiparity, and obesity. In older women, chronic obstructive pulmonary disease predicted SUI and MUI, whereas cardiovascular conditions were linked to UUI and MUI. "Moderately severe" or "severe" depressive symptoms were associated with UUI in both age groups. Prediabetic hemoglobin A1c was associated with SUI and MUI in older women only. Urinary incontinence remains prevalent and symptomatically burdensome among US women. Age-specific risk profiles underscore the importance of tailored screening and management. Addressing functional and mental health, as well as ensuring equitable access to urological care, will be critical priorities as the US population ages.

Obstetric anal sphincter injuries (OASI) affect 2.9% of vaginal births and are associated with significant morbidity (Dudding et al. Ann Surg 247(2):224-237). Our objective was to evaluate if women sustaining minor OASI (3a) experience less pelvic floor dysfunction compared to major OASI (3b, 3c and 4). In a tertiary Urogynaecology centre, patients were followed-up in a perineal clinic, with data regarding clinical outcomes recorded prospectively between 2011 and 2023. Patients graded bowel and urinary symptoms on a scale of 0-4. Pelvic floor muscle (PFM) strength, squeeze on per rectal (PR) examination and a Pescatori score were assigned by clinicians. Scores were retrospectively compared between minor and major tear groups. Statistical analysis was conducted using the chi-squared test for symptom scores and Mann-Whitney U test for PFM strength, Pescatori score and PR squeeze. Data were complete for 1327 of 1455 women: 639 minor and 688 major tears. The majority of patients were asymptomatic or minimally symptomatic, 3months postpartum, in respect to faecal passive incontinence, flatal incontinence and urinary symptoms with no difference between groups. There was no significant difference in Pescatori score, PFM strength or PR squeeze. There was a statistically significant difference between groups for faecal urgency (2.8% vs 5.1%, p = 0.0045) and faecal urgency incontinence (0.2% vs 1.2% p = 0.003). Women sustaining minor OASI are less likely to experience faecal urgency and urgency incontinence than following major OASI. There was no significant difference for all other outcomes. Prospective studies using validated questionnaires with long-term follow-up are required to confirm our findings.

Working during non-traditional hours is becoming more prevalent in modern societies and presents a significant hurdle to an individual's circadian rhythm. We examined the bladder health of shift workers in the United States by analyzing information obtained from the National Health and Nutrition Examination Survey. National Health and Nutrition Examination Survey (NHANES) datasets from 2005 to 2010 were utilized. Regression analyses were used to assess the association between shift work and bladder health (stress incontinence, urge incontinence, and nocturia) by adjusting for age, race, education, smoking, and other factors. The percentage of non-Hispanic Black individuals was notably higher among shift workers (25.8% vs. 17.8%). Among shift workers, there was a lower percentage of individuals with a college degree or higher compared to day workers. Shift work was found to be associated with nocturia in men in the unadjusted model (OR=1.2, 95%CI=1.0-1.5, p = 0.038). However, the adjusted results indicate that the connection is not statistically significant (Adjusted Model II: OR=1.2, 95%CI=1.0-1.5, p = 0.105). Similarly, no statistically significant association was observed between shift work and nocturia in women. There was also no significant relationship between shift work and Stress Urinary Incontinence (SUI) in men or women. The results from the fully adjusted model (Adjusted Model II) indicate a significant association between shift work and the prevalence of Urgency Urinary Incontinence (UUI) in women (OR=1.2, 95%CI=1.0-1.5, p = 0.041). Results of this cross-sectional study indicated that shift work was associated with a higher risk of UUI in women. Further research is needed to explore this relationship.

Background: Patients with Polycystic Ovarian Disease (PCOD) frequently experience urge incontinence, which has a substantial negative influence on their quality of life. The Knack approach has been proposed as a viable strategy to enhance urine control in these patients. It includes pre-emptively contracting the pelvic floor muscles. Objective: This case study attempts to assess the impact of the Knack approach on the function of the pelvic floor muscles in a PCOD patient who is having urge incontinence. Methods: For this study, a female patient with PCOD with urge incontinence, aged 18 to 25, was chosen. During the course of four weeks, the patient was trained to employ the Knack technique as part of the intervention. A pelvimeter was used to test the strength of the pelvic floor muscles, and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was used to assess the degree of urine incontinence. Additionally, the Polycystic Ovary Syndrome Questionnaire (PCOSQ) was used to evaluate quality of life. Result: Pelvic floor muscular strength and coordination significantly improved following the session, as evidenced by pelvimeter readings. Additionally, the patient noted a discernible decrease in the number and intensity of bouts of urge incontinence. Conclusion: For PCOD patients, the Knack approach seems to be a useful non-invasive strategy for enhancing pelvic floor muscle function and lowering urge incontinence. It is advised that more research be done with bigger sample sizes to validate these results.

Background: The literature regarding lower urinary tract symptoms (LUTS) in the transgender and non-binary population is scarce. There are emerging data surrounding the impact of hormonal, surgical, and behavioral factors for this population; however, direct impact on pelvic floor function is still lacking. Case Description: This case report describes a 39-year-old transgender man referred to pelvic health rehabilitation for urinary urgency and urge urinary incontinence (UUI), which were limiting participation in occupational activities. The plan of care utilized a multimodal treatment approach, incorporating behavioral techniques, manual therapy, therapeutic exercise, and neuromodulation via sacral transcutaneous electrical nerve stimulation to improve functional outcomes. Outcomes: Clinically significant improvement on the National Institutes of Health Chronic Prostatitis Severity Index score from 13 to 3, reduction in urinary urgency from daily to weekly, and reduction in UUI from weekly to none were reported upon discharge. Functional outcomes included return to prior level of occupational participation. Discussion: This case report represents a successful course of pelvic health rehabilitation for LUTS in a transgender man. This case aims to begin bridging the significant gap in the literature regarding treatment of LUTS among transgender men with hormonal and post-operative considerations.

The aim of this study was to evaluate the prevalence of faecal incontinence (FI) among patients attending colorectal clinics in a global setting, treatment choices and accessibility to diagnostic and treatment tools. An international, prospective, multi-centre snapshot audit and survey of patients undergoing consultation regarding FI was undertaken from January 9 to February 28, 2023. Participating units included patients in the audit who presented until March 28, 2023. Main outcomes measured included the prevalence of FI in clinical practice, diagnostic approaches, treatment patterns and availability of interventions. A total of 1853 outpatients with FI and 363 surgical patients were included, representing a prevalence of 6.3% of total clinic attendance over the same period. The majority of patients were female (75.3%), parous (85% of females). Patients presented with passive and urge incontinence, or both, in fairly even proportions (34.8 vs. 29.4 vs. 33.7%, respectively). Aetiology was most commonly anal injury (surgical or obstetric: 15.4% vs. 19.8%, respectively), but with significant proportions of other surgical conditions, such as low anterior resection syndrome (11.1%) and rectal prolapse (12.7%). In the surgical audit (n = 363), the majority of patients had received previous treatment (61.1%), including pelvic floor physiotherapy (67.1%), bowel retraining with biofeedback (51.4%), and nurse-led continence support (40.5%). Of 395 procedures performed, sacral neuromodulation was the most common (28.9%), followed by sphincteroplasty (22.0%). In the global practice survey (n = 250 respondents), endoanal ultrasound (EAUS) (82.4%) and anorectal manometry (74.4%) were the most available diagnostic tools. Globally, FI forms a significant part of colorectal surgeons' clinical workload, with a skew toward structural causes of FI. Practice varies according to the availability of diagnostics and procedures.

ABSTRACTPatients with deep endometriosis of the posterior pelvic compartment might present various lower urinary tract symptoms, including urinary retention, without any prior pelvic surgery in their medical history. These symptoms, including urinary retention, pollakiuria or urge incontinence, urinary urgency, and decreased bladder sensitivity, imply an infiltration of the pelvic autonomic nerves by endometriosis lesions, in combination with inflammatory phenomena. Although there are numerous publications dealing with de novo urinary dysfunction after endometriosis surgery, significantly less scientific information is available on the effect of endometriosis surgery specifically tailored to improve preoperative voiding dysfunction in endometriosis. Therefore, in this case report, we analyze the effect of laparoscopic endometriosis surgery in a 28‐year‐old nulliparous woman with serious preoperative urinary retention mandating clean intermittent self‐catheterization three to four times daily. Patient history revealed neither prior pelvic nor abdominal operation, nor any neurological or other known disease. Uroflowmetry demonstrated significant voiding dysfunction. Filling cystometry showed signs of reduced bladder sensation (normal desire to void at 400 mL) along with preserved bladder compliance. During the pressure‐flow study, the patient was unable to initiate micturition, although abdominal straining and detrusor contraction were registered. The cause of voiding dysfunction was deemed to be pelvic floor dysfunction (dysfunctional voiding) rather than detrusor underactivity. Alpha blocker, muscle relaxant therapy, and pelvic floor relaxation training were introduced, achieving poor short‐term response. Transvaginal ultrasound examination showed hypoechogenic alterations on both uterosacral ligaments in the vicinity of their cervical attachment sites. These areas appeared to be painful while scanning with the probe. MRI examination confirmed the previous finding of transvaginal ultrasound with regard to bilateral alteration of the uterosacral ligaments characteristic of endometriosis. During laparoscopy, we confirmed the presence of endometriotic lesions of both uterosacral ligaments that were completely removed. The patient showed significantly improved emptying function following surgery. Uroflowmetry also demonstrated improved voiding parameters. We conclude that laparoscopic removal of endometriotic lesions of the uterosacral ligaments can significantly improve bladder function in patients suffering from preoperative voiding dysfunction.

Among the wide range of congenital kidney and urinary tract anomalies, posterior urethral valve (PUV) has most devastating complications such as recurrent urinary tract infections, urinary incontinence, and chronic kidney disease. To assess the quality-of-life (QoL) of children with PUV, determine the factors contributing to reduced patient's QoL and increased caregiver burden. A total of 36 boys with PUV and 54 healthy controls aged between 4 and 18 years were included. Both groups completed the Children's Health Related Quality of Life (KINDL). Children with PUV also completed ICIQ-CLUTS incontinence questionnaire. Caregivers of PUV patients completed Impact on Family Scale (IOFS) to assess caregiver burden. Boys with PUV aged between 7 and 18 years old had significantly lower total QoL scores and lower scores in physical well-being, emotional well-being, self-esteem, family interactions, social interactions and school subscales compared to healthy controls. Patients who underwent multiple surgeries had lower emotional wellbeing scores than those with a single surgery. Among PUV patients, enuresis was associated with lower physical wellbeing score, daytime incontinence with lower emotional wellbeing and urge incontinence with lower school scores. Higher lower urinary tract symptom severity was correlated higher IOFS total scores, including familial/social impact and personal strain subscales. Boys aged 7-18 years with PUV experience lower QoL than healthy peers. Lower urinary tract symptoms are a major contributing factor to both reduced QoL in patients and increased caregiver burden. Early and effective management of lower urinary tract symptoms may improve QoL of PUV patients and lower caregiver burden.

This study aimed to assess the limitations of the International Prostate Symptom Score (IPSS) in evaluating male lower urinary tract symptoms (LUTS) and to determine whether the International Consultation on Incontinence Questionnaire-Male LUTS (ICIQ-MLUTS) can uncover clinically relevant symptoms overlooked by IPSS. A total of 239 Turkish men aged 50-80 with LUTS were prospectively evaluated using the linguistically validated Turkish versions of the IPSS and the short form of the ICIQ-MLUTS questionnaires. Symptoms not assessed by IPSS (urgency incontinence, stress incontinence, unaware leakage, nocturnal enuresis, postvoid dribbling) were identified. Multivariate logistic regression and ROC analyses were conducted to explore predictors of having at least one of these symptoms with a severity score ≥ 2. While the IPSS categorized patients into mild (18.0%), moderate (47.7%), and severe (34.3%) LUTS groups, 32.6% of all participants reported at least one significant symptom not captured by IPSS. In multivariate analysis, an IPSS question 4 (urgency) score ≥ 3 was independently associated with a 1.5-fold increased risk (p = 0.002), while being classified as severely symptomatic conferred a 7.7-fold increased risk (p = < 0.001) of having overlooked symptoms. ROC analysis showed acceptable predictive performance (AUC = 0.710 for urgency score ≥ 3; AUC = 0.671 for severe IPSS classification). A considerable proportion of clinically relevant LUTS, especially incontinence and post-micturition symptoms, go undetected when using IPSS alone. Patients with high urgency scores or severe symptom burden may benefit from further evaluation beyond the IPSS, which highlights the potential role of IPSS as a triage test in LUTS assessment. This study does not require clinical trial registration because it is not a prospective interventional trial involving human participants.

Benign prostatic hyperplasia (BPH) and benign prostatic obstruction (BPO) remain significant contributors to male lower urinary tract symptoms, often leading to bladder damage and dysfunction. The traditional approach focuses on the management of bothersome symptoms through the use of BPH medications and may delay essential interventions, leading to disease progression and a negative impact on quality of life. This review proposes a paradigm shift to focus on bladder health preservation, as the bladder is an end organ that cannot be transplanted. Therefore, earlier diagnosis and timely surgical treatment within the “window of curability” are required. We introduce the Man vs Prostate “Five Stages of Bladder Health” to provide the needed framework to build the next iterations of BPH/BPO care. This patient-facing decision-making aid categorizes BPH/BPO progression. It integrates clinical observations with underlying pathophysiology and patient experience. This categorization highlights how untreated BPH/BPO can progress to more serious and pressing stages, the possible consequences of not taking action, and the goal to prevent late-stage disease: stage I, BPO; stage II, detrusor overactivity; stage III, urgency incontinence; stage IV, acute retention; and stage V, detrusor underactivity. On an individual patient basis, transitions are not distinct, stages can coexist, and stages can be skipped. Although promising, this proposed staging system requires further validation through prospective randomized clinical trials to confirm its clinical value and prognostic accuracy.The concept of the “window of curability” emphasizes the need for therapeutic intervention at the optimal time. By identifying patients in earlier stages and initiating appropriate treatment, disease progression can be potentially stabilized or even reversed while aiming to optimally preserve detrusor function. Along with the Man vs Prostate staging system, this framework provides a structure for future research, shared decision making, and personalized treatment strategies. This paradigm shift necessitates a collaborative effort among urologists to reevaluate current practices, focus on earlier intervention within the “window of curability,” and prioritize bladder health preservation.

I saw the "hourglass" sign: CT diagnosis of inguinoscrotal bladder herniation with pseudo-diverticula.

The objective was to determine whether the addition of prophylactic retropubic colposuspension is superior to no anti-incontinence procedure during minimally invasive surgical sacrocolpopexy for stress-continent patients in decreasing rates of postoperative de novo stress urinary incontinence (SUI). In this randomized superiority trial, we recruited stress-continent prolapse patients undergoing either conventional or robotic-assisted laparoscopic sacrocolpopexy with negative preoperative supine cough stress tests. Patients were randomized to receive either prophylactic retropubic colposuspension or no retropubic colposuspension (control). The primary outcome was the composite measure of postoperative de novo SUI at 3 months, which included either (1) "Yes" to Question #17 on the Pelvic Floor Distress Inventory-20 endorsing symptoms of urinary leakage with coughing, sneezing, laughing, (2) positive retrofill cough stress test, or (3) any SUI treatment after sacrocolpopexy. Using data from the Colpopexy and Urinary Reduction Efforts trial, a sample size of 42 participants would demonstrate the addition of prophylactic retropubic colposuspension to be superior to control with a superiority margin of 15%. Fifty patients underwent randomization, with 26 assigned to prophylactic retropubic colposuspension and 24 as controls. Three months after surgery, 50.0% of the patients in the retropubic colposuspension group and 41.7% of controls met one or more criteria for de novo SUI (P = 0.555). There was no difference between the retropubic colposuspension and control groups in symptoms of urinary frequency, urgency incontinence, or urinary retention at 3 months. Among stress-continent patients undergoing minimally invasive surgical sacrocolpopexy in this single-center study, the addition of prophylactic retropubic colposuspension was not superior to no retropubic colposuspension in preventing postoperative de novo SUI at 3 months after surgery.

A Self-Selection Validation Study of the Uresta Bladder Support.

Background/Objectives: Lower urinary tract symptoms (LUTS), such as frequency, urgency, nocturia, and urge incontinence, are commonly linked to overactive bladder (OAB) and benign prostatic hyperplasia (BPH). Oxytocin receptor (OXTR) upregulation has been proposed to enhance bladder and prostate contractility, while obesity is a recognized risk factor for LUTS, OAB, and BPH. This study aimed to investigate whether the OXTR antagonist atosiban attenuates spontaneous and oxytocin-induced contractions in bladder and prostate tissues from obese and non-obese rats. Methods: Bladder and prostate tissues were obtained from obese and non-obese rats and studied in in vitro organ bath preparations. The effects of atosiban (1 µM and 10 µM) on spontaneous contractility and oxytocin-induced responses were examined. Immunohistochemistry was performed to evaluate OXTR expression in the bladder. Results: Atosiban significantly reduced spontaneous contractions in the bladder (p < 0.0001 in obese; p < 0.01 in non-obese) and prostate (p < 0.01 in obese; p < 0.0001 in non-obese). Oxytocin-induced bladder contractions were significantly increased in obese rats but were attenuated by atosiban at 10 µM (p < 0.05), an effect absent in non-obese rats. Immunohistochemical analysis confirmed elevated OXTR expression in both epithelial and stromal compartments of the bladder in obese rats (p < 0.05). Conclusions: These findings indicate that oxytocin contributes to bladder and prostate hypercontractility, particularly in obesity. Targeting OXTR with atosiban may represent a novel therapeutic strategy for the management of LUTS, OAB, and BPH.