Urodynamic Parameters Research Articles

Primary bladder neck obstruction in men: The importance of urodynamic assessment and cystourethrography in measuring its severity.

Primary bladder neck obstruction (PBNO) is a condition primarily affecting young men, characterized by obstruction at the bladder neck, leading to lower urinary tract symptoms. The aim of this study was to identify a correlation between the severity of bladder neck opening impairment and urinary symptoms by means of urodynamic studies. A retrospective analysis was conducted in adult males diagnosed with PBNO at a university neurourology department between 2015 and 2022 who underwent voiding cystourethrography (VCUG) and pressure-flow studies. The cohort was divided into two groups: absence of bladder neck opening on VCUG (Group A) and incomplete bladder neck opening (Group B). Out of the 82 patients with PBNO screened, 53 were included in the analysis. Nocturia was the only symptom more prevalent in Group A (65% in Group A vs. 30% in Group B, p = 0.02) but scores and subscores of the Urinary Symptom Profile questionnaire were not different between groups. In addition, the detrusor pressure at a maximum flow rate (PdetQmax), bladder outlet obstruction index (BOOI), and bladder contractility index (BCI) were higher in Group A than in Group B [PdetQmax (A = 93.7 ± 53.7 cmH2O vs. B = 65.7 ± 26.4 cmH2O; p = 0.01)-BOOI (A = 77 ± 58.3 vs. B = 48 ± 25.7; p = 0.03)-BCI (A = 136 ± 51.3 vs. B = 110 ± 41.7; p = 0.04)]. This study demonstrates a significant association between the extent of bladder neck opening impairment observed on VCUG and obstruction and contraction urodynamic parameters, but no association with the severity of urinary symptoms. Future studies should evaluate the predictive value of treatment response and the occurrence of complications based on clinical and urodynamic parameters.

De-obstruction of bladder outlet in humans reverses organ remodelling by normalizing the expression of key transcription factors

BackgroundBenign prostatic hyperplasia in elderly males often causes bladder outlet obstruction termed benign prostatic obstruction (BPO). BPO induces lower urinary tract symptoms and quantifiable urodynamic alterations in bladder function. When conservative medical treatments are exhausted, surgical interventions like transurethral resection of the prostate (TURP) are employed for bladder outlet de-obstruction. Elucidating the molecular changes in the human bladder resulting from BPO and their reversal post-de-obstruction is pivotal for defining the “point of no return”, when the organ deterioration becomes irreversible. In this study we carried out a comprehensive molecular and urodynamic characterization of the bladders in men with BPO before TURP and 3 months after the relief of obstruction.MethodsWe report integrated transcriptome and proteome analysis of bladder samples from male patients with BPO before and 3 months after de-obstruction surgery (TURP). mRNA and protein profiles were correlated with urodynamic findings, specifically voiding detrusor pressure (PdetQmax) before TURP. We delineated the molecular classifiers of each group, pointing at the different pre-TURP bladder status.ResultsAge-matched patients with BPO without DO were divided into two groups based on the PdetQmax values recorded by UDI before de-obstruction: high and medium pressure (HP and MP) groups. Three months after de-obstruction surgery, the voiding parameters PdetQmax, Qmax and RV were significantly improved in both groups, without notable inter-group differences in the values after TURP. Patients with high PdetQmax showed less advanced remodeling and inflammatory changes than those with lower values. We detected significant dysregulation of gene expression, which was at least partially reversed by de-obstruction in both patients’ groups. Transcription factor SOX21 and its target thrombospondin 4 (THBS4) demonstrated normalization post-TURP.ConclusionsOur findings reveal substantial yet incomplete reversal of cell signalling pathways three months after TURP, consistent with improved urodynamic parameters. We propose a set of biomarker genes, indicative of BPO, and possibly contributing to the bladder changes. This study unveils the stages of progressive obstruction-induced bladder decompensation and offers insights into selecting an optimal intervention point to mitigate loss of contractility.

Therapeutic efficacy of 180-W GreenLight laser photoselective vaporization of the prostate for storage symptoms concomitant with benign prostatic obstruction and a search for outcome predictors.

Benign prostatic obstruction (BPO) is the most common cause of lower urinary tract symptoms among men. GreenLight photoselective vaporization of the prostate (GL-PVP) using a 180-W Xcelerated performance system (XPS) laser is a well-established method for treating BPO-induced voiding symptoms. However, its therapeutic effects on storage symptoms remain unclear. This study aimed to analyze the storage outcomes in patients who underwent 180-W XPS GL-PVP for BPO and to identify outcome predictors. Patients who underwent 180-W XPS GL-PVP for BPO between May 2018 and May 2021 were retrospectively reviewed. Data on clinical characteristics, prostate volume, preoperative and postoperative International Prostate Symptom Scores (IPSS), and preoperative urodynamic parameters were collected. A favorable storage outcome was defined as ≥50% reduction in the IPSS storage subscore. Ninety-nine male patients were included, with a mean age of 69.4 ± 9.6 years and a baseline prostatic volume of 75.9 ± 33.1 mL. The IPSS total, storage, and voiding subscores significantly decreased after GL-PVP (all p < 0.001). Seventy-two patients achieved favorable storage outcome at 6 months. Multivariate analysis revealed that detrusor underactivity was predictive of unfavorable storage outcomes (p = 0.022), while IPSS voiding-to-storage subscore ratio >1.25 and the presence of detrusor overactivity were predictive of favorable storage outcomes (p = 0.008 and 0.033, respectively). 180-W XPS GL-PVP provided excellent outcomes in both voiding and storage lower urinary tract symptoms concomitant with BPO. Preoperative IPSS and multichannel urodynamic parameters including detrusor overactivity and underactivity are valuable predictors of postoperative storage outcomes.

Effect of tamsulosin on urethral tone in healthy male cats.

Alpha-adrenergic antagonists are commonly used to prevent recurrent urethral obstruction in cats with mixed reports of efficacy. No published data on tamsulosin use in cats are available. The objective of this study was to measure changes in urodynamic parameters and blood pressure in five healthy male cats before and after administration of tamsulosin orally for 4 and 10 days. Five young healthy adult male cats from a research colony were administered tamsulosin at 0.1 mg/cat PO q24h for 10 days. Urethral pressure profile and blood pressure measurements were performed before treatment and approximately 6 h after treatment on days 4 and 10. Maximum urethral closure pressure (MUCP) for the prostatic and penile urethra, functional urethral length (FPL), functional area (FA) and systolic blood pressures were recorded and compared between the time points. Significant changes in blood pressure on day 4 (121.1 mmHg ± 20.2 mmHg) and on day 10 (112.6 mmHg ± 14.9 mmHg) compared with day 0 (141.1 mmHg± 33.4 mmHg) were not detected (P = 0.18) in anesthetized cats. No significant difference in MUCP, FA or FPL measurements were detected among baseline, day 4 and day 10 of treatment. Hematuria and transient pollakiuria were induced in two cats with 3.5 Fr urethral catheters. Tamsulosin at 0.1 mg/cat PO q24h did not induce hypotension in healthy cats. Urodynamic testing performed 6 h after the tamsulosin pill was administered did not detect consistent decreases in urodynamic functions induced by tamsulosin. Repeated catheterization of tom cats with 3.5 Fr catheters may induce significant urethral trauma.

Intravesical Botulinum Toxin Injection Plus Hydrodistention Is More Effective in Patients with Bladder Pain-Predominant Interstitial Cystitis/Bladder Pain Syndrome.

Intravesical botulinum toxin A (BoNT-A) injections are included in the interstitial cystitis/bladder pain syndrome (IC/BPS) treatment guidelines. However, the IC phenotype suitable for treatment with BoNT-A has not been clarified. Therefore, we identified the factors influencing treatment outcomes for intravesical BoNT-A injections in patients with non-Hunner IC/BPS (NHIC). This retrospective study included patients with NHIC who underwent 100 U BoNT-A intravesical injections over the past two decades. Six months after treatment, treatment outcomes were assessed using the Global Response Assessment (GRA). Outcome endpoints included GRA, clinical symptoms, urodynamic parameters, urine biomarkers, and the identification of factors contributing to satisfactory treatment outcomes. The study included 220 patients with NHIC (42 men, 178 women). The satisfactory group (n = 96, 44%) had significantly higher pain severity scores and IC symptoms index, larger maximum bladder capacity (MBC), and lower 8-isoprostane levels at baseline. Logistic regression revealed that larger MBC (≥760 mL) and bladder pain predominance were associated with satisfactory outcomes after BoNT-A injection. Subjective parameters and pain severity scores improved significantly in patients with bladder pain-predominant IC/BPS after BoNT-A injection. Thus, NHIC patients with bladder or pelvic pain are more likely to experience satisfactory outcomes following intravesical BoNT-A injections.

Patient reported outcomes of intermittent self-dilatation after direct vision internal urethrotomy.

Long-term results on quality of life (QoL) as well as clinical outcomes of intermittent self-dilatation (ISD) of the urethra after direct visual internal urethrotomy (DVIU) are scarce. The aim of this study was to prospectively evaluate patient reported outcomes (PROs) on voiding symptoms and QoL in a large cohort of urethral stricture patients performing ISD. We identified a total of 121 patients who performed ISD following DVIU between 2008 and 2013. Baseline assessment was conducted for each patient before ISD was started. Follow-up visits were scheduled in 6-month intervals. Each assessment included the following questionnaires: International prostate symptom score (IPSS), IPSS quality of life index (IPSS-QoL), patient global impression of severity (PGI-S), and patient global impression of improvement (PGI-I). Additional parameters were maximum urinary flow rate (Qmax ), postvoid residual urine, rate of complications, and stricture recurrence. Linear mixed models were used to examine the change over the course of the follow-up visits to the baseline. The median age of the patients was 58 years (interquartile range [IQR]: 43-70). The median follow-up was 17 months (IQR: 7-30). Mean change from baseline IPSS was -6.1, -5.9, -4.2, and -4.8 points at 6, 24, 36, and 48 months. Mean change from baseline IPSS-QoL was -1.3, -1.4, -1.6, and -1.8 points, respectively. Mean PGI-I was 1.7 points at 6, 1.9 points at 24, 1.9 points at 36, and 2.2 points at 48 months after ISD initiation. Mean change of Qmax ranged from 1.7 at 6 to 2.2 mL/sat 48 months. The median complication rate was 3.3% per 6-month ISD interval. Overall, 11 patients developed stricture recurrence (9%). ISD after DVIU had no negative impact on patients' QoL (IPSS-QoL, PGI-I, PGI-S). Urodynamic parameters remained stable for up to 48 months with low complications and an acceptable stricture recurrence rate.

Impact of patient position on cystometric parameters in pediatric patients with neurogenic bladder: A prospective study.

Urodynamic studies (UDSs) play a crucial role in evaluating lower urinary tract function in pediatric patients with neurogenic bladder. However, the influence of patient position on urodynamic parameters in this population remains understudied. This study aims to investigate the effect of patient position on urodynamic results in children with neurogenic bladder. A prospective study was conducted with 50 pediatric patients diagnosed with neurogenic bladder. Urodynamic recordings were obtained during a single session, with the first two fillings in the supine position and the third filling in the sitting position. Urodynamic parameters assessed included detrusor overactivity (DO), maximum detrusor pressure (MDP), cystometric bladder capacity (CBC), compliance (C), detrusor leak point pressure (DLPP), and bladder volume at the moment of incontinence (DLPV). Patient position did not significantly influence CBC, DO, C, and DLPV (p > 0.05). However, there were significant differences in MDP and DLPP between the supine and sitting positions (p < 0.05), with higher values observed in the supine position. These findings highlight the importance of considering the patient's position when interpreting urodynamic results and making treatment decisions for children with neurogenic bladder. The higher MDP and DLPP values in the supine position may have clinical implications for assessing upper urinary tract integrity and treatment planning. However, further research is needed to understand the underlying mechanisms and generalize these findings to broader patient populations.

Assessment of the Incidence and Risk Factors of Stress Urinary Incontinence in Women after Cervical Cancer Surgery: A Single-Centre Retrospective Study.

Stress urinary incontinence (SUI) is a common postoperative complication that significantly affects the quality of life in women who have undergone radical hysterectomy for cervical cancer. This study evaluates the incidence and risk factors associated with SUI in women after cervical cancer surgery. This case-control study included women diagnosed with cervical cancer who underwent radical hysterectomy at our hospital between May 2020 and May 2023. Participants were divided into two groups based on the presence of postoperative SUI, namely the SUI group and the SUI-free group. Inclusion criteria required the absence of preoperative urinary incontinence and stable vital signs. Data were collected on demographic characteristics, tumour histology and staging, urodynamic parameters, and intraoperative and postoperative factors. Ninety-seven patients with cervical cancer who underwent radical hysterectomy were divided into two groups: The SUI group (n = 27) and the SUI-free group (n = 70), with an SUI incidence of 27.8% in the study population. Significant differences between the SUI and SUI-free groups were observed in menopausal status (p = 0.026), chronic constipation (p = 0.011), and tumour diameter (p < 0.001). Urodynamic assessments revealed a higher maximum urinary flow rate (Qmax) in the SUI group compared to the SUI-free group (21.36 ± 6.41 vs. 17.38 ± 5.18 mL/s; p = 0.002). Logistic regression analysis identified menopause (odds ratio (OR) = 7.700, 95% confidence interval (CI) = 1.256-47.192), chronic constipation (OR = 9.918, 95% CI = 1.387-70.911), Qmax (OR = 1.302, 95% CI = 1.061-1.598), and surgery duration (OR = 1.040, 95% CI = 1.001-1.081) as independent protective factors. SUI is a significant postoperative complication in women undergoing cervical cancer surgery. Menopause, chronic constipation, tumour diameter, Qmax, and surgery duration were independent risk factors.

Re: Ioannis Tsikopoulos, Lazaros Lazarou, Lazaros Tzelves L et al. The effect of pelvic floor muscle training on urodynamic parameters in women with stress urinary incontinence

Re: Ioannis Tsikopoulos, Lazaros Lazarou, Lazaros Tzelves L et al. The effect of pelvic floor muscle training on urodynamic parameters in women with stress urinary incontinence

Impact of deep brain stimulation on urogenital function in Parkinson's disease: a systematic review and meta-analysis.

Deep Brain Stimulation (DBS) effectively treats Parkinson's motor symptoms, but its effects on the urogenital system are debated. A research was conducted in PubMed, Embase, Cochrane Library, Web of Science, and Scopus until February 27, 2024. We primarily focused on DBS's impact on Parkinson's patients' Urine storage function, voiding function, sexual function, and quality of life. Our meta-analysis included 14 studies. The main results showed that DBS resulted in fewer instances of urinary urgency (OR = 1.85, 95% CI: 1.26 to 2.70, p = 0.002) and increased maximum bladder capacity (MD = -66.10, 95% CI: -119.37 to -12.82, p = 0.02) in terms of urinary storage function. However, there were no significant differences in first desire to void and strong desire to void. In terms of voiding function, DBS showed significant improvements in maximum flow rate (MD = -0.64, 95% CI: -1.23 to -0.05, p = 0.03), post-void residual (MD = -6.79, 95% CI: 4.54 to 9.05, P < 0.00001) and detrusor pressure during maximum flow (MD = -1.37, 95% CI: -2.73 to -0.02, p = 0.05). Additionally, there was no significant difference in sexual function between the two groups (MD = -1.41, 95% CI: -12.40 to 9.57, p = 0.80). DBS has demonstrated a certain degree of efficacy in ameliorating urinary storage and voiding function in patients with Parkinson's disease. However, certain urodynamic parameters or scores do not demonstrate any statistically significant disparities. Furthermore, DBS has no significant impact on erectile function in male Parkinson's patients. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023476661, identifier CRD42023476661.

Machine learning in female urinary incontinence: A scoping review.

The aim was to conduct a scoping review of the literature on the use of machine learning (ML) in female urinary incontinence (UI) over the last decade. A systematic search was performed among the Medline, Google Scholar, PubMed, and Web of Science databases using the following keywords: [Urinary incontinence] and [(Machine learning) or (Predict) or (Prediction model)]. Eligible studies were considered to have applied ML model to explore different management processes of female UI. Data analyzed included the field of application, type of ML, input variables, and results of model validation. A total of 798 papers were identified while 23 finally met the inclusion criteria. The vast majority of studies applied logistic regression to establish models (91.3%, 21/23). Most frequently ML was applied to predict postpartum UI (39.1%, 9/23), followed by de novo incontinence after pelvic floor surgery (34.8%, 8/23).There are also three papers using ML models to predict treatment outcomes and three papers using ML models to assist in diagnosis. Variables for modeling included demographic characteristics, clinical data, pelvic floor ultrasound, and urodynamic parameters. The area under receiver operating characteristic curve of these models fluctuated from 0.56 to 0.95, and only 11 studies reported sensitivity and specificity, with sensitivity ranging from 20% to 96.2% and specificity from 59.8% to 94.5%. Machine learning modeling demonstrated good predictive and diagnostic abilities in some aspects of female UI, showing its promising prospects in near future. However, the lack of standardization and transparency in the validation and evaluation of the models, and the insufficient external validation greatly diminished the applicability and reproducibility, thus a focus on filling this gap is strongly recommended for future research.

What clinical parameter strongly associates white matter tract alterations in a Multiple Sclerosis population with voiding dysfunction? A prospective exploratory study.

To correlate clinical and urodynamics parameters in Multiple Sclerosis patients (MS) presenting Lower Urinary Tract Symptoms (LUTS) with both Expanded Disability Status Scale (EDSS) and changes in white matter integrity as seen on Diffusion Tensor Images (DTI). LUTS worsen throughout MS, as does lesion burden. We investigated which symptoms correlated best with structural changes in white matter structure. Ten adult women >18 years were recruited with stable MS for ≥3 months and voiding dysfunction defined as %PVR/BV > 20%. Patients participated in a clinical Urodynamic Study (UDS) and completed several questionnaires (i.e., HAM, AUASS, NBS-QoL). DTI images were acquired using a 7-Tesla Siemens MAGNETOM Terra MRI scanner. DTI maps were constructed, and individual patients were co-registered with the ICBM-DTI-81 white matter atlas to extract fractional anisotropy (FA) and mean diffusivity (MD). Pearson's correlation test was performed between each WMT and clinical parameters and between clinical parameters and the EDSS score as well. P-values < 0.05 were considered significant. Of the clinical parameters, %PVR/BV obtained from the average of multiple un-instrumented uroflow assessments had significant correlations to the greatest number of WMTs. Furthermore, we observed that in all recorded clinical parameters, %PVR/BV was the only significant parameter correlated to the EDSS score. This study demonstrates that %PVR/BV can be used as an objective parameter to gauge WMT changes and disease progression in MS patients. Future studies are needed to refine this model.

Peripheral Sacral Magnetic Stimulation in Patients with Idiopathic Overactive Bladder: a Single Blind Prospective Randomized Comparative Clinical Study

INTRODUCTION. Overactive bladder (OAB) is a symptom complex that includes urgency, frequent urination, imperative urinary incontinence and nocturia. The idiopathic form of OAB is associated with dysfunction of sensory signal transmission at the level of the peripheral and central nervous system, which leads to bladder hypersensitivity. The low level of patients’ compliance to OAB drug therapy and the high level of refusal to take drugs emphasize the urgency of finding new effective methods of influencing the lower urinary tract. Magnetic stimulation (MS) is a non-drug treatment for lower urinary tract dysfunction.&#x0D; AIM. To study the efficacy and safety of the sacral MS method in women with idiopathic detrusor overactivity (DO) and OAB symptoms.&#x0D; MATERIALS AND METHODS. A single blind prospective randomized comparative study included 55 female patients with urodynamically confirmed idiopathic DO. The patients were divided by simple randomization into the main group (n = 29), which received MS 3 times a week for 5 weeks with a frequency of 5 Hz per sacral root area (S2–S4), and the placebo group (n = 26), in which sham stimulation was performed.&#x0D; RESULTS AND DISCUSSION. The study revealed that sacral MS is reliably effective against the clinical symptoms of OAB in idiopathic DO. The dynamics of clinical symptoms is confirmed by changes in urodynamic parameters. The effect of sacral MS significantly exceeds placebo. MS is a safe procedure and is well tolerated by patients.&#x0D; CONCLUSION. The sacral MS method, the effectiveness of which has been proven in comparison with placebo, is recommended to be included in the treatment regimen of patients with idiopathic OAB. The mechanism of action of sacral MS is associated with the activation of sympathetic and inhibition of parasympathetic influences, as well as changes in supraspinal control and cerebral activity.

Personalized Rehabilitation of Patients with Prostate Cancer after Radical Prostatectomy: a Comparative Analysis of Urodynamic Parameters

INTRODUCTION. Applying a personalized approach in the treatment of urinary incontinence in patients after RP can significantly improve the rates of correction of postoperative incontinence.&#x0D; AIM. To study the effect of personalized rehabilitation of patients with prostate cancer (PCa) after radical prostatectomy on the state of functional indicators of the lower urinary tract.&#x0D; MATERIALS AND METHODS. The study included 60 patients with verified primary resectable prostate cancer who underwent laparoscopic nerve-sparing prostatectomy. Patient ages ranged between 46 and 77 years (median 62.8 years). The patients were divided into main and control groups of 30 people each. The patients of the main group received rehabilitation using a personalized approach. The rehabilitation programs for the patients in the control group were formed on the basis of a syndromic-pathogenetic approach. Functional parameters of the lower urinary tract were assessed using a 24-hour pad test and a comprehensive urodynamic study before and after surgery, after a course of rehabilitation and 1 year after surgery.&#x0D; RESULTS. Assessment of the degree of urinary incontinence in patients with prostate cancer using a 24-hour pad test showed similar clinical pictures in both groups in the postoperative period in the form of mild or moderate disorders. After the rehabilitation course, a positive trend was observed, however, in the observation group, 66.7 % of patients completely retained urine, while in the comparison group only 40%. Similar trends were observed in a year after a surgical treatment. According to a comprehensive urodynamic study (CUDS), after rehabilitation in the observation group, 76.7 % of patients showed signs of restoration of detrusor activity to the preoperative level with retention of the effect a year after the intervention (p 0.05). A peak decrease in maximum detrusor pressure was observed in the postoperative period with a partial recovery of the indicator after rehabilitation and after 1 year in both groups. In the comparison group, a more pronounced decrease in detrusor pressure was observed, but the difference was statistically insignificant (p 0.05).&#x0D; DISCUSSION. This study tested a personalized approach in the rehabilitation of patients with urological oncology. This concept allows the use of physical and rehabilitation medicine technologies with maximum efficiency by identifying a specific patient model. The results of functional research methods (pad test, KUDI) are one of the potential determinants of the effectiveness of the use of rehabilitation technologies.&#x0D; CONCLUSION. The results of rehabilitation of patients in the group with a personalized approach can significantly improve the rates of correction of postoperative incontinence.

Multi-omic approaches provide insights into the molecular mechanisms of Sojae semen germinatum water extract against overactive bladder

Sojae semen germinatum (SSG) is derived from mature soybean seeds that have been germinated and dried, typically with sprouts measuring approximately 0.5 cm in length. SSG is traditionally known for its properties in clearing heat and moisture. Nevertheless, limited information was reported on the effects and mechanisms of SSG in alleviating urinary symptoms. This study employed urodynamic parameters to investigate the therapeutic effect of SSG water extract on overactive bladder (OAB) in the rat model with benign prostatic hyperplasia. Through a combination of transcriptomic and metabolomic analyses, the pathways and key proteins of the SSG treatment for OAB were identified and validated by ELISA and Western blotting. Furthermore, network pharmacology elucidated the roles of SSG’s isoflavones acting on the target which was identified by above-mentioned multi-omics analysis. Our results indicate that SSG water extract significantly mitigated OAB by down-regulating the PGE2/EP1/PLCβ2/p-MLC signaling pathway. It was speculated that the active ingredient in the SSG on EP1 was genistein. This study provided valuable insights into the molecular mechanisms of SSG water extract, emphasizing the multi-target characteristics and critical pathways in improving OAB. Furthermore, this study contributes to the potential utilization of SSG as a functional food.

The role of interferential current electrical stimulation in pediatric urology: A systematic review of randomized controlled trials.

In recent years, interferential current (IFC) electrical stimulation has been studied as a novel treatment for various lower urinary tract dysfunctions in children. As the findings of multiple studies may vary, we aimed to evaluate the current view on IFC in pediatric urology problems based on the findings of randomized clinical trials (RCTs). We performed a systematic search in the Embase, Medline, and SCOPUS databases in accordance with the latest Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies comprised studies evaluating IFC for lower urinary tract problems in children. The studies' quality was assessed using the Cochrane risk of bias (RoB) tool 2. A total of 125 articles were initially obtained, among which 40 articles were duplicates. There were six eligible RCTs with an overall low RoB. All subjects underwent 10-18 sessions of treatment. The outcomes measured consisted of the alleviation of symptoms and urodynamic parameters. The trials reported that 61-90% of patients responded positively to the treatment. Both IFC and transcutaneous electrical nerve stimulation generated improvements in the subjects. However, overall the IFC group showed better immediate and short-term improvement. IFC is a promising therapy for bladder dysfunction and enuresis in children. More comparative RCTs are required in the future to quantitatively determine the superiority of IFC to other alternatives. The safety aspects of the treatment should also be studied further before it can be used in a clinical setting as the standard and protocol for children are still unclear.

A Y-shape connection device for pediatric patients with an indwelling catheter (Dia = 8Fr) during urodynamic studies, especially for filling phase measurements: a single-center prospective study for safety and effectiveness.

This prospective study aimed to assess the effectiveness of a Y-shape connection device in reducing pain and bleeding in pediatric patients with indwelling catheters during urodynamic studies (UDS), while also obtaining effective results in the filling phase. A total of 45 pediatric patients with a mean age of 13 years were included, all of whom underwent both a UDS with the Y-shape connection device (Method A) and a standard UDS procedure (Method B). The Y-shape connection device demonstrated similar overall urodynamic parameters compared to the standard procedure, while also resulting in significantly less bleeding (P = 0.006) and lower VAS scores during (1.12 ± 0.58 vs. 3.88 ± 1.01, P = 0.001) and after (0.12 ± 0.08 vs 2.91 ± 0.89, P = 0.001) the procedure. No adverse events were reported at the 1-month follow-up. These findings suggest that the Y-shape connection device can effectively reduce pain and bleeding during and after UDS in pediatric patients with indwelling catheters (Dia = 8Fr), while also obtaining effective results in the filling phase. Therefore, this Y-shape connection device has a more significant value for children who require urodynamic studies and place more emphasis on filling phase parameters. ChiCTR2300068280.

Which parameters, related to the female urethra and pelvic floor, determine therapy selection for recurrent female stress urinary incontinence: ICI-RS 2023?

The evidence basis for therapy selection in women who have failed primary stress urinary incontinence (SUI) surgery is limited. The ICI-RS group discussed the available data at its meeting in June 2023, particularly the anatomical characteristics as assessed using magnetic resonance imaging (MRI) and ultrasound (US) modalities, functional characteristics associated with storage and voiding urodynamic assessment, as well as the patient characteristics that might influence outcomes. This paper summarizes the evidence base that supported these discussions and offers the basis for research proposals for future groups. A literature search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was performed, and the data is presented. Research questions are based on the knowledge gaps highlighted. Possible MRI parameters that may influence outcomes were striated urethral sphincter volume, bladder and proximal urethral funneling, pubo-urethral ligament integrity, distance of the bladder neck below the pubococcygeal line, posterior urethra-vesical angle, and bladder neck to levator ani distance. US parameters included sling distance to the urethral lumen and pubis, sling position, bladder neck mobility, and lateral arm asymmetry, twisting, or curling. Urodynamic parameters included detrusor overactivity, Valsalva leak point pressure, maximum urethral closure pressure, and bladder outlet obstruction. Important patient parameters included body mass index, age, and previous interventions. Identifying and quantifying causative factors in patients with recurrent SUI, that allow clinicians to modify subsequent treatment choices and techniques may help reduce treatment failure and complications. Formulating algorithms is the next step in optimizing patient counseling, surgical selection, and healthcare allocation.

Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI-RS 2023.

The postvoid residual (PVR) volume of urine in the bladder is widely used in clinical practice as a guide to initiate treatment, including clean-intermittent self-catheterization (CISC). It is often believed that an elevated PVR causes complications such as recurrent urinary tract infections (UTI) and renal failure. However, evidence for this is limited and identifying alternative measures to guide treatment decisions may optimize patient care. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2023 a Think Tank addressed the question of whether we can define the optimal PVR at which CISC should be recommended, and whether there are other measures that could guide a CISC protocol. The Think Tank conducted a literature review and expert consensus meeting focusing on current limitations in defining and measuring PVR, and highlighting other measures that may optimize selection for, and persistence with, CISC. There is no consensus on the threshold value of PVR that is considered "elevated"or "significant." There is a lack of standardization on terminology, and the normal range of PVR in different populations of different ages remains to be well-studied. The measurement of PVR is influenced by several factors, including intraindividual variation, timing and method of measurement. Furthermore, the evidence linking an elevated PVR with complications such as UTI and renal failure is mixed. Other measures, such as bladder voiding efficiency or urodynamic parameters, may be better at predicting such complications, and therefore may be more relevant at guiding a CISC protocol. There is a lack of high quality evidence to support PVR as a predictor for complications of UTI or renal failure. Threshold values for normal PVR in different populations are unknow, and so threshold values for "elevated"or "significant"PVR cannot be determined. Other factors, such as urodynamic findings, may be better at predicting complications and therefore guiding management decisions, and this remains to be studied. Areas for further research are proposed.

Relationship between MRI Findings and Urodynamic Parameters in Patients with Multiple Sclerosis: Prediction of Upper Urinary Tract Damage?

Lower urinary tract dysfunction is frequently observed in individuals with multiple sclerosis (MS), significantly impacting their quality of life and increasing the risk of upper urinary tract (UUT) damage. Magnetic resonance imaging (MRI) serves as the gold standard imaging technique for identifying demyelinating lesions and aiding in the clinical diagnosis of MS. However, despite its diagnostic utility, the precise relationship between MRI lesions and bladder dysfunction remains poorly established. We aimed to examine the correlation between MRI lesion localizations and both urodynamic parameters and risk factors for UUT damage. In this retrospective study, we conducted a comprehensive review of 201 patients diagnosed with MS who were referred for primary neurourological evaluation, including a videourodynamic study (VUDS). To explore potential significant relationships between the independent variable of MRI lesion localization and the dependent outcome variables, we conducted a multivariate analysis of variance (MANOVA) regression. A significant correlation was observed between the presence of a brainstem lesion and specific urodynamic parameters, including lower maximum cystometric bladder capacity and higher bladder compliance. Similarly, an increased number of diverse MRI lesion localizations demonstrated a significant correlation with these urodynamic parameters. In conclusion, MRI findings did not exhibit a significant association with urodynamic risk factors for UUT damage, thereby limiting their utility in stratifying MS patients for subsequent neurourological assessment and treatment.