Does sheath size matter: benchtop comparison of flow and pressure across variety of continuous flow endoscopes.

INTRODUCTION: Laser enucleation utilizes purpose-built endoscopes for laser stabilization and continuous flow. No evaluation has been done with respect to flow or intravesical pressure with these scopes. We sought to evaluate the effect different endoscopes and sheath sizes on irrigation outflow and intravesical pressure. METHODS: Using a benchtop model using a silicone bladder model, five outer/inner sheath combinations were assessed: Storz 28/26Fr, Storz 26/26Fr, Wolf 26/24Fr, Wolf 26/22Fr, and Wolf 24/22Fr. A urodynamics pressure transducer was inserted alongside the scope for bladder pressure measurement and outflow from scope to drain was measured using uroflowmetry device. Four 1-minute trials were recorded for each sheath and the steady state flow and pressure was recorded. RESULTS: The Storz 28 F outer sheath and 26 F inner sheath had the highest outflow (12.4 ± 0.5 mL/s, p < 0.01). The Wolf 24 F outer and 22 F inner had the lowest outflow (7.0 ± 0.0 mL/s, p < 0.01). The steady state bladder pressure was the lowest in the Storz 28/26 (1.5 ± 1.7 cm H2O, p < 0.01)) and the greatest in the Storz 26/26 (24.2 ± 1.9 cm H2O, p < 0.01). CONCLUSION: The Storz 28/26 combination had best outflow rate and lowest intravesical pressures in our benchtop study. Flow rates generally decreased with smaller sheath sizes and steady state bladder pressures increased as the difference between the outflow and inflow sheath size narrowed. These findings provide initial parameters that could guide sheath selection in future to optimize visualization and success of voiding trials.

Clinical features and sequelae of detrusor underactivity: a study of possible cause and effect.

PURPOSE: To describe the clinical presentation and urodynamic findings in detrusor underactivity (DU) patients and investigate the association between DU and straining related complications such as pelvic organ prolapse (POP), inguinal hernia, and hemorrhoids. METHODS: We retrospectively reviewed all consecutive patients who underwent urodynamic studies (UDS) from 2012 to 2023, divided into two groups: those with evidence of DU (n = 573), and control subjects with normal voiding parameters (n = 522). Exclusion criteria were patients who lacked sufficient data, those with obstructive voiding parameters, and those who had received intravesical botulinum toxin injections within the previous nine months. Demographic information, clinical presentation, straining related complications, and UDS findings were compared between the two groups using univariate statistical analysis. RESULTS: The male DU group had a statistically significant higher prevalence of spinal disease and previous cerebrovascular accidents, while the female DU group had a statistically significant higher prevalence of spinal disease, multiple sclerosis, diabetes, previous colorectal surgery, previous transabdominal gynecological surgery, POP surgery, and recurrent UTIs. Female DU patients had a higher prevalence of pronounced vaginal bulging symptoms, recurrent POP, inguinal hernia, and hemorrhoids. The predominant LUTS were voiding symptoms (81.2% in males and 77.9% in females), followed closely by storage symptoms (66.2% in males and 74.7% in females). The median Qmax, PdetQmax, and PVR were 6 ml/sec, 18 cmH2O, 190 ml for male DU patients, and 8 ml/sec, 11 cmH2O, and 200 ml for female DU patients, respectively. CONCLUSION: Risk factors for DU that were identified include age, neurological diseases (spinal disease, CVA in men, MS in women), diabetes and transabdominal surgery (colorectal, gynecological) that can cause pelvic denervation in women. DU patients commonly present with both voiding and storage symptoms. There is approximately twice the risk of having POP surgery and inguinal hernia, an eight-fold risk of hemorrhoids, and a three-fold risk of recurrent UTIs for females. This is thought to be secondary to increased intra-abdominal pressure during urinary straining.

Uroflowmetry: nomograms in healthy young Pakistani men.

OBJECTIVE: To create a nomogram based on urine volume and flow of males without lower urinary tract symptoms. METHODS: The prospective, cross-sectional study was conducted at the Department of Urological Surgery and Transplantation, Jinnah Postgraduate Medical Centre, Karachi, from November 1, 2020, to October 31, 2022, and comprised healthy young males without lower urinary tract dysfunction who were recruited from the hospital as well as a large textile mill. They were asked to void on their normal desire. Uroflowmetry was done to determine maximum flow rate, average flow rate, and void volume values. A best-fit regression model was used to formulate uroflowmetry nomogram using average and maximum urine flow rate over voided volume. The sample size was calculated using PASS 2020 Power Analysis and Sample Size Software (2020). NCSS, LLC. Kaysville, Utah, USA. The database was developed on NCSS 2020 Statistical Software (2020). NCSS, LLC. Kaysville, Utah, USA for the data analysis. RESULTS: Of the 468 male subjects enrolled, data was analysed related to 432(92.3%). The mean age was 25.59±4.32 years. Mean maximum flow rate, average flow rate and void volume were 25.28±8.70mL/s, 14.77±4.79mL/s and 405.48±163.86mL, respectively. The association of age was noted with maximum flow rate (r=0.1435, p=0.004), average flow rate (r=0.1135, p=0.004) and void volume (r=0.0619, p=0.004). The best-fitted model for maximum and average flow rate was subsequently developed which was statistically significant (p<0.05). CONCLUSIONS: The nomograms developed could reliably predict the maximal flow rate in young Pakistani men.

A New Rat Model of Sacral Cord Injury Producing a Neurogenic Bladder and Its Functional and Mechanistic Studies.

Sacral spinal cord injury (SSCI) can disrupt bladder neuromodulation and impair detrusor function. Current studies provide limited information on the histologic and genetic changes associated with SSCI-related neurogenic lower urinary tract dysfunction (NLUTD), resulting in few treatment options. This study aimed to establish a simple animal model of SSCI to better understand the disease progression. Ninety 8-week-old Sprague-Dawley (SD) rats were randomly separated into sham operation and SSCI groups. The SSCI group underwent sacral spinal cord injury, while the sham group did not. Urodynamic and histological assessments were conducted at various intervals (1, 2, 3, 4, and 6 weeks) post-injury to elucidate the disease process. Urodynamic examinations revealed significant bladder dysfunction in the SSCI group compared to the sham group, stabilizing around 3-4 weeks post-injury. Histological examination, including hematoxylin-eosin and Masson's trichrome staining, correlated these functional changes with bladder microstructural alterations. RNA-seq was performed on bladder tissues from the sham group and SSCI group at 6 weeks to identify differentially expressed genes and pathways. Selected genes were further analyzed using polymerase chain reaction (PCR). The findings indicated a pronounced inflammatory response in the first 2 weeks post-SSCI, progressing to bladder fibrosis at 3-4 weeks. In conclusion, this study presents a reliable, reproducible, and straightforward SSCI model, providing insights into bladder functional and morphological alterations post-SSCI and laying the groundwork for future therapeutic research.

Using Urine Biomarkers to Differentiate Bladder Dysfunctions in Women with Sensory Bladder Disorders.

Sensory bladder disorders encompass several distinct conditions with overlapping symptoms, which pose diagnostic challenges. This study aimed to evaluate urine biomarkers for differentiating between various sensory bladder disorders, including non-Hunner's interstitial cystitis (NHIC), detrusor overactivity (DO), hypersensitive bladder (HSB), and urodynamically normal women. A retrospective analysis of 191 women who underwent a videourodynamic study (VUDS) was conducted, with some also receiving cystoscopic hydrodistention to confirm the presence of NHIC. Participants were categorized into four groups: DO (n = 51), HSB (n = 29), NHIC (n = 81), and normal controls (n = 30). The urine levels of inflammatory and oxidative stress biomarkers were measured. The DO patients exhibited elevated IP-10 levels, while the HSB patients had decreased TAC and 8-OHdG levels. The NHIC patients showed lower IL-2 and higher TNF-α levels. A TNF-α ≥ 1.05 effectively identified NHIC, with an AUROC of 0.889, a sensitivity of 98.8%, and a specificity of 81.3%. An IP-10 ≥ 6.31 differentiated DO with an AUROC of 0.695, a sensitivity of 56.8%, and a specificity of 72.3%. An 8-OHdG ≤ 14.705 and a TAC ≤ 528.7 identified HSB with AUROCs of 0.754 and 0.844, respectively. The combination of 8-OHdG and TAC provided an AUROC of 0.853 for HSB. These findings suggest that TNF-α, IP-10, TAC, 8-OHdG, and IL-2 are promising non-invasive biomarkers for distinguishing between these conditions, which may improve diagnosis and management.

Clinical Efficacy of Electroacupuncture at Sacral Four Points Combined with Moxibustion at Abdominal Three Points for Treating Post-Stroke Urinary Incontinence: Observations on Urodynamics, Quality of Life, and Safety.

BACKGROUND: Urinary incontinence is a common complication following a stroke. No specific drugs are available in Western medicine, and surgical treatment is highly traumatic, limiting its clinical application. This study aimed to observe the clinical efficacy of electroacupuncture at the "Sacral Four Points" combined with moxibustion at the "Abdominal Three Points" on post-stroke urinary incontinence, exploring its impact on urodynamics and quality of life. METHODS: Patients with post-stroke urinary incontinence treated at our Hospital from January 2021 to December 2023 were recruited. The study included 117 patients: 57 in the electroacupuncture group and 60 in the combined group. Urodynamic parameters were measured, and scores from the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Incontinence Quality of Life Questionnaire (I-QOL) were recorded before, and after the first and third courses of treatment. Clinical efficacy and adverse reactions were evaluated post-treatment. RESULTS: The study found no significant differences in clinical characteristics between the groups (p > 0.05), providing a baseline for comparison. Both groups showed substantial decreases in leakage volume after one course of treatment (p < 0.05), with a reduction in the ICIQ-UI SF score (p < 0.05) and an increase in the I-QOL score (p < 0.05). After three courses of treatment, the leakage volume of patients in both groups significantly decreased (p < 0.05), the ICIQ-UI SF score decreased (p < 0.05), and the I-QOL score increased (p < 0.05). The combined group showed a lower leakage volume compared to the electroacupuncture group (p < 0.05), with lower ICIQ-UI SF scores (p = 0.027) and higher I-QOL scores (p = 0.048). Importantly, the total effective rate was significantly higher in the combined group (88.33% vs 64.91%, p = 0.037), demonstrating the safety and efficacy of the treatment. CONCLUSIONS: Electroacupuncture at the "Sacral Four Points" combined with moxibustion at the "Abdominal Three Points" improves the clinical symptoms and enhances the quality of life for patients with post-stroke urinary incontinence, showing superior results compared to electroacupuncture alone.

Nocturia and obstructive sleep apnea in spinal cord injured patients - a cohort study.

PURPOSE: To describe the prevalence of nocturia and obstructive sleep apnea (OSA) in a cohort of spinal cord injury (SCI) patients and to describe their association. Additionally, to assess clinical and urodynamic data explaining nocturia and to evaluate the effect of OSA management with continuous positive airway pressure (CPAP). METHOD: Retrospective analysis of data from patients with SCI followed in a tertiary care rehabilitation center with a specialized sleep and neuro-urology units. All adult SCI patients who underwent urodynamic assessment before polysomnography (PSG) between 2015 and 2023 were eligible. Subjective (nocturia) and objective data (urodynamic data, polysomnography, CPAP built-in software) were collated from the Handisom database (database register no. 20200224113128) and the medical records of SCI patients. Statistical testing used Mann-Whitney test for non-parametric variables, Fisher's exact test for contingency analysis and the Spearman correlation test to assess correlations. A p-value < 0.05 was considered significant. Statistical analyses were performed using GraphPad Prism v9. RESULTS: 173 patients (131 males, 42 females) were included. The majority of patients were paraplegic (n = 111 (64,2%)) and had complete lesions (n = 75 (43,4%)). A total of 100 patients had nocturia (57,5%). The prevalence of OSA (Apnea Hypopnea Index (AHI) ≥ 15/h) in the studied population was 61,9%. No correlation was found between nocturia and OSA. A significant difference was observed between patients with and without nocturia in terms of the presence of neurogenic detrusor overactivity (p = 0,049), volume at the first detrusor contraction (p = 0,004) and the bladder functional capacity (p < 0,001). CONCLUSION: Nocturia and OSA are highly prevalent in patients with SCI, but no statistical association was found between these two disorders. A prospective study focusing on nocturnal polyuria will be needed to assess the impact of OSA on lower urinary tract symptoms in SCI patients.

A comparative study between EMG uroflowmetry with and without a catheter in children.

OBJECTIVES: To evaluate the effect of urethral catheterization on the accuracy of EMG uroflowmetry in children with non-neurogenic voiding disorders during pressure-flow (PF) studies compared to the non-invasive EMG uroflowmetry test. METHODS: A retrospective study of children undergoing a urodynamic evaluation at our institution between 8/2018 and 7/2022 was employed. Urination curves and pelvic floor muscle activity were compared between PF studies and non-invasive EMG uroflowmetry test. The non-invasive test was selected as the standard benchmark. RESULTS: 104 children were tested, with 34 children (33%) being able to urinate only in a non-invasive EMG uroflowmetry. The percentage of boys unable to urinate with a catheter was significantly higher than girls (54% vs. 13%, p-value < 0.001). In 70 children, a normal bell-shaped urination curve was found in 13 compared to 33 children in the PF studies and non-invasive uroflowmetry, respectively. PF studies demonstrated a specificity of 39% (95% CI 23-57) and a positive predictive value (PPV) of 61% (95% CI 53-67) in finding non-bell-shaped curves. Relaxation of pelvic muscles was found in 21 (30%) as opposed to 39 (55%) of children in invasive and non-invasive EMG uroflowmetry, respectively (p-value = 0.5). CONCLUSION: The accuracy of PF studies in children, primarily in boys, compared to the non-invasive uroflowmetry, was poor. This may pose potential errors in diagnosis and subsequent treatment. We recommend completing a non-invasive EMG uroflowmetry in cases where the child refused to urinate, or pathology was found, requiring a modification in treatment.

Prevalence and risk factors for overactive bladder symptoms in patients with artificial urinary sphincter.

To demonstrate the prevalence and risk factors for overactive bladder symptoms associated with artificial urinary sphincter implantation, we investigated the patients who underwent primary artificial urinary sphincter implantation with severe urinary stress incontinence. Forty-eight patients who completely answered the questionnaires of the overactive bladder symptom score before surgery were included. Patient characteristics, urinary status at pre and 1, 3, 6, and 12 months post-device activation, and predictive factors for overactive bladder symptoms were examined. Sixty percent of the patients had preoperative overactive bladder symptoms. Until 12 months after device activation, 35-40% of all patients had overactive bladder symptoms. The rate of persistent and de novo postoperative overactive bladder symptoms was 44.8% and 26.3%, respectively. Daily pad use was not different between patients w/wo overactive bladder symptoms. The only risk factor for postoperative overactive bladder symptoms was a max cystometoric capacity < 200 mL measured by a preoperative urodynamic study. Attention must be given to both persistent and de novo overactive bladder symptoms associated with artificial urinary sphincter implantation for patients with stress incontinence. Counsel should equally be provided for preoperative overactive bladder symptoms, especially in cases with a cystometric capacity < 200 mL.

Comparative analysis of surgical prognostic between HIC and NHIC patients after cystoscopy with hydrodistention.

This study aims to clarify the pathogenic mechanism of interstitial cystitis (IC), which has led to uncertainty in its diagnosis and treatment. We examined data from 18 interstitial cystitis with Hunner lesions (HIC) and 18 interstitial cystitis without Hunner lesions (NHIC) patients, including their clinical information, urodynamic test results, and maximum bladder capacity. A 1-year follow-up tracked disease progression. Postoperative recovery showed that HIC patients experienced significantly greater improvements in Visual Analog Scale pain scores compared to NHIC patients (P = .0049). This trend continued at the 6-month mark (P = .0056). Over the 1-year follow-up, NHIC patients exhibited a statistically significant improvement in Pain and Urgency/Frequency scores, while HIC patients had a gradual overall score increase from preoperative to postoperative stages. However, no significant differences were observed in either group at 1 year postoperatively compared to preoperative scores. This study revealed distinct differences between HIC and NHIC patients, including reduced bladder volumes and more severe nociceptive pain in HIC patients. Early analgesic interventions effectively alleviated discomfort in HIC patients. The combination of cystoscopic hydrodistention and water dilatation was highly effective in relieving pain symptoms in HIC patients but increased the risk of recurrence, necessitating recurrent bladder infusion and timely therapeutic adjustments. In contradiction to prior paradigms, the surgical intervention of cystoscopic water hydrodistention also yielded favorable outcomes among NHIC patients.

Single incision mini sling for the treatment of urodynamic stress incontinence: Surgical outcomes and preoperative predictors of failure.

OBJECTIVE: To evaluate the surgical outcomes and predictors of failure of Single Incision Mini Sling (Ophira) in women with urodynamic stress incontinence. MATERIALS AND METHODS: Records of 115 women underwent anti-incontinence procedure using Ophira Mini Sling from June 2019 to September 2020 reviewed. Subjective evaluation was assessed using validated IIQ-7, UDI-6, POPDI-6 and PISQ-12 questionnaires. Multichannel urodynamics, 1-h pad test and 72-h voiding diary was performed as objective evaluation. Primary outcome was the objective cure rate of negative urine leak on provocative filling cystometry and 1-h pad test weight <2 g, and subjective cure rate was negative response to question 3 of UDI-6. Secondary outcome was to identify risk factors associated with failure for Ophira. RESULTS: Total of 108 women were evaluated. The objective cure rate was 91.7% with subjective cure rate of 86.1%. Comparison of clinical outcome shows significant improvement of USI post-operatively (p < 0.001) and reflected in 1-h pad test (p < 0.001). Improvement in all subjective evaluation parameters is seen except for POPDI-6. Failure of Ophira correlate significantly in women age >66 years, presence of asthma, pre-operative Intrinsic Sphincter Deficiency (ISD), and Maximum Urethral Closure Pressure (MUCP) value < 40 cmH20. CONCLUSION: Ophira Single Incision Mini Sling is safe and effective treatment option for USI, showing high objective and subjective cure rates with low incidence of complications. Non-modifiable risks of age ≥66 years, asthma status, pre-operative intrinsic sphincteric deficiency and low maximal urethral closure pressure were the factors of failure for Ophira.

What maximal urethral closure pressure threshold predicts failure of mid-urethral sling surgery?

OBJECTIVE: Low Maximal Urethral Closure Pressure (MUCP) is linked to unfavourable outcome of anti-incontinence surgery, however the cut-off value varied within studies. This study aimed to predict the cut-off value of MUCP that contributes to poor outcome of Mid-Urethral Sling (MUS) surgery in Urinary Stress Incontinence (USI) patients. MATERIALS AND METHODS: Records of 729 women underwent MUS procedure from January 2004 to April 2017 reviewed. Patients were divided into four MUCP groups, which were <20 cmH2O (≥20 and < 40) cmH2O (≥40 and ≤ 60) cmH2O and >60 cmH2O. Objective evaluation comprising 72-h voiding diary, multichannel urodynamic study (UDS) and post-operative bladder neck angle measurement. Subjective evaluation through validated urinary symptoms questionnaires. Primary outcome was objective cure rate of negative urine leak on provocative filling cystometry and 1-h pad test weight <2 g, and subjective cure rate was negative response to question 3 of UDI-6. Secondary outcome was identifying risk factors of cure failure for MUS in low MUCP groups. To identify the risk factors of cure failure, MUCP groups were narrowed down into <40 cmH2O or ≥40 cmH2O. RESULTS: Total of 688 women evaluated. Overall objective cure rate was 88.2% with subjective cure rate of 85.9%. Objective and subjective cure rates were lower in groups with low MUCP <40 cmH2O. Failure of MUS correlate significantly in patients with low MUCP <40 cmH20, bladder neck angle <30° and Functional urethral length (FUL) < 2 cm. CONCLUSION: Women with MUCP <40cmH2O, bladder neck angle <30° and FUL < 2 cm are more likely to have unfavorable outcome following MUS surgery. We proposed the cut-off low MUCP <40cmH2O as predictor for fail MUS surgery in SUI patients.

Predictive Factors for the Successful Outcome of Urethral Sphincter Injections of Botulinum Toxin A for Non-Neurogenic Dysfunctional Voiding in Women.

PURPOSE: Dysfunctional voiding (DV) is not uncommon in women with non-neurogenic voiding dysfunction. Because of its unknown pathophysiology, effective and durable treatment is lacking. This study aimed to analyze the results of treatment and predictive factors for a successful outcome of botulinum toxin A (BoNT-A) treatment in female patients with DV. METHODS: In total, 66 women with DV confirmed by a videourodynamic study (VUDS) were treated with a BoNT-A injection into the urethral sphincter once (n = 33) or several times (n = 33). VUDS was performed before (baseline) and after the BoNT-A treatment. Patients with a global response assessment of the voiding condition of 2 or 3 and a voiding efficiency (VE) of >20% than baseline were considered to have a successful outcome. The baseline demographics, VUDS parameters, and VUDS DV subtypes were compared between the successful and failed groups. Predictive factors for a successful outcome were investigated by logistic regression analyses. RESULTS: Successful and failed outcomes were achieved in 27 (40.9%) and 39 (59.1%) women, respectively. After BoNT-A injections, the maximum flow rate (Qmax), voided volume, and VE all significantly increased, and the postvoid residual (PVR) was slightly improved. No significant difference in the number of injections and medical comorbidity was found between the groups. However, the successful group had a higher incidence of previous pelvic surgery. No significant difference in the treatment outcome was found among patients with different urethral obstruction sites. Significant improvements in Qmax, voided volume, PVR, VE, and the bladder outlet obstruction (BOO) index were noted in the successful group. A lower VE at baseline and a history of surgery were identified as predictive factors for a successful outcome of BoNT-A injections for treating DV. CONCLUSION: BoNT-A injections into the urethral sphincter can effectively improve VE in 40.9% of women with DV. Women with higher BOO grades and previous pelvic surgery are predicted to have a successful treatment outcome.

Urinary dysfunction after spinal cord injury: Comparing outcomes after thoracic spinal transection and contusion in the rat.

Spinal cord injury (SCI) above the lumbosacral spinal cord induces loss of voluntary control over micturition. Spinal cord transection (SCT) was the gold standard method to reproduce SCI in rodents, but its translational value is arguable and other experimental SCI methods need to be better investigated, including spinal cord contusion (SCC). At present, it is not fully investigated if urinary impairments arising after transection and contusion are comparable. To explore this, we studied bladder-reflex activity and lower urinary tract (LUT) and spinal cord innervation after SCT and different severities of SCC. Severe-contusion animals presented a longer spinal shock period and the tendency for higher residual volumes, followed by SCT and mild-contusion animals. Urodynamics showed that SCT animals presented higher basal and peak bladder pressures. Immunostaining against growth-associated protein-43 (GAP43) and calcitonin gene-related peptide (CGRP) at the lumbosacral spinal cord demonstrated that afferent sprouting is dependent on the injury model, reflecting the severity of the lesion, with a higher expression in SCT animals. In LUT organs, the expression of GAP43, CGRP cholinergic (vesicular acetylcholine transporter (VAChT)) and noradrenergic (tyrosine hydroxylase (TH)) markers was reduced after SCI in the LUT and lumbosacral cord, but only the lumbosacral expression of VAChT was dependent on the injury model. Overall, our findings demonstrate that changes in LUT innervation and function after contusion and transection are similar but result from distinct neuroplastic processes at the lumbosacral spinal cord. This may impact the development of new therapeutic options for urinary impairment arising after spinal cord insult.

Do peri-operative changes in voiding function and pelvic organ mobility predict improvement in urgency urinary incontinence following prolapse surgery?

OBJECTIVES: To evaluate whether peri-operative changes in voiding function, pelvic organ descent and urethral mobility predict improvement in urgency urinary incontinence (UUI) following prolapse surgery. METHODS: A retrospective study of women undergoing prolapse surgery without a history of or without a concomitant anti-incontinence surgery at a tertiary unit between 2005 and 2019. All patients underwent a pre- and post-operative standardised interview, POP-Q examination, uroflowmetry and 4D translabial ultrasound. Post processing of ultrasound volume data was performed to assess pelvic organ descent and functional urethral anatomy. RESULTS: The datasets of 123 women were analysed. Mean follow-up was 5.5 months (SD 3.2). Mean age was 61 years (SD 11.7). UUI was reported by 68 before and 44 after operation (p = 0.001 for the reduction). Among those with pre-operative UUI, 34 reported cure of UUI, 20 improvement, 9 no change and 5 worsened UUI after their operation. De novo UUI was reported in 11. Fifty-seven women reported voiding dysfunction before and 32 after operation (p = 0.09 for the reduction). Abnormal uroflowmetry was noted in 63 women before and 37 after operation (p = 0.003 for change). On binary logistic regression, improved/cured UUI was associated with improved subjective voiding function (p = 0.003) and reduced residual urine volume (p = 0.02), but not with peri-operative changes in pelvic organ descent or functional urethral anatomy. CONCLUSION: Prolapse surgery resulted in short- to medium- term improvement in UUI. This was associated with subjective improvement in voiding function and with a reduction in post-void residual urine volume. SUMMARY: Prolapse surgery was associated with improvement in UUI which in turn was associated with subjectively improved voiding and reduced residual urine volume.

Bridging present and future: A narrative review and visionary outlook on innovative solutions for the diagnosis and treatment of urinary incontinence.

Urinary incontinence, characterized by the involuntary leakage of urine, significantly impacts millions globally, affecting their quality of life, social interactions, and psychological well-being. Traditional diagnostic methods and treatments often fall short, especially for refractory urinary incontinence, due to their invasive nature and limited scope for continuous, real-time assessment. This narrative review critically examines current approaches to diagnosing and managing urinary incontinence, highlights significant gaps in practice, and underscores the urgent need for innovative solutions. We explore the evolution of diagnostic and treatment modalities and introduce a preliminary method involving a conceptual catheter device that promises to shift toward non-invasive, real-time monitoring and management. This review synthesizes prevailing research and provides a visionary outlook on how emerging technologies could revolutionize urinary incontinence care, offering a future of personalized, patient-centered strategies. Our discussion extends to the limitations of conventional urodynamic studies, which are often uncomfortable and fail to capture the dynamic nature of urinary incontinence in everyday settings. The proposed preliminary method features an advanced, smart-device solution integrating sensors and artificial intelligence to offer precise, real-time insights into bladder activity. This device, still in the conceptual stages, has the potential to transform the landscape of urinary incontinence management by enhancing diagnostic accuracy and therapeutic efficacy. By bridging the gap between current limitations and future possibilities, this paper aims to inspire ongoing innovation and research in the field of urogynecology.

A randomized controlled trial of low-frequency repeated transcranial magnetic stimulation in patients with poststroke neurogenic bladder.

Urinary incontinence is a common complication in stroke survivors for whom new interventions are needed. This study investigated the therapeutic effect of low-frequency (LF) repeated transcranial magnetic stimulation (rTMS) on the contralesional primary motor cortex (M1) in patients with poststroke urinary incontinence (PSI). A total of 100 patients were randomly assigned to the rTMS group or sham-rTMS group on basis of the intervention they received. Both groups underwent five treatment sessions per week for 4 weeks. Data from the urodynamic examination were used as the primary outcome. The secondary outcome measures were questionnaires and pelvic floor surface electromyography. After 4 weeks of intervention, the maximum cystometric capacity (MCC), maximum detrusor pressure (Pdet.max), residual urine output, overactive bladder score (OABSS) (including frequency, urgency, and urgency urinary incontinence), and the ICIQ-UI SF improved significantly in the rTMS group compared with those in the sham-rTMS group (P < 0.05). However, no changes in pelvic floor muscle EMG were detected in patients with PSI (both P > 0.05). Our data confirmed that 4 weeks of LF-rTMS stimulation on the contralateral M1 positively affects poststroke urinary incontinence in several aspects, such as frequency, urgency urinary incontinence, MCC, end-filling Pdet, OABSS, and ICIQ-UI SF scores.

Optimization of activity-driven event detection for long-term ambulatory urodynamics.

Lower urinary tract dysfunction (LUTD) is a debilitating condition that affects millions of individuals worldwide, greatly diminishing their quality of life. The use of wireless, catheter-free implantable devices for long-term ambulatory bladder monitoring, combined with a single-sensor system capable of detecting various bladder events, has the potential to significantly enhance the diagnosis and treatment of LUTD. However, these systems produce large amounts of bladder data that may contain physiological noise in the pressure signals caused by motion artifacts and sudden movements, such as coughing or laughing, potentially leading to false positives during bladder event classification and inaccurate diagnosis/treatment. Integration of activity recognition (AR) can improve classification accuracy, provide context regarding patient activity, and detect motion artifacts by identifying contractions that may result from patient movement. This work investigates the utility of including data from inertial measurement units (IMUs) in the classification pipeline, and considers various digital signal processing (DSP) and machine learning (ML) techniques for optimization and activity classification. In a case study, we analyze simultaneous bladder pressure and IMU data collected from an ambulating female Yucatan minipig. We identified 10 important, yet relatively inexpensive to compute signal features, with which we achieve an average 91.5% activity classification accuracy. Moreover, when classified activities are included in the bladder event analysis pipeline, we observe an improvement in classification accuracy, from 81% to 89.0%. These results suggest that certain IMU features can improve bladder event classification accuracy with low computational overhead.Clinical Relevance: This work establishes that activity recognition may be used in conjunction with single-channel bladder event detection systems to distinguish between contractions and motion artifacts for reducing the incorrect classification of bladder events. This is relevant for emerging sensors that measure intravesical pressure alone or for data analysis of bladder pressure in ambulatory subjects that contain significant abdominal pressure artifacts.

Onset of Spontaneous Filling and Voiding Cycles in the Lower Urinary Tract: A Modeling Study.

Spontaneous filling and voiding cycles represent a key dynamical feature of the healthy lower urinary tract. Some urinary tract dysfunctions, such as over-flow incontinence, may alter the natural occurrence of these cycles. As the function of the lower urinary tract arises from the interplay of a multitude of factors, it is difficult to determine which of them can be modulated to regain spontaneous cycles. In this study, we develop a mathematical model of the lower urinary tract that can capture filling and voiding cycles in the form of periodic solutions of a system of ordinary differential equations. After experimental validation, we utilize this model to study the effect that several physiological quantities have on the onset of cycles. We find that some parameters have an associated numerical threshold that determines whether the system exhibits healthy cycles or settles in a state of constant overflow.

Validation of the area under the Watts factor curve during the voiding cycle as a novel parameter for diagnosing detrusor underactivity in females.

OBJECTIVE: Detrusor underactivity (DU) is a common cause of lower urinary tract symptoms (LUTS). To date, no consensus has been reached on the urodynamic criteria for defining DU. We previously proposed the area under the curve of the Watts factor (WF-AUC) as a new parameter for diagnosing DU. By comparing previously reported five criteria for DU and WF-AUC, we analyzed whether the WF-AUC could assess detrusor contraction in women with LUTS. METHODS: Using urodynamic data of consecutive 77 women with LUTS, first, we classified DU based on previously reported five criteria. Second, we assessed the potential correlation between multiple parameters and WF-AUC. Third, receiver operating characteristic curve analysis was performed to determine the cutoff value of WF-AUC for diagnosing DU based on previously reported five criteria. Fourth, a linear regression analysis was conducted and compared using multiple criteria and female bladder outlet obstruction index (BOOIf). RESULTS: WF-AUC was positively correlated with the maximum values of WF, bladder contractility index (BCI), and projected isovolumetric pressure 1 (PIP1) with correlation coefficients of 0.63, 0.57, and 0.34, respectively. AUC for diagnosing DU based on previously reported five criteria ranging from 0.773 to 0.896 with different cutoff values of AUC-WF. The Spearman's correlation test revealed that BOOIf was significantly correlated with BCI, but not Wmax, PIP1 and WF-AUC. CONCLUSIONS: This study demonstrated the non-inferiority of the WF-AUC compared to previously reported criteria for defining DU. Depending on the cutoff value, the WF-AUC could appropriately evaluate women with DU, regardless of the presence of BOO.