Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction

The added value of home-uroflowmetry; Analysing an individuals' VV-Qmax curve and inflection point

OBJECTIVES

To analyse individual VV-Qmax plots based on multiple home uroflowmetries and compare these with cross-sectional nomograms.

METHODS

Healthy volunteers (16-69 years) without LUTS were asked to take a Minze HomeflowTM device home to register 25 uroflows. Participants reporting urinary tract disorders, malignancy or medication affecting bladder function were excluded. Dysfunctional voiding curves or participants with less than 15 acceptable flows were also excluded. For each individual, a VV-Qmax scatterplot was visually evaluated and a segmented regression was performed to determine the volume at which inflection occurred.

RESULTS

145 participants were enrolled. 38 were excluded based on medical history or LUTS, another 3 because the minimum amount of acceptable flows was not reached. This resulted in 104 participants (40M/64F) and 2498 acceptable uroflows with intra-individual differences based on voided volume, urge and time of the day. Individual VV-Qmax plots derived from multiple measurements do not align with the published nomograms based on cross-sectional data. The VV-Qmax curve for an individual demonstrates that Qmax increases with rising voided volumes up to a specific transitional voided volume (VVtrans) of 253ml (in men) and 214ml (in women), after which Qmax remains stable despite further increases in voided volumes.

CONCLUSION

A single uroflowmetry is insufficient to represents an individuals' voiding pattern. An individuals' VV- Qmax curve may give a better picture and can identify a new parameter, VVtrans, which might be a reflection of a patient's bladder function and urethra patency. Further evaluation and application in clinical LUTS scenarios are needed.

A First-In-Human Feasibility Study of a New Implantable Tibial Nerve Stimulator for Overactive Bladder Syndrome

OBJECTIVES

This study aimed to evaluate the preliminary feasibility and safety of a new implantable tibial nerve stimulator device in patients with overactive bladder (OAB).

MATERIALS AND METHODS

Ten patients with OAB in whom conservative treatments had failed participated in the study. All patients received daily stimulation therapy for two weeks and weekly stimulation therapy for 13 weeks, at the lowest electrical output amplitude at which paresthesia or motor response occurred. OAB symptoms (three-day bladder diary), quality-of-life scores (OAB-questionnaire Short Form), and patient global response (GRA) were assessed at each follow-up visit.

RESULTS

Among the patients enrolled (mean age 68 years), seven were OAB-wet and three OAB-dry. After 13 weeks of therapy delivery, a reduction in the number of daily voids during waking hours (8.5 ± 2.5 to 6.3 ± 1.9; p = 0.016), incontinence episodes (2.5 ± 1.8 to 0.3 ± 0.5; p < 0.001), and the daily voids associated with urgency (7.6 ± 3.1 to 3.0 ± 3.1; p < 0.001) was reported. Eight of the ten subjects were classified as responders for ≥one OAB component, with one patient reporting worsened symptoms of urgency (+6%). All ten patients reported global improvement in symptoms on the GRA with a median score of 6. Improvements in OAB severity and health-related quality-of-life scores were noted from pre- to posttreatment across participants (p < 0.001). No serious adverse effects were noted.

CONCLUSION

This first-in-human pilot study allowed for capture of preliminary safety and effectiveness information on a new implantable tibial nerve stimulator device in the population of interest to adequately power a larger, pivotal randomized study.

CLINICAL TRIAL REGISTRATION

The Clinicaltrials.gov registration number for the study is NCT04115228.

Antimuscarinics or β3 Adrenoreceptor Agonists: Which Should Be the First Step?

Antimuscarinics are historically considered the cornerstone for pharmacological treatment of overactive bladder syndrome (OAB). The more recent introduction of β3 adrenoreceptor agonists has increased the range of therapeutic possibilities, but it is still not possible to determine a priori which drug class should be used first. Considering the comparable effectiveness in terms of symptom improvement, the choice should take into account the different tolerability profile of these drugs according to the patient's clinical features (age, neurologic disease and comorbidities, and risk factors for adverse events). In the absence of specific characteristics that guide the choice towards one of these drug classes, shared decision-making with the patient that takes into account their personal values, preferences, and expectations should be undertaken. PATIENT SUMMARY: We provide recommendations on choice of the first drug type to use in treating overactive bladder. Two drug classes with similar effectiveness but different side effects are available. The decision on which medication to use first should take into account the patient's characteristics and their personal values, preferences, and expectations.

Stretchable Strain Sensors for Real-Time Bladder Volume Monitoring

Urinary incontinence (UI) is a prevalent condition that adversely affects quality of life, driving the need for innovative technologies for continuous bladder monitoring. In this study, we introduce a wrinkled metal (platinum and gold) strain sensor tailored for real-time bladder volume monitoring. This stretchable sensor is designed to provide robust and reliable performance for 5000 cycles with minimal hysteresis, and its mechanical properties match that of bladder tissue, enabling accurate monitoring during bladder filling and emptying. Our experimental results demonstrate that the sensor offers high sensitivity and stability, with a dynamic range of up to 230% strain, Young's modulus of 11.7-32 kPa, and a gauge factor (GF) of 2.9-4.7. The sensor's efficacy was validated through in vitro bladder phantom studies and ex vivo pig bladder experiments, where it consistently tracked bladder volume changes with a sensitivity of 4.60 mL-1. The results suggest that the strain sensor is a promising candidate for robust, biocompatible bladder volume monitoring in patients with urinary disorders, offering an alternative to traditional methods by being more comfortable and biocompatible.

Adiponectin signaling regulates urinary bladder function by blunting smooth muscle purinergic contractility

Lower urinary tract symptoms (LUTS) affect approximately 50% of the population over 40 years of age and are strongly associated with obesity and metabolic syndrome. Adipose tissue plays a key role in obesity/metabolic syndrome by releasing adipokines that regulate systemic energy/lipid metabolism, insulin resistance, and inflammation. Adiponectin (ADPN), the most abundant adipokine, modulates energy/metabolism homeostasis through its insulin-sensitizing and antiinflammatory effects. Human plasma ADPN levels are inversely associated with obesity and diabetes. To the best of our knowledge, the role of adipokines such as ADPN in the LUTS associated with obesity/metabolic syndrome remains unknown. We have tested such a possible role in a global ADPN-knockout (Adpn-/-) mouse model. Adpn-/- mice exhibited increased voiding frequency, small voids, and reduced bladder smooth muscle (BSM) contractility, with absence of purinergic contraction. Molecular examination indicated significantly altered metabolic and purinergic pathways. The ADPN receptor agonist AdipoRon was found to abolish acute BSM contraction. Intriguingly, both AMPK activators and inhibitors also abolished BSM purinergic contraction. These data indicate the important contribution of what we believe is a novel ADPN signaling pathway to the regulation of BSM contractility. Dysregulation of this ADPN signaling pathway might be an important mechanism leading to LUTS associated with obesity/metabolic syndrome.

Comparison of the effects of transcranial direct current stimulation and transcutaneous tibial nerve stimulation on the urgency and frequency of women with overactive bladder syndrome: study protocol of a randomized clinical trial

BACKGROUND

Overactive bladder syndrome is common, with a prevalence of 12-17% among adults. Posterior tibial nerve stimulation is the primary nonpharmacological and conservative treatment for overactive bladder syndrome. While several human brain imaging studies have shown the involvement of supraspinal centers in bladder control, a literature review has found that no research has specifically investigated cortical stimulation through transcranial direct current stimulation as a treatment for overactive bladder syndrome in women. Therefore, this study aims to assess the potential benefits of transcranial direct current stimulation (tDCS) and compare them with the effects of posterior tibial nerve stimulation on overactive bladder syndrome.

METHODS/DESIGN

The random allocation method will be used to divide the participants into two groups. Group 1 (n = 19) will undergo pelvic floor muscle training and transcutaneous tibial nerve stimulation. Group 2 (n = 19) will undergo pelvic floor muscle training and transcranial direct current stimulation. The transcranial direct current stimulation for group 2 will consist of 12 sessions occurring thrice a week, each lasting for 20 min. Anodal tDCS will be administered to FPz targeting the medial prefrontal cortex (mPFC) for 12 sessions, with the cathode electrode positioned between Oz and inion at an intensity of 2 mA for 20 min.

DISCUSSION

It is believed that utilizing an approach involving non-invasive electrical stimulation of the cortex could lead to a more efficient treatment for individuals with overactive bladder. Additionally, it is theorized that combining the effects of tDCS and pelvic floor muscle training could present an innovative technique for alleviating the negative impacts of overactive bladder syndrome. Ultimately, this new method could provide help for patients who have not responded to conventional therapy.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT) ID: IRCT20090301001722N26, registration date: May 17, 2023. https://en.irct.ir/ .

Suoquan Wan mitigates bladder overactivity via modulation of neuroimmune homeostasis in perimenopausal rats

BACKGROUND

Overactive bladder (OAB) is a common disorder in perimenopausal women, involving detrusor regulation by bladder neuro-immune interactions. While Suoquan Wan (SQW) has shown efficacy in alleviating OAB symptoms, its underlying mechanisms remain unclear.

PURPOSE

The aim of this study was to investigate the therapeutic effects of SQW on perimenopausal overactive bladder (OAB) and elucidate its underlying mechanisms in restoring bladder neuro-immune homeostasis.

METHODS

Initially, vaginal smears were performed to identify perimenopausal rats. The effects of SQW on the structure and function of the perimenopausal bladder were assessed using urodynamic studies, organ bath assays, and histological analyses, including hematoxylin and eosin (HE) and Masson staining. Subsequently, single-nucleus RNA sequencing (snRNA-seq) was conducted to investigate the mechanisms by which SQW modulates neuron-macrophage interactions. To validate the sequencing data, PCR and immunofluorescence (IF) assays were utilized to evaluate neural homeostasis. Further analyses involved IF, flow cytometry, and fluorescence bead assays to determine the function and proportion of bladder macrophages. The co-localization of neurons and macrophages was visualized using IF. Finally, transwell co-culture experiments were carried out to explore the regulatory effects of SQW on bladder neuro-immune homeostasis.

RESULTS

SQW significantly attenuates the frequency of non-micturition contractions and reduces residual urine volume, alleviates detrusor hyperactivity in OAB rats in response to external stimuli such as EFS, CCh, and KCl, and markedly improves urinary efficiency in perimenopausal OAB rats. SnRNA-seq data indicate that SQW modulates bladder neuro-immune homeostasis in these rats. Furthermore, SQW obviously decreases the proportion of ChAT-positive nerve fibers while enhancing the abundance of nNOS and MAP-positive nerve fibers in the bladder. SQW also reduces the proportion of CD45+ CD11b/C+MHCⅡ+ macrophages in the bladder muscle layer. Transwell co-culture assays reveal that the effects of SQW on MAP-2 and ChAT are mediated through the neuron-macrophage interaction mechanism.

CONCLUSIONS

SQW alleviated perimenopausal OAB by specifically modulating the neuron-macrophage interaction and enhancing bladder neuro-immune homeostasis.

A canine model of reversible urethral sphincter insufficiency

This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study. There is a need for a reliable, applicable, and reproducible animal model for studying urinary incontinency disease due to incorrect sphincter function. Seven adult male dogs were used for this study. The urethral sphincter was bypassed by inserting a catheter between the bladder neck and the distal sphincter. The animals' physical condition was closely monitored for 9 weeks, and standard urodynamic and radiologic studies were performed before and 1-2 months after surgery. The animals were killed at 9 weeks after surgery for pathological assessment. Catheter placement caused complete incontinence in the animal, with urodynamic assessments indicating that the animal was unable to control urination and radiological assessments indicating an empty bladder with a residual volume of 50 ± 10 cc. Tissue analysis did not show significant histological damage and inflammation. The study shows that by bypassing the urethral sphincter, which is a reliable and reproducible method, an animal model of urinary incontinence can be developed, which can be used in various studies such as assessing the adequacy of artificial sphincter function. The animals under study did not have any permanent defect, so they were able to return to their normal life.

Efficacy of 100-U Onabotulinumtoxin A Treatment in Female Idiopathic Overactive Bladder-A Prospective Follow-Up Study

INTRODUCTION AND HYPOTHESIS

Overactive bladder (OAB) affects 11-17% of the female population. First-line treatment with lifestyle modifications and second-line therapy with medications are often limited by inadequate efficacy or pharmacological side effects. This study was aimed at assessing the effect of 100 U onabotulinumtoxin A treatment on idiopathic OAB (iOAB) as a second-line treatment.

METHODS

This prospective follow-up study involved 94 women who received onabotulinumtoxin A treatment at a dose of 100 U as a second-line treatment for iOAB at the Department of Obstetrics and Gynecology, Oulu University Hospital, Finland, between May 2018 and December 2023. The impact of the treatment on iOAB symptoms was evaluated 3 months after administration using self-reported symptoms and the following internationally validated questionnaires: Visual Analogue Scale (VAS), Incontinence Impact Questionnaire (IIQ-7), and Urogenital Distress Inventory (UDI-6). Postoperative complications were assessed.

RESULTS

The follow-up data were obtained from 74 (78%) patients, of whom 66 (95.7%) reported a good outcome and 3 (4.3%) reported a poor outcome. Incontinence episodes, the number of incontinence pads needed, and daily micturitions were significantly reduced. For all questionnaires, the total scores decreased significantly after the treatment (VAS 8.27 ± 1.78 vs 3.50 ± 3.08, p < 0.001; IIQ-7 72.14 ± 20.55 vs 28.73 ± 29.40, p < 0.001; UDI-6 55.01 ± 18.86 vs 29.66 ± 22.03, p < 0.001). Postoperative urinary tract infection occurred in 9 patients (9.6%), whereas urinary retention occurred in 6 patients (6.4%).

CONCLUSIONS

Onabotulinumtoxin A (100 U) demonstrates good effectiveness in the second-line treatment of female iOAB.

Relationship between alcohol use and overactive bladder disease: a cross-sectional study of the NHANES 2005-2016

Background

Overactive bladder syndrome (OAB) is a prevalent urological condition which has a substantial impact on the life quality of affected individuals, resulting in restrictions in daily activities and work productivity. Alcohol is a diuretic, which means that it increases urine production and can potentially worsen urinary urgency and frequency. Several studies have investigated the association between alcohol consumption and OAB symptoms, but the results have been conflicting. This study aimed to investigate the relationship between alcohol consumption and OAB symptoms using a large, nationally representative sample.

Method

Data from the National Health and Nutrition Examination Survey 2005-2016 were obtained for analysis. The Overactive Bladder Symptom Scale (OBSS) was used to determine the presence of OAB in each participant. Multivariate logistic regression and ordinal logistic regression were used to analyze the association of alcohol use frequency and quantity with the onset and severity of OAB, respectively.

Results

A total of 7,805 samples (representing the 1,473,525,341 US population after weighting) were included in our analysis. Approximately 12.4% of this weighted sample self-reported having OAB. A greater proportion of nondrinkers, a higher proportion of females, higher blood pressure, older age, and lower income levels were observed in OAB patients compared to non-OAB patients. Univariate logistic regression revealed that the risk of OAB was significantly greater in the nondrinker group than in the 1-5 drinks/month (OR 0.64; 95% CI, 0.50-0.83), 5-10 drinks/month (OR 0.60; 95% CI, 0.43-0.82) and 10+ drinks/month groups (OR 0.41; 95% CI, 0.30-0.56) and the risk of OAB in the lowest quartile of alcohol consumption quantity was significantly higher than the second (OR 0.58; 95% CI, 0.47-0.70), third (OR 0.49; 95% CI, 0.39-0.62), and highest quartiles groups (OR 0.58; 95% CI, 0.45-0.75). The adjusted model revealed that only patients in the 10+ drinks/month group had a significantly lower risk of OAB than did those in the nondrinker group (OR = 0.64; 95% CI = 0.45-0.92), while the other two groups had similar risks. Furthermore, no significant association was found for the highest quartiles in the adjusted model; however, the second and third quartiles of alcohol consumption quantity group still exhibited obvious associations. These findings suggest that higher alcohol consumption, when appropriate, is associated with a lower risk of OAB compared to nondrinkers and the lowest quartile of alcohol consumption quantity group, even after adjusting for age, sex, race, and comorbidities.

Conclusion

In conclusion, our findings revealed a significant association between alcohol consumption and the incidence of OAB in the study population. In terms of long-term effects, alcohol may not be a risk factor for OAB. These factors may represent intervention targets for lowering the risk and severity of OAB symptoms, but this needs to be confirmed in large clinical trials.

Development of a clinical decision support tool for Primary care Management of lower Urinary tract Symptoms in men: the PriMUS study

Background

Lower urinary tract symptoms particularly affect older men and their quality of life. General practitioners currently have no easily available assessment tools to diagnose lower urinary tract symptom causes. Referrals to urology specialists are increasing. General practitioner access to simple, accurate tests and clinical decision tools could facilitate management of lower urinary tract symptoms in primary care.

Objectives

To determine which of several index tests in combination, best predicted three diagnoses (detrusor overactivity, bladder outlet obstruction and/or detrusor underactivity) in men presenting with lower urinary tract symptoms in primary care. To develop and validate three diagnostic prediction models, and a prototype primary care clinical decision support tool.

Design

Prospective diagnostic accuracy study. Two participant cohorts, for development and validation, underwent simple index tests and a reference standard (invasive urodynamics).

Setting

General practices in England and Wales.

Participants

Men (16 years and over) consulting their general practitioner with lower urinary tract symptoms.

Sample size

Separate calculations for model development and validation cohorts, from literature estimates of detrusor overactivity, bladder outlet obstruction and detrusor underactivity prevalences of 57%, 31% and 16%, respectively.

Predictors and index tests

Twelve potential predictors considered for three diagnostic models.

Main outcome measures

The primary outcome was diagnostic model sensitivity and specificity for detecting bladder outlet obstruction, detrusor underactivity and detrusor overactivity, with 75.0% considered minimum clinically useful performance.

Statistical analysis

Three separate logistic regression models generated with index test variables to predict the presence of bladder outlet obstruction, detrusor overactivity, detrusor underactivity conditions in men with lower urinary tract symptoms.

Results

One model each was developed and validated for bladder outlet obstruction and detrusor underactivity, two for detrusor overactivity (detrusor overactivity main, detrusor overactivity sensitivity analysis 2). Age, voiding symptoms subscore, prostate-specific antigen level, median maximum flow rate, median voided volume were predictors for bladder outlet obstruction. Median maximum flow rate and post-void residual volume were predictors for detrusor underactivity. Age, post-void residual volume and median voided volume were included in detrusor overactivity main model, while age and storage symptoms subscore predicted detrusor overactivity sensitivity analysis 2. For all four models, sensitivity of 75.0% could be achieved with a specificity of 74.2%, 47.3%, 45.6% and 46.2% for bladder outlet obstruction, detrusor underactivity, detrusor overactivity main and detrusor overactivity sensitivity analysis 2 models, respectively. Similarly, a specificity of 75.0% could be achieved with a sensitivity of 71.3%, 39.8%, 33.3% and 62.7% for bladder outlet obstruction, detrusor underactivity, detrusor overactivity main and detrusor overactivity sensitivity analysis 2 models, respectively. The prototype tool (not yet intended for use in practice) is available at Primary care Management of lower Urinary tract Symptoms decision aid for lower urinary tract symptoms (shinyapps.io). General practitioner feedback during tool development and small-scale user-testing in simulated consultation scenarios was favourable. Patients supported such management in primary care.

Strengths/limitations

This was a prospective, multicentre study in an appropriate primary care population. Most of the index tests are possible routinely in primary care or at home by patients. The diagnostic models were validated in a separate cohort from the same population. Limitations include that target condition prevalences may differ in other populations.

Conclusion

We identified sensitivities and specificities of diagnostic models for detrusor overactivity, bladder outlet obstruction and detrusor underactivity in routine United Kingdom practice and developed a prototype clinical decision support tool.

Future work

Economic modelling, a feasibility trial and powered randomised controlled trial are needed to evaluate the Primary care Management of lower Urinary tract Symptoms tool in practice.

Study registration

Current Controlled Trials ISRCTN10327305.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/40/05) and is published in full in Health Technology Assessment; Vol. 29, No. 1. See the NIHR Funding and Awards website for further award information.

Comparison of Surgical Outcomes of Autologous Mid-Urethral Fascia Slings and Retropubic Mid-Urethral Slings for Women Undergoing a Primary Surgery for Stress Urinary Incontinence: A Systematic Review and Meta-Analysis

AIM

Current guidelines on surgical treatment of stress urinary incontinence (SUI) recommend an informed decision making process between the physicians and patients reviewing all available surgical options with and without mesh. However, there is a lack of synthesized clinical evidence on some of the comparisons that can feed into patient counseling processes. The aim of this study was to review the available studies comparing clinical outcomes of an autologous fascial sling (AFS) and a retropubic (RP) synthetic sling for women undergoing a primary surgery for SUI.

METHODS

We conducted a literature search from 1990 to 2024 following international guidelines. We have included studies reporting on comparative outcomes of AFS and RP synthetic sling surgeries as a primary procedure.

RESULTS

Three randomized studies were included with follow-up durations ranging from 24 months to 10 years. The mean percentage change in symptom scores ranged from 27.7% to 44.9%, with no significant difference between the two sling types. There was no difference between groups with regard to objective cure rates, subjective cure rates and length of hospital stay between AFS and RP slings. AFS surgeries had longer operative times. There were concerns about bias, particularly related to allocation, blinding, and missing outcome data.

CONCLUSION

Overall, both types of slings had similar cure rates but AFSs were associated with longer operative times. The study highlights the need for more research on the comparative effectiveness of AFS and synthetic slings for SUI surgery to guide decision-making for SUI surgical treatments.

Continence care quality from the perspective of older adults receiving home care services and residents of long-term care: a scoping review protocol

INTRODUCTION

Urinary incontinence is associated with social isolation, deconditioning, depression, falls and early mortality. It impairs quality of life, even in residents of nursing homes, and, in the community, increases the risk of institutionalisation. Care focused on the preservation of dignity during intimate care is important in the care of older adults. Despite this, there are few data which seek to define the quality of care or desired outcomes of care from the older adult's perspective. This scoping review aims to assess the research literature addressing the question of what is known about the quality of continence care from the perspective of older adults (>65 years old) in long-term care and from those in receipt of home care to identify gaps in the literature and direct further research.

METHODS AND ANALYSIS

The Joanna Briggs Institute (JBI) method will be followed. The CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, PROSPERO, Web of Science and JBI Evidence Synthesis databases will be searched using keywords for publications within the last 20 years without restriction on publication type or language. A search of grey literature and websites will be conducted. Reference lists of the retrieved articles will be used to identify additional literature. A preliminary search of MEDLINE was performed (21 November 2023), to identify articles. Search results will be exported into a management tool for screening and analysis. Article screening will be undertaken by two authors, and a third will be included if needed to resolve any differences. Data analysis will be guided by theoretical frameworks. The protocol for this study was registered at Open Science Framework (https://osf.io/bprq9/).

POTENTIAL IMPACT

Information on what constitutes quality of care or desired outcomes of care from the perspective of this segment of the population is lacking. This review will synthesise knowledge and provide research direction. Findings can potentially lead to new directions in the provision of care for vulnerable older adults.

ETHICS AND DISSEMINATION

Formal ethics approval for a scoping review is not required. The results will be published in a high-impact journal with a focus on open access publication.

The prevalence of incontinence and its impact on quality of life

The study set out to find out how common urine incontinence was in the community and how it affected people's quality of life and other relevant characteristics. Patients who applied to Family Medicine Outpatient Clinics were asked to complete a questionnaire as part of the study. Participants who consented to participate in the study were given access to a questionnaire that included the Incontinence Quality of Life Scale (I-QOL), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Three Incontinence Questions (3IS) form. There were 18.5% of male participants and 81.5% of female participants in terms of gender distribution. It was found that urine incontinence affected 29.9% of the individuals. The median ICIQ-SF Score values varied statistically significantly depending on whether incontinence was present (P < .001). The ICIQ-SF Score median values according to incontinence types showed a statistically significant difference (P < .001). The total score of the incontinence quality of life scale showed a statistically significant variation based on the presence of incontinence (P < .001). For people without incontinence, the median overall score on the incontinence quality of life scale was 82, whereas for people with incontinence, it was 67. Urinary incontinence (UI) is a frequent health issue that can have a significant negative impact on a person's quality of life because of the psychosocial impacts, lifestyle limits, and social effects. As a result, it is critical to comprehend the impacts of urine incontinence, create support and treatment plans, and strive toward early patient detection to enhance quality of life.

Phytomedicines in Pharmacotherapy of LUTS/BPH - What Do Patients Think?

Purpose

Lower urinary tract symptoms (LUTS) consist of voiding and storage symptoms. While the therapeutic efficacy of current LUTS medications is limited, and with more than 20% of patients suffering from mixed symptoms, current guidelines offer nothing more than combining monotherapies. An individualized approach is urgently warranted, and phytomedicines have become an integral part of patient-empowerment in therapeutic shared-decision making processes. Therefore, we aimed to investigate patients' preference of phytomedicines and treatment adherence at the dawn of an era leaving α1-blocker monotherapies behind.

Patients and Methods

A questionnaire was prepared, and patients at our tertiary referral center were given the opportunity to voluntarily participate in our survey. We collected questionnaires from 300 patients during their visits from January 2022 to December 2022.

Results

With 73% (218/300), most of our study cohort had either taken one or more or were currently on prescription medication for LUTS/BPH. Patients were prescribed α1-blockers (72%), followed by 5α-reductase inhibitors (21%), and phosphodiesterase-5-inhibitor (5%), while antimuscarinics and β3-agonists were rarely prescribed. However, 41% (89/218) of our patients, who were taking medication for LUTS, had taken or were currently taking phytomedicines, making this the second most common drug class in our patient cohort. Patients scored the efficacy of phytomedicines at a mean in the lower third, but 87% of patients attributed excellent tolerability, and only 9% experienced side effects. While 43% of patients recommended phytomedicines for other patients, two-thirds of patients thought phytomedicines should be covered by statutory health insurance.

Conclusion

We found that phytomedicines were the second most common drug class taken by LUTS patients at our hospital. Reasons may be easy availability as over the counter medication and a superior safety profile with less bothersome side effects than commonly prescribed drug classes. Taken together, phytomedicines may be able to bridge an important gap in LUTS pharmacotherapy to provide sufficient treatment adherence where prescription drug classes fail, and ultimately, adequate improvement of symptoms. However, patients need to be counseled on potentially limited efficacy.

Validation of the Hungarian Version of the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS)

Objectives: Urinary incontinence (UI) is a prevalent condition that significantly impacts the quality of life. This study aimed to validate the Hungarian version of the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and assess its psychometric properties in the context of the Hungarian population. Study design: A cross-sectional study involved 215 Hungarian-speaking women with a mean age of 67.6 ± 11.9 years. Main outcome measure: Participants were administered both the ICIQ-FLUTS and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The psychometric analysis included test-retest reliability, convergent validity, and internal consistency. Results: The Hungarian version of ICIQ-FLUTS demonstrated strong psychometric properties. The test-retest reliability analysis showed a high intraclass correlation coefficient (ICC = 0.921), indicating excellent agreement between measurements over a 14-day interval. Convergent validity was supported by a strong positive correlation between the total scores of ICIQ-FLUTS and ICIQ-SF (ρ = 0.686, p < 0.001), emphasizing shared underlying constructs. Furthermore, the ICIQ-FLUTS questionnaire exhibited good internal consistency, with a Cronbach's α coefficient of 0.862. Conclusions: This study successfully validated the Hungarian version of the ICIQ-FLUTS questionnaire and demonstrated its robust psychometric properties. This tool will enable healthcare practitioners and researchers to effectively assess and address UI's impact on their quality of life.

Assessment of lower urinary tract symptoms 6 weeks after delivery and the relationship of pelvic floor muscle function

Background

Studies on lower urinary tract symptoms (LUTS) in women, especially in relation to different modes of delivery, are limited. The relationship between the emergence of LUTS and the decline of pelvic muscle function after childbirth remains uncertain.

Study design

This observational study was carried out at the Peking University First Hospital over a time span of 2019-2022. A total of 2,462 women were recruited and surveyed 6 weeks after delivery, utilizing questionnaires for data collection. Additionally, gynecological physical examinations and pelvic floor muscle screenings were conducted as part of the study. To assess individual LUTS and the level of discomfort caused by these symptoms, a modified Chinese version of the Bristol Female Lower Urinary Tract Symptoms questionnaire was employed. Data analysis methods such as descriptive statistics, χ 2 tests, one-way ANOVAs, and multivariate logistic regressions were used to thoroughly examine the collected data.

Results

A high prevalence of LUTS was observed in the study participants, with 70.6% experiencing any symptoms. Storage symptoms were reported by 65.4%, while voiding symptoms were reported by 23.0%. Nocturia was the most commonly reported symptom (35.4%), followed by frequency (25.6%) and urgency (25.3%). Stress urinary incontinence (SUI) was reported by 20.8% of women. Interestingly, nocturia and frequency were generally perceived as less troublesome, with only a minority rating them as problematic. In contrast, urinary incontinence (UI) was frequently reported as highly bothersome, with SUI and urge urinary incontinence (UUI) accounting for significant proportions. Vaginal delivery (VD) and forceps delivery (FD) were identified as significant predictors of LUTS, with statistical significance observed (P < 0.05). Specifically, women who underwent VD, particularly FD, exhibited lower surface electromyography (sEMG) activity compared to those who had cesarean section (CS), both in terms of resting baseline and contraction amplitude (P < 0.001).

Conclusions

Over half of the examined women exhibited LUTS 6 weeks postpartum, with the most common symptoms being nocturia, frequency, urgency, and SUI. Straining and urinary incontinence were commonly reported as significantly uncomfortable, particularly severe in cases of UI. Additionally, vaginal delivery methods, especially those involving the use of forceps (FD), seemed to be more likely to cause pelvic floor muscle or nerve damage, making it the key predictor of storage-related LUTS.

Female urinary incontinence in middle-aged women in four hospitals in Northern Italy: A multicentre prevalence study

Urinary Incontinence (UI) has been identified as a health priority by the World Health Organization. Despite being a widely discussed topic, UI remains an underrecognized condition: affected individuals often refrain from reporting it due to its status as a socially sensitive topic and a source of embarrassment. UI exhibits a markedly higher prevalence in the female population compared to males and significantly diminishes the quality of life for those affected. It impacts various personal, relational, and social domains in which women aged 40-65 years are often actively engaged. Moreover, the most recent Italian prevalence publications date back to the early 2000s. Consequently, an observational study focused on UI in Italy could provide valuable insights. This paper outlines a protocol designed to investigate the point prevalence, risk factors, quality of life, social impact and economic burden of UI in female patients, caregivers, healthcare and administrative workers aged 40-65 years across four hospitals in Northern Italy using a survey (UI SURVEY) and two questionnaires validated in Italian (ICIQ UI-SF and IIQ-7). The findings of this study could also inform nursing and midwifery practices in the management of women affected by UI.

How Useful are Current Chatbots Regarding Urology Patient Information? Comparison of the Ten Most Popular Chatbots' Responses About Female Urinary Incontinence

This research evaluates the readability and quality of patient information material about female urinary incontinence (fUI) in ten popular artificial intelligence (AI) supported chatbots. We used the most recent versions of 10 widely-used chatbots, including OpenAI's GPT-4, Claude-3 Sonnet, Grok 1.5, Mistral Large 2, Google Palm 2, Meta's Llama 3, HuggingChat v0.8.4, Microsoft's Copilot, Gemini Advanced, and Perplexity. Prompts were created to generate texts about UI, stress type UI, urge type UI, and mix type UI. The modified Ensuring Quality Information for Patients (EQIP) technique and QUEST (Quality Evaluating Scoring Tool) were used to assess the quality, and the average of 8 well-known readability formulas, which is Average Reading Level Consensus (ARLC), were used to evaluate readability. When comparing the average scores, there were significant differences in the mean mQEIP and QUEST scores across ten chatbots (p = 0.049 and p = 0.018). Gemini received the greatest mean scores for mEQIP and QUEST, whereas Grok had the lowest values. The chatbots exhibited significant differences in mean ARLC, word count, and sentence count (p = 0.047, p = 0.001, and p = 0.001, respectively). For readability, Grok is the easiest to read, while Mistral is highly complex to understand. AI-supported chatbot technology needs to be improved in terms of readability and quality of patient information regarding female UI.

Safety and Effectiveness of Vibegron in Japanese Patients With Overactive Bladder: A Japanese Postmarketing Survey

OBJECTIVES

To evaluate the safety and effectiveness of vibegron, a highly selective β3-adrenoceptor agonist, in Japanese patients with overactive bladder (OAB) in a real-world clinical setting.

METHODS

This prospective survey was conducted from August 2019 to July 2023 using a central registration method. Patients newly treated with vibegron for OAB were followed for 12 weeks, and those who continued treatment were observed for up to 52 weeks. Adverse drug reactions (ADRs) and the overall improvement level were assessed, and overactive bladder symptom score (OABSS) and International Prostate Symptom Score-Quality of Life (IPSS QOL) score were collected.

RESULTS

Of the 1848 patients in the safety analysis set, 154 ADRs were reported in 141 patients (7.63%). Common ADRs were increased residual urine volume (1.30%), constipation (1.14%), dysuria and urinary retention (0.97% each), cystitis (0.65%), and dry mouth (0.32%). The incidence of urinary retention-related adverse events (AEs) was higher in male patients, patients ≥ 65 years old, and patients with benign prostatic hyperplasia. The effectiveness rate was 88.8% among the 1561 patients in the effectiveness analysis set. Significant improvement in both OABSS and IPSS QOL scores was observed at all observation periods. The rate of achieving the minimal clinically important change in OABSS total score at the final evaluation was 75.35%. OABSS scores were also significantly reduced in all subgroup analyses.

CONCLUSIONS

This survey found no major concerns regarding the safety and effectiveness of vibegron in Japanese OAB patients, except for urinary retention-related AEs. Vibegron is considered to represent a useful drug for treating OAB symptoms in a real-world clinical setting.

The association between education level and overactive bladder: Evidence from a U.S. population-based study

Background

Education level significantly impacts individual health outcomes. This research investigates the correlation between education level and the prevalence of overactive bladder (OAB).

Methods

This study employed data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2020 to conduct a thorough investigation of the association between educational level and OAB using multivariable logistic regression, smooth curve fitting, and generalized additive model.

Results

Out of 37,423 surveyed participants from the United States, 8,033 were identified with OAB. The comprehensive adjusted model revealed a notable inverse correlation between education level and OAB prevalence (odds ratio [OR] = 0.86, 95 % confidence interval [CI] = 0.83-0.89, P < 0.001). When education level was categorized, participants with the highest educational qualification (college graduates or higher) had a 44 % lower likelihood of having OAB compared to those with the lowest education (below 9th grade) (OR = 0.56, 95 % CI = 0.47-0.66, P < 0.001).

Conclusion

The findings underscore a substantial inverse correlation between education level and OAB prevalence. Although continued research is required to confirm these findings, educational attainment may guide the development of preventative and therapeutic strategies for OAB.

Adiponectin Signaling Regulates Urinary Bladder Function by Blunting Smooth Muscle Purinergic Contractility

Lower urinary tract symptoms (LUTS) affect ∼ 50% of the population aged >40 years and are strongly associated with obesity and metabolic syndrome. Adipose tissue plays a key role in obesity/metabolic syndrome by releasing adipokines that regulate systemic energy/lipid metabolism, insulin resistance, and inflammation. Adiponectin (ADPN), the most abundant adipokine, modulates energy/metabolism homeostasis through its insulin-sensitizing and anti-inflammatory effects. Human plasma ADPN levels are inversely associated with obesity and diabetes. The role of adipokines such as ADPN in the LUTS associated with obesity/metabolic syndrome remains unknown. We have tested such a possible role in a global ADPN knockout mouse model ( Adpn -/- ). Adpn -/- mice exhibited increased voiding frequency, small voids, and reduced bladder smooth muscle (BSM) contractility with absence of purinergic contraction. Molecular examination indicated significantly altered metabolic and purinergic pathways. The ADPN receptor agonist AdipoRon was found to abolish acute BSM contraction. Intriguingly, both AMPK activators and inhibitors also abolished BSM purinergic contraction. These data indicate the important contribution of a novel ADPN signaling pathway to the regulation of BSM contractility. Dysregulation of this ADPN signaling pathway might be an important mechanism leading to LUTS associated with obesity/metabolic syndrome.

ARTICLE HIGHLIGHTS

Lower urinary tract symptom (LUTS) is strongly associated with obesity and metabolic syndrome, however, the underlying molecular mechanisms are missing. Dysregulation of adipokine signaling could be the link for this association.Whether adiponectin, the most abundant adipokine, plays a role in regulating bladder function and dysfunction.Mice null for adiponectin exhibited increased voiding frequency, small voids, and reduced bladder smooth muscle contractility, with corresponding metabolic and purinergic pathway changes.Dysregulation of adiponectin signaling might be an important mechanism leading to LUTS associated with obesity/metabolic syndrome.

An update on the cognitive safety of antimuscarinics in the treatment of overactive bladder

INTRODUCTION

Antimuscarinics are often the first-choice medications used to treat overactive bladder (OAB), a condition that increasingly affects the aging population. However, concerns regarding their potential impact on cognitive function have persisted for more than a decade.

AREAS COVERED

This review was conducted to update the literature on the cognitive safety profiles of various antimuscarinics, integrating findings from both recent and earlier studies to present an updated and comprehensive analysis. A search of English-language publications, including electronic databases and gray literature, focused on the cognitive impacts of antimuscarinics, resulting in a review and assessment of diverse studies and their associated outcomes.

EXPERT OPINION

Oxybutynin requires caution due to potential adverse effects, suggesting a need to consider alternative therapies. Darifenacin, while promising in preserving cognitive function, warrants further investigation for use in dementia patients. Fesoterodine has shown tolerance without cognitive decline in controlled trials. However, Tolterodine and Solifenacin present conflicting evidence regarding cognitive impairment and dementia risk, respectively, necessitating additional research to ascertain their safety profiles. Careful monitoring and treatment of patients taking these medications for cognitive impairment are essential. Further research, particularly in vulnerable populations, is crucial to establish cognitive safety profiles of various antimuscarinics and inform optimal OAB treatment strategies.

Research on dynamic urine volume detection system based on smart flexible textile sensors

Urine leakage volume is an important indicator reflecting the severity of incontinence in patients. Currently, there are limited smart diapers capable of continuous dynamic monitoring of urine volume. This study developed two types of urine volume sensors, resistive and capacitive, which were integrated with traditional diapers to assess urine leakage levels: mild leakage (0-5 mL), moderate leakage (6-12 mL), and severe leakage (above 12 mL). Three patterns of resistive urine volume sensors were designed, and the results showed that the A pattern could accurately determine urine volume and frequency levels. Additionally, three electrode spacing designs were tested for the capacitive urine volume sensors. The results indicated that the sensor with a 1 cm electrode spacing could determine the urine volume range, with each 1 mL increase in urine causing a capacitance rise of approximately 1.5-1.8 pF, with an error of about ± 0.5 mL per increment. Both resistive and capacitive methods showed high accuracy in monitoring urine volume and frequency. This study validated the feasibility of smart flexible fabric sensors in detecting urine volume and frequency, providing a potential solution for better assessing and managing the condition of incontinence patients.

Electroacupuncture versus solifenacin succinate for female overactive bladder: study protocol for a multicentre, randomised, controlled, double-dummy, non-inferiority trial

INTRODUCTION

Overactive bladder (OAB) affects approximately 500 million people worldwide, with a higher prevalence in women than in men, significantly impacting the quality of life of female patients. Treatment options for OAB are currently limited. Previous research has proposed that electroacupuncture could be a viable treatment for OAB in women, but there is a lack of high-quality clinical evidence. This study aims to evaluate the effectiveness of electroacupuncture as a safe and efficient non-pharmacological treatment for female OAB by comparing it with solifenacin succinate.

METHODS AND ANALYSIS

This study is a multicentre, single-blind, double-dummy randomised controlled non-inferiority clinical trial involving 204 eligible female participants with OAB. Participants will be randomly assigned in a 1:1 ratio to either the electroacupuncture group (receiving electroacupuncture and placebo) or the solifenacin succinate group (receiving sham electroacupuncture and solifenacin succinate). Each participant will undergo 12 sessions of electroacupuncture (or sham electroacupuncture) treatment and solifenacin succinate (or placebo) treatment over a 4-week period. The primary outcome measure will be the percentage change in the number of micturition episodes every 24 hours at week 4 compared with baseline. Secondary outcomes will include a percentage reduction in the number of micturition episodes every 24 hours at 2th, 8th and 16th weeks of the trial, Overactive Bladder Symptom Score, number of urinary incontinence and urgency episodes every 24 hours based on a 3-day voiding diary, OAB Questionnaire, Generalised Anxiety Disorder Scale-7, King's Health Questionnaire and Participant Self-evaluation of Therapeutic Effects. Adverse events will be monitored throughout the study. Efficacy analyses will be conducted on both the intention-to-treat population and the per-protocol set population.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Medical Ethics Committee of Longhua Hospital Shanghai University of Traditional Chinese Medicine (approval number: 2022LCSY097). Each participant will sign a written informed consent before randomisation. The results of this study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER : NCT05798403.

Evaluating the impact of a new clean intermittent self-catheterisation device: experiences of male patients

Urinary incontinence is common and has many causes. A main one is urinary retention, and clean intermittent self-catheterisation is the gold standard for managing it. There are, however, complications associated with performing this, which affect patient experience, quality of life and compliance with the procedure. The most common complication is urinary tract infection (UTI), which can be debilitating and have serious consequences. On average, patients experience 2.7 UTIs a year. Infection often arises from residual urine left behind, this can be caused by mucosal suction into catheter eyelets giving the impression that the bladder has finished emptying and leading to early withdrawal of the catheter. Mucosal suction by catheter eyelets can also lead to micro-trauma. Hydrophilic catheters have long been used to prevent micro-trauma. A catheter using Micro-hole Zone Technology instead of conventional two eyelets was developed with the aim of reducing UTI risk by addressing risk factors for bladder micro-trauma and incomplete voiding. A recent evaluation of Coloplast's Luja male intermittent catheter found that 97% of nurses would recommend Luja, 96% of nurses felt confident their patients will learn how to completely empty their bladder with Luja, and 88% of nurses were less worried that their patients are at risk of getting UTIs due to incomplete bladder emptying.

Non-inferiority, randomised, open-label clinical trial on the effectiveness of transurethral microwave thermotherapy compared to prostatic artery embolisation in reducing severe lower urinary tract symptoms in men with benign prostatic hyperplasia: study protocol for the TUMT-PAE-1 trial

BACKGROUND

One-fourth of men older than 70 years have lower urinary tract symptoms (LUTS) that impair their quality of life. Transurethral resection of the prostate (TURP) is considered the gold standard for surgical treatment of LUTS caused by benign prostatic hyperplasia (BPH) that cannot be managed conservatively or pharmacologically. However, TURP is only an option for patients fit for surgery and can result in complications. Transurethral microwave thermotherapy (TUMT) and prostatic artery embolisation (PAE) are alternative minimally invasive surgical therapies (MISTs) performed in an outpatient setting. Both treatments have shown to reduce LUTS with a similar post-procedure outcome in mean International Prostate Symptom Score (IPSS). It is however still unknown if TUMT and PAE perform equally well as they have never been directly compared in a randomised clinical trial. The objective of this clinical trial is to assess if PAE is non-inferior to TUMT in reducing LUTS secondary to BPH.

METHODS

This study is designed as a multicentre, non-inferiority, open-label randomised clinical trial. Patients will be randomised with a 1:1 allocation ratio between treatments. The primary outcome is the IPSS of the two arms after 6 months. The primary outcome will be evaluated using a 95% confidence interval against the predefined non-inferiority margin of + 3 points in IPSS. Secondary objectives include the comparison of patient-reported and functional outcomes at short- and long-term follow-up. We will follow the patients for 5 years to track long-term effect. Assuming a difference in mean IPSS after treatment of 1 point with an SD of 5 and a non-inferiority margin set at the threshold for a clinically non-meaningful difference of + 3 points, the calculated sample size was 100 patients per arm. To compensate for 10% dropout, the study will include 223 patients.

DISCUSSION

In this first randomised clinical trial to compare two MISTs, we expect non-inferiority of PAE to TUMT. The most prominent problems with MIST BPH treatments are the unknown long-term effect and the lack of proper selection of candidates for a specific procedure. With analysis of the secondary outcomes, we aspire to contribute to a better understanding of durability and provide knowledge to guide treatment decisions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05686525. Registered on January 17, 2023, https://clinicaltrials.gov/study/NCT05686525 .

Overactive bladder and cognitive impairment in middle-aged women: A cross-sectional study

BACKGROUND

Overactive bladder (OAB) is a common condition in middle-aged and older women. It has been reported to be potentially linked to cognitive decline, particularly in older adults. This study investigated the association between OAB symptoms and cognitive impairment in middle-aged women.

MATERIALS AND METHODS

This cross-sectional study had a sample of 1652 women (mean age 49.3 ± 2.8 years) who were not taking medication for either urinary tract infection or OAB. OAB symptoms and cognitive function were evaluated by self-administered questionnaires: the Overactive Bladder Symptom Score and the Alzheimer's disease 8. Logistic regression models estimated prevalence ratios (PRs) with 95 % confidence intervals (CI) for cognitive impairment according to the presence/absence of OAB. Mediation analyses assessed the impact of poor sleep quality on this association.

RESULTS

Cognitive impairment was more prevalent in women with OAB than in those without OAB (multivariable-adjusted PR: 1.88 [95 % CI: 1.52-2.24]). Women experiencing nocturia (≥twice a night), urinary urgency at least once a week, and urgency urinary incontinence at least once a week had multivariable-adjusted PRs (95 % CI) for cognitive impairment of 2.08 (1.50-2.65), 2.12 (1.66-2.58), and 1.75 (1.17-2.34), respectively. Poor sleep quality mediated 10.81 % [95 % CI: 4.55-19.44 %] of the relationship between OAB and cognitive impairment.

CONCLUSIONS

Among middle-aged women not taking OAB medications, OAB symptoms were associated with cognitive impairment, partly because of poor sleep quality. Further research is needed to determine whether early screening of patients with OAB can help identify those susceptible to cognitive impairment associated with OAB medication and if preventive measures should be targeted at this group.

Potential bladder cancer therapeutic delivery systems: a recent update

INTRODUCTION

Bladder Cancer is one of the most expensive cancers to treat due to its high cost of therapy as well as the surveillance expenses incurred to prevent disease recurrence and progression. Thus, there is a strong need to develop safe, efficacious drug formulations with controlled drug release profiles and tumor-targeting potential, for improved therapeutic outcomes of bladder cancer patients.

AREAS COVERED

This review aims to provide an overview of drug formulations that have been studied for potential bladder cancer treatment in the last decade; highlight recent trends in bladder cancer treatment; mention ongoing clinical trials on bladder cancer chemotherapy; detail recently FDA-approved drug products for bladder cancer treatment and identify constraints that have prevented the translation of promising drug formulations from the research laboratory to the clinics.

EXPERT OPINION

This work revealed that surface functionalization of particulate drug delivery systems and incorporating the nanoparticles into in situ gelling systems could facilitate controlled drug release for extended periods, and improve the prognosis of bladder cancer treatment. Future research directions could incorporate multiple drugs into the drug delivery systems to treat advanced stages of the disease. In addition, smart nanomaterials, including photothermal therapies, could be exploited to improve the therapeutic outcomes of bladder cancer patients.

Mirabegron 50 mg once daily, long-term treatment maximizes benefit in middle-aged and older people with overactive bladder syndrome: a systematic review and meta-analysis of nine phase II/III, randomized, double-blind, parallel-design, placebo-controlled, multicenter, and multinational trials

The prevalence and severity of overactive bladder increase with age, and mirabegron is an approved treatment for this condition. This meta-analysis systematically evaluated the efficacy and safety of mirabegron compared with placebo for overactive bladder treatment. We searched PubMed and the Cochrane Library (30 October 2023) for relevant articles (source: MEDLINE, EMBASE, ClinicalTrials.gov, ICTRP, CINAHL). We included randomized controlled trials involving adults with overactive bladder syndrome that compared mirabegron with placebo treatment. Data were analyzed according to the Cochrane Handbook for Systematic Reviews of Interventions [Review Manager (computer program) Version 5.4]. Nine parallel-group trials (10 articles) were included. The evaluation included a total of 8,527 adults, including 6,445 women and 2,082 men, of whom 5,726 were White, 2,462 were Asian, and 161 were Black. The mean age of the participants ranged from 53.4 to 60.3 years. This evaluation involved three specifications of mirabegron: 25 mg, 50 mg, and 100 mg. In all trials, patients were enrolled in a 12-week double-blind treatment period, and the dose was once daily. The review of trials found that on average, people taking mirabegron had about 13 ml more volume voided per micturition, five fewer micturitions, and four fewer incontinence episodes every week, with moderate improvements in quality of life. About one in five people taking the drug reported TRAEs. Mirabegron treatment is well tolerated, with the risk of adverse events similar to that of a placebo. For best results, a dose of 50 mg once daily is recommended for long-term use. It is unclear whether any benefits are sustained after treatment discontinuation. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42023430737).

An integrated and flexible ultrasonic device for continuous bladder volume monitoring

Bladder volume measurement is critical for early detection and management of lower urinary tract dysfunctions. Current gold standard is invasive, and alternative technologies either require trained personnel or do not offer medical grade information. Here, we report an integrated wearable ultrasonic bladder volume monitoring device for accurate and autonomous continuous monitoring of the bladder volume. The device incorporates flexible and air-backed ultrasonic transducers and miniaturized control electronics with wireless data transmission capability. We demonstrate the real-life application of the device on healthy volunteers with various bladder shapes and sizes with high accuracy. Apart from the lower urinary tract dysfunctions, the proposed technology could also be adapted for various wearable ultrasonic applications.

Effects of carvedilol on human prostate tissue contractility and stromal cell growth pointing to potential clinical implications

BACKGROUND

Apart from antagonizing ß-adrenoceptors, carvedilol antagonizes vascular α1-adrenoceptors and activates G protein-independent signaling. Even though it is a commonly used antihypertensive and α1-adrenoceptors are essential for the treatment of voiding symptoms in benign prostatic hyperplasia, its actions in the human prostate are still unknown. Here, we examined carvedilol effects on contractions of human prostate tissues, and on stromal cell growth.

METHODS

Contractions of prostate tissues from radical prostatectomy were induced by electric field stimulation (EFS) or α1-agonists. Growth-related functions were examined in cultured stromal cells.

RESULTS

Concentration-response curves for phenylephrine, methoxamine and noradrenaline were right shifted by carvedilol (0.1-10 µM), around half a magnitude with 100 nM, half to one magnitude with 1 µM, and two magnitudes with 10 µM. Right shifts were reflected by increased EC50 values for agonists, with unchanged Emax values. EFS-induced contractions were reduced by 21-54% with 0.01-1 µM carvedilol, and by 94% by 10 µM. Colony numbers of stromal cells were increased by 500 nM, but reduced by 1-10 µM carvedilol, while all concentrations reduced colony size. Decreases in viability were time-dependent with 0.1-0.3 µM, but complete with 10 µM. Proliferation was slightly increased by 0.1-0.5 µM, but reduced with 1-10 µM.

CONCLUSIONS

Carvedilol antagonizes α1-adrenoceptors in the human prostate, starting with concentrations in ranges of known plasma levels. In vitro, effect sizes resemble those of α1-blockers used for the treatment of voiding symptoms, which requires concentrations beyond plasma levels. Bidirectional and dynamic effects on the growth of stromal cells may be attributed to "biased agonism".

Immunomodulatory imide drugs inhibit human detrusor smooth muscle contraction and growth of human detrusor smooth muscle cells, and exhibit vaso-regulatory functions

BACKGROUND

The immunomodulatory imide drugs (IMiDs) thalidomide, lenalidomide and pomalidomide may exhibit therapeutic efficacy in the prostate. In lower urinary tract symptoms (LUTS), voiding and storage disorders may arise from benign prostate hyperplasia, or overactive bladder. While current therapeutic options target smooth muscle contraction or cell proliferation, side effects are mostly cardiovascular. Therefore, we investigated effects of IMiDs on human detrusor and porcine artery smooth muscle contraction, and growth-related functions in detrusor smooth muscle cells (HBdSMC).

METHODS

Cell viability was assessed by CCK8, and apoptosis and cell death by flow cytometry in cultured HBdSMC. Contractions of human detrusor tissues and porcine interlobar and coronary arteries were induced by contractile agonists, or electric field stimulation (EFS) in the presence or absence of an IMID using an organ bath. Proliferation was assessed by EdU assay and colony formation, cytoskeletal organization by phalloidin staining, RESULTS: Depending on tissue type, IMiDs inhibited cholinergic contractions with varying degree, up to 50 %, while non-cholinergic contractions were inhibited up to 80 % and 60 % for U46619 and endothelin-1, respectively, and EFS-induced contractions up to 75 %. IMiDs reduced viable HBdSM cells in a time-dependent manner. Correspondingly, proliferation was reduced, without showing pro-apoptotic effects. In parallel, IMiDs induced cytoskeletal disorganization.

CONCLUSIONS

IMiDs exhibit regulatory functions in various smooth muscle-rich tissues, and of cell proliferation in the lower urinary tract. This points to a novel drug class effect for IMiDs, in which the molecular mechanisms of action of IMiDs merit further consideration for the application in LUTS.

Efficacy, Satisfaction, and Compliance: Insights from 15 Years of Botulinum Toxin Use for Female Urgency Urinary Incontinence

Urgency urinary incontinence (UUI) refractory to medical treatment poses significant challenges despite advancements. This study evaluates the efficacy of intravesical botulinum toxin for UUI and identifies factors influencing treatment outcomes. Among 368 women receiving botulinum toxin injections, 74.5% achieved a complete discontinuation of pad usage. Predictors of efficacy included lower pre-treatment pad usage and the absence of prior sling placement. Patients often required repeat injections (60.3%), with younger age and satisfaction correlating with treatment repetition. The interval between injections averaged 18 months, influenced by logistical challenges and patient preferences. Despite concerns about diminishing efficacy, subjective perceptions did not align with objective findings. Limitations include retrospective analysis and heterogeneous clinical records. In conclusion, intravesical botulinum toxin is effective for UUI, with pre-treatment pad usage and sling placement history influencing outcomes and patient characteristics influencing treatment repetition.

Ligand-Receptor Interactions and Structure-Function Relationships in Off-Target Binding of the β3-Adrenergic Agonist Mirabegron to α1A-Adrenergic Receptors

The β3-adrenoceptor agonist mirabegron is available for the treatment of storage symptoms of overactive bladder, including frequency, urgency, and incontinence. The off-target effects of mirabegron include binding to α1-adrenoceptors, which are central in the treatment of voiding symptoms. Here, we examined the structure-function relationships in the binding of mirabegron to a cryo-electron microscopy structure of α1A. The binding was simulated by docking mirabegron to a 3D structure of a human α1A-adrenoceptor (7YMH) using Autodock Vina. The simulations identified two binding states: slope orientation involving 10 positions and horizontal binding to the receptor surface involving 4 positions. No interactions occurred with positions constituting the α1A binding pocket, including Asp-106, Ser-188, or Phe-312, despite the positioning of the phenylethanolamine moiety in transmembrane regions close to the binding pocket by contact with Phe-288, -289, and Val-107. Contact with the unique positions of α1A included the transmembrane Met-292 during slope binding and exosite Phe-86 during horizontal binding. Exosite binding in slope orientation involved contact of the anilino part, rather than the aminothiazol end, to Ile-178, Ala-103, and Asn-179. In conclusion, contact with Met-292 and Phe-86, which are unique positions of α1A, accounts for mirabegron binding to α1A. Because of its lack of interactions with the binding pocket, mirabegron has lower affinity compared to α1A-blockers and no effects on voiding symptoms.

The Prevalence and Related Risk Factors of Urinary Incontinence Among Adult Women in Al Medina Al Munawara, Saudi Arabia

Introduction Urinary incontinence (UI) is a common clinical problem. It has an impact on an individual's social, professional, psychological, and physical elements of life. The present study aimed to identify the prevalence of UI and associated risk factors among Saudi women in Al Medina Al Munawara, Saudi Arabia. Methods A cross-sectional study was conducted using an online questionnaire among 430 women aged 18-60 in Al Medina Al Munawara. The participants completed the validated Arabic version of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) to assess the prevalence of UI and its associated factors. Results Among the participants, 64.8% did not experience urine incontinence, while 17.8% reported slight, 14.0% reported moderate, and 3.3% reported severe incontinence. Stress incontinence caused by coughing or sneezing was the most common cause (48.6%), followed by before reaching the toilet (urge incontinence) (34.5%) and after urination (15.5%). Significant associations were found between age, marital status, number of children, diabetes mellitus, urinary tract diseases, previous abdominal or pelvic surgery, obesity, constipation, and menopausal symptoms. However, no significant association was found between pregnancy and urine incontinence. Conclusions This study reveals a moderate prevalence of UI among Saudi women in Al Medina Al Munawara. The findings highlight the importance of early detection, treatment, and education on pelvic floor exercises to address UI. Factors such as age, marital status, number of children, and various medical conditions are associated with this condition, emphasizing the need for comprehensive management strategies.

i-Flow: Design and evaluation of a wearable uroflowmeter with non-invasive low power bio-impedance sensing

Urological problems involving lower urinary tract symptoms (LUTS) such as urinary frequency, urgency, nocturia, and urine volume have a significant impact on patient health and quality of life. At present, clinical uroflowmeter tests and a urination frequency-volume chart (FVC) or bladder diary is recommended for monitoring the symptoms and the efficacy of treatment. However, these solutions are intermittent, needing high user compliance, repeated visits to the clinic and are inconvenient, especially for elderly patients. Such limitations lead to misdiagnosis and an inability to personalise treatments. This work proposes i-Flow, a low-power bio-impedance sensing system enabling wearable uroflowmetry. To demonstrate the effectiveness of the proposed solution, a preliminary dataset has been collected from 6 healthy subjects. Furthermore, the dataset acquired with a developed wearable system has been used to design a low-complexity, lightweight bladder voiding measurement algorithm and evaluates the overall hardware-software performance. In addition, repeatability tests on a single subject with multiple voiding instances (n=5) were conducted. The experimental evaluation demonstrates high-performance bladder voiding estimation with the total end volume (TEV) error for multi-subject voiding instances to be 38.4±18 ml. While the TEV error for repeated measures with a single subject was 21.7±15 ml for five voiding instances. The presented system for recording bladder voiding achieves an unobtrusive, comfortable and reliable method for automated recording of the frequency of voiding, the total voided volume and urine flowrate. Thus providing a means of conducting uroflowmetry tests in at-home settings while also maintaining a digital bladder diary devoid of human lapses. Such a system has the ultimate goal of assisting in diagnosis and personalizing treatment of LUTS.

Association between body roundness index and overactive bladder: results from the NHANES 2005-2018

BACKGROUND AND AIM

An increasing amount of research has indicated obesity greatly affects individuals with overactive bladder (OAB). However, traditional anthropometric methods present challenges in accurately assessing the likelihood of OAB. Hence, this study's objective was to identify the correlation between the body roundness index (BRI) and OAB.

METHODS

The research included 12,401 individuals who participated in the National Health and Nutrition Examination Survey spanning 2005-2018. The correlation between BRI and OAB was explored by using weighted multiple logistic regression and weighted restricted cubic spline (RCS). Subgroup analyses showed the associations based on different population types. The study also analyzed the predictive capability of various anthropometric indices, including BRI, body mass index, waist circumference, and weight, in assessing the likelihood of OAB through Receiver-operating characteristic (ROC) curves.

RESULTS

An independent positive correlation between OAB and BRI was identified after adjusting for potential confounders in weighted multivariate logistic models[odds ratio (OR) = 1.15, 95% confidence interval (CI), 1.12-1.17]. Weighted RCS analysis found a positive dose-response correlation between OAB and BRI. The effect size of BRI on OAB remained stable across all prespecified subgroups (all P for interactions > 0.05). In ROC analysis, BRI showed better discriminatory ability for OAB compared with other anthropometric measures for both genders (all P < 0.01). The best BRI cutoff for predicting OAB was lower for men (5.151) than for women (5.383), suggesting that men were more susceptible to changes in BRI than women.

CONCLUSIONS

This study demonstrated that a raised BRI is correlated with a higher likelihood of OAB. Due to the effectiveness and non-invasiveness of BRI in predicting OAB, it is expected to become the preferred method for early detection and management strategies.

The association between weight-adjusted-waist index and stress urinary incontinence in female adults: a population-based study

INTRODUCTION

Obesity has a significant impact on female stress urinary incontinence. The weight-adjusted-waist index (WWI), a newly explored metric for measuring physical obesity and stress urine incontinence, has not been investigated.

METHODS

Cross-sectional data were obtained from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES) of participants with complete data for WWI and SUI. The independent connection between WWI and SUI was examined using weighted multivariable logistic regression analyses. Smoothed curve fitting was used to study their relationship. In addition, subgroup analyses were performed, and interaction tests were undertaken.

RESULTS

In 2,361 female participants over 20, WWI and SUI showed a positive association. Model 3 found that for each one-unit increase in WWI, SUI prevalence increased by 38% [1.38 (1.20, 1.59)]. The prevalence of SUI was 84% higher among participants in the highest quartile of WWI compared to those in the lowest quartile [1.84 (1.32, 2.57)]. Observed nonlinear positive correlation between WWI and SUI was revealed through smoothed curve fitting. In addition, we found that WWI was more strongly associated with SUI than traditional indicators of obesity, including BMI and weight.

CONCLUSIONS

Females with higher weight-adjusted waist index levels were more likely to develop stress urinary incontinence and have a stronger correlation than traditional indicators of obesity. According to our research, WWI may help detect women's stress urinary incontinence (SUI), and managing obesity through the WWI index may reduce SUI prevalence rates.

A Dynamic Ultrasound Phantom with Tissue-Mimicking Mechanical and Acoustic Properties

Tissue-mimicking phantoms are valuable tools that aid in improving the equipment and training available to medical professionals. However, current phantoms possess limited utility due to their inability to precisely simulate multiple physical properties simultaneously, which is crucial for achieving a system understanding of dynamic human tissues. In this work, novel materials design and fabrication processes to produce various tissue-mimicking materials (TMMs) for skin, adipose, muscle, and soft tissue at a human scale are developed. Target properties (Young's modulus, density, speed of sound, and acoustic attenuation) are first defined for each TMM based on literature. Each TMM recipe is developed, associated mechanical and acoustic properties are characterized, and the TMMs are confirmed to have comparable mechanical and acoustic properties with the corresponding human tissues. Furthermore, a novel sacrificial core to fabricate a hollow, ellipsoid-shaped bladder phantom complete with inlet and outlet tubes, which allow liquids to flow through and expand this phantom, is adopted. This dynamic bladder phantom with realistic mechanical and acoustic properties to human tissues in combination with the developed skin, soft tissue, and subcutaneous adipose tissue TMMs, culminates in a human scale torso tank and electro-mechanical system that can be systematically utilized for characterizing various medical imaging devices.

Enzyme-induced hypoxia leads to inflammation in urothelial cells in vitro

PURPOSE

To determine the contributions of different durations of hypoxia to NLRP3 inflammasome activation in urothelial cells and how ischemic changes in bladder tissues is an important chemical que that leads to pathological changes seen in BOO.

METHODS

A rat urothelial cell line (MYP3) was exposed to either a short duration (2 h) or long duration (6 h) of enzyme-induced hypoxia. Following exposure to a short duration of hypoxia, NO and ATP concentrations were measured from supernatant media and caspase-1 levels were measured from cell lysates. In a separate experiment, cells were fixed following hypoxia exposure and immunostained for HIF-1α stabilization.

RESULTS

Although short exposure of low oxygen conditions resulted in a hypoxic response in MYP3 cells, as indicated by HIF-1α stabilization and increased NO activity, NLRP3 inflammasome activation was not observed as caspase-1 activity remained unchanged. However, exposure of MYP3 cells to a longer duration of hypoxia resulted in an increase in intracellular caspase-1 activity. Furthermore, treatment with antioxidant (GSH) or TXNIP inhibitor (verapamil) attenuated the hypoxia-induced increase in caspase-1 levels indicating that hypoxia primarily drives inflammation through a ROS-mediated TXNIP/NLRP3 pathway.

CONCLUSION

We conclude that hypoxia induced bladder damage requires a duration that is more likely related to elevated storage pressures/hypoxia, seen in later stages of BOO, as compared to shorter duration pressure elevation/hypoxia that is encountered in normal micturition cycles or early in the BOO pathology where storage pressures are still normal.

Incontinence and homelessness

The fundamental principles of why specific people become homeless, can be grounded in a simple rationale or founded within sophisticated reasoning. For instance, people who suffer from substance abuse, addiction, alcohol, gambling, have mental health concerns or financial difficulties may be susceptible to homelessness. It is also identified that persons who experienced violence in their childhood or abuse by a partner are at a higher risk of becoming homeless. Homelessness knows no ethnic, cultural, religious or gender boundaries, and can impact all individuals' health and well-being. A health problem and worldwide phenomenon that affects all cohorts of the population, including the homeless, is urinary incontinence. The aim of this article is to increase the awareness of incontinence and highlight the impact it has on the lives of people that experience homelessness.

Isoform-independent promotion of contractility and proliferation, and suppression of survival by with no lysine/K kinases in prostate stromal cells

With no lysine/K kinases (WNKs) promote vasocontraction and vascular smooth muscle cell proliferation. In the prostate, smooth muscle contraction and growth may be critical for the development and medical treatment of voiding symptoms in benign prostatic hyperplasia. Here, we examined the effects of isoform-specific WNK silencing and of the WNK inhibitor WNK463 on growth-related functions and contraction in prostate stromal cells, and in human prostate tissues. Impacts of WNK silencing by transfection of cultured stromal cells with isoform-specific siRNAs were qualitatively and quantitatively similar for each WNK isoform. Effects of silencing were largest on cell death (3-5 fold increase in annexin V-positive/7-AAD-positive cells), on proliferation rate, Ki-67 mRNA expression and actin organization (reduced around two-thirds). Contraction in matrix contraction assays and viability were reduced to a lower degree (approximately half), but again to a similar extent for each WNK isoform. Effects of silencing were quantitatively and qualitatively reproduced by 10 μM WNK463, while 1 μM still induced cell death and breakdown in actin organization, without affecting proliferation or viability. Using 500 nM and 10 μM, WNK463 partly inhibited neurogenic and U46619-induced contractions of human prostate tissues (around half), while inhibition of α1-adrenergic contractions (around half) was limited to 10 μM. All four WNK isoforms suppress cell death and promote proliferation in prostate stromal cells. WNK-driven contraction of stromal cells appears possible, even though to a limited extent. Outcomes of isoform-specific WNK silencing can be fully reproduced by WNK463, including inhibition of smooth muscle contraction in human prostate tissues, but require high concentrations.

Insights into the associative role of hypertension and angiotensin II receptor in lower urinary tract dysfunction

In men, the lower urinary tract comprises the urinary bladder, urethra, and prostate, and its primary functions include urine storage and voiding. Hypertension is a condition that causes multi-organ damage and an age-dependent condition. Hypertension and the renin-angiotensin system activation are associated with the development of lower urinary tract dysfunction. Hypertensive animal models show bladder dysfunction, urethral dysfunction, and prostatic hyperplasia. In the renin-angiotensin system, angiotensin II and the angiotensin II type 1 receptor, which are expressed in the lower urinary tract, have been implicated in the pathogenesis of lower urinary tract dysfunction. Moreover, among the several antihypertensives, renin-angiotensin system inhibitors have proven effective in human and animal models of lower urinary tract dysfunction. This review aimed to elucidate the hitherto known mechanisms underlying the development of lower urinary tract dysfunction in relation to hypertension and the angiotensin II/angiotensin II type 1 receptor axis and the effect of renin-angiotensin system inhibitors on lower urinary tract dysfunction. Possible mechanisms through which hypertension or activation of Ang II/AT1 receptor axis causes LUTD such as bladder dysfunction, urethral dysfunction, and prostatic hyperplasia. LUT: lower urinary tract, LUTD: lower urinary tract dysfunction, AT1: angiotensin II type 1, ACE: angiotensin-converting enzyme.

Urinary incontinence following successful closure of obstetric vesicovaginal fistula repair in Southern Ethiopia

BACKGROUND

Urinary incontinence (UI) after successful closure of obstetric vesicovaginal fistula (VVF) repair is a widely recognized public health problem. However, there is insufficient research evaluating the factors associated with UI after successful obstetric VVF repair in Ethiopia.

OBJECTIVES

The main aim of this study was to assess the magnitude and associated factors of UI following the successful closure of obstetric VVF repair at the Yirgalem Hamlin Fistula Center in the Sidama region of southern Ethiopia.

METHODS

A retrospective cross-sectional analytical study was performed on patients who underwent obstetric VVF repair at the Yirgalem Hamlin Fistula Center between 2016 and 2020. The data were collected from September to October 2021. EPI Data Version 3.1 and SPSS Version 25.0 were used for data entry and analysis. A multivariable binary logistic regression model was used for all variables significant in the bivariate binary logistic analysis to determine the association between the independent variables and outcome variables. The data are presented in tables and figures. Variables with a p-value < 0.05 were considered to be statistically associated with the study outcome.

RESULTS

In total, 499 study subjects were included. The magnitude of UI after successful closure of obstetric VVF repair was 23.25%. A Goh type 4 fistula (AOR = 4.289; 95% CI 1.431, 12.852), a fistula size > 3 cm (AOR = 8.855; 95% CI 4.786, 16.382), a partially damaged urethra (AOR = 2.810; 95% CI 1.441, 5.479), and a completely destroyed urethra (AOR = 5.829; 95% CI 2.094, 16.228) were found to be significantly associated factors with the outcome variable.

CONCLUSIONS

Nearly one in four patients who had successful closure of obstetric VVF repair at the Yirgalem Hamlin fistula center had UI, which is above the WHO recommendations. The presence of a Goh type 4 fistula, large fistula size, and damaged urethral status significantly affect the presence of UI. Therefore, interventions are necessary to prevent and manage UI among patients who underwent obstetric VVF repair and had a closed fistula.

Urinary incontinence associates with poor work ability in middle-aged women: A Northern Finland Birth cohort 1966 study

INTRODUCTION

Urinary incontinence is a common ailment in women and is likely to affect their work ability. We investigated the associations between the different subtypes of urinary incontinence and several dimensions of perceived work ability in middle-aged general population.

MATERIAL AND METHODS

Cross-sectional survey at age 46 among participants of the Northern Finland Birth Cohort 1966 study (n = 3706, response rate 72%). Urinary incontinence symptoms and several items of Work Ability Index were collected by postal questionnaire. Work ability was dichotomized as good or poor work ability in general, in relation to physical job demands, to diseases and own 2-year prospect of work ability. The associations between urinary incontinence and work ability measures were assessed using logistic regression models, with further adjustments for biological, behavioral and work-related factors as well as general health.

RESULTS

The odds ratio (OR), from lowest to highest, for poor work ability were 1.4-fold among women with stress urinary incontinence (OR 1.37, 95% confidence interval [CI] 1.09-1.72), 2.5-fold with mixed urinary incontinence (OR 2.51, 95% CI 1.68-3.74) and 3.3-fold with urgency urinary incontinence (OR 3.34, 95% CI 1.95-5.70). We note that our results reflect work ability in a Nordic society.

CONCLUSIONS

Especially urgency and mixed types of urinary incontinence are associated with poor work ability among middle-aged women.

Sleep-related disorders and lower urinary tract symptoms in middle-aged and elderly males: a cross-sectional study based on NHANES 2005-2008

PURPOSE

Lower urinary tract symptoms (LUTS) and sleep disorders both commonly affect people's quality of life. This study aimed to explore the associations between sleep-related disorders and LUTS through epidemiological investigations.

METHODS

Data were generated from the cross-sectional study called the National Health and Nutrition Examination Survey (NHANES) 2005-2008. Multivariable logistic regression models were conducted to investigate the relationships between sleep-related disorders and LUTS.

RESULTS

A total of 2516 men were included in the study. Participants sleeping ≤ 6 h/night had higher odds ratios of LUTS (OR: 1.38; 95% CI 1.08, 1.77), daytime LUTS (OR: 1.26; 95% CI 1.03, 1.54), and nocturia (OR: 1.23; 95% CI 1.02, 1.49) than those sleeping 7-8 h/night. Participants who required > 30 min to fall asleep had an approximately 39% higher odds ratios of nocturia than those who fell asleep within 6 to 30 min (OR: 1.39; 95% CI 1.12, 1.73). Sleep problems were positively related to LUTS (OR: 1.42; 95% CI 1.11, 1.82), daytime LUTS (OR: 1.32; 95% CI 1.08, 1.61), urinary hesitancy (OR: 1.75; 95% CI 1.31, 2.34), and nocturia (OR: 1.52; 95% CI 1.26, 1.84). Obstructive sleep apnea (OSA) symptoms were positively associated with urinary incontinence (OR: 1.52; 95% CI 1.12, 2.08). In addition, participants with daytime sleepiness were at higher prevalence of LUTS (OR: 1.66; 95% CI 1.29, 2.15), daytime LUTS (OR: 1.44; 95% CI 1.16, 1.78), urinary hesitancy (OR: 1.95; 95% CI 1.45, 2.63), and nocturia (OR: 1.66; 95% CI 1.35, 2.05).

CONCLUSION

The findings suggested that sleep-related disorders were associated with LUTS, daytime LUTS, urinary hesitancy, incomplete emptying, urinary incontinence, and nocturia in middle-aged and elderly males.

Correlation between metabolic syndrome and periurethral prostatic fibrosis: results of a prospective study

BACKGROUND

Prostatic fibrosis, characterized by the accumulation of myofibroblasts and collagen deposition, is closely associated with LUTS and may lead to mechanical obstruction of the urethra. Additionally, Metabolic Syndrome (MetS), characterized by central obesity, high blood sugar, lipid metabolism disorders, and hypertension, is increasingly recognized as a proinflammatory condition linked to prostate inflammation.

METHODS

Clinical data from 108 subjects who underwent transurethral resection of the prostate or bipolar plasmakinetic enucleation of the prostate were prospectively collected between June 2021 and August 2022. Patients were divided in two groups according to whether or not they had a diagnosis of MetS. Specimens were stained with Masson trichrome and the periurethral prostatic fibrosis extent was evaluated using quantitative morphometry.

RESULTS

Forty-three patients (39.8%) were diagnosed with MetS. Patients with MetS showed a significantly greater extent of prostatic fibrosis than the others (68.1 ± 17.1% vs. 42.5 ± 18.2%, P < 0.001), and there was a positive correlation between the number of positive MetS parameters and the extent of prostatic fibrosis (R2 = 0.4436, P < 0.001). Multivariate regression analysis revealed that central obesity (B = 2.941, 95% confidence interval, 1.700-3.283), elevated fasting glucose (B = 1.036, 95% confidence interval, 0.293-1.780), reduced HDL cholesterol (B = 0.910, 95% confidence interval, 0.183-1.636) and elevated triglycerides (B = 1.666, 95% confidence interval, 0.824-2.508) were positively correlated to prostatic fibrosis. Elevated blood pressure, however, was unrelated to prostatic fibrosis (B = 0.009, 95% confidence interval, -0.664-0.683).

CONCLUSIONS

The present findings suggest that prostatic fibrosis is positively correlated with MetS and its components including central obesity, elevated fasting glucose, reduced high density lipoprotein cholesterol and elevated triglycerides.

Targeting Thbs1 reduces bladder remodeling caused by partial bladder outlet obstruction via the FGFR3/p-FGFR3 pathway

BACKGROUND

Partial bladder outlet obstruction (pBOO) may lead to bladder remodeling, including fibrosis and extracellular matrix (ECM) deposition. Despite the extensive research on the mechanisms underlying pBOO, potential therapeutic targets for the treatment of pBOO require further research. Dysregulated expression of thrombospondin-1 (Thbs1) has been reported in various human fibrotic diseases; however, its relationship with pBOO remains unclear.

AIMS

Investigate the effects of Thbs1 on bladder remodeling caused by pBOO.

METHODS

We established a pBOO model in Sprague-Dawley rats and performed urodynamic analyses to estimate functional changes in the bladder, validated the histopathological changes in the bladder by using haematoxylin-eosin and Masson's trichrome staining, identified key target genes by integrating RNA sequencing (RNA-seq) and bioinformatics analyses, validated the expression of related factors using Western blot analysis and RT-qPCR, and used immunofluorescence staining to probe the potential interaction factors of Thbs1.

RESULTS

Urodynamic results showed that pressure-related parameters were significantly increased in rats with pBOO. Compared with the sham group, the pBOO group demonstrated significant increases in bladder morphology, bladder weight, and collagen deposition. Thbs1 was significantly upregulated in the bladder tissues of rats with pBOO, consistent with the RNA-seq data. Thbs1 upregulation led to increased expression of matrix metalloproteinase (MMP) 2, MMP9, and fibronectin (Fn) in normal human urinary tract epithelial cells (SV-HUC-1), whereas anti-Thbs1 treatment inhibited the production of these cytokines in TGF-β1-treated SV-HUC-1. Further experiments indicated that Thbs1 affected bladder remodeling in pBOO via the fibroblast growth factor receptor 3 (FGFR3) pathway.

CONCLUSIONS

Thbs1 plays a crucial role in bladder remodeling caused by pBOO. Targeting Thbs1 might alleviate ECM damage. Mechanistically, Thbs1 may function via the FGFR signaling pathway by regulating the FGFR3 receptor, identified as the most relevant disease target of pBOO, and FGF2 may be a mediator. These findings suggest that Thbs1 plays a role in BOO development and is a therapeutic target for this condition.

Organ-specific off-target effects of Pim/ZIP kinase inhibitors suggest lack of contractile Pim kinase activity in prostate, bladder, and vascular smooth muscle

Smooth muscle contraction by Pim kinases and ZIPK has been suggested, but evidence for lower urinary tract organs or using Pim-selective inhibitor concentrations is not yet available. Here, we assessed effects of the Pim inhibitors AZD1208 and TCS PIM-1 and the dual ZIPK/Pim inhibitor HS38 on contractions of human prostate and bladder tissues and of porcine interlobar arteries. Human tissues were obtained from radical prostatectomy and radical cystectomy and renal interlobar arteries from pigs. Contractions were studied in an organ bath. Noradrenaline-, phenylephrine- and methoxamine-induced contractions were reduced (up to > 50%) with 500-nM AZD1208 in prostate tissues and to lesser degree and not consistently with all agonists in interlobar arteries. A total of 100-nM AZD1208 or 500-nM TCS PIM-1 did not affect agonist-induced contractions in prostate tissues. Decreases in agonist-induced contractions with 3-µM HS38 in prostate tissues and interlobar arteries were of small extent and did not occur with each agonist. Carbachol-induced contractions in detrusor tissues were unchanged with AZD1208 (500 nM) or HS38. Electric field stimulation-induced contractions were not affected with AZD1208 or HS38 in any tissue, but slightly reduced with 500-nM TCS PIM-1 in prostate tissues. Concentration-dependent effects of Pim inhibitors suggest lacking Pim-driven smooth muscle contraction in the prostate, bladder, and interlobar arteries but point to organ-specific functions of off-targets. Procontractile functions of ZIPK in the prostate and interlobar arteries may be limited and are lacking in the detrusor.