Search Results (199)

Introduction: Although lipomas are common benign tumors found in adults, lipomas of the bladder are extremely rare. Bladder lipomas are infrequently reported in the urologic literature, with only 19 cases published worldwide. These can present as a mass on cystoscopy and cause irritative voiding symptoms, depending on their location. Upon transurethral resection, seeing fat can be concerning for a perforation, as lipoma can be mistaken for extravesical fat. Hence, familiarity with this rare entity is of paramount importance for urologists to prevent unnecessary investigations and interventions that are needed in case of a true bladder perforation. Case presentation: This study presents a case of bladder lipoma in a 73-year-old male with end-stage renal disease who presented for pretransplant urologic evaluation due to microscopic hematuria and irritative lower urinary tract symptoms (LUTS). During cystoscopy, a bladder mass was seen, and a transurethral resection of the bladder tumor (TURBT) revealed bright yellow adipose tissue immediately underneath the bladder mucosa. Concerns about perforation were obviated when seeing intact detrusor muscle underneath, visually confirming the integrity of the bladder wall. The resection was completed, and the CT scan was re-read with the radiologist, which confirmed the presence of a lipoma that was missed pre-operatively due to patient’s oliguria and collapsed bladder. No catheter drainage or cystogram was performed based on these findings. Outcome: The patient healed without any complications. Histopathology confirmed the diagnosis of a mature lipoma. The patient was cleared for transplant from a urologic standpoint and had a successful renal transplantation without delay. Discussion: This case documents the anomalous occurrence of a lipoma within the bladder and supports maintaining a broad differential, including liposarcoma, angiomyolipoma, and other non-malignant fatty tumors during the evaluation of a bladder mass. Full article

Spinal cord injury (SCI) frequently leads to neurogenic lower urinary tract dysfunction, for which appropriate bladder management is essential. While clinical care relies on continuous low-pressure drainage in the acute phase, rat models commonly use twice-daily manual bladder expression—a method known to generate high intravesical pressures and retention. This study evaluated the impact of this standard practice on bladder tissue remodeling by comparing it to continuous drainage via high vesicostomy in a rat SCI model. 32 female Lewis rats underwent thoracic contusion SCI and were assigned to either manual expression or vesicostomy-based bladder management. Over eight weeks, locomotor recovery, wound healing, and bladder histology were assessed. Vesicostomy proved technically simple but required tailored wound care and calibration. Results showed significantly greater bladder wall thickness, detrusor muscle hypertrophy, urothelial thickening, collagen deposition, and mast cell infiltration in the manual expression group compared to both vesicostomy and controls. In contrast, vesicostomy animals exhibited near-control levels across most parameters. These findings highlight that commonly used bladder emptying protocols in rat SCI models may overestimate structural bladder changes and inflammatory responses. Refined drainage strategies such as vesicostomy can minimize secondary damage and improve the translational relevance of preclinical SCI research. Full article

Introduction: Overactive bladder (OAB) and urinary incontinence (UI) are prevalent, particularly in older adults, and affect quality of life. OAB involves urgency, frequency, nocturia, and urgency incontinence, often linked to involuntary detrusor contractions. Treatment guidelines recommend a stepwise approach, starting with pelvic floor muscle training (PFMT), followed by pharmacological or minimally invasive therapies, such as neuromodulation. However, the combined effects of PFMT and neuromodulation have not been well established. This study aimed to evaluate the impact of combining pelvic floor exercises with neuromodulation versus PFMT with sham neuromodulation or standard physiotherapy after a 12-week intervention in individuals with OAB and UI. Methods/Materials: A double-blind, randomized controlled trial was designed with three groups: PFMT + neuromodulation, PFMT + sham, and conventional physiotherapy (control) in a 1:1:1 ratio. This study followed the CONSORT guidelines and was registered at ClinicalTrials.gov (NCT06783374). The sample size was calculated using GPower^® software, assuming a Cohen’s effect size of 1.04, a power of 0.80, an alpha of 0.05, and a 15% dropout rate, totaling 63 participants (21 per group). Participants attended 24 sessions over 12 weeks (2 sessions per week). The interventions were based on previously validated protocols. Outcomes: The primary outcomes included health-related quality of life, pelvic floor muscle function, pain, adherence, and general health. The secondary outcomes included Incontinence Quality of Life questionnaire, 3-day bladder diary, International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form, kinesiophobia, and electromyographic data. Full article

Background/Objectives: Overactive bladder (OAB), common in elderly women, involves urgency, frequency, and nocturia, with complex phenotypes. The use of neurotrophins as non-invasive urinary biomarkers has been previously explored. The objective of this study was to assess the diagnostic and therapeutic utility of urinary biomarkers in a Canadian population of aging female OAB patients. Methods: We conducted a single-center prospective study of aging female patients diagnosed with OAB and age-matched healthy controls, where we conducted pre- and post-treatment assessments using a combination of clinical questionnaires, voiding diaries, and urinary biomarkers nerve growth factor (NGF), proform of NGF (proNGF), brain-derived neurotrophic factor (BDNF), proform of BDNF (proBDNF), and neurotrophin receptor p75 extracellular domain (p75^ECD)) quantified using ELISA. Baseline and post-treatment urinary biomarker levels in OAB patients were compared with those of controls. Results: OAB patients and controls at baseline displayed significant differences in neurotrophin levels and in their ratios of mature/precursors. In the post-treatment OAB cohort, only NGF and proNGF exhibited significant improvement correlating with clinical symptom relief. Biomarkers in non-responders remained unchanged, suggesting heterogeneity in therapeutic response. Conclusions: Urinary neurotrophins show promise as non-invasive diagnostic markers of OAB and monitoring treatment response in aging female patients. While this study focused on patients broadly diagnosed with OAB, future research should aim to classify OAB subtypes—such as those based on urodynamic studies or underlying pathophysiology—to better understand how urinary neurotrophins can differentiate between mechanisms like detrusor overactivity, detrusor underactivity, or bladder outlet obstruction. This will enhance their relevance in guiding personalized treatment strategies and predicting outcomes. Full article

Background/Objectives: Intradetrusor botulinum toxin injection is a well-established third-line therapy for patients with refractory overactive bladder (OAB) and detrusor overactivity (DO). Botulinum toxin type A (BoNT-A) is most commonly used due to its prolonged therapeutic duration. We aimed to evaluate the effectiveness of intradetrusor BoNT-A injection therapy in managing refractory OAB by performing a urodynamic study (UDS). Methods: The patients were prospectively enrolled between February 2020 and March 2021. The patients received treatment regimens comprising behavioral modification therapy, pelvic floor muscle physiotherapy, and/or OAB medications for at least three months. The UDS procedure was carried out by a single examiner, in accordance with the International Continence Society standards for good urodynamic practice. A total of 100 units of BoNT-A was dissolved in 10 mL of saline, and 0.5 mL (5 units) was injected at 20 sites on the posterior wall of the bladder. The primary endpoint was the change in DO, which was measured using the UDS from the baseline to two months after treatment with BoNT-A. Results: Prior to treatment initiation, DO was observed in all the patients during the UDS. The occurrence of DO during the filling phase demonstrated a significant decrease following treatment, with DO no longer identified in 27.3% of the patients. The first sensation of bladder filling, maximum cystometric capacity, DO, and terminal DO all demonstrated significant improvement after intradetrusor BoNT-A injection, based on the UDS. The OAB symptom scores also significantly decreased after BoNT-A therapy. Conclusions: The present study demonstrated that intradetrusor BoNT-A injection significantly improved symptoms in patients with OAB who had been unresponsive to various treatments. This study also demonstrated the usefulness of performing a UDS before and after treatment to prove the efficacy of BoNT-A. Full article

Bladder dysfunction is among the most drastic and quality-of-life-reducing conditions after spinal cord injury (SCI). Neuroinflammation in the lower urinary tract (LUT) after SCI could be a key driver of neurogenic bladder dysfunction and tissue fibrosis. Leukotrienes, a group of highly active lipid mediators, are potent inflammatory mediators. Here, we explored the potential of early montelukast (MLK) therapy, a cysteinyl leukotriene receptor 1 antagonist, on LUT function and structure four weeks after severe SCI in rats. Rats (strain Lewis, female, n = 50) received a permanent bladder catheter, followed by a complete T9 spinal cord transection. MLK was given daily, starting on day one post-injury. Bladder and locomotor function were regularly assessed. Bladder tissue was histologically and immunhistochemically analyzed. Post-SCI, MLK concentrations in plasma and cerebrospinal fluid were clinically relevant. MLK improved bladder functionality. MLK had no impact on smooth muscle alignment and uroepithelial integrity at this early SCI time point. This pilot study gave first insights into early, continuous oral MLK treatment with the first promising results of preserved LUT function and possible subsequent improved tissue integrity. Full article

Bladder neck dysfunction (BND) is a pathophysiology associated with voiding dysfunction in patients with neurogenic or non-neurogenic voiding dysfunction. Botulinum toxin A (BoNT-A) injection is a minimally invasive alternative for treating bladder outlet dysfunction; however, its efficacy for BND has not been well established. In this retrospective study, 41 patients with videourodynamic study-confirmed BND who failed medical therapy received a transurethral bladder neck injection of 100-U BoNT-A. Treatment outcomes were assessed using the Global Response Assessment. After BoNT-A injection, the patients were followed up and subsequent urological management was recorded. At 6 months, 65.9% of the patients reported satisfactory outcomes (26.8% successful and 39.0% improved). Patients with non-neurogenic BND had the highest satisfaction rate, higher than those with neurogenic BND (NBND) with and without detrusor sphincter dyssynergia (DSD). Among patients without detrusor acontractility (DA), a higher bladder outlet obstruction index predicted treatment failure. Patients with pure BND confirmed by urodynamics may benefit more from BoNT-A injections, whereas those with high baseline voiding detrusor pressure or spinal cord injury with detrusor sphincter dyssynergia may have less favorable results. Bladder neck BoNT-A injections for treating BND-associated voiding dysfunction did not achieve very successful outcomes. Only 26.8% of the patients had successful treatment outcomes, while 39.0% had improved outcomes and 34.1% failed the treatment. Full article

Background: Detrusor underactivity (DU) and bladder outlet obstruction (BOO) are common causes of voiding dysfunction in women with lower urinary tract symptoms (LUTS). However, differentiating between them remains challenging due to overlapping clinical presentations and a reliance on invasive urodynamic studies (UDS). This study aimed to develop a non-invasive, office-based clinical prediction model to distinguish DU from BOO in women with non-neurogenic LUTS. Methods: We conducted a retrospective analysis of 88 women who underwent pressure-flow studies at two outpatient clinics between 2012 and 2022. DU was defined using a projected isovolumetric pressure 1 (PIP1) < 30 cm H₂O, and BOO was defined by a Female-Specific Bladder Outlet Obstruction Index (BOOIf) > 18. Clinical symptoms, uroflowmetry (UFL) parameters, and pelvic organ prolapse staging (POP-Q) were evaluated. A multivariate logistic regression model was constructed using a stepwise selection procedure. Results: Of the 88 patients, 38 (43.2%) were diagnosed with DU and 50 (56.8%) with BOO. Four predictors were retained in the final model: hesitancy (OR = 2.06, p = 0.18), incomplete emptying (OR = 3.52, p = 0.02), POP-Q < 3 (OR = 0.15, p = 0.02), and longer time to Qmax on UFL (OR = 1.05, p = 0.004). The model achieved a Harrell’s Concordance Index (C-index) of 0.779. Using a probability cutoff of 0.3, the model demonstrated a sensitivity of 86.8%, specificity of 46.0%, positive predictive value of 55.0%, and negative predictive value of 82.1%. Conclusions: We present a novel non-invasive prediction model incorporating clinical symptoms, UFL metrics, and pelvic exam findings that may aid in differentiating DU from BOO in women with LUTS. Full article

Background: Pediatric neurogenic bladder (NB), often resulting from myelomeningocele, impairs bladder function due to disrupted neural control and is worsened by urinary retention, recurrent urinary tract infections, the absence of voluntary voiding, and additional sequelae of myelomeningocele, such as motor impairments, delayed colonic transit, and nutritional deficiencies. Oxidative stress arises from an imbalance between oxidant production and the body’s antioxidant defenses and is recognized as both a contributor to and a consequence of various pathological conditions. This study aims to assess the total antioxidant status (TAS) in NB patients, evaluate its impact on urinary antioxidants, and correlate the findings with the urodynamic parameters in NB patients compared to those in non-NB controls. Methods: This study included 29 patients with NB, who were compared with 57 non-NB individuals. The comparative analyses encompassed serum and urinary total antioxidant status normalized to creatinine (uTAS/creatinine) and renal function markers (creatinine, urea, uric acid, and the glomerular filtration rate [GFR]), as well as urodynamic findings. TAS was determined using the colorimetric ABTS method. Results: The patients with NB demonstrated a significantly lower serum TAS and elevated urinary TAS and uTAS/creatinine ratios in comparison to these values in the control group (p < 0.001). Furthermore, a positive correlation was observed between uTAS/creatinine and detrusor pressure at the maximum cystometric capacity, while a negative correlation was found between uTAS/creatinine and bladder wall compliance (r = 0.5, r = −0.68 respectively). Conclusions: The observed decrease in serum TAS and the increase in urinary TAS in NB may not only serve as evidence of an imbalance in antioxidant homeostasis but also suggest a potential contributory role to the deterioration of urodynamic function. Full article

Background: Mixed urinary incontinence (MUI), particularly the urge-predominant subtype, involves both stress urinary incontinence (SUI) and urge urinary incontinence (UUI), posing a therapeutic challenge. Duloxetine, a serotonin–norepinephrine reuptake inhibitor (SNRI), enhances urethral tone, while tolterodine, an antimuscarinic agent, reduces detrusor overactivity. Their combination may offer synergistic benefits. Aim: The aim of this study was to evaluate the efficacy of duloxetine and tolterodine combination therapy in urge-predominant MUI and identify factors influencing treatment success. Method: A retrospective study was conducted on 106 patients (mean age: 56.45 years) with urge-predominant MUI treated with duloxetine (40 mg twice daily) and tolterodine (4 mg once daily) for 12 weeks. Treatment outcomes were evaluated using the overactive bladder symptom score (OABSS), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), 24 h pad test, and Clinical Global Impression Scale (CGI). Univariate and multivariate regression analyses were performed to determine predictors of success. Results: Significant improvements were observed: OABSS decreased from 11.08 to 6.95, ICIQ-SF decreased from 15.69 to 8.84, and pad use decreased from 3.58 to 0.73/day (all p 0.0001). Bladder capacity increased from 315.09 mL to 436.32 mL. Baseline ICIQ-SF scores were independent predictors of success (odds ratio [OR] = 2.919, p = 0.001). Patient satisfaction reached 77.4%, with mild side effects (constipation and dizziness) in 14 patients. Conclusions: Duloxetine and tolterodine combination therapy significantly improved symptoms and quality of life in urge-predominant MUI. Baseline ICIQ-SF scores may predict treatment success. Further prospective studies are needed. Full article

Introduction and Objectives: Onabotulinum toxin A (BTXA) is an effective treatment for refractory idiopathic overactive bladder (iOAB). Given the wide spectrum of patient factors and combination of symptoms, a tailored approach to management is needed. This scoping review assesses injection paradigms for iOAB. Prior studies have established the safety and efficacy of BTXA injections, and this review focuses on exploring variations in injection techniques that may inform more tailored approaches and support future research toward optimizing patient outcomes. Methods: We conducted a systematic literature search. Inclusion criteria included full-text English language and primary research studies assessing outcomes in adults undergoing BTXA for iOAB. Findings are summarized using narrative synthesis. Results: Forty-three articles were identified. Key findings include fewer injections (1–10 vs. 20–40) maintains efficacy while reducing procedure time, discomfort, and retreatment hesitancy. Durability appears to be lower with suburothelial and bladder base injections and higher with detrusor and bladder body injections, though these may carry an increased risk of urinary retention requiring clean intermittent catheterization. Trigone inclusion appears safe and effective without increased vesicoureteral reflux risk. Conclusions: Study heterogeneity and inconsistent reporting limit strong conclusions. Included injection paradigms demonstrated efficacy, high tolerability, symptom relief, and quality-of-life improvements with few adverse events. Further research is needed to refine optimal injection strategies to enhance patient comfort, maximize efficacy, and minimize adverse events. Future studies should ensure comprehensive data collection to clarify these associations. Full article

Neurogenic detrusor overactivity (NDO) is a complex condition associated with detrusor overactivity, reduced bladder compliance, and high intravesical pressures, potentially leading to urinary tract infections (UTIs) and renal impairment. This retrospective study evaluated the safety and potential efficacy of intravesical botulinum toxin A (BoNT/A) injections in children with NDO at a single institution. Eighteen pediatric patients (median age: 8.1 years) were followed for a median of 6.3 years. At follow-up, 77.8% achieved a global response assessment (GRA) score of ≥2. A statistically significant improvement was found in cystometric bladder capacity (p = 0.041), but it did not remain significant after Bonferroni correction, while other urodynamic trends were not statistically significant. Adverse events were infrequent, with only 11.8% experiencing mild febrile UTIs. While some patients with poorer baseline bladder conditions reported greater subjective improvement, no statistically significant predictors of success were identified. Overall, intravesical BoNT/A injection appears to be a safe and potentially effective option for managing pediatric NDO, though larger prospective studies are needed to confirm these findings. Full article

Botulinum toxin A (BTX-A) injection into the detrusor vesicae is an established therapy for neurogenic lower urinary tract dysfunction as well as idiopathic overactive bladder. Pelvic radiotherapy causes comparable lower urinary tract symptoms (LUTS) in a third of radiated patients. Little is known about the effects of BTX-A injections into the detrusor vesicae in the management of radiogenic LUTS. Our aim was to assess the effect of BTX A injections on these symptoms and related quality of life. Material and Methods: In total, 28 patients with BTX-A injections for radiogenic LUTS were assessed retrospectively. We analyzed symptoms recorded in bladder diaries, the results of quality-of-life questionnaires (ICIQ-LUTSqol), and urodynamic studies (UDS) before and after BTX-A injections. Results: A significant reduction in daily micturition frequency, nocturia, and pad consumption was demonstrated in the overall cohort and in gender-related subgroup analysis. There was a significant decrease in the ICIQ-LUTSqol independent of gender or BTX-A units. For UDS maximum cystometric bladder capacity (188.0 vs. 258.2 mL, p = 0.043), micturition volume (138.2 vs. 216.7 mL, p = 0.018), and first desire to void (98.2 vs. 171.2 mL, p = 0.042) was significantly improved. No side effects of the toxin injection or urinary retention were observed. Conclusions: Intradetrusor injection therapy with BTX-A could represent a safe and effective therapeutic option for radiogenic LUTS with increasing quality of life, reductions in symptoms, and the improvement of urodynamic parameters. Full article

This paper proposes a machine learning-based modeling and multi-objective optimization method for transcutaneous energy transfer coils to address the problem that current transcutaneous energy transfer coils with single-objective optimization design methods have difficulty achieving optimal solutions. From modeling to multi-objective optimization design, the whole transcutaneous energy transfer coil process is covered by this approach. This approach models transcutaneous energy transfer coils using the Extreme Learning Machine, and the Gray Wolf Optimization algorithm is used to tune the Extreme Learning Machine’s parameters in order to increase modeling accuracy. The Non-Dominated Sorting Whale Optimization algorithm is utilized for multi-objective optimization of the transcutaneous energy transfer coils, which is based on the established model. Using the optimization of planar helical coils applied in artificial detrusors as an example, a verification analysis was conducted, and the final optimization analysis results were demonstrated. The results indicate that the Gray Wolf Optimization algorithm significantly outperforms the comparison algorithms in tuning the parameters of the Extreme Learning Machine model, and it exhibits good convergence ability and stability. The established transcutaneous energy transfer coil prediction model outperforms the comparative prediction model in terms of evaluation metrics for predicting the three outputs (transmission efficiency, coupling coefficient, and secondary coil diameter), demonstrating excellent prediction performance. The Non-Dominated Sorting Whale Optimization algorithm performs well in the multi-objective optimization process of transcutaneous energy transfer coils, showing excellent results. The Pareto optimal solutions obtained using this algorithm have errors of 3.03%, 0.1%, and 1.7% for transmission efficiency, coupling coefficient, and secondary coil diameter, respectively, when compared to the simulation and experimental calculations. The small errors validate the correctness and effectiveness of the proposed method. Full article

Background/Objectives: Conventional transurethral resection of bladder tumor (TURBT) for non-muscle invasive bladder cancer (NMIBC) is usually performed in a piecemeal manner, leading to difficulties in accurate pathological assessment. En bloc resection of bladder tumor (ERBT) has been developed to address these limitations, offering improved specimen quality. So far, ERBT has been restricted to small bladder tumors due to difficulties in en bloc extraction of large ones (>3 cm). Recently, the morcellation technique has been proposed to facilitate the removal of large bladder tumors during ERBT. This narrative review aims to evaluate the feasibility of ERBT with subsequent morcellation for large bladder tumors, focusing on its role in tumor extraction and its impact on pathological assessment. Methods: A comprehensive literature search was conducted across multiple databases to identify studies evaluating the use of morcellation in ERBT for large bladder tumors. Inclusion criteria comprised studies reporting recurrence rates, detrusor muscle (DM) presence in pathological specimens, and perioperative complications. Additionally, we offered uropathologists a questionnaire to gather their perspectives on the use of morcellation following ERBT, focusing on its impact on pathological assessment, margin evaluation, and staging accuracy. Results: While there is limited evidence on the use of morcellation in ERBT for tumors larger than 3 cm and its impact on oncologic outcomes, morcellation has shown potential in facilitating the retrieval of large tumor specimens, ensuring clear resection margins and accurate staging. However, the learning curve for morcellation techniques and the need for specialized equipment may limit widespread adoption. Conclusions: Morcellation in ERBT for large bladder tumors represents a promising advancement in the management of these challenging cases, offering adequate pathological assessment and oncologic outcomes. Pathologists’ reviews of morcellated specimens will likely further validate the technique. Continued research and technological innovations are necessary to optimize its implementation in clinical practice. Full article