Clinical, Translational, and Basic Research and Novel Therapy on Functional Bladder Diseases and Lower Urinary Tract Dysfunctions

Topic Information

Dear Colleagues,

Recently, the diagnosis and treatment of functional urology have attracted great attention in urology, gynecology, and neurology. Although functional bladder diseases and lower urinary tract symptoms (LUTS) do not usually immediately affect general health, LUTS have been found to have a great impact on mental health and quality of life. Clinically, these bladder diseases and bladder outlet dysfunction result in storage and emptying symptoms. There is a wide spectrum of overlap between bladder and bladder outlet diseases—for example, patients with an overactive bladder or interstitial cystitis may have bladder storage symptoms and voiding dysfunction, and bladder hypersensitivity could result in a dysfunctional voiding. Male patients with bladder outlet obstruction may also have overactive bladder symptoms in addition to voiding difficulty. Furthermore, bladder dysfunction in patients with spinal cord injury may influence upper urinary tract health and recurrent urinary tract infection. Lower urinary tract dysfunction (LUTD) might also be an early neurological sign of central nervous system disease, such as cerebral ischemia, Parkinson’s disease, or early dementia. Conducting urodynamic and electrophysiology studies enables us to understand the etiology and physiology of LUTD. Using urine protein analysis, it is possible to diagnose different LUTDs and identify the pathophysiology of bladder or bladder outlet diseases. These clinical and research advances have brought the treatment of bladder diseases and LUTD to a new era. The diagnosis of LUTD is not only predicated on examining clinical symptoms and images but also on urodynamics, electrophysiology, and perhaps in the future, urine biomarkers analysis. The treatment of functional LUTD may include medicines, injecting agents, and surgical intervention.

This Topic welcomes articles from clinical, translational, and basic research on any bladder diseases and LUTD, such as male or female bladder outlet obstruction, interstitial cystitis, overactive bladder syndrome, detrusor underactivity, neurogenic lower urinary tract dysfunction due to spinal cord injury, or central nervous diseases. With the collection of these articles, we hope to further advance functional urology.

Prof. Dr. Hann-Chorng Kuo
Dr. Yao-Chi Chuang
Dr. Chun-Hou Liao
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Biomedicines biomedicines	3.9	6.8	2013	17 Days	CHF 2600	Submit
Diseases diseases	3.0	3.7	2013	22.7 Days	CHF 1800	Submit
Journal of Clinical Medicine jcm	2.9	5.2	2012	17.7 Days	CHF 2600	Submit
Journal of Personalized Medicine jpm	-	6.0	2011	21.5 Days	CHF 2600	Submit
Uro uro	-	-	2021	39.4 Days	CHF 1000	Submit
Reports reports	0.6	-	2018	21.7 Days	CHF 1400	Submit

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Open AccessSystematic Review

Effect of Preoperative Pelvic Floor Muscle Training on Erectile Dysfunction After Radical Prostatectomy—A Systematic Review

by Vahid Mehrnoush, Dhruv Lalkiya, Nilanga Aki Bandara, Fatemeh Darsareh, Emmanuelle Rousseau, Sara Paziraei, Omar AbdelAziz, Waleed Shabana and Walid Shahrour

Uro 2026, 6(1), 2; https://doi.org/10.3390/uro6010002 - 29 Dec 2025

Abstract

Background: The societal effects of prostate cancer are profound. Prostate surgeries remain one of the main treatment modalities in the care of prostate cancer, and one of the common complications associated with this procedure is postoperative erectile dysfunction (ED). ED can have [...] Read more.

Background: The societal effects of prostate cancer are profound. Prostate surgeries remain one of the main treatment modalities in the care of prostate cancer, and one of the common complications associated with this procedure is postoperative erectile dysfunction (ED). ED can have a significant negative impact on men’s quality of life. The included articles from the last systematic review on effect of pre-operative pelvic floor muscle training (PPFMT) on ED after radical prostatectomy (RP) showed mixed findings but recommended the need for better exercise regime to witness better outcome. Therefore, this systematic review aims to provide further evidence from 2018 to understand the impact of PPFMT on postoperative ED and provide latest insights for future research. Methods: A systematic search was conducted on Medline, Embase, CINAHL, and Google Scholar from 2018 to June 2025, with the assistance of a subject-expert librarian. The inclusion criteria include articles which examine the effect of PPFMT on ED post prostatectomy from 2018 to June 2025 and have a minimum of two comparative groups (control vs. case). In addition, non-English articles were excluded from the study. The included articles were further assessed by two independent reviewers using Covidence, and disagreements were resolved by another independent reviewer. Results: A total of 344 articles were located and after removing duplicates, 250 articles remained. Following the abstract and title screening, nine articles were assessed for eligibility. Upon full-text review, three studies (two randomized control trials (RCTs) and one non-RCT) were ultimately included. The two RCTs showed no significant impact of PPFMT on post-operative ED. On the other hand, the non-RCT reported a significant difference in the post-operative ED rate in the case (5%) vs. control (48.6%) group. PPFMT was defined as ten pre-operative physiotherapy sessions in ten consecutive working days using anal biofeedback. Conclusions: The current study, since 2018, reveals mixed findings on the effect of PPFMT on postoperative ED. However, upon reviewing the evidence on the positive role of PPFMT in other fields (e.g., gynecology, general surgery), we noticed that the included studies may be lacking some major components like knowledge assessment, subjective and objective assessment, along with characteristics of sessions (number, duration, intensity, interval to surgery, and biofeedback) that play a crucial role in the effectiveness of the PPFMT in strengthening the pelvic floor muscle and improving the outcomes. Further research with robust designs is warranted. Full article

(This article belongs to the Topic Clinical, Translational, and Basic Research and Novel Therapy on Functional Bladder Diseases and Lower Urinary Tract Dysfunctions)

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17 pages, 1958 KB  

Open AccessArticle

Predicting Prostatic Obstruction and Bladder Outlet Dysfunction in Men with Lower Urinary Tract Symptoms and Small-to-Moderate Prostate Volume Using Noninvasive Diagnostic Tools

by Jing-Hui Tian, Tsung-Cheng Hsieh and Hann-Chorng Kuo

Biomedicines 2025, 13(12), 2894; https://doi.org/10.3390/biomedicines13122894 - 27 Nov 2025

Viewed by 367

Abstract

Objective: The current study aimed to develop predictive models based on noninvasive clinical parameters to facilitate the early identification and stratification of patients with suspected bladder outlet dysfunction (BOD), thereby reducing the need for invasive diagnostic procedures. Materials and Methods: This retrospective study [...] Read more.

Objective: The current study aimed to develop predictive models based on noninvasive clinical parameters to facilitate the early identification and stratification of patients with suspected bladder outlet dysfunction (BOD), thereby reducing the need for invasive diagnostic procedures. Materials and Methods: This retrospective study included 307 male patients with lower urinary tract symptoms (LUTS) refractory to medical therapy who were enrolled between January 2001 and May 2022. To assess the predictive performance of the model in an independent cohort, the dataset was randomly divided into the training set (70%) for model development and the test set (30%) for external validation. A two-stage modeling approach was adopted: Stage 1 involved detecting BOD, and stage 2 focused on identifying specific BOD subtypes. Backward stepwise logistic regression was conducted for model derivation, with internal validation performed using 5-fold cross-validation repeated 20 times. Clinical nomograms and a clinical decision-making framework were constructed based on the final modeling results. Results: In stage 1, the derived BOD model for detecting suspected BOD incorporated maximum flow rate, voided volume, intravesical prostatic protrusion (IPP), and prostatic urethral angle (PUA) as predictors. In stage 2, the derived benign prostatic obstruction (BPO) model included post-void residual (PVR), total prostate volume (TPV), and IPP as predictors. We also constructed nomogram to broadly screening BOD by the combination of maximum flow rate, voided volume, IPP, and PUA, a total score of ≥107 yielded the probability of 0.78 to identify BOD of 0.78. Subsequently, by combining PVR, TPV, and IPP, a total score of ≥39 yielded the probability of 0.35 to discriminate BPO. However, the BOD model (0.47) had a relatively low specificity, and the BPO model (0.58) had a lower sensitivity. Thus, these findings should be considered when applying the models in clinical practice. Conclusions: The results of this study revealed that using the clinical non-invasive parameters to create models can only yield a low sensitivity and low specificity for identifying BPO and the other BOD subtype. In patients with LUTS and small to moderate prostate volume, invasive video urodynamic study is still necessary when invasive treatment modality is recommended. Full article

(This article belongs to the Topic Clinical, Translational, and Basic Research and Novel Therapy on Functional Bladder Diseases and Lower Urinary Tract Dysfunctions)

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12 pages, 737 KB  

Open AccessReview

Dissecting the Development of the Evaluation and Management of Pediatric Diurnal Enuresis

by Alicia DuPont, Caroline Little, Veronica Vuong, Rachael Martino, Zia Flaminio, Heather Ferrill and Benjamin Brooks

Uro 2025, 5(4), 21; https://doi.org/10.3390/uro5040021 - 14 Nov 2025

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Abstract

Diurnal enuresis can significantly affect a child’s biopsychosocial well-being; however, there is a lack of diagnostic and management algorithms on the diagnosis. The purpose of this literature review is to dissect the development of the evaluation and management of diurnal enuresis. A total [...] Read more.

Diurnal enuresis can significantly affect a child’s biopsychosocial well-being; however, there is a lack of diagnostic and management algorithms on the diagnosis. The purpose of this literature review is to dissect the development of the evaluation and management of diurnal enuresis. A total of 44 articles published from January 1900 to December 2024 were chosen through literature searches in PubMed, Science Direct, Embase, and Google scholar. Search terms were “Diurnal Enuresis” or “Daytime Incontinence” as Mesh terms, and subsequent terms included “pediatrics”, “urinary bladder, overactive”, and “therapeutics”. Inclusion criteria included studies involving pediatric study subjects aged 5–18 years old with a specific diagnosis of diurnal enuresis, exclusion criteria were studies before 1900 and involving night-time wetting diagnoses. A consensus among the literature and the American Academy of Family Physicians recommends a stepwise diagnostic evaluation, including history taking followed by a focused physical exam, for diurnal enuresis has proven to be the most effective. Regarding treatment, biofeedback was shown to improve symptoms in 74% of cases in one study by Wiener, while pharmacological treatment via Mirabegron (beta 3 agonist) showed a 70% improvement in one study by Fryer, but older drugs such as oxybutynin (anticholinergics) are still preferred. A multidisciplinary approach with TENS therapy, behavioral modification, biofeedback, and pharmacology can enhance effectiveness, improve reliability, and provide more successful results while minimizing the impact of diurnal enuresis on a child’s well-being. Further research is needed to optimize pharmacologic management strategies and improve adherence to increase the likelihood of reaching treatment goals. Full article

(This article belongs to the Topic Clinical, Translational, and Basic Research and Novel Therapy on Functional Bladder Diseases and Lower Urinary Tract Dysfunctions)

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12 pages, 239 KB  

Open AccessArticle

Urodynamic Predictive Factors for Successful Treatment Outcomes Following Intravesical Botulinum Toxin a Injection in Patients with Detrusor Overactivity

by Yu Khun Lee and Hann-Chorng Kuo

Biomedicines 2025, 13(9), 2147; https://doi.org/10.3390/biomedicines13092147 - 3 Sep 2025

Cited by 1 | Viewed by 926

Abstract

Purpose: This study aimed to identify the predictive factors for successful or failed treatment outcomes following intravesical injection of botulinum toxin A (BoNT-A) through an analysis of baseline video urodynamic characteristics and parameters. Methods: This study retrospectively analyzed the therapeutic outcomes [...] Read more.

Purpose: This study aimed to identify the predictive factors for successful or failed treatment outcomes following intravesical injection of botulinum toxin A (BoNT-A) through an analysis of baseline video urodynamic characteristics and parameters. Methods: This study retrospectively analyzed the therapeutic outcomes of intravesical BoNT-A injection in patients who had an overactive bladder (OAB), who were diagnosed with detrusor overactivity (DO), and who had been refractory to OAB medications or intolerant of the adverse events associated with them. Treatment outcomes were classified as successful, improved, or failed according to the patients’ subjective report of improvement in OAB symptoms at three months post-injection. The patients were split into male and female cohorts and neurogenic or non-neurogenic DO for data analysis. The video urodynamic study characteristics and parameters were compared across the successful, improved, and failed subgroups. Results: This study included 571 patients who received intravesical BoNT-A injections for treating their OAB and urodynamic DO, of which 272 were men and 299 were women. The treatment outcome of BoNT-A injection was successful in 55.7%, improved in 27.8%, and failed in 16.5% of the patients. Patients with urodynamic detrusor underactivity (DU) and neurogenic DO due to diseases of the central nervous system did not usually achieve a successful outcome. The following factors predicted successful treatment outcomes following BoNT-A injection: lower baseline detrusor pressure, higher maximum flow rate (Qmax), larger voided volume, and smaller post-void residual (PVR) in men; larger voided volume and smaller PVR in women. Conclusions: The therapeutic success of intravesical BoNT-A injection for treating refractory OAB can be predicted by lower Pdet, higher Qmax, larger voided volume, and smaller PVR in men and by higher Qmax and smaller PVR in women. Patients with neurogenic DO and DU usually have unsuccessful treatment outcomes. Full article

(This article belongs to the Topic Clinical, Translational, and Basic Research and Novel Therapy on Functional Bladder Diseases and Lower Urinary Tract Dysfunctions)

11 pages, 490 KB  

Open AccessArticle

Patient-Reported Urinary Symptom Progression After Bacillus Calmette–Guerin Therapy for Bladder Cancer

by Zorawar Singh, Ananth Punyala, Christina Sze, Naeem Bhojani, Kevin C. Zorn, Dean Elterman and Bilal Chughtai

Uro 2025, 5(1), 4; https://doi.org/10.3390/uro5010004 - 28 Feb 2025

Viewed by 1906

Abstract

Background/Objectives: Lower urinary tract symptoms (LUTs) are commonly reported complications of intravesical Bacillus Calmette–Guerin (BCG) instillation for non-muscle invasive bladder cancer; however, there is limited characterization of the severity of the symptoms. We aim to explore the progression of LUTs with BCG treatment [...] Read more.

Background/Objectives: Lower urinary tract symptoms (LUTs) are commonly reported complications of intravesical Bacillus Calmette–Guerin (BCG) instillation for non-muscle invasive bladder cancer; however, there is limited characterization of the severity of the symptoms. We aim to explore the progression of LUTs with BCG treatment for bladder cancer. Methods: Patients were given the Overactive Bladder Questionnaire Short Form (OAB-q SF) to complete prior to their weekly BCG instillation during their primary six-week induction course. Mean symptom scores were compared for weeks 2 through 6 to baseline scores (week 1) utilizing two-sample tests. Subgroup analysis was conducted to identify cohorts at increased risk for urinary symptom progression. Simple linear regression was performed to determine the change in mean symptom scores over time. Results: A total of 60 patients completed the full six-week induction course and completed the required questionaries. Intravesical BCG administration was associated with no significant change in scores across either the symptom bothers or HFQL surveys, which were taken independently or in aggregate. No statistically significant differences in symptom scores were found between subgroups created based on demographic variables, tumor characteristics, or clinical presentation. Conclusions: Although intravesical BCG may cause acute urinary symptoms, it does not seem to impact a patient’s baseline urinary symptom profile. This is important when counseling patients about the perceived chronic urinary symptom risk associated with BCG treatment. Full article

(This article belongs to the Topic Clinical, Translational, and Basic Research and Novel Therapy on Functional Bladder Diseases and Lower Urinary Tract Dysfunctions)

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16 pages, 1598 KB  

Open AccessArticle

Clustering of Urinary Biomarkers to Identify Interstitial Cystitis Subtypes and Different Clinical Characteristics and Treatment Outcomes

by Jing-Hui Tian, Chung-You Tsai, Wan-Ru Yu, Yuan-Hong Jiang, Jia-Fong Jhang and Hann-Chorng Kuo

Biomedicines 2025, 13(2), 369; https://doi.org/10.3390/biomedicines13020369 - 5 Feb 2025

Cited by 3 | Viewed by 2203

Abstract

Purpose: Interstitial cystitis/bladder pain syndrome (IC/BPS) is mysterious and difficult to diagnose without cystoscopic hydrodistention. This study aimed to explore non-invasive and highly reliable urine biomarkers to identify Hunner’s IC (HIC) and different non-Hunner’s IC (NHIC) subtypes. Methods: In total, 422 women with [...] Read more.

Purpose: Interstitial cystitis/bladder pain syndrome (IC/BPS) is mysterious and difficult to diagnose without cystoscopic hydrodistention. This study aimed to explore non-invasive and highly reliable urine biomarkers to identify Hunner’s IC (HIC) and different non-Hunner’s IC (NHIC) subtypes. Methods: In total, 422 women with and without clinically diagnosed IC/BPS (n = 376 and 46, respectively) were retrospectively enrolled. Patients were diagnosed with HIC or NHIC by cystoscopic hydrodistention under anesthesia. Then, the maximal bladder capacity (MBC) and glomerulation grade were determined. Thirteen urine inflammatory cytokines, chemokines, and oxidative stress biomarkers based on the previously reported predictors of IC/BPS were assayed using commercial microsphere kits. The dataset was randomly divided into training (70%) and test (30%) sets for model construction and validation using logistic regression and stepwise variable selection techniques. To construct the predictive models, univariate analysis was performed to evaluate the discriminative power of each urinary biomarker, measured by the area under the curve (AUC). Biomarkers with AUC values < 0.6 were excluded from further modeling. Multivariate logistic regression was then employed, with variables selected through stepwise forward selection based on log-likelihood criteria. For dichotomization, cutoff values were determined using quartile ranges from the control group. The final model’s performance was assessed using AUC, accuracy, sensitivity, and specificity in both training and test sets. Results: By setting the screening criterion to AUC ≥ 0.60, the potential urinary biomarkers for identifying IC/BPS cases were eotaxin, monocyte chemoattractant protein-1, tumor necrosis factor-alpha (TNF-α), 8-hydroxy-2′-deoxyguanosine (8-OHdG), and 8-isoprostane. Those for identifying HIC from the IC/BPS cohort were interleukin (IL)-6, IL-8, interferon γ-inducible protein 10 (IP-10), and regulated on activation, normal T-cell expressed and secreted (RANTES). A diagnostic algorithm using a cluster of urinary biomarkers included TNF-α ≥ 0.95 pg/mL or 8-OHDG ≥ 22.34 pg/mL and 8-isoprastane ≥ 22.34 pg/mL for identifying IC/BPS from the overall cohort; for identifying HIC from the IC/BPS cohort, the urinary IP-10 ≥ 3.74 pg/mL or IP-10 ≥ 19.94 pg/mL was added. Conclusions: Using a cluster of urinary biomarkers such as TNF-α or 8-OHdG and 8-isoprostane can identify IC/BPS from a study cohort, and adding the urinary IP-10 can distinguish HIC from IC/BPS cases. Full article

(This article belongs to the Topic Clinical, Translational, and Basic Research and Novel Therapy on Functional Bladder Diseases and Lower Urinary Tract Dysfunctions)

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11 pages, 231 KB  

Open AccessArticle

Prediction of Bladder Outlet Obstruction in Male Patients with Lower Urinary Tract Symptoms Based on Symptom Scores and Noninvasive Office-Based Diagnostic Tools

by Min-Ching Liu, Yuan-Hong Jiang and Hann-Chorng Kuo

Biomedicines 2025, 13(2), 301; https://doi.org/10.3390/biomedicines13020301 - 26 Jan 2025

Cited by 1 | Viewed by 2839

Abstract

Purpose: The purpose of this study was to investigate the predictive values of combining symptom scores, prostatic parameters, uroflowmetry parameters, intravesical prostatic protrusion, and prostatic urethral angle for the establishment of a bladder outlet obstruction (BOO) risk score for diagnosing BOO in men [...] Read more.

Purpose: The purpose of this study was to investigate the predictive values of combining symptom scores, prostatic parameters, uroflowmetry parameters, intravesical prostatic protrusion, and prostatic urethral angle for the establishment of a bladder outlet obstruction (BOO) risk score for diagnosing BOO in men with lower urinary tract symptoms. Materials and Methods: A total of 355 men with lower urinary tract symptoms were enrolled and divided into a training set (N = 285) and validation set (N = 70). Videourodynamic studies were used to diagnose lower urinary tract dysfunction subtypes, which were subdivided into a non-BOO and BOO group, which included bladder neck dysfunction and benign prostate obstruction. The parameters were categorized as 0, 1, 2, or 3 according to their cutoff value regarding the specificity of predicting BOO. The BOO risk score was constructed by summing scores of seven variables of symptoms and prostate and uroflowmetry parameters. The area under the curve (AUC) was used to select appropriate cutoff values for predicting lower urinary tract dysfunctions. Results: Among the 355 men examined, 234 (65.9%) had BOO, including 136 (38.3%) with bladder neck dysfunction and 98 (27.6%) with benign prostate obstruction. Other lower urinary tract dysfunctions included detrusor overactivity in 37 patients (10.4%), dysfunctional voiding in 28 patients (7.9%), poor relaxation of the external sphincter in 26 patients (7.3%), detrusor underactivity in 14 patients (3.9%), stable bladder in 9 patients (2.5%), and a hypersensitive bladder in 7 patients (2%). With the summation of the BOO risk scores from each variable, a BOO risk score of ≥10 could yield a sensitivity of 0.822 and specificity of 0.656 for benign prostate obstruction in the training set [AUC = 0.800 (0.741–0.859)] and a sensitivity of 0.80 and specificity of 0.64 in the validation set [AUC = 0.813 (0.701–0.925)]. Conclusions: With office-based diagnostic tools, including symptom scores and uroflowmetry and prostate parameters, a BOO risk score was established. A BOO risk score of ≥10 can predict the presence of benign prostate obstruction in >80% of men with lower urinary tract symptoms refractory to initial medication. Full article

(This article belongs to the Topic Clinical, Translational, and Basic Research and Novel Therapy on Functional Bladder Diseases and Lower Urinary Tract Dysfunctions)

15 pages, 285 KB  

Open AccessReview

Posterior Urethral Valves and Fertility: Insight on Paternity Rates and Seminal Parameters

by Marcello Della Corte, Simona Gerocarni Nappo, Antonio Aversa, Sandro La Vignera, Francesco Porpiglia, Cristian Fiori and Nicola Mondaini

Diseases 2025, 13(1), 21; https://doi.org/10.3390/diseases13010021 - 17 Jan 2025

Cited by 2 | Viewed by 1448

Abstract

Background: Posterior urethral valves (PUVs) represent the most common cause of male congenital lower urinary tract obstruction, often responsible for renal dysplasia and chronic renal failure. Despite recent improvements in patients’ outcomes thanks to prenatal ultrasound early diagnosis, PUVs can still impact sexual [...] Read more.

Background: Posterior urethral valves (PUVs) represent the most common cause of male congenital lower urinary tract obstruction, often responsible for renal dysplasia and chronic renal failure. Despite recent improvements in patients’ outcomes thanks to prenatal ultrasound early diagnosis, PUVs can still impact sexual function and fertility. This study aims to review the available evidence on fertility in PUV patients, examining paternity rates and semen parameters. Methods: A review was conducted of the PubMed, Cochrane, Scopus, and Embase databases. Studies focusing on fertility and paternity outcomes in PUV patients were selected, including case reports, case series, and retrospective and prospective studies. Results: A total of 15 studies met the inclusion criteria. The review revealed that PUV patients often exhibit compromised semen parameters, including low sperm count, reduced motility, and abnormal morphology, as well as alterations in seminal plasma. PUV diagnoses are common in adults exhibiting infertility and ejaculation disorders, suggesting PUVs cannot be considered only a pediatric disease. Paternity rates among PUV patients were rarely reported in extenso, hampering the correct assessment of the overall medium paternity rate and its comparison with that of healthy individuals. Lastly, seminal parameters were assessed in a minimal cohort of patients, therefore, they could not be considered representative. Conclusions: Fertility and seminal parameters in PUV patients represent an under-investigated area. PUVs can variably and non-univocally affect fatherhood, and they may be associated with compromised semen quality. Early intervention and long-term follow-up are essential to address potential fertility issues. Future research should focus on developing targeted strategies to preserve and enhance fertility in this patient population. Full article

(This article belongs to the Topic Clinical, Translational, and Basic Research and Novel Therapy on Functional Bladder Diseases and Lower Urinary Tract Dysfunctions)

12 pages, 242 KB  

Open AccessArticle

Clinical Comorbidities and Videourodynamic Characteristics of Dysfunctional Voiding in Women

by Cheng-Ling Lee, Yuan-Hong Jiang, Jia-Fong Jhang, Tien-Lin Chang, Jing-Hui Tian and Hann-Chorng Kuo

Biomedicines 2025, 13(1), 199; https://doi.org/10.3390/biomedicines13010199 - 15 Jan 2025

Cited by 2 | Viewed by 1532

Abstract

Purpose: The current study aimed to investigate the clinical comorbidities and urodynamic characteristics of a large cohort of women with dysfunctional voiding (DV) validated on a videourodynamic study (VUDS). Methods: Women who presented with VUDS-confirmed DV from 1998 to 2022 were retrospectively analyzed. [...] Read more.

Purpose: The current study aimed to investigate the clinical comorbidities and urodynamic characteristics of a large cohort of women with dysfunctional voiding (DV) validated on a videourodynamic study (VUDS). Methods: Women who presented with VUDS-confirmed DV from 1998 to 2022 were retrospectively analyzed. Data on clinical symptoms, VUDS findings, and medical comorbidities including medical illness and previous surgical history were recorded and examined. Patients with DV were subgrouped according to age, presence of medical comorbidity, and different urodynamic parameters. The urodynamic parameters and treatment outcomes among the different subgroups were examined. Results: In total, 216 women were retrospectively analyzed. Among them, 188 (88.3%) presented with storage symptoms and 130 (61.0%) with voiding symptoms. Regarding outcomes, 48 (22.2%) patients had successful treatment outcomes; 76 (35.2%), improved outcomes; and 92 (42.6%), failed outcomes. Then, 150 (69.0%) patients presented with urodynamic DO. Patients with terminal DO experienced a significantly higher incidence of hypertension (56.8%), diabetes mellitus (37.9%), and latent central nervous system diseases (38.9%) than those with non-DO or phasic DO. Patients with phasic DO had a significantly higher detrusor pressure (Pdet) and bladder outlet obstruction index than those with non-DO and terminal DO. Patients with hypertension or those with a Pdet ≥ 35 cmH₂O had high rates of successful treatment outcomes. Conclusions: DV is significantly associated with older age and a higher incidence of central nervous system diseases, hypertension, and diabetes mellitus in women. Patients with phasic DO had a high Pdet and BOO, and patients with hypertension or those with Pdet ≥35 cm H₂O who received urethral sphincter treatment had a better treatment outcome. Full article

(This article belongs to the Topic Clinical, Translational, and Basic Research and Novel Therapy on Functional Bladder Diseases and Lower Urinary Tract Dysfunctions)

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Open AccessArticle

Lower Urinary Tract Dysfunction Among Patients Undergoing Surgery for Deep Infiltrating Endometriosis: A Prospective Cohort Study

by Anna-Sophie Villiger, Diana Hoehn, Giovanni Ruggeri, Cloé Vaineau, Konstantinos Nirgianakis, Sara Imboden, Annette Kuhn and Michael David Mueller

J. Clin. Med. 2024, 13(23), 7367; https://doi.org/10.3390/jcm13237367 - 3 Dec 2024

Cited by 2 | Viewed by 2091

Abstract

Background/Objectives: Postsurgical lower urinary tract dysfunction (LUTD) is a common problem following deep infiltrating endometriosis (DIE) resection. The condition may be caused either by surgically induced damage to the bladder innervation or by pre-existing endometriosis-associated nerve damage. The aim of this study [...] Read more.

Background/Objectives: Postsurgical lower urinary tract dysfunction (LUTD) is a common problem following deep infiltrating endometriosis (DIE) resection. The condition may be caused either by surgically induced damage to the bladder innervation or by pre-existing endometriosis-associated nerve damage. The aim of this study is to evaluate the efficacy of preoperative and postoperative multichannel urodynamic testing (UD) in identifying pre-existing or surgically induced LUTD among patients with DIE. Methods: Women with suspected DIE and planned surgical resection of DIE at the Department of Obstetrics and Gynecology at the University Hospital of Bern from September 2015 to October 2022 were invited to participate in this prospective cohort study. UD was performed before and 6 weeks after surgery. The primary outcome was the maximum flow rate (uroflow), an indicator of LUTD. Secondary outcomes were further urodynamic observations of cystometry and pressure flow studies, lower urinary tract symptoms (LUTS) as assessed by the International Prostate Symptom Score (IPSS), and pain as assessed by the visual analog scale (VAS). Results: A total of 51 patients requiring surgery for DIE were enrolled in this study. All patients underwent surgical excision of the DIE. The cohort demonstrated a uroflow of 22.1 mL/s prior to surgery, which decreased postoperatively to 21.5 mL/s (p = 0.56, 95%CI −1.5–2.71). The mean bladder contractility index (BCI) exhibited a notable decline from 130.4 preoperatively to 116.6 postoperatively (p = 0.046, 95%CI 0.23–27.27). Significant improvements were observed in the prevalence of dysmenorrhea, abdominal pain, dyspareunia, and dyschezia following surgical intervention (p = <0.001). The IPSS score was within the lower moderate range both pre- and postoperatively (mean 8.37 vs. 8.51, p = 0.893, 95%CI −2.35–2.05). Subgroup analysis identified previous endometriosis surgery as a significant preoperative risk factor for elevated post-void residual (43.6 mL, p = 0.026, 95%CI 13.89–73.37). The postoperative post-void residual increased among participants with DIE on the rectum to 54.39 mL (p = 0.078, 95%CI 24.06–84.71). Participants who underwent hysterectomy exhibited a significantly decreased uroflow (16.4 mL/s, p = 0.014, 95%CI 12–20) and BCI (75.1, p = 0.036, 95%CI 34.9–115.38). Conclusions: Nerve-respecting laparoscopy for DIE may alter bladder function. UD is not advisable before surgery, but the measurement may detect patients with LUTD. Full article

(This article belongs to the Topic Clinical, Translational, and Basic Research and Novel Therapy on Functional Bladder Diseases and Lower Urinary Tract Dysfunctions)

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