Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions

Topic Information

Dear Colleagues,

Recently, 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) usually do not immediately affect general health, the LUTS have been found to have a great impact on mental health and quality of life. Clinically, these bladder diseases and bladder outlet dysfunctions result in storage and emptying symptoms. There is a wide spectrum of overlap between the bladder and bladder outlet diseases—for example, patients with overactive bladder or interstitial cystitis may have bladder storage symptoms and voiding dysfunction, and bladder hypersensitivity could result in a dysfunctional voiding during 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 the 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. Urodynamic study and electrophysiology study enable 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 bladder diseases and LUTD to a new era. Diagnosis of LUTD is not only based on clinical symptom and image study, but also on urodynamics, electrophysiology, and in the future, urine biomarkers analysis. Treatment of functional LUTD may include medicines, injecting agents, and surgical intervention. This Special Issue 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

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Biomedicines biomedicines	3.9	5.2	2013	14.6 Days	CHF 2600
Journal of Clinical Medicine jcm	3.0	5.7	2012	16 Days	CHF 2600
Journal of Personalized Medicine jpm	-	4.1	2011	17.4 Days	CHF 2600
Reports reports	0.8	-	2018	18.6 Days	CHF 1400
Toxins toxins	3.9	7.5	2009	20.3 Days	CHF 2700
Uro uro	-	-	2021	27.9 Days	CHF 1000

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11 pages, 873 KiB  

Open AccessArticle

Effectiveness of Platelet-Rich Plasma Injections as Prophylaxis for Recurrent Urinary Tract Infection in Women

by Yu-Khun Lee and Hann-Chorng Kuo

J. Clin. Med. 2023, 12(12), 4129; https://doi.org/10.3390/jcm12124129 - 19 Jun 2023

Cited by 3 | Viewed by 2454

Abstract

Purpose: To investigate the therapeutic efficacy of intravesical platelet-rich plasma (PRP) injections as prophylaxis for adult women with recurrent urinary tract infection (rUTI). Methods: This proof-of-concept study enrolled 63 women with rUTI in PRP treatment and control groups after achieving control of the [...] Read more.

Purpose: To investigate the therapeutic efficacy of intravesical platelet-rich plasma (PRP) injections as prophylaxis for adult women with recurrent urinary tract infection (rUTI). Methods: This proof-of-concept study enrolled 63 women with rUTI in PRP treatment and control groups after achieving control of the most recent urinary tract infection (UTI) episode. The treatment group included 34 women who received 4 monthly intravesical PRP injections. The control group was made up of 30 women who received continuous antibiotic treatment for 3 months. After the completion of PRP or antibiotic treatment, outpatient follow-up was continued for up to 12 months. Treatment was considered successful if ≤2 UTI episodes occurred during a period of 12 months or ≤1 UTI episode within 6 months; otherwise, the outcome was considered a treatment failure. The frequency of symptomatic UTI episodes before and after PRP treatment was compared with that of the controls. Regression analysis was used to determine the association between potential predictors for a failed treatment outcome. Results: At the study endpoint, 33 PRP and 25 control group patients were available for analysis. After four PRP injections, the frequency of rUTI episodes per month was significantly decreased compared with baseline (0.46 ± 0.27 vs. 0.28 ± 0.30, p = 0.047). The PRP treatment success rate was 51.5% (17 of 33) for the PRP group versus 48% (12 of 25) for the control group. The PRP treatment success group had significantly higher voided volume, lower post-void residual volume, and higher voiding efficiency than the PRP treatment failure group. A higher baseline voiding efficacy ≥0.71 was significantly associated with a successful outcome (OR 16.56; p = 0.049). Conclusions: The study results revealed that repeat intravesical PRP injections decreased the recurrence rate of UTI within 1 year in women with rUTI. The treatment success rate with intravesical PRP injections for rUTI was about 51.5%, whereas for women with prolonged antibiotic treatment, it was 48.0%. A baseline VE ≥ 0.71 was associated with a better treatment outcome with PRP injections. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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10 pages, 779 KiB  

Open AccessArticle

Voiding Dysfunction Due to Urethral Sphincter Dysfunction Might Be an Early Neurological Presentation of Central Nervous System Disorders in Aged Patients

by Guan-Ru Ho, Chiao-Wen Wei and Hann-Chorng Kuo

J. Pers. Med. 2023, 13(4), 693; https://doi.org/10.3390/jpm13040693 - 20 Apr 2023

Cited by 3 | Viewed by 2193

Abstract

Purpose: To investigate the incidence of central nervous system (CNS) diseases in adult patients with voiding dysfunction and videourodynamics (VUDS) proven urethral sphincter dysfunction. Methods: This retrospective analysis reviewed the medical charts of patients aged > 60 years who underwent VUDS for non-prostatic [...] Read more.

Purpose: To investigate the incidence of central nervous system (CNS) diseases in adult patients with voiding dysfunction and videourodynamics (VUDS) proven urethral sphincter dysfunction. Methods: This retrospective analysis reviewed the medical charts of patients aged > 60 years who underwent VUDS for non-prostatic voiding dysfunction from 2006 to 2021. A chart review was performed to search for the occurrence and treatment of CNS diseases after the VUDS examination up to 2022. The diagnosis of CNS disease, such as cerebrovascular accidents (CVA), Parkinson’s disease (PD), and dementia, by neurologists was also retrieved from the charts. Based on the VUDS findings, patients were divided into the following subgroups: dysfunctional voiding (DV), poor relaxation of the external sphincter (PRES), and hypersensitive bladder (HSB) and coordinated sphincter subgroups. The incidence of CVA, PD, and dementia in each subgroup was recorded and compared among them using one-way analysis of variance (ANOVA). Results: A total of 306 patients were included. VUDS examinations revealed DV in 87 patients, PRES in 108, and HSB in 111. Among them, 36 (11.8%) patients had CNS disease, including CVA in 23 (7.5%), PD in 4 (1.3%), and dementia in 9 (2.9%). Among the three subgroups, the DV group had the highest incidence rate of CNS disease (n = 16, 18.4%), followed by PRES (n = 12, 11.1%) and HSB (n = 8, 7.2%). However, no significant difference was noted in the incidence of CNS disease across the three subgroups. Nevertheless, the incidence of CNS disease was higher in patients with DV and PRES than that in the general population. Conclusions: The incidence of CNS diseases was high in patients aged > 60 years with voiding dysfunction due to urethral sphincter dysfunction. Patients with VUDS-confirmed DV had the highest incidence of CNS disease among the three subgroups. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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9 pages, 899 KiB  

Open AccessArticle

Efficacy of Intravesical Botulinum Toxin A Injection in the Treatment of Refractory Overactive Bladder in Children

by Yu-Hua Fan and Hann-Chorng Kuo

J. Pers. Med. 2023, 13(4), 616; https://doi.org/10.3390/jpm13040616 - 31 Mar 2023

Cited by 3 | Viewed by 2293

Abstract

This study aimed to evaluate the efficacy of intravesical botulinum toxin A (BoNT-A) injections for the treatment of pediatric overactive bladder (OAB) by exploring the differential treatment outcomes in children with different OAB etiologies and those who received additional intrasphincteric BoNT-A injections. We [...] Read more.

This study aimed to evaluate the efficacy of intravesical botulinum toxin A (BoNT-A) injections for the treatment of pediatric overactive bladder (OAB) by exploring the differential treatment outcomes in children with different OAB etiologies and those who received additional intrasphincteric BoNT-A injections. We performed a retrospective review of all pediatric patients who received intravesical BoNT-A injections between January 2002 and December 2021. All patients underwent a urodynamic study at baseline and three months after BoNT-A administration. A Global Response Assessment (GRA) score of ≥2 at three months after BoNT-A injection was defined as successful treatment. Fifteen pediatric patients (median age, 11 years), including six boys and nine girls, were enrolled in the study. A statistically significant decrease in detrusor pressure from baseline to three months postoperatively was observed. Thirteen (86.7%) patients reported successful results (GRA ≥ 2). The cause of OAB and additional intrasphincteric BoNT-A injections did not affect the improvement in urodynamic parameters and treatment success. The study demonstrated that intravesical BoNT-A injection is effective and safe for the treatment of neurogenic and non-neurogenic OAB in children refractory to conventional therapies. Additionally, intrasphincteric BoNT-A injections do not provide additional benefits in the treatment of pediatric OAB. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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11 pages, 589 KiB  

Open AccessArticle

Urinary Oxidative Stress Biomarker Levels Might Be Useful in Identifying Functional Bladder Disorders in Women with Frequency and Urgency Syndrome

by Yuan-Hong Jiang, Jia-Fong Jhang and Hann-Chorng Kuo

J. Clin. Med. 2023, 12(6), 2336; https://doi.org/10.3390/jcm12062336 - 17 Mar 2023

Cited by 6 | Viewed by 2065

Abstract

Purpose: lower urinary tract dysfunctions (LUTDs) are difficult to diagnose based on symptoms. This study used a cluster of urinary biomarkers, including inflammatory cytokines, neurogenic proteins, and oxidative stress biomarkers, to identify LUTDs in women with frequency and urgency symptoms. Methods: in total, [...] Read more.

Purpose: lower urinary tract dysfunctions (LUTDs) are difficult to diagnose based on symptoms. This study used a cluster of urinary biomarkers, including inflammatory cytokines, neurogenic proteins, and oxidative stress biomarkers, to identify LUTDs in women with frequency and urgency symptoms. Methods: in total, 253 women with video urodynamics (VUDS)- and cystoscopy-confirmed detrusor overactivity (DO), interstitial cystitis/bladder pain syndrome (IC/BPS), dysfunctional voiding (DV), and hypersensitive bladder (HSB), and normal controls were included. Before diagnosis and treatment, urine samples were collected for analysis of biomarkers. The urine levels of biomarkers were compared between groups with bladder dysfunctions and controls and were combined to test the sensitivity in identifying total pathological bladder diseases and specific bladder diseases. Results: After video urodynamic study, VUDS, and urological examinations, bladder dysfunctions were classified into DO (n = 31), IC/BPS (n = 114), DV (n = 45), HSB (n = 29), and control (n = 34) groups. By using a cystomeric bladder capacity of ≤350 mL, 186/219 (84.9%) of the patients with DO, IC/BPS, DV, and HSB can be discriminated from the controls. Among these urine biomarkers, oxidative stress biomarkers 8-isoprostane, 8-hydroxydeoxyguanosine (8-OHdG), or total antioxidant capacity (TAC) are useful for identifying pathological bladder dysfunction (DO, IC/BPS, and DV) and HSB. With elevated IL-1β and lower IL-2, and elevated TNF-α levels, most patients with DV can be identified. Between DO and IC/BPS, a higher NGF level can identify 58.3% of IC/BPS cases, whereas a lower NGF level can identify 75.0% of DO cases. Conclusion: by using a cluster of urine biomarkers, DO, IC/BPS, and DV cases can be identified based on elevated levels of urine oxidative stress biomarkers 8-isoprostane, TAC, or 8-OHdG, and HSB cases with a low TAC. These urine biomarkers are useful for identifying specific LUTDs in women with frequency and urgency symptoms. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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12 pages, 445 KiB  

Open AccessReview

Conservative Bladder Management and Medical Treatment in Chronic Spinal Cord Injury Patients

by Hueih Ling Ong, I-Ni Chiang, Lin-Nei Hsu, Cheih-Wen Chin, I-Hung Shao, Mei-Yu Jang, Yung-Shun Juan, Chung-Cheng Wang and Hann-Chorng Kuo

J. Clin. Med. 2023, 12(5), 2021; https://doi.org/10.3390/jcm12052021 - 3 Mar 2023

Cited by 5 | Viewed by 2552

Abstract

To review the available data on non-surgical management for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI) and provide the most updated knowledge for readers. We categorized the bladder management approaches into storage and voiding dysfunction separately; [...] Read more.

To review the available data on non-surgical management for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI) and provide the most updated knowledge for readers. We categorized the bladder management approaches into storage and voiding dysfunction separately; both are minimally invasive, safe, and efficacious procedures. The main goals for NLUTD management are to achieve urinary continence; improve quality of life; prevent urinary tract infections and, last but not least, preserve upper urinary tract function. Annual renal sonography workups and regular video urodynamics examinations are crucial for early detection and further urological management. Despite the extensive data on NLUTD, there are still relatively few novel publications and there is a lack of high-quality evidence. There is a paucity of new minimally invasive and prolonged efficacy treatments for NLUTD, and a partnership between urologists, nephrologists and physiatrists is required to promote and ensure the health of SCI patients in the future. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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14 pages, 996 KiB  

Open AccessArticle

Discriminating Different Bladder and Bladder Outlet Dysfunctions by Urinary Biomarkers in Women with Frequency–Urgency Syndrome

by Jia-Fong Jhang, Yuan-Hong Jiang and Hann-Chorng Kuo

Biomedicines 2023, 11(3), 673; https://doi.org/10.3390/biomedicines11030673 - 23 Feb 2023

Cited by 3 | Viewed by 2239

Abstract

Objectives: To investigate the role of urinary biomarkers in discriminating different bladder and bladder outlet dysfunctions in women with frequency–urgency syndrome. Materials and Methods: Urine samples collected from 146 women with frequency–urgency syndrome and 34 controls were investigated. All patients were included in [...] Read more.

Objectives: To investigate the role of urinary biomarkers in discriminating different bladder and bladder outlet dysfunctions in women with frequency–urgency syndrome. Materials and Methods: Urine samples collected from 146 women with frequency–urgency syndrome and 34 controls were investigated. All patients were included in previous clinical trials of functional urology studies and underwent a videourodynamic study. Patients with frequency–urgency syndrome were subdivided into idiopathic detrusor overactivity (IDO), neurogenic detrusor overactivity (NDO), dysfunctional voiding (DV), and hypersensitive bladder (HSB) subgroups. Urine samples were collected before any treatment, and urinary inflammatory proteins (interleukin- (IL-) 1β, IL-2, IL-6, IL-8, tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF)), neurogenic proteins (nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and prostaglandin E2 (PGE2)), and oxidative stress biomarkers (8-isoprostane, total antioxidant capacity (TAC), and 8-hydroxydeoxyguanosine (8-OHdG)) were measured and compared between the different OAB subgroups and controls. Results: Of the 146 patients, 31 had IDO, 41 had NDO, 45 had DV, and 29 had HSB. The control group included 34 women. The patients with HSB had lower urinary TAC and IL-2 levels than the controls. The patients with IDO, NDO, and DV had significantly higher urinary TNF-α levels than those with HSB. The patients with IDO and NDO showed an increase in the urinary 8-isoprostane levels, whereas the patients with IDO had higher urinary IL-2, NGF, and BDNF levels than those with NDO. The other urinary inflammatory biomarkers did not show enough significant differences to discriminate between the different bladder and bladder outlet dysfunctions. Conclusions: The urinary levels of inflammatory, neurogenic, and oxidative stress biomarkers varied widely among the patients with bladder and bladder outlet dysfunction. This study’s results provide evidence that women with frequency–urgency syndrome and different urodynamic subtypes have varying bladder inflammation and oxidative stress conditions, which might have an impact on treatment outcomes. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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10 pages, 612 KiB  

Open AccessArticle

Long-Term Follow-Up of Lower Urinary Tract Outcome in Children with Dysfunctional Voiding

by Chung-Hsin Peng, Sheng-Fu Chen and Hann-Chorng Kuo

J. Clin. Med. 2022, 11(24), 7395; https://doi.org/10.3390/jcm11247395 - 13 Dec 2022

Cited by 1 | Viewed by 2148

Abstract

Objective: To investigate the long-term clinical and urodynamic outcomes of a small cohort of children who received short-term urotherapy for confirmed dysfunctional voiding (DV) and lower urinary tract symptoms (LUTS). Materials and Methods: This study included 26 children with confirmed LUTS and DV [...] Read more.

Objective: To investigate the long-term clinical and urodynamic outcomes of a small cohort of children who received short-term urotherapy for confirmed dysfunctional voiding (DV) and lower urinary tract symptoms (LUTS). Materials and Methods: This study included 26 children with confirmed LUTS and DV via video urodynamic study (VUDS) and received standard urological therapy, pelvic floor muscle training, or surgical intervention in childhood. Their current lower urinary tract conditions were assessed by chart review and direct and telephone interviews. Charts of 14 patients who underwent follow-up VUDS were reviewed to investigate their bladder and voiding dysfunction or follow-up on previous treatment results. The satisfaction of lower urinary tract status was assessed using the global response assessment (GRA) scale. Results: At initial enrolment, the mean age was 9.54 ± 3.88 years, and urological treatment was performed during the first 1–5 years thereafter. Most patients were not regularly followed in the urology clinic. Among the 14 children available for follow-up, a GRA score of 3 was reported by 10 (71.4%) after a mean follow-up period of 10.3 ± 6.74 (range, 2–20) years, indicating satisfactory bladder and voiding conditions. Four children with less favorable outcomes (GRA score of <3) had significantly more post-void residual urine volume at baseline, and 75% of these patients had central nervous system diseases. Daytime incontinence and enuresis rates were significantly decreased at follow-up compared with the baseline. Significantly increased bladder capacity and sensation and significantly decreased voiding detrusor pressure were found on follow-up VUDS. Conclusions: Children with DV who received standard urotherapy upon diagnosis exhibited improved LUTS at a 10-year follow-up. Of the 14 children available for follow-up, 10 (71.4%) reported satisfactory bladder and voiding status without further medication or urotherapy, with significantly decreased voiding detrusor pressure. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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16 pages, 342 KiB  

Open AccessReview

Long-Term Surveillance and Management of Urological Complications in Chronic Spinal Cord-Injured Patients

by Shu-Yu Wu, Jia-Fong Jhang, Hsin-Ho Liu, Jian-Ting Chen, Jian-Ri Li, Bin Chiu, Sung-Lang Chen and Hann-Chorng Kuo

J. Clin. Med. 2022, 11(24), 7307; https://doi.org/10.3390/jcm11247307 - 9 Dec 2022

Cited by 16 | Viewed by 4070

Abstract

Bladder dysfunction is a common complication after chronic spinal cord injury (SCI). Patients may experience renal function loss, urinary tract infection (UTI), urolithiasis, bladder cancer, and even life-threatening events such as severe sepsis or renal failure. Suitable patient care may prevent UTI and [...] Read more.

Bladder dysfunction is a common complication after chronic spinal cord injury (SCI). Patients may experience renal function loss, urinary tract infection (UTI), urolithiasis, bladder cancer, and even life-threatening events such as severe sepsis or renal failure. Suitable patient care may prevent UTI and urinary incontinence, decrease medication use, and preserve renal function. As the primary goal is to preserve renal function, management should be focused on facilitating bladder drainage, the avoidance of UTI, and the maintenance of a low intravesical pressure for continence and complete bladder emptying. Currently, several bladder management options are available to SCI patients: (1) reflex voiding; (2) clean intermittent catheterization; (3) indwelling catheterization. The target organ may be the bladder or the bladder outlet. The purposes of intervention include the following: (1) increasing bladder capacity and/or decreasing intravesical pressure; (2) increasing bladder outlet resistance; (3) decreasing bladder outlet resistance; (4) producing detrusor contractility; (5) urinary diversion. Different bladder management methods and interventions may have different results depending on the patient’s lower urinary tract dysfunction. This review aims to report the current management options for long-term bladder dysfunction in chronic SCI patients. Furthermore, we summarize the most suitable care plans for improving the clinical outcome of SCI patients. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

14 pages, 975 KiB  

Open AccessReview

Bladder Management Strategies for Urological Complications in Patients with Chronic Spinal Cord Injury

by Yu-Chen Chen, Yin-Chien Ou, Ju-Chuan Hu, Min-Hsin Yang, Wei-Yu Lin, Shi-Wei Huang, Wei-Yu Lin, Chih-Chieh Lin, Victor C. Lin, Yao-Chi Chuang and Hann-Chorng Kuo

J. Clin. Med. 2022, 11(22), 6850; https://doi.org/10.3390/jcm11226850 - 20 Nov 2022

Cited by 5 | Viewed by 4437

Abstract

Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, inevitably results in urological complications. To address neurogenic lower urinary tract dysfunction after spinal cord injury, proper and adequate bladder management is important in spinal cord injury rehabilitation, with the [...] Read more.

Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, inevitably results in urological complications. To address neurogenic lower urinary tract dysfunction after spinal cord injury, proper and adequate bladder management is important in spinal cord injury rehabilitation, with the goal and priorities of the protection of upper urinary tract function, maintaining continence, preserving lower urinary tract function, improvement of SCI patients’ quality of life, achieving compatibility with patients’ lifestyles, and decreasing urological complications. This concise review aims to help urologists address neurogenic lower urinary tract dysfunction by focusing on the risks of long-term urological complications and the effects of different bladder management strategies on these complications based on scientifically supported knowledge. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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9 pages, 242 KiB  

Open AccessArticle

Prevalence of Lower Urinary Tract Symptoms in Children with Attention-Deficit/Hyperactivity Disorder: Comparison of Hospital and Population-Based Cohorts of 13,000 Patients

by Teng-Kai Yang, Wei-Yi Huang, Ya-Jun Guo, Yu-Fen Chen, Hong-Chiang Chang and Kuo-How Huang

J. Clin. Med. 2022, 11(21), 6393; https://doi.org/10.3390/jcm11216393 - 28 Oct 2022

Cited by 1 | Viewed by 1822

Abstract

Background: This study investigates the prevalence of lower urinary tract symptoms (LUTS) in school-age children with Attention-Deficit/Hyperactivity Disorder (ADHD) based on hospital-based and population-based cohorts. Methods: The hospital-based sample comprised 42 children with ADHD and 65 without ADHD aged 6–12 years. Voiding dysfunction [...] Read more.

Background: This study investigates the prevalence of lower urinary tract symptoms (LUTS) in school-age children with Attention-Deficit/Hyperactivity Disorder (ADHD) based on hospital-based and population-based cohorts. Methods: The hospital-based sample comprised 42 children with ADHD and 65 without ADHD aged 6–12 years. Voiding dysfunction was assessed by the Dysfunctional Voiding Scoring System (DVSS) questionnaire. We compared the baseline data, DVSS score, and uroflowmetry between the two groups. For the population-based cohort in the national insurance database, we included 6526 children aged 6–12 years, whose claims record included the diagnosis of ADHD, and another 6526 control subjects matched by gender and age. We compared the presence of LUTS diagnosis codes between the two groups. Results: Our results showed that, for the hospital-based cohort, the mean total DVSS score and the proportion of significant LUTS in children in the ADHD group were significantly higher than in subjects in the non-ADHD group. The DVSS subscales showed that the item “I cannot wait when I have to pee” item was significantly higher in the ADHD group (1.62 ± 1.17 vs. 0.90 ± 1.09, p = 0.002). For the population-based cohort, children with ADHD had a significantly higher likelihood of storage symptoms (5.53% vs. 2.91%, p < 0.001) and enuresis (3.28% vs. 1.95%, p < 0.001) compared with those of the no ADHD group. Conclusions: Children with ADHD have a higher prevalence of significant LUTS, especially storage symptoms and enuresis, than children without ADHD. The observed correlations between ADHD and LUTS provided the supporting evidence to evaluate the concomitant voiding dysfunction in children with ADHD. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

12 pages, 4381 KiB  

Open AccessArticle

Exploring the Association between Gut and Urine Microbiota and Prostatic Disease including Benign Prostatic Hyperplasia and Prostate Cancer Using 16S rRNA Sequencing

by Kai-Yen Tsai, Deng-Chyang Wu, Wen-Jeng Wu, Jiunn-Wei Wang, Yung-Shun Juan, Ching-Chia Li, Chung-Jung Liu and Hsiang-Ying Lee

Biomedicines 2022, 10(11), 2676; https://doi.org/10.3390/biomedicines10112676 - 23 Oct 2022

Cited by 21 | Viewed by 3822

Abstract

Numerous microorganisms residing in the gastrointestinal and genitourinary tracts affect host health. We investigated stool and voided urine samples collected from patients with benign prostatic hyperplasia (BPH) or prostate cancer (PC) and a control group to explore the potential relationship between human microbiota [...] Read more.

Numerous microorganisms residing in the gastrointestinal and genitourinary tracts affect host health. We investigated stool and voided urine samples collected from patients with benign prostatic hyperplasia (BPH) or prostate cancer (PC) and a control group to explore the potential relationship between human microbiota and prostatic disease, and aimed to identify correlations and pathogenic taxonomic units. We studied microbial composition using 16S rRNA sequencing to identify operational taxonomic units (OTUs). Extracted genome was amplified and filtered sequences were used to classify OTUs based on their specific taxonomy. No statistically significant differences were observed in stool samples among the groups. However, urine samples indicated different microbiota compositions in different patient populations. The top five microbial genera that showed significant differences between the BPH and control groups were Alcaligenes, Pseudomonas, Lactobacillus, Akkermansia, and Cetobacterium. Faecalibacterium, Staphylococcus, Ruminococcaceae_UCG_002, Neisseria, and Agathobacter were the genera with the largest proportion differences when comparing the PC and control groups. We discovered that the urine microbiota composition of the BPH and PC groups was distinct from that of the control group. Due to the impact of microbiota on prostatic disease, it is necessary to identify specific microbes for further research. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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10 pages, 655 KiB  

Open AccessArticle

Multimodal Treatment with Cognitive Behavioral Therapeutic Intervention Plus Bladder Treatment Is More Effective than Monotherapy for Patients with Interstitial Cystitis/Bladder Pain Syndrome—A Randomized Clinical Trial

by Wan-Ru Yu, Jia-Fong Jhang, Bai-Yueh Chen, Syuan-Ru Ou, Hao-Ming Li and Hann-Chorng Kuo

J. Clin. Med. 2022, 11(20), 6221; https://doi.org/10.3390/jcm11206221 - 21 Oct 2022

Cited by 6 | Viewed by 2357

Abstract

(1) Background: Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) not only induces physiological damage but also greatly affects psychological stress. Multidisciplinary therapy has been recommended for IC/BPS treatment, but clinical trial data of combined bladder therapy and cognitive behavioral therapy (CBT) are lacking. This [...] Read more.

(1) Background: Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) not only induces physiological damage but also greatly affects psychological stress. Multidisciplinary therapy has been recommended for IC/BPS treatment, but clinical trial data of combined bladder therapy and cognitive behavioral therapy (CBT) are lacking. This study evaluated CBT efficacy in patients with IC/BPS. (2) Methods: Patients with IC/BPS were randomized to the bladder monotherapy (BT) or combined CBT (CBT) group. The primary endpoint was the self-reported outcome by global response assessment (GRA). Secondary endpoints included IC symptoms and problem index, bladder pain score, Beck’s anxiety inventory (BAI), and depression inventory, and objective parameters were also compared. (3) Result: A total of 30 patients receiving BT and 30 receiving CBT therapy were enrolled. Significant improvement of the BAI at 8 (p = 0.045) and 12 weeks (p = 0.02) post-treatment was observed in the CBT group, with significantly greater GRA scores at 12 weeks (p < 0.001). Repeated measures analysis of variance showed a significant effect within the CBT group on IC/BPS patients’ self-reported treatment outcomes (p = 0.001) and anxiety severity BAI scores (p = 0.033). (4) Conclusion: A multimodal treatment of CBT combined with suitable bladder treatment more effectively improves anxiety severity and treatment outcomes in patients with IC/BPS. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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11 pages, 272 KiB  

Open AccessArticle

Satisfaction with Surgical Procedures and Bladder Management of Chronic Spinal Cord Injured Patients with Voiding Dysfunction Who Desire Spontaneous Voiding

by Shu-Yu Wu and Hann-Chorng Kuo

J. Pers. Med. 2022, 12(10), 1751; https://doi.org/10.3390/jpm12101751 - 21 Oct 2022

Cited by 9 | Viewed by 2061

Abstract

We aimed to investigate treatment outcome and satisfaction with bladder outlet surgeries and bladder management in patients with spinal cord injury (SCI), voiding dysfunction, and to seek a spontaneous voiding or reflex voiding program. A total of 261 patients were included in this [...] Read more.

We aimed to investigate treatment outcome and satisfaction with bladder outlet surgeries and bladder management in patients with spinal cord injury (SCI), voiding dysfunction, and to seek a spontaneous voiding or reflex voiding program. A total of 261 patients were included in this retrospective study. The mean age at surgical procedure was 49.2 ± 15.9 years; the median follow-up period was 11 (IQR 6, 17) years; 119 received a urethral Botox injection, 41 underwent transurethral incision of the bladder neck (TUI-BN), 77 underwent transurethral incision or resection of the prostate (TUI-P or TUR-P), and 24 had an external sphincterotomy. Satisfactory surgical outcome was reported by 80.5% of patients undergoing TUI-BN, 70.8% undergoing external sphincterotomy, 64.9% receiving TUI-P or TUR-P, and 59.7% receiving the urethral Botox injection. Persistent dysuria was the most common reason for dissatisfaction after the urethral Botox injection (73.1%) and TUI-BN (58.5%). Recurrent urinary tract infection continued in most patients after any type of surgery (all >75%). Most patients with SCI were satisfied with their initial bladder outlet operation in facilitating spontaneous voiding. However, repeat, or multiple surgical interventions were needed in 65.5% of SCI patients to achieve satisfactory voiding. A correct diagnosis is very important before every intervention and bladder management to reach the best satisfaction. VUDS is suggested before surgical procedures to ensure efficacy, even in patients with the same level of SCI. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

11 pages, 241 KiB  

Open AccessArticle

Satisfaction with Urinary Incontinence Treatments in Patients with Chronic Spinal Cord Injury

by Sheng-Fu Chen, Yu Khun Lee and Hann-Chorng Kuo

J. Clin. Med. 2022, 11(19), 5864; https://doi.org/10.3390/jcm11195864 - 4 Oct 2022

Cited by 8 | Viewed by 2385

Abstract

Purpose: To investigate the long-term satisfaction and complications in chronic spinal cord injury (SCI) patients after various bladder management strategies and surgical procedures for the treatment of urinary incontinence. Methods: Patients at a single institution with chronic SCI who received bladder management treatment [...] Read more.

Purpose: To investigate the long-term satisfaction and complications in chronic spinal cord injury (SCI) patients after various bladder management strategies and surgical procedures for the treatment of urinary incontinence. Methods: Patients at a single institution with chronic SCI who received bladder management treatment or surgical procedure to improve urinary continence were retrospectively assessed. Thorough urological examinations and videourodynamic studies were performed. Patients were treated either through conservative approaches including medical treatment, clean intermittent catheterization (CIC), cystostomy, and indwelling urethral catheter, or through surgical procedures including detrusor botulinum toxin (Botox) injections, augmentation, ileal conduit, Kock pouch diversion, continent cystostomy, suburethral sling, and artificial urethral sphincter (AUS) implantation. The patients’ satisfaction with urinary continence improvement, causes of dissatisfaction, long-term complications, and overall satisfaction with bladder and voiding condition were assessed. Results: A total of 700 consecutive patients were enrolled in this study. High satisfaction rates were noted after detrusor Botox injection (81.1%), augmentation enterocystoplasty (91.4%), autoaugmentation (80%), Kock pouch diversion, and continent cystostomy (all 100%). Fair satisfaction rates were noted after ileal conduit diversion (66.7%), suburethral sling (64.3%), and AUS implantation (66.7%). Patients who received conservative treatment with medicines, CIC, cystostomy, or an indwelling urethral catheter all had less-satisfactory outcomes (all < 40%). Conclusion: Overall satisfaction with surgical procedures aimed to improve urinary continence in chronic SCI patients was higher than with conservative bladder management (35.4%). Appropriate surgical procedures for chronic SCI patients with neurogenic lower urinary tract dysfunction (NLUTD) and urological complications yielded satisfaction with both urinary continence improvement and with overall bladder and voiding condition. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

9 pages, 650 KiB  

Open AccessArticle

Silodosin Improves Pain and Urinary Frequency in Bladder Pain Syndrome/Interstitial Cystitis Patients

by Pedro Abreu-Mendes, Beatriz Araújo-Silva, Ana Charrua, Francisco Cruz and Rui Pinto

J. Clin. Med. 2022, 11(19), 5659; https://doi.org/10.3390/jcm11195659 - 26 Sep 2022

Cited by 3 | Viewed by 2872

Abstract

Purpose: Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) is a bladder-related chronic inflammatory disease. Data indicate that stress enhances the excitability of bladder nociceptors through the stimulation of alpha1A-adrenoceptors. Stress is known to play a crucial role in BPS/IC patients. We aimed to assess the [...] Read more.

Purpose: Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) is a bladder-related chronic inflammatory disease. Data indicate that stress enhances the excitability of bladder nociceptors through the stimulation of alpha1A-adrenoceptors. Stress is known to play a crucial role in BPS/IC patients. We aimed to assess the efficacy and safety of daily silodosin in refractory BPS/IC female patients and its correlation with stress coping. Materials and Methods: An open-label trial was conducted with 20 refractory BPS/IC patients. Evaluations occurred at baseline and the 8th and 12th weeks. Primary endpoint was bladder pain evaluated by visual analogue scale (VAS). Secondary endpoints included daily frequency, nocturia and maximum voided volume obtained from a 3-day bladder diary, the O’Leary–Sant Symptom Score, and two questions accessing stress coping. Patients initiated daily doses of 8 mg silodosin, which could be titrated to 16 mg. Median values with percentiles 25 and 75 (25; 75) were used. Wilcoxon signed-rank test was used for comparisons. A minimally important difference of 3 points for pain was established to define clinically relevant improvement. Results: Median age was 56 years. Median pain score decreased from 8.00 (6.00; 8.00) at baseline to 4.00 (2.00; 5.50) (p < 0.001), meaning that the primary endpoint was reached. Total urinary frequency decreased from 14.00 (13.00; 21.00) to 9.00 (7.50; 11.00) (p < 0.05), and all the other secondary endpoints also showed a statistically significant improvement. Eleven patients improved by ≥3 pain points in VAS, meaning that 65% of patients that ended the study protocol achieved clinical significant improvement or, in the full analysis set, that 55% of the 20 initial patients improved significantly. Fourteen (82%) decreased by ≥2 micturitions/day. Overall, the cohort’s stress coping was low. Conclusions: Silodosin can be an effective and well-tolerated treatment for refractory BPS/IC female patients. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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17 pages, 2583 KiB  

Open AccessReview

Current Understanding of the Pathophysiology and Novel Treatments of Interstitial Cystitis/Bladder Pain Syndrome

by Jia-Fong Jhang, Yuan-Hong Jiang and Hann-Chorng Kuo

Biomedicines 2022, 10(10), 2380; https://doi.org/10.3390/biomedicines10102380 - 23 Sep 2022

Cited by 28 | Viewed by 7959

Abstract

The pathophysiology of interstitial cystitis/bladder pain syndrome (IC/BPS) is multifactorial. Identifying the clinical characteristics and cystoscopic findings of bladder-centered IC/BPS facilitates optimal treatment strategies targeting the diseased urinary bladder. Patients with Hunner’s lesion (HIC) and without Hunner’s lesion (NHIC) should be treated differently. [...] Read more.

The pathophysiology of interstitial cystitis/bladder pain syndrome (IC/BPS) is multifactorial. Identifying the clinical characteristics and cystoscopic findings of bladder-centered IC/BPS facilitates optimal treatment strategies targeting the diseased urinary bladder. Patients with Hunner’s lesion (HIC) and without Hunner’s lesion (NHIC) should be treated differently. Based on the histopathological findings, NHIC can be treated with intravesical instillation of urothelial protective agents, such as hyaluronic acid, to cover the urothelial defects. In non-responders, chronic inflammation and higher urothelial dysfunction can be treated with intravesical botulinum toxin A injection, platelet-rich plasma injection, or low-energy shock wave treatment to reduce inflammation, increase tissue regeneration, and improve the urothelial barrier. Patients with HIC should be treated with electrocauterization first; augmentation enterocystoplasty should only be used in end-stage HIC when the contracted bladder is refractory to other treatments. The antiviral agent, valacyclovir, can be used in patients with HIC, small bladder capacity, and high-grade glomerulations. In addition, behavioral modification is always recommended from the beginning of treatment. Treatment with cognitive behavioral therapy interventions in combination with bladder therapy can reduce anxiety and improve treatment outcomes. Herein, recent advances in the pathophysiology and novel treatments for IC/BPS are reviewed. Full article

(This article belongs to the Topic Clinical, Translational, Basic Researches, and Application of Bacterial Toxins on Bladder Diseases and Lower Urinary Tract Dysfunctions)

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