Search Results (144)

Bladder dysfunction, particularly overactive bladder (OAB), is increasingly recognized as a clinical concern in patients with sickle cell disease (SCD), yet its pathophysiological mechanisms remain poorly understood. This study investigated the relationship between oxidative stress, inflammation, and bladder dysfunction in the Townes transgenic SCD mouse model. Cystometric analysis revealed that SCD mice exhibit an OAB phenotype, characterized by increased frequencies of voiding and non-voiding contractions and reduced bladder compliance. In vitro functional assays demonstrated detrusor hypocontractility in SCD mice, associated with a significant reduction in carbachol- and EFS-induced contractions and downregulation of muscarinic M3 receptor expression. Purinergic signaling and calcium-dependent contractility remained preserved. Molecular analyses showed increased mRNA expression of NOX-2 and IL-1β, and elevated protein levels of 3-nitrotyrosine and myeloperoxidase (MPO) activity, indicating redox imbalance and chronic inflammation in bladder tissue. Together, these changes suggest that oxidative and nitrosative stress, combined with inflammation, contribute to bladder remodeling and dysfunction in SCD. This is the first study to characterize bladder alterations in Townes SCD mice, establishing this model as a valuable tool for investigating lower urinary tract complications in SCD. Our findings provide mechanistic insight into the genitourinary manifestations of SCD and identify redox and inflammatory pathways as potential therapeutic targets for bladder dysfunction in affected individuals. Full article

Background/Objectives: A variant of autism spectrum disorder (ASD) known as Asperger syndrome (AS) shows increasing incidence worldwide, affecting between 0.02% and 0.03% of children. Patients display abnormal conduct, are limited in social interaction and communication, and are more often affected by micturition disorders, incontinence, and voiding symptoms than typically developing children. Methods: The present study aimed to review the literature related to the current management of lower urinary tract conditions in children with Asperger syndrome and to present a case of a 14-year-old girl with ASD, with characteristic impairments, including communication challenges, stereotyped, repetitive behaviors, and chronic constipation with concomitant bladder dysfunction, presenting recurrent urinary tract infections (UTIs) and lower urinary tract symptoms (LUTS), including voiding and filling storage symptoms. For the AS, she was treated with a selective serotonin reuptake inhibitor (Sertraline). An abdominal ultrasound, PLUTTS—pediatric lower urinary symptoms scoring (21); QL-quality of life (3); voiding diary; and uroflowmetry were performed, revealing an incomplete urinary retention (incomplete bladder emptying of 120 mL), a prolonged and interrupted curve, a maximum urinary flow rate (Qmax) 7 mL/s, and a UTI with Enterococcus. Results: Besides psychiatric reevaluation and antibiotic therapy, functional magnetic stimulation (FMS) sessions were performed. After eight sessions (20 min, 35 MHz, every second day), the ultrasound control and the uroflowmetry showed no residual urine, and the Qmax was 17 mL/s. The curve continued to be interrupted: PLUTSS-11, QL-1. FMS was continued at two sessions per week. At the 3-month follow-up, no residual urine was detected, and Qmax reached 24 mL/s. Conclusions: ASD is an incapacitating/debilitating condition that significantly impairs social functioning. In many cases, in addition to psychological symptoms, other conditions such as LUTS and constipation may coexist. Antipsychotics and antidepressants are frequently prescribed for these patients, often leading to various side effects, including micturition disorders. Therefore, screening for LUTS is recommended, and, if indicated, treatment—especially non-pharmacological and non-invasive approaches, such as FMS—should be considered. Full article

Background/Objectives: To characterize functional brain activation during smiling and to assess cognitive profiles in patients with Ochoa (Urofacial) syndrome (UFS). Materials and Methods: In a block-design fMRI paradigm, participants alternated between imitating a smiling emoji and viewing a fixation cross. Images were preprocessed and analyzed in SPM12; Smile > Rest contrasts were tested with a voxelwise threshold of p < 0.001 (uncorrected). Cognitive levels were assessed using age-appropriate Wechsler scales administered by certified psychologists. Results: Six patients (mean age 20 years; 50% female) with genetically/clinically confirmed UFS were included. Smile > Rest elicited robust activation in the supplementary motor area (highest Z = 4.70), insula (largest cluster), dorsal anterior cingulate, primary motor cortex, and frontal eye fields, among others. Five patients completed cognitive testing; Full-Scale IQ ranged 50–74, consistent with mild intellectual disability to borderline intellectual functioning. Conclusions: During voluntary smiling, UFS patients exhibit activation patterns that overlap extensively with those reported in healthy cohorts. Nevertheless, cognitive performance was limited in this sample. Given the rarity of UFS and the small cohort, findings should be interpreted cautiously and validated in multicenter studies. Full article

Background and Objectives: This study aimed to evaluate the association between relationship dynamics as measured by dyadic adjustment and factors such as erectile function and lower urinary tract symptoms, adjusting for relevant clinical characteristics. Materials and Methods: This cross-sectional study collected data from 94 males in relationships of at least 6 months and with a prostate volume equal to or higher than 30 cc. Lower urinary tract symptoms, erectile function, and relationship dynamics were assessed with the International Prostate Symptom Score (I-PSS), International Index of Erectile Function (IIEF), Dyadic Adjustment Scale (DAS). Results: We found significant positive correlations between DAS affective expressions (AEs) and erectile dysfunction duration; between IIEF general satisfaction and DAS dyadic adjustment (DA), dyadic consensus (DC), and dyadic cohesion (DH); and between prostate width and DAS DA and DC (all ρ ≈ 0.2–0.3, p < 0.05). Further multiple regression analyses adjusting for age, prostate width, and comorbidities showed that the associations between IIEF general satisfaction and DAS DA (p = 0.013) and DH (p = 0.008) remained significant, while the relationship with DAS DC (p = 0.051) was borderline. Conclusions: Our findings highlight that general sexual satisfaction, as measured with the IIEF, had a small but independent association with higher affective expressions, dyadic cohesion, and dyadic consensus in couples, which are key domains of dyadic adjustment, regardless of relationship duration, prostate width, and comorbidities. These results emphasize the importance of considering sexual satisfaction in the context of relationship quality and, therefore, involving the female partner in the assessment and treatment of erectile dysfunction. Full article

Focal therapy for prostate cancer (PCa) provides approaches to treat PCa patients in a less invasive manner than traditional whole-gland surgical or radiation modalities. This manuscript provides a case series of high-intensity focused ultrasound (HIFU), cryoablation, and irreversible electroporation (IRE) for PCa at a single institution and cost analysis with a review of the literature. All patients who underwent HIFU, cryoablation, or IRE for localized PCa were retrospectively reviewed, excluding patients who received whole-gland therapy. Functional outcomes were erectile dysfunction and lower urinary tract symptoms. Cost data were collected. A total of 45 patients were included in the study with focal therapy ranging from 2023 to 2025 (4 HIFU, 20 cryoablation, 21 IRE). A total of 30 patients had focally treated lesions, and 15 patients had hemi-gland treatment. The mean preoperative PSA was 7.7 ng/mL. On the paired sample t-test, there was no significant difference between pre-focal and post-focal therapy PSA. Three patients experienced biochemical recurrence requiring prostate biopsy after focal treatment. Mean cost was USD 3804.50 and not significantly different by focal treatment. No metastatic events occurred nor deaths at a median follow-up of 6 months. Patients in this series had largely unaltered functional outcomes. Cost analysis in contemporary publications is lacking. Although follow-up was short, cancer control was adequate. Full article

Background: Anorectal malformations (ARMs) are rare congenital anomalies requiring surgical correction and long-term multidisciplinary care. Despite advances in surgical techniques like posterior sagittal anorectoplasty (PSARP), patients often experience ongoing issues with bowel and urinary function and psychosocial well-being. Aim: To evaluate the long-term outcomes of bowel function, urinary function, and quality of life in patients born with anorectal malformation and treated at our center. Methods: A cross-sectional study evaluated 55 ARM patients treated at the University Hospital of Palermo between 2002 and 2020. Data on clinical characteristics, surgical management, bowel and urinary function, and quality of life were collected using the following validated tools: Rintala Bowel Function Score, PedsQL Family Impact Module, Fecal Incontinence Quality of Life Score, and Lower Urinary Tract Symptoms Questionnaire. Statistical analysis was performed using Fisher’s exact test and ANOVA. Results: Excellent bowel function was observed in 44% of patients, particularly those with low-type ARMs. A bowel management program (BMP) was required in 62% of cases, though 44% of these patients, especially adolescents, showed poor adherence. BMP non-adherence significantly correlated with lower quality of life and worse bowel function (p < 0.01). Bladder dysfunction was noted in 24% of patients, mainly younger ones. Conclusions: Tailored BMPs and transition care are important for long-term success in ARM patients. Adherence to BMPs improves continence and quality of life, highlighting the need for continuous, multidisciplinary follow-up from childhood into adulthood. Full article

Urinary tract infections (UTIs) are among the most prevalent bacterial infections in women, with high recurrence rates and growing concerns over antimicrobial resistance. The need for alternative or adjunctive therapies has spurred interest in plant-based treatments, which offer antimicrobial, anti-inflammatory, antioxidant, and immune-modulatory benefits. This review summarizes the mechanisms of action, clinical efficacy, and therapeutic potential of various medicinal plants and natural compounds for preventing and treating UTIs in women. Notable candidates include cranberry, bearberry, pomegranate, green tea, and other phytochemicals with proven anti-adhesive and biofilm-disrupting properties. Evidence from clinical trials and meta-analyses supports the role of cranberry natural products and traditional herbal medicines (THMs) in reducing UTI recurrence, especially when combined with antibiotics. Notably, A-type proanthocyanidins in cranberry and arbutin in bearberry are key bioactive compounds that exhibit potent anti-adhesive and biofilm-disrupting properties, offering promising adjunctive strategies for preventing recurrent urinary tract infections. Additionally, emerging therapies, such as platelet-rich plasma (PRP), show promise in restoring bladder function and reducing infection in women with lower urinary tract dysfunction. Overall, plant-based strategies represent a valuable and well-tolerated complement to conventional therapies and warrant further investigation through high-quality clinical trials to validate their efficacy, safety, and role in personalized UTI management. 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

Background/Objectives: Benign prostatic hyperplasia (BPH) is a common urological condition that can significantly impair quality of life in aging men by causing lower urinary tract symptoms (LUTS), including nocturia, weak stream, and incomplete emptying. While pharmacotherapy and surgical approaches such as transurethral resection of the prostate (TURP) remain cornerstone treatments, minimally invasive surgical therapies (MISTs) have emerged to bridge the gap between long-term medication use and invasive surgery. This narrative review assesses Rezūm therapy (water vapor thermal therapy, WVTT) by examining its mechanism of action, clinical efficacy, safety profile, and place in the BPH treatment algorithm. Methods: This narrative review synthesizes evidence from randomized controlled trials (RCTs), prospective studies, real-world cohorts, and published systematic reviews with meta-analyses to provide a comprehensive evaluation of Rezūm therapy for BPH. Key outcomes assessed include changes in International Prostate Symptom Score (IPSS), urinary flow rates, retreatment rates, adverse events, and sexual function preservation. Results: Across multiple studies, Rezūm significantly reduces IPSS (typically by ≥50%) and increases peak urinary flow by 4–5 mL/s. These improvements are durable, with five-year follow-up data showing low retreatment rates of approximately 4–5% and sustained symptom relief. The procedure, performed under local or minimal anesthesia, has a favorable safety profile: most adverse events are mild or transient, and notable complications, such as bleeding requiring transfusion or persistent sexual dysfunction, are rare. Importantly, Rezūm preserves both erectile and ejaculatory function in most patients, setting it apart from many traditional surgical interventions associated with higher sexual side effect rates. Conclusions: Rezūm is an effective and minimally invasive alternative for men with moderate prostatic enlargement who desire durable symptom improvement while avoiding the morbidity and sexual side effects associated with more invasive surgery. Future research should aim to further refine patient selection and assess long-term outcomes in broader populations. Full article

Background: Postpartum urinary retention (PPUR) typically resolves within the first three days following delivery. However, in rare instances, it may persist beyond 72 h and, in some cases, extend for several weeks. The current study aimed to evaluate long-term sequelae in women who endured PPUR following vaginal delivery. Methods: Between January 2013 and December 2019, 362 women who experienced PPUR following delivery at our institution were identified and subsequently invited to complete the UDI-6 questionnaire that serves to assess lower urinary tract symptoms. The questionnaires were filled out and returned by 242 women (66.8%). Results: Participants who had no urinary complaints (145/242; 60%) were assigned to Group 1. Of the 97 women allocated to Group 2 (97/242; 40%), 96 reported only mild urinary symptoms, while just 1 individual scored above the threshold of 33.3, suggesting elevated urinary distress. Risk factors known to be associated with PPUR were equally distributed among the two groups. A predominance of Caucasians was noted in Group 2 (p = 0.012). Voiding dysfunction (question 5 of UDI-6), taken separately, was proclaimed by 15 women from Group 2 (15/97 = 15.5%). When these were compared to the rest of the cohort (n = 227), an association with hypothyroidism was recognized (p = 0.036). Well-established risk factors for PPUR, such as nulliparity and epidural analgesia, were observed less frequently among women with persistent voiding dysfunction (p = 0.045 and p = 0.049, respectively), while postpartum uterine atony was more frequent (p = 0.047). Significant long-term effects after PPUR are uncommon. Conclusions: Hypothyroidism and postpartum uterine atony emerge as risk factors allied to long-term voiding dysfunction. 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

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 and Objectives: Lower urinary tract symptoms (LUTSs) are prevalent among patients with uterine myoma (UM); however, these health issues have not been systematically evaluated. To address this research gap, this systematic review and meta-analysis synthesizes existing findings on the prevalence estimates and odds ratios for LUTSs in patients with UM. Materials and Methods: A systematic literature search using PubMed and Embase was conducted for articles published between 1 January 2000 and 24 September 2023. The search and review processes followed the PRISMA and MOOSE guidelines. This study was registered in PROSPERO (CRD42023474156). Data on the prevalence and odds ratios of LUTSs—including storage symptoms (frequency, urgency, nocturia), voiding symptoms, and urinary incontinence (UI) subtypes such as stress incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI)—were extracted. Pooled prevalence estimates and odds ratios were calculated using random-effects meta-analysis. Subgroup analyses and univariate meta-regression were conducted to examine associations with age, BMI, parity, WHO region, and risk of bias. The impact of UM size was assessed using standardized mean differences. Results: Of the 572 articles screened, 20 met the inclusion criteria. The overall pooled prevalence of LUTSs in UM patients was 49% (95% CI, 26–72%), with substantial heterogeneity across studies (I² = 99.8%). The pooled prevalence for urinary frequency, urgency, nocturia, voiding dysfunction, and overall UI, SUI, UUI, and MUI ranged from 15% to 54%. SUI and UUI were significantly associated with UM (OR = 2.0, 95% CI: 1.2–3.3; OR = 1.5, 95% CI: 1.1–2.0, respectively). Hysterectomy was not associated with an improvement in overactive bladder (OAB) symptoms (OR = 1.9, 95% CI: 0.6–5.7). A larger UM size was not linked to worsening LUTS. Fourteen studies (70%) had some concerns about the risk of bias, while six studies (30%) had a low risk of bias. Egger’s test showed no significant publication bias (p = 0.19). Conclusions: Approximately half of patients with UM experience LUTSs or UI. The findings emphasize the need to consider urinary symptoms in UM management. Further research is warranted to reduce heterogeneity and explore treatment-specific outcomes. Full article

Pediatric lower urinary tract symptoms (LUTS) are influenced by age and coexist with nocturnal enuresis (NE) and bladder-bowel dysfunction (BBD). Urinary tract infections (UTIs) are common and linked to LUTS, though the causal relationship remains unclear. This systematic review aims to analyze microbiome alterations in pediatric LUTS and UTIs. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Embase, and CINAHL databases were searched for studies analyzing gut and urinary microbiomes in pediatric patients with LUTS and UTIs. Quality assessment was performed using the QUADOMICS checklist. Results: Nine studies published between 2018 and 2024 were included; seven out of nine studies employed prospective designs. Six hundred nineteen patients (44.3% pathology groups, 55.7% controls) were analyzed, with microbiome sequencing performed on stool samples in four studies and urine samples in five studies. UTIs and BBD were associated with reduced alpha diversity and distinct bacterial compositions, while beta diversity analyses revealed distinct clustering of microbiome compositions between affected and healthy groups. The gut microbiome of UTI patients showed alterations in Actinobacteria and Proteobacteria abundance, while voiding dysfunction (VD) was linked to the presence of Fusobacterium nucleatum, Clostridium difficile, and Bacteroides clarus without significant VDSS correlation. Conclusion: This systematic review reveals microbial alterations in pediatric LUTS and UTIs, with lower urinary diversity in UTI patients and sex-specific differences post-puberty. Microbiome-based interventions may offer novel therapeutic strategies for LUTS and UTIs. 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