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Aims: The nitric oxide (NO•)/soluble guanylate cyclase/cyclic‐GMP (cGMP) signaling pathway is ubiquitous and regulates several functions in physiological systems as diverse as the vascular, nervous, and renal systems. However, its roles in determining normal and abnormal lower urinary tract functions are unclear. The aim was to identify potential therapeutic targets associated with this pathway to manage lower urinary tract functional disorders. Methods: This review summarizes a workshop held under the auspices of ICI‐RS with a view to address these questions. Results: Four areas were addressed: NO• signaling to regulate neurotransmitter release to detrusor smooth muscle; its potential dual roles in alleviating and exacerbating inflammatory pathways; its ability to act as an antifibrotic mediator; and the control by nitrergic nerves of lower urinary tract vascular dynamics and the contractile performance of muscular regions of the bladder wall. Central to much of the discussion was the role of the NO• receptor, soluble guanylate cyclase (sGC) in regulating the generation of the enzyme product, the second messenger cGMP. The redox state of sGC is crucial in determining its enzymic activity and the role of a class of novel agents, sGC activators, to optimize activity and to potentially alleviate the consequences of lower urinary tract disorders was highlighted. In addition, the consequences of a functional relationship between nitrergic and sympathetic nerves to regulate vascular dynamics was discussed. Conclusions: Several potential NO•‐dependent drug targets in the lower urinary tract were identified that provide the basis for future research and translation to clinical trials. [ABSTRACT FROM AUTHOR]

Aim: Bladder sensation is critical for coordinating voluntary micturition to maintain healthy bladder function. Sensations are initiated by the activation of sensory afferents that innervate throughout the bladder wall. However, the physiological complexity that underlies the initiation of bladder sensory signaling in health and disease remains poorly understood. This review summarises the latest knowledge of the mechanisms underlying the generation of bladder sensation and identifies key areas for future research. Methods: Experts in bladder sensory signaling reviewed the literature on how the lower urinary tract contributes to bladder sensation and identified key research areas for discussion at the 10th International Consultation on Incontinence—Research Society. Results: The importance of bladder sensory signals in maintaining healthy bladder function is well established. However, better therapeutic management of bladder disorders with exaggerated bladder sensation, including overactive bladder syndrome (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS) is limited by a lack of knowledge in a number of key research areas including; the contribution of different nerves (pudendal, pelvic, hypogastric) to filling sensations in health and disease; the relative contribution of stretch sensitive (muscular) and stretch‐insensitive (mucosal) afferents to bladder sensation in health and disease; the direct and indirect contributions of the muscularis mucosae to bladder contraction and sensation; and the impact of manipulating urothelial release factors on bladder sensation. Conclusion: Disturbances in bladder sensory signaling can have severe consequences for bladder sensation and function including the development of OAB and IC/BPS. Advancing therapeutic treatments for OAB and IC/BPS requires a deeper understanding of the mechanisms underlying the generation of bladder sensation, and key areas for future research have been identified. [ABSTRACT FROM AUTHOR]

Background/objectives Major causes of hip fractures are osteoporosis and falls, both of which are determined by nutrition. Information on the nutritional status of patients admitted to hospital with a hip fracture is lacking. In this study, we assessed determinants and adverse outcomes associated with malnutrition and malnourishment. Methods Nutritional status, assessed using the Malnutrition Universal Screening Tool protocol, was compared to age and residency prior to admission, and outcomes during hospital stay and at discharge. Results A total of 1239 patients admitted with a hip fracture (349 men, 890 women), aged 60-100 years. Compared with well-nourished individuals, the prevalences of malnutrition risk or malnourishment were higher in older age groups and those from residential or nursing care. Those with risk of malnutrition or malnourishment stayed in hospital longer by 3.0 days (95% confidence interval (CI), 1.5-4.5 days; p < 0.001) and 3.1 days (95% CI, 0.7-5.5 days; p = 0.011), respectively. Compared with the well-nourished group, malnourished individuals had increased: (1) risk for failure to mobilise within 1 day of surgery (rates = 17.9 versus 27.0%; odds ratio (OR) = 1.6 (95% CI, 1.0-2.7), p = 0.045); (2) pressure ulcers (rates = 1.0% versus 5.0%; OR = 5.5 (95% CI, 1.8-17.1), p = 0.006); (3) in-patient mortality (rates = 4.5% versus 10.1%; OR = 2.3 (95% CI, 1.1-4.8) p = 0.033) and (4) discharge to residential/nursing care: rates = 4.3% versus 11.1%; OR = 2.8 (95% CI, 1.2-6.6), p = 0.022. Conclusions Inadequate nutrition is common in patients admitted to hospital with a hip fracture, which in turn predisposes them to a number of complications. More research on nutritional support should be directed to this group to prevent or minimise hip fractures., Author(s): Thang S. Han [sup.1] , Keefai Yeong [sup.2] , Radcliffe Lisk [sup.2] , David Fluck [sup.3] , Christopher H. Fry [sup.4] Author Affiliations: (1) Institute of Cardiovascular Research, Royal [...]

Objectives: During the coronavirus disease (COVID‐19) pandemic, patients with altered mental status (AMS: dementia, delirium and delirium superimposed on dementia) were profoundly affected by an abrupt transformation in healthcare systems. Here, we evaluated quality‐care outcomes, including length of stay (LOS), in‐hospital mortality, early readmission and mortality after hospital discharge, in older adults admitted for AMS during the pandemic and compared them to patients admitted prior to the pandemic. Methods: Chi‐squared and Fisher's exact tests were used to examine changes to admissions for AMS before and during the pandemic, and their outcomes. Logistic regression analyses, with reference to pre‐pandemic data, were conducted to examine the impact of the pandemic on outcomes. Design: Prospective data of 21,192 non‐COVID admissions to an acute general medical department in a Surrey (UK) hospital were collected from patients admitted before (1st April 2019 to 29th February 2020) and during the pandemic (1st March 2020 to 31st March 2021). Results: There were 10,173 (47.7% men) from the pre‐pandemic and 11,019 (47.5% men) from the pandemic periods; overall mean age = 68.3yr. During the pandemic AMS patients had significantly higher admission rates (1.1% vs 0.6%, P < 0.001). However, median LOS in hospital was shorter (9.0 days [IQR = 5.3–16.2] vs 15.5 days [IQR = 6.2–25.7], P < 0.001) and thus were less likely to stay in hospital >3 weeks: adjusted OR = 0.26 (95%CI = 0.12–0.57). In‐hospital mortality and readmission within 28 days of discharge did not change during the pandemic, but were less likely to die within 30 days of discharge: adjusted OR = 0.32 (95%CI = 0.11–0.96). Conclusions: This combination of higher admission rate, shorter LOS, and an unchanging early readmission suggests a higher admission‐discharge turnover of different patients with AMS and provides important insights into the potential impact of the COVID‐19 pandemic on healthcare delivery to individuals with AMS. Key points: During the coronavirus disease (COVID‐19) pandemic, patients with altered mental status (AMS: dementia, delirium and delirium superimposed on delirium) were profoundly affected by an abrupt transformation in healthcare systems.Patients admitted with AMS during the pandemic had higher admission rates but shorter length of stay (LOS) in hospital, whilst mortality in hospital and readmission within 28 days of discharge did not change during the pandemicThese observations suggest a higher admission‐discharge turnover of different patients with AMS and provide important insights into the potentially impact of the COVID‐19 pandemic on healthcare delivery to individuals with AMS. [ABSTRACT FROM AUTHOR]

Background: The presence of urinary incontinence (UI) in acute stroke patients indicates poor outcomes in men and women. However, there is a paucity and inconsistency of data on UI risk factors in this group and hence we conducted a sex‐specific analysis to identify risk factors. Methods: Data were collected prospectively (2014–2016) from the Sentinel Stroke National Audit Program for patients admitted to four UK hyperacute stroke units. Relevant risk factors for UI were determined by stepwise multivariable logistic regression, presented as odds ratios (OR) and 95% confidence intervals (CI). Results: The mean (±SD) age of UI onset in men (73.9 year ± 13.1; n = 1593) was significantly earlier than for women (79.8 year ± 12.9; n = 1591: p < 0.001). Older age between 70 and 79 year in men (OR = 1.61: CI = 1.24–2.10) and women (OR = 1.55: CI = 1.12–2.15), or ≥80 year in men (OR = 2.19: CI = 1.71–2.81), and women (OR = 2.07: CI = 1.57–2.74)–reference: <70 year–both predicted UI. In addition, intracranial hemorrhage (reference: acute ischemic stroke) in men (OR = 1.64: CI = 1.22–2.20) and women (OR = 1.75: CI = 1.30–2.34); and prestroke disability (mRS scores ≥ 4) in men (OR = 1.90: CI = 1.02–3.5) and women (OR = 1.62: CI = 1.05–2.49) (reference: mRS scores < 4); and stroke severity at admission: NIHSS scores = 5–15 in men (OR = 1.50: CI = 1.20–1.88) and women (OR = 1.72: CI = 1.37–2.16), and NIHSS scores = 16–42 in men (OR = 4.68: CI = 3.20–6.85) and women (OR = 3.89: CI = 2.82–5.37) (reference: NIHSS scores = 0–4) were also significant. Factors not selected were: a history of congestive heart failure, hypertension, atrial fibrillation, diabetes and previous stroke. Conclusions: We have identified similar risk factors for UI after stroke in men and women including age >70 year, intracranial hemorrhage, prestroke disability and stroke severity. [ABSTRACT FROM AUTHOR]

This document is the cover image for the August 2024 issue of the journal Neurourology & Urodynamics. The image is related to an invited review article titled "How does the lower urinary tract contribute to bladder sensation?" The article discusses the sensory innervation of the bladder and how it detects bladder stretch, inflammation, and cell destruction. It also explores the release of neurotransmitters by the urothelium during bladder stretch and the role of different nerves in relaying sensory signals to the central nervous system. The article highlights the impact of alterations in sensory signals on bladder sensation. [Extracted from the article]