Search

This study investigates predictors of unsatisfactory outcomes in female overactive bladder (OAB) patients treated with oral monotherapy by analyzing skin sympathetic nerve activity (SKNA) using a novel "neuECG" method. The study included 55 newly diagnosed female patients with idiopathic OAB, autonomic function was evaluated using neuECG before treatment initiation, and validated OAB questionnaires and urodynamic studies were administered. Initial monotherapy was administered for the first 4 weeks, with non‐responders defined as patients not achieving satisfactory symptom relief and requiring further treatment. Responders (n = 32) and non‐responders (n = 23) had no significant differences in baseline characteristics or urodynamic parameters; however, non‐responders exhibited significantly higher baseline average SKNA (aSKNA) (1.36 ± 0.49 vs. 0.97 ± 0.29 μV, p = 0.001), higher recovery aSKNA (1.28 ± 0.46 vs. 0.97 ± 0.35 μV, p = 0.007), and a lower stress/baseline ratio of aSKNA (1.05 ± 0.42 vs. 1.26 ± 0.26, p = 0.029). Baseline aSKNA had the highest predictive value for monotherapy refractoriness in OAB (AUROC = 0.759, p = 0.001), with an optimal cut‐off point of >1.032 μV. These findings suggest that elevated pre‐treatment aSKNA can predict resistance to oral monotherapy in OAB, warranting close monitoring and proactive treatment strategies for patients with high aSKNA. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) includes cardiovascular risk factors like obesity, dyslipidemia, hypertension, and glucose intolerance, which increase the risk of overactive bladder (OAB), characterized by urgency, frequency, urge incontinence, and nocturia. Both MetS and ovarian hormone deficiency (OHD) are linked to bladder overactivity. Nitric oxide (NO) is known to reduce inflammation and promote healing but its effect on bladder overactivity in MetS and OHD is unclear. This study aimed to investigate NO's impact on detrusor muscle hyperactivity in rats with MetS and OHD. Female Sprague-Dawley rats were divided into seven groups based on diet and treatments involving L-arginine (NO precursor) and L-NAME (NOS inhibitor). After 12 months on a high-fat, high-sugar diet with or without OVX, a cystometrogram and tracing analysis of voiding behavior were used to identify the symptoms of detrusor hyperactivity. The MetS with or without OHD group had a worse bladder contractile response while L-arginine ameliorated bladder contractile function. In summary, MetS with or without OHD decreased NO production, reduced angiogenesis, and enhanced oxidative stress to cause bladder overactivity, mediated through the NF-kB signaling pathway, whereas L-arginine ameliorated the symptoms of detrusor overactivity and lessened oxidative damage via the NRF2/HIF-1α signaling pathway in MetS with or without OHD-induced OAB. [ABSTRACT FROM AUTHOR]

Simple Summary: This study reports on a comparison between the Hugo RAS system and the da Vinci (DV) system in robot-assisted radical prostatectomy. The parameters consisted of intraoperative anastomosis and overall console time, functional outcomes, and oncological outcomes. We found that, although the anastomosis time of the urinary bladder and urethra was lengthened, the overall console time was not affected. In short-term functional and oncological outcomes, these two parameters were not compromised in the Hugo RAS group. Based on our results, the DV system could facilitate swift adaptation to the Hugo RAS system. Importantly, the functional and oncological outcomes would not be compromised in the process of adapting to the Hugo RAS system. Objective: In a previous study, we proved that an experienced urologist is more likely to adapt to the Hugo RAS system. Based on this, we further examine various parameters in this study. Parameters included in this study consisted of console time, functional outcomes, and oncological outcomes. Materials and Methods: A total of 60 patients who underwent robot-assisted radical prostatectomy (RARP) performed by a single surgeon using the da Vinci (DV) system (n = 30) or the Hugo RAS system (n = 30) between March 2023 and August 2023 were included in the analysis. The intraoperative operative time was categorized into vesicourethral anastomosis time and overall console time. Functional and oncological outcomes were documented at the 1st and 3rd postoperative months. Parametric and non-parametric methods were adopted after checking skewness and kurtosis, and an α value of 5% was used to determine the significance. Results: The vesicourethral anastomosis time was significantly lengthened (Hedge's g: 0.87; 95% confidence interval (CI): 0.34–1.39; J factor = 0.987). However, the overall console time was not affected. The functional (postoperative 3rd month: p = 0.130) and oncological outcomes (postoperative 3rd month: p = 0.103) were not significantly different. We also found that the adverse effect on surgical specimens and positive surgical margins was not affected (p = 0.552). Conclusion: During the process of adaptation, although intricate motions (such as the vesicourethral anastomosis time) would be lengthened, the overall console time would not change remarkably. In this process, the functional and oncological outcomes would not be compromised. This encourages urologists to adopt the Hugo RAS system in RARP if they have previous experiences of using the DV system, since their trifecta advantage would not be compromised. [ABSTRACT FROM AUTHOR]

Urological complications are common in patients with chronic spinal cord injury (SCI). Inappropriate bladder management may result in high voiding pressure, low bladder compliance, large postvoid residual urine volume, and recurrent urinary tract infections. Thus, long-term surveillance of high-risk patients with SCI is required to avoid urological complications and improve the quality of life. Herein, the current evidence and expert opinions on patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic SCI in Taiwan are presented. Regular physical and urological examinations should be performed in patients with SCI depending on their risk of upper urinary tract deterioration. For patient with SCI who have received different bladder management and surgical intervention, education on proper bladder emptying and regular surveillance are mandatory. It is critical to identify high-risk patients to prevent renal functional deterioration in those with chronic SCI-induced NLUTD. Thus, annual active surveillance of bladder and renal function is required, particularly in high-risk patients with SCI. [ABSTRACT FROM AUTHOR]