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Traumatic brain injury (TBI) can induce a coma and directly affect the pathways that help control lower urinary tract (LUT) function. This paper reviews the clinical and urodynamic data from the literature on LUT function after TBI in the acute, rehabilitation and chronic phases. The number of papers available on LUT function after TBI is very limited, but the studies have been well conducted, and the sample size is acceptable. The interpretation of reported data is complex due to heterogeneity in the items studied and the level of detail. During the early phase, indwelling catheters are needed for critical care, but spontaneous voiding is possible in most patients as soon as the catheter can be removed. The ability to void is primarily independent of the Glasgow Coma Scale value. During rehabilitation, spontaneous voiding is observed in the majority, but re-learning of voluntary control may be needed. In the follow-up, complete recovery of continence and voiding is possible, but overactive bladder and other LUT symptoms (LUTS) have been described. The data show that afferent and sensory functions related to the LUT remain active in many TBI patients, making long-term use of indwelling catheters unnecessary. There are no studies that follow the evolution in the same patient over a long period. Urodynamic studies show that LUT function varies after TBI and that variables such as age, previous dysuria, diabetes and local anatomic pathologies can also influence the outcome. Personalized management after an evaluation is therefore needed in TBI patients.

Introduction: A continent catheterizable channel (CCC) may be a solution for patients with impaired bladder emptying and difficult transurethral access. Leakage of the CCC is a common complication. To prevent leakage, the pressure in the CCC has to be higher than the reservoir (bladder/pouch) pressure in at least one location. It has not been clearly defined through which mechanism(s) the CCC achieves continence. In this feasibility study, we measured the CCC pressure profile in adult patients with various types of CCC's with and without stomal leakage. Methods: Adult patients with a CCC on a (augmented) bladder or pouch who underwent a urodynamic investigation between January and March 2023 were included. Next to the standard urodynamic investigation, a continuous stomal pressure measurement (CSP) and stomal pressure profilometry with empty bladder (SPP‐1) and with filled bladder (SPP‐2) of the CCC were performed. Results: A total of 17 patients were included. It was technically possible to perform SPP‐1 and SPP‐2 in all patients, and to measure the CSP in 16/17 patients. The median maximum stomal pressures in SPP‐1 and SPP‐2 were 112 (interquartile range [IQR], 76–140) cmH2O and 120 (IQR, 92–140) cmH2O, respectively. Nine patients had stomal leakage during the urodynamic investigation. In five patients, the detrusor leak point pressure (dLPP) was low (<20 cmH2O). A pressure peak at the beginning of SPP‐2 was absent in all patients with stomal leakage at low dLPP. Conclusion: SPP and CSP measurement in CCCs are feasible. We found differences in SPP‐2 between patients with and without leakage at low dLPP, indicative of a role of the intravesical tunnel in continence or high dLPP. The results of this study may improve our understanding of the physiology and dynamics of CCCs as well as the management of CCC‐related complications. [ABSTRACT FROM AUTHOR]

Introduction: Inflammation and neuronal hypersensitivity are reactive protective mechanisms after urothelial injury. In lower urinary tract dysfunctions (LUTD), such as urinary tract infection (UTI), bladder pain syndrome with interstitial cystitis (BPS/IC) and neurogenic LUTD after spinal cord injury (SCI), chronic inflammation can develop. It is unclear how the protective reactionary inflammation escalates into chronic disease in some patients. Methods: During its 2023 meeting in Bristol, the International Consultation on Incontinence‐Research Society (ICI‐RS) reviewed the urothelial and inflammatory changes after UTI, BPS/IC and SCI. Potential factors contributing to the evolution into chronic disease were explored in a think‐tank. Results: Five topics were discussed. (1) Visceral fat metabolism participates in the systemic pro‐inflammatory effect of noradrenalin in BPS/IC and SCI. Sympathetic nervous system‐adipocyte‐bladder crosstalk needs further investigation. (2) Sympathetic hyperactivity also potentiates immune depression in SCI and needs to be investigated in BPS/IC. Gabapentin and tumor necrosis factor‐α are promising research targets. (3) The exact peripheral neurons involved in the integrative protective unit formed by nervous and immune systems need to be further identified. (4) Neurotransmitter changes in SCI and BPS/IC: Neurotransmitter crosstalk needs to be considered in identifying new therapeutic targets. (5) The change from eubiosis to dysbiosis in SCI can contribute to UTI susceptibility and needs to be unraveled. Conclusions: The think‐tank discussed whether visceral fat metabolism, immune depression through sympathetic hyperactivity, peripheral nerves and neurotransmitter crosstalk, and the change in microbiome could provide explanations in the heterogenic development of chronic inflammation in LUTD. High‐priority research questions were identified. [ABSTRACT FROM AUTHOR]

Introduction: Continent catheterizable channels (CCC) provide an alternative route to the bladder in both pediatric and adult patients. This study compared very long‐term complications and revision‐free survival of three different CCC techniques: appendicovesicostomy (AVS), ileum (Monti), and tubularized bladder flap (TBF). Materials and Methods: A retrospective cohort study was performed. Data from adult patients with CCC under surveillance at our academic tertiary referral urological center in 2020 and 2021 were collected. Both patients who acquired the CCC as a child and as an adult were included. The primary outcome was revision‐free survival of the three CCC types. The secondary outcome was the prevalence of complications requiring surgical revision. Revisions were categorized as major (open subfascial or complete revisions) and minor (open suprafascial or endoscopic). Results: We included 173 CCCs (AVS 90, Monti 51, TBF 32). Median follow‐up was 12.4 years (4.8–18). Mean revision‐free survival was 162 ± 13 months, with no significant difference between the three types. Ninety‐two individual CCCs (53%) required surgical revision and a total of 157 surgical revisions were performed. Seventy CCCs (40%) required major surgical revision: AVS (27/90%–30%), Monti (31/51%–61%), TBF (12/32%–38%). Conclusion: Complications of CCCs are common; in this study with very long‐term follow‐up, more than half of CCCs required surgical revision. Revisions were more common in Monti channels compared with AVS and TBF. The mean revision‐free survival of >13 years illustrates the sustained long‐term durability of CCCs which is important in the lifelong urological care of this population with high life expectancy. [ABSTRACT FROM AUTHOR]

Introduction: An Indiana Pouch (IP) is a heterotopic, continent, urinary diversion from an ileocolonic segment. Numerous studies have investigated its long‐term outcomes, albeit none extending beyond a 5‐year follow‐up period. IPs can be used as urinary diversion for benign indications and as such are constructed in typically young patients. As a consequence of their extended lifespan, there is a need for very long‐term (>5 years) IP outcome data and comprehensive complication analysis. Materials and Methods: In this retrospective cohort study, the data of all patients attending our academic functional urology tertiary referral center for surveillance between 2015 and 2022 after an earlier IP procedure without uro‐oncological indication were analyzed. The primary objective was to identify the prevalence of complications associated with IP, including stomal stenosis, ureter‐pouch stenosis, pouch calculi, stomal leakage, pouch perforation, and parastomal herniation, and to determine the time span between creation of the IP and occurrence of complications. Results: A cohort of 33 patients (23 female) was analyzed. Median age at IP creation was 38 (range 5–62) years. Median follow‐up was 258 (range 24–452) months. During follow‐up, 22 (67%) patients underwent at least one surgical revision. In total, 45 revision procedures were performed. The estimated mean revision‐free survival was 198 (95%‐CI 144–242) months. Conclusion: Two‐thirds of our IP patients required surgical revision during very long‐term follow‐up. However, the mean revision‐free survival was 198 months. This establishes the IP as a durable and resilient option for urinary diversion, yet underlines the need for lifelong follow‐up as some of these complications and indication were subclinical. These results contribute significantly to patient counseling when discussing different options for urinary diversion, especially at a younger age. [ABSTRACT FROM AUTHOR]

Introduction: Overactive bladder (OAB) is a prevalent urological condition characterized by urinary urgency, with or without urgency urinary incontinence, accompanied by increased daytime frequency and nocturia. However, the current definition of OAB lacks a specified time frame, hindering our understanding of the temporal aspects and transitions that occur within the OAB spectrum. Methods: A modified Delphi study was conducted in three rounds, involving a panel of international experts in functional urology, urogynaecology, geriatrics, transitional medicine, and pediatric urology. The study took place between February 2023 and June 2023 and employed two sequential rounds of online surveys, followed by a final hybrid group discussion session in June 2023. Results: The Delphi process resulted in a consensus definition of lifelong OAB as a persistent and continuous condition that may manifest differently from birth and evolve over time, with varying levels of clinical perception. The course of its progression is influenced by transition periods and modifying factors, mainly anatomical, hormonal, and psychosocial/stressors. Three main transition periods were identified: achievement of daytime continence, adulthood to elderly, and transition to frail elderly. The panel also considered the therapeutic and diagnostic implications of lifelong OAB, as well as future research prospects in terms of importance and feasibility. Conclusions: Future longitudinal research is needed to develop this concept and further identify transitions and temporal dynamics. [ABSTRACT FROM AUTHOR]