Background/Objectives: The aim of this study was to evaluate the association between hypertensive disorders of pregnancy and the frequency of urinary incontinence and lower urinary tract symptoms and to assess the impact of these symptoms on quality of life in pregnant women. Methods: This observational comparative study was conducted between March 2024 and September 2025 and included 182 pregnant women between 24 and 40 weeks of gestation. The study group consisted of 91 pregnant women diagnosed with hypertensive disorders of pregnancy, while 91 normotensive pregnant women served as controls. Demographic and obstetric characteristics were recorded. Urinary incontinence and selected lower urinary tract symptoms, as well as the impact of urinary symptoms on quality of life, were assessed using the International Consultation on Incontinence Questionnaire-Short Form, Urinary Distress Inventory-6, and Incontinence Impact Questionnaire-7. Logistic regression analyses were performed to identify independent factors associated with the presence of urinary incontinence. Results: Urinary incontinence was significantly more frequent in the hypertensive group compared with controls (65.9% vs. 20.9%, p < 0.001). Lower urinary tract symptoms were also more prevalent among hypertensive pregnant women (71.5% vs. 53.8%, p = 0.011). UDI-6, ICIQ-SF, and total IIQ-7 scores were significantly higher in the hypertensive group, indicating greater symptom severity and worse quality of life (all p < 0.001). In multivariable logistic regression analysis including the entire study population, hypertensive pregnancy was independently associated with urinary incontinence (OR: 8.33, 95% CI: 4.00-16.67, p < 0.001), whereas age, body mass index, smoking status, and gravida were not independently associated with UI. Conclusions: Hypertensive disorders of pregnancy are strongly and independently associated with an increased frequency of urinary incontinence and lower urinary tract symptoms, as well as a significant deterioration in quality of life. These findings highlight the importance of routine evaluation of urinary symptoms in hypertensive pregnancies and support a multidisciplinary approach to their management.
To investigate the association of Cannabis Use Disorder (CUD) with new diagnoses of lower urinary tract symptoms (LUTS) in a young adult cohort. Using the TriNetX database, we identified patients aged 18-34 and stratified by sex and CUD diagnosis into cohorts. Propensity score matching was utilized on demographics and variables potentially affecting LUTS. The primary outcomes were 5-year risks of new onset lower urinary tract diagnoses, including all-cause LUTS, dysuria, pelvic/perineal pain, overactive bladder (OAB), and urinary tract infection (UTI), among patients with CUD compared to controls. We identified 101,761 and 67,110 matched pairs of males and females, respectively. At 5-year follow-up, CUD was associated with a higher risk of new onset of all-cause LUTS in males (RR 1.69, 95% CI 1.60-1.80, p<0.01) and females (RR 1.81, 95% CI 1.73-1.89, p<0.01) compared to controls. Increased risks of dysuria, pelvic/perineal pain, and UTI were observed in both male and female CUD patients compared to controls (all p<0.01). CUD was not associated with OAB in either males or females. In a cohort of young adults, CUD was associated with a greater risk of developing LUTS in both men and women. Further research is needed to define the impact of cannabinoids on lower urinary tract function.
Background: Lower urinary tract symptoms (LUTS) are prevalent among aging men and negatively affect quality of life. Salvia miltiorrhiza extract (SAGX), which exhibits anti-inflammatory and antioxidant properties, has been developed as a functional ingredient to improve LUTS. However, comparative clinical data against established standards, such as saw palmetto, are currently lacking. Objectives: To compare the efficacy and safety of SAGX with saw palmetto extract in men with LUTS. Methods: In this randomized, parallel-group pilot study, 30 men with LUTS were assigned to receive either 400 mg of SAGX or 320 mg of saw palmetto extract once daily for 12 weeks. The primary outcome was the change in the International Prostate Symptom Score (IPSS) and the LUTS-related quality-of-life (QoL) score. Secondary outcomes included changes in the erectile function assessed using the International Index of Erectile Function (IIEF). Safety was evaluated by monitoring adverse events. Results: SAGX supplementation resulted in a significantly greater reduction in total IPSS compared with the saw palmetto group (p = 0.031), with notable improvements in storage symptoms (p = 0.003) and QoL (p = 0.035). Erectile function also improved significantly in the SAGX group (p = 0.005). All adverse events were mild and transient, with treatment-related events occurring less frequently in the SAGX group. Conclusions: Although this study was a pilot study with a limited cohort, these findings provide preliminary evidence for the use of SAGX as a functional ingredient for supporting urinary health in men with LUTS.
Aquablation therapy is an effective treatment for benign prostatic obstruction. However, its functional outcomes in older patients remain underexplored. In this study, we aimed to compare improvements in lower urinary tract symptoms (LUTS) after Aquablation therapy in patients aged ≥ 75 and ≤ 74 years. We retrospectively analyzed data from 103 men with moderate-to-severe LUTS who underwent Aquablation between 2023 and 2025. Patients were stratified into two age groups (years): ≤ 74 (n = 72) and ≥ 75 (n = 31). Primary outcomes included changes in the International Prostate Symptom Score (IPSS), IPSS-Quality of Life (IPSS-QoL), maximum urinary flow rate (Qmax), and post-void residual (PVR) from baseline to 3 months postoperatively. Secondary outcomes included transfusion and complication rates. After 3 months, both groups showed significant improvements in total IPSS (-10.46 and -7.38 in those aged ≤ 74 and ≥ 75 years, respectively), QoL (-2.32 vs. -2.33), Qmax (+8.67 vs. +6.03 mL/s), and PVR (-89.1 vs. -75.3 mL; all p < 0.05). In the ≥ 75 group, voiding subscores, including incomplete emptying, intermittency, weak stream, and straining, improved significantly (p < 0.05), whereas storage symptoms, including frequency, urgency, and nocturia, did not (p = 0.07, 0.6, and 0.7, respectively). In patients aged ≤ 74 years, both voiding and storage symptom subscores improved significantly. No significant differences in operative time, transfusion rate, or complication rate were observed between groups. Aquablation therapy is a safe and effective surgical option for patients aged ≥ 75 years. In this older population, although storage symptoms were less treatment-responsive, substantial improvements in voiding symptoms and overall QoL were achieved.
Introduction Persistent lower urinary tract symptoms (LUTS) in young adults following childhood primary nocturnal enuresis (PNE) refractory to desmopressin represent an undercharacterized condition at the pediatric-adult care interface. No prior study has compared pharmacotherapy options in this specific population. Methods We performed a retrospective, single-center, hypothesis-generating comparative cohort study at a tertiary urology center (January 2017-September 2025). Male adults aged 18-35 years with documented childhood primary nocturnal enuresis (PNE) based on International Children's Continence Society (ICCS) criteria, desmopressin treatment failure, and persistent storage-phase lower urinary tract symptoms (LUTS) were included. Patients received mirabegron 25-50 mg daily (Group A, n=33) or anticholinergic therapy (Group B, n=32). The primary outcome was categorical treatment response (complete ≥75%, partial 50-74%, minimal 25-49%, failure <25%). Secondary outcomes included nocturia, urgency, micturition frequency, incontinence episodes, International Prostate Symptom Score (IPSS), quality of life, and adverse events. Analyses used independent t-tests, chi-square/Fisher exact tests, paired t-tests, and analysis of covariance (ANCOVA). Results Baseline characteristics were comparable between groups. Childhood nonmonosymptomatic enuresis (NMSE) phenotype was prevalent in 86.2% of patients, with reduced functional bladder capacity documented in 86.2%. Mirabegron achieved higher overall clinical benefit (≥50% improvement) than anticholinergics (78.8% vs. 56.3%, p=0.042) and higher complete response rates (24.2% vs. 6.3%, p=0.044). Symptom reductions consistently favored mirabegron: nocturia 51% vs. 38% (p=0.031), urgency 48% vs. 36% (p=0.024), micturition frequency 37% vs. 26% (p=0.018), and quality of life improvement 58% vs. 38% (p=0.009). Safety profiles were comparable with no serious adverse events and similar treatment persistence (90.9% vs. 87.5%, p=0.642). Conclusion Pending prospective confirmation, mirabegron provides superior efficacy with comparable safety versus anticholinergic therapy in male adults with persistent LUTS after desmopressin-refractory childhood PNE, supporting β3-adrenergic agonist therapy as a promising option for this underserved transitional population.
In the United States alone, 1.6 million people identify as transgender and gender diverse. Although transgender individuals commonly report lower urinary tract symptoms (LUTS), the factors underlying these symptoms are poorly understood. Our primary aim was to compare the severity and effect of LUTS in transgender men/transmasculine individuals taking testosterone therapy with those not taking testosterone. We hypothesize that patients who are using gender-affirming testosterone have less severe LUTS compared with those who are not receiving such treatment. We conducted a cross-sectional study of transgender individuals assigned female at birth aged 18 years and older receiving care with Obstetrics and Gynecology and Family Medicine within a single tertiary care hospital system. Our primary outcome was LUTS as measured by the Patient Perception of Bladder Condition, a validated single-item questionnaire that queries if participants have bladder symptoms that cause problems. One hundred thirty-one respondents were included in the analysis: 106 currently taking testosterone and 25 not taking testosterone. Mean age (±SD) for all participants was 30.4 ± 7.2 years. Overall, 108 (82.4%) of participants identified as White and 12 (9.2%) identified as Black. Sixty-nine participants (52.7%) identified as men, and 56 (42.8%) identified as nonbinary. Individuals taking testosterone were 5 times less likely to report moderate-to-severe bladder problems compared with those not taking testosterone: (6.6% [7/106] vs 36% [9/25], P <0.001). Genderaffirming testosterone therapy was associated with less bothersome LUTS in our population of transgender men/transmasculine individuals. Further research will be necessary to elucidate the nature of and underlying reason for this relationship.
Patient-reported outcome measures (PROMs) are commonly used to monitor lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH). However, there is limited evidence on patients' perspectives on integrating PROMs into clinical practice and on best practices to improve their implementation to better meet patient needs. The aim of this study is to explore patients' experiences completing PROMs during routine BPH management, and to develop patient-informed strategies for PROM implementation in urologic care. Virtual semi-structured telephone interviews were conducted with English-speaking patients aged 50 years or older with BPH who attended outpatient urology clinics between May and October 2025. Patients were purposively sampled based on the type of treatment received (medical or surgical). Interview data were analyzed using interpretive description. Themes were synthesized inductively, and practical implementation strategies were developed from participants' suggestions. Twenty patients participated (12 received medical treatment and 8 received surgical treatment). Four themes emerged regarding patient perspectives on PROM use in routine care: (1) Perceived benefits-patients viewed PROMs as valuable tools for tracking symptom progression, prompting self-reflection, and facilitating communication among the clinical care team; (2) Questionnaire content-patients questioned the relevance of specific domains, particularly the non-specificity of the PROMIS pain scales as well as mental health, and sexual health items; (3) Perceived barriers-participants criticized the excessive volume of questionnaires; and (4) Considerations for PROM Integration-participants emphasized the importance of visible follow-up actions based on PROM results. Practical recommendations for PROM integration in routine clinical practice included: (1) enhancing patient understanding of PROMs by providing a brief rationale prior to survey administration; (2) implementing a patient-preference PROM workflow in the electronic health record (EHR); and (3) providing tangible actions based on PROM results, such as summarizing scores in plain language and incorporating results into discussions during visits. This study provides patient-informed insights into the implementation of a broad PROM battery in LUTS/BPH care. Participants emphasized that PROMs are more acceptable when their purpose is clearly explained and when responses are visibly discussed or acted upon in care. Future research should examine how these patient-informed strategies can be operationalized within clinical workflows and integrated with clinician, administrator, and EHR perspectives to support sustainable PROM use in routine practice.
Straining to void is widely regarded as a clinical indicator of bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS). However, the physiological significance of this behaviour remains poorly understood. This review examines the role of straining during the voiding cycle and evaluates current evidence regarding its relationship with BOO. Straining represents a voluntary increase in intra-abdominal pressure that may occur at different stages of micturition. Studies comparing patient-reported straining with urodynamic findings demonstrate poor correlation, and the prevalence of the symptom does not differ significantly between obstructed and unobstructed individuals. Furthermore, straining may persist after surgical relief of obstruction, suggesting that it may represent behavioural or compensatory mechanisms rather than mechanical obstruction. Overall, available evidence indicates that straining is a non-specific finding with limited diagnostic value for BOO and should be interpreted alongside objective urodynamic assessment. PATIENT SUMMARY: We reviewed research on why some people strain when passing urine. Straining can occur in people with and without bladder outlet blockage and may simply reflect a habit or a way of to help the bladder empty. This means that straining alone is not a reliable sign of obstruction.
This study aims to evaluate whether urinating by pulling down the trousers vs. unzipping the trousers only has an effect on maximum flow rate (Qmax), average flow rate (Qave), voiding time and post-void residual urine (PVR) in patients with lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction (BPO). Patients receiving alpha-blocker therapy and habitually voiding in a standing position were prospectively enrolled. Each participant underwent uroflowmetry (UF) in two separate sessions, with one session involving voiding by pulling the trousers down to the knees and the other involving voiding by unzipping the trousers only. Qmax, Qave, voiding time and PVR volume were recorded and compared between the two positions. A total of 74 patients were included in the analysis. The mean Qmax was 10.80 ± 3.20 mL/s in the unzipping position and 13.10 ± 4.04 mL/s in the pulling-down position. The Qave, voiding time and PVR in the unzipping position were 5.01 ± 2.57 mL/s, 70.80 ± 50.40 s and 63.99 ± 38.11 mL, respectively, and those in the pulling-down position were 5.89 ± 3.09 mL/s, 58.20 ± 26.90 s and 53.38 ± 38.96 mL, respectively. Statistically significant differences were observed in Qmax (p < 0.001), Qave (p < 0.001), PVR volume (p < 0.001) and voiding time (p = 0.006). In patients with LUTS secondary to BPO who void in a standing position, the specific subposition (pulling down trousers vs. unzipping) significantly affects UF parameters and PVR volumes. These findings demonstrate that standing voiding should not be considered as a single, uniform posture. ClinicalTrials.gov identifier: NCT06260917; available at https://clinicaltrials.gov/study/NCT06260917.
Many men referred from primary care entering magnetic resonance imaging (MRI)-based prostate cancer (PCa) pathways have an MRI without abnormalities, highlighting the need to improve MRI risk stratification. Optimising this process in primary care could reduce unnecessary referrals and MRIs. This study aimed to develop a prediction model incorporating the International Prostate Symptom Score (IPSS) to improve MRI risk stratification and reduce hospital referrals and MRIs in biopsy-naïve men with suspected PCa in primary care. We prospectively identified men with suspected PCa referred from primary care to a Dutch teaching hospital in 2022-2023. Standard work-up included IPSS and upfront biparametric MRI. Study outcomes included Prostate Imaging Reporting and Data System (PI-RADS) ≥ 4, the number of potentially reduced hospital referrals and subsequent MRIs, and missed PCa cases. Men with an abnormal digital rectal examination (DRE) were excluded from model development, as they have a direct indication for MRI according to current guidelines. Multivariable logistic regression identified predictors of PI-RADS ≥ 4. Model performance was assessed using the area under the curve (AUC), and clinical utility was evaluated with decision curve analysis using a predefined threshold probability of 20%. Of 409 men, 334 without abnormal DRE were included in the model development cohort; 30% (101/334) had PI-RADS ≥ 4, of whom 59% (60/101) had significant PCa (International Society of Urological Pathology [ISUP] grade group ≥ 2). Prostate-specific antigen (PSA) and IPSS were independent predictors of PI-RADS ≥ 4. The model showed fair discrimination (AUC = 0.68; 95% confidence interval [CI] = 0.62-0.74). Decision curve analysis showed greater net benefit than 'treat none' across all thresholds and greater net benefit than 'treat all' between 17% and 30%. At a 20% threshold, 23% of MRIs could be avoided, while 3.9% of all patients would not be referred despite having a positive MRI (13% of positive MRI findings), including eight cases of missed significant PCa. Limitations include the lack of external validation. Incorporating IPSS in primary care for biopsy-naïve patients with suspected PCa improves risk stratification for MRI and offers an easily available parameter to optimise diagnostic pathways.
This study aimed to evaluate the prevalence of urinary symptoms in women with parametrial endometriosis before and after surgery. We systematically searched MEDLINE, Web of Science, and Scopus through March 2025, with no language or publication year restrictions. Reference lists of included studies and relevant reviews were also screened. Studies reporting pre- and/or postoperative urinary symptoms in women with parametrial endometriosis were included. A systematic review and meta-analysis, including 21 articles, was conducted. Data were extracted and categorized into dysuria, lower urinary tract symptoms (LUTS), and voiding dysfunction. Preoperatively, dysuria affected 15% (95% CI: 5-35) of women, with a mean VAS score of 1.10 (95% CI: 0.90-1.30). LUTS affected 27% (95% CI: 10-56), with a mean BFLUTS score of 13.23 (95% CI: -1.26-27.72). Voiding dysfunction was scarcely reported before surgery. Postoperatively, the prevalence of LUTS decreased to 13% (95% CI: 7-25), and the mean BFLUTS score to 7.84 (95% CI: -0.36-16.03). Voiding dysfunction was experienced in 14% of women (95% CI: 5-32), and 12% were symptoms that persisted after discharge (95% CI: 6-23). Subgroup analysis suggested a trend toward lower postoperative voiding dysfunction prevalence in patients with uterosacral involvement compared with those with lateral parametrium involvement. Urinary symptoms are common in women with parametrial endometriosis, and a significant proportion may persist after surgery. Parametrectomy appears to improve urinary function, with rare persistent complications. Careful parametrial evaluation, nerve-sparing techniques, and patient counselling are essential.
Following a first male urinary tract infection (mUTI), systematic investigation for predisposing factors is called for, as mUTIs frequently arise secondarily to anatomical or functional urinary tract abnormalities. Although no international consensus defines a minimal etiological work-up, guidelines from the French (AFU) and European (EAU) Associations of Urology provide a clinical framework. First-line assessment comprises a targeted history (laying emphasis on macroscopic hematuria and lower urinary tract symptoms, LUTS), digital rectal examination (DRE), the International Prostate Symptom Score (IPSS), and urinary tract ultrasonography with post-void residual (PVR) measurement. LUTS, classified as storage (urgency, frequency), voiding (weak stream, straining), or post-micturition (incomplete emptying) may indicate benign prostatic hyperplasia (BPH), the leading aetiology in men over 50. Ultrasound evaluates prostate volume, bladder morphology, and PVR; voiding diaries complement assessment when storage LUTS predominate. Alpha-blockers represent first-line therapy for BPH-related LUTS. Routine PSA testing following mUTI is not recommended, as elevations are non-specific: prostatitis may raise PSA independently of malignancy, and levels can remain elevated up to three months post-infection. No association exists between a first mUTI and prostate cancer, nor between PSA and UTI recurrence. Second-line referral is indicated for pyelonephritis, urinary retention, macroscopic hematuria, IPSS >7, PVR >100 mL, recurrent UTI, age under 40, or imaging abnormalities. Cross-sectional imaging (CT or MRI) is reserved for suspected obstruction, severe presentations, or treatment failure. This stratified approach optimizes cost-effectiveness, ensuring identification of underlying pathology (BPH, urolithiasis, or malignancy) while avoiding unnecessary investigations.
Invasive urodynamic study(UDS) remains the gold-standard test for diagnosing and characterizing the neurogenic bladder. UDS being an invasive test is difficult to implement as a screening test for children who are predisposed for neurogenic bladder. An observational study was conducted to evaluate the urodynamic features of lower urinary tract dysfunction (LUTD) in follow-up pediatric surgical (nonurological primary etiology) cases "at-risk" for neurogenic bladder and the efficacy of noninvasive uroflowmetry was assessed. A prospective study was done from November 2019 to December 2022. All the postoperative patients with a history of primary non-urological congenital anomalies, aged less than 15 years presenting with LUTD were included. Noninvasive free-flow uroflowmetry and invasive UDS were done for these patients. Abnormal UDS defined in terms of voiding pattern was compared with abnormal uroflowmetry defined as inadequate Qmax and nonbell shaped flow curve. Thirty-four children with primary diagnosis of spina-bifida (n = 12), anorectal malformation (n = 20), and sacrococcygeal teratoma (n = 2) were included, who presented with LUTD at a mean age of 4.76 ± 1.60 years. 29.4% children had acontractile bladder at presentation. Abnormal findings of uroflowmetry were comparable to abnormal findings of UDS (p > 0.05; kappa > 0.7). Uroflowmetry had sensitivity of 88.2% and specificity of 82.3% in diagnosing neurogenic bladder. Delayed presentation of neurogenic bladder with irreversible detrusor changes in predisposed cases highlights the need for stringent follow-up. Noninvasive uroflowmetry has high sensitivity and specificity with respect to invasive UDS in identifying neurogenic bladder in predisposed cases; it can be implemented as a routine screening test in predisposed cases to identify the at-risk cases in advance of clinical symptoms.
Interpretation of urine culture results requires key clinical information such as symptom status, catheterization, and multidrug-resistant organism (MDRO) risk. However, this information is frequently absent from routine request forms, contributing to overtreatment of asymptomatic bacteriuria (ASB) and suboptimal antimicrobial prescribing. This study evaluated the impact of implementing a structured urine-culture request form as part of a diagnostic and therapeutic stewardship program. This prospective, non-randomized interventional study was conducted at an 1800-bed tertiary-care hospital in India (March 2023-March 2024). Patients undergoing urine culture testing in Urology/Nephrology departments used a structured request form capturing symptoms, risk factors, and clinical context (test arm), while General Medicine continued routine forms (control arm). Primary outcomes included ASB treatment, MDRO detection, recurrence, and guideline-concordant prescribing. Patients were followed for one year. A total of 484 patients were included (198 test arm, 286 control arm). Antibiotic treatment for ASB was significantly lower in the test arm compared with the control arm (3.6% vs 67.0%; p < 0.001), without adverse outcomes. Guideline-compliant prescribing was higher in the test arm (73.7% vs 26.2%; p < 0.001). MDRO prevalence was higher in the test arm (32.2% vs 11.3%), reflecting greater clinical complexity rather than the intervention itself. Recurrent urinary tract infection (UTI) within one year was significantly lower in the test arm (14.1% vs 29.0%; p < 0.001). Introducing a structured urine-culture request form improved diagnostic clarity and antibiotic prescribing, particularly by reducing unnecessary treatment of ASB and increasing guideline compliance, without compromising patient outcomes. This low-cost intervention represents a practical and scalable diagnostic stewardship strategy for improving UTI management.
To evaluate the efficacy and safety of triple double-J (DJ) stents in treating uretero-ileal anastomotic strictures (UIAS) following urinary diversion procedures (ileal conduit and ileal orthotopic neobladders). A prospective analysis and follow-up observation were conducted on patients who underwent triple-stent placement for UIAS after urinary diversion at our center between August 2022 and January 2024. During follow-up, surgical success rates, renal function parameters, and complication incidence were evaluated. Surgical success was defined as either ureteral stents remaining in situ with unobstructed urinary drainage or, in cases where there was unplanned stent replacement or removal, the sustained maintenance of stable renal function parameters without subsequent deterioration. During the 2-year follow-up period, patients underwent regular triple-stent replacement at our hospital every 6 months. The overall success rate of triple-stent reached 83.3% among 29 patients (36 cases). At the 2-year follow-up, there was a statistically significant decrease in hydronephrosis volume (59.0 ± 55.8 vs. 30.2 ± 17.0 cm³, p = 0.008), blood creatinine level (124.7 ± 38.3 vs. 109.6 ± 22.3 µmol/L, p < 0.001), and urea nitrogen level (7.4 ± 2.6 vs.6.6 ± 1.8 mmol/L, p < 0.001). Glomerular filtration rate remained stable (54.1 ± 22.0 vs. 53.3 ± 20.6 mL/min/1.73 m², p = 0.067). Surgical complications during follow-up included pain (5.6%), hematuria (2.8%), urinary tract infection (11.1%), and lower urinary tract symptoms (13.9%). Our center innovatively proposed the triple-stent for treating UIAS in patients after urinary diversion. Two-year follow-up data demonstrate that, for patients unsuitable for surgical reconstruction or with limited financial resources, regular triple-stent placement and replacement is feasible, showing good long-term patency rates and a low incidence of adverse events. Our clinical trial is registered in the Chinese Clinical Trial Registry ( https://www.chictr.org.cn ), and registration identifier: ChiCTR2400079508.
Studies have shown that approximately half of the female population may experience some degree of pelvic organ prolapse (POP) during their lifetime, although only 3-6% report symptomatic prolapse. To evaluate the clinical and adverse outcomes associated with transvaginal repair using partially absorbable lightweight polypropylene Seratom PA MR MN® mini mesh for enhanced apical support in the treatment of advanced POP. A retrospective study was conducted on 114 patients who underwent transvaginal repair with the Seratom partially absorbable lightweight polypropylene mini mesh between August 2013 and January 2016. Data collected included demographic, surgical, adverse symptoms, and anatomical characteristics assessed via the modified Pelvic Organ Prolapse Quantification system (POP-Q). Postoperative pain was assessed using the Visual Analog Scale. Significant improvements were observed in POP-Q measurements (P-value < 0.001). Subjective outcomes demonstrated significant pre- to 4-month postoperative reductions in urinary stress incontinence and overactive bladder (P < 0.001). No cases of mesh erosion were reported. Immediate complications included bleeding (3.5%), fever (1.7%), and urinary obstruction (0.9%). The recurrence rate was 12.3%. Patient satisfaction scores were consistently high, with an average of 95.96% at 1 month, 94.73% at 4 months, and 91.33% at the most recent follow-up. Transvaginal repair with the Seratom PA MR MN® partially absorbable mini mesh demonstrated significant improvements in anatomical and subjective outcomes, with few complications, and low recurrence rates. Further studies are necessary to validate these outcomes and optimize patient selection.
Urinary and bowel incontinence are common in young adults with spina bifida and may affect emotional functioning and health-related quality of life. Prospective data describing day-level incontinence experiences in this population are limited. This study used ecological momentary assessment to characterize daily variability in urinary and bowel incontinence and to examine associations with mood, incontinence-related anxiety, and health-related quality of life. In a 30-day ecological momentary assessment study of adults with spina bifida and recent incontinence, young adults with spina bifida (n = 23; ages 18-26) completed 643 end-of-day assessments. Daily measures included urinary and bowel incontinence frequency, amount, dry intervals, management independence, activity avoidance, positive and negative mood, and incontinence-related anxiety. Health-related quality of life was assessed at study completion. Analyses were exploratory and used nonparametric methods appropriate for ordinal and intensive repeated measures data. Urinary incontinence was reported on 54.1% of study days and bowel incontinence on 20.8%. For urinary incontinence, greater frequency, shorter dry intervals, larger amounts, and activity avoidance were associated with lower positive mood, higher negative mood, and greater urinary incontinence-related anxiety. For bowel incontinence, greater symptom severity, management dependence, and activity avoidance were associated with poorer mood and higher bowel incontinence-related anxiety. Multiple day-level incontinence characteristics and daily emotional responses were associated with lower end-of-month health-related quality of life. In young adults with spina bifida, day-level incontinence burden is associated with same-day emotional functioning and longer-term health-related quality of life. These findings highlight the relevance of day-level symptom variability for rehabilitation assessment and individualized continence management.
Posterior urethral valves (PUV) are rare congenital malformations affecting both the upper and lower urinary tract and can lead to severe long-term complications. Thanks to advances in prenatal diagnostics, neonatal care, and pediatric urological-nephrological management, an increasing number of patients now reach adulthood. Long-term outcomes are primarily determined by the extent of prenatal renal dysplasia as well as the early recognition and targeted management of bladder dysfunction. Care of adult PUV patients remains challenging, as many adult urologists have limited experience and evidence-based guidelines for long-term management are lacking. Adult PUV patients constitute a clearly defined high-risk cohort with characteristic urological and renal sequelae, including persistent or secondary progressive bladder dysfunction with clinically significant lower urinary tract symptoms (LUTS) and an increased risk of progressive chronic kidney disease (CKD) up to end-stage renal disease (ESRD). In cases of ESRD, kidney transplantation may be required; optimized bladder function is crucial to preserve graft function, and reconstructive procedures, such as bladder augmentation, may be necessary.Bladder function evolves throughout life: initially hypertrophic and hyperactive, it may later decompensate, leading to hypocontractility or atony ("myogenic failure"). Adult patients often report voiding difficulties, post-void residual urine, urgency, incontinence, and recurrent urinary tract infections, which can significantly impair quality of life, self-esteem, and sexual self-efficacy. Treatment is guided by the individual urodynamic phenotype and may include conservative, pharmacological, and, when necessary, interventional strategies.Sexual function and fertility are preserved in most patients; limitations primarily occur in advanced CKD or complex bladder management scenarios. Psychosocial burdens related to altered body image, incontinence, catheterization, or concerns regarding partnership and family planning are common and should be addressed early. Optimal care for PUV patients requires lifelong, interdisciplinary follow-up, structured transition from pediatric to adult care, and close coordination between urology, nephrology, pediatric urology/nephrology, and transplant medicine to ensure long-term preservation of renal function, quality of life, and graft survival. Posteriore Urethralklappen (PUV) sind seltene angeborene Fehlbildungen, die sowohl den oberen als auch den unteren Harntrakt betreffen und langfristig schwerwiegende Komplikationen verursachen können. Dank Fortschritten in pränataler Diagnostik, neonatologischer Versorgung sowie kinderurologisch-nephrologischer Therapie erreichen zunehmend mehr Patienten das Erwachsenenalter. Für das Langzeit-Outcome sind insbesondere das Ausmaß der pränatalen Nierendysplasie sowie die frühzeitige Erkennung und gezielte Behandlung von Blasendysfunktionen entscheidend. Die Betreuung erwachsener PUV-Patienten stellt dennoch eine besondere Herausforderung dar, da viele Erwachsenenurologen nur begrenzte Erfahrung besitzen und evidenzbasierte Leitlinien zur Langzeitversorgung fehlen. Erwachsene PUV-Patienten bilden eine klar definierte Hochrisikokohorte mit charakteristischen urologischen und renalen Langzeitfolgen. Dazu gehören persistierende oder sekundär progrediente Blasenfunktionsstörungen mit klinisch relevanten Lower Urinary Tract Symptoms (LUTS) sowie ein erhöhtes Risiko für progressive chronische Nierenerkrankung bis zur terminalen Niereninsuffizienz. Im Fall einer terminalen Niereninsuffizienz kann eine Nierentransplantation erforderlich werden; hierbei ist eine optimierte Blasenfunktion entscheidend, um das Transplantat langfristig zu schützen, diesbezüglich können rekonstruktive Maßnahmen, wie eine Harnblasenaugmentation notwendig sein.Die Blasenfunktion verändert sich lebenslang: Anfangs hypertroph und hyperaktiv, kann sie im Verlauf bis hin zur Atonie dekompensieren („myogenic failure“). Erwachsene Patienten berichten häufig über Miktionsstörungen, Restharn, Drangbeschwerden, Inkontinenz und rezidivierende Harnwegsinfektionen, die Lebensqualität, Selbstwert und sexualbezogene Selbstwirksamkeit erheblich beeinträchtigen können. Die Therapie richtet sich am individuellen urodynamischen Phänotyp aus und umfasst konservative, medikamentöse und ggf. interventionelle Maßnahmen.Sexualfunktion und Fertilität sind bei den meisten Patienten erhalten; Einschränkungen treten überwiegend bei fortgeschrittener CKD oder komplexem Blasenmanagement auf. Psychosoziale Belastungen durch verändertes Körperbild, Inkontinenz, Katheterisierung oder Sorgen bezüglich Partnerschaft und Familienplanung sind häufig und sollten frühzeitig adressiert werden. Die Betreuung von PUV-Patienten erfordert daher eine lebenslange, interdisziplinäre Nachsorge, eine strukturierte Transition von der Kinder- zur Erwachsenenmedizin sowie enge Abstimmung zwischen Urologie, Nephrologie, Kinderurologie/-nephrologie und Transplantationsmedizin, um Nierenfunktion, Lebensqualität und Transplantatfunktion langfristig zu sichern.
Urogenital symptoms associated with cycling, such as perineal pain, penile numbness, or lower urinary tract symptoms, are frequently reported in routine urological practice and may be of particular clinical relevance in predisposed patients. The aim of this study was to assess the prevalence of cycling-associated symptoms in a urological cohort and to investigate perineal pressure distribution using a prostate volume-adapted bicycle saddle (Prostasella). In addition, an exploratory algorithm for non-invasive estimation of prostate volume was developed to enable individualized saddle sizing. A total of 50 male patients from a urological practice underwent a clinical examination and standardized assessment of cycling-associated symptoms. Prostate volume was determined by transrectal ultrasound.Sensor-based perineal pressure measurements were performed in a subgroup of 24 patients. Two independent groups were evaluated: an intervention group using a prostate volume-adapted bicycle saddle and a control group using a conventional bicycle saddle under comparable measurement conditions.Central perineal pressure load was compared between independent groups rather than in an intra-individual crossover design.The primary endpoint was central perineal pressure load within the predefined perineal measurement area. The use of a prostate volume-adapted bicycle saddle resulted in a significant reduction in central perineal pressure load compared with conventional saddle systems (reduction of approximately 88%, P < 0.001). A prostate volume-adapted saddle design enables a clinically relevant reduction in central perineal pressure load and represents a potentially relevant approach for the prevention and treatment of cycling-associated urogenital symptoms. The developed algorithm should be considered exploratory and requires further validation. Urogenitale Beschwerden wie perinealer Druckschmerz, penile Taubheit oder Miktionsbeschwerden im Zusammenhang mit dem Fahrradfahren werden im klinischen Alltag urologischer Praxen regelmäßig berichtet und können insbesondere bei vorerkrankten Patienten klinische Relevanz besitzen.Ziel der vorliegenden Studie war es, die Prävalenz von radfahrassoziierten Beschwerden in einer urologischen Kohorte zu erfassen und die perineale Druckverteilung unter Verwendung eines prostatavolumenadaptierten Fahrradsattels (Prostasella) zu untersuchen. Zusätzlich wurde ein explorativer Algorithmus zur nicht-invasiven Abschätzung des Prostatavolumens entwickelt, um eine patientenspezifische Sattelgrößenbestimmung zu ermöglichen.Insgesamt wurden 50 männliche Patienten einer urologischen Praxis klinisch untersucht und standardisiert befragt. Das Prostatavolumen wurde mittels transrektaler Sonographie bestimmt. Die sensorbasierte perineale Druckmessung erfolgte in einer Subkohorte von 24 Patienten. Hierbei wurden zwei voneinander unabhängige Gruppen untersucht: eine Interventionsgruppe unter Verwendung eines prostatavolumenadaptierten Fahrradsattels sowie eine Kontrollgruppe unter Verwendung eines konventionellen Fahrradsattels unter vergleichbaren Messbedingungen.Der Vergleich der zentralen perinealen Druckbelastung erfolgte als unabhängiger Gruppenvergleich und nicht als intraindividueller Crossover-Vergleich.Primärer Endpunkt war die zentrale perineale Druckbelastung im definierten perinealen Messbereich.Die Verwendung des prostatavolumenadaptierten Fahrradsattels führte zu einer signifikanten Reduktion der zentralen perinealen Druckbelastung im Vergleich zu konventionellen Sattelsystemen (Reduktion um ca. 88 %, P < 0,001).Eine prostatavolumenadaptierte Sattelkonstruktion ermöglicht eine relevante Reduktion der perinealen Druckbelastung und stellt einen potenziell klinisch relevanten Ansatz zur Prävention und Therapie radfahrassoziierter urogenitaler Beschwerden dar. Der entwickelte Algorithmus ist als explorativer Ansatz zu werten und bedarf weiterer Validierung.
Mesh erosion into the urinary bladder is an uncommon but potentially serious late complication of laparoscopic inguinal hernia repair, particularly following transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches. Proposed mechanisms include inadequate peritoneal coverage, excessive mesh fixation, postoperative infection, and chronic inflammatory responses. Clinical presentation is often delayed and nonspecific, leading to diagnostic challenges and prolonged morbidity. We report the case of a 60-year-old male with recently diagnosed hypertension and diabetes mellitus who had undergone laparoscopic mesh repair for left inguinal hernia (details unavailable). He presented with a 9-month history of recurrent burning micturition, lower abdominal pain, and intermittent hematuria. His history was notable for recurrent urinary tract infections over 5 years. Initial evaluation at another centre revealed vesical calculus, left staghorn calculus, and grade 1 prostatomegaly; he underwent transurethral resection of the prostate with cyst lithotripsy. One month later, his urinary symptoms recurred. Investigations at our center showed, on cystoscopy, polypropylene mesh eroding into the anterior bladder wall. Computed tomography (CT) revealed a heterogeneously enhancing lesion in the right anterolateral bladder wall with contrast extravasation. Definitive surgical management involved laparotomy with excision of the involved bladder wall segment containing the mesh, followed by two-layer bladder repair and suprapubic catheter placement. The patient had an uneventful recovery. Intravesical mesh migration should be considered in any patient with persistent urinary symptoms following laparoscopic inguinal hernia repair. A high index of suspicion, combined with early use of CT urography and cystoscopy, facilitates timely diagnosis. Surgical removal of the mesh with bladder wall repair is curative in most cases. This case underscores the importance of meticulous mesh placement and secure peritoneal closure during laparoscopic hernia repairs to minimize such rare but significant complications. RésuméL’érosion du maillage chirurgical dans la vessie urinaire est une complication tardive rare mais potentiellement grave de la réparation laparoscopique de hernie inguinale, en particulier après les approches transabdominale prépéritonéale (TAPP) et totalement extrapéritonéale (TEP). Les mécanismes proposés incluent une couverture péritonéale inadéquate, une fixation excessive du maillage, une infection postopératoire et des réponses inflammatoires chroniques. La présentation clinique est souvent retardée et non spécifique, entraînant des difficultés diagnostiques et une morbidité prolongée. Nous rapportons le cas d’un homme de 60 ans, récemment diagnostiqué hypertendu et diabétique, ayant bénéficié auparavant d’une réparation laparoscopique d’une hernie inguinale gauche par pose de maillage (détails indisponibles). Il présentait une histoire de 9 mois de brûlures mictionnelles récurrentes, de douleurs abdominales basses et d’hématurie intermittente. Ses antécédents étaient marqués par des infections urinaires récidivantes depuis 5 ans. L’évaluation initiale dans un autre centre avait révélé un calcul vésical, un calcul coralliforme rénal gauche et une prostatomégalie de grade 1 ; il avait alors subi une résection transurétrale de la prostate associée à une lithotritie vésicale. Un mois plus tard, les symptômes urinaires ont récidivé. Les investigations réalisées dans notre centre ont montré, à la cystoscopie, un maillage en polypropylène érodant la paroi antérieure de la vessie. La tomodensitométrie (TDM) a révélé une lésion à rehaussement hétérogène de la paroi antérolatérale droite de la vessie avec extravasation du produit de contraste. Le traitement chirurgical définitif a consisté en une laparotomie avec exérèse du segment de paroi vésicale contenant le maillage, suivie d’une réparation vésicale en deux plans et de la mise en place d’un cathéter sus-pubien. L’évolution postopératoire a été favorable sans complication. La migration intravésicale du maillage doit être envisagée chez tout patient présentant des symptômes urinaires persistants après une réparation laparoscopique de hernie inguinale. Un haut degré de suspicion clinique, associé à l’utilisation précoce de l’urographie par TDM et de la cystoscopie, permet un diagnostic rapide. L’ablation chirurgicale du maillage avec réparation de la paroi vésicale est curative dans la majorité des cas. Ce cas souligne l’importance d’un positionnement méticuleux du maillage et d’une fermeture péritonéale sécurisée lors des réparations laparoscopiques de hernie afin de minimiser ces complications rares mais significatives.