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A newborn (5 h old) quarter horse colt was presented because of lethargy and severe abdominal distention. Uroperitoneum was suspected during initial workup, based on sonographic imaging and peritoneal fluid analysis. Definitive diagnosis was confirmed during exploratory celiotomy. Surgery revealed a congenitally abnormal allantoic stalk/urachal remnant and a failure of embryological fusion of the dorsal bladder wall. Recovery was successful and the animal is now a healthy, 4-year-old western performance gelding. These specific congenital abnormalities have not been previously documented in the peer-reviewed literature. Key clinical message: Congenital abnormalities of the urachus and the urinary bladder should be suspected in foals with uroperitoneum at birth. Cases involving congenital abnormalities of the urachus and urinary bladder might have favorable prognoses if animals retain adequate function of the urogenital tract and do not have secondary complications before and following surgery.

AIMS: There is limited evidence to support the efficacy of sacral neuromodulation (SNM) for older adults with overactive bladder (OAB). This study aims to report outcomes following SNM among nursing home (NH) residents, a vulnerable population with high rates of frailty and comorbidity. METHODS: This is a retrospective cohort study of long-stay NH residents who underwent a trial of percutaneous nerve evaluation (PNE) or Stage 1 permanent lead placement (Stage 1) between 2014 and 2016. Residents were identified using the Minimum Data Set linked to Medicare claims. The primary outcome of this study was successful progression from trial to implant. Rates of 1-year device explant/revisions were also investigated. RESULTS: Trial of SNM was observed in 1089 residents (mean age: 77.9 years). PNE was performed in 66.9% of residents and 33.2% underwent Stage 1. Of Stage 1 procedures, 23.8% were performed with simultaneous device implant (single-stage). Overall, 53.1% of PNEs and 72.4% of Stage 1 progressed to device implant, which was associated with Stage 1 procedure versus PNE (adjusted relative risk [aRR]: 1.34; 95% confidence interval [95% CI]: 1.21-1.49) and female versus male sex (aRR: 1.26; 95% CI: 1.09-1.46). One-year explant/revision was observed in 9.3% of residents (6.3% for PNE, 10.5% for Stage 1, 20.3% single-stage). Single stage procedure versus PNE was significantly associated with device explant/revision (aRR: 3.4; 95% CI: 1.9-6.2). CONCLUSIONS: In this large cohort of NH residents, outcomes following SNM were similar to previous reports of younger healthier cohorts. Surgeons managing older patients with OAB should use caution when selecting patients for single stage SNM procedures.

PurposeOveractive bladder (OAB) syndrome significantly impairs quality of life, often necessitating pharmacological interventions with associated risks. The fragility of OAB trial outcomes, as measured by the fragility index (FI: smallest number of event changes to reverse statistical significance) and quotient (FQ: FI divided by total sample size expressed as a percentage), is critical yet unstudied.Materials and methodsWe conducted a systematic search for randomized controlled trials on OAB medications published between January 2000 and August 2023. Inclusion criteria were trials with two parallel arms reporting binary outcomes related to OAB medications. We extracted trial details, outcomes, and statistical tests employed. We calculated FI and FQ, analyzing associations with trial characteristics through linear regression.ResultsWe included 57 trials with a median sample size of 211 participants and a 12% median lost to follow-up. Most studies investigated anticholinergics (37/57, 65%). The median FI/FQ was 5/3.5%. Larger trials were less fragile (median FI 8; FQ 1.0%) compared to medium (FI: 4; FQ 2.5%) and small trials (FI: 4; FQ 8.3%). Double-blinded studies exhibited higher FQs (median 2.9%) than unblinded trials (6.7%). Primary and secondary outcomes had higher FIs (median 5 and 6, respectively) than adverse events (FI: 4). Each increase in 10 participants was associated with a +0.19 increase in FI (p

Purpose: Scheduled administration of intravenous acetaminophen improves catheter-related bladder discomfort (CRBD) after urological surgery. However its efficacy for patients undergoing transurethral resection of bladder tumors (TURBT) remains unclear. This study aimed to investigate the efficacy of scheduled administration of intravenous acetaminophen after TURBT. Materials and Methods: At the end of surgery, patients in both the control (n=39) and the scheduled administration (n=45) groups received analgesics at the discretion of the anesthesiologists. In the scheduled administration group, intravenous acetaminophen was administered every 4 hours for 12 hours after the surgery. Both groups were administered on-demand analgesics as needed. The primary outcome was CRBD scores, and the secondary outcomes were the face rating scale for lower abdominal pain, administration rates of additional analgesics, durations of bladder catheterization, lengths of postoperative hospital stay, and postoperative complication rate. Results: The scheduled administration group had significantly lower CRBD scores than those of the control group at 8 hours postoperatively (p=0.014), and lower administration rates of additional analgesics 4–8 hours (p=0.029) and 8–12 hours (p=0.027) postoperatively compared to those of the control group. Other secondary outcomes were not significantly different between the groups (all p>0.05). The scheduled administration group did not have postoperative complications related to the scheduled administration of intravenous acetaminophen. Conclusions: Scheduled intravenous acetaminophen administration alleviated postoperative CRBD and reduced the need for additional analgesics in patients who underwent TURBT. These findings can be utilized to improve the quality of postoperative care. [ABSTRACT FROM AUTHOR]

This comprehensive review examines recent advancements in the integration of multiparametric ultrasound for diagnostic imaging of the urinary bladder. It not only highlights the current state of ultrasound imaging but also projects its potential to further elevate standards of care in managing urinary bladder pathologies. Specifically, contrast-enhanced ultrasound (CEUS) and elastography show significant improvements in detecting bladder tumors and assessing bladder wall mechanics compared to traditional methods. The review also explores the future potential of ultrasound-mediated nanobubble destruction (UMND) as an investigational targeted cancer therapy, showcasing a novel approach that utilizes nanobubbles to deliver therapeutic genes into tumor cells with high precision. Emerging AI-driven innovations and novel techniques, such as microvascular ultrasonography (MVUS), are proving to be powerful tools for the non-invasive and precise management of bladder conditions, offering detailed insights into bladder structure and function. These advancements collectively underscore their transformative impact on the field of urology. [ABSTRACT FROM AUTHOR]

Purpose: The BlueWind Medical Device, Revi, is a novel implantable tibial neuromodulation system powered by an external, battery-operated wearable that facilitates individually tailored stimulation to provide treatment for urgency urinary incontinence (ie, overactive bladder wet). The Revi System is the first Food and Drug Administration–cleared implantable neuromodulation device which can be used without prior failure with more conservative treatment options. Two-year follow-up results of the OASIS (Overactive Bladder Stimulation System) study are presented. Materials and Methods: The Revi System was implanted in 151 female participants. The primary efficacy and safety end points were assessed at 6 and 12 months, after which participants either consented to extend follow-up for long-term assessment of treatment durability and safety or they chose to exit the study. Results: Ninety-seven participants completed the 24-month assessment, and of these, 79% were therapy responders (≥50% reduction in urgency urinary incontinence episodes, demonstrated on a 3-day voiding diary). Importantly, therapeutic response was durable, with comparable effectiveness at 6, 12, and 24 months (response rates of 78%, 82%, and 79%, respectively). Participants who completed both the 6- and 24-month assessment had similar demographics and treatment results at the 6-month visit, indicating that these results at 24 months are representative of the overall study population. In addition, high satisfaction and patient impression of improvement were reported, with 97% (88/91) of the participants satisfied with the therapy and 80% (78/97) feeling "much better" or "very much better." There were no serious adverse events related to the device or the procedure through 24 months. Conclusions: Two-year results demonstrate durable efficacy, high patient satisfaction, and a very favorable safety profile. Trial Registration: ClinicalTrials.gov Identifier: NCT03596671 [ABSTRACT FROM AUTHOR]

Background Catheter-associated urinary tract infections (CA-UTIs) are a common hospital-acquired infection. We examined ciprofloxacin activity in a novel CA-UTI in vitro model. Methods Three ATCC strains [ Escherichia coli (ECO)-25922, Klebsiella pneumoniae (KPN)-700721, Pseudomonas aeruginosa (PAE)-27853] and 45 clinical urinary isolates were assessed. Biofilm mass and planktonic bacterial density were quantified during drug-free incubation (72 h) and following ciprofloxacin exposure (equivalent 750 mg orally q12h, 3 days). Results ECO produced smaller biofilms (6.3 ± 1.1 log10 cfu/cm2) compared with KPN (7.1 ± 0.7 log10 cfu/cm2) and PAE (7.0 ± 1.2 log10 cfu/cm2), which extended along the entire catheter length. Following ciprofloxacin, all isolates with MIC > 4 mg/L had minimal biofilm disruption or planktonic kill. Ciprofloxacin resistance was most common in PAE isolates (10/16 isolates), compared with ECO (3/16 isolates) and KPN (6/16 isolates). Greater ciprofloxacin exposure (AUC0–24/MIC) was required for a 3 log10 biofilm kill for KPN (5858; R 2 = 0.7774) compared with ECO (2117; R 2 = 0.7907) and PAE (2485; R 2 = 0.8260). Due to persistent growth in the bladder, ECO required greater ciprofloxacin exposure for a 3 log10 planktonic kill (5920; R 2 = 0.8440) compared with KPN (2825; R 2 = 0.9121) and PAE (1760; R 2 = 0.8781). Monte Carlo simulation supported a 95% PTA for both a 3 log10 biofilm and planktonic kill for ECO and KPN isolates with MIC ≤ 0.5 mg/L and PAE isolates with MIC ≤ 1 mg/L. Conclusions In a novel CA-UTI model, following simulated ciprofloxacin therapy, KPN biofilms were comparatively more difficult to disrupt, ECO planktonic growth frequently persisted in the bladder, and PAE had greater propensity for emergence of ciprofloxacin resistance. [ABSTRACT FROM AUTHOR]

Objectives The use of mouse models of complicated urinary tract infection (cUTI) has usually been limited to a single timepoint assessment of bacterial burden. Based on longitudinal in vitro and in vivo data, we developed a pharmacokinetic-pharmacodynamic (PKPD) model to assess the efficacy of apramycin, a broad-spectrum aminoglycoside antibiotic, in mouse models of cUTI. Methods Two Escherichia coli strains were studied (EN591 and ATCC 700336). Apramycin exposure–effect relationships were established with in vitro time–kill data at pH 6 and pH 7.4 and in mice with cUTI. Immunocompetent mice were treated with apramycin (1.5–30 mg/kg) starting 24 h post-infection. Kidney and bladder tissue were collected 6–96 h post-infection for cfu determination. A PKPD model integrating all data was developed and simulations were performed to predict bacterial burden in humans. Results Treatment with apramycin reduced the bacterial load in kidneys and bladder tissue up to 4.3-log compared with vehicle control. In vitro and in vivo tissue time-course efficacy data were integrated into the PKPD model, showing 76%–98% reduction of bacterial net growth and 3- to 145-fold increase in apramycin potency in vivo compared with in vitro. Simulations suggested that an 11 mg/kg daily dose would be sufficient to achieve bacterial stasis in kidneys and bladder in humans. Conclusions PKPD modelling with in vitro and in vivo PK and PD data enabled simultaneous evaluation of the different components that influence drug effect, an approach that had not yet been evaluated for antibiotics in the cUTI model and that has potential to enhance model-informed drug development of antibiotics. [ABSTRACT FROM AUTHOR]

Marine teleosts experience ion gain and water loss in their natural habitats. Among other tissues, the urinary bladder epithelium of marine fishes has been shown to actively transport ions to facilitate water absorption. However, transport properties of the urinary bladder epithelium of marine fishes and its plasticity in altered ambient salinities is relatively under-investigated. We describe urinary bladder epithelium electrophysiology, water flux, and expressions of ion transporters in urinary bladder tissue of Gulf toadfish (Opsanus beta) acclimated to either 35 ppt or 60 ppt seawater. Water absorption in bladder sac preparations increased ∼350% upon acclimation to 60 ppt. Increases in water transport coincided with a significant ∼137% increase in urinary bladder tissue mucosal-to-serosal short circuit current (Isc) and a ∼56% decrease in tissue membrane resistance. Collectively, these metrics indicate that an active electrogenic system facilitates water absorption via Na+ (and Cl−) transport in urinary bladder tissue. Furthermore, pharmacological inhibition of urinary bladder tissue Isc and expression of a suite of ion transporters and channels previously unidentified in this tissue provide mechanistic insights into the transport processes responsible for water flux. Analysis of water transport to overall Gulf toadfish water balance reveals a modest water conservation role for the urinary bladder of ∼0.5% of total water absorption in 35 ppt and 1.9% in 60 ppt acclimated toadfish. These results emphasize that electrogenic ion transport facilitates water-absorptive properties of the urinary bladder in Gulf toadfish—a process that is regulated to facilitate water homeostasis. NEW & NOTEWORTHY: Novel experiments showcasing increased urinary bladder water absorption, ion transport, and altered channel/transporter expression in a marine fish acclimated to high salinities. Our results provide additional and noteworthy mechanistic insight into the ionoregulatory processes controlling water transport at the level of the urinary bladder in marine teleosts. Experimental outcomes are applied to whole organism-level water transport values, and the relative importance of marine teleost urinary bladder function to overall organism water conservatory measures is discussed. [ABSTRACT FROM AUTHOR]

Objective: Adhesions between the uterus, bladder and anterior abdominal wall are associated with clinical sequelae, including chronic pelvic pain and dyspareunia, and can also yield complications during surgery. The transvaginal sonographic (TVS) sliding bladder sign is a minimally invasive diagnostic tool to evaluate the presence of vesicouterine adhesions. This study aimed to determine the predictive value and intra‐ and interobserver variation of the TVS sliding bladder sign in the assessment of vesicouterine adhesions. Methods: This was a prospective observational double‐blind diagnostic accuracy study conducted at the Amsterdam University Medical Center. Patients scheduled for gynecological laparoscopic surgery for a benign disorder between January 2020 and December 2022 were included consecutively. All patients underwent preoperative TVS, including a dynamic sliding bladder sign examination in our outpatient clinic. Videoclips of the TVS scans were stored for offline assessment and used as an index test. The recordings of both TVS and laparoscopy were evaluated for diagnostic characteristics of vesicouterine adhesions by independent assessors, who were blinded to the clinical situation in addition to the laparoscopic findings when assessing recordings of TVS and vice versa. The presence of adhesions on laparoscopy was used as the reference standard. The positive predictive value (PPV), negative predictive value (NPV), specificity and sensitivity of the sliding bladder sign were calculated. In addition, inter‐ and intraobserver variability of the sliding bladder sign on TVS were assessed. Results: Of 116 included women, 57 had a negative sliding bladder sign on TVS, while on laparoscopy, 51 women had mild and 28 had severe vesicouterine adhesions. A negative sliding bladder sign had a PPV of 94.7% (95% CI, 88.9–100%) for the presence of any vesicouterine adhesions, and a positive sliding bladder sign had a specificity of 91.9% (95% CI, 83.1–100%). For severe adhesions, the negative sliding bladder sign had a sensitivity of 89.3% (95% CI, 77.8–100%) and a positive sliding bladder sign had a NPV of 94.9% (95% CI, 89.3–100%). When using Cohen's kappa coefficient, inter‐ and intraobserver agreement between assessors was good. Conclusions: Sliding bladder sign evaluation using TVS is a reliable diagnostic tool for the prediction of vesicouterine adhesions on laparoscopy. A negative sliding bladder sign indicates the presence of vesicouterine adhesions, while a positive sliding bladder sign makes the presence of severe adhesions unlikely. Establishing vesicouterine adhesions by TVS may optimize preoperative planning, and can be used for future studies to evaluate the relationship between symptomatology and vesicouterine adhesions and, subsequently, the effect of adhesion‐prevention interventions. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Introduction Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. Materials and Methods This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. Results Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. Conclusions In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries. [ABSTRACT FROM AUTHOR]

Purpose: Mirabegron, the first-in-class beta-3 agonist, is the mainstay medication for overactive bladder (OAB). The aim of this study was to investigate the efficacy and safety of generic drugs of mirabegron (Mirabek®) in adults diagnosed with OAB through a multicenter, prospective, non-interventional observational study. Materials and Methods: Adult patients with OAB prescribed Mirabek® SR Tab. 50 mg for the first time were recruited from hospitals between September 2021 and September 2022. Participants underwent baseline registration followed by two follow-ups at 4- and 8-week intervals. Data on demographics, medical history, OAB symptoms, vital signs, medication administration, and adverse events were collected. Results: Among 1,714 patients, Mirabek® SR Tab. 50 mg effectively improved OAB symptoms over an 8-week treatment period, with significant differences in symptom improvement between baseline and both 4- and 8-week time points as well as between 4 weeks and 8 weeks. The incidence rate of adverse events was 0.70%; most cases were mild with no severe reactions. Conclusions: This study demonstrated that Mirabek®, a generic drug of betmiga, is an effective and safe treatment option for adults with OAB. Furthermore, the introduction of generic drug reduced the costs of prescription drugs and expanded the opportunity for many patients to access mirabegron. [ABSTRACT FROM AUTHOR]

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Implantable tibial neuromodulation (iTNM) systems have recently become commercially available in the US, and offer a new method of neurostimulation for the treatment of overactive bladder (OAB). In the absence of head-to-head studies, the aim of this meta-analysis was to indirectly compare the efficacy and safety of sacral neuromodulation (SNM) and implantable tibial neuromodulation (iTNM) for the treatment of OAB. Methods: A comprehensive search was performed using terms for OAB and neuromodulation. Primary efficacy measures included a ≥ 50% reduction in urgency urinary incontinence (UUI) episodes, urinary frequency, and/or OAB symptoms. Primary safety measures included the rate of device-related adverse events (AEs). Results: A total of 20 studies met selection criteria, encompassing 1416 patients treated with SNM and 350 patients treated with iTNM. No comparative or placebo-controlled studies for SNM and iTNM were identified, and therefore the analysis was completed using single-arm results. Weighted averages showed that the UUI responder rate was similar for both SNM and iTNM (71.8% and 71.3%, respectively). Similarly, weighted averages of OAB responder rates were 73.9% for SNM and 79.4% for iTNM. Similar rates of device-related AEs were also observed. Conclusions: This meta-analysis found similar efficacy and safety of SNM and iTNM for the treatment of OAB and UUI, including UUI and OAB symptom response rates, reduction in UUI episodes, significant improvements in quality-of-life (QoL), and low rates of procedure and device-related adverse events. Notably, this comparable efficacy was seen without the use of a trial phase of neuromodulation in the iTNM studies versus SNM studies. [ABSTRACT FROM AUTHOR]

Tissue engineering has been considered a potential choice for urinary system reconstruction. Here, we aim to a broad spectrum of employed stem cells in bladder regeneration by performing a comprehensive systematic review. In January 2024, we searched Scopus, PubMed, and Embase databases for studies that tried bladder regeneration by tissue engineering using stem cells. We excluded non-English studies, review articles, and manuscripts that met the other exclusion criteria. Among 43 included studies, comparative studies demonstrated the similar or superior potentiality of stem cells to regenerate tissues and improve bladder function compared with autologous cells. Furthermore, data suggest an increased use of bio-synthetic scaffolds and their appropriate bio-compatibility with stem cells. The evidence establishes that adipose-derived and bone marrow-derived mesenchymal stem cells are the most frequently used stem cells. And both are suitable for urothelium and smooth muscle formation along with the capability of bone marrow-derived mesenchymal stem cells for lamina propria formation. Additionally, the competency of smooth muscle-derived progenitor cells, urine-derived stem cells, umbilical mesenchymal SCs for smooth muscle and urothelium regeneration, and the capability of hair follicle stem cells for smooth muscle formation are demonstrated. Also, the superiority of endothelial progenitor cells for neo-vascularization and smooth muscle progenitor cells for neuron formation are demonstrated. In addition to adding growth factors to the culturing media, hypoxic conditions and intra-peritoneal incubation are introduced as promoter conditions that can improve histological and physiological components. Available evidence is limited, although it suggests the precious capability of stem cells for bladder regeneration.

To date, there are no efficacious translational solutions for end-stage urinary bladder dysfunction. Current surgical strategies, including urinary diversion and bladder augmentation enterocystoplasty (BAE), utilize autologous intestinal segments (e.g. ileum) to increase bladder capacity to protect renal function. Considered the standard of care, BAE is fraught with numerous short- and long-term clinical complications. Previous clinical trials employing tissue engineering approaches for bladder tissue regeneration have also been unable to translate bench-top findings into clinical practice. Major obstacles still persist that need to be overcome in order to advance tissue-engineered products into the clinical arena. These include scaffold/bladder incongruencies, the acquisition and utility of appropriate cells for anatomic and physiologic tissue recapitulation, and the choice of an appropriate animal model for testing. In this study, we demonstrate that the elastomeric, bladder biomechanocompatible poly(1,8-octamethylene-citrate-co-octanol) (PRS; synthetic) scaffold coseeded with autologous bone marrow-derived mesenchymal stem cells and CD34+ hematopoietic stem/progenitor cells support robust long-term, functional bladder tissue regeneration within the context of a clinically relevant baboon bladder augmentation model simulating bladder trauma. Partially cystectomized baboons were independently augmented with either autologous ileum or stem-cell-seeded small-intestinal submucosa (SIS; a commercially available biological scaffold) or PRS grafts. Stem-cell synergism promoted functional trilayer bladder tissue regeneration, including whole-graft neurovascularization, in both cell-seeded grafts. However, PRS-augmented animals demonstrated fewer clinical complications and more advantageous tissue characterization metrics compared to ileum and SIS-augmented animals. Two-year study data demonstrate that PRS/stem-cell-seeded grafts drive bladder tissue regeneration and are a suitable alternative to BAE.

BackgroundHemorrhagic cystitis (HC) is an inflammatory disease of the bladder with sustained hematuria for which there is currently no approved drug treatment. We evaluated a liposomal tacrolimus preparation (LP-10) in patients with refractory moderate to severe sterile HC.MethodsThis phase 2a dose-escalation study assessed the safety and efficacy of up to 2 intravesical instillations of LP-10 (2, 4, or 8 mg tacrolimus) in 13 patients with HC. Primary efficacy outcomes were changes from baseline in the number of bleeding sites on cystoscopy, microscopic urine analysis for red blood cells (RBCs), and hematuria on dipstick. Additional efficacy measures included urinary incontinence, frequency, and urgency on a 3-day diary and cystoscopy global response assessment (GRA). Blood samples for pharmacokinetic (PK) assessment were obtained in all patients.ResultsIntravesical LP-10 was well tolerated, with no treatment-related severe or serious adverse events (AEs) and only 3 drug-related AEs (artificial urinary sphincter malfunction, dysuria, and bladder spasms). LP-10 blood levels showed short durations of minimal systemic uptake. Treatment resulted in significant improvements in bleeding on cystoscopy, RBC counts in urine, hematuria on dipstick, and urinary incontinence. Bleeding on cystoscopy and urinary incontinence showed dose-dependent improvements that were more pronounced in the 4 mg and 8 mg dose groups. All dose groups showed a significant improvement in cystoscopy GRA.ConclusionLP-10 was well tolerated, with clinically relevant efficacy seen in improvements in cystoscopic bleeding, hematuria, and urinary incontinence. The benefit-risk profile supports the further clinical development of LP-10 at a tacrolimus dose of 4 mg.

Interstitial cystitis (IC) presents as a chronic pain condition with variable combinations of symptoms depending on the species and individual patient. It is diagnosed by the presence of lower urinary tract signs and symptoms in combination with a variety of comorbid health problems, a history of life adversities, and the absence of other conditions that could cause the lower urinary tract signs. IC occurs naturally in humans and cats as a dimensional condition, with patients presenting with mild, moderate, and severe symptoms. Most patients appear to recover without specific treatment. A number of rodent models of IC have been used to study its causes and treatments. Unfortunately, current therapies generally fail to ameliorate IC symptoms long-term. The recent classification of IC as a chronic primary pain disorder calls for a rethinking of current clinical and research approaches to it. Beginning when a patient encounters a clinician, precipitating, perpetuating, and palliating risk factors can be addressed until a cause or reliably effective therapy is identified, and identifying predisposing and preventive factors can inform epidemiological studies and health promotion interventions. Predisposing, precipitating, and perpetuating risk factors, including environmental, psychological, and biological, increase the activity of the central threat response system (CTRS), which plays a clinically important role in IC symptoms. Studies in cats and rodent models have revealed that environmental enrichment (EE), in the absence of bladder-directed therapies, leads to amelioration of IC symptoms, implying a central role for the CTRS in symptom precipitation and perpetuation. Conceptually moving the source of IC pain to the brain as a motivational state rather than one resulting from peripheral nociceptive input offers both clinicians and researchers novel opportunities to improve care for patients with IC and for researchers to use more ecologically valid rodent models. It may even be that IC results from an excess of risk to protective factors, making this imbalance a targetable cause rather than a consequence of IC.

BACKGROUND: Hemorrhagic cystitis (HC) is an inflammatory disease of the bladder with sustained hematuria for which there is currently no approved drug treatment. We evaluated a liposomal tacrolimus preparation (LP-10) in patients with refractory moderate to severe sterile HC. METHODS: This phase 2a dose-escalation study assessed the safety and efficacy of up to 2 intravesical instillations of LP-10 (2, 4, or 8 mg tacrolimus) in 13 patients with HC. Primary efficacy outcomes were changes from baseline in the number of bleeding sites on cystoscopy, microscopic urine analysis for red blood cells (RBCs), and hematuria on dipstick. Additional efficacy measures included urinary incontinence, frequency, and urgency on a 3-day diary and cystoscopy global response assessment (GRA). Blood samples for pharmacokinetic (PK) assessment were obtained in all patients. RESULTS: Intravesical LP-10 was well tolerated, with no treatment-related severe or serious adverse events (AEs) and only 3 drug-related AEs (artificial urinary sphincter malfunction, dysuria, and bladder spasms). LP-10 blood levels showed short durations of minimal systemic uptake. Treatment resulted in significant improvements in bleeding on cystoscopy, RBC counts in urine, hematuria on dipstick, and urinary incontinence. Bleeding on cystoscopy and urinary incontinence showed dose-dependent improvements that were more pronounced in the 4 mg and 8 mg dose groups. All dose groups showed a significant improvement in cystoscopy GRA. CONCLUSION: LP-10 was well tolerated, with clinically relevant efficacy seen in improvements in cystoscopic bleeding, hematuria, and urinary incontinence. The benefit-risk profile supports the further clinical development of LP-10 at a tacrolimus dose of 4 mg.

Emphysematous cystitis is a rare condition that can have fatal complications if left untreated. A timely diagnosis and proper treatment are crucial to achieving appropriate outcomes. Patients with this condition should be evaluated, and if necessary, conservative treatment or surgery should be provided. This case report describes a 73-year-old male patient with emphysematous cystitis who underwent conservative treatment for bladder rupture and reviews the existing literature on this topic. The gold standard for diagnosis of EC is a computerized tomographic scan. This condition should be evaluated, and if necessary, conservative treatment or surgery should be provided. [ABSTRACT FROM AUTHOR]

Background and Aim: Urinary bladder paraganglioma (UBPGL) is a rare neuroendocrine neoplasm, accounting for

Purpose: Urgency urinary incontinence (UUI) is a prevalent condition with significant implications for quality of life, yet its association with mortality was less examined by a few studies. Using data from representative U.S. population, this study aims to investigate the relationship between UUI and cause-specific mortality. Methods: We utilized data from the NHANES collected between 2005 and 2014, comprising 21,973 patients (median age 49, 50.3% male). All data were combined with the National Death Index (NDI), which assessed mortality in December 2019. UUI was characterized by at least one incident of involuntary urination before reaching a toilet within a year. The Cox regression analysis was applied to compute the adjusted hazard ratios for mortality, with further subgroup and cause-specific analyses to assess the differential risk of mortality associated with UUI. Results: Of the participants, 21.8% (4781/21,973) reported experiencing UUI over the year. The average duration of follow-up was 9.3 years, during which 2968 (13.5%) subjects passed away. Controlling for potential confounders, individuals with UUI exhibited an elevated mortality risk. Interaction analyses did not show statistical interactions between UUI and age- and sex-stratified subgroups. However, the findings were consistently indicative of an increased risk of mortality from cardiovascular disease, cancer and other causes. Conclusions: UUI presents a significant burden across all ages and sexes, being associated with various conditions and an increased risk of overall mortality including cardiovascular disease and cancer-related death. The causal relationship between UUI and mortality can provide a basis for understanding the mechanism. [ABSTRACT FROM AUTHOR]

Sensitization of primary afferents is essential for the development of pain, but the molecular events involved in this process and its reversal are poorly defined. Recent studies revealed that acid-sensing ion channels (ASICs) control the excitability of nociceptors in the urinary bladder. Using genetic and pharmacological tools we show that ASICs are functionally coupled with voltage-gated Ca2+ channels to mediate Ca2+ transients evoked by acidification in sensory neurons. Genetic deletion of Asic3 of these sensory neurons does not alter the mechanical response of bladder afferents to distension in naïve mice. Both control and sensory neuron conditional Asic3 knockout (Asic3-KO) mice with chemical cystitis induced by cyclophosphamide (CYP) administration exhibit frequent low volume voiding events. However, these changes are transient and revert over time. Of major significance, in Asic3-KO mice, CYP treatment results in the sensitization of a subset of bladder afferents and pelvic allodynia that persist beyond the resolution of the inflammatory process. Thus, ASICs function is necessary to prevent long-term sensitization of visceral nociceptors. [ABSTRACT FROM AUTHOR]

Background/Objectives: Postsurgical lower urinary tract dysfunction (LUTD) is a common problem following deep infiltrating endometriosis (DIE) resection. The condition may be caused either by surgically induced damage to the bladder innervation or by pre-existing endometriosis-associated nerve damage. The aim of this study is to evaluate the efficacy of preoperative and postoperative multichannel urodynamic testing (UD) in identifying pre-existing or surgically induced LUTD among patients with DIE. Methods: Women with suspected DIE and planned surgical resection of DIE at the Department of Obstetrics and Gynecology at the University Hospital of Bern from September 2015 to October 2022 were invited to participate in this prospective cohort study. UD was performed before and 6 weeks after surgery. The primary outcome was the maximum flow rate (uroflow), an indicator of LUTD. Secondary outcomes were further urodynamic observations of cystometry and pressure flow studies, lower urinary tract symptoms (LUTS) as assessed by the International Prostate Symptom Score (IPSS), and pain as assessed by the visual analog scale (VAS). Results: A total of 51 patients requiring surgery for DIE were enrolled in this study. All patients underwent surgical excision of the DIE. The cohort demonstrated a uroflow of 22.1 mL/s prior to surgery, which decreased postoperatively to 21.5 mL/s (p = 0.56, 95%CI −1.5–2.71). The mean bladder contractility index (BCI) exhibited a notable decline from 130.4 preoperatively to 116.6 postoperatively (p = 0.046, 95%CI 0.23–27.27). Significant improvements were observed in the prevalence of dysmenorrhea, abdominal pain, dyspareunia, and dyschezia following surgical intervention (p = <0.001). The IPSS score was within the lower moderate range both pre- and postoperatively (mean 8.37 vs. 8.51, p = 0.893, 95%CI −2.35–2.05). Subgroup analysis identified previous endometriosis surgery as a significant preoperative risk factor for elevated post-void residual (43.6 mL, p = 0.026, 95%CI 13.89–73.37). The postoperative post-void residual increased among participants with DIE on the rectum to 54.39 mL (p = 0.078, 95%CI 24.06–84.71). Participants who underwent hysterectomy exhibited a significantly decreased uroflow (16.4 mL/s, p = 0.014, 95%CI 12–20) and BCI (75.1, p = 0.036, 95%CI 34.9–115.38). Conclusions: Nerve-respecting laparoscopy for DIE may alter bladder function. UD is not advisable before surgery, but the measurement may detect patients with LUTD. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to assess the clinical efficacy and safety of combining silodosin and solifenacin for overactive bladder (OAB) in females. Methods: A retrospective analysis of 586 females with OAB was conducted. Patients received either combination therapy (silodosin 8 mg + solifenacin 5 mg) or monotherapy (solifenacin 5 mg) for 12 weeks. Baseline and follow-up assessments included the overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), voided volume (VV), and postvoid residual urine volume (PVR). Results: Overall, 287 and 299 patients received combination therapy and monotherapy respectively. Both groups experienced significant improvements in OABSS and total IPSS after 12 weeks. The combination therapy group demonstrated a greater improvement in QoL compared to the monotherapy group (P=0.031). No significant differences were observed in Qmax or VV between the groups. However, the combination therapy group showed a significant reduction in PVR compared to the monotherapy group (P<0.001). Conclusions: Combining silodosin with solifenacin significantly improved OAB symptoms and QoL in females. This combination therapy was particularly effective in reducing postvoid residual volume compared to solifenacin alone. These findings suggest that adding an alpha-blocker to antimuscarinic therapy can enhance OAB management and patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: Mesenchymal stem cells (MSCs) have been identified to have a unique migratory pattern toward tumor sites across diverse cancer types, playing a crucial role in cancer progression, treatment resistance, and immunosuppression. This study aims to formulate a prognostic model focused on MSC‐associated markers to efficiently predict the clinical outcomes and responses to therapy in individuals with bladder cancer (BC). Methods: Clinical and transcriptome profiling data were extracted from The Cancer Genome Atlas Urothelial Bladder Carcinoma (TCGA‐BLCA) and GSE31684 databases. Systematic quantification of MSC prevalences and stromal indices was undertaken, culminating in the discernment of genes correlated with stromal MSCs following a thorough application of weighted gene coexpression network analysis techniques. Subsequently, an exhaustive risk signature pertinent to MSC was formulated by amalgamating methods from univariate and Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression models. Drugs targeting genes associated with MSCs were screened using molecular docking. Results: The prognostic model for MSC incorporated five critical genes: ZNF165, matrix remodeling‐associated 7 (MXRA7), CEMIP, ADP‐ribosylation factor‐like 4C (ARL4C), and cerebral endothelial cell adhesion molecule (CERCAM). In the case of BC patients, stratification was performed into discrete risk categories, utilizing the median MSC risk score as a criterion. It was striking that those classified within the high‐MSC‐risk bracket demonstrated correlations with unfavorable prognostic implications. Enhanced responsiveness to immunotherapy in low‐MSC‐risk patients was delineated compared to their high‐MSC‐risk counterparts. A heightened receptivity was noted toward particular chemotherapy drugs, encompassing gemcitabine, vincristine, paclitaxel, gefitinib, and sorafenib, within this high‐risk group. Conversely, a superior reaction to cisplatin was distinctly evident among those marked by low MSC scores. The results of molecular docking demonstrated that kaempferol exhibited favorable docking with ZNF165, quercetin exhibited favorable docking with MXRA7, mairin exhibited favorable docking with CEMIP, and limonin diosphenol exhibited favorable docking with ARL4C. Conclusions: The five‐gene MSC prognostic model demonstrates substantial efficacy in prognosticating clinical outcomes and gauging responsiveness to chemotherapy and immunotherapy regimens. The genes ZNF165, MXRA7, CEMIP, ARL4C, and CERCAM are underscored as promising candidates warranting further exploration for anti‐MSC therapeutic strategies, thereby offering novel insights for personalized treatment approaches in BC. [ABSTRACT FROM AUTHOR]

Inappropriate urinary tract infection diagnosis in patients with neurogenic bladder may result from ambiguous symptoms experienced by these patients and contributes to antibiotic overuse. Characterization of patient-reported signs and symptoms may help providers more appropriately diagnose urinary tract infections. A previous study collected signs and symptoms recorded in electronic medical records of patients with neurogenic bladder due to spinal cord injury/disorder, multiple sclerosis, and Parkinson’s disease with at least one urinary tract infection diagnosis between 2017–2018 at four medical centers. In this study, 23 veterans from this cohort with urinary tract infection diagnoses in the previous year participated in focus groups conducted May 2021– May 2022. Transcripts were coded using mixed deductive and inductive coding. Qualitative data were compared to electronic medical records data to give a comprehensive picture of signs and symptoms. Both providers and patients attributed nonspecific symptoms like urine changes to urinary tract infection, but there was discordance between patients and providers in the identification of other signs and symptoms. Several patients described providers disregarding symptoms other than fever or chills. Optimizing urinary tract infection care for patients with neurogenic bladder could involve improving patient-provider communication about urinary tract infection signs and symptoms and emphasizing thorough elicitation and evaluation of all signs and symptoms. [ABSTRACT FROM AUTHOR]

Objectives: The study was aimed to establish the "inside‐out" preparation with the urothelium and investigate the changes in urothelial permeability of the cyclophosphamide (CYP)‐induced cystitis model in rats. Methods: In female rats with or without CYP injection, the isolated whole bladder was utilized as an "inside‐out" preparation with the urothelium, which was created by reversing the bladder from a top portion. The preparation was fixed in the organ bath, and instilled with a Krebs solution (0.5 mL) through the bladder neck. After it was kept under an isovolumetric condition, high K+ (KCl: 50 mM) or acetylcholine (ACh: 10 μM) was added into the organ bath. Results: In the normal bladder, the intravesical pressure of the inside‐out preparation with the urothelium did not change with the addition of KCl or ACh. Contrarily, in the CYP‐injected bladder 24 or 48 h after injection of CYP, the intravesical pressure of the inside‐out preparation increased with the addition of KCl or ACh. Histological examinations showed a denuded and/or cracked surface of the urothelial layer, and the intensity of uroplakin III staining of the urothelial layer decreased in the CYP‐injected rats. Conclusions: The study demonstrated the bladder urothelium has robust barrier mechanisms for preventing the absorption of water (urine) under the normal condition. However, these barrier mechanisms were disrupted in the CYP‐induced cystitis, suggesting that water and urine insults can be permeabilized into the urinary bladder, specifically to the smooth muscle layer. [ABSTRACT FROM AUTHOR]

Based on lineage-specific transcription factors, small-cell neuroendocrine carcinoma (SmCC) of the urinary bladder has recently been subtyped into three molecular subtypes: ASCL1, NEUROD1 and POU2F3. The latter is a master transcriptional regulator of tuft cells (TCs) which are rare solitary cells found in various mucosal epithelia such as the gastrointestinal tract, but which have not been reported in the bladder. The POU2F3 subtype shows low or absent neuroendocrine marker expression. A case of mixed SmCC and conventional-type urothelial carcinoma (CUC) of the urinary bladder with POU2F3-expressing intraepithelial small-cell carcinoma in keeping with a tuft cell phenotype, arising in association with intestinal metaplasia (IM) is described. The presence of POU2F3-expressing cells in normal urothelium, cystitis cystica glandularis and IM of the urinary bladder is demonstrated in separate cases of cystitis cystica glandularis with IM. Also, POU2F3 expression is identified in a subset of bladder SmCC. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this guideline is to provide evidence‐based guidance to clinicians of all specialties on the evaluation, management, and treatment of idiopathic overactive bladder (OAB). The guideline informs the reader on valid diagnostic processes and provides an approach to selecting treatment options for patients with OAB through the shared decision‐making process, which will maximize symptom control and quality of life, while minimizing adverse events and burden of disease. Methods: An electronic search employing OVID was used to systematically search the MEDLINE and EMBASE databases, as well as the Cochrane Library, for systematic reviews and primary studies evaluating diagnosis and treatment of OAB from January 2013 to November 2023. Criteria for inclusion and exclusion of studies were based on the Key Questions and the populations, interventions, comparators, outcomes, timing, types of studies and settings (PICOTS) of interest. Following the study selection process, 159 studies were included and were used to inform evidence‐based recommendation statements. Results: This guideline produced 33 statements that cover the evaluation and diagnosis of the patient with symptoms suggestive of OAB; the treatment options for patients with OAB, including Noninvasive therapies, pharmacotherapy, minimally invasive therapies, invasive therapies, and indwelling catheters; and the management of patients with BPH and OAB. Conclusion: Once the diagnosis of OAB is made, the clinician and the patient with OAB have a variety of treatment options to choose from and should, through shared decision‐making, formulate a personalized treatment approach taking into account evidence‐based recommendations as well as patient values and preferences. [ABSTRACT FROM AUTHOR]

Simple Summary: The presented MRI results increase the imaging morphologic knowledge of the kidney, ureter and urinary bladder. The data will be useful in imaging anatomy and diagnostic studies of various pathologies of the excretory system in rabbits and other mammalian species. MR urography is a modern imaging technique for the examination of the entire urinary tract that replaces the gold standard excretory urography for the detection of urinary pathological changes. Twelve clinically healthy and sexually mature New Zealand White rabbits were studied. The non-contrast imaging included T1-weighted and T2-weighted spin-echo and gradient-echo sequences in the transverse, sagittal and dorsal planes. Transverse MRI (T2-weighted image) through L1 demonstrated only the right kidney. The transverse T2-weighted image through L2 showed both kidneys. The cranial part of the urinary bladder on T1-weighted transverse scans through L4 was flexed to the left. The T2-weighted sagittal image 30 mm to the right of the median plane showed the right kidney, the right ureter and the urinary bladder. The T2-weighted sagittal image 30 mm to the left of the median plane showed part of the left kidney, the left ureter and the urinary bladder. The T2-weighted sagittal image 45 mm to the left of the median plane presented the lateral part of the left kidney. The dorsal MRI image (T2-weighted sequence) through the horizontal plane 30 mm ventral to the spine demonstrated the whole organs. These data will be useful in imaging anatomy and diagnostic studies of various pathologies of the excretory system in rabbits and other mammalian species. [ABSTRACT FROM AUTHOR]

Summary: Trefoil factor family (TFF) peptides have been examined primarily in the gastrointestinal tract, where they play an important role in the epithelial regeneration. The therapeutic effects of TFFs, particularly the TFF3 protein, have been well studied in humans and in animal models of gastrointestinal injury, whereas little is known about their occurrence and function in the urinary bladder. In this study, we investigated the presence, location, and function of Tff3 in the urinary bladders of wild-type mice (Tff3WT) and compared them with Tff3 knockout mice (Tff3KO) using molecular and microscopic methods at the light and electron microscopic level. Our results show that Tff3 is expressed in the superficial cells of the urothelium, where it colocalizes with the uroplakin UP1b as one of the fundamental structural components of the apical plasma membrane, which is an important component of the blood-urine permeability barrier. Analysis of the urothelium with experimentally induced injury revealed that injury is more severe in Tff3KO mice and urothelial regeneration is attenuated compared with Tff3WT mice, suggesting that Tff3 plays a fine-tuned role in homeostasis and protection of the urothelium. This study provides the first data on the precise location and function of Tff3 in the bladder epithelium. (J Histochem Cytochem XX. XXX–XXX, XXXX) [ABSTRACT FROM AUTHOR]

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A specific type of beta-adrenergic receptor was discovered in the decade of 1980s and subsequently recognized as a new type of beta-adrenergic receptor, called beta3-adrenoceptor (β3-AR). β3-AR expresses in different tissues, including adipose tissue, gall bladder, stomach, small intestine, cardiac myocytes, urinary bladder, and brain. Structurally, β3-AR is very similar to β1- and β2-AR and belongs to a G-protein coupled receptor that uses cAMP as an intracellular second messenger. Alternatively, it also activates the NO-cGMP cascade. Stimulation of the β3-AR increases lipolysis, fatty acid oxidation, energy expenditure, and insulin action, leading to anti-obesity and anti-diabetic activity. Moreover, β3-AR differentially regulates the myocardial contraction and relaxes the urinary bladder to balance the cardiac activity and delay the micturition reflex, respectively. In recent years, this receptor has served as an attractive target for the treatment of obesity, type 2 diabetes, congestive heart failure, and overactive bladder syndrome. Several β3-AR agonists are in the emerging stage that can exert novel pharmacological benefits in different therapeutic areas. The present review focuses on the structure, signaling, physiological, and metabolic activities of β3-AR. Additionally, therapeutic approaches of β3-AR have also been considered. [ABSTRACT FROM AUTHOR]

Urinary bladder wound healing shares many features with skin healing, involving several molecular players, including microRNAs (miRs). This study investigated the role of miR-132 in urothelial cells. We analyzed miR-132 expression in rat bladder using in situ hybridization and conducted gain and loss of miR-132 function assays in primary human urothelial cells (HUCs). These assays included cell proliferation and migration studies. To explore the regulation of miR-132 expression, cells were treated with wound-healing-related factors such as interleukin 6 (IL-6), interleukin 10 (IL-10), and transforming growth factor beta-1 (TGF-β1). Predictive bioinformatics and a literature review identified potential miR-132 targets, which were validated through real-time polymerase chain reaction (RT-PCR) and Western blot analysis. miR-132 was found to promote cellular proliferation and migration during the early stages of urothelial wound repair. Its expression was modulated by key cytokines such as IL-6, IL-10, and TGF-β1. miR-132 played a crucial role in urothelial wound healing by enhancing cell proliferation and migration, regulated by cytokines, suggesting its action within a complex regulatory network. These findings highlight the therapeutic potential of targeting miR-132 in bladder injury repair, offering new insights into bladder repair mechanisms. [ABSTRACT FROM AUTHOR]

The current study aimed to evaluate the effectiveness of fascia lata for grafting of the urinary bladder. Clinical, ultrasonographic and radiographic evaluations were performed. The study was carried out on ten healthy mongrel dogs of both sexes. They were divided into two equal groups. The animals in the control group were subjected to cystectomies, followed by suturing of the remaining wall using an inverting suture technique. The dogs in the Fascia lata group were subjected to partial cystectomies followed by grafting using fascia lata which was harvested from the thigh region. The graft was sutured to the bladder using the inverting suture pattern. The results revealed that the animals in both groups were healthy throughout the experiment except two animals in the control group showed urinary incontinence at the early post-operative period. One animal in the fascia lata group showed incontinence and another one displayed arching of the back in the first three days postoperation. The ultrasonographic and radiographic evaluation revealed a well-contoured bladder without any leakage. The bladder volume was significantly decreased in the control group post-operatively compared to the pre-operative manual measurement. However, there was no significant variation in the bladder volume pre- and post-grafting in the fascia lata group when measured manually and radiographically. Ultrasound is considered an unreliable method for measuring bladder volume. The results showed that fascia lata is an easily harvested tissue used for grafting the urinary bladder. It causes no complications (leakage, stone formation), and it keeps bladder capacity within normal or close to normal. [ABSTRACT FROM AUTHOR]

Background/Aim. Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a condition with recurring discomfort or pain in the urinary bladder and the surrounding pelvic region without an identifiable disease. The aim of this study was to assess hydrodistension as a diagnostic and treatment procedure in patients with BPS. Methods. This prospective study included 45 patients who underwent cystoscopy with hydrodistension. The m ean v alues f or 2 4-hr voiding frequency, maximal voided urine volume, average voided urine volume, and minimal voided urine volume originated from the frequency volume chart. The values were compared between the time before hydrodistension and one, three, and six months after that. Results. By comparing the initial data and data in all three follow-up periods (after one, three, and six months), the statistical significance (p < 0.046) was found, and that: for 24-hr voiding frequency, it was 19.64 ± 3.56, 9.42 ± 1.71, 9.58 ± 1.45, and 12.2 ± 2.79, respectively; then, for the minimal voided urine volume (p < 0.03), it was 59.11 ± 23.72 mL, 114.89 ± 4.09 mL, 112.44 ± 100.86 mL, and 89.00 ± 29.45 mL, respectively; for an average voided volume (p < 0.04), it was 105.33 ± 18.29 mL, 186.89 ± 23.14 mL, 186.44 ± 21.44 mL, and 155.78 ± 30.78 mL, respectively. There was no significant statistical difference (p < 0.1) regarding the maximal voided urine volume between initial and follow-up interval data: 196.89 ± 43.68 mL, 312.89 ± 54.59 mL, 316.00 ± 49.47 mL, 266.67 ± 53.17 mL, respectively. Conclusion. Our results demonstrate that hydrodistension is a reliable diagnostic and therapeutic procedure. [ABSTRACT FROM AUTHOR]

Infections are common in patients with diabetes. Moreover, increasing incidence of antibiotic resistance impedes the complete bacterial clearance and calls for alternative treatment strategies. Along with antibacterial resistance, compromised host conditions create a favorable condition for the disease progression. In particular, cell junction proteins are of major importance as they contribute to a tight cell barrier, protecting against invading pathogens. However, the impact of high glucose on cell junction proteins has received little attention in the urinary bladder but merits closer investigation. Here, we report that during diabetes the expression of cell junction protein, claudin 14 is compromised in the human urine exfoliated cells and in the urinary bladder of type 2 diabetic mouse. Further in vitro analysis confirmed a direct correlation of lower intracellular calcium levels with claudin 14 expression in high glucose-treated human uroepithelial cells. Moreover, external calcium supplementation in high glucose-treated cells significantly affected the cell migration and restored the claudin 14 expression through focal adhesion and β-1 integrins. Strengthening the epithelial barrier is essential, especially in individuals with diabetes where basal calcium levels could contribute. [ABSTRACT FROM AUTHOR]

Aims: We hypothesise that PTNS is a safe and effective treatment for OAB. Overactive bladder (OAB) is estimated to affect 11.8% of women worldwide, causing diminished quality of life. Lifestyle modifications, muscarinic receptor antagonist and beta‐adrenoreceptor agonist remain the mainstay of treatment but are limited by their efficacy and adverse effects. Access to third‐line therapies of intravesical botulinum toxin type A or sacral neuromodulation is limited by their invasive nature. Percutaneous tibial nerve stimulation (PTNS) has emerged as a non‐invasive treatment option for OAB. Methods: This study was a single‐arm trial of women requesting third‐line treatment for OAB. The primary treatment outcome was patient‐reported visual analogue score (VAS) improvement of at least 50%. Secondary outcome measures were Urinary Distress Inventory Short Form (UDI‐6) score and two‐day bladder diary. Patients also provided feedback on adverse effects encountered. Results: In the 84 women recruited, initial treatment protocol showed a success rate of 77.2% among those who completed treatment based on VAS, with a statistically significant improvement in mean UDI‐6 score of 20.13 (P < 0.01, standard deviation: 12.52). Continued success following tapering protocol of 60.8% and a mean maintenance protocol of 14.2 months was achieved. No adverse effects were reported. Conclusion: The results from this study are in concordance with previously published literature on the effectiveness and safety of PTNS as a treatment modality for OAB. Further randomised controlled trials to evaluate the optimal treatment protocol are warranted to establish a standardised regime. [ABSTRACT FROM AUTHOR]

Many organs are designed to move: the heart pumps each second, the gastrointestinal tract squeezes and churns to digest food, and we contract and relax skeletal muscles to move our bodies. Sensory neurons of the peripheral nervous system detect signals from bodily tissues, including the forces generated by these movements, to control physiology. The processing of these internal signals is called interoception, but this is a broad term that includes a wide variety of both chemical and mechanical sensory processes. Mechanical senses are understudied, but rapid progress has been made in the last decade, thanks in part to the discovery of the mechanosensory PIEZO ion channels (Coste et al., 2010). The role of these mechanosensors within the interoceptive nervous system is the focus of this review. In defining the transduction molecules that govern mechanical interoception, we will have a better grasp of how these signals drive physiology. [ABSTRACT FROM AUTHOR]

Objectives. The Mitrofanoff principle has been extensively evaluated in terms of associated morbidity and mortality. However, there is limited literature specifically addressing quality of life (QoL), particularly concerning the laparoscopic procedure. The aim of this study was to assess the impact of laparoscopic appendicovesicostomy (LA) on QoL by using a specific questionnaire targeted at patients and their families. Materials and methods. This observational and descriptive study involved patients who underwent LA between May 2018 and December 2023. A survey consisting of 29 questions, organized into three sections was used: satisfaction with the surgery, outcomes, and current continence status. Responses were graded according to the Likert scale (1-5) (1 = strongly disagree, 5 = strongly agree). Results. Of the 29 contacted families, 24 (82.8%) responded. The average age was 12.3 years (SD 4.4), with 75.9% being male. The primary indication for surgery was pain during urethral catheterization (69%). Mean postoperative follow-up was 36.5 months. Regarding satisfaction with surgery: overall satisfaction, hospitalization duration and pain control was rated with a score of 5 by 66.7%, 58.3% and 58.3%, respectively. In terms of outcomes: 54.2% rated aesthetic results with a score of 5, and 83.3% rated improvement in QoL with a score of 4 or 5. Concerning current continence status, 66.6% were very satisfied with the results and reported total absence of leakages or on a very specific occasion (score of 4 or 5). Conclusions. This study supports the improvement in perceived QoL among patients requiring an LA. Overall satisfaction with the procedure and outcomes related to continence were perceived as very good by both patients and their families. [ABSTRACT FROM AUTHOR]

Diabetic bladder dysfunction (DBD) is the most prevalent complication of diabetes mellitus (DM), affecting >50% of all patients. Currently, no specific treatment is available for this condition. In the early stages of DBD, patients typically complain of frequent urination and often have difficulty sensing when their bladders are full. Over time, bladder function deteriorates to a decompensated state in which incontinence develops. Based on studies of diabetic changes in the eye, kidney, heart, and nerves, it is now recognized that DM causes tissue damage by altering redox signaling in target organs. NADPH oxidase (NOX), whose sole function is the production of reactive oxygen species (ROS), plays a pivotal role in other well-known and bothersome diabetic complications. However, there is a substantial gap in understanding how NOX controls bladder function in health and the impact of NOX on DBD. The current review provides a thorough overview of the various NOX isoforms and their roles in bladder function and discusses the importance of further investigating the role of NOXs as a key contributor to DBD pathogenesis, either as a trigger and/or an effector and potentially as a target. [ABSTRACT FROM AUTHOR]

Objectives: High-intensity focused ultrasound (HIFU) is widely used to treat uterine fibroids. HIFU preoperative localization of uterine fibroids can be used to determine whether the patient is a suitable candidate for HIFU treatment. This study investigated the clinical significance of bladder training in improving the success rate of HIFU preoperative localization uterine fibroids. Material and methods: Our sample consists of patients who planned to undergo HIFU treatment in our hospital but who were failed in previous HIFU preoperative localization. They were recruited between July 2021 and April 2022, and randomly divided into experimental and control groups. A total of 150 patients were enrolled. Each group consisted of 75 patients. The patients in the experimental group adopted the procedure of drinking water multiple times and retaining urine. The training program lasted three days. The patients in the control group were required to keep regular drinking and urination habits without any special instructions or requirements. Results: There were no statistically significant differences between the two groups in maximum bladder capacity, residual urine volume of bladder, bladder filling levels, and bladder shape change. After bladder training, the maximum bladder capacity and the degree bladder shape change of the patients in the experimental group were improved significantly. The success rate of HIFU preoperative localization in the patients in the experimental group was significantly higher than that of the control group. Conclusions: Bladder training can effectively improve the success rate of HIFU preoperative localization of uterine fibroids. [ABSTRACT FROM AUTHOR]

Rhabdomyosarcoma (RMS) of the urinary bladder in adults and elderly is an exceptionally rare neoplasm that displays poorly differentiated solid (alveolar-like) small cell pattern, frequently indistinguishable from small cell neuroendocrine carcinoma (SCNEC). However, the histogenesis of RMS and SCNEC and their inter-relationship have not been well studied and remained controversial. We herein analyzed 23 SCNEC and 3 small round cell RMS of the bladder for neuroendocrine (synaptophysin + chromogranin A) and myogenic (desmin + myogenin) marker expression and for TERT promoter mutations. In addition, the RMS cohort and one SCNEC that was revised to RMS were tested for gene fusions using targeted RNA sequencing (TruSight Illumina Panel which includes FOXO1 and most of RMS-related other genes). Overall, significant expression of myogenin and desmin was observed in one of 23 original SCNEC justifying a revised diagnosis to RMS. On the other hand, diffuse expression of synaptophysin was noted in 2 of the 4 RMS, but chromogranin A was not expressed in 3 RMS tested. TERT promoter mutations were detected in 15 of 22 (68%) SCNEC and in two of three (67%) assessable RMS cases, respectively. None of the four RMS cases had gene fusions. Our data highlights phenotypic and genetic overlap between SCNEC and RMS of the urinary bladder. High frequency of TERT promoter mutations in SCNEC is in line with their presumable urothelial origin. In addition, the presence of TERT promoter mutation in 2 of 3 RMS and lack of FOXO1 and other gene fusions in all 4 RMSs suggest a mucosal (urothelial) origin, probably representing extensive monomorphic rhabdomyoblastic transdifferentiation in SCNEC. [ABSTRACT FROM AUTHOR]