UNASSIGNED: This study aims to investigate cases of acontractile bladder as the initial presentation of benign and malignant spinal conditions. The focus is on the challenges in making a diagnosis and the importance of a thorough neurological evaluation.
UNASSIGNED: We conducted a retrospective case series involving three patients who exhibited symptoms of acontractile bladder. Detailed clinical histories, urodynamic studies, and imaging techniques such as lumbosacral magnetic resonance imaging (MRI) were analyzed. Histopathological findings from relevant biopsies were also taken into account.
UNASSIGNED: Case 1: A 14-year-old female presented with urinary retention, back pain, and an acontractile bladder on urodynamic study. Further examination, including lumbosacral MRI and histopathology, confirmed a diagnosis of metastatic Ewing\'s Sarcoma. Case 2: A 39-year-old female with urinary incontinence and elevated post-void residual exhibited delayed bladder sensation. Lumbar spine MRI revealed a grade I Schwannoma after surgical resection. Case 3: A 15-year-old male with lower urinary tract symptoms and an acontractile detrusor on urodynamic study was found to have a Tarlov cyst on lumbosacral MRI.
UNASSIGNED: Atonic or Underactive bladder syndrome may be the initial presentation of a serious spinal condition. Complete neurological evaluation is mandatory if no obvious clinical cause.

OBJECTIVE: We compared heart rate variability parameters between patients with spina bifida and a control group during urodynamic studies, with the goal of evaluating the autonomic nervous system dysfunction present in spina bifida.
METHODS: Continuous heart rate variability parameters were recorded during 3 successive periods (P0, the 2 minutes prior to the start of filling; P1, from the start of filling to the first desire to void; and P2, from P1 to the end of filling or the start of voiding). The control group consisted of children with vesicoureteral reflux who had undergone video-urodynamic studies. Our study included 11 patients with spina bifida and 9 control participants.
RESULTS: At baseline, patients with spina bifida exhibited lower values for the root mean square of successive differences in NN intervals, the percentage of successive R-R interval differences exceeding 50 msec relative to the total number of intervals, and high frequency (HF). In contrast, the low frequency (LF)/HF ratio was elevated in these patients (5.04 ± 4.75 vs. 0.67 ± 0.42, P = 0.014). During bladder filling, LF/HF values increased in the control group (P0, 0.67 ± 0.42; P1, 0.89 ± 0.34; P2, 1.21 ± 0.64; P = 0.018), while they declined in patients with spina bifida (P0, 5.04 ± 4.75; P1, 3.96 ± 4.35; P2, 3.26 ± 4.03; P < 0.001). The HF values were significantly elevated in children with spina bifida during bladder filling (P = 0.002). In the time domain, the standard deviations of all NN intervals were elevated only in the control group during bladder filling. Parasympathetic activity domains were reduced in the children with spina bifida at the initial assessment.
CONCLUSIONS: During the bladder filling phase, parasympathetic activity increased along with fixed sympathetic activity in the spina bifida group. In contrast, the control group exhibited a shift towards a sympathetic preponderance at the conclusion of bladder filling. These observations may be associated with the pathophysiology of neurogenic bladder in spina bifida.

Neuromyelitis optica (NMO) is a rare autoimmune disorder of the central nervous system that can cause a variety of neurological symptoms, including urinary dysfunction. Here, we present the case of a 21-year-old male patient who was diagnosed with NMO after presenting with urinary retention.

Postoperative urinary dysfunction following untethering surgery for spinal lipoma is devastating. To assess urinary function, we invented a pediatric urinary catheter equipped with electrodes for the direct transurethral recording of myogenic potential from the external urethral sphincter (EUS). This paper presents two cases in which urinary function was monitored intraoperatively by recording of motor-evoked potential (MEP) from EUS during untethering surgery in children.
Two children (aged 2 and 6 years) were included in this study. One patient had no preoperative neurological dysfunction, while the other had frequent urination and urinary incontinence. A pair of surface electrodes was attached to a silicone rubber urethral catheter (6 or 8 Fr; diameter, 2 or 2.6 mm). The MEP from the EUS was recorded to assess the function of the centrifugal tract from the motor cortex to the pudendal nerve.
Baseline MEP waveforms from the EUS were successfully recorded with latency and amplitude of 39.5 ms and 66 µV in patient 1 and 39.0 ms and 113 µV in patient 2, respectively. A significant decrease in amplitude was not observed during surgery in the two cases. No new urinary dysfunction and complications associated with the urinary catheter-equipped electrodes developed postoperatively.
Using an electrode-equipped urinary catheter, monitoring of MEP from the EUS could be applicable during untethering surgery in pediatric patients.

Nocturia negatively impacts the quality of life and is associated with poor general health, but our understanding of its etiologies is incomplete. Urodynamic studies (UDS) findings in patients with nocturia are not well described and may help guide management. Our objective was to compare UDS findings with age-matched patients with and without nocturia.
We retrospectively reviewed UDS findings of 1124 patients (2010-2017). A total of 484 (43%) presented with nocturia and 821 (73%) were female. Female patients were separated into age-matched groups with and without nocturia. Urinary symptoms, past medical diagnoses, demographic information, and UDS findings were compared.
A total of 596 female patients were included, 298 (50%) with nocturia and 298 without. Past medical history, including diabetes mellitus and cardiovascular disease, did not differ between groups. Patients with nocturia were more likely to have pelvic pain (p = 0.0014) and other daytime symptoms (frequency, urgency, and urgency incontinence). On UDS, patients with nocturia were more likely to have bladder outlet obstruction (BOO) (p = 0.025) and dysfunctional voiding (DV) (p < 0.0001). There was no difference in the frequency of detrusor overactivity (DO). Bladder capacity and postvoid residual volumes were lower, though not significantly, in the nocturia group.
When comparing UDS findings in contemporary, age-matched groups of female patients with and without nocturia, we found only BOO and DV to be associated with nocturia. While the treatment of nocturia is often aimed at managing DO, our data suggest that this may not be the primary urodynamic correlation with nocturia. Further studies are needed to assess whether successful treatment of BOO and DV can improve nocturia.

暂无摘要。

Neurogenic lower urinary tract dysfunction (NLUTD) is a common urological disease that causes long-term complications and severely reduces patient\'s quality of life. Sacral neuromodulation has proven to be an effective treatment for NLUTD. However, most previous studies have focused mainly on the efficacy and safety of sacral neuromodulation in the treatment of NLUTD and less on the changes in urodynamic parameters in patients before and after sacral neuromodulation. This study aimed to evaluate the effect of short-term sacral neuromodulation on the results of video-urodynamic parameters in a 63-year-old woman with NLUTD with vesicoureteral reflux. The patient was admitted to the Department of Urology of Beijing Hospital in January 2021 and examined using video-urodynamics. In the same month, the patient underwent the first stage of sacral neuromodulation, with an experience period of 2 weeks. After the experience period ended, video-urodynamics was performed again in February 2021. By comparing the two video-urodynamic results, the effect of short-term sacral neuromodulation on the anatomy and physiology of the lower urinary tract was determined. After 2 weeks of sacral neuromodulation treatment, video-urodynamic parameter analysis showed that while the urine storage period of the patient significantly improved, the voiding period was not significantly changed. This was specifically reflected in the improvement of bladder compliance, safe capacity of the bladder, and significant reduction in vesicoureteral reflux. The improvement of the safe capacity of the bladder effectively helped the patient to control the number of intermittent catheterizations within an acceptable range, which greatly improved her quality of life. Therefore, the patient underwent permanent sacral neuromodulation implantation in February 2021. This study suggests that short-term sacral neuromodulation can significantly improve lower urinary tract function and reduce vesicoureteral reflux in patients with NLUTD with vesicoureteral reflux. In short, we believe that sacral neuromodulation may be a good choice for patients with NLUTD.

METHODS: Since the declaration of COVID-19 as a pandemic, other unexpected symptoms related to the infection besides the respiratory system have been reported. Although a few case reports have revealed that adult patients with COVID-19 also complained of urinary frequency and nocturia, the exact pathophysiology is still unclear. In this case series, we present three children aged 14 to 17 years with urodynamically proven lower urinary tract dysfunction (LUTD) following COVID-19.
RESULTS: None of the patients had constipation or bowel disorder before the diagnosis of COVID-19. In addition, neurological examination and related imaging revealed no signs of etiological factors. The median time from diagnosis of COVID-19 infection to the onset of lower urinary tract symptoms was 3 months. Incomplete bladder emptying/urinary retention supported by increased bladder compliance, high post-micturition residual urine volumes, and absence of detrusor pressure increase during the voiding phase in the pressure flow study (acontractile detrusor in two patients and hypocontractile detrusor in one patient) were observed.
CONCLUSIONS: We observed that LUTD (eg, incomplete bladder emptying, urinary retention) can be prominent some time after the diagnosis of COVID-19. Even though psychogenic or neurogenic causes may not be excluded completely, clinicians should be aware of a recent COVID-19 infection in children with sudden-onset LUTD.

A 44-year-old man was carried to the hospital in an ambulance because of dyspnea, paralysis and dysuria after signs of the flu. Acute encephalomyelitis was diagnosed by examination of magnetic resonance imaging. Antimicrobial treatment and respirator management was carried out with indwelling of urethral catheter for urinary retention. After improvement of encephalitis, the urethral catheter was removed. However, he still needed medical care because of persistent lower urinary tract symptoms. He complained of urge incontinence and urination frequency. Decrease of functional bladder capacity was noticed in a frequency volume chart. After consulting with our neurologist, acute transverse myelitis was diagnosed from imaging and neurological findings. Pressure flow study (PFS)demonstrated detrusor overactive during the filling phase and insufficient contractility during the voiding phase. We reached the diagnosis of detrusor hyperactivity with impaired contractility (DHIC). We did not introduce clean intermittent catheterization but used the mirabegron instead. Although storage symptoms did not improve on the mirabegron monotherapy, the symptoms improved by solifenacin added. There is a possibility that combination therapy with mirabegron and solifenacin is effective for DHIC.

BACKGROUND: Myelomeningocele, which causes a neurogenic bladder, is usually treated with anticholinergics in children with neurogenic detrusor overactivity (NDO); however, anticholinergics cause side effects such as dry mouth, constipation, attention deficit, and inadequate reduction in detrusor leak point pressure. Vibegron, a novel selective beta-3 adrenoreceptor agonist, is a well-established alternative to anticholinergics in adults with an overactive bladder. It remains unknown whether this agent can be used for pediatric patients. We report the case of a girl with anticholinergic-resistant NDO due to tethered cord syndrome after myelomeningocele repair, who was treated with vibegron.
METHODS: A 4-year-old Filipino girl had increased frequency of daytime urinary incontinence and foul-smelling urine since the age of 3. Clinical examination revealed constipation, and urinalysis revealed bacteriuria. Voiding cystourethrography revealed an enlarged and trabeculated bladder without vesicoureteral reflux. On the urodynamic study (UDS), she was found to have detrusor overactivity (DO) and low bladder compliance. She could not void and was diagnosed with overflow incontinence. Clean intermittent catheterization (CIC) and orally administered propiverine (0.8 mg/kg/day) were initiated, and urinary incontinence was resolved. She underwent a UDS annually; the UDS at 6 years of age still revealed DO and low bladder compliance in spite of receiving propiverine. The treatment was switched from propiverine to vibegron (1.4 mg/kg/day). On the UDS after a 5-week treatment schedule of vibegron, the DO disappeared and the bladder compliance improved. CIC and orally administered vibegron have been continued for 7 months so far, and she has had no urinary tract infection with no drug-related adverse events.
CONCLUSIONS: Vibegron was effective and well tolerated in the treatment of a pediatric patient with NDO. Vibegron improved the urodynamic parameters for anticholinergic-resistant neurogenic bladder. This agent can be a beneficial and preferable alternative therapeutic agent to anticholinergics in patients with anticholinergic-resistant NDO.