Background Nocturnal lower urinary tract symptoms (LUTS), including enuresis, nocturia, and nocturnal incontinence, present differently across the lifespan, with growing relevance of cardiorenal contributors in later life. These symptoms arise from age-specific disruptions in the circadian regulation of the brain, kidney, and bladder, often modified by developmental transitions and comorbid conditions. Objective To provide a clinically relevant overview of nocturnal LUTS from childhood to advanced age, highlighting diagnostic priorities and treatment strategies tailored to life stage and symptom phenotype. Methods This narrative review synthesises current evidence on the pathophysiology and management of nocturnal LUTS, organised by age group. Key transitional phases; namely childhood, puberty, menopause, and frailty, are examined for their impact on symptom evolution. Results Although the underlying mechanisms may differ with age, a consistent diagnostic framework applies across all groups: careful history-taking, targeted examination, and symptom quantification through appropriately chosen bladder diaries. In children and adolescents, structured urotherapy forms the basis of care, while in adults, adaptation of lifestyle factors, including sleep and circadian realignment are the focus of interest. Older and frail patients require broader assessment due to comorbidity, sleep disturbance, polypharmacy, and cardiorenal mechanisms contributing to biphasic nocturnal diuresis. Pharmacological treatment, including desmopressin and antimuscarinics, should be guided by phenotype and used cautiously in vulnerable populations. Conclusion Nocturnal LUTS reflect a continuum of age-related phenotypes, requiring individualised, pathophysiology-based care. Aligning management with both symptom phenotype and life stage would improve outcomes across the lifespan, while greater attention to the sleep factor in all age groups and to cardiorenal drivers in older adults might enhance the precision and safety of care.
Urinary tract infections (UTIs) are among the most common bacterial infections, with increasing antimicrobial resistance posing a major public health concern. The evaluation of antimicrobial sensitivity patterns has a significant role in prescribing antimicrobial drugs to treat patients suffering from urinary tract infections (UTIs). This study aimed to investigate the prevalence, microbial profile and antibiotic susceptibility patterns of uropathogens in both outpatient and inpatient settings. A total of 4200 suspected UTI cases were enrolled between July 2023 and July 2024. Urine cultures were collected and subjected to culture, biochemical and sensitivity testing. Prior antibiotic history and co-infection patterns were also analyzed. Of the total cases, 21.8% were culture positive. Females constituted 69.8% of the cases, with the highest prevalence in the 21-40 years age group; among children, UTIs were most common in ages 1-5 years. A total of 917 microorganisms were isolated, with Escherichia coli (65%) and Klebsiella pneumoniae (14%) being predominant. Antibiotic susceptibility testing showed high sensitivity to Imipenem (94.9%), Meropenem (94.1%), Amikacin (88.4%), Netilmicin (89.2%), Chloramphenicol (87.8%) and Nitrofurantoin (86.9%), whereas high resistance was observed against Ampicillin (74.2%), Azithromycin (65.5%) and several cephalosporins. Prior antibiotic exposure was associated with reduced culture positivity (17.4%) and co-infections were detected in 4.9% of cases, mainly in inpatients. UTIs were predominantly caused by E. coli and K. pneumoniae with carbapenems, aminoglycosides and Nitrofurantoin showing the highest efficacy. High resistance rates to commonly used antibiotics highlight the need for continuous surveillance, rational antibiotic use and strict infection control measures.
Background Overactive bladder (OAB) is a chronic condition that can significantly affect women's quality of life. Understanding women's lived experiences with OAB treatments can provide valuable insights for adapting clinical guidelines to local and cultural contexts. This scoping review aimed to explore how women perceive and experience different treatment options for OAB, which can contribute to enriching our guideline adaptation process. Methods A scoping review was conducted following the Joanna Briggs Institute (JBI) framework. We conducted a systematic search in PubMed, EMBASE, SCOUPUS, and Web of Science. Google Scholar was also searched for the first 100 records. Data were extracted and thematically synthesized to identify key themes across treatment categories. Results Twelve studies were included. Women's experiences showed a continuous balance between benefits and side effects. Common negative feelings included fear of side effects, uncertainty about long-term risks, and practical barriers to adhering to behavioral therapies. Feelings of empowerment were reported when treatments promoted self-management and control, such as tibial nerve stimulation and self-catheterization. Invasive procedures like Botox injections and sacral neuromodulation (SNM) showed feelings of both hope and anxiety. Women emphasized the need for information, empathy, and ongoing support from healthcare providers. Conclusions Women's lived experiences highlighted that OAB management extends beyond symptom control to include emotional, informational, and practical dimensions. These findings offer important directions for adapting OAB treatment guidelines, emphasizing flexible, patient-centered supportive care models that address real-world challenges faced by women.
Background: Artificial urinary sphincter (AUS) implantation is considered the gold standard for refractory stress urinary incontinence (SUI). Still, adoption in females has been limited due to technical complexity and anatomical challenges. Robot-assisted approaches may offer encouraging visualization and surgical precision, yet current evidence remains limited. Objective: Systematically evaluate continence outcomes, perioperative complications, and device-related events following robot-assisted AUS implantation in women with non-neurogenic SUI. Methods: A systematic review and single-arm meta-analysis were conducted according to the Cochrane Handbook and PRISMA 2020 guidelines. Searches of PubMed, Cochrane Library, Scopus, and Wiley were performed on 28 November 2025. Results: Four studies comprising 146 female patients were included. The pooled continence rate following robotassisted AUS implantation was 0.73 (95% CI: 0.65-0.81; I2 = 0%). The overall postoperative complication rate was 0.29 (95% CI: 0.20-0.38; I2 = 15%), with major complications occurring in 0.05 of patients (95% CI: 0.00-0.13). Device-related reoperation occurred in 0.12 of cases (95% CI: 0.04-0.22). Vaginal and bladder injuries were observed in 0.17 (95% CI: 0.08-0.29) and 0.20 (95% CI: 0.07-0.37) of patients, respectively. Conclusion: Robot-assisted AUS implantation provides encouraging continence outcomes with manageable complication and reoperation rates in women with non-neurogenic SUI.
Background: Wolfram syndrome (WS) is a rare autosomal recessive neurodegenerative disorder frequently associated with lower urinary tract dysfunction, which may lead to recurrent urinary tract infections, upper urinary tract dilatation, and renal impairment. Urodynamic evaluation plays a key role in characterizing these dysfunctions and guiding management. Objective: To describe the spectrum of urodynamic findings in patients with WS and to emphasize the importance of early detection and longitudinal follow-up. Case presentations: We report two patients with WS referred for evaluation of urinary symptoms. Assessment included symptom questionnaires, uroflowmetry, post-void residual (PVR) urine measurement, and multichannel cystometry. Evaluated parameters included bladder sensation, detrusor activity, bladder compliance, cystometric capacity during filling, and urethral relaxation during voiding. Both patients presented with recurrent urinary tract infections, significant PVR volumes, and bilateral ureterohydronephrosis. In the first case, urodynamic testing showed detrusor overactivity during filling, associated with bladder acontractility and absent urethral relaxation during voiding. In the second case, findings included reduced voided volume and maximum flow rate, low bladder compliance, reduced cystometric capacity, and bladder acontractility during voiding. Conclusion: These cases illustrate the wide spectrum of bladder dysfunction in WS, ranging from detrusor overactivity to low compliance and bladder acontractility. The progressive involvement of both filling and voiding phases highlights the need for early and regular urodynamic monitoring to prevent urological and renal complications.
Male stress urinary incontinence (SUI) represents a substantial postoperative and functional burden among men, particularly following radical prostatectomy. Over the past century, therapeutic concepts have progressed from autologous fascial grafts to anatomically tailored synthetic sling systems. This narrative historical review outlines the evolution of male urethral sling technologies, describing the key design principles, materials, and surgical instruments that shaped their development. Using structured searches of Ovid, PubMed, and Google Scholar, together with grey literature sources, we identified historical milestones that defined three major eras of innovation. Era I (1900-1972) established foundational concepts, beginning with early fascial slings and progressing to the Berry and Kaufman procedures, which introduced synthetic materials and initial attempts at male-specific urethral support. Era II (1972-1998) marked a developmental gap driven largely by the introduction of the artificial urinary sphincter and the absence of standardized sling techniques. The widespread adoption of radical prostatectomy in the late 1980s renewed interest in alternative continence solutions. Era III (1998-present) represents the maturation of modern sling systems, encompassing bone-anchored slings, retropubic and transobturator repositioning slings, and adjustable compression devices such as InVanceTM, ArgusTM, RemeexTM, ATOMSTM, and AdVanceTM. Improvements in materials, fixation mechanisms, tension-adjustment features, and transobturator instrumentation have significantly enhanced safety and efficacy. Understanding the historical trajectory of male sling devices highlights how iterative refinement in biomechanics, biomaterials, and surgical tools has shaped contemporary continence surgery. Continued innovation-guided by long-term outcomes, device durability, and individualized patient selection-remains essential for optimizing future sling design and expanding therapeutic indications.
Background Wolfram syndrome (WS) is a rare autosomal recessive neurodegenerative disorder frequently associated with lower urinary tract dysfunction, which may lead to recurrent urinary tract infections, upper urinary tract dilatation, and renal impairment. Urodynamic evaluation plays a key role in characterizing these dysfunctions and guiding management. Objective To describe the spectrum of urodynamic findings in patients with WS and to emphasize the importance of early detection and longitudinal follow-up. case presentations We report two patients with WS referred for evaluation of urinary symptoms. Assessment included symptom questionnaires, uroflowmetry, post-void residual (PVR) urine measurement, and multichannel cystometry. Evaluated parameters included bladder sensation, detrusor activity, bladder compliance, cystometric capacity during filling, and urethral relaxation during voiding. Both patients presented with recurrent urinary tract infections, significant PVR volumes, and bilateral ureterohydronephrosis. In the first case, urodynamic testings showed detrusor overactivity during filling, associated with bladder acontractility and absent urethral relaxation during voiding. In the second case, findings included reduced voided volume and maximum flow rate, low bladder compliance, reduced cystometric capacity, and bladder acontractility during voiding. Conclusion These cases illustrate the wide spectrum of bladder dysfunction in WS, ranging from detrusor overactivity to low compliance and bladder acontractility. The progressive involvement of both filling and voiding phases highlights the need for early and regular urodynamic monitoring to prevent urological and renal complications.
Purpose Anal incontinence (AI) is defined as the inability to control the elimination of feces and flatus, and among the most common causes are third- and fourth-degree lacerations, known as Obstetric Anal Sphincter Injury (OASIS). Treatment options for AI are varied; however, physiotherapy has already shown widely recognized benefits. Therefore, this case report aims to present the physiotherapy treatment for AI focusing on the anorectal sensitivity of a patient after a fourth-degree perineal laceration. Methods Twenty-five-year-old, primiparous patient with a history of vaginal delivery with a birth canal fourth-degree laceration. Since the immediate puerperium, she reported loss of flatus and feces. She subsequently underwent surgical correction of a rectovaginal fistula; however, two and a half years after delivery, she continued to present fecal and flatus incontinence, with insensible fecal loss and daily pad use. 10 sessions of electrostimulation-assisted physiotherapy and pelvic floor muscle training (PFMT) with supervision and exercises at home were carried out. A specialized physiotherapist measured symptoms and severity of AI (Werner scale), pelvic floor muscle function (digital palpation and dynamometry), and the effect of the AI on quality of life and sexual function (Questionnaire of Quality of Life in Fecal Incontinence and Female Sexual Function Index). Results Improvement in PFM function (strength and endurance) was observed after treatment and after the 3-month follow-up. Quality of life, symptoms of AI and sexual function also improved at both time points, especially symptoms related to desire and orgasm domains of the FSFI. Conclusion In this patient with AI, anal electrostimulation combined with PFMT had a significant impact on improving muscle function, quality of life, and sexual function.
Introduction Pelvic organ prolapse (POP) is a prevalent condition among women, with clinical presentations ranging from asymptomatic to life-threatening. Complete bladder eversion is an exceptionally rare and morbid manifestation, typically observed in elderly women with advanced POP. Prompt recognition and intervention are critical, with management strategies spanning from bedside manual reduction to radical surgical procedures such as cystectomy with urinary diversion. Methods We report the case of an elderly multiparous woman who presented in septic shock with acute kidney injury secondary to complete bladder eversion involving the trigone and advanced pelvic organ prolapse. Initial attempts at manual reduction of the bladder were unsuccessful. Operative exploration by a multidisciplinary team involving Urology and Urogynecology revealed necrosis of the bladder neck and trigone. While the uterus was successfully reduced with pessary placement, the bladder could not be repositioned. Due to the risk of pressure necrosis on the already necrotic bladder neck and trigone, the pessary was not retained. Results Following shared decision-making, the patient underwent a combined surgical approach including cystectomy with ileal conduit urinary diversion, LeFort colpocleisis, and perineorrhaphy. Postoperatively, the patient recovered well and returned to her baseline functional status. Conclusion This case underscores the importance of urgent evaluation and stabilization in patients with bladder eversion and concurrent POP. Intraoperative assessment of bladder viability and timely involvement of multidisciplinary surgical teams are essential to optimize outcomes in these complex cases. Early recognition and treatment of pelvic organ prolapse may prevent bladder eversion.
Background Urinary incontinence (UI) affects one in three women globally, disproportionately impacting quality of life. Although digital self-management tools like the URinControl app have proven effective and cost-saving, they risk excluding women with low literacy due to usability barriers. Methods We conducted a teach-back usability study within the national implementation project "URinControl-4All" in the Netherlands. Seven women with low literacy, recruited through the health disparities center Pharos, participated in structured sessions assessing the URinControl app. This was conducted through three testing rounds and in total twelve sessions. Using screen-by-screen testing, participants explained content in their own words, identified navigation barriers, and provided improvement suggestions. Data were thematically analyzed and iteratively used to inform app redesign over three testing rounds. Results Five main usability themes emerged: readability, content, navigation, usefulness, and overall usage experience. Understandability was the overarching theme. Participants found language and instructions overly complex, layouts visually distracting, and navigation non-intuitive. Misunderstandings often led to incorrect use of therapeutic exercises. Key strategies to improve inclusiveness included simplifying language, refining illustrations, aligning image-text-message, and making navigation more intuitive. Despite challenges, participants valued the app’s goals and expressed willingness to recommend or use it if supported by healthcare professionals. Conclusion This study identifies critical usability barriers for women with low literacy using the URinControl app and demonstrates how inclusive redesign, guided by structured teach-back testing, can enhance accessibility. These insights are transferable to other eHealth interventions, underscoring the need for user-centered design in digital health tools to prevent widening health disparities.
Vincent van Gogh was interested in health issues throughout his life, including those relating to his genital and urinary organs. He regularly discussed with his brother and other artists the need for continence in order to achieve great art: artists had to conserve their energy for their work and take good care of themselves. This was not an isolated idea, but was based on centuries-old ideas and medical knowledge of the time. Because of his experiences with gonorrhea, Van Gogh was extra cautious. He regularly visited doctors to get information and was interested in medical publications, such as Emile Jozan's Traite pratique des maladies des voies urinaires et des organes generateurs de l'homme and Fran & ccedil;ois-Vincent Raspail's Manuel annuaire de la sante. Since his death, some doctors have claimed that Van Gogh suffered from syphilis and that this would explain his mental problems at the end of his life. However, there is no evidence to support this.
Reading the literature about chronic pelvic pain it is noticed that this condition is often mentioned as being complex and difficult to treat. Pelvic pain patients have a reputation of being dissatisfied, wanting more and visiting your office regularly. This article highlights the background of the consultation process and the consecutive helping ideas in approaching a patient that is referred to you with chronic pelvic pain. Attention is paid to basic attitude at the start, patient expectations, language used, requesting diagnostics and making a therapy plan. All applied to the first consultation with your patient. Special attention will be given to placebo and nocebo effects of the words used in the conversation. Furthermore the communication about what and why for diagnostics and referrals is discussed. Many practical tips and helping ideas are presented to improve the joy of working with patients presenting with this interesting complaint.
Introduction: Urinary incontinence represents one of the most prevalent yet under-recognized chronic health conditions worldwide and also a challenging public health issue with unmet needs across age, gender, and geography. The purpose of this review is to summarize all existing literature on the role of patient organizations and active patient involvement in international societies and the formulation process of guidelines, regarding urinary incontinence issues. Method: ology: A thorough literature search was performed on the PubMed database from inception to July 24, 2025, using the keywords "urinary incontinence", "UI", "patients", "patient organizations", "patient office", "guidelines", "international societies" and "international societies meetings". All types of studies, including reviews, case-series, observational studies, retrospective and prospective studies were included. Moreover, the websites of professional societies, both general urology (American Urological Association, European Association of Urology, British Association of Urological Surgeons) and topic-specific (International Continence Society, European Reference Network for Rare and Complex Uro-Recto-Genital Diseases and Conditions, International Urogynecological Association) were carefully screened, emphasizing on how they organize patient involvement. Results: Many organizations, such as the European Patients' Forum and the European Reference Networks have institutionalized patient involvement in governance and guideline development. In Urology, Europa Uomo, the World Federation for Incontinence and Pelvic Problems, Prostate Cancer UK and US-based National Association for Continence, are leading examples. In order to ensure meaningful patient involvement, national and international societies and guideline panels must take some particular actions, such as inclusion of patient representatives in guideline formulation groups and training of their patient advocates in guideline methodology and public communication skills. Conclusions: By incorporating patient experience into the design, evaluation, and delivery of healthcare, Urologists and Urological societies at all levels, have the opportunity not only to improve their outcomes in urinary incontinence, but also to lead by example in reimagining what truly patient-centered care should look like. Despite the significant steps that have already been made, there is a current gap between intentions and actual performance.
Introduction: Benign prostatic hyperplasia (BPH) is a common condition affecting aging males, leading to lower urinary tract symptoms (LUTS) that negatively impact quality of life. Language barriers may limit access to healthcare for Chinese-speaking patients. Our aim was to translate and validate the International Prostate Symptom Score (IPSS) in Chinese, ensuring it accurately captures LUTS severity and can be administered both in-clinic and remotely. Methods: The English IPSS was translated into simplified Chinese using forward-backward translation and assessed by Chinese-speaking urologists. An existing traditional Chinese version was also reviewed. A hybrid model (written survey in clinic, followed by a phone-administered survey) and a remote model (two phone-administered surveys) were used for validation. Internal validity was assessed using Cronbach's alpha, test-retest reliability with Spearman's correlation, and discriminant validity with T-Tests and ANOVA to compare LUTS severity groups between hybrid and remote models. Results: A total of 115 patients were included, with 46 in the hybrid, 50 in the remote, and 19 in the control groups. Internal validity was acceptable, with Cronbach's alpha of 0.848 (hybrid) and 0.734 (remote). Spearman's correlation coefficients ranged from 0.43 to 0.91 (p < 0.01), demonstrating strong test-retest reliability. Pearson's correlation of 0.986 confirmed consistency across survey administrations. ANOVA analysis (p < 0.001) showed significant differences in LUTS scores between mild, moderate and severe symptom groups, validating the Chinese IPSS's ability to differentiate symptom severity. Conclusion: The Chinese translation of the IPSS is a valid and reliable tool for assessing LUTS in Chinese-speaking patients. Its successful validation in both hybrid and remote models ensures its utility in telehealth settings, allowing for improved patient assessment and management of BPH.
This review explores the prevalence, risk factors, and pathophysiology of urinary incontinence (UI) and pelvic organ prolapse (POP) during pregnancy and the postpartum period. It provides an overview of both non-surgical and surgical treatment strategies, emphasizing early intervention and multidisciplinary care. Key factors, including hormonal changes, delivery methods, and lifestyle habits, are discussed in relation to pelvic floor dysfunction (PFD). The manuscript highlights the importance of early diagnosis, preventive care, and rehabilitation in managing these conditions.
Radiation-induced vesicovaginal fistulae represent one of the most challenging complications of pelvic surgery because irradiated tissues exhibit severe fibrosis, ischemia, and impaired healing. Among various surgical techniques, Martius flap repair is widely employed because it provides a well-vascularized tissue buttress and enhances closure rates. However, while most reports have focused on anatomical success, little attention has been paid to the long-term bladder function after closure.We describe the case of a 50-year-old woman who developed a radiation-induced vesicovaginal fistula after chemoradiotherapy for cervical cancer. The fistula was successfully closed using a Martius flap, and no further vaginal leakage was observed. Nevertheless, during follow-up, she developed persistent bladder dysfunction, characterized by reduced compliance, detrusor overactivity, and nocturnal urinary leakage, which was confirmed by serial urodynamic evaluations.This case illustrates a discrepancy between anatomical closure and functional outcomes. Even after technically successful repairs, latent bladder dysfunction may persist and place patients at risk of upper urinary tract deterioration. Our report emphasizes the importance of incorporating systematic urodynamic follow-up into postoperative care, particularly for complex or irradiated fistulas, to ensure anatomical and functional success.
In functional urology, efficiency is sought by asking patients to complete questionnaires before their appointment to evaluate their symptoms. This is difficult for a large number of patients, according to research on the IPSS and bladder diaries. In this review article, we describe the threats to the validity and thus the usability of these questionnaires. Making questionnaires easier to understand and involving the target group in the development of the questionnaires can improve the quality of information from the patient to the medical professional.
Background Ionizing radiation from medical imaging poses health risks to patients and healthcare professionals. Awareness of these risks is critical for safe practice, especially in Obstetrics and Gynecology, where fetal exposure must be minimized. Objectives This study aimed to evaluate the knowledge and awareness of ionizing radiation among consultants, specialists, resident doctors, interns, and radiographers at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Methods A cross-sectional survey was conducted between 2022 and 2024 among 146 out of 160 invited healthcare professionals in the OB/GYN department (response rate: 91.3%). Participants completed a structured questionnaire assessing knowledge of radiation doses, associated risks, and safety practices. Knowledge scores (0–14) were categorized as poor (<60%) or good (≥60%). Data were analyzed using SPSS version 26, and associations between professional title and knowledge level were assessed using Chi-squared tests. Missing data were handled using pairwise deletion. Results The mean knowledge score was 2.41 ± 2.17, with only 3/146 participants (2.1%) demonstrating good knowledge and 143/146 (97.9%) showing poor understanding. Interns correctly identified the radiation dose for abdominal ultrasound in 45/95 (47.4%) and abdominal MRI in 18/95 (18.9%) (p < 0.05). Only 23/146 (15.8%) recognized that a single abdominal CT in childhood increases lifetime cancer risk, and only 20/146 (13.6%) reported routinely informing patients about radiation risks before ordering imaging exams. Conclusions A substantial knowledge gap exists among OB/GYN professionals at KAUH regarding ionizing radiation risks. Targeted education, policy changes, and improved patient communication are essential to enhance safety. Future research should evaluate the impact of educational interventions on improving radiation awareness and clinical decision-making.
We present the case of a 29-year-old male who developed new-onset overactive bladder (OAB) symptoms shortly after commencing oral isotretinoin for acne. No alternative cause was identified, and urodynamics revealed no detrusor overactivity. Isotretinoin, a vitamin A-derived retinoid, is associated with multiple side effects; rare urological complications include urethritis, haematuria, and nephritis, but OAB has not been reported. Animal studies demonstrate retinoid-induced detrusor overactivity, reversible with anticholinergics. Proposed mechanisms include polydipsia, urothelial irritation, and altered acetylcholine-mediated detrusor stimulation. This case highlights a novel association warranting further investigation into retinoid effects on bladder function.
