To review the role of urodynamics (UDS) in the evaluation of patients undergoing bladder reconstruction, including augmentation cystoplasty, orthotopic neobladders, continent cutaneous channels, and continent cutaneous reservoirs. We examine the evidence supporting UDS and its impact on patient selection, surgical planning, and long-term surveillance. Recent studies demonstrate that UDS provides an objective assessment of bladder capacity, compliance, detrusor overactivity, outlet function, and emptying after reconstruction. Preoperative UDS may identify patients at risk for poor outcomes, and postoperative evaluation can detect persistent or new dysfunction that threatens upper tract function. Emerging techniques, including ambulatory urodynamics, have expanded its applicability but need further evaluation in this patient population. UDS remains a valuable tool in selected patients before and after bladder reconstruction, but its routine use is not well defined. Standardized protocols, prospective studies, and integration of patient-reported outcomes are needed to better establish its role and optimize long-term functional and renal outcomes.
Autonomic dysreflexia (AD) can be a serious complication encountered during urodynamic studies (UDS) in patients with suprasacral spinal cord injury. This review serves to summarize current and emerging evidence regarding the identification, prevention, and management of AD in the UDS setting with the goal of providing clinicians with practical strategies to safely integrate UDS into the clinic while minimizing patient risk. Findings over the past decade highlighted in our review include an improved understanding of AD pathophysiology and identification of at-risk patients. Updated clinical guidance continues to recommend prompt cessation of bladder stimulation, bladder drainage, and topical nitroglycerin as first-line therapy for acute episodes. Emerging technologies, including wireless catheter-free urodynamic systems, remain investigational in spinal cord injury populations. Likewise, evidence supporting prophylactic interventions - including intravesical lidocaine, nifedipine, and α-adrenergic blockers - remains limited, with insufficient data to support routine use during diagnostic UDS. Safe performance of UDS in patients at risk for AD requires careful pre-procedural assessment, continuous cardiovascular monitoring, early recognition of hemodynamic changes, and standardized treatment protocols. Current evidence favors individualized risk assessment and rapid intervention over routine pharmacologic prophylaxis. Future research should focus on prospective trials evaluating preventive therapies, validating novel urodynamic technologies in spinal cord injury populations, and establishing standardized protocols that optimize diagnostic accuracy while reducing the incidence and severity of procedure-related autonomic dysreflexia.
Urodynamic studies (UDS) remain the gold standard for the objective evaluation of lower urinary tract dysfunction, yet their diagnostic precision is frequently compromised by technical inconsistencies, interobserver variability, and methodological flaws in multicentre trials. This review maps these sources of variability and outlines strategies to restore reproducibility. Variability spans technical acquisition errors, inconsistent patient coaching and terminology, interpretive subjectivity in trace reading, and trial-design flaws such as restrictive selection criteria and oversimplified diagnostic classification. Empirical surveys reveal marked heterogeneity in clinical practice across centres. Emerging solutions include structured quality assurance frameworks, standardized communication protocols, wireless catheter-free pressure sensors, and artificial intelligence pipelines achieving diagnostic accuracies of 80–95
Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, and increasing antimicrobial resistance has created a need to explore complementary treatment strategies. This narrative review summarizes the current clinical evidence evaluating Ayurvedic interventions for the treatment of UTIs. Twenty-one clinical studies, including nine randomized controlled trials, evaluated a variety of Ayurvedic formulations. Several interventions containing herbs such as Gokshura (Tribulus terrestris), Varuna (Crataeva nurvala), and Yavakshara (Hordeum vulgare) were associated with improvements in patient-reported urinary symptoms. However, interpretation of these findings is limited by inconsistent microbiologic confirmation of infection, small sample sizes, heterogeneous outcome measures, inadequate safety reporting, and a high overall risk of bias. Current evidence suggests that Ayurvedic interventions may offer promising complementary approaches for UTI management; however, the certainty of evidence remains very low. Well-designed randomized controlled trials using standardized diagnostic criteria, validated patient-reported outcomes, microbiologic endpoints, and comprehensive safety reporting are needed to define their clinical role.
This scoping review protocol aims to map evidence on clinical presentation, diagnostic evaluation, underlying mechanisms, and management of lower urinary tract symptoms (LUTS) in men aged 19–50 years, and to identify gaps requiring further study and consensus. Recent literature indicates LUTS in younger men cannot be adequately interpreted using frameworks centered on benign prostatic enlargement. Reported causes include bladder dysfunction, bladder outlet obstruction, urethral disease, pelvic floor dysfunction, neurologic conditions, behavioral factors, pain syndromes, and systemic disorders. Studies vary in age definitions, symptom classification, diagnostic testing, urodynamic criteria, and treatment approaches, limiting comparability and synthesis. The review will follow JBI methodology for scoping reviews and will be reported using PRISMA-ScR. Results will be summarized using descriptive statistics, evidence maps, tables, and narrative synthesis. The review will clarify diagnostic and treatment strategies, evidence gaps, and inform a Delphi consensus on LUTS in young men.
