ABSTRACT Objective To investigate predictors for selecting an appropriate treatment strategy for ketamine‐associated cystitis (KC) due to chronic ketamine abuse for entertainment. Methods This retrospective study included 62 patients with KC who underwent baseline videourodynamics and bladder cold‐cup biopsy; 43 subsequently underwent AE and 19 continued conservative treatment. Histopathology–urodynamic associations were assessed using Spearman correlations. A parsimonious logistic model evaluated factors associated with subsequent AE. The exploratory five‐item histopathological score was assessed in complete cases with bootstrap resampling. Results Patients subsequently undergoing AE had lower first sensation of filling, fullness sensation, compliance, Q max , and voided volume, while cystoscopic maximal bladder capacity was not significantly different ( p = 0.085). Urothelial denudation severity correlated with lower first sensation ( ρ = −0.36, p = 0.017) and fullness sensation ( ρ = −0.49, p < 0.001). In the multivariable model ( N = 44), higher voided volume was associated with lower odds of AE (OR: 0.72 per 10 mL, 95% CI: 0.57–0.90, p = 0.004), whereas severe urothelial denudation was associated with higher odds (OR: 27.24, 95% CI: 1.73–428.36, p = 0.019). The complete‐case score ( N = 50) had AUC 0.941 (bootstrap 95% CI: 0.875–0.988); cutoff ≥ 2 yielded 94.4% sensitivity and 78.6% specificity. Conclusion Lower voided volume and severe urothelial denudation were associated with subsequent AE. The composite histopathological score is exploratory and requires external validation.
ABSTRACT Interstitial cystitis and bladder pain syndrome are clinically overlapping conditions that should be distinguished according to Hunner lesion status. IC with Hunner lesions is a distinct inflammatory bladder disease characterized by urothelial denudation, lymphoplasmacytic infiltration, adaptive immune activation, and progressive structural impairment. The intensity and distribution of these inflammatory and structural abnormalities may vary among patients with IC, but the underlying pathological pattern is comparatively coherent. BPS without Hunner lesions is substantially more heterogeneous. Urothelial barrier dysfunction, mast cell and sensory nerve signaling, pelvic floor dysfunction, peripheral sensitization, and central or nociplastic pain mechanisms may contribute to symptoms in different combinations. Candidate urine and blood‐based biomarkers, including cytokines, chemokines, neurotrophic factors, immune cell indices, and multiomics signatures, may support phenotyping, assessment of disease activity, or prediction of treatment response. However, most remain exploratory because their intended clinical use, analytical standardization, diagnostic thresholds, and external validity have not been established. This narrative review compares the clinical and histopathological features of IC and BPS, evaluates the evidence for proposed immune and neuroregulatory mechanisms, examines the translational status of candidate biomarkers, and discusses disease‐specific and phenotype‐guided management. These findings support a primary distinction between IC and BPS. Additional phenotyping is useful after this distinction to characterize heterogeneity within BPS and clinically relevant coexisting mechanisms.
ABSTRACT Objectives To compare symptomatic improvement after photoselective vaporization of the prostate (PVP) between patients with and without detrusor underactivity (DU), together with objective changes in urodynamic parameters assessed by pressure‐flow study (PFS). Methods This single‐center retrospective study evaluated 136 benign prostatic hyperplasia (BPH) patients treated with a 180 W PVP‐XPS system from 2020 through 2025. The patients were divided into DU and non‐DU groups based on the bladder contractility index (BCI), with DU defined as BCI < 100. We retrospectively analyzed selected patients with BPH and clinically or urodynamically relevant bladder outlet obstruction (BOO) who underwent PVP and completed PFS before and 6 months after surgery. Propensity score matching (PSM) was applied to adjust for age and the baseline BOO index (BOOI). Results A total of 105 patients were included in the final analysis and 53 were in the DU group. The DU group had a significantly lower BOOI (48.6 ± 17.5 vs. 71.4 ± 32.3, p < 0.01) than the non‐DU group. After PSM, age and baseline BOOI were well balanced, but BCI remained significantly different. No significant differences between the two groups were observed in questionnaire scores or uroflowmetry findings at 6 months after surgery. The BOOI at 6 months after surgery was not significantly different between the DU group (13.4 ± 13.7) and the non‐DU group (13.7 ± 19.3) ( p = 0.93). BOOI reduction was also not significantly different between the DU group (−37.0 ± 24.1) and the non‐DU group (−36.2 ± 24.5) ( p = 0.90). Conclusion In selected patients with clinically or urodynamically relevant BOO, significant improvements in BOOI and LUTS were observed in patients with DU after PVP, with no statistically significant between‐group differences detected at 6 months.
Objectives Drug treatment for overactive bladder (OAB) is changing, with an increasing share of beta 3-adrenoceptor agonists relative to anticholinergics, but it is not known how far this change has progressed in older people, who are most vulnerable to the risks of anticholinergics. We examined the use of these drugs in Japan by age and sex, and analyzed changes in anticholinergic burden using a large database.Methods We analyzed outpatient prescriptions of two beta 3-adrenoceptor agonists and six anticholinergics from FY2017 to FY2024, using the sex- and age-stratified tables of the NDB Open Data of Japan. Dispensed tablets were converted into patient-days, and the beta 3-adrenoceptor agonist share was calculated. Anticholinergic burden was measured as ACB-weighted prescription volume (patient-days multiplied by the anticholinergic cognitive burden score). Because FY2021-FY2022 was a period of nationwide generic supply disruption, FY2018 and FY2024 were used as endpoints when estimating change over time.Results The beta 3-adrenoceptor agonist share rose from 36.2% to 64.9%, but anticholinergic use fell only slightly (3.10 & times; 108 to 2.94 & times; 108 tablets; -5.0%). In FY2024, the beta 3-adrenoceptor agonist share was higher in men than in women in every age group, and the difference widened with age (+1.2 percentage points at 50-54 years and +14.2 at >= 90 years). ACB-weighted prescription volume was higher in women than in men, and the female-to-male ratio rose with age (1.1 at 65-74 years, 1.6 at 75-84 years, and 2.8 at >= 85 years). Between FY2018 and FY2024, prescription volume fell by about 20% at 65-74 and 75-84 years, but the fall was smallest in women aged >= 85 years (-11.3%).Conclusions The beta 3-adrenoceptor agonist share for OAB has continued to increase in Japan, but this change appears slower in older women, in whom anticholinergic exposure remains high.
Objectives This study assessed changes in renal function from baseline to 6 months after photoselective vaporization of the prostate (PVP). Methods Among 117 consecutive patients who underwent PVP at our institution between November 2020 and September 2024, 88 patients with complete baseline and 6-month postoperative blood sampling and pressure flow study (PFS) data were included in the analysis. The primary endpoints were the changes in serum creatinine (sCr) and the estimated glomerular filtration rate (eGFR) from baseline to 6 months postoperatively. Secondary endpoints included changes in urodynamic parameters and clinical outcomes from baseline to 6 months postoperatively. An exploratory group comparison was performed between patients with and without an increase in eGFR of >= 5 mL/min/1.73 m(2). Results Overall, median sCr and eGFR showed no significant changes, with sCr remaining at 0.93-0.92 mg/dL and eGFR unchanged at 61.7 mL/min/1.73 m(2) (p = 0.59 and p = 0.29, respectively). Clinical and urodynamic outcomes improved significantly, including a decrease in median Bladder Outlet Obstruction Index (BOOI) from 54.4 to 13.4 (p < 0.001). Eleven patients (12.5%) met the exploratory eGFR improvement criterion. Compared with the remaining patients, they had a lower baseline eGFR and higher proportions of CKD stage >= 3, preoperative catheterization or clean intermittent catheterization, and phasic detrusor overactivity (p = 0.015, p = 0.0027, p = 0.033, and p = 0.0019, respectively). Conclusions Overall renal function did not significantly change at 6 months after PVP. The exploratory findings may provide preliminary support for considering PVP in patients with impaired renal function who otherwise meet established indications for surgery; however, they do not establish a renal protective effect and require prospective validation.
