Introduction and Hypothesis Stress urinary incontinence (SUI) is prevalent among obese women. We hypothesize that body composition modulates the risk of SUI among nonobese women. Methods The National Health and Nutrition Examination survey, a nationally representative examination of adults in the United States, was used to test correlates for the presence of SUI in women aged 20-59 in two cohorts: (1) nonobese and (2) obese. Demographic data, medical comorbidities, body composition (measured by dual energy X-ray absorptiometry [DXA]), laboratory values, and macronutrient intake (24-h dietary diary; per kg lean body mass) were compared between participants with and without SUI. Data were compared using the SurveyLogistic procedure to include NHANES sample weighting for univariate and multivariate logistic regression. Results We analyzed 6,276 women, 19.3% with SUI. Our univariate analysis identified that in nonobese women, increasing total body fat mass, truncal and visceral fat, and decreasing subcutaneous fat proportion were associated with risk of SUI, as were increasing total cholesterol, triglycerides, and Hgb A1c. Multivariable analysis identified that the most significant correlates in both cohorts were higher BMI, increasing age, smoking history, and increasing vaginal parity. Additionally, on multivariable analysis of the nonobese cohort, increased saturated fat intake and increased total moderate or vigorous physical activity were significant. In comparison, the obese cohort was also found to have a significant increased correlation with increased caloric intake and increased serum triglyceride levels. Conclusions Increased visceral fat distribution and cardiovascular risk factors modulate the risk for SUI in both obese and nonobese women.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a heterogeneous condition of uncertain etiology. We assessed bladder collagen characteristics in phenotypically characterized IC/BPS patient subgroups that may influence pathophysiology. Forty-four females (30 IC/BPS; 14 non-IC/BPS) were included. Patients were divided into groups based on Hunner lesions (HL; N=14 or non-HL; N=16) and anesthetic bladder capacity (BC) (BC≤500 cc; low BC; N=17 or BC>500 cc; non-low BC; N=13). Bladder biopsy tissue slides were stained with hematoxylin and eosin or picrosirius red and semi-quantitatively analyzed by a pathologist. CT-FIRE software was used to quantitatively assess lamina propria collagen. All patients with IC/BPS had lower collagen fiber density independent of subgroup (p<0.0001-0.0038) compared to controls. HL had more peri-muscular collagen accumulation (p=0.0061), more acute inflammation (p=0.0364), more severe chronic inflammation (p=0.0088), and narrower collagen fibers than non-HL and controls. Non-low-BC patients had lower collagen density (p=0.0075) and straighter collagen fibers (p=0.0127) than low BC. Low-BC patients had narrower collagen fibers than control (p=0.0096). IC/BPS, regardless of subgroup, is associated with a bladder lamina propria with diminished collagen density. HL, non-low-BC, and low-BC subgroups have unique collagen characteristics. These findings suggest a collagen fiber destruction and redistribution process, which differs by subgroup, and may contribute to pathophysiology of IC/BPS.

AIMS:The objective of this study was to assess the duration and clinical correlates of positive response in interstitial cystitis/bladder pain syndrome patients undergoing therapeutic bladder hydrodistension (HOD) or HOD with electrofulguration (for those with Hunner lesions). METHODS:One hundred and twenty four women were enrolled in this prospective IRB-approved study. Participants answered a set of validated questionnaires at intake including chronic overlapping pain conditions (COPCs), brief pain index (BPI), and IC/BPS symptomatic questionnaires. These were repeated at 1, 2-, 3-, 6-, and 12-months posttreatment, together with a global response assessment (GRA). The primary outcome measure was the GRA score. A secondary analysis of patients who were strong responders to treatment was used to identify clinical correlates of positive response. RESULTS:At 1-month post-HOD, 62 patients (53.9%) were responders (i.e., reported persistent positive response to treatment). Further, 21/49 (42.9%) respondents continued to report a positive response at 12 months. Logistic regression analyses identified several correlates of strong response to therapy including absence of Huynner lesions (odds ratio (OR) = 3.629), lack of diagnosis of fibromyalgia (OR = 0.31), lower number of total sites of pain on BPI pain map (OR = 0.91), fewer total number of COPCs (OR = 0.36), and lower complex medical symptom inventory scale (CMSI; OR = 0.91). After false discovery rate correction, only the CMSI remained statistically significant. CONCLUSIONS:Therapeutic hydrodistension results in a clinically meaningful and sustained improvement in associated symptoms and pain for many patients. However, having higher scores on markers of a widespread pain/non-bladder centric phenotype was associated with a lower treatment success rate.

Infertility is a common problem. Despite this, a dearth of urologists are trained in infertility care. Improved training opportunities may improve proficiency and interest in subspecialized training. We present a narrative review of current and proposed techniques in microsurgical education, with noted methods from other specialties. Opportunities for quality improvement include technological advancements, dedicated training laboratories, and artificial and animal models. Ample opportunity exists for improvement and standardization of microsurgical skills training, institutionally and nationally. Adoption of training methods may bolster resident interest in andrology and male infertility as a career and improve outcomes for those who complete fellowship training.

OBJECTIVE:The Society of Academic Urologists (SAU) made no definitive recommendation on interview format for the 2025 urology match. The purpose of this study was to survey applicants for this cycle regarding preferences and perceptions related to interview format. METHODS:As part of a prospective assessment, surveys were administered to all applicants to our urology residency program for the 2025 cycle, both before interview and following the match process. Applicants answered a series of multiple-choice and rank choice questions and rated agreement for a series of statements. RESULTS:Total 274 applicants received both surveys, with 142 (51.8%) completing the preinterview survey and 25 (9.1%) completing the postmatch survey. Applicants prioritized perceived quality of clinical training and geographical location when ranking institutions. If programs offered only virtual interviews, most respondents strongly disagreed that this resulted in a negative perception on pre- and postmatch (60%; 44%) surveys. Most strongly agreed on pre- and postmatch surveys that program culture was perceived better by in-person interviews (51%; 68%) and felt that traveling to meet residents/faculty in person was important (45%; 68%). CONCLUSIONS:Geographic location, quality of clinical training, and program ''culture'' are characteristics reportedly valued by residency applicants. Applicants for 2025 did not perceive programs offering only virtual interviews more negatively and found the cost of interviewing to be substantial. However, they found value with the in-person interaction with residents and faculty at the program location.

INTRODUCTION: Our primary purpose was studying utilization rates of home nursing assistance (HNA) and skilled nursing facility (SNF) placement after radical cystectomy (RC) and evaluating if their use was associated with emergency department (ED) visits, hospital readmissions, or mortality. Secondarily, we evaluated if patient socioeconomic status was associated with these factors following RC. METHODS: Patients who underwent RC for bladder cancer were retrospectively analyzed. Discharge destination was labeled as home, HNA, or SNF. The incidence of ED visits was recorded at 30 and 90 days after discharge from surgical admission. Readmissions were tracked similarly. Area deprivation index (ADI) was collected on each patient and organized in quartiles (ADIQ), with worsening socioeconomic status as ADIQ increased. RESULTS: A total of 215 patients were discharged home, 148 to HNA and 25 to SNF. ED visits and readmissions after RC at the 30-and 90-day marks did not differ based on discharge destination (p>0.05). Home patients had a lower incidence of death after RC compared to HNA and SNF (p=0.037), but not overall survival (OS) time (p=0.572). Readmission to the hospital after 30 days of discharge was more likely as ADIQ increased (p=0.017). Discharge destination, ED visits, and readmission after 90 days of discharge from RC were not different based on patient ADIQ (p>0.05). CONCLUSIONS: Discharge to home after RC is associated with lower mortality rates. Rates of readmission and use of ED resources appear independent of discharge destination. A greater ADIQ may interact with the likelihood of admission post-RC. Future efforts remain warranted to address disparities in postoperative management in the pursuit of health equity in urology.

AIMS:In April of 2025, the Wake Forest Institute for Regenerative Medicine hosted a Global Consensus meeting on IC/BPS in Winston-Salem, NC. The goal of this meeting was to establish global consensus regarding diagnostic criteria, phenotyping, treatment outcome assessment, and etiopathology in interstitial cystitis/bladder pain syndrome (IC/BPS). Our sub-committee was tasked with developing a consensus document on patient phenotyping in IC/BPS. METHODS:Narrative review. RESULTS:Patients with IC/BPS populate broad groups that have been characterized as having a bladder-focused disease phenotype (bladder-centric), a widespread pain and symptoms phenotype (systemic), or by other variable phenotypes including those with myofascial pelvic pain. In this review, we discuss the published evidence supporting each of these patient phenotypic groups. CONCLUSIONS:Future clinical trials and treatment development in IC/BPS should include patient phenotyping efforts with, at minimum, a focus on stratification into bladder-centric vs systemic and efforts to refine discriminative thresholds (cut-off points) that may influence differential treatment outcomes. It is important to continue to investigate the importance of patient phenotypes on treatment strategy selection, outcomes, and our understanding of the underlying pathophysiology for this disease spectrum. CLINICAL TRIAL REGISTRATION:N/A.

OBJECTIVE:To review the available literature on variant genital gender-affirming surgery (GGAS), including the reasons for performing it, the surgeries themselves and their outcomes. METHODS:A systematic review on the performance of variant GGAS was conducted (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42022306684) researching PubMed, Embase, Web of Science and Cochrane databases from inception up to 31 December 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and risk of bias was assessed for each study using the five-criteria quality assessment checklist. RESULTS:In total 23 case series were included, of which 17 on masculinising and six on feminising surgeries. Patients mainly choose these surgical procedures out of personal desire to avoid risk of complication or because they do not have dysphoria about certain parts of their genitalia. Complications in masculinising surgeries primarily arose from the extended urethra, which could be mitigated through primary perineal urethrostomy. Both phalloplasty and metoidioplasty carried a higher risk of urethral complications when the vagina was preserved. In feminising surgeries, risk of visceral damage and requirement for lifelong self-dilation could be avoided when vulvoplasty was performed without vaginal canal creation. All studies had a high risk of bias. CONCLUSION:This review highlights the importance of variant GGAS and acknowledges the preferences of transgender and gender-diverse individuals. Patients should be informed about the risks and benefits of each step in these procedures.

Background: This study aims to compare perioperative morbidity and drainage tube dependence following open radical cystectomy (ORC) with ileal conduit (IC) or cutaneous ureterostomy (CU) for bladder cancer. Methods: A single-center, retrospective cohort study of patients undergoing ORC with IC or CU urinary diversion between 2020 and 2023 was carried out. The 90-day perioperative morbidity, as per Clavien–Dindo (C.D.) complication rates (Minor C.D. I–II, Major C.D. III–V), and urinary drainage tube dependence (ureteral stent or nephrostomy tube) after tube-free trial were assessed. Results: The study included 56 patients (IC: 26, CU: 30) with a 14-month median follow-up. At 90 days after IC or CU, the frequencies of any, minor, and major C.D. complications were similar (any—69% vs. 77%; minor—61% vs. 73%; major—46% vs. 30%, respectively, p > 0.2). Tube-free trial was performed in 86% of patients with similar rates of tube replacement (19% IC vs. 32% CU, p = 0.34) and tube-free survival at 12 months was assessed (76% IC vs. 70% CU, p = 0.31). Conclusions: Compared to the ORC+IC, ORC+CU has similar rates of both 90-day perioperative complications and 12-month tube-free dependence. CU should be offered to select patients as an alternative to IC urinary diversion after RC.

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Interstitial Cystitis (PD25)1 May 2024PD25-06 A SIGNIFICANT PROPORTION OF INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME PATIENTS HAVE SUSTAINED SYMPTOM IMPROVEMENT FOLLOWING THERAPEUTIC HYDRODISTENSION Dylan T. Wolff, Robert J. Evans, Gopal Badlani, Carl Langefeld, Julie Ziegler, and Stephen J. Walker Dylan T. WolffDylan T. Wolff , Robert J. EvansRobert J. Evans , Gopal BadlaniGopal Badlani , Carl LangefeldCarl Langefeld , Julie ZieglerJulie Ziegler , and Stephen J. WalkerStephen J. Walker View All Author Informationhttps://doi.org/10.1097/01.JU.0001008584.88541.ff.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cystoscopy under anesthesia with 5 minute hydrodistension (HOD) is a treatment option for interstitial cystitis/bladder pain syndrome (IC/BPS) patients. There is a paucity of high level evidence to support the efficacy of this treatment. The objective of this longitudinal study was to assess the level and duration of positive response to HOD in a large IC/BPS cohort. METHODS: 124 female patients with IC/BPS scheduled for HOD were enrolled in this prospective IRB-approved study. Participants answered a set of validated questionnaires (including global response assessment (GRA), O'Leary Sant Interstitial Cystitis Symptom and Problem Indices (ICSI/ICPI), and Female Genitourinary Pain Index (F-GUPI)), at intake and then again at 1, 2-, 3-, 6-, and 12-months post-treatment. The primary outcome measure was based on GRA, a patient reporting symptom improvement of "mild", "moderate", or "marked", compared to baseline, was considered a "responder". Secondary outcomes were assessed based on a significant change in scores on ICSI, ICPI, and F-GUPI. At each time point, the mean change in validated questionnaire symptom scores (compared to baseline) was compared between responders and non-responders using Wilcoxon Rank Sum tests, with a p-value <0.05 considered statistically significant. RESULTS: The number of patients that completed validated GRA assessment at 1-month post-HOD was 115, followed by 101 at 2 months, 91 at 3 months, 78 at 6 months, and 49 at 12 months. Overall demographic (e.g., age, race) and clinical characteristics (e.g., anesthetic bladder capacity, Hunner lesion status, frequency of non-urologic syndromes) were similar between responders and non-responders at any time point. At 1-month post-HOD, 62 patients (53.9%) reported persistent positive response to treatment (i.e., were responders), while 21/49 (42%) respondents continued to report a positive response at 12 months. Patients classified as responders, when compared to non-responders, continued to have significantly improved ICSI, ICPI, and F-GUPI scores through the 3 month follow up point (p<0.05). CONCLUSIONS: For a large subset of IC/BPS patients, therapeutic hydrodistension results in a clinically meaningful and sustained improvement in associated symptoms and pain. Source of Funding: Subcontract from 5U01DK082316-08; R01 DK124599 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e538 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Dylan T. Wolff More articles by this author Robert J. Evans More articles by this author Gopal Badlani More articles by this author Carl Langefeld More articles by this author Julie Ziegler More articles by this author Stephen J. Walker More articles by this author Expand All Advertisement PDF downloadLoading ...

IMPORTANCE:Since transvaginal mesh (VM) kits for apical pelvic organ prolapse (APOP) were labeled "high-risk" in 2016 and subsequently banned in 2019 by the U.S. Food and Drug Administration, the most common remaining surgical options include abdominal mesh-augmented sacrocolpopexy (AS) and transvaginal native tissue suspension (VN). OBJECTIVE:The objective of this study was to determine temporal trends in APOP procedures for urologists and gynecologists. STUDY DESIGN:Between 2011 and 2020, the American College of Surgeons National Surgical Quality Improvement Program database was queried for AS, VM, and VN. RESULTS:There were 26,477 cases of APOP repair (32% AS, 6% VM, 62% VN) included, 9% by urologists. Urologists operated on older (65 vs 61 years) patients with more medical comorbidities. Urologists performed significantly higher proportion of AS (65% vs 29%) and VM (8% vs 6%) relative to VN (27% vs 65%) than gynecologists ( P < 0.0001). Transvaginal mesh utilization has decreased over time for both specialties ( P < 0.05); nonsignificant trends toward increasing AS ( P = 0.1646) in urologists and VN ( P = 0.0913) in gynecologists concurrently occurred. Significant independent predictors of the operating surgeon being a urologist were surgery being performed in the latter half of the cohort (2016-2020; odds ratio [OR], 1.22), non-White patient race (OR < 1 for all), a concomitant sling being placed (OR = 0.89), the surgery being VM (OR = 2.95) or AS (OR = 4.36), the patient being older (OR > 1 for each age range), and having a higher frailty index score (OR = 1.16). CONCLUSIONS:Significant differences in APOP repair choices exist between specialties. Urologists operate on older, more medically complex patients while demonstrating a strong preference for mesh-augmented compared with transvaginal native tissue repairs.

IMPORTANCE:Interstitial cystitis/bladder pain syndrome (IC/BPS) is a highly prevalent condition with incompletely understood pathophysiology, especially in relation to the systemic symptoms experienced. The role of autonomic nervous system dysfunction in IC/BPS remains poorly understood. OBJECTIVE:The purpose of this study was to assess the relationship between autonomic symptom severity and clinical characteristics of patients with IC/BPS. STUDY DESIGN:This is a retrospective cohort study of 122 IC/BPS patients who completed the Composite Autonomic Symptoms Score (COMPASS-31) questionnaire. Data were collected on anesthetic bladder capacity (BC), Hunner lesion (HL) status, results for validated IC/BPS symptom questionnaires (O'Leary Sant Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index (ICSI/ICPI) and the Pelvic Pain and Urgency/Frequency (PUF) scale), and comorbid nonurologic associated syndromes. Using the first quartile of COMPASS-31 scores as the cutoff, we compared patients within the first quartile (low symptom load; n = 30), to the remainder of the patients (high symptom load; n = 92). RESULTS:Patients scoring ≥20.36 were significantly less likely to be HL positive (10.9% vs 26.7%; P = 0.043) and had a significantly higher BC (823.10 ± 396.07 vs 635.00 ± 335.06; P = 0.027), higher scores on the PUF questionnaire (23.80 ± 4.98 vs; 19.61 ± 5.22 P < 0.001), and a higher number of nonurologic associated syndromes (5.65 ± 2.90 vs 2.60 ± 1.89; P < 0.001). CONCLUSIONS:Patients with IC/BPS experience widespread symptoms associated with autonomic nervous system dysfunction. A higher symptom load strongly correlates with a nonbladder-centric phenotype. These findings provide further evidence that total body nervous system dysfunction is present in patients with nonbladder centric IC/BPS.

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Interstitial Cystitis (PD25)1 May 2024PD25-12 TWO BLADDER-CENTRIC PHENOTYPIC SUBGROUPS WITHIN INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME PATIENTS WITH LOW BLADDER CAPACITY Raymond Xu, Dylan Wolff, Trang Simon, Sarah Wachtman, Robert Evans, Gopal Badlani, and Stephen Walker Raymond XuRaymond Xu , Dylan WolffDylan Wolff , Trang SimonTrang Simon , Sarah WachtmanSarah Wachtman , Robert EvansRobert Evans , Gopal BadlaniGopal Badlani , and Stephen WalkerStephen Walker View All Author Informationhttps://doi.org/10.1097/01.JU.0001008584.88541.ff.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The underlying pathophysiology behind a bladder-centric phenotype in interstitial cystitis/bladder pain syndrome (IC/BPS) is poorly understood. Given that Hunner lesions (HL) are a predominant feature of the bladder-centric phenotype, as is a low anesthetic bladder capacity (BC), the objective of this study was to determine the contribution of HL to gene expression differences in bladder mucosa from low BC patients. METHODS: Gene expression profiles were measured in mucosal bladder biopsies from women with IC/BPS (N=22) and a low anesthetic BC (≤ 400cc); biopsy samples from non-IC/BPS patients (N=16) served as controls. Low BC IC/BPS samples were further stratified into HL positive (HL+; N=8) and HL negative (HL-; N=14). Total RNA was extracted from all biopsy tissues and gene expression profiles were generated using the Nanostring nCounter Fibrosis Panel, comprised of 770 genes related to inflammation and fibrosis. Differentially expressed genes (DEG) were identified between each of the two IC/BPS subgroups, compared to controls. Comparison of these two DEG lists was used to identify differential gene expression common to all low BC patients, as well as genes uniquely associated with either the HL+ or HL- phenotype. RESULTS: There was significant overlap (86 genes) between DEGs in HL+ and HL- groups. The HL+ subgroup had 186 unique DEGs associated with active inflammation and fibrotic pathways including TGF-β signaling. In contrast, the HL- group had 28 unique DEG's which were associated primarily with fibrotic pathways including WNT/β-catenin signaling. These data are summarized in Table 1. CONCLUSIONS: Regardless of Hunner lesion status, IC/BPS patients with a low BC bladder-centric phenotype exhibit significant differential gene expression in pathways involved in fibrosis. HL+ patients exhibit a gene expression profile that is suggestive of a significantly active inflammatory state. These results suggest that distinct pathophysiologic mechanisms may underlie these two similar, but distinct, bladder-centric IC/BPS subgroups. Source of Funding: NIDDK 1R01DK124599-01 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e541 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Raymond Xu More articles by this author Dylan Wolff More articles by this author Trang Simon More articles by this author Sarah Wachtman More articles by this author Robert Evans More articles by this author Gopal Badlani More articles by this author Stephen Walker More articles by this author Expand All Advertisement PDF downloadLoading ...

Objectives: In a previous study we reported that molecular profiling of bladder mucosal tissue from a modest number of IC/BPS patients resulted in a clear separation based on anesthetic bladder capacity (BC), with 400 cc representing the apparent breakpoint between low and non-low BC. The purpose of the current study was to revisit this earlier stratification finding, using a combination of molecular and clinical data, from a large and heterogeneous patient cohort. Materials and Methods: To provide an updated assessment of IC/BPS patient stratification based on anesthetic BC, whole genome gene expression data from 48 mucosal biopsy samples (41 IC/BPS patients; 7 controls) were analyzed with unsupervised clustering and principal component analysis (PCA) to identify primary clusters of patients. This identified three primary individual clusters: (1) IC/BPS patients with a BC between 200- 500 cc (n=19), (2) IC/BPS patients with a BC of 501-1500 cc (n=22), and (3) controls. Next, complete demographic, clinical, and questionnaire data prospectively collected from an additional 450 patients from our patient registry were used to conduct a combined analysis to verify this relationship. Characteristics of all 491 IC/BPS patients were compared between those having the current low BC cutoff (<= 400 cc) and the proposed new cutoff (<= 500 cc) by utilizing independent samples t-test (continuous variables) and chi square tests (categorical variables; p <= 0.05 was considered significant). Results: A statistical comparison of the demographic and clinical characteristics of the entire 491 IC/BPS patient cohort showed that those with a bladder capacity <= 500 cc were older, were more likely to have Hunner lesions, and had higher symptom scores. This group also had a lower average number of non-urologic associated symptoms, pelvic pain syndromes, and neurologic, immune, or systemic pain syndromes. Conclusion: By combining newly acquired molecular data with clinical and demographic characteristics in a large cohort of IC/BPS patients, we conclude that anesthetic BC <= 500 cc provides a clinically meaningful biomarker for the bladder centric IC/BPS phenotypic subgroup.

You have accessJournal of UrologyCME1 Apr 2023PD05-02 SMALL FIBER POLYNEUROPATHY AS A THERAPEUTIC TARGET FOR PATIENTS WITH INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME Wyatt Whitman, Maxwell Sandberg, Dylan Wolff, Raymond Xu, Tyler Overholt, Robert Evans, Catherine Matthews, Gopal Badlani, and Stephen Walker Wyatt WhitmanWyatt Whitman More articles by this author , Maxwell SandbergMaxwell Sandberg More articles by this author , Dylan WolffDylan Wolff More articles by this author , Raymond XuRaymond Xu More articles by this author , Tyler OverholtTyler Overholt More articles by this author , Robert EvansRobert Evans More articles by this author , Catherine MatthewsCatherine Matthews More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , and Stephen WalkerStephen Walker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003229.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In addition to a variety of co-occurring urological and non-urological symptoms and syndromes, we have found that ∼30% of patients with a diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) also have small fiber polyneuropathy (SFPN). The objective of this study was to determine the association between SFPN and co-occurring symptoms and syndromes in IC/BPS patients. METHODS: Skin biopsies were taken from the distal calf of IC/BPS patients who were undergoing therapeutic hydrodistension (HOD). SFPN status (+ or -) was determined by counting intraepidermal nerve fibers (IENF) in a stained section from the biopsy and comparing the IENF density to normative reference values. Patient characteristics such as anesthetic bladder capacity (BC), Hunner lesion (HL) status, and glomerulations were determined at the time of hydrodistension under direct cystoscopy. Patient demographics, co-occurring medical conditions, and symptomatology was obtained via patient reports and review of medical records. To test for an association of SFPN+ with demographic and clinical characteristics, an optimized logistic regression model was created using variables with p<0.1 on univariable analysis and/or those with an established clinical relevance. Standard logistic regression diagnostics were utilized to ensure the model fit to the data RESULTS: Between October 2019 and April 2022 153 participants were enrolled (134F;19M). Mean age was 50.32 (±15.32). Overall, one third (50/153) were SFPN+. There was a statistically significant difference in the adjusted odds ratios (OR, [95% CI]) between the SFPN+ and SFPN- groups for chronic fatigue syndrome (3.054, [1.22, 7.68]) and diabetes mellitus (4.185, [1.471, 11.90]). CONCLUSIONS: SFPN is common in patients with IC/BPS and is significantly associated with concomitant diagnoses of chronic fatigue syndrome and diabetes mellitus. These findings suggest that for a large subset of IC/BPS patients that have a systemic pain disorder, SFPN may provide an important new therapeutic target. Source of Funding: R01 DK124599 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e148 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wyatt Whitman More articles by this author Maxwell Sandberg More articles by this author Dylan Wolff More articles by this author Raymond Xu More articles by this author Tyler Overholt More articles by this author Robert Evans More articles by this author Catherine Matthews More articles by this author Gopal Badlani More articles by this author Stephen Walker More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: A universal mobile application (WeShare URO by Symptelligence Medical Informatics, LLC) was developed to allow patients to provide diary and symptom information to the provider prior to the visit and to aid in the tracking of treatment progress. The purpose of the present study is to validate that the app correctly calculates the values required for the proper evaluation of a patients' symptoms. Materials and Methods: Data from paper diaries of men with lower urinary tract symptoms (LUTS) was entered into the app. Total urine volume (TUV), total voids, actual number of nightly voids (ANV), nocturnal urine volume (NUV), maximum voided volume (MVV), nocturia index (Ni), nocturnal polyuria index (NPi), predicted number of nightly voids (PNV), and nocturnal bladder capacity index (NBCi) were calculated. Correlations between manual (Manual and Quickhand) and automatic (App) values were calculated using Spearman's nonparametric rank coefficient. Results: The study included 66 paper diaries completed by a total of 51 male patients (median age = 68, IQR = 6) evaluated for LUTS. After applying exclusion criteria, 35 diaries were left for analysis (median age = 68, IQR = 0). Manual calculations were similar to those calculated by the app (0%- 2% difference). Comparison between Quickhand and App calculations had a higher difference (0% - 27%). Conclusions: Bladder diary applications can improve LUTS care through accurate calculations via an automated scaling equation. The error rate of "Quickhand"(calculations done by a clinician as a back-of-the- envelope method) supports the claim that these calculations are inaccurate and that an automated scaling equation provides more specific values critical to therapeutic decision-making.

The insertion of foreign bodies underneath the skin of the penis is commonly referred to as "pearling." Although rare, there are case reports that describe acute complications such as infection and damage to surrounding penile neurovascular structures; however, there is a paucity of data describing long-term complications and surgical management of such cases. A 43-year-old male presented with a penile abscess secondary to "pearling" five years after insertion. His abscess was drained and selected foreign objects were subsequently removed during a simultaneous circumcision procedure. This report describes a case in which surgical removal of penile foreign bodies was performed during a circumcision without the need for additional incisions. The case is unique in that it details a complication five years after initial insertion with microbiological data to guide adequate treatment.

IMPORTANCE:The pathophysiology of interstitial cystitis/bladder pain syndrome (IC/BPS) is imperfectly understood. Recent studies reported that small-fiber polyneuropathy (SFPN) is common in fibromyalgia, a condition commonly comorbid with IC/BPS. OBJECTIVE:The objective of this study was to determine the prevalence of SFPN in a large cohort of IC/BPS patients. METHODS:Adults diagnosed with IC/BPS scheduled to undergo either therapeutic hydrodistention (n = 97) or cystectomy with urinary diversion (n = 3) were prospectively recruited to this study. A skin biopsy obtained from the lower leg was used for intraepidermal nerve fiber density measurement. Small-fiber polyneuropathy (+/-) status was determined by comparing linear intraepidermal nerve fiber density (fibers/mm2) with normative reference values. Demographic information, medical history, and diagnoses for 14 conditions (both urologic and nonurologic) known to co-occur with IC/BPS were documented from self-report and electronic medical record. RESULTS:In this large cohort of patients with IC/BPS, 31% (31/100) were positive for SFPN. Intraepidermal nerve fiber density was below the median for age and sex in 81% (81/100) of patients. Approximately one-third (31%) of SFPN+ patients reported co-occurring chronic fatigue syndrome, compared with 10.6% of the SFPN- group (P = 0.034). Small-fiber polyneuropathy-positive patients reported significantly fewer allergies than SFPN- patients (37.9% vs 60.6%; P = 0.047). There were no significant differences in bladder capacity or Hunner lesion status between the SFPN+ and SFPN- subgroups. CONCLUSIONS:Small-fiber polyneuropathy is a common finding in patients with IC/BPS, and SFPN status is significantly correlated with co-occurring chronic fatigue syndrome and negatively correlated with the presence of allergies in this population.