PURPOSE:Urinary tract infections (UTIs) are a known complication after cystectomy, but patients undergoing cystectomy for benign conditions represent an understudied population. This study quantified UTI rates after benign cystectomy (BC) and identified patient factors associated with infection. MATERIALS AND METHODS:We reviewed all patients who underwent BC at our institution from 2012-2025, excluding those treated for malignancy. Cystectomy type and urinary diversion were recorded. UTIs required culture confirmation of >10⁵ colony-forming units and were categorized as occurring either during the immediate postoperative period before discharge or within 90 days after discharge. Demographics and perioperative characteristics were compared between patients with and without UTIs in each time frame. RESULTS:Among 183 patients undergoing BC, 27 (14.8%) developed an immediate postoperative UTI, and 35 (19.1%) developed a UTI within 90 days. Sixty patients (32.8%) received postoperative antibiotic prophylaxis (AP). AP was not associated with lower rates of immediate postoperative UTIs, and patients who developed a UTI within 90 days were more likely to have received AP (55.9% vs. 28.1%; p<0.05). Common pathogens included Enterococcus species, Escherichia coli, and Klebsiella pneumoniae. Patients with immediate postoperative UTIs had longer operative times (390 minutes vs. 340 minutes; p<0.05). Those with UTIs within 90 days were more frequently readmitted (94.3% vs. 26.1%; p<0.05). CONCLUSIONS:UTIs after BC are common both immediately postoperatively and within 90 days. AP did not reduce early UTIs and were associated with higher 90-day UTI rates. Further investigation is warranted to clarify risk factors and optimize prevention strategies.

Introduction:The impact of socioeconomic status (SES) on surgical outcomes is often underrecognized. Benign cystectomy (BC) for nononcologic bladder disease carries high morbidity but remains understudied. We evaluated the effect of SES on postoperative outcomes and healthcare utilization following BC. Methods:We retrospectively reviewed all BCs performed at our institution from 2012 to 2025. Neighborhood-level socioeconomic disadvantage was measured using the area deprivation index (ADI; scale 1-10), with higher scores indicating greater deprivation. Patients were stratified into deciles (ADID). ADI reflects area-level socioeconomic conditions rather than individual-level characteristics and therefore may not capture patient-specific socioeconomic factors. Surgical outcomes, emergency department (ED) utilization, and 90-day readmissions were compared across ADID groups. Results:Among 183 patients, the median ADI was 5 (IQR 4-8). Preoperative comorbidities, urinary diversion type, operative time, length of stay, and in-hospital complication rates were similar across ADID groups. ED visits and 90-day readmission rates did not differ by SES (p > 0.05). On multivariable analysis, Indiana pouch diversion was associated with higher odds of postoperative complications (OR, 4.2; 95% CI, 1.4-12.8; p < 0.05). Both Indiana pouch (OR, 4.1; 95% CI, 1.3-13.1; p < 0.05) and a neobladder (OR, 3.7; 95% CI, 1.4-9.8; p < 0.05) were associated with a greater likelihood of readmission within 90 days of discharge. Conclusions:SES, as measured by ADID, was not significantly associated with outcomes or postoperative healthcare utilization. BC carries high morbidity regardless of SES. These findings warrant prospective validation.

BACKGROUND:The transplantation of autologous muscle precursor cells (MPCs) is effective in the regeneration of muscle in multiple pathologies. This phase I clinical trial sought to use MPCs to treat stress urinary incontinence (UI). METHODS:Female patients with either stress urinary incontinence (SUI) or congenitally acquired UI had thigh muscle biopsies prior to MPC expansion and processing. The MPCs were injected directly into the bladder neck. Symptoms were measured using pad weight tests (1-h and 3-day), baseline questionnaires (Urogenital Distress Inventory [UDI-6], Incontinence Impact Questionnaire [IIQ-7]), and self-reported accident frequencies. RESULTS:Ten women aged 16-75 were included. For the 8 SUI subjects, there was a reduction in pad weight between pre- and post-treatment for the 1-h (P < .0001) and 3-day (P = .0076) pad tests after adjusting for age, gravida, and body mass index. The reduction was observed by the 6-week post-treatment visit and remained relatively constant thereafter. There was no evidence of a difference among the 4 post-treatment pad weights for either the 1-h (P > .05) or the 3-day (P > .05) pad tests. Similarly, there was evidence of a reduction from pre- to post-treatment in UDI-6 (P = .0034), IIQ-7 (P = .0455), and the number of self-reported accidents (P = .0656). There was no evidence of regression during the post-treatment visits for UDI-6 (P > .5), IIQ-7 (P > .25), and the number of self-reported accidents (P > .25). The 2 subjects with congenital incontinence did not improve (P > .05). CONCLUSIONS:Autologous thigh muscle-derived MPC injection into the bladder neck is a safe and well-tolerated treatment for acquired stress UI in adult women.

Research has often focused on radical cystectomy for bladder cancer; however, there is an entirely different population, namely those who undergo cystectomy for benign, non-cancerous reasons, which requires attention. The purpose of this study was to compare patients who underwent cystectomy for benign (BC) and malignant (MC) reasons, focusing on complications, emergency department (ED) utilization, readmission, and socioeconomic status (SES). Cystectomies performed at our institution from 2012 to 2025 were reviewed. Patients were divided based on indication into BC versus MC (for bladder cancer with pathologic confirmation). Non-oncologic cystectomies were either for neurogenic bladder, interstitial cystitis/bladder pain syndrome, or “other reasons.” Complications were divided into in-house immediately following cystectomy prior to discharge and those occurring within 90 days of discharge. The Memorial Sloan Kettering Cancer Center classification system of cystectomy complications was used to qualify complications. ED utilization and readmissions were charted within the first 90 days of discharge. Area Deprivation Index (ADI) scores, which assign rankings to SES for neighborhoods, were used as a surrogate for patient SES. BC and MC patients were compared. 569 patients were included in the analysis (183 BC and 386 MC). Urinary diversion choice differed between groups, with more cutaneous ureterostomies in MC patients and Indiana Pouches in BC patients (p < 0.001). In-house complications were significantly greater in the benign cohort (51

There is significant variation in interstitial cystitis/bladder pain syndrome (IC/BPS) biopsy processing and reporting. The objective of this study was to review pathology reports from a large IC/BPS patient cohort to identify differences in findings. We hypothesize that variation in IC/BPS bladder biopsy reporting might be most frequent when it comes to mast-cell counts. We performed a retrospective analysis of 461 diagnostic pathology reports collected from our IRB-approved prospective study of patients diagnosed with IC/BPS at the Urology Clinic at Wake Forest Baptist Hospital from October 2011 to July 2023 (IRB00018552). Data were assigned as continuous or categorical variables. Groups were compared using Student’s t test, Mann–Whitney, or Chi-squared tests. Staining strategy for mast-cell visualization differed between pathologists and included in order of frequency mast-cell tryptase (TPSAB1), CD117 (KIT), unspecified stain, a combination of stains, and toluidine blue. Mast-cell count was reported as a single number, range, or qualitatively. Pathologists used units of high-powered field (HPF), mm2, or did not specify. As expected, average mast-cell count per HPF was significantly lower than per mm2 across all stains (p < 0.0001). Average count with KIT was significantly lower than TPSAB1 (p < 0.0001). This trend remained significant when considering only KIT and TPSAB1 counts per HPF (p = 0.0007). Additionally, reports identified squamous metaplasia, acute inflammation, and/or chronic inflammation. There is a lack of standardization regarding histological analysis of bladder biopsies from patients with IC/BPS, leading to inconsistent data and confusion surrounding the significance of pathology report findings.

Pelvic venous disorders (PVDs) are a group of inter-related pathological diagnoses that can present with a range of symptoms including pelvic and urinary symptoms similar to those seen in interstitial cystitis/bladder pain syndrome (IC/BPS). The relationship between PVDs and IC/BPS in humans has yet to be evaluated. This study’s objectives are to determine the prevalence of PVD in patients with IC/BPS and to identify associated characteristics. Charts from our study on patients with IC/BPS undergoing hydrodistension (HOD) were screened for those with an MRI or CT scan of the abdomen/pelvis. Imaging findings suggestive of PVD were noted. Information regarding anesthetic bladder capacity (BC), Hunner lesion (HL) status, results for validated IC/BPS symptoms, and patient reports of comorbid non-urological associated syndromes (NUAS) known to co-occur with IC/BPS were collected. A total of 133 patients with IC/BPS had the appropriate studies for a diagnosis of PVD, of which 64 (48.1

ImportanceInterstitial cystitis/bladder pain syndrome (IC/BPS) presents as a complex heterogeneous disorder that poses a significant clinical challenge both for diagnosis and treatment. The identification of patient subgroups with significant overlap in their nonurological associated symptoms, including endometriosis, may enable a more targeted therapeutic approach.ObjectiveThis study investigated the prevalence, clinical correlates, and clinical sequelae associated with concurrent endometriosis in patients with IC/BPS.Study DesignDemographic, clinical, surgical, and questionnaire data from female patients (n = 533) with a diagnosis of IC/BPS were evaluated in this retrospective cohort study. Surgical history was obtained from patient electronic medical records, using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Data from participants with and without concurrent endometriosis were compared using univariate analysis, followed by binary logistic regression to identify associated variables.ResultsOf 533 participants, 108 (20.3%) reported a history of endometriosis. Those with concurrent endometriosis were younger, had a larger bladder capacity, and had a higher number of nonurological associated symptoms. Patients with concurrent endometriosis were less likely to have a history of cystectomy (the surgical removal of the bladder) and report allergies but more prone to report comorbidities such as chronic pelvic pain, chronic fatigue, fibromyalgia, migraines, and pelvic floor dysfunction. Binary logistic regression identified a positive association between endometriosis and chronic pelvic pain, and a negative association between allergies and low bladder capacity for those with concurrent endometriosis.ConclusionsEndometriosis is common in younger female patients with IC/BPS and is associated with a non-bladder-centric (ie, systemic pain disorder) phenotype.

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Interstitial Cystitis (PD25)1 May 2024PD25-01 SMALL FIBER POLYNEUROPATHY IN INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME: AN IMPORTANT FEATURE OF THE NON-BLADDER-CENTRIC SYSTEMIC PAIN PHENOTYPE Mary Namugosa, Rory Ritts, Robert Evans, Gopal Badlani, Catherine Ann Matthews, and Stephen J. Walker Mary NamugosaMary Namugosa , Rory RittsRory Ritts , Robert EvansRobert Evans , Gopal BadlaniGopal Badlani , Catherine Ann MatthewsCatherine Ann Matthews , and Stephen J. WalkerStephen J. Walker View All Author Informationhttps://doi.org/10.1097/01.JU.0001008584.88541.ff.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Small fiber polyneuropathy (SFPN) is a condition resulting from damage to A-delta and C sensory nerve fibers that plays a role in pain and temperature perception. While SFPN is known to be a common finding in fibromyalgia and irritable bowel syndrome (IBS), we have also shown that approximately 30% of interstitial cystitis/bladder pain syndrome (IC/BPS) patients exhibit SFPN, making it a potential therapeutic target. The goal of this study is to determine how SFPN fits into the overall IC/BPS clinical picture. METHODS: 172 IC/BPS patients (152 F; 20 M) undergoing therapeutic hydrodistension were enrolled in this study. A 3mm punch biopsy was obtained from the mid-calf, processed, stained, and read by a dermatopathologist to determine linear intraepidermal nerve fiber density (IENFD). Co-occurring diagnoses were charted from patient reports and medical records. Univariate analysis was conducted to compare demographics and clinical characteristics of participants with and without SFPN and logistic regression was performed to identify the variables that impacted the dependent variable SFPN. RESULTS: Of the 172 participants, 58 (34%) were identified to have an IENFD indicative of SFPN based on normative reference ranges that account for age and gender. Notably, 139 (80.8%) had an IENFD less than the median for their demographic. The average age for all participants was 50.74 (±15.0). Age, bladder capacity (BC), and the total number of non-urologic associated syndromes did not differ significantly based on SFPN status. Logistic regression identified race (OR 3.66, CI 1.223-10.921), HL status (OR 0.176, 0.038-0.820), chronic fatigue syndrome (CFS: OR 6.541, CI 2.188-19.55), migraines (OR 0.233, CI 0.089-0.606) and diabetes mellitus (DM: OR 3.680, CI1.25-10.87) to be correlated with SFPN. CONCLUSIONS: SFPN is an important clinical finding in a significant proportion of IC/BPS patients and is likely to co-occur with CFS, but not HL. This suggests that a finding of SFPN in IC/BPS is associated with a systemic pain disorder phenotype rather than a bladder-centric disease phenotype. Source of Funding: RO1 DK124599/DK/NIDDK NIH HHS/United States © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e536 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mary Namugosa More articles by this author Rory Ritts More articles by this author Robert Evans More articles by this author Gopal Badlani More articles by this author Catherine Ann Matthews More articles by this author Stephen J. Walker More articles by this author Expand All Advertisement PDF downloadLoading ...

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 ...