Monitoring bladder filling is crucial in patients with neurogenic lower urinary tract dysfunction, particularly for safe and timely clean intermittent catheterization. Wearable ultrasound devices have recently gained attention as potential aids for continuous bladder monitoring, but they differ fundamentally from traditional bladder scanners. While portable scanners directly measure postvoid residual volume in milliliters, first-generation wearable devices using amplitude mode (A-mode) ultrasound primarily monitor bladder fullness trends and provide threshold-based alerts rather than precise quantitative volume measurements. This narrative review examines wearable ultrasound technologies in neurourology, searching PubMed, Embase, IEEE Xplore, and Google Scholar for relevant clinical studies. Most available data come from small observational studies in pediatric populations. In children with functional voiding dysfunction (FVD), devices such as SENS-U achieved sensitivities of 85%–90% for detecting bladder fullness thresholds with good correlation to urodynamic measurements. However, performance in neurogenic bladder populations is concerning: a recent study in children with neurogenic bladder reported only 46% accuracy and 13% specificity using DFree, indicating unacceptably high false-positive rates. No prospective validation studies have been conducted in adults with spinal cord injury, multiple sclerosis, or those at risk for autonomic dysreflexia. Regulatory classifications vary significantly among devices: SENS-U holds Conformité Européenne marking as a Class IIa medical device for pediatric use, while DFree is marketed as a consumer wellness product without medical device approval. EdgeFlow UW20, which employs a deep learning-based automatic bladder contour detection, recently received Ministry of Food and Drug Safety approval in Korea as a digital medical device. Currently, evidence supports considering wearable bladder monitors only for pediatric FVD under medical supervision. For neurogenic bladder populations, these devices are not recommended for routine clinical use until population-specific validation studies demonstrate adequate diagnostic accuracy. The emergence of B-mode (brightness mode) deep learning-based devices may address the fundamental limitations of first-generation A-mode technology.

Purpose: Postmicturition dribbling (PMD) is a common but underrecognized lower urinary tract symptom (LUTS). This study evaluated the clinical and urodynamic characteristics of PMD in men with medication-refractory LUTS. Methods: From 2008 to 2010, 150 male patients underwent questionnaire assessment, urodynamic study (UDS), and transrectal ultrasound of the prostate (TRUSP). PMD was defined as a Likert score ≥3. Results: PMD was reported by 47% of patients and was significantly associated with higher International Prostate Symptom Score (IPSS) scores, particularly LUTS such as urgency, incomplete emptying, and weak stream. PMD also adversely affected quality of life, especially motivation, sexual function, and psychological well-being. Among the UDS and TRUSP parameters, only poor bladder compliance was significantly associated with PMD (4% vs. 17%, P=0.016), corresponding to a 4-fold higher risk. Conclusions PMD was prevalent and clinically meaningful in men with LUTS and was strongly associated with core LUTS and reduced bladder compliance. Because PMD is not included in the IPSS, it may be underrecognized in routine clinical evaluation, underscoring the need for broader symptom assessment.

Purpose: To evaluate whether time-series analysis of detrusor pressure during the pressure-flow phase provides diagnostic information that complements conventional urodynamic parameters in the assessment of bladder outlet obstruction (BOO) in men with lower urinary tract dysfunction. Methods: An observational, analytical, cross-sectional study was conducted including men ≥18 years undergoing urodynamic evaluation for voiding dysfunction. Pressure-flow studies were performed according to International Continence Society standards. Detrusor pressure data recorded during voiding were exported at one-second resolution and analyzed as timeseries restricted to the active flow phase. From these segments, descriptive statistical metrics were derived, including mean detrusor pressure during voiding (mPeDet). BOO was classified using conventional indices and final clinical judgment by an experienced urologist, which served as the reference standard. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and Cohen kappa. Results: Forty-one patients were included (median age, 59 years). mPeDet showed a strong correlation with the bladder outlet obstruction index (r=0.89, P<0.001). ROC analysis demonstrated excellent diagnostic performance for mPeDet in identifying BOO, with an area under the curve of 0.95. A cutoff value of 37 cm H₂O yielded a sensitivity of 88% and specificity of 87%. Agreement between mPeDet-based classification and final clinical diagnosis was moderate (κ=0.69). Conclusions Time-series-based evaluation of detrusor pressure during voiding provides additional clinically relevant information compared to conventional point-based urodynamic parameters. mPeDet may serve as a simple and reproducible complementary marker for the assessment of BOO, particularly in cases with diagnostic uncertainty.

Purpose: Overactive bladder (OAB) symptoms may improve following surgical correction of cystocele. This study aimed to evaluate changes in urgency, the primary symptom of OAB, and identify factors associated with improvement in urgency after surgical treatment for cystocele. Methods: We conducted a retrospective analysis of medical records for patients who underwent surgical treatment for cystocele and had preoperative urgency measuring ≥3 on a 5-point urinary sensation scale. Patients were categorized into 2 groups based on their urgency status 3 months postsurgery: those with improved urgency and those without improvement. Improvement was defined as a reduction of 2 or more points on the scale following surgery. We compared preoperative clinical and urodynamic factors between the 2 groups. Results: A total of 137 patients were included in the study, with 98 (71.5%) showing improvement in urgency symptoms after surgery. The improved group had a significantly higher prevalence of preoperative urgency urinary incontinence (UUI) (62.2% vs. 30.8%, P=0.001) and bladder outlet obstruction (43.9% vs. 20.5%, P=0.011) compared to the nonimproved group. Urodynamic evaluations indicated that the detrusor pressure at maximum flow rate (PdetQmax) was significantly higher in the improved group than in the nonimproved group (P=0.004). Multivariate logistic regression analysis identified preoperative UUI, higher PdetQmax, and lower vaginal parity as independent predictors of improvement in urgency postoperatively. Conclusions Preoperative UUI, higher PdetQmax, and lower vaginal parity were significant predictors of postoperative improvement in urgency. Both clinical and urodynamic factors may help identify patients with cystocele and preoperative urgency who are most likely to benefit from anatomical correction.

Purpose: Urodynamic studies (UDS) are the gold standard for evaluating pediatric lower urinary tract dysfunction (LUTD). However, previous studies have shown that the interpretation of cystometric findings may vary according to the observer’s level of experience and the criteria used for evaluation. This study aimed to investigate interobserver differences in the reporting of cystometric parameters in children with spina bifida. Methods: Patients who underwent UDS between 2020 and 2025 for neurogenic LUTD secondary to spina bifida were retrospectively reviewed. Studies that did not reach 80% agreement for compliance with good urodynamic practice standards were excluded. Detrusor overactivity (DOA) and bladder compliance were independently evaluated by 4 pediatric urologists and 3 urologists experienced in neuro-urology. Agreement was assessed using Fleiss’ kappa test. Results: A total of 100 children, including 53 females and 47 males, were included; the median age was 6.5 (range, 1–17) years. Agreement of at least 80% was reached in 86% of evaluations for DOA and 82% of evaluations for compliance. Based on the ratings of 7 observers, the Fleiss’ kappa value was 0.60 for DOA, indicating moderate agreement, and 0.46 for bladder compliance, indicating weak agreement. Conclusions This study demonstrated substantial interobserver variation in the interpretation of UDS, even among experienced centers and observers. Because UDS are essential for the diagnosis, treatment, and follow-up of patients with spina bifida, standardized criteria are needed to improve interobserver consistency in this patient group. Multicenter prospective studies involving observers with varying levels of experience are warranted to improve concordance in UDS reporting.

Purpose: This study aimed to evaluate the correlation between bladder outlet obstruction (BOO) and bladder trabeculation in patients with benign prostatic hyperplasia (BPH). Methods: We analyzed data from consecutive BPH patients from July 2014 to June 2024, who underwent urodynamic study (UDS) and cystourethroscopy. The results of free uroflowmetry, filling cystometry, and pressure-flow study were analyzed to evaluate functional parameters. For anatomical parameters, bladder trabeculation grade, lateral lobe protrusion of prostate, and bladder neck elevation (BNE) measured in cystourethroscopy were used. BOO was defined as the BOO index of 40 or higher in UDS. Bladder trabeculation was graded using our previous studies. Results: Among total of 1,452 BPH patients, 1,028 patients had trabeculation on cystoscopy. Age, serum prostate-specific antigen, postvoid residual, total prostate volume, transition zone volume, terminal type detrusor overactivity, detrusor pressure at the maximal flow rate, bladder contractility index (BCI), and BOO index increased according to increase in bladder trabeculation. Multivariable logistic analysis showed that bladder trabeculation was significantly associated with age (odds ratio [OR], 1.05; P<0.001), kissing sign (OR, 1.55; P=0.007), BNE (OR, 1.76; P<0.001), detrusor overactivity (OR, 1.88; P=0.002), BCI (OR, 1.01; P=0.037), BOO (OR, 2.27; P<0.001). BOO had the greatest correlation with bladder trabeculation. In addition, BOO index showed a positive correlation (r=0.39, P<0.001) with bladder trabeculation. BOO index well distinguished between moderate trabeculation of grade 2 or higher in receiver operating characteristic analysis (area under curve=0.72, P<0.001). Conclusions Our results showed that the severity of BOO is positively associated with the severity of bladder trabeculation.

Purpose: To evaluate the effectiveness of virtual reality glasses (VRG) intervention during urodynamic testing (UT) on procedural pain (PP), anxiety levels, and hemodynamic parameters. Methods: This prospective, randomized controlled trial enrolled 84 patients undergoing UT, randomized 1:1 to VRG (n=42) or control group (n=42). The VRG group viewed immersive 3-dimensional nature videos via VRG throughout the procedure, while controls received routine care. Primary outcomes included PP (visual analogue scale) and anxiety levels (State Anxiety Inventory) assessed at baseline (pre-UT1), immediately postprocedure (post-UT2), and 15 minutes postprocedure (post-UT3). Secondary outcomes comprised hemodynamic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], respiratory rate [RR], oxygen saturation [SpO₂]) measured at identical timepoints. Results: Groups demonstrated comparable baseline characteristics and PP scores (VRG: 2.52±2.76 vs. control: 3.07±2.99, P=0.386). While baseline anxiety levels were similar between groups, the VRG group exhibited significantly lower postprocedural anxiety scores (post-UT2: 34.64±4.98 vs. 39.21±8.11, P=0.003; post-UT3: 34.45±4.68 vs. 39.45±8.27, P=0.001). Hemodynamically, the VRG group demonstrated significantly reduced DBP at post-UT3 (73.4±9.7 mmHg vs. 78.7±12.0 mmHg, P=0.028) and lower RRs at both postprocedural timepoints (P<0.001 and P=0.015, respectively). No significant between-group differences were observed for SBP, HR, or SpO₂. Conclusions VRG intervention during UT effectively reduced postprocedural anxiety and demonstrated beneficial effects on RR and DBP, without significantly impacting PP. These findings support the use of VRG by nurses as a safe, nonpharmacological adjunct for enhancing patient comfort during invasive urological procedures.

To review the time course of muscle mechanics, etiological factors, and molecular mechanisms contributing to the development of postvoid residual urine (PVR), with an emphasis on transcriptomic changes in detrusor underactivity secondary to bladder outlet obstruction (BOO). PVR, the volume of urine remaining in the bladder after micturition, is a key marker of lower urinary tract dysfunction. While often overlooked in routine assessment, it may signal underlying BOO or detrusor underactivity and is associated with serious complications. PVR, bladder physiology and mechanics, and BOO-associated molecular changes were integrated with mRNA expression data from patients with bladder outlet obstruction, as well as from short- and long-term obstructed rat bladders from our own laboratory. Efficient voiding depends on tightly coordinated neural and muscular activity; disruption by elevated outlet resistance, impaired detrusor contractility, or failed coordination can produce residual urine. Chronic BOO and detrusor underactivity are interlinked, with chronic obstruction initiating time-dependent compensatory mechanisms, but ultimately the bladder decompensates. Transcriptomic studies in humans reveal fibroblast-macrophage-epithelial crosstalk driving extracellular matrix remodeling, inflammation, and tissue repair, with conserved molecular pathways across species, including transforming growth factor beta, nuclear factor-kappa B, and phosphoinositide 3-kinase/protein kinase B signaling. Rat models highlight Cthrc1 as a regulator of smooth muscle proliferation after denervation and implicate hypoxia-responsive transcription factors. PVR arises from a multifactorial interplay of timedependent mechanical, myogenic, and neurogenic factors, underpinned by conserved molecular pathways. Molecular diagnostics integrating messenger RNA/microRNA signatures hold promise for early detection of detrusor decompensation, enabling targeted interventions to preserve bladder function and prevent complications.

Purpose: This study investigated whether music affected pain, embarrassment, and urodynamic outcomes during invasive urodynamic testing. Methods: In this randomized controlled trial, 94 patients were assigned to a music group (n=49) or a control group (n=45). Patients in the music group listened to slow-tempo classical instrumental music at 40–60 dB, whereas those in the control group received standard care. The primary outcome was procedural pain, which was measured using a visual analogue scale at 3 stages: uroflowmetry, positioning on the examination table, and catheter insertion. Secondary outcomes included embarrassment and objective urodynamic parameters. Nonparametric methods were used because of the data distribution. Results: The music group reported lower pain during uroflowmetry (T1; P=0.022) and positioning on the examination table (T2; P=0.041), although the absolute reductions were small. Pain did not differ significantly between groups during catheter insertion (T3). No significant between-group differences were found in embarrassment or urodynamic parameters (P>0.05). Conclusions Music may modestly reduce pain during some stages of invasive urodynamic testing, but it did not affect embarrassment or urodynamic outcomes. Because it is simple, safe, and low cost, music may be a useful supportive nursing intervention to improve patient comfort, although its clinical effect appears limited.