Purpose: This study aimed to investigate the potential role of obsessive-compulsive disorder (OCD), altered perception of bodily sensations, and somatization in the etiology of overactive bladder (OAB). Methods: A total of 124 participants were included in the study. The case group consisted of 63 female patients diagnosed with OAB, and the control group comprised 61 age-matched healthy females. Demographic data were collected from all participants. All participants completed the OAB Questionnaire-V8 (OABQ-V8), Obsessive Beliefs Questionnaire-44 (OBQ-44), Body Sensations Questionnaire (BSQ), and Somatosensory Amplification Scale (SSAS). Results: There were no statistically significant differences between the groups in terms of age, education, or marital status. The OAB group demonstrated significantly higher scores on the OABQ-V8, OBQ-44, BSQ, and SSAS. Furthermore, the OABQ-V8 score exhibited a significant positive correlation with the OBQ-44, BSQ, and SSAS scores. Conclusions This study offers a new perspective on the psychological aspects of OAB, suggesting that OAB symptoms may result from heightened bodily sensations and subsequent somatization associated with OCD.

Purpose: Gold-standard urodynamic examination is widely used in the diagnosis and treatment of lower urinary tract dysfunction. The purpose of urodynamic quality control is to standardize urodynamic examination and ensure its clinical reference value. In our study, we attempted to use a deep learning (DL) algorithm model, mainly for the recognition of typical urodynamic signal, to help physicians complete high-quality urodynamic examinations. Methods: Urodynamic image data from 2 cohorts of adult patients with neurogenic bladder were used: (1) 300 patients with neurogenic bladder in our center from 2012 to 2018 (1,960 images used to train and validate the DL model); and (2) 100 patients with neurogenic bladder from 2020 to 2021 (695 images used to test the performance of the DL model). This resulted in a total of 2,655 images to train, validate and test the DL algorithm to predict the urdynamic signals. Results: Yolov5l had the best detection performance and the highest comprehensive index score (F1, 0.81; mean average precision, 0.83). Our study is a retrospective single-center study, and the generalization ability of the model has not been verified. Conclusions DL algorithms can help operators identify typical urodynamic signals in real time, improve the interpretation and quality of urodynamic examination, and benefit patients.

Purpose: Cystoscopic intravesical onabotulinumtoxinA injection is a safe and effective minimally invasive treatment for refractory overactive bladder. While the procedure can be performed in outpatient clinics under local anesthetic, some clinicians still use sedation or general anesthesia in an operating theatre. Our study aimed to assess acceptability of intravesical onabotulinumtoxinA injection versus widely accepted diagnostic cystoscopy in the outpatient setting via the medium of patient experience. Methods: A 16-item patient experience survey was administered following diagnostic cystoscopy or intravesical onabotulinumtoxinA injection in an outpatient clinic. Both procedures were performed using a flexible cystoscope with local anesthetic gel. A visual analogue scale (VAS) assessed intraprocedure pain. Dichotomous questions assessed whether significant pain or postprocedure symptoms were experienced and if these required medical attention. A free-text question assessed which symptoms had occurred. Results: One hundred responses from 188 patients were received (53.2% response rate). Sixty-eight patients underwent cystoscopic intravesical onabotulinumtoxinA injection and 32 diagnostic cystoscopy. Mean VAS scores were higher for onabotulinumtoxinA injection (24 of 100) than diagnostic cystoscopy (11 of 100) (P=0.002). VAS scores were higher among patients reporting preprocedure anxiety (31 of 100 vs. 14 of 100, P=0.0013). Twenty-four percent of onabotulinumtoxinA injection patients experienced symptoms postprocedure versus 41% for cystoscopy. Medical attention was sought more frequently in the diagnostic cystoscopy group (9.4% vs. 1.5%). Common symptoms following both procedures were dysuria, urinary frequency, urgency, abdominal pain and urine discoloration. Conclusions Cystoscopic intravesical injection of onabotulinumtoxinA appears more painful than diagnostic cystoscopy. However, as VAS scores were relatively low, this is unlikely to represent clinically significant discomfort burdensome to the patient. There were no significant complications postprocedure. Cystoscopic intravesical onabotulinumtoxinA injection is acceptable in an outpatient setting.

Purpose: Urinary incontinence (UI) is a significant complication following surgery for pelvic organ prolapse (POP), including laparoscopic sacrocolpopexy (LSC). Although the incidence of postoperative UI is lower after LSC than after transvaginal mesh surgery, a subset of patients still experience UI. This study aimed to determine which factors, including mesh-related factors, contribute to UI impairing daily life following LSC. Methods: The study enrolled 96 patients who underwent LSC at our institution between June 2016 and September 2023. The Pearson chi-square test, multiple logistic regression analysis, and Cox proportional hazards model were used to determine the independent factors contributing to UI after LSC. Results: The Pearson chi-square test showed that body mass index, POP quantification (POP-Q) stage 4 and the presence of preoperative UI significantly correlated with the postoperative UI among preoperative and intraoperative factors (all P<0.05). POP-Q stage 4 and the presence of preoperative UI were also significant factors in both univariate and multivariate analyses of multiple logistic regression analysis (all P<0.05). However, only preoperative UI remained an independent predictor for shorter time to UI onset in the multivariate Cox proportional hazards model (hazard ratio, 3.56; 95% confidence interval, 1.29–11.58; P=0.0158). Conclusions Patients with preoperative UI and stage 4 POP should receive close monitoring for postoperative UI.

Purpose: This study investigated urinary incontinence (UI) following holmium laser enucleation of the prostate (HoLEP), based on the postoperative period, type of UI, and severity according to prostate volume. Methods: We analyzed prospectively collected data from patients who underwent HoLEP for benign prostatic hyperplasia at Seoul National University Hospital between January 2010 and June 2022. Patients were followed-up at 2 weeks, 3 months, and 6 months postoperatively. The patients were divided into 3 prostate volume groups: A (30–80 mL), B (81–120 mL), and C (>120 mL). We compared clinical outcomes and UI rates between the groups. Results: In total, 1,675 patients were included. The preoperative urgency UI (UUI) rate was 16.1%, with no significant difference between the groups (P=0.81). Two weeks postoperatively, the UUI rate was 6.0% (including a de novo UUI rate of 4.2%), with no significant differences between the groups. The stress UI (SUI) rate at 2 weeks postoperatively was 6.3%, and increased with larger prostate volume (P=0.04). The UUI and SUI rates decreased to 0.9% and 1.2%, respectively, 6 months postoperatively. Six months postoperatively, the SUI rate was significantly lower in group A (P=0.02), whereas the UUI rate did not differ between the groups (P=0.69). Conclusions Our results demonstrated that the preoperative UUI rate was high at baseline. Both the UUI and SUI rates continuously decreased up to 6 months postoperatively. Although the SUI rates significantly differed according to prostate volume, there was no significant difference in the UUI rate.

Purpose: Urgency urinary incontinence (UUI) is a common finding in patients with a history of stroke or cerebrovascular accident (CVA). UUI is associated with impaired quality of life as well as increased morbidity, mortality, and need for institutionalization. Medical therapy is often limited by side effects and/or cost prohibitiveness. As a result, third-line therapy is often implemented. The objective is to determine the efficacy of sacral neuromodulation (SNM) and onabotulinum toxin (BTX) in the management of post-CVA UUI. Methods: Retrospective analysis was performed to identify patients with post-CVA UUI who underwent SNM or BTX at a large academic medical center. The primary outcome was patient symptom response to third-line therapy. Treatment response was determined using the global response assessment scale. Patients reporting >50% improvement were categorized as having significant response. Secondary endpoints were proportion of patients achieving total dry and duration of therapy for those achieving significant response. Results: One hundred seventy-seven patients were identified (95 BTX, 82 SNM). Patients in the BTX group were older (71.9 years vs. 67.4 years, P=0.02) with otherwise similar demographics. Rate of symptom improvement to >50% of baseline was similar between the groups (66% of BTX, 61% of SNM, P=0.46) as was rate of patients experiencing total dryness (24% of BTX, 16% of SNM, P=0.17). Among patients achieving significant improvement there was no difference in continuation of therapy between the BTX and SNM groups. Younger age was identified as a predictor of >50% symptom improvement (odds ratio, 0.96; P=0.04) and treatment discontinuation (hazard ratio, 0.97; P=0.04) in SNM. Most common adverse events were urinary tract infection in BTX (11%) and pain in SNM (4%). Conclusions BTX and SNM show roughly equal efficacy in the management of post-CVA UUI with nearly two-thirds of patients achieving significant benefit.

Purpose: To investigate the effectiveness of acotiamide on lower urinary tract dysfunction by using a rat model of neurogenic underactive bladder induced through pelvic nerve crush (PNC) injury. Methods: Bilateral PNC injuries were performed on 8-week-old female Sprague-Dawley rats (PNC group); the sham surgery group was used as control (control group). Two weeks after surgery, awake cystometrography (CMG) was performed, and acotiamide (10 or 100 mg/kg) was subcutaneously administered to the control and PNC groups. Subsequently, CMG parameter values obtained before and after treatment were compared. Results: In baseline CMG, compared to control group, PNC group revealed statistically significant elevations in the intercontraction intervals (ICIs), number of nonvoiding contractions, baseline pressure, threshold pressure, bladder capacity, voided volumes, and postvoid residual. However, contraction amplitudes and voiding efficiency were significantly decreased. In the control group, compared with the baseline values, 10-mg/kg acotiamide resulted in statistically significant elevations in contraction amplitudes. Treatment with 100-mg/kg acotiamide led to statistically significant elevations in contraction amplitudes and decreases in ICI and bladder volume. In the PNC group, there were no statistically significant changes noted in CMG parameters after treatment with 10-mg/kg acotiamide (n=6). Compared with the baseline values, the administration of 100-mg/kg acotiamide significantly decreased ICI (1,025±186 seconds vs. 578±161 seconds; P=0.012), bladder capacity (1,841±323 µL vs. 871±174 µL, respectively; P=0.0059) and postvoid residual (223±46 µL vs. 44±22 µL, respectively; P=0.023), and increased contraction amplitudes (22.09±1.76 cm H2O vs. 43.84±6.87 cm H2O, respectively; P=0.012) and voiding efficiency (0.87±0.02 vs. 0.94±0.03, respectively; P=0.029). Conclusions Acotiamide showed effectiveness in the treatment of underactive bladder, possibly through activation of bladder afferent and detrusor activities.

Purpose: This study aimed to investigate the potential role of obsessive-compulsive disorder (OCD), altered perception of bodily sensations, and somatization in the etiology of overactive bladder (OAB). Methods: A total of 124 participants were included in the study. The case group consisted of 63 female patients diagnosed with OAB, and the control group comprised 61 age-matched healthy females. Demographic data were collected from all participants. All participants completed the OAB Questionnaire-V8 (OABQ-V8), Obsessive Beliefs Questionnaire-44 (OBQ-44), Body Sensations Questionnaire (BSQ), and Somatosensory Amplification Scale (SSAS). Results: There were no statistically significant differences between the groups in terms of age, education, or marital status. The OAB group demonstrated significantly higher scores on the OABQ-V8, OBQ-44, BSQ, and SSAS. Furthermore, the OABQ-V8 score exhibited a significant positive correlation with the OBQ-44, BSQ, and SSAS scores. Conclusions This study offers a new perspective on the psychological aspects of OAB, suggesting that OAB symptoms may result from heightened bodily sensations and subsequent somatization associated with OCD.

Purpose: Gold-standard urodynamic examination is widely used in the diagnosis and treatment of lower urinary tract dysfunction. The purpose of urodynamic quality control is to standardize urodynamic examination and ensure its clinical reference value. In our study, we attempted to use a deep learning (DL) algorithm model, mainly for the recognition of typical urodynamic signal, to help physicians complete high-quality urodynamic examinations. Methods: Urodynamic image data from 2 cohorts of adult patients with neurogenic bladder were used: (1) 300 patients with neurogenic bladder in our center from 2012 to 2018 (1,960 images used to train and validate the DL model); and (2) 100 patients with neurogenic bladder from 2020 to 2021 (695 images used to test the performance of the DL model). This resulted in a total of 2,655 images to train, validate and test the DL algorithm to predict the urdynamic signals. Results: Yolov5l had the best detection performance and the highest comprehensive index score (F1, 0.81; mean average precision, 0.83). Our study is a retrospective single-center study, and the generalization ability of the model has not been verified. Conclusions DL algorithms can help operators identify typical urodynamic signals in real time, improve the interpretation and quality of urodynamic examination, and benefit patients.