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PurposeRefractory lower urinary tract symptoms (LUTS) coexisting with lumbar disc hernia (LDH) have been shown to resolve following LDH surgery, implying that LDH causes these LUTS. The purpose of this study was to report outcomes in patients with refractory LUTS and LDH following non-surgical treatment targeting LDH.MethodsA retrospective cohort study was conducted using outpatient data collected at Tongji Hospital, China, between 2016 and 2018. This study included 131 adult patients with refractory LUTS and LDH. Patients were stratified into two groups. Group A underwent non-surgical treatment for LDH plus pharmacological treatment for LUTS. Group B underwent only pharmacological treatment for LUTS. The International Prostate Symptom Score (IPSS), the IPSS quality of life (QoL) score, and uroflowmetry were used to evaluate outcomes.ResultsIn group A, following treatment, the maximum flow rate (Qmax) increased by 3.92 ml/s (p < 0.001), the IPSS reduced by 5.99 points (p < 0.001), and the QoL score decreased by 1.51 points (p < 0.001). In group B, the Qmax increased by 0.09 ml/s (p = 0.833), the IPSS reduced by 0.72 points (p = 0.163), and the QoL score decreased by 0.07 points (p = 0.784).ConclusionsLUTS can be relieved by a combination of pharmacological treatment for LUTS and non-surgical treatment for LDH in some refractory LUTS patients with LDH. MRI is recommended for these patients.

Background The efficacy of surgical treatment for benign prostatic hyperplasia (BPH) patients with detrusor underactivity (DU) remains controversial. Methods To summarize relevant evidence, three databases (PubMed, Embase, and Web of Science) were searched from database inception to May 1, 2023. Transurethral surgical treatment modalities include transurethral prostatectomy (TURP), photoselective vaporization of the prostate (PVP), and transurethral incision of the prostate (TUIP). The efficacy of the transurethral surgical treatment was assessed according to maximal flow rate on uroflowmetry ( Q max ), International Prostate Symptom Score (IPSS), postvoid residual (PVR), quality of life (QoL), voided volume, bladder contractility index (BCI) and maximal detrusor pressure at maximal flow rate (PdetQ max ). Pooled mean differences (MDs) were used as summary statistics for comparison. The quality of enrolled studies was evaluated by using the Newcastle–Ottawa Scale. Sensitivity analysis and funnel plots were applied to assess possible biases. Results In this study, 10 studies with a total of 1142 patients enrolled. In BPH patients with DU, within half a year, significant improvements in Q max (pooled MD, 4.79; 95% CI, 2.43–7.16; P  < 0.05), IPSS(pooled MD, − 14.29; 95%CI, − 16.67–11.90; P  < 0.05), QoL (pooled MD, − 1.57; 95% CI, − 2.37–0.78; P  < 0.05), voided volume (pooled MD, 62.19; 95% CI, 17.91–106.48; P  < 0.05), BCI (pooled MD, 23.59; 95% CI, 8.15–39.04; P  < 0.05), and PdetQ max (pooled MD, 28.62; 95% CI, 6.72–50.52; P  < 0.05) were observed after surgery. In addition, after more than 1 year, significant improvements were observed in Q max (pooled MD, 6.75; 95%CI, 4.35–9.15; P  < 0.05), IPSS(pooled MD, − 13.76; 95%CI, − 15.17–12.35; P  < 0.05), PVR (pooled MD, − 179.78; 95%CI, − 185.12–174.44; P  < 0.05), QoL (pooled MD, − 2.61; 95%CI, − 3.12–2.09; P  < 0.05), and PdetQ max (pooled MD, 27.94; 95%CI, 11.70–44.19; P  < 0.05). Compared with DU patients who did not receive surgery, DU patients who received surgery showed better improvement in PVR (pooled MD, 137.00; 95%CI, 6.90–267.10; P  < 0.05) and PdetQ max (pooled MD, − 8.00; 95%CI, − 14.68–1.32; P  < 0.05). Conclusions Our meta-analysis results showed that transurethral surgery can improve the symptoms of BPH patients with DU. Surgery also showed advantages over pharmacological treatment for BPH patients with DU. Systematic review registration PROSPERO CRD42023415188.

Urethral pressure profile (UPP) and leak-point pressure (LPP) measurements as well as external urethral sphincter (EUS) electromyography (EMG) and videourodynamic analyses are the primary methods for evaluating urethral function in humans. However, UPP recording in female rats, a widely used animal model, is challenging due to their small body sizes. This study reports a novel method for recording UPP in female rats. Seventeen anesthetized female rats were studied. LPP data for 14 rats were included. The other 3 rats were excluded because of death or abnormal urogenital organs. UPP curves were recorded using a modified water-perfusion catheter system, with the lateral hole facing the 3-, 6-, 9-, and 12-o'clock positions in a randomized sequence. LPP, functional urethral length (FUL) and maximum urethral closure pressure (MUCP) were analyzed. The mean LPP was 64.39 ± 20.29 cm H2O. The mean FUL and MUCP values at the 3-, 6-, 9-, and 12-o'clock positions were 12.90 ± 1.20, 16.70 ± 1.95, 13.90 ± 2.42, and 11.60 ± 0.97 mm, respectively, and 38.70 ± 11.85, 33.90 ± 11.82, 37.40 ± 11.95, and 71.90 ± 23.01 cm H2O, respectively. The FUL at the 6-o'clock position and MUCP at the 12-o'clock position were significantly greater than those at the other 3 positions. The FUL and MUCP of repeated UPP recordings were not significantly different than those of the first recordings. UPP recording using a modified method based on a water-perfusion catheter system is feasible and replicable in female rats. It produces UPP curves that sensitively and appreciably reflect detailed pressure changes at different points within the urethra and thus provides opportunity to evaluate urethral structures, especially the urethral sphincter, in detail. These results may enhance the utility of female rat models in research of urinary sphincter mechanisms.

Introduction and Hypothesis This study was aimed at investigating non-invasive indicators correlated with detrusor overactivity (DO) and at developing a prediction model for DO by reviewing clinical and urodynamic data of female patients. Methods We retrospectively enrolled 1,084 female patients who underwent a urodynamic study (UDS) at Tongji Hospital between September 2011 and April 2021. Associated factors and the independent prediction factors of DO were demonstrated by univariate and multivariate analysis. A non-invasive prediction model of DO was developed and validated by applying these data. Results A total of 194 patients (17.9%) were classified as having DO. A logistic regression of a multivariate nature showed that DO risk factors were independent of age, nocturia, urgency, urgency urinary incontinence (UUI), and the lack of stress urinary incontinence (SUI). The DO prediction model had good performance, with an area under the curve of 0.880 (95% CI 0.826–0.933), which was verified by urodynamic data of patients in Tongji Hospital to be 0.818 (95% CI 0.783–0.853). An outstanding correspondence between the anticipated probability and the observed frequency was revealed by the calibration curve. Decision curve analysis demonstrated that clinical net benefit can be obtained by applying the DO prediction model when the DO risk probability was between 8 and 97%. Conclusions A non-invasive prediction model of DO was developed and validated using clinical and urodynamic data. Five independent factors associated with DO were identified: age, nocturia, urgency, UUI, and SUI. This prediction model can contribute to assessing the risk of female DO without the need for invasive urodynamic studies.

Introduction and hypothesisTransurethral catheterization in pressure-flow study (PFS) may interfere with the function of the lower urinary tract and produce an incorrect urodynamic diagnosis. We aimed to investigate the influence of a 7F catheter on urinary flow parameters in PFS and its significance for urodynamic diagnosis. Our hypothesis was that intubation causes adverse effects on urinary flow rate and further influences the urodynamic diagnosis.MethodsWe reviewed a urodynamic database of men and women referred for evaluation of lower urinary tract symptoms. The urinary flow parameters of PFS and free flow (FF) were compared. The influence of intubation on urodynamic diagnosis was determined by re-evaluating bladder outlet obstruction (BOO) and detrusor underactivity (DU), with the maximum flow rate of PFS (Qmax.P) being replaced by Qmax of FF (Qmax.F).ResultsWe initially screened 1,791 patients and included 1,144 for the analysis. Overall, PFS had a lower Qmax (p < 0.001), longer flow time (p < 0.001), and a similar voided volume (p > 0.05). However, Qmax.P displayed inconsistent changing directions: Qmax.P decreased in 72.8% of male patients and 83.5% of female patients but increased in 14.7% of male patients and 9.5% female patients. Qmax.P was unchanged in the remaining patients. The urodynamic diagnosis of BOO and DU changed correspondingly in both the decreased group and the increased group when Qmax.P was replaced by Qmax.F.ConclusionsCompared with Qmax.F, the changing directions and magnitude of Qmax.P varied with each individual, which could have a significant impact on urodynamic diagnosis. Thus, when a similar volume is voided in FF and PFS, and Qmax.P differs obviously from Qmax.F, replacing Qmax.P with Qmax.F for evaluating BOO and DU may be a sensible choice.

This study evaluated the efficacy and safety of a non-ablative vaginal Er: YAG laser device in treating stress urinary incontinence (SUI). We conducted a prospective, multicenter, randomized, sham-controlled clinical trial in which women with SUI received either active treatment with Er: YAG laser therapy or sham control with a non-therapeutic handpiece. Patients underwent three treatments spaced one month apart. The primary endpoint measure was the treatment success rate at three months post-treatment. A total of 126 participants with SUI were recruited, with 84 in the active arm and 42 in the sham arm. One participant in the sham arm was excluded due to not using research instruments. The treatment success rate at three months post-treatment was 36.59% in the sham arm and 71.43% in the active arm, with an absolute difference of 34.84% (95% CI: 17.2–52.5%). Incontinence quality of life questionnaire (I-QOL) score and incontinence questionnaire short form (ICIQ-SF) score demonstrated significant improvement in the both arms with no substantial difference between the groups. Non-ablative vaginal ErYAG laser therapy demonstrated a significant improvement in objectively measured SUI symptoms compared to sham treatment. The non-ablative Er: YAG laser therapy seems to be a promising non-surgical treatment option for SUI patients. The limitations of this study are the short follow-up and limited sample size, so additional studies with longer follow-up and larger number of patients are needed to further elucidate the role of this therapy for SUI.

The spinal cord is a cylinder structure in the vertebra and thought a simplified with the gray matter and white matter. Rexed lamination for the gray matter and regional sub-division for whiter matter are completely termed to date. Anterior commissure locates between the central canal and the anterior median fissure. However, some experimental data may still confront with new confined anatomical interpretation. By using NADPH diaphorase [N-d] enzyme histology, we found a vertical oriented neuronal pathway between the central canal and the anterior median fissure in the sacral spinal cord of young adult and aged dog. We used a term supra fissure area [SFA] to illustrate the region which consisted of the gray commissure and anterior white commissure. The N-d pathway was notably observable in aged animals. The vertical neurites revealed the cerebrospinal fluid [CSF] contacting neurites between the anterior median fissure and the central canal. We further examined the monkey, rat and pigeon in the region for better understanding of the structure and potential function. The neurodegeneration of N-d dystrophy was detected in the [SFA] in the thoracic spinal cord of the aged monkey. N-d positive fibers were detected in anterior fissure of the rat spinal cord. N-d fibrous structures were also detected in the pigeon spinal cord. These results suggested a new pathway of CSF contacting neurons and the neuronal communications about the central canal. Competing Interest Statement The authors have declared no competing interest.

NADPH-diaphorase (N-d) activity is commonly used to identify NOS-ergic neurons. In our previous study, N-d positive neuritic dystrophy and spheroid termed aging-related N-d Body is discovered in the lumbosacral spinal cord in the normal aging rats. Histological studies also reveal that N-d positive neurodegenerative changes occur in the gracile nucleus. We re-examined N-d activity in gracile nucleus in aged rat. We found N-d positive neuritic dystrophy and spheroid also occurred in the cuneatus nucleus and spinal trigeminal nucleus. Besides regular coronal section, longitudinal oriented dystrophic neurites were detected in the sagittal and horizontal section in gracile nucleus and dorsal column. We fziurther examined the medullary oblongata with regular classical histology including Golgi staining, immunocytochemistry of NOS and phosphorylated tau protein, neuronal tracing method with wheat germ agglutinin conjugated alexa-fluor-488 through sciatic nerve, and spinal cord transection at thoracic level. Most of N-d positive neuritic dystrophy and spheroid did not showed colocalization with NOS or phosphorylated tau protein. Neuronal tracing and spinal cord transection revealed that N-d dystrophic neurites in gracile nucleus originated from terminal of sensory projection from spinal cord and peripheral somatic input. The results suggested that aging-related N-d dystrophy in the gracile nucleus was unique morphological feature. In conclusion, it was postulated that the N-d dystrophy as a morphological marker of aging degenerative damage in normal aged organisms.

Highlights An all-in-one cryogel is proposed for hemostasis of coagulopathy bleeding and repair of infected diabetic ulcers. The cryogel possesses rapid liquid-triggered volume expansion capability and physicochemical synergistic hemostatic properties. The cryogel can accelerate the healing of infected diabetic wounds by releasing oxygen and deferoxamine. Traditional hemostatic materials are difficult to meet the needs of non-compressible bleeding and for coagulopathic patients. In addition, open wounds are susceptible to infection, and then develop into chronic wounds. However, the development of integrated dressings that do not depend on coagulation pathway and improve the microenvironment of chronic wounds remains a challenge. Inspired by the porous structure and composition of the natural extracellular matrix, adipic dihydrazide modified gelatin (GA), dodecylamine-grafted hyaluronic acid (HD), and MnO 2 nanozyme (manganese dioxide)@DFO (deferoxamine)@PDA (polydopamine) (MDP) nanoparticles were combined to prepare GA/HD/MDP cryogels through amidation reaction and hydrogen bonding. These cryogels exhibited good fatigue resistance, photothermal antibacterial (about 98% killing ratios of both Escherichia coli and methicillin-resistant Staphylococcus aureus (MRSA) after 3 min near-infrared irradiation), reactive oxygen species scavenging, oxygen release, and angiogenesis properties. Furthermore, in the liver defect model of rats with coagulopathy, the cryogel displayed less bleeding and shorter hemostasis time than commercial gelatin sponge. In MRSA-infected diabetic wounds, the cryogel could decrease wound inflammation and oxidative stress, alleviate the hypoxic environment, promote collagen deposition, and induce vascular regeneration, showing a better repair effect compared with the Tegaderm™ film. These results indicated that GA/HD/MDP cryogels have great potential in non-compressible hemorrhage for coagulopathic patients and in healing infected wounds for diabetic patients.

Non-compressible hemorrhage remains the chief cause of battlefield mortality and civilian trauma death. Here, we propose a hemostatic strategy based on ultrafast self-gelling self-expanding powder of polyacrylic acid (PAA), polyethyleneimine (PEI) and foaming agent, which achieves non-compressible hemorrhage hemostasis through the multiple synergistic effects of expansion plugging, self-gelling adhesion and activating the coagulation factors. The hemostatic powder integrates rapid physical crosslinking with spontaneous gas foaming, exhibits a fast gelation rate, high expansion ratio, strong tissue adhesion, and activation of red blood cells, platelets, and fibrin. The optimized formulation (PP/PT5-TXA30) achieves superior hemostatic performance compared to commercial powders in rat liver volumetric defect, femoral artery and vein transection, as well as complete transection of the subclavian artery and vein in rabbits. Notably, in a lethal porcine model of complete subclavian artery and vein transection, PP/PT5-TXA30 achieves superior performance of non-compressible hemorrhage compared to gauze and XStat™. Additionally, PP/PT5-TXA30 accelerates full-thickness skin wound healing. This work demonstrates a strategy based on ultra-fast self-gelling and self-expanding mechanisms for developing hemostatic materials for non-compressible hemorrhage. Uncontrollable hemorrhage is a leading cause of preventable death. Here, Huang et al. develop a rapid, self-expanding, coagulation-promoting hemostatic powder for non-compressible hemorrhage management.