Publications by authors named "Paul Abrams"
Context: Lower Urinary Tract Symptoms (LUTS) are defined by their distressing effect on patients' day-to-day life. Given the pressures on secondary care resources, LUTS may be overlooked or inadequately assessed and therefore patients may be burdened for an extended period before treatment.
Methods: In a debate held at the International Consultation on Incontinence Research Society (ICI-RS) meeting in Bristol in June 2024, we considered how new technologies might contribute to an expedited, dignified and effective investigation of LUTS.
Aims: Lower urinary tract (LUT) sensations form an essential part of diagnostic criteria for many LUT symptoms, additionally LUT sensations are used to evaluate the effectivity of therapeutic interventions. The accurate measurement of LUT sensations, however, is severely hampered by the subjective nature of these sensations.
Methods: This paper summarizes the discussions from the 2024 meeting of the International Consultation for Incontinence-Research Society (ICI-RS 2024) regarding systematic evaluations of LUT sensations and the design of more objective tools to measure these.
Aims: Insights into the role of the urethra in maintaining continence and in normal voiding have been provided with advances in imaging techniques. Also, functional urethral testing is used to understand which treatments are optimal for women with functional bladder outlet obstruction (BOO), but which testing is better for which treatment? This review aims to describe our current understanding of female urethral function and dysfunction and to provide future research directions for treating functional female urethral disorders.
Materials And Methods: This is a consensus report of the proceedings of a research proposal discussed at the annual International Consultation on Incontinence-Research Society (ICI-RS), 6th-8th June 2024 (Bristol, UK): "Do we need to re-focus on functional female urethral disorders in lower urinary tract dysfunction? ICI-RS 2024".
Article Synopsis
- Robot-assisted (RA) surgery shows potential benefits for urinary tract and pelvic floor reconstruction (UTPFR), but research on its use is limited and needs to grow.
- An International Consultation on Incontinence-Research Society (ICI-RS) meeting suggested prioritizing multicenter studies to assess RA UTPFR's clinical effectiveness, safety, and training needs.
- The proposal emphasizes the need for cost-utility models, improved surgeon training, and embracing new technologies like digitalization to enhance surgical outcomes.
Introduction: Lower urinary tract symptoms (LUTS) are prevalent among older adults, a population that faces multiple medical challenges, with frailty being a major concern. Despite the high prevalence of LUTS, current treatment strategies for older adults are often inadequate. This paper aims to address these issues by defining daytime and/or nighttime LUTS and examining the impact of comorbid conditions on these symptoms.
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- Ketamine is increasingly used recreationally, leading to health issues like ketamine-induced uropathy (KIU), which has lower urinary tract symptoms and may affect the upper urinary tract.
- The 2024 ICI-RS meeting focused on KIU, employing literature reviews, expert talks, and group discussions to examine its clinical and research aspects comprehensively.
- Research highlights include bladder fibrosis mechanisms, the potential for reversing fibrosis, and the relationship between ketamine use and urinary symptoms, suggesting the need for further studies on the systemic effects and psychological dependency of users.
Think Tank 2: How Do We Precisely Define the "High Risk Bladder" and What Are the Interrelationships Between Inflammation, Blood Flow, Fibrosis, and Loss of Bladder Compliance?
Neurourol Urodyn
October 2024
Introduction: Defining "high-risk bladder" or "high-pressure bladder" involves recognizing the potential for an unsafe lower urinary tract, where dysfunction in storage and micturition can threaten upper urinary tract health, leading to unfavorable outcomes like dialysis, recurrent infections, systemic impact, or mortality.
Methods: ICI-RS was held in Bristol in June 2024, and Think Tank 2 aimed to define research priorities including identifying clinical predictors and developing prevention and monitoring strategies.
Results: Risk factors encompass both congenital and neurogenic lower urinary tract dysfunction, bladder outlet obstruction, vascular diseases, and inflammatory disorders, but a validated stratification risk is lacking.
Aims: The integration of artificial intelligence (AI) into functional urology management must be assessed for its clinical utility, but hopefully will change, perhaps to revolutionize the way LUTD and other conditions are assessed, the aim being to offer patients more rapid and effective management which enhances patient outcomes. The aim of this proposal, discussed at the ICI-RS annual meeting, is to evaluate the available evidence on AI and the way it might change the approach to urodynamic (UDS) diagnoses, including overactive bladder syndrome (OAB), and perhaps other LUTDs such as bladder outflow obstruction.
Methods: A compendium of discussion based on the current evidence related to AI and its potential applications in UDS and OAB.
Context: Water intake in drinks and food is essential for life. Multiple guidelines exist to help give recommendations for healthy water intake and urine output, but few of these are specific to patients with lower urinary tract symptoms.
Methods: A debate held at the International Consultation on Incontinence-Research Society meeting, held in Bristol in June 2024, considered ways to improve this situation.
Is Our Limited Understanding of the Effects of Nerve Stimulation Resulting in Poor Outcomes and the Need for Better "Rescue Programming" in SNM and PTNS, and Lost Opportunities for New Sites of Stimulation? ICI-RS 2024.
Neurourol Urodyn
October 2024
Article Synopsis
- Sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) are recommended treatments for complex lower urinary tract issues, but they often face challenges like treatment failure and limited long-term effectiveness, necessitating better follow-up strategies.
- A recent consensus report from a 2024 meeting highlighted the importance of "rescue programming" to enhance patient outcomes and device use, alongside exploring alternative stimulation sites for better results.
- Current SNM techniques have not evolved significantly, and while there's little evidence for PTNS rescue programming, advancements in implantable devices and neurostimulation targeting the pudendal nerve show promise for improving treatment adherence and effectiveness.
Introduction: Detrusor muscle weakness is commonly noted on urodynamics in patients with refractory voiding difficulty. No approved therapies have been proven to augment the strength of a detrusor voiding contraction.
Methods: This subject was discussed by a think-tank at the International Consultation on Incontinence- Research Society (ICI-RS) meeting held in Bristol, June 2024.
Article Synopsis
- Detrusor muscle weakness is a common problem that makes it hard for people to urinate, and there's no proven way yet to make the muscle stronger.
- Experts discussed this issue at a meeting in Bristol and looked at various treatments like electrical stimulation, surgery for bladder problems, and ways to help with constipation.
- Although some treatments may help patients feel better, there's not enough strong evidence showing they actually make the detrusor muscle stronger, so more research is needed.
Aims: To discuss the role of autocrine/paracrine signaling of urothelial arginine vasopressin (AVP) on mammalian bladder capacities and micturition thresholds, impact of distension on water/urea reabsorption from the bladder, review of the literature to better characterize the central/peripheral effects of AVP, desmopressin (dAVP) toxicity, and urine biomarkers of nocturia.
Methods: This review summarizes discussions during an International Consultation on Incontinence-Research Society 2024 think tank with respect to the role of urothelial AVP in aged individuals with nocturnal polyuria, impact of solute and water reabsorption by the bladder on uninterrupted sleep, central effects of AVP, pharmacological basis of dAVP toxicity, and biomarkers in nocturia/lower urinary tract dysfunction (LUTD) with neurological diseases.
Results: Consensus recognized AVP function and pathways in the central nervous system (CNS), pre-proAVP localized using immunohistochemistry in bladder sections from adult/aged noncancerous human punch biopsies and rodent bladder sections is likely to accelerate the systemic uptake of water and urea from the bladder of anesthetized mice instilled with H-water and C-urea.
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) and produced a worldwide pandemic in 2020. There have been 770,875,433 confirmed cases and 6,959,316 attributed deaths worldwide until September 19, 2023. The virus can also affect the lower urinary tract (LUT) leading to bladder inflammation and producing lower urinary tract symptoms (LUTS) in both the acute and chronic phases of disease.
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- Up to 50% of men experience persistent lower urinary tract symptoms (LUTS) after bladder outflow resistance reduction surgery (BORRS), prompting a think tank to identify predictive factors and improve preoperative counseling.
- The think tank concluded that predicting persistent LUTS is challenging due to the complex nature of the condition, but certain preoperative urodynamic factors, like severe overactive bladder symptoms and low bladder capacity, can increase the likelihood of ongoing issues.
- The need for further research is emphasized to better understand the reasons behind persistent male LUTS post-surgery and to enhance patient selection and counseling processes.
Introduction And Hypothesis: The aim of this review is to discuss the link between menopause and nocturia and to give an overview of the increasing prevalence, risk factors, causative factors, treatment needs and options for nocturia in peri-menopausal women.
Methods: This opinion article is a narrative review based on the expertise and consensus of a variety of key opinion leaders, in combination with an extensive literature review. This literature search included a thorough analysis of potential publications on both the PubMed Database and the Web of Science and was conducted between November 2022 and December 2022.
Article Synopsis
- The study focuses on the factors that predict successful urination after bladder surgery in men with urinary retention.
- A think tank discussed various elements, including the challenges in diagnosing urinary obstruction and the mixed results from previous research due to patient diversity.
- They found that surgical methods like resection are effective, but there's a need for more research on predicting success and the effectiveness of newer, minimally invasive techniques.
Aims: This International Consultation on Incontinence-Research Society report aims to summarize the evidence and uncertainties regarding the use of hormone replacement therapy by any route in the management of lower urinary tract symptoms (LUTS) including recurrent urinary tract infections (rUTI), with a review of special considerations for the elderly. Research question proposals to further this field have been highlighted.
Methods: An overview of the existing evidence, guidelines, and consensus regarding the use of topical or systemic estrogens in the management of LUTS.
Introduction: Overactive bladder (OAB) is a prevalent urological condition characterized by urinary urgency, with or without urgency urinary incontinence, accompanied by increased daytime frequency and nocturia. However, the current definition of OAB lacks a specified time frame, hindering our understanding of the temporal aspects and transitions that occur within the OAB spectrum.
Methods: A modified Delphi study was conducted in three rounds, involving a panel of international experts in functional urology, urogynaecology, geriatrics, transitional medicine, and pediatric urology.
Article Synopsis
- The management of overactive bladder (OAB) starts with lifestyle changes and conservative measures, progressing to oral drugs like antimuscarinics and beta 3 agonists if symptoms persist.
- Recent debates, including discussions at the ICI-RS meeting 2023, suggest a shift toward a more personalized treatment strategy based on individual patient factors, rather than a one-size-fits-all approach.
- There are concerns about long-term side effects of current medications, and adherence to treatment is often poor, indicating a need for better research and improved therapeutic options.
Introduction: Overactive bladder (OAB) and underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction.
Objectives: The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment.
Methods: A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU using urodynamic tests, functional neuro-imaging, urinary markers, and microbiome.
Introduction: Overactive bladder (OAB) and Underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction.
Objectives: The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment.
Methods: A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU investigating metabolic, neurogical, psychological and gastrointestinal aspects with the aim to personalize the treatment.
Background: Clean intermittent self-catheterisation (CISC or ISC) is used by patients/carers to empty the bladder if needed. Sometimes the urethral lumen leading out of the bladder is blocked; sometimes, the bladder (detrusor) muscle itself or the autonomic motor nerves innervating the bladder are damaged, resulting in a failure of the detrusor muscle to work, leading to a failure of the bladder being able to empty adequately. Prior consensus as to the indications and timing of CISC has yet to be provided.
View Article and Find Full Text PDFAims: To address how invasive therapies for benign prostatic obstruction (BPO) have been evaluated, what their effect is on BPO, if they can prevent progression to BPO and how new therapies need to be evaluated before implementation into clinical practice.
Methods: The think tank conducted a literature review and looked at the previous and current American Urological Association, European Association of Urology and the International Consultation on Urological Diseases guidelines to see what procedures have been used to treat BPO. They then assessed whether trials have been conducted before implementation of the procedures and whether they have been compared to a "gold" standard treatment.