Potential Targets for Overactive Bladder in Older Men Based on Urinary Analysis of Metabolomics

<b><i>Objective:</i></b> We investigated the association between overactive bladder (OAB) and urinary metabolites in men. <b><i>Methods:</i></b> This prospective observational study included 42 men aged 65–80 years. The 3-day frequency volume chart (FVC), International Prostate Symptom Score (IPSS), and quality of life score were adapted to assess the micturition behavior. Participants with IPSS urgency score ≥2 were included in the OAB group, and those with IPSS urgency score &#x3c;2 were included in the control group. We performed a comprehensive metabolomic analysis using urine samples. Metabolites were compared between the groups using an unpaired <i>t</i> test and Fisher’s exact test in a nonadjusted analysis. Multivariable logistic regression analysis was performed to investigate the association between OAB and the metabolites. <b><i>Results:</i></b> Overall, 23 men were included in the OAB group and 19 in the control group. There were no differences in the background factors except age between the groups. FVC analysis demonstrated that nocturnal urine volume, 24-h micturition frequency, and nocturnal micturition frequency were significantly higher, and the maximum voided volume was significantly lower in the OAB group than in the controls. Metabolomic analysis revealed 14 metabolites that were differentially expressed between the groups. Multivariate analysis indicated that an increase in the levels of 5-iso prostaglandin F2α-VI (5-iPF2a-VI) and 5-methoxyindoleacetic acid was associated with OAB. <b><i>Conclusion:</i></b> Abnormal urinary metabolites, including metabolites in the tryptophan (5-methoxyindoleacetic acid, 3-indoleacetonitrile, and 3-hydroxyanthranilic acid) and arachidonic acid (5-iPF2a-VI) pathways, play a role in the pathogenesis of OAB in older men.

Investigating the link between medical urgency and hospital efficiency – Insights from the German hospital market

With hospital budgets remaining tight and healthcare expenditure rising due to demographic change and advances in technology, hospitals continue to face calls to contain costs and allocate their resources more efficiently. In this context, efficiency has emerged as an increasingly important way for hospitals to withstand competitive pressures in the hospital market. Doing so, however, can be challenging given unpredictable fluctuations in demand, a prime example of which are emergencies, i.e. urgent medical cases. The link between medical urgency and hospitals’ efficiency, however, has been neglected in the literature to date. This study therefore aims to investigate the relationship between hospitals’ urgency characteristics and their efficiency. Our analyses are based on 4094 observations from 1428 hospitals throughout Germany for the years 2015, 2016, and 2017. We calculate an average urgency score for each hospital based on all cases treated in that hospital per year and also investigate the within-hospital dispersion of medical urgency. To analyze the association of these urgency measures with hospitals’ efficiency we use a two-stage double bootstrap data envelopment analysis approach with truncated regression. We find a negative relationship between the urgency score and hospital efficiency. When testing for non-linear effects, the results reveal a u-shaped association, indicating that having either a high or low overall urgency score is beneficial in terms of efficiency. Finally, our results reveal that higher within-hospital urgency dispersion is negatively related to efficiency.

Effect of sacral neuromodulation in patients with neurogenic bladder

Background: Sacral neuromodulation (SNM) is widely used in patients with non-neurogenic overactive bladder and urinary retention but has only been applied recently for the management of the neurogenic bladder, and data are still scarce. Methods: This was a case series of patients who met the diagnosis of neurogenic bladder and received SNM between January 2016 and April 2019. Each participant received SNM. The evaluation of the participants' quality of life and urination diary (bladder symptom tracking form) included urine leaks, if urine pads need to be changed, urgent urination (0-5 points), urinary catheterization, and urinary output. The participants' expected values were analyzed. An effect >50% was considered effective. Results: All participants complied with the preoperative perineal floor exercise training. Among the 14 participants who underwent phase I SNM, one had no response at all and was excluded. After permanent electrode implantation, the urine output of one participant was similar to that of before surgery, and one participant had an incision infection, and the electrode was eventually removed. The postoperative follow-up after stage II SNM was 7.5±2.1 (range, 5-12) months. All 11 patients showed significant improvements in numbers of urination, urgency score, residual volume, and urination volume. The postoperative NEWS pain score was 1.6±0.9. Conclusions: Two-stage SNM can achieve satisfactory results in patients with neurogenic bladder. The key to success might lie in the correct and effective nursing and guidance throughout the perioperative management.

A noninvasive smart wearable for diaper moister quantification and notification

A baby feels uncomfortable in a wet diaper and it can cause health issues such as diaper rash. Diaper rash can be avoided by changing the diaper as soon as the baby urinates or passes stool. In this project, a smart wearable gadget is developed which sends an automatic notification to a caregiver’s smartphone whenever the baby urinates. The proposed wearable detects urination event noninvasively by sensing the temperature rise on the outer surface of the diaper and quantifies the event using a decision tree and a midpoint based k-nearest neighbor (KNN) hybrid classification algorithm. The gadget is a small size, low power, low cost and reusable electronic device that is attached externally to the outer surface of the diaper. The gadget can be used with any disposable diaper, thus no change in the diaper production process or price increase is required. The smartphone app shows the diaper change urgency score and logs all the urination events. This record can facilitate treating diseases where accurate records of urination are required. A prototype of the hardware gadget and a smartphone app is developed and tested.