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?

Autor: Arlandis S; Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain., Fry C; School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK., Wyndaele M; Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands., Apostolidis A; 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece., Finazzi-Agró E; Urology Department, Tor Vergata University Hospital, Rome, Italy., Tyagi P; Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Winder M; Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Hashitani H; Department of Cell Physiology, Nagoya City University, Nagoya, Japan., Mosiello G; Department of Nephrology and Urology, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy., Averbeck MA; Urology Department, Moinhos de Vento Hospital, São Lucas Hospital, PUCRS, Porto Alegre, Brazil., Wein A; Desai-Seth Institute of Urology, University of Miami, Miami, Florida, USA., Abrams P; Department of Urology, University of Bristol, Bristol, UK.
Jazyk: angličtina
Zdroj: Neurourology and urodynamics [Neurourol Urodyn] 2024 Oct 30. Date of Electronic Publication: 2024 Oct 30.
DOI: 10.1002/nau.25604
Abstrakt: 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. Reduced compliance and detrusor overactivity lead to high filling pressures and raised detrusor leak point pressure, playing urodynamic studies a crucial role in risk assessment, though further research is needed for different neurogenic populations. Congenital conditions such as spina bifida, posterior urethral valves, and bladder exstrophy also contribute to a high-risk bladder through fibrosis and reduced compliance. Inflammation and ischemia are key factors, with inflammation leading to fibrosis and impaired bladder storage and voiding function. Novel treatments, including sGC activators, PDE5 inhibitors, and regenerative therapies like stem cell injections and extracorporeal shock wave treatment, show promise in mitigating fibrosis and improving bladder compliance.
Conclusions: Identifying and validating clinical risk stratification models, precise biomarkers and therapeutic windows remains essential for effective management and reversal of bladder fibrosis and dysfunction.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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