Voiding problems are among the most bothersome conditions, significantly affecting quality of life (QoL). A previous study demonstrated that severe lower urinary tract symptoms (LUTS) have a greater negative impact on QoL than chronic diseases such as hypertension and diabetes mellitus in daily life [1]. Currently, various standard therapies aim to address LUTS, helping patients manage conditions like overactive bladder (OAB), benign prostatic hyperplasia (BPH), and neurogenic bladder. However, developing new therapeutic modalities and patientcentered treatments remains crucial, as many patients have comorbidities influencing LUTS, and individual medical profiles often necessitate tailored approaches.
The December issue of the International Neurourology Journal (INJ) features studies offering valuable insights into the diagnosis and treatment of LUTS.
Minimally invasive surgical therapy for BPH represents a patient-centered option for managing LUTS while balancing efficacy and adverse events. Radiofrequency thermotherapy (RF), highlighted in the INJ, demonstrated similar improvements in voiding symptoms compared to transurethral resection of the prostate while offering superior effects in reducing storage symptoms [2]. RF may therefore be a viable option for patients seeking less invasive treatments and relief from storage symptoms. However, further research is necessary to validate its reproducibility and reliability.
As survival rates improve for patients undergoing radical cystectomy for bladder cancer, issues like urinary incontinence and sexual dysfunction have emerged as critical QoL concerns. Prostatic capsule-sparing (PCS) radical cystectomy has shown superior outcomes in restoring urinary continence and sexual function compared to nerve-sparing approaches. Importantly, PCS did not compromise oncological outcomes, though it is associated with specific complications, such as bladder-neck obstruction [3].
Women’s voiding health has also received greater attention. Female bladder outlet obstruction (BOO), though less studied than in men, has been increasingly recognized. Research on postvoid residual volume (PVR) and the female BOO index suggests that PVR and PVR percentage could serve as noninvasive diagnostic tools for female BOO [4].
Anticholinergics remain a standard treatment for OAB; however, some women on anticholinergics, such as solifenacin, experience increased PVR and associated voiding difficulty. For these patients, combination therapy with silodosin and solifenacin may improve OAB symptoms and QoL [5].
In women with artificial urinary sphincters, challenges with pump manipulation are more prevalent compared to men. Studies emphasizing these difficulties highlight the need for tailored patient education and specialized care to address postoperative discomfort and functional limitations [6].
Neuromodulation has emerged as an option for refractory LUTS in patients unresponsive to medical treatments [7]. Sacral and pudendal neuromodulation have shown efficacy in improving LUTS in neurogenic bladder patients due to diabetes or spinal cord injury [8]. Additionally, sacral neuromodulation using augmented reality-guided electrode implantation has enhanced surgical precision, reduced operative times, and minimized postoperative pain [9]. This integration of technology exemplifies the synergy between innovation and patient care.
From a pharmacological perspective, eugenol, a natural compound, has shown promise as a novel treatment for OAB in preclinical studies [10].
Advancements in the diagnosis and treatment of LUTS underscore a shift toward patient-centered and technology-integrated care. Continued research and innovation are essential to further enhance patient outcomes, reduce complications, and improve QoL for individuals managing these chronic and impactful conditions.
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