Expertise Area 1.4: Nonsyndromic urogenital tract malformation (neurogenic bladder and spina bifida)

Mosiello, Giovanni; Nijman, Rien; Radmayr, Christian; Dellenmark-Blom, Michaela; Roozen, Sylvia; Jouannic, Jean Marie; Stein, Raimund; Abrahamsson, Kate

doi:10.1016/b978-0-323-99934-2.00005-x

Rare and Complex Urology 2024

DOI: 10.1016/b978-0-323-99934-2.00005-x

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Expertise Area 1.4: Nonsyndromic urogenital tract malformation (neurogenic bladder and spina bifida)

Giovanni Mosiello,

Rien Nijman,

Christian Radmayr

et al.

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2024

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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?

Arlandis,

Fry,

Wyndaele

et al. 2024

Neurourology and Urodynamics

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IntroductionDefining “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.MethodsICI‐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.ResultsRisk 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.ConclusionsIdentifying and validating clinical risk stratification models, precise biomarkers and therapeutic windows remains essential for effective management and reversal of bladder fibrosis and dysfunction.

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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?

Arlandis,

Fry,

Wyndaele

et al. 2024

Neurourology and Urodynamics

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show abstract

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Expertise Area 1.4: Nonsyndromic urogenital tract malformation (neurogenic bladder and spina bifida)

Cited by 1 publication

References 119 publications

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?

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?

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