Karel Everaert

Background Nocturia is a common and burdensome symptom that may reflect underlying cardiovascular dysfunction. While previous studies have linked nocturia to heart failure and fluid overload, direct hemodynamic evidence supporting this association remains limited. Objective To evaluate the relationship between left- and right-sided filling pressures, particularly pulmonary artery wedge pressure (PAWP) and right atrial (RA) pressure, and nocturia severity in a cohort of patients undergoing right heart catheterization. Methods We conducted a prospective observational study of 74 adult patients undergoing right heart catheterization with documented PAWP. Nocturia frequency was assessed via structured interview and modeled as an ordinal outcome. Spearman’s correlation and ordinal logistic regression were used to examine associations between PAWP and nocturia severity. Additional analyses explored relationships with right-sided filling pressures (right atrial, right ventricular end-diastolic (RVEDP), and pulmonary artery (PA) pressures). Because of multicollinearity, we fit separate adjusted ordinal logistic models including one pressure variable at a time (PAWP, RA, PA and RVEDP), each adjusted for left ventricular ejection fraction (LVEF), diuretic use, and peripheral edema (where available). Results PAWP was significantly associated with nocturia severity (ρ = 0.35, p = 0.003). In adjusted ordinal logistic regression, each 1 mmHg increase in PAWP was associated with a 7–10% higher odds of more frequent nighttime voiding. In separate multivariable models adjusted for LVEF, diuretic use, and peripheral edema both RA pressure (OR 1.15 per mmHg, p = 0.021) and RVEDP (OR 1.17 per mmHg, p = 0.002) were independently associated with greater nocturia severity, wereas PA pressure showed a trend (OR = 1.06 per mmHg, p = 0.078). Conclusions Both left- and right-sided ventricular filling pressures, particularly PAWP and RA pressure, are independently associated with nocturia severity in adjusted analyses. These findings support nocturia as a clinical marker of hemodynamic congestion, highlighting the importance of nocturia as a symptom of fluid overload and potential cardiac dysfunction.

Background and Objectives: Urinary incontinence (UI) is a prevalent issue among older adults and may require urodynamic studies (UDSs) for accurate diagnosis. However, these procedures can be uncomfortable and time-consuming, especially in a geriatric population, where certain practical restrictions may apply. This study examines whether posture of filling cystometry during UDSs in an older patient group affects diagnostic outcomes and whether a single UDS in one posture is sufficient for a reliable diagnosis or if multiple postures provide added value. Materials and Methods: This is a secondary analysis of the Think Dry: Optimalisation of Diagnostic Process of Urinary Incontinence in Older People study (NCT04094753), a prospective observational cohort study. Each patient underwent both sitting and standing filling cystometry during UDS. The final diagnosis was determined by the referring urologist by integrating results from both the sitting and standing groups alongside all available clinical data. Subsequently, each separate UDS was reviewed independently by a second, blinded, urologist, and a diagnosis was established based on a single UDS. The agreement between these independent diagnoses and the final diagnosis was then evaluated using Cohen’s kappa coefficient (κ). Results: Results from the UDS with the standing filling cystometry had an almost perfect agreement (κ = 0.92) with the final diagnosis, compared to only a moderate agreement (κ = 0.42) while sitting. Conclusions: UDS with standing filling cystometry may be sufficient for an accurate diagnosis, potentially eliminating the need for additional filling cystometry in the sitting position. By streamlining the diagnostic process, this approach could enhance efficiency, reduce patient burden, and optimize resource utilization in older adults.

Pediatric lower urinary tract symptoms (LUTS) are influenced by age and coexist with nocturnal enuresis (NE) and bladder-bowel dysfunction (BBD). Urinary tract infections (UTIs) are common and linked to LUTS, though the causal relationship remains unclear. This systematic review aims to analyze microbiome alterations in pediatric LUTS and UTIs. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Embase, and CINAHL databases were searched for studies analyzing gut and urinary microbiomes in pediatric patients with LUTS and UTIs. Quality assessment was performed using the QUADOMICS checklist. Results: Nine studies published between 2018 and 2024 were included; seven out of nine studies employed prospective designs. Six hundred nineteen patients (44.3% pathology groups, 55.7% controls) were analyzed, with microbiome sequencing performed on stool samples in four studies and urine samples in five studies. UTIs and BBD were associated with reduced alpha diversity and distinct bacterial compositions, while beta diversity analyses revealed distinct clustering of microbiome compositions between affected and healthy groups. The gut microbiome of UTI patients showed alterations in Actinobacteria and Proteobacteria abundance, while voiding dysfunction (VD) was linked to the presence of Fusobacterium nucleatum, Clostridium difficile, and Bacteroides clarus without significant VDSS correlation. Conclusion: This systematic review reveals microbial alterations in pediatric LUTS and UTIs, with lower urinary diversity in UTI patients and sex-specific differences post-puberty. Microbiome-based interventions may offer novel therapeutic strategies for LUTS and UTIs.