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?

Fecha de publicación: 30/10/2024 Fecha Ahead of Print: 30/10/2024

Autores de IIS La Fe

• Salvador Arlandis Guzmán

  Autor

Participantes ajenos a IIS La Fe

• Fry C
• Wyndaele M
• Apostolidis A
• Finazzi-Agró E
• Tyagi P
• Winder M
• Hashitani H
• Mosiello G
• Averbeck MA
• Wein A
• Abrams P

Grupos

• Urología

  Leader

  Francisco Boronat Tormo

Abstract

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.

Keywords

• bladder fibrosis; bladder inflammation; bladder vascularization; high risk bladder; low bladder compliance