Psychological stress causes and deteriorates interstitial cystitis/painful bladder syndrome with urinary frequency, incontinence, bladder pain and urgency. The major alkaloid of kratom (Mitragyna speciosa), mitragynine, shows analgesic, anxiolytic, and smooth muscle relaxant effects. However, the effects of kratom leaf extract on stress-induced anxiety-like behavior, urinary bladder pain and urinary bladder dysfunction remain unknown. Therefore, this study aims to examine the effect of kratom leaf extract administration on anxiety-like behaviors, bladder pain, bladder contractile properties, and mast cell number in mice exposed to water avoidance stress. Male C57BL/6 mice were exposed to water avoidance stress (WAS) protocol for 10 consecutive days and compared with the stress-exposed mice receiving oral administration of kratom leaf extract (2.5 and 5 mg/kg of mitragynine) or solifenacin (10 mg/kg). Anxiety-like behaviors were assessed using open field test. Bladder pain sensitivity was evaluated with von Frey test, while voiding behavior was analyzed using voiding pattern analysis. Bladder contractility was examined using an in vitro organ bath technique, and urinary bladder mast cell infiltration was assessed by toluidine blue staining. Results show that mice receiving WAS had a reduction in the total duration and number of unsupported rearing behaviors, reduced voiding area, and increased bladder pain responses; however, these effects were reversed by treatment with kratom leaf extract (2.5 and 5 mg/kg of mitragynine). Interestingly, the WAS group also exhibited markedly increased tonic contractions in response to carbachol, a muscarinic agonist; these responses were attenuated in mice treated with kratom leaf extract (2.5 and 5 mg/kg) The enhanced tonic contractile response to carbachol was abolished by pre-incubation with ondansetron (a 5-HT3 antagonist). The WAS group showed an increased total number of mast cells in the urinary bladder, which was reduced by treatment with kratom leaf extract at both 2.5 and 5 mg/kg. Our results indicate that treatment with kratom leaf extract attenuated chronic stress-induced bladder pain responses, voiding abnormalities, and mast cell numbers, and was associated with reduced contractile response to muscarinic stimulation, suggesting a potential modulatory effect on stress-induced bladder dysfunction.

Overactive bladder (OAB) is a highly prevalent condition characterized by urinary urgency that negatively affects quality of life. Because obesity and metabolic syndrome (MetS) are known as major risk factors for OAB, we explored the mechanisms underlying obesity-/MetS-associated OAB using a high-fat-diet (HFD)-induced obesity mouse model. Four-week-old male C57BL6 mice were subjected to either a HFD (60 kcal% fat) or a normal diet (ND, 10 kcal% fat). Cystometry and bladder afferent activity recordings in anaesthetized mice, isometric tension recordings in detrusor smooth muscle (DSM) strips and intravesical pressure recordings in isolated whole bladders were performed after 12 weeks of ND or HFD feeding. Bladder morphology was examined using histochemistry. HFD mice exhibited a MetS phenotype characterized by abdominal obesity, hyperglycaemia and insulin resistance. HFD mice developed enlarged non-voiding contractions (NVCs) during bladder filling associated with enhanced afferent activity. Both were attenuated by intravenous administration of atropine (1 mg/kg) or pyridoxalphosphate-6-azophenyl-2',4'-disulfonic acid (PPADS), a P2X purinoceptor antagonist (10 mg/kg), or by bilateral pelvic nerve transection. In ND mice these drugs attenuated NVCs but not afferent activity. Spontaneous or nerve-evoked DSM contractions or transient pressure increases in isolated whole bladders were unaltered in HFD mice. DSM thickness, collagen deposition or parasympathetic nerve density in HFD bladders was unaltered. Thus the OAB phenotype in HFD mice appears to primarily results from the increased parasympathetic neural activity during the bladder storage phase. These results provide the basis of the clinical effectiveness of anti-muscarinic agents on OAB as well as the enhanced purinergic transmission in OAB patients known as 'atropine resistance'. KEY POINTS: High-fat-diet (HFD)-induced obese mice exhibiting metabolic syndrome phenotype display overactive bladder (OAB) phenotype characterized by enlarged non-voiding contractions (NVCs) associated with bladder afferent overactivity. Both enlarged NVCs and afferent overactivity in HFD mice are reversed by intravenous administration of atropine or the P2X receptor antagonist pyridoxalphosphate-6-azophenyl-2',4'-disulfonic acid (PPADS), or by bilateral pelvic nerve transection. Detrusor muscle strip contractility, corresponding spontaneous pressure increases in isolated whole bladder and bladder morphology are unaltered in HFD mice. The OAB phenotype in HFD-induced obese mice primarily results from excessive parasympathetic activity during the bladder storage phase. These findings provide a basis for the clinical effectiveness of anti-muscarinic drugs on bladder storage symptoms as well as the relevance of enhanced purinergic transmission in OAB patients known as 'atropine resistance'.

Overactive bladder (OAB) is a urological syndrome characterized by urinary urgency, frequency, nocturia, and, in some cases, urge incontinence in the absence of infection or other identifiable pathology. It can significantly impair health-related quality of life (HRQoL) through physical discomfort, psychological distress, and social embarrassment. This study aimed to compare the prevalence of OAB and its impact on HRQoL among medical and nonmedical university students in Pakistan. A comparative cross-sectional study was conducted between February and October 2025 among 418 university students (217 medical and 201 nonmedical) recruited through convenience sampling. Data were collected using self-administered questionnaires, including the Overactive Bladder Awareness Tool, the Perception of Academic Stress Scale, and the International Consultation on Incontinence Questionnaire-Overactive Bladder Module. Statistical analysis was performed using SPSS version 22. Chi-square tests were used for categorical variables, independent t tests for group comparisons, ANOVA for differences across academic years, and logistic regression to identify independent factors associated with OAB. A P-value < .05 was considered statistically significant. OAB symptoms were reported by 23.2% of students. Smoking was significantly associated with OAB (50% in smokers vs 21.4% in nonsmokers, P = .002). In logistic regression analysis, smoking (odds ratio = 0.334, P = .029) and greater HRQoL impact (odds ratio = 1.16, P = .004) were independently associated with OAB. OAB severity scores were positively correlated with HRQoL impairment (ρ = 0.234, P < .001). Despite the burden of symptoms, only 11.7% of affected students sought medical care, while medical students demonstrated greater awareness of treatment options compared with nonmedical students (P = .046). Nearly 1 in 4 university students experienced OAB symptoms, which were associated with significant impairment in HRQoL but remained largely underrecognized and undertreated. This highlights a substantial gap between symptom burden and healthcare-seeking behavior, underscoring the need for targeted awareness, lifestyle modification, and improved access to care in university settings.

Overactive bladder (OAB) is a common urological condition with significant impacts on quality of life and healthcare burden. Chronic inflammation and insulin resistance have been independently linked to bladder dysfunction. The C-reactive protein-triglyceride glucose index (CTI), a novel composite marker reflecting both inflammatory and metabolic status, may provide additional value in assessing OAB risk, but has not been previously studied in this context. We conducted a cross-sectional analysis using data from National Health and Nutrition Examination Survey 2005-2010 and 2015-2018. OAB was defined based on self-reported symptoms of urgency incontinence and nocturia. CTI was calculated as 0.412 × ln (CRP) + TyG, where TyG = ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Survey-weighted multivariable logistic regression models were used to assess the association between CTI and OAB. Subgroup, interaction, and generalized additive model analyses were performed to explore potential effect modification and nonlinear trends. Discriminative performance was evaluated using receiver operating characteristic curves. A total of 9390 adults were included. Higher CTI levels were significantly associated with increased odds of OAB. In fully adjusted models, each unit increase in CTI was associated with a 17% higher risk of OAB (OR = 1.17, 95% CI: 1.06-1.28, P = .002). Compared to the lowest CTI quartile, the highest quartile showed a 50% increased risk of OAB (OR = 1.50, 95% CI: 1.17-1.93, P = .002). The association persisted across subgroups, with stronger effects observed in females, younger adults, and participants with lower poverty income ratio. Interaction tests confirmed significant effect modification by age (P for interaction < .001) and socioeconomic status (P = .02). Generalized additive model analysis demonstrated a nonlinear positive trend between CTI and OAB prevalence. In receiver operating characteristic analysis, CTI showed superior discriminative ability (AUC = 0.607) compared to CRP (AUC = 0.588) and TyG (AUC = 0.569). CTI is independently associated with the presence of OAB in a representative US adult population. As a composite marker of metabolic and inflammatory burden, CTI may serve as a useful tool for identifying individuals at elevated risk of OAB, particularly among younger and socioeconomically disadvantaged groups.

Waldenström macroglobulinemia (WM) is a rare CD20-positive B-cell non-Hodgkin lymphoma. It is characterized by lymphoplasmacytic infiltration in the bone marrow and abnormal monoclonal IgM secretion. WM complicated by renal amyloidosis is uncommon but associated with rapid progression of organ damage. Accurate identification of pathogenic factors and individualized treatments are essential to improve prognosis. This paper reports the case of a 75-year-old female who initially presented with facial edema and bilateral lower-extremity edema lasting 2 days. Additional symptoms included foamy urine, frequent urination, and urgency. Laboratory tests revealed significant proteinuria (24-h urinary protein, 6.11 g), hypoalbuminemia (serum albumin, 20.07 g/L), and impaired renal function (serum creatinine, 129.90 μmol/L; eGFR, 45.2 mL/min/1.73 m2). Immunofixation electrophoresis detected monoclonal IgM-λ immunoglobulin in both serum and urine. Bone marrow biopsy demonstrated clonal lymphoplasmacytic infiltration (32%), and genetic testing revealed a positive MYD88-L265P mutation (mutation frequency, 28.5%). Renal biopsy indicated diffuse deposition of λ light chains predominantly in the glomerular mesangium. Ultrastructural examination revealed amyloid fibrils, confirming the diagnosis of AL λ - type amyloid nephropathy. Chemotherapy with rituximab, cyclophosphamide, and dexamethasone (RCD regimen), combined with symptomatic supportive therapy, resulted in temporary improvement of clinical symptoms and laboratory parameters. However, the disease progressed rapidly. The patient died on Jan 28, 2024, approximately 3 months after discharge, due to multiple organ failure involving cardiac, renal, and respiratory dysfunction. Based on relevant literature and the Chinese Expert Consensus on Diagnosis and Treatment of Lymphoplasmacytic Lymphoma (LPL)/WM (2022 Edition) [Abstract 3], this paper discusses diagnostic criteria, differentiation of pathogenic components, treatment strategies, and prognostic factors. These findings may provide clinical guidance for similar rare cases.

Lower-urinary-tract symptoms are common in Parkinson's disease (PD) and are a key autonomic symptom affecting quality of life. We demonstrate that situational triggers of urinary urgency are extremely common in a qualitative study of participants with overactive bladder and PD. 82% reported at least one trigger, and the mean number were 1.6. Running water was a consistent theme, however many were highly specific. This work is important for looking at developing tailored behavioural therapies.