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. 2025 Apr 3;15(1):11474.
doi: 10.1038/s41598-025-96496-4.

Urodynamic assessment and proteomic analysis of lower urinary tract dysfunction following nerve-sparing radical hysterectomy

Tsuyoshi Majima  1 , Yoshihisa Matsukawa  2 , Yasuhito Funahashi  2 , Keishi Kajikawa  3 , Momokazu Gotoh  2 , Naoto Sassa  3
Affiliations

Urodynamic assessment and proteomic analysis of lower urinary tract dysfunction following nerve-sparing radical hysterectomy

Tsuyoshi Majima et al. Sci Rep. .

Abstract

This study aimed to evaluate lower urinary tract dysfunction after radical hysterectomy using urodynamic studies and to identify urinary biomarkers for detrusor underactivity via proteomic analysis. This prospective single-center study included women who underwent nerve-sparing radical hysterectomy for cervical carcinoma. Preoperative and postoperative assessments (at 1 and 6 months) included the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, urethral pressure profiling, and pressure flow studies. Detrusor contractility was assessed using the projected isovolumetric pressure (PIP1). Proteomic analysis was performed to identify urinary biomarkers associated with postoperative detrusor underactivity. Twenty-five patients were included. The total IPSS increased significantly at 1 and 6 months postoperatively. The maximum urethral closure pressure decreased significantly at 1 month and stabilized thereafter. PIP1 and voiding efficiency decreased significantly at 1 month, but improved by 6 months. Proteomic analysis revealed significant correlations between the changes in urinary ezrin, moesin, transthyretin, and PIP1 levels. Receiver operating characteristic analysis identified the optimal cutoff values for these biomarkers in diagnosing detrusor underactivity (PIP1 < 30). It was concluded that nerve-sparing radical hysterectomy impairs detrusor contractility and urethral function. Additionally, urinary ezrin, moesin, and transthyretin levels may be valuable biomarkers for diagnosing detrusor underactivity.

Keywords: Biomarkers; Hysterectomy; Underactive; Urinary bladder; Urodynamics.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Disclosure: This study followed the principles outlined in the Declaration of Helsinki and was approved by the ethics committee of our institution (Institutional Review Board approval No. 2016 − 0199). Written informed consent was obtained from all participants before enrollment. Trial registration number: UMIN000022369. The date of the first registration was 20/05/2016. The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Changes in projected isovolumetric pressure (PIP1). The proportions of patients with PIP1 < 30 were 33% and 12% at 1 and 6 months postoperatively, respectively.
Fig. 2
Fig. 2
Changes in urinary ezrin, moesin, and transthyretin from baseline to 1 and 6 months after the surgery. These protein changes were mainly divided into two patterns: (1) an increase in the first postoperative month and a decrease in the sixth postoperative month and (2) a sustained increase. There was no significant relationship between the patterns of protein changes and the recovery of bladder function.
Fig. 3
Fig. 3
Comparison of urinary ezrin, moesin, and transthyretin levels between DU and non-DU groups. These proteins increased significantly in the DU group compared with the non-DU group. DU: Detrusor underactivity.
Fig. 4
Fig. 4
Optimal cutoff values of urinary ezrin, moesin, and transthyretin for diagnosing detrusor underactivity (DU). The optimal cutoff values of urinary ezrin, moesin, and transthyretin for diagnosing DU (PIP1 < 30) were determined using receiver operating characteristic curves.
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