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Journal of Surgical Case Reports Oct 2023The application of indocyanine green (ICG) has recently been reported to aid in the resection of endometriosis in the bladder wall and/or involving the ureters. A...
The application of indocyanine green (ICG) has recently been reported to aid in the resection of endometriosis in the bladder wall and/or involving the ureters. A symptomatic 41-year-old patient with dysmenorrhea and pollakisuria was referred to our tertiary center. Imaging revealed a 1.5-2 cm intramural endometriotic nodule in the posterior bladder wall. She was planned for robotic resection of the endometriotic nodule, under ICG guidance, together with a hysterectomy. After placement of double-J ureteral stents and clamping the bladder, perforation of the bladder mucosa could be avoided whilst performing a circumferential resection of the nodule. By clamping the bladder catheter after instillation of ICG, both the bladder wall thickness and ureters could be visualized with near-infrared imaging during robotic resection of the endometriotic nodule and hysterectomy. With the surgical approach described here, endometriotic nodules/tissue can be removed precisely with enlarged vision at the robot console, safely, and completely without damaging adjacent tissues.
PubMed: 37942346
DOI: 10.1093/jscr/rjad604 -
Anticancer Research Aug 2023The aim of the present study was to investigate the factors related to overactive bladder (OAB)-like symptoms in patients with bladder cancer.
BACKGROUND/AIM
The aim of the present study was to investigate the factors related to overactive bladder (OAB)-like symptoms in patients with bladder cancer.
PATIENTS AND METHODS
This study included 59 patients who underwent transurethral resection of bladder tumor (TURBT). OAB-like symptoms were identified based on the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score (IPSS) questionnaires. The main outcome measures were elucidation of bladder cancer-related factors that might induce OAB-like symptoms.
RESULTS
Non-muscle invasive bladder cancer (NMIBC) was observed in 50 patients, and carcinoma in situ (CIS) was observed in 14 patients. OABSS total score, IPSS total score, and quality of life index were 5±3, 12±7 and 3±1, respectively. The OABSS question 1 score, indicating pollakisuria, was significantly higher in NMIBC patients with CIS than in those without CIS (presence of CIS vs. absence of CIS=1.0±0.6 : 0.5±0.6, p=0.02). IPSS question 4 score, indicating urgency (r=0.31, p=0.01), and OABSS question 4 score, indicating urgency incontinence (r=0.29, p=0.03), correlated significantly with the maximum bladder tumor diameter. Multivariate regression analysis demonstrated that presence of CIS in NMIBC cases correlated significantly with pollakisuria (p=0.02), and that maximum diameter of the bladder tumor correlated significantly with both urgency (p=0.04) and urgency incontinence (p=0.01).
CONCLUSION
CIS induced pollakisuria in NMIBC. Larger diameter bladder tumors induced both urgency and urgency incontinence. Patients with bladder cancer who present with pollakisuria might have CIS.
Topics: Male; Humans; Urinary Bladder, Overactive; Quality of Life; Urinary Bladder; Urinary Incontinence; Urinary Bladder Neoplasms
PubMed: 37500156
DOI: 10.21873/anticanres.16540 -
Urologie (Heidelberg, Germany) Jun 2023In this review, aspects of interstitial cystitis/bladder pain syndrome (IC/BPS) are presented against the background of the German S2k guideline on this disease. (Review)
Review
BACKGROUND
In this review, aspects of interstitial cystitis/bladder pain syndrome (IC/BPS) are presented against the background of the German S2k guideline on this disease.
OBJECTIVE
Quite often this disease, characterized by bladder or lower abdominal pain (permanent or intermittent) and pollakisuria without pathogenic bacteria in the urine culture, is diagnosed much too late.
MATERIALS AND METHODS
The debate on disease definition, aspects on pathophysiology and epidemiology are presented. For diagnosis, disease severity must be determined and relevant differential diagnoses like bladder cancer must be excluded. Conservative measures (clothing, food, sexuality, sport, bladder training, sufficient fluid intake, prevention of hypothermia) are effective especially in early stages of the disease. Combination drug therapy with mucosa stabilizing, anti-inflammatory, psychotropic, and pain-reducing drugs should be adjusted individually. Inpatient rehabilitation, hydrodistension, laser- and electrocoagulation, neuromodulation (sacral or pudendal) or hyperbaric oxygen therapy may help after pharmacotherapy failure. Cystectomy and urinary diversion are used in irreversible shrunken urinary bladder.
RESULTS
If all treatment modalities are consequently used, many patients may reach a state that is more bearable.
CONCLUSION
With a high level of suffering in many patients with IC/BPS, all available treatment modalities should be known and used.
Topics: Humans; Cystitis, Interstitial; Urinary Bladder; Urinary Bladder Neoplasms; Cystectomy; Urinary Diversion
PubMed: 37115301
DOI: 10.1007/s00120-023-02080-x -
European Urology Focus Nov 2022Although bacillus Calmette-Guerin (BCG) is a standard treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), a high rate of adverse events with a variety of... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of Levofloxacin on the Efficacy and Adverse Events in Intravesical Bacillus Calmette-Guerin Treatment for Bladder Cancer: Results of a Randomized, Prospective, Multicenter Study.
BACKGROUND
Although bacillus Calmette-Guerin (BCG) is a standard treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), a high rate of adverse events with a variety of grades remains a difficulty.
OBJECTIVE
In this randomized, prospective, multicenter study, we examined whether levofloxacin, given after each intravesical instillation of BCG, could improve its tolerance in patients with intermediate- to high-risk urothelial carcinoma of the bladder without compromising its efficacy.
DESIGN, SETTING, AND PARTICIPANTS
Overall, 106 Japanese patients (85 men and 21 women; age: median, 69.5 yr) with primary or recurrent NMIBC were randomized after transurethral resection to induce treatment with intravesical BCG plus levofloxacin (group 1) or BCG alone (group 2).
INTERVENTION
Patients who underwent intravesical instillation of BCG were randomized with or without levofloxacin administration.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Adverse events were assessed using the National Cancer Institute-Common Toxicity Criteria version 3.0. Cumulative incidence functions and Kaplan-Meier methods were applied to estimate survival outcomes.
RESULTS AND LIMITATIONS
There was no significant difference in baseline characteristics between the groups. The completion rate of group 1 (85.5%) was not significantly lower than that of group 2 (76.5%; p = 0.321). There was no significant difference in the completion rate of patients with pollakisuria, painful micturition, gross hematuria, fever elevation, and others between the groups. The incidence of adverse events in patients with high-grade pollakisuria (7.3% vs 25.4%, p = 0.041) and fever (0% vs 9.1%, p = 0.034) was significantly lower in group 1. The 5-yr progression-free and cancer-specific survival rates were significantly better in group 1.
CONCLUSIONS
Prophylactic levofloxacin administration may reduce the severity of adverse events and contribute to better outcomes from BCG intravesical therapy in patients with NMIBC.
PATIENT SUMMARY
Levofloxacin administration seems to be a safe and effective therapy for non-muscle-invasive bladder cancer patients treated with bacillus Calmette-Guerin intravesical therapy.
Topics: Humans; Female; BCG Vaccine; Carcinoma, Transitional Cell; Urinary Bladder Neoplasms; Levofloxacin; Prospective Studies
PubMed: 35717522
DOI: 10.1016/j.euf.2022.06.002 -
Pediatric Nephrology (Berlin, Germany) Apr 2022
Topics: Cystitis; Dysuria; Eosinophilia; Humans; Polyuria
PubMed: 34796394
DOI: 10.1007/s00467-021-05130-8 -
Pediatric Nephrology (Berlin, Germany) Apr 2022
Topics: Cystitis; Dysuria; Eosinophilia; Humans; Polyuria
PubMed: 34796393
DOI: 10.1007/s00467-021-05128-2 -
Aktuelle Urologie Sep 2021The urinary tract is the site of many adverse drug reactions, including the formation of residual urine, urinary retention, pollakisuria, polyuria, nycturia, detrusor...
The urinary tract is the site of many adverse drug reactions, including the formation of residual urine, urinary retention, pollakisuria, polyuria, nycturia, detrusor stimulation, detrusor inhibition, haematuria, dysuria and other symptoms. Nevertheless, there is no general overview or evaluation of the substances that can trigger these adverse drug reactions. The available lists of "potential inadequate medication" either focus on a pharmacological group of adverse reactions ("anticholinergic burden score"), a group of drugs for a specific indication (LUTS-Forta) or on a selected group of patients (PRISKUS List, Beers List).The following interdisciplinary project has been processed by the group for urogeriatrics in the University of Witten/Herdecke and is intended to fill this gap. We have identified substances which can in principle trigger adverse reactions in the urinary tract - according to a variety of databases. We also categorise the available literature (case reports, case series, RCT, meta-analysis) and present a structured analysis of the risk by 33 experts. This results in a list of 235 substances that can lead to various different adverse reactions of the urinary tract. This list includes a "theoretical" score from the reports in the databases or the corresponding literature, a "practical" score based on an expert evaluation of clinical reality and a cumulative score, classified in accordance with the Rote Liste".It is now possible to classify the extent to which newly prescribed drugs may pose a risk of adverse reactions in different patients. Conversely, this may also help to clarify whether a functional disorder of the urinary tract is fully or partially linked to treatment with a specific drug. We plan to develop an app to assess adverse drug reactions in the urinary tract.
Topics: Drug-Related Side Effects and Adverse Reactions; Humans; Lower Urinary Tract Symptoms; Male; Nocturia; Prostatic Hyperplasia; Urinary Retention
PubMed: 34058770
DOI: 10.1055/a-1352-9370 -
Endocrinology, Diabetes & Metabolism... Mar 2021Apart from adrenal myelolipomas, adrenal lipomatous tumors are rare and only seldom described in the literature. We present the case of a 50-year-old man, with a...
SUMMARY
Apart from adrenal myelolipomas, adrenal lipomatous tumors are rare and only seldom described in the literature. We present the case of a 50-year-old man, with a classical form of congenital adrenal hyperplasia (CAH), which was well treated with prednisolone and fludrocortisone. The patient presented with pollakisuria and shortness of breath while bending over. On MRI, fat-equivalent masses were found in the abdomen (14 × 19 × 11 cm on the right side and 10 × 11 × 6 cm on the left side). The right adrenal mass was resected during open laparotomy and the pathohistological examination revealed the diagnosis of an adrenal lipoma. Symptoms were subdued totally postoperatively. This is the first report of a bilateral adrenal lipoma in a patient with CAH that we are aware of.
LEARNING POINTS
Macronodular hyperplasia is common in patients with congenital adrenal hyperplasia (CAH). Solitary adrenal tumors appear in approximately 10% of adult CAH patients and are often benign myelolipomas. The Endocrine Society Clinical Practice Guideline does not recommend routine adrenal imaging in adult CAH patients. Adrenal imaging should be performed in CAH patients with clinical signs for an adrenal or abdominal mass. Adrenal lipoma is rare and histopathological examinations should rule out a differentiated liposarcoma.
PubMed: 33845451
DOI: 10.1530/EDM-20-0204 -
International Journal of Molecular... Dec 2020, widely used in traditional Chinese medicine, exhibits pharmacological effects against erectile dysfunction and pollakisuria, which are pathological symptoms of benign...
, widely used in traditional Chinese medicine, exhibits pharmacological effects against erectile dysfunction and pollakisuria, which are pathological symptoms of benign prostatic hyperplasia (BPH). Although traditional usage and a study on BPH have been reported, to our knowledge, no study has investigated the exact molecular mechanism(s) underlying the anti-proliferative effects of standardized on prostatic cells. We standardized 30% ethanol extract (COFE) and demonstrated the therapeutic effects of COFE on human BPH epithelial cells and testosterone-induced BPH in rats. In vitro studies using BPH-1 cells demonstrated an upregulation of BPH-related and E2F Transcription Factor 1(E2F1)-dependent cell cycle markers, whereas treatment with COFE clearly inhibited the proliferation of BPH epithelial cells and reduced the overexpression of G1 and S checkpoint genes. Additionally, COFE administration alleviated the androgen-dependent prostatic enlargement in a testosterone-induced BPH animal model. COFE exerted these anti-BPH effects by the inhibition of anti-apoptotic markers, suppression of PCNA expression, and regulation of E2F1/pRB-dependent cell cycle markers in rats with BPH. These results suggest that COFE exerts anti-proliferative effect by regulating PCNA/E2F1-dependent cell cycle signaling pathway both in vivo and in vitro. These findings reveal the therapeutic potential of COFE, which could be used as a substitute for BPH treatment.
Topics: Androgens; Animals; Biomarkers; Cell Cycle; Cell Line; Cell Proliferation; Cell Survival; Cells, Cultured; Chromatography, High Pressure Liquid; Cornus; Disease Models, Animal; E2F1 Transcription Factor; Epithelial Cells; Humans; Male; Plant Extracts; Proliferating Cell Nuclear Antigen; Prostate; Prostatic Hyperplasia; Rats; Signal Transduction; Testosterone
PubMed: 33334082
DOI: 10.3390/ijms21249567 -
International Journal of Molecular... Jul 2020Bladder dysfunction is characterized by urgency, frequency (pollakisuria, nocturia), and dysuria and may lead to urinary incontinence. Most of these symptoms can be...
Bladder dysfunction is characterized by urgency, frequency (pollakisuria, nocturia), and dysuria and may lead to urinary incontinence. Most of these symptoms can be attributed to disturbed bladder sensitivity. There is growing evidence that, besides the urothelium, suburothelial interstitial cells (suICs) are involved in bladder afferent signal processing. The massive expansion of the bladder during the filling phase implicates mechanical stress delivered to the whole bladder wall. Little is known about the reaction of suICs upon mechanical stress. Therefore, we investigated the effects of mechanical stimulation in cultured human suICs. We used fura-2 calcium imaging as a major physiological readout. We found spontaneous intracellular calcium activity in 75 % of the cultured suICs. Defined local pressure application via a glass micropipette led to local increased calcium activity in all stimulated suICs, spreading over the whole cell. A total of 51% of the neighboring cells in a radius of up to 100 µm from the stimulated cell showed an increased activity. Hypotonic ringer and shear stress also induced calcium transients. We found an 18-times increase in syncytial activity compared to unstimulated controls, resulting in an amplification of the primary calcium signal elicited in single cells by 50%. Our results speak in favor of a high sensitivity of suICs for mechanical stress and support the view of a functional syncytium between suICs, which can amplify and distribute local stimuli. Previous studies of connexin expression in the human bladder suggest that this mechanism could also be relevant in normal and pathological function of the bladder in vivo.
Topics: Aged; Calcium; Cells, Cultured; Female; Humans; Male; Middle Aged; Osmotic Pressure; Stress, Mechanical; Urinary Bladder; Urinary Bladder, Overactive; Urinary Bladder, Underactive; Urothelium
PubMed: 32751838
DOI: 10.3390/ijms21155474