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Urologia Internationalis 2003Augmentation cystoplasty is an effective approach to the detrusor hyperreflexia which is refractory to conservative treatment. Sporadic data have been published in...
INTRODUCTION
Augmentation cystoplasty is an effective approach to the detrusor hyperreflexia which is refractory to conservative treatment. Sporadic data have been published in patients with progressive diseases such as multiple sclerosis (MS).
MATERIALS AND METHODS
Augmentation ileocystoplasty (Goodwin 'cup-patch') was performed in 9 patients (7 females, 2 males). The average Expanded Disability Status Scale score was 4.1 (range 3.0-6.5); 7 patients had relapse-remitting MS and 2 patients secondary-progressive MS. The indication was a detrusor hyperreflexia refractory to conservative treatment in 8 patients and a detrusor hyperrefluxia with third degree bilateral vesico-ureteral reflux and renal insufficiency in 1 patient. Pre- and postoperative objective parameters were evaluated by urodynamic examination, imaging methods and laboratory examination. Subjective evaluation was performed using a questionnaire on micturition symptoms (score 0-5) and on quality of life (score 0-6).
RESULTS
With a follow-up of 6-19 months, we recorded an average increase of the maximum detrusor capacity from 105 to 797 ml and decrease of maximum detrusor pressure from 53 to 30 cm H(2)O. Postmicturition residual urine >25% of the maximum capacity was present in 6 patients who performed clear intermittent autocatheterization postoperatively (2 patients preoperatively). In all patients there was a significant improvement in the irritation micturition symptomatology (pollakisuria, nycturia, urgency and urge incontinence) and the quality of life score improved on average from 5 to 0.7. In the case of the patient with renal insufficiency, the creatinine level decreased from 286 to 150 micromol/l; in the other patients renal function remained normal.
CONCLUSIONS
Augmentation cystoplasty is a safe and effective method for indicated patients, which significantly enhances their quality of life.
Topics: Adult; Female; Follow-Up Studies; Humans; Ileum; Male; Middle Aged; Multiple Sclerosis; Prospective Studies; Sampling Studies; Severity of Illness Index; Treatment Outcome; Urinary Bladder, Neurogenic; Urinary Reservoirs, Continent; Urodynamics; Vesico-Ureteral Reflux
PubMed: 12566810
DOI: 10.1159/000067708 -
Hinyokika Kiyo. Acta Urologica Japonica Oct 2002A 67-year-old man presented with pollakisuria, and miction pain. The patient who had superficial bladder cancer was treated with transurethral resection and instillation...
A 67-year-old man presented with pollakisuria, and miction pain. The patient who had superficial bladder cancer was treated with transurethral resection and instillation of Pirarubicin hydrochloride. Urinalysis revealed a marked increase in eosinophilic cells. A cystoscopic examination revealed an ischemic lesion and hypervascular lesion throughout the bladder. Histological findings of biopsied bladder specimens showed eosinophilic cystitis. Bladder symptoms are improved with steroid administration.
Topics: Aged; Anti-Inflammatory Agents; Betamethasone; Cystitis; Eosinophils; Humans; Leukocyte Count; Male; Urinalysis
PubMed: 12491620
DOI: No ID Found -
Hinyokika Kiyo. Acta Urologica Japonica Oct 2002We report three cases of inverted papilloma of the urinary bladder. Case 1. A 19-year-old male complained of pollakisuria, gross hematuria and micturition pain....
We report three cases of inverted papilloma of the urinary bladder. Case 1. A 19-year-old male complained of pollakisuria, gross hematuria and micturition pain. Cystoscopy revealed a smooth-surfaced tumor on a stalk at the bladder neck. The tumor was removed transurethrally. Histological diagnosis was inverted papilloma. As a safe guard, intravesical chemotherapy (Adriamycin) was performed, since pathological findings revealed a small region with mild atypical cells in the removed tumor. The patients has been subsequently followed up for ten years without any evidence of recurrence. Case 2. A 63-year-old male was admitted to our hospital because of a bladder tumor incidentally found by abdominal ultrasonography. The tumor was removed transurethrally. Histological diagnosis was inverted papilloma. The patient has been subsequently followed up for one year without any evidence of recurrence. Case 3. A 71-year-old male complained of pollakisuria, loss of urinary force and interruption of the urinary stream. A smooth-surfaced tumor found at the bladder neck was removed transurethrally. Histological diagnosis was inverted papilloma. Three months later, cystoscopy revealed two sessile papillary tumors on the left lateral wall of the urinary bladder. Pathological diagnosis was transitional cell carcinoma (G2, pTa). Although the inverted papilloma is a benign tumor, there is a possibility of recurrence or development of transitional cell carcinoma. Therefore, we advocate periodical follow-up examinations.
Topics: Adult; Aged; Humans; Male; Middle Aged; Papilloma, Inverted; Urinary Bladder Neoplasms
PubMed: 12491619
DOI: No ID Found -
Hinyokika Kiyo. Acta Urologica Japonica Jul 2002In the two cases we report here, tumors were diagnosed as nephrogenic adenoma by pathohistological examination. Case 1 was a 72-year-old female presenting with a bladder... (Review)
Review
In the two cases we report here, tumors were diagnosed as nephrogenic adenoma by pathohistological examination. Case 1 was a 72-year-old female presenting with a bladder tumor 8 months after receiving ureteral tumor surgery. Transurethral resection of bladder tumor (TUR-Bt) was performed. Case 2 was a 57-year-old female who had received intravesical bacillus Calmette-Guérin (BCG) treatment 6 times after her fifth TUR-Bt. Two tumors were found by cystoscopy, and TUR-Bt was performed. There have been 39 cases of nephrogenic adenoma of the bladder reported in Japan; 21 were male and 18 female with a mean age of 56.5 years. The main complaint was hematuria, which was seen in 16 cases followed by pollakisuria in 6 cases. Nephrogenic adenoma occurred after surgery of the urinary tract in 16 cases, followed by urinary tract infection in 9 cases and intravesical BCG treatment in 6 cases. The ratio of cases occurring after intravesical BCG treatment has increased since BCG approval for bladder carcinoma treatment in December 1996 in Japan, and an increase in the number of cases is expected in the future.
Topics: Adenoma; Administration, Intravesical; Aged; BCG Vaccine; Female; Humans; Male; Middle Aged; Neoplasms, Second Primary; Urinary Bladder Neoplasms; Urologic Surgical Procedures
PubMed: 12229190
DOI: No ID Found -
Hinyokika Kiyo. Acta Urologica Japonica Feb 2002A 49-year-old man complained of dysuria and pollakisuria. The prostate was enlarged, and the serum level of prostate specific antigen was within the normal range. Under...
A 49-year-old man complained of dysuria and pollakisuria. The prostate was enlarged, and the serum level of prostate specific antigen was within the normal range. Under the diagnosis of benign prostatic hypertrophy, transurethral resection of the prostate was performed. Unexpectedly, histopathological examination of the resected tissues revealed pure small cell carcinoma. The serum level of progastrin-releasing peptide (ProGRP) was slightly elevated. The cancer was clinically diagnosed as stage C. Pelvic radiotherapy combined with chemotherapy using cisplatin (CDDP) and etoposide (VP-16) was started according to the treatment for limited small cell cancer of the lung. After one month, the serum level of ProGRP decreased to the normal range. After four months, the prostate was reduced in size without any findings of metastases on computed tomography, and prostate biopsy revealed no viable cancer cells.
Topics: Carcinoma, Small Cell; Combined Modality Therapy; Humans; Male; Middle Aged; Prostatic Neoplasms
PubMed: 11968736
DOI: No ID Found -
Acta Medica Croatica : Casopis... 2001A case of a 37-year-old man admitted to our Department of Internal Medicine for medical evaluation of hypertension is reported. The patient had a 4-year history of...
A case of a 37-year-old man admitted to our Department of Internal Medicine for medical evaluation of hypertension is reported. The patient had a 4-year history of oscillating hypertension prior to admission, however, with no major subjective complaints, except for pollakisuria. Clinical and biochemical assessment revealed no damage to target organs. Laboratory parameters showed normal values, except for hyperlipidemia. On routine ultrasonography of the pelvis confirmed a pelvic tumor of uncertain etiology, with no abdominal lymph node enlargement. No signs of metastasis were found. The patient was transferred to the Department of Surgery, where the tumor was removed in toto. Histopathologic analysis of the tumor, 11 x 8 x 8 cm in size, composed of cellular and mixoid areas with traces of collagenous connective tissue, necrosis, and tiny calcifications with scattered palisading nuclei and Verocay bodies, pointed to the diagnosis of a benign tumor, i.e. neurilemmoma. Postoperatively, the patient's subjective state was excellent, with normal blood pressure values, and without pollakisuria. A very large space-occupying lesion was responsible for compression of the neighboring organs, especially urinary bladder, resulting in pollakisuria. To our knowledge, pelvic localization of neurilemmoma, particularly a large one, is rare.
Topics: Adult; Humans; Male; Neurilemmoma; Pelvic Neoplasms; Retroperitoneal Neoplasms; Urination Disorders
PubMed: 11505636
DOI: No ID Found -
Hinyokika Kiyo. Acta Urologica Japonica Apr 2001We have found steroid pulse therapy to be effective and safe for local and systemic adverse reactions of BCG therapy. Two cases are reported. Case 1: A 57-year-old woman...
We have found steroid pulse therapy to be effective and safe for local and systemic adverse reactions of BCG therapy. Two cases are reported. Case 1: A 57-year-old woman with initial recurrence of urinary bladder carcinoma was treated with transurethral resection. The histopathological findings were transitional cell carcinoma (TCC), G2 > G1, pT1a. To prevent a second recurrence, she was administered Bacillus Calmette-Guerin (BCG) instillation therapy: 80 mg of BCG, (Tokyo strain) suspended in 40 ml of normal saline, instilled into her bladder weekly. After the fifth week of instillation, she was found to have a cough, sputum, edema of the eyelids, congestion of palpebral conjunctive, severe pain on micturition and pollakisuria. Although she was administered antituberculus, antibiotics and antiallergic drugs, all sign and symptoms were aggravated. Blood, urine and sputum cultures remained negative for mycobacterium. She was later diagnosed as having hypersensitive reactions against BCG and treated with steroid pulse therapy. The signs and symptoms mentioned above were decreased immediately and disappeared after a week. Case 2: A 76-year-old man with initial recurrence of urinary bladder carcinoma was treated with transurethral resection. To prevent a second recurrence, he was instilled the BCG six (6) times. Although no adverse reaction was observed, urinary cytology remained positive (class V) and small papillary tumor was detected at the dome of the bladder. Transurethral biopsy was then performed. The histopathological findings showed TCC, G3, CIS on the dome of bladder. Then he was again administered the same BCG instillation therapy. After the fifth instillation, he complained of severe pain of micturition, pollakisuria and dysuria. Although he was administered antibiotics and antiinflammatory drugs, all signs and symptoms were aggravated. Urine culture remained negative for mycobacterium. He was diagnosed as having hypersensitive reactions against BCG and was treated with two times of steroid pulse therapy. The signs and symptoms mentioned above were decreased immediately and disappeared after the second steroid pulse therapy.
Topics: Adjuvants, Immunologic; Administration, Intravesical; Aged; BCG Vaccine; Carcinoma, Transitional Cell; Female; Humans; Hypersensitivity; Male; Methylprednisolone; Middle Aged; Prednisolone; Pulse Therapy, Drug; Urinary Bladder Neoplasms
PubMed: 11411106
DOI: No ID Found -
Gan To Kagaku Ryoho. Cancer &... Apr 2001An early phase II study (dose-finding study) of amrubicin hydrochloride for superficial bladder cancer was conducted. Amrubicin was dissolved in 30 ml of physiological... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
An early phase II study (dose-finding study) of amrubicin hydrochloride for superficial bladder cancer was conducted. Amrubicin was dissolved in 30 ml of physiological saline and injected intravesically for 6 consecutive days. The drug solution was retained for 2 hours. Patients were randomly assigned to four groups, which were administered amrubicin at doses of 30, 60, 90, and 120 mg/day, respectively. Of 65 patients registered in this study, 63 were eligible and assessable for toxicities, and 55 assessable for efficacy. The response rate at each dose level was 50.0% (7PRs/14 patients) at 30 mg/day, 53.3% (8 PRs/15) at 60 mg/day, 61.5% (2 CRs + 6 PRs/13) at 90 mg/day, and 69.2% (2 CRs + 7 PRs/13) at 120 mg/day, respectively. These data suggests that the efficacy was related to the doses of amrubicin. The major toxicities were cystic irritabilities, such as micturition pain, pollakisuria and hematuria. These toxicities were related to the doses of amrubicin. Their incidence and the severity were not high compared with those reported about other anthracyclines such as doxorubicin and epirubicin. The optimal dose of amrubicin was estimated to be 90 to 120 mg/day in the intravesical treatment for superficial bladder cancer once a day for 6 consecutive days.
Topics: Administration, Intravesical; Aged; Anthracyclines; Antineoplastic Agents; Drug Administration Schedule; Female; Hematuria; Humans; Male; Middle Aged; Pain; Urinary Bladder Neoplasms; Urination
PubMed: 11329782
DOI: No ID Found -
Gan To Kagaku Ryoho. Cancer &... Apr 2001A phase I study of intravesical chemotherapy with amrubicin hydrochloride for superficial bladder cancer was conducted. Amrubicin was dissolved in 30 ml of physiological... (Clinical Trial)
Clinical Trial
A phase I study of intravesical chemotherapy with amrubicin hydrochloride for superficial bladder cancer was conducted. Amrubicin was dissolved in 30 ml of physiological saline and injected intravesically on 6 consecutive days. The drug solution was retained for 2 hours. The starting dose was 60 mg/day, and the dose was escalated to 150 mg/day in 30 mg/day increments. Fifteen patients were entered into this study, of whom 14 were eligible and assessable for toxicity, and 13 were assessable for efficacy. The incidence and severity of cystic irritabilities such as micturition pain, pollakisuria and hematuria were related to the doses of amrubicin. At 150 mg/day, one of three patients experienced grade 3 micturition pain and pollakisuria. The dose-limiting toxicities, therefore, were micturition pain and pollakisuria, and the maximal tolerated dose was estimated to be 150 mg/day, considering that none of the three patients could retain the drug solution for 2 hours. One complete response and four partial responses were obtained in 13 assessable patients, and the overall response rate was 38.5%. A breakdown according to the doses was as follows. One PR of 3 patients were achieved at 60 and 90 mg/day, respectively 2 PRs of 5 patients at 120 mg/day, and one CR of 2 patients at 150 mg/day.
Topics: Administration, Intravesical; Aged; Anthracyclines; Antineoplastic Agents; Drug Administration Schedule; Female; Hematuria; Humans; Male; Middle Aged; Pain; Urinary Bladder Neoplasms; Urination
PubMed: 11329781
DOI: No ID Found -
Hinyokika Kiyo. Acta Urologica Japonica Feb 2001A 81-year-old man was admitted to our department with the chief complaints of pollakisuria and difficulty in voiding. He presented with increased serum PSA level (over...
A 81-year-old man was admitted to our department with the chief complaints of pollakisuria and difficulty in voiding. He presented with increased serum PSA level (over 100 ng/ml). We performed biopsy of the prostate and found a moderately differentiated adenocarcinoma. Various urological examinations showed metastases to paraaortic lymph nodes and systemic bones. He was started-on hormonal therapy. Nine months from the start of hormonal therapy, this therapy was effective and the serum PSA level was decreased to 14 ng/ml. Thereafter, the serum PSA level and the tumor volume were increased and he died 29 months from the start of treatment. The autopsy revealed small cell carcinoma with adenocarcinoma of the prostate.
Topics: Aged; Carcinoma, Small Cell; Humans; Lymphatic Metastasis; Male; Prostatic Neoplasms
PubMed: 11280883
DOI: No ID Found