Bladder (San Francisco, Calif.)最新文献

Background: Stress urinary incontinence (SUI), characterized by involuntary urine leakage during increased abdominal pressure, is prevalent among women with multiple sclerosis (MS), significantly impacting their quality of life (QoL). Traditional treatments are less suitable for MS patients due to potential complications, highlighting the need for less invasive alternatives, that is, urethral bulking agents (UBAs) and pelvic floor muscle training (PFMT). UBAs increase urethral tissue volume, while PFMT strengthens pelvic muscles. Despite promising outcomes, their efficacy in MS-related SUI is under-researched.

Objective: This study assessed the effectiveness of UBAs and PFMT in managing SUI among female patients with MS.

Methods: This nine-month study involved 14 female MS patients with moderate SUI, who were equally divided into two groups to evaluate the effectiveness of UBAs and PFMT. UBAs were administered through injections to enhance urethral resistance, while PFMT used guided exercises to improve pelvic control. Outcomes were assessed in terms of urinary pad usage, scores of International Consultation on Incontinence Questionnaire-Short Form, and QoL metrics to evaluate reductions in incontinence and symptom severity.

Results: Both treatment groups showed significant improvement with SUI management. Daily pad usage decreased to 0-1 in both groups, with reductions in symptom severity and improvements in QoL scores. UBAs provided quicker symptomatic relief, while PFMT supported long-term management. However, two participants in the PFMT group discontinued follow-up due to MS-related complications, highlighting the challenges of maintaining adherence in progressive conditions.

Conclusion: UBAs and PFMT are effective management options for SUI in MS patients, improving symptom control and QoL. This study underscored the importance of individualized, multimodal approaches to optimize outcomes for women with MS-related SUI. Nevertheless, further research is needed for long-term validation.

Background: Among the numerous complications associated with post-coronavirus disease 2019 (COVID-19) syndrome, neurogenic lower urinary tract dysfunction (NLUTD) has been rarely reported, particularly in the pediatric population.

Case presentation: This report presented three pediatric cases of NLUTD that developed following severe acute respiratory syndrome coronavirus 2 infection, with clinical features resembling Elsberg syndrome. These cases were notable for the severity of their urinary symptoms, which required specialized and individualized bladder management strategies. This case series aims to raise awareness of this emerging clinical condition, which may be underdiagnosed in children recovering from COVID-19. Pediatricians, general practitioners, and urologists should be vigilant in considering NLUTD as a potential diagnosis in children presenting with new or unexplained urinary symptoms. Early diagnosis and timely management are crucial to address these symptoms effectively and prevent potential complications, such as irreversible upper urinary tract damage or long-term bladder dysfunction.

Conclusion: Further investigations are warranted to clarify the pathophysiological mechanisms underlying post-COVID-19 NLUTD. Moreover, long-term follow-up studies are needed to better understand the natural history and implications of this condition in the pediatric population, as well as to develop effective strategies for prevention and treatment.

Background: Transurethral resection of bladder tumor is associated with some limitations when used in the diagnosis and treatment of non-muscle invasive bladder cancer.

Objectives: This study explored the application of needle electrodes in the transurethral resection of single bladder tumor (SBT) and highlighted the advantages of en bloc resection of bladder tumors.

Methods: A retrospective analysis was conducted on 79 patients with SBT treated at the Department of Urology, People's Liberation Army General Hospital, from January to December 2023. Among the patients, 64 (81.0%) were male, and 15 (19.0%) were female, with a mean age of 62.6 years. Among the patients, 68 (86.1%) had primary tumors, 11 (13.9%) had recurrent tumors, and 2 (2.5%) had SBTs following upper urothelial carcinoma radical resection. All patients underwent transurethral resection of bladder tumors using needle electrodes.

Results: All procedures were successfully completed. The mean operation time lasted 51.0 min, and the mean blood loss was 7.9 mL. The median tumor size was 2 cm. The obturator nerve block was employed in 22 (33.8%) cases. The incidence of obturator nerve reflex was 40.9% (9/22) and 23.3% (10/43) without (p = 0.139). Post-operative complications included bladder tamponade in one patient (1.3%). The accuracy of muscle invasion reporting was 89.9%. Three patients were lost to follow-up, and two patients (2.6%) suffered from recurrence at 6 months. The median follow-up time was 13 months.

Conclusion: Needle electrode resection for SBTs was highly safe, had low complication rates, and offered accurate tumor staging, resulting in precise treatment and low postoperative recurrence.

Background: Intravesical Bacille Calmette-Guérin (BCG) therapy is a widely adopted treatment for non-muscle-invasive bladder cancer (NMIBC). Despite its extensive use, the historical origins of BCG therapy remain under-appreciated by many practitioners. Initially developed as a tuberculosis vaccine by Albert Calmette and Camille Guérin in the early 20^th century, BCG's immunomodulatory potential was later harnessed for cancer treatment. The unintended discovery of its attenuated virulence, combined with extensive subsequent research, laid the foundation for its clinical application in bladder cancer. Currently, BCG is a cornerstone treatment for NMIBC, particularly in high-risk cases, and has significantly influenced the evolution of modern immunotherapies, including checkpoint inhibitors.

Objective: This paper was written with the intent of exploring the origins of BCG and historically significant research that led to it's use and acceptance as a treatment for NMIBC while highlighting it's impact on the development of immunotherapy as a whole.

Conclusion: The BCG vaccine's journey from a tuberculosis preventive to a groundbreaking cancer treatment underscores the interconnected nature of scientific discovery and its enduring impact on modern medicine.

Background: Bladder cancer (BC) remains a significant global health concern, and its incidence is influenced by a wide array of factors, including geography, sex, and socioeconomic status.

Objective: This systematic review evaluated the potential association between pioglitazone use and the risk of BC. We sought to determine whether pioglitazone, used in diabetes management, is associated with an increased risk of BC by reviewing recent studies.

Methods: A comprehensive search was conducted in the PubMed, Scopus, and Web of Science databases for relevant studies published between January 31, 2018 and July 31, 2024. From an initial pool of 212 articles, 176 were excluded due to failure to meet the inclusion criteria, 24 were removed for inadequate data or unclear conclusions, and six were eliminated due to inaccessibility. Ultimately, six eligible studies were included in the final review.

Results: Of the included studies, two suggested a potential association between pioglitazone use and an increased risk of BC, whereas four reported no statistically significant correlation.

Conclusion: These mixed findings highlight the need for further research that accounts for confounding factors, such as treatment duration and patient demographics. This systematic review emphasizes the importance of cautious interpretation regarding the safety profile of pioglitazone in relation to BC risk.

Background: Factors predictive of the efficacy of pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) or mixed urinary incontinence (MUI) are poorly defined. Identifying these factors is crucial for guiding treatment decisions, determining training repetitions, and predicting PFMT outcomes.

Objective: This study aimed to identify clinical factors predictive of PFMT outcomes in women with primary SUI.

Methods: We retrospectively reviewed data from 188 consecutive women with either SUI (n = 90) or MUI (n = 98) with a primary stress component. All participants underwent a 3-month PFMT program. Predictive factors for 50% improvement and complete cure of incontinence were assessed through urogynecological history/examination, medical history, digital pelvic floor muscle (PFM) evaluation (n = 87), and 3-day bladder diaries. Logistic regression analyses were conducted for the overall group and separately for the SUI and MUI subpopulations.

Results: At 3 months, 10% of SUI patients and 11.2% of MUI patients achieved complete SUI cure, while 35.7% of MUI patients were free from urge urinary incontinence (UUI). A complete cure of SUI was correlated with a negative or mildly positive results of stress test (p = 0.014). For MUI patients, complete UUI cure was linked to initial digital PFM evaluation results (p = 0.003) and negative (p = 0.005) or mildly positive findings of stress tests (p = 0.003). The absence of prior surgery and digital evaluation predicted a 50% improvement in MUI (p = 0.021 and p = 0.026, respectively). Endurance improvement was related independently with >50% improvement in MUI patients (odds ratio = 3.794, p = 0.019).

Conclusion: Negative or mildly positive stress tests and digital PFM evaluation predict better outcomes with PFMT. Further prospective studies are needed to validate these findings.

Background: Radical cystectomy (RC) for bladder cancer is associated with substantial postoperative complications. Among these complications, venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is particularly notable for its morbidity. Efforts to reduce VTE have been largely revolving around extended thromboprophylaxis (ETP) after discharge, typically with injectable heparins, and, more recently, with oral anticoagulants.

Objective: The purpose of this study was to quantify the incidence of VTE within 90 days following RC and to identify risk factors associated with its development.

Methods: We conducted a retrospective review of all patients who underwent RC for bladder cancer at our institution between 2012 and 2024, documenting instances of postoperative VTE. Data on demographics, anticoagulation therapy, surgical approach, and hospitalization were collected and analyzed.

Results: A total of 372 patients received RC for bladder cancer during the study. Of them, 12 patients (3.2%) developed VTE at some point after surgery. The median time to VTE occurrence was between 31 and 90 days post-discharge. A higher rate of VTE was observed immediately following RC in patients who underwent surgery before 2018 (p = 0.021), the year in which enhanced recovery after surgery (ERAS) protocols were implemented. Demographic factors and operation-related variables did not influence the VTE rate (p > 0.05). Kaplan-Meier analysis revealed that cancer-specific survival was significantly lower in patients who developed VTE after RC compared to those who did not (p < 0.001).

Conclusion: These findings underscored the importance of interventions such as ETP and ERAS protocols in reducing the incidence of VTE following RC for bladder cancer.

Background: Urinary tract infection, defined as the presence of bacteria or yeast in the urinary tract, is the most common community-acquired infection after respiratory infections. The cytobacteriological examination of urine (CBEU) remains the primary diagnostic test for urinary tract infections and is the most frequently conducted test in microbiology laboratories. Direct examination is a crucial step of CBEU, enabling the assessment of cytology, including leukocytes and red blood cells, as well as the identification of crystals, epithelial cells, and microorganisms when present in significant quantities. This examination also provides preliminary results that can guide clinical decision-making. While the standard method for urine cytology is a microscopic examination, automation offers several advantages, including standardized results with higher repeatability, improved reproducibility, increased sample throughput, and seamless data transfer to laboratory information systems.

Objectives: This study aimed to compare the performance of two automated urine cytology systems: Sysmex UF-1000i and the Beckman Coulter DxU 850 Iris.

Methods: We described the methodology and technology underlying each system and assessed their analytical performance. The UF-1000i uses flow cytometry for the objective characterization and identification of particles based on forward scattering, fluorescence, and adaptive typing analysis. In contrast, the DxU-850 Iris, a urine microscopy analyzer, employs proprietary digital flow morphology technology alongside automatic particle recognition software to isolate, identify, and characterize digital images of particles.

Conclusion: Our comparison showed that both systems performed exceptionally well, delivering results that are comparable, and, in some cases, superior to, those obtained through the reference method of optical microscopy.

Background: The urethral wall consists of layers of striated muscle, circular and longitudinal smooth muscles, collagen fibers, and a vascular plexus. However, the relative contributions of these components to urethral pressure in humans remain poorly understood. The circular and longitudinal smooth muscle components can develop a spontaneous contractile activity, generating a basal tone. They can further contract or relax in response to excitatory or inhibitory stimuli. Animal studies suggest that smooth muscle activity in the mid-urethra plays a crucial role in determining maximal urethral closing pressure. Notably, the highest sympathetic activity occurs in the middle segment of the female urethra during increasing smooth muscle tone. This finding is supported by human studies that did not detect any electromyographic activity from striated muscle in this region.

Objectives: This study was conducted to review the contributions of the primary structural components and control mechanisms of urethral.

Conclusion: In females, the external urethral striated sphincter is located at the distal urethra, which is not the segment associated with the highest closing pressure. Rather, the sphincter has been shown to modulate urethral pressure during exercise and physical stress. Basic science research does not support the notion that mid-urethral pressure is caused by the external striated sphincter tone in females. Instead, findings suggest that, at rest and during bladder filling, maximal urethral pressure is primarily determined by the activity of the urethral smooth muscles.

Background: Muscle-invasive bladder cancer (MIBC) is universally classified as high-grade urothelial carcinoma, precluding the use of histological grading alone for prognostication. However, specific morphological features of MIBC may provide useful information to guide treatment decisions. In the last decade, there has been increasing interest in genetic profiling of MIBC.

Objective: The aim of the study is to validate the use of Lund Classification in attributing phenotype to large series with extreme reliability and reproducibility compared to all histological sections in the clinical practice.

Methods: We performed a molecular profiling study on a large, consecutive cohort of MIBC cases using a straightforward immunohistochemical algorithm aligned with the Lund Classification.

Results: We evaluated 450 MIBC cases. In a subgroup of 103 patients, we assessed the concordance between transurethral resection of bladder tumor (TURBT) specimens and cystectomy on paired samples. Luminal tumor types showed a statistically significant association with the usual histotype, while basal and NULL types were more frequently associated with variant histotypes (p < 0.0001). A stromal lymphocytic infiltrate ≥10% was more commonly observed in basal types (p < 0.0001). Basal types also exhibited higher positive rates of human epidermal growth factor receptor-2 (HER2/neu) positivity, while luminal types were more likely to be positive for tumor suppressor protein p53. Luminal types have demonstrated longer survival compared to their basal and NULL counterparts. In the concordance analysis, tumor type assignment based on TURBT showed sensitivity, specificity, and both positive and negative predictive values of 100% for basal and NULL types. The predictive accuracy for luminal types on TURBT ranged between 89.5% and 98.2%.

Conclusion: Our findings demonstrate the feasibility of applying the Lund Classification for molecular subtyping of MIBC in routine diagnostics. The consistency in tumor type assignment between TURBT and cystectomy samples further supports the clinical utility of this approach. Tumor types significantly influenced survival outcomes, underscoring its relevance in patient stratification and personalized treatment strategies.