Bladder (San Francisco, Calif.)最新文献

Objectives: The objectives of the study are to evaluate the oncological and functional outcomes of three bladder preservation regimens: radiotherapy alone (RT-alone group), concurrent chemoradiotherapy (CRT) using gemcitabine plus platinum (GP-RT group), and low-dose gemcitabine (LD-Gem-RT group) for muscle-invasive bladder cancer.

Methods: The three oncological outcomes, bladder-intact distant metastasis-free survival (BI-DMFS), cancer-specific survival, and overall survival (OS), were compared among RT alone (n = 10), GP-RT (n = 16), and LD-Gem-RT (n = 11) groups. Treatment-related adverse events were evaluated against the Common Terminology Criteria for Adverse Events (version 5.0). In the LD-Gem-RT group, time-course changes in the domains and scales related to the quality of life were evaluated by utilizing three questionnaires.

Results: Age was significantly higher in the RT alone group (84 ± 7.2 years old) than in the GP-RT (74 ± 9.0) and LD-Gem-RT (75 ± 6.7) groups (P = 0.016). At a median follow-up of 26 months, the 2-year BI-DMFS rates were 80, 81, and 55% in the RT alone, GP-RT, and LD-Gem-RT groups, respectively, and the 2-year OS rates were 69, 62, and 81%, respectively. In the CRT groups, only the baseline CRP ≥ 1.0 mg/dL was associated with poor survival outcomes. Common early-onset adverse events included diarrhea, urinary frequency, and hematotoxicity. A questionnaire survey in the LD-Gem-RT group revealed patients experienced significant deterioration in the global health status/quality of life and the physical component summary score.

Conclusion: We reported the oncological and functional outcomes of bladder preservation therapy using three different regimens, yielding acceptable outcomes.

Background: Photobiomodulation (PBM) may stabilize autonomic neural drive from the pontine micturition Center to the urinary bladder in individuals with overactive bladder (OAB) symptoms.

Methods: A safety profile study preceded a single-case experimental design with repeated measures across subjects to establish the safety and effect direction of PBM to modify symptoms in patients with OAB.

Results: No adverse events occurred with PBM, specifically blood pressure remained unchanged. Urinary frequency improved significantly during the intervention and at follow-up. PBM therapy was associated with a meaningful impact on OAB-related quality of life and a small to medium-to-high effect size on OAB symptom severity.

Conclusion: Nasal application of PBM is safe and may impact OAB symptoms. A controlled trial of PBM in patients with lower urinary tract symptoms is warranted.

Objectives: The present study aimed to investigate the susceptibility profiles of vancomycin-resistant Enterococcus isolates in urine culture to create an antibiogram to guide selection of oral antimicrobials in British Columbia (BC), Canada.

Methods: An audit was conducted on all urine cultures reported from January 1, 2021, to December 31, 2023, in LifeLabs BC microbiology laboratories. Enterococcus species in urine were routinely tested with ampicillin, ciprofloxacin, nitrofurantoin, tetracycline, and vancomycin. Linezolid and fosfomycin were tested in selected cases.

Results: Three hundred and thirty-five vancomycin-resistant Enterococcus faecium, 47 vancomycin-resistant Enterococcus faecalis, 48 Enterococcus gallinarum, 25 Enterococcus casseliflavus, and no Enterococcus flavescens isolates were reported in urine culture. Vancomycin-resistant E. faecium isolates were >90% susceptible to linezolid, but <15% susceptible to ampicillin, ciprofloxacin, nitrofurantoin, and tetracycline. Vancomycin-resistant E. faecalis isolates were >90% susceptible to ampicillin, linezolid, and nitrofurantoin, but <10% susceptible to ciprofloxacin and tetracycline. E. casseliflavus isolates were >90% susceptible to ampicillin, nitrofurantoin, and tetracycline. E. gallinarum isolates were >90% susceptible to ampicillin and nitrofurantoin. In the seven and 263 selected cases of vancomycin-resistant E. faecium and E. faecalis, respectively, fosfomycin susceptibility rates were 57% and 86%, respectively.

Conclusions: Ampicillin and nitrofurantoin may be considered for urinary tract infections secondary to vancomycin-resistant E. faecalis, E. casseliflavus, and E. gallinarum. Tetracycline may also be considered for E. casseliflavus. Linezolid remained to be the only reliable oral antimicrobial for vancomycin-resistant E. faecium.

Background: Bladder cancer (BC) is an aggressive disease that begins in the cells lining the bladder, which grows abnormally due to mutations. One of the aggravating factors during treatment is the nutritional risk, contributing to increased morbidity and mortality. Nutritional screening can be extremely important for these patients since the nutritional condition can deteriorate during treatment and due to the progression of the disease.

Objectives: This cross-sectional observational study aimed to compare the results of using the Mini Nutritional Assessment (MNA) nutritional screening tool obtained by urologists and nutritionists at our center.

Methods: The target audience were adult patients diagnosed with BC. They were followed up at the urology outpatient clinic and were asked to answer the questions in the short version of MAN during a nutritional screening conducted by a medical team, and later answer the questions contained in the full version of the instrument during a nutritional consultation by nutritionists. The data were analyzed and organized by employing a RedCap database. Statistical analysis of data was performed using the SPSS software package. For comparison between continuous variables, the Mann-Whitney U-test and Student's t-test were utilized. For analyses of the categorical variables, the Wilcoxon Matched Pairs test and the Cohen Kappa test were used. A significance level of 5% (P ≤ 0.05) with a confidence level of 95% was set for all statistical tests.

Results: A total of 46 patients were evaluated. The medical team identified 18 (39.1%) with normal nutritional status, while the nutrition team identified 13 (28.3%). In comparison, the use of the full version of the MNA administered by the nutrition team found that 32 (69.6%) patients were at nutritional risk. Individual questions of the short-version MNA were also compared between the two groups and the Wilcoxon Matched Pairs test was performed. The short-version MNA was found to be an excellent screening tool. When applied by a urologist, it yielded a sensitivity of 87.5% (P = 0.87) and a sensitivity of 93.7% (P = 0.76) when used by the nutritionist. A raw match rate was 71.7% achieved by both questionnaires, and the Cohen Kappa test showed that the agreement was moderate, with an agreement rate of 77.9% (k = 0.50).

Conclusion: The application of short-version MNA has a high sensitivity. However, the full-version MNA is necessary for nutritional screening to improve the sensitivity of the assessment and to serve as a guide for nutritionists and the multidisciplinary care team.

Introduction: Bladder pain syndrome/Interstitial cystitis (BPS/IC) is clinically of diverse types because different causes contribute to the development of their symptoms. It is important to classify patients into various groups based on the possible etiopathogenesis of their condition. Treatment may be tailored to each specific group according to the possible cause.

Methodology: Twenty-five patients diagnosed with BPS/IC were categorized into four different clinical phenotypes (CP) based on their history of symptoms, allergy, dysfunctional voiding, neuropathic pain, and the presence of Hunner's ulcer. Some patients could be classified into multiple groups. The patients were given oral pentosan polysulfate, and treatment specific to their CP. Patients in CP1, CP2, and CP3 groups received, respectively hydroxyzine, clonazepam, and amitriptyline. Patients with Hunner's lesions (HL) (CP4) underwent hydro distension and ablation of the lesion, followed by intravesical instillation of heparin and hydrocortisone. The patients were evaluated using the Apollo clinical scoring (ACS) system and their clinical scores were recorded at 1, 3, and 6 month(s).

Results: Among the 25 patients, 5, 7, 4, and 9 patients were classified into CP 1 - CP4 groups respectively, and were all subjected to ACS assessment. In CP1 group (allergy group), 80% (4/5) of patients responded well to the treatment and 20% (1/5) had unsatisfactory responses. In CP2 group (dysfunctional voiding group), 71.42% (5/7) patients had good, and 28.57% (2/7) had excellent responses. In CP3 group (neuropathic pain group), 28.57% (3/4) patients had excellent, and 75% (1/4) patients had good responses. In CP4 group (HL group), 33.33% (3/9) patients had unsatisfactory, 44.44% (4/9) achieved good, and 22.22% (2/9) had excellent responses. Overall, 16% (4/25) patients had unsatisfactory, 56% (14/25) attained good, and 28% (7/25) had an excellent response at the completion of the study.

Conclusion: Using clinical phenotyping-based features indicative of etiology could potentially improve treatment outcomes by targeting the specific pathological processes contributing to the patients' symptoms.

Bladder dysfunction represents a frequent and important clinical problem in stroke patients. The aim of this narrative review was to explore the currently available information regarding the diagnosis and management of bladder dysfunction following stroke. The most common symptoms of bladder dysfunction following stroke are urinary incontinence, urgency, increased frequency, and difficulty voiding. Medical history, including voiding diary, physical examination, and urodynamic studies are useful in establishing diagnosis. Bladder pressure in stroke patients with detrusor overactivity is rarely high enough to damage the upper urinary tract. In neurogenic bladder, however, there is always a risk for transmission of intravesical pressure to the upper tract. In incontinent patients, urodynamic studies can reveal bladder hyper- or hyporeflexia, detrusor overactivity with impaired contractility or detrusor-sphincter dyssynergia, or even no abnormalities at all. With stroke patients with urinary dysfunction, establishing a proper diagnosis is of paramount importance to start appropriate treatment, prevent upper tract damage, maintain continence, and ensure complete emptying. After diagnosis, an individually tailored treatment plan is mandatory, including behavioral techniques, lifestyle interventions, and anticholinergic medication. Other therapeutic choices include alternative drugs, intradetrusor injection of botulinum toxin, and spinal neuromodulation. A bladder rehabilitation program is essential for improving post-stroke lower urinary symptoms and depends on the patient's awareness, cooperation, and independence. Bladder dysfunction after stroke, as a strong prognostic factor of disability, exerts an enormous impact on health and economy. Therefore, every single effort toward a proper diagnosis and effective rehabilitation is crucial.

Urothelial carcinoma (UC) refers to the malignancies originating from transitional epithelium located on the upper and lower urinary tract. Precise diagnosis of UC is crucial since it dictates the treatment efficacy and prognosis of UC patients. Conventional diagnostic approaches of UC mainly fall into four types, including liquid biopsy, imaging examination, endoscopic examination, and histopathological assessment, among others, each of them has contributed to a more accurate diagnosis of the condition. Therapeutically, UC is primarily managed through surgical intervention. In recent years, minimally invasive surgery (MIS) has been incrementally used and is showing superiority in terms of lowered perioperative morbidity and quicker recovery with similar oncological outcomes achieved. For advanced UC (aUC), medical therapy is dominant. While platinum-based chemotherapies are the standard first-line option for aUC, some novel treatment alternatives have recently been introduced, such as immune checkpoint inhibitors (ICIs), targeted therapies, and antibody-drug conjugates (ADCs). ADCs, a group of sophisticated biopharmaceutical agents consisting of monoclonal antibodies, cytotoxic payload, and linker, have been increasingly drawing the attention of clinicians. In this review, we synthesize the recent developments in the precise diagnosis of UC and provide an overview of the treatment options available, including MIS for UC and emerging medications, especially ADCs of aUC.

The incidence of upper tract urothelial carcinoma (UTUC) has been on the rise and the malignancy is more commonly managed surgically as higher proportions of in situ disease are being detected. One challenge facing urologists is the high rate of post-treatment intravesical recurrence (IVR) of UTUC (23 - 50%). Genomic research indicated that cells of recurrent bladder lesions are most often clonally derived from the primary UTUC and are likely to seed into the bladder after tumor manipulation. This calls for effective strategies to prevent the spread of UTUC. The methods we discuss here are the use of a ureteral access sheath during diagnostic ureteroscopy, application and timing of intravesical chemoprophylaxis, early ureteral ligation distal to UTUC, and formal bladder cuff excision. Urologic surgeons should aim to achieve a reduced rate of IVR when applying these techniques.

Background: Bladder cancer is among the most lethal urinary system cancers across the globe. Macrophage 1 and Macrophage 2 play an essential role in the pathogenesis of tumors. Nevertheless, prior studies failed to investigate the implication of the two cells, working in combination, in the development, growth, progression and metastasis of bladder cancer.

Methods: We computed the M1/M2 ratio of the samples retrieved from The Cancer Genome Atlas (TCGA) by using the Cibersortx algorithm and calculated the ratio in 32 patients in our series by employing flow cytometry. SurvivalRandomForest was utilized to reduce the dimension of the list of the M1/M2-related genes, with an aim to obtain the most survival-predictive gene (EMP1) encoding epithelial membrane protein 1 (EMP1). The EMP1 was biologically characterized by using Gene Set Enrichment Analysis (GSEA), Gene Set Variation Analysis (GSVA), and Gene Ontology (GO). The single-cell transcriptome (sc-RNA) analysis was then applied to further look into the function of EMP1. Finally, Cellchat was employed to examine the interaction between macrophages and epithelium cells.

Results: The results showed that higher M1/M2 ratio was found to be associated with a more favorable prognosis of bladder cancer. EMP1 was identified to be the key gene indicative of M1/M2 ratio and higher EMP1 expression was associated with poor prognosis. Further analyses showed that EMP1 might promote tumor invasion and metastasis via epithelial-mesenchymal transition (EMT) and focal adhesion (FA). Moreover, the expression level of EMP1 could serve as an indicator of immunotherapy efficacy. The scRNA-seq data indicated that EMP1 in cancer cells was strongly associated with tumor proliferation. Finally, the Cellchat results exhibited that EMP1 might promote the interaction between macrophages and cancer cells through the fibronectin 1-syndecan 1 (FN1-SDC1) pathway.

Conclusion: Our study identified EMP1, an M1/M2-related gene, the expression of which may act as a prognostic indicator for the proliferation, metastasis, and response to immunotherapy. EMP1 might be involved in the regulation on M1/M2 ratio.

Urothelial carcinoma (UC) represents a common malignancy of the urinary system that can involve the kidneys, ureter, bladder, and urethra. Advanced/metastatic UC (mUC) tends to have a poor prognosis. UC ranks third in terms of human epidermal growth factor receptor 2 (HER2) overexpression among all tumors. However, multiple studies found that, unlike breast cancer, variable degrees of HER2 positivity and poor consistency between HER2 protein overexpression and gene amplification have been found. Trials involving trastuzumab, pertuzumab, lapatinib, afatinib, and neratinib have failed to prove their beneficial effect in patients with HER2-positive mUC, and a clinical trial on T-DM1 (trastuzumab emtansine) was terminated prematurely because of the adverse reactions. However, a phase II trial showed that RC48-ADC was effective. In this review, we provided an in-depth overview of the advances in the research regarding HER2-targeted therapy and the role of HER2 in mUC. Furthermore, we also discussed the prospects of potential strategies aimed at overcoming anti-HER2 resistance, and summarize the novel anti-HER2 approaches for the management of mUC used in recent clinical trials.