Bladder (San Francisco, Calif.)最新文献

Background: Malakoplakia is a rare granulomatous disease that commonly involves the genitourinary tract with the urinary bladder being the most frequently affected site. It is characterized by histiocytes containing distinct basophilic calcified inclusions called Michaelis-Gutmann bodies. It is believed to result from abnormally functioning macrophages, with inclusions representing calcifications around incompletely digested bacteria. Although its pathogenesis remains unknown, it is well-documented that the condition is associated with chronic urinary tract infections and immunosuppression. Grossly, it can present as soft, yellow plaques, nodules, bladder mass, or even without any visible lesion. It poses a huge diagnostic challenge as it tends to mimic malignancy.

Case presentation: Described here is an 86-year-old female with recurrent bladder malakoplakia who presented with foul-smelling urine, hematuria, and dysuria. The clinicopathological features of this rare bladder lesion are described along with a review of the literature.

Conclusion: Early identification of malakoplakia's features by pathologists is essential for effective patient management. This condition should be considered in the differential diagnosis of bladder lesions, especially when Escherichia coli is present.

Background: Bladder outlet obstruction (BOO) represents a common cause of lower urinary tract symptoms in men, frequently resulting from benign prostatic hyperplasia. Key symptoms include both obstructive and irritative urinary tract symptoms, such as dysuria, increased frequency and urgency of urination, and recurrent urinary tract infections. BOO can also cause upper urinary tract dilation (hydronephrosis), damage structure, and impair function of the bladder.

Objective: Early diagnosis of BOO is essential to the protection of kidney and bladder functions. The gold standard for diagnosing BOO is urodynamic studies (UDS), which measure detrusor pressure and urinary flow. However, UDS is an invasive test and is associated with risks for urinary tract infections, bothersome urinary symptoms, and hematuria. Given the invasiveness and discomfort associated with UDS, non-invasive diagnostic methods have been developed. Nevertheless, the main limitation of these techniques is the variability in threshold values, highlighting the need for further standardization of measurement protocols. This article reviews the current diagnostic approaches for BOO in men and explores their clinical utility.

Conclusion: Various non-invasive diagnostic methods are promising; yet, UDS remains the primary diagnostic approach.

Background: Robot-assisted radical cystectomy (RARC) has become widely adopted due to its numerous advantages, with the da Vinci robotic surgical system being the most commonly used across the globe. However, the high cost limits its broader application.

Objective: This study aimed to evaluate the safety and efficacy of performing RARC using the more economical MP1000 surgical system.

Methods: In this prospective, single-center, single-blind study, 21 patients scheduled for RARC between April and June 2024 were randomly assigned to undergo surgery with either the da Vinci Si system or the MP1000 system. The primary outcome was the rate of conversion to open or laparoscopic surgery. Secondary outcomes included robotic arm installation time, total surgery duration, intraoperative complications, intraoperative blood loss, post-operative positive margin rate, length of post-operative hospital stay, and short-term post-operative complications.

Results: All surgeries were successfully completed without conversion to open or laparoscopic procedures, and no intraoperative complications related to robotic mechanical failure were observed. The robotic arm installation time was slightly longer with the MP1000 system compared to the da Vinci Si system (20.75 vs. 17.13 min, P < 0.001). There were no statistically significant differences between the two groups in surgery duration, intraoperative blood loss, post-operative positive margin rate, post-operative hospital stay, or short-term post-operative complications. In addition, there was no significant difference in National Aeronautics and Space Administration Task Load Index scores, a measure of the operator workload. The primary limitation of this study was its small sample size.

Conclusion: The study demonstrated that the MP1000 surgical system was a safe, feasible, and effective alternative for RARC, and achieved comparable outcomes to the da Vinci Si system.

Background: Ureteric stenting is a ubiquitous procedure, but it is associated with symptoms that affect psychological well-being and quality of life. While many factors are linked to worse symptomatology, some innovative modifications to the stent's structure, as well as treatments, have been studied to reduce their clinical impact. Pharmacotherapy is a well-evaluated treatment modality derived from the treatment of lower urinary tract symptoms not related to stents.

Objective: This review focuses on these pharmacological treatments. Several drug classes have been trialed to treat stent-related symptoms. Most of these studies investigated adrenoceptor modulators (both alpha-blockers and beta-3 agonists), muscarinic receptor antagonists, phosphodiesterase-5 inhibitors, as well as novel pharmacological modalities. Most trials and subsequent meta-analyses support treatment over placebo and controls, and some drugs are better at treating certain symptom domains, such as phosphodiesterase-5 inhibitors working on sexual issues. Furthermore, a combination therapy with alpha-blockers and muscarinic receptor antagonists appears to be superior to monotherapy with either of them. Treatments are also well tolerated.

Conclusion: However, initiating pharmacotherapy should be part of a shared decision-making approach that balances the severity of symptoms and the duration the stents will remain in situ against potential side effects.

Background: Migration of fixing tacks into the bladder wall is a rare complication following laparoscopic hernia repairs.

Case presentation: This report detailed an 80-year-old male who presented to the clinic with hematuria. Cystoscopy revealed a bladder calculus adherent to the bladder wall, with an underlying metallic tack. A stent snare was used to secure the edges of the tack, and a resectoscope loop was carefully used to resect and free it from surrounding mucosa.

Conclusion: This was the first case report to describe the successful removal of a metallic fixing tack from the bladder through a transurethral approach in a patient post-hernia repair.

Background: Repeated intravesical activation of protease-activated receptor-4 (PAR4) serves as a model of persistent bladder hyperalgesia (BHA) in mice, which lasts several days after the final stimulus. Spinal macrophage migration inhibitory factor (MIF) and high mobility group box 1 (HMGB1) are critical mediators in the persistence of BHA.

Objective: We aimed to identify effective systemic treatments for persistent BHA using antagonists or transgenic deletions.

Methods: Persistent BHA was induced through transurethral instillations of a PAR4-activating peptide (PAR4-AP; 100 μM, 1 h; scrambled peptide, control) under anesthesia, administered on Days 0, 2, and 4. Lower abdominal hypersensitivity was measured on Days 0-4 and 7-9. Systemic injections from Days 2-8 included ISO-1 (a MIF antagonist), ethyl pyruvate (an inhibitor of HMGB1 release), phosphate-buffered saline, or 10% DMSO (vehicle control) in C57BL/6 mice. To examine the role of HMGB1 receptors, Toll-like receptor-4 (TLR4)-null mice or systemic treatment with FPS-ZM1 (receptor for advanced glycation end product [RAGE] antagonist) were used. In addition, TIR-domain-containing adaptor-inducing interferon-β (TRIF)-null mice were tested to assess the involvement of TLR4 signaling pathways. Micturition volume and frequency were assessed on Day 9, and the bladder was histopathologically examined to assess inflammation and edema.

Results: MIF antagonism significantly reversed persistent BHA, whereas HMGB1 antagonism led to a partial reduction of persistent BHA. TLR4 deficiency or systemic administration of FPS-ZM1 significantly mitigated persistent BHA, while TRIF-deficient mice experienced a faster onset of BHA. Only MIF or HMGB1 inhibition resulted in increased micturition volume. The histopathological examination revealed no changes in inflammation or edema.

Conclusion: MIF and HMGB1, acting through TLR4 and RAGE, mediated persistent BHA, while TRIF might modulate its onset. Further exploration of downstream TLR4 signaling may uncover novel therapeutic targets for treating persistent bladder pain.

Introduction: COVID-19-associated cystitis (CAC) may arise following a COVID-19 infection and is characterized by the development of novel or worsening overactive bladder (OAB). CAC is possibly associated with bladder mucosal damage and the release of pro-inflammatory cytokines, resulting in inflammation and fibrosis of the bladder wall. Amniotic membrane (AM) has been shown to possess anti-inflammatory and anti-fibrotic properties and might potentially be beneficial for CAC. This study investigated the safety and efficacy of bladder injections of AM in CAC patients with resistant OAB symptoms.

Methods: Five CAC patients, with an average age of 73 ± 1.0 years and a median disease duration of 2.4 years, received intra-detrusor injections of 100 mg micronized AM under general anesthesia and were followed for 20 weeks. Key urodynamic measures (involuntary detrusor contraction and maximum cystometric capacity) were determined to evaluate treatment response. Quality of life (QOL) was assessed using the OAB assessment tool, and safety was analyzed.

Results: All five patients showed improved urodynamic bladder function and significantly improved QOL improvements. The improvement was evident from 4 weeks post-treatment and sustained until 12 weeks. Symptoms re-surged at 20 weeks. No safety concerns arose during the study.

Conclusion: The observed improvements in symptom scores and bladder volume parameters highlighted the promise of AM bladder injections as a viable intervention for CAC patients with refractory OAB symptoms. Comprehensive studies are needed to validate its therapeutic potential, and treatment protocol refinement is warranted to address the observed reduction in efficacy over time.

Objectives: Urinary symptoms of urgency, frequency, and pain are thought to be the result of inflammation in several bladder pathologies although the cause of these symptoms remains uncertain. Extracellular adenosine triphosphate (ATP) released from the bladder urothelium during normal bladder stretch is believed to bind to purinergic receptors on afferent nerves to signal bladder sensation. This study examined pro-inflammatory cytokines in the urine of women with detrusor overactivity (DO) with or without urinary tract infection (UTI) compared to controls and then determined the effect of pro-inflammatory cytokines on ATP signaling (release and breakdown) from the urothelium.

Methods: The urinary concentrations of interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) were determined in women with DO with or without UTI compared to female controls. The effect of pro-inflammatory cytokines (IFN-γ, TNF-α, and IL-1β) on control and hypotonic-induced ATP release using human UROtsa urothelial cells was examined, as was the effect of these cytokines on nucleotide (ATP, adenosine diphosphate and adenosine monophosphate) breakdown.

Results: Urinary concentrations of IFN-γ, TNF-α, and IL-1β were increased in women with DO and UTI. Pre-treatment of urothelial cells with individual cytokines stimulated a decrease rather than an increase in ATP release whereas pre-treatment with a cocktail of all three cytokines stimulated a small but significant increase in hypotonic-induced ATP release. Pre-treatment of urothelial cells with cytokines significantly enhanced nucleotide breakdown.

Conclusion: Using a simple cell culture model we have demonstrated that the response of the urothelium to pro-inflammatory cytokines is complex, affecting both release and breakdown of ATP.

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.