Bladder (San Francisco, Calif.)最新文献

Background: Non-muscle invasive bladder cancer is commonly treated by Bacillus Calmette-Guérin (BCG) therapy, but its efficacy is limited. Research into recombinant BCG (rBCG) aims to enhance its effectiveness and minimize side effects through genetic modifications.

Objective: This review explored advancements in rBCG therapy (2015 - 2024), focusing on genetic modifications designed to enhance cytokine production, introduce bacterial effectors, and boost immune responses. It also discusses future research on alternatives such as Mycobacterium smegmatis for safety concerns and integrating rBCG with other therapies to improve patient outcomes.

Conclusion: While rBCG therapies offer promising potential, overcoming translational challenges entails interdisciplinary endeavor to address the issues of safety, cost, and accessibility, and ultimately maximize their benefits for bladder cancer patients.

Background: The combination of immune checkpoint inhibitors and radiotherapy (RT) is emerging as a promising therapeutic approach for advanced bladder cancer. However, clinical evidence of the abscopal effect in this context is still limited.

Case presentation: Presented here is a 61-year-old female with high-grade urothelial carcinoma who had initially undergone chemotherapy, followed by treatment with atezolizumab (an anti-programmed death-ligand 1 antibody). Due to disease progression and symptoms, she received palliative RT alongside continued immunotherapy. Post-RT staging scans showed a significant reduction in the size of the bladder mass and a marked improvement in the patient's quality of life. Although this case did not demonstrate a definite abscopal effect, it underscores the potential benefits of combining immunotherapy and RT.

Conclusion: The observed outcomes suggest that this combination can effectively manage advanced bladder cancer, highlighting the need for further research to refine and optimize these treatment strategies.

Background: The bladder represents one of the genitourinary organs most vulnerable to iatrogenic injuries. Ideal repair can be challenging and may require augmentation to fully preserve bladder structure and function. The omentum has been employed as a flap or graft to close bladder defects.

Objective: This study presented a novel approach involving a complete omental wrap for repairing a small-capacity, irreparably damaged bladder following cystotomy in a complex transvesical vesicouterine fistula repair.

Methods: Salvage repair was performed on a severely damaged bladder that had resulted from a chronic vesicouterine fistula, using an omental wrap for augmentation. The omental wrap fully enclosed the bladder to enhance its recovery. The patient had an uneventful post-operative recovery, and follow-up cystography showed a small-capacity bladder with no leakage. Extended follow-up demonstrated resolution of the patient's symptoms and an improvement in bladder capacity.

Results: This was the first documented application of the omentum as a complete wrap to support an irreparable bladder. The omentum's mechanical and anti-inflammatory properties provided significant support, leading to a rapid and complete healing of a bladder that initially appeared to have an unfavorable outcome due to extensive inflammation.

Conclusion: The use of omental wrap for bladder repair leverages the omentum's unique properties to support and augment challenging repairs, resulting in outstanding outcomes and expedited restoration in what would be considered a poor outcome procedure.

Background: Urethral stricture is characterized by long-term scarring and narrowing of the urethral canal caused by acute trauma, inflammation, or medical procedures, such as urethral instrumentation or surgery. Despite the widespread use of both buccal and lingual mucosal grafts (LMG) in urethroplasty, few prospective studies have directly compared their surgical outcomes and donor site morbidity. This study aims to fill that gap.

Objective: This study compares the use of buccal and LMG in managing anterior urethral stricture with surgical outcomes and donor site morbidity evaluations.

Methods: This case-control comparative study was conducted at Ain Shams University Hospital. Patients who attended the urology outpatient clinic, presenting with lower urinary tract symptoms secondary to stricture anterior urethra and underwent surgical management by urethroplasty with a dorsal onlay technique, were selected as cases.

Results: No statistically significant differences were observed between the studied groups regarding age, smoking status, comorbidities, related urinary conditions, or the presence of a urinary catheter. In addition, the groups had no significant differences concerning stricture characteristics, graft details, or operation specifics. Similarly, general and urethral outcomes showed no statistically significant variation between the groups. Problems with drinking, soft food consumption, solid food consumption, dysgeusia, and speaking were significantly less frequent in the buccal mucosal graft (BMG) group than in the LMG group. In contrast, oral tightness was significantly more frequent in the BMG group than in the LMG group.

Conclusion: The study concluded that buccal and LMG effectively repair anterior urethral stricture, showing similar success rates. However, LMG patients experience earlier oral complications, while BMG patients face more long-term oral tightness, making graft choice dependent on patient-specific tolerances.

Background: Bladder cancer (BLCA) remains a prevalent and complex malignancy characterized by significant heterogeneity. Treatment strategies are diverse, based on patient characteristics and cancer stage. Early identification of biomarkers is crucial for improving diagnosis, staging, and treatment planning. These biomarkers offer valuable insights into lesion features, tumor differentiation, and disease progression, thereby playing a pivotal role in the personalized management of BLCA.

Objective: This study investigated the expression of cancer-testis antigens SPEF1 and SPEF2 in BLCA using comprehensive bioinformatic analyses to assess their potential as biomarkers.

Methods: The UALCAN database, based on The Cancer Genome Atlas datasets, was employed to compare SPEF1 and SPEF2 expression levels in normal bladder tissues and BLCA samples. In addition, the Kaplan-Meier Plotter, OncoDB, and TIMER 2.0 platforms were utilized to evaluate the prognostic and immunotherapeutic relevance of these antigens.

Results: The findings suggest that SPEF1 and SPEF2 are integral to various biological processes driving BLCA onset and progression. Both genes appear to facilitate BLCA cell progression and migration, contributing to poor prognosis through specific pathways and by altering tumor microenvironment. Notably, SPEF1 expression was significantly upregulated in BLCA tissues compared to normal tissues. Conversely, higher SPEF2 expression was associated with longer overall survival and positively correlated with immunotherapeutic targets.

Conclusion: Although these results were derived from in silico analyses, they offer insights into the potential roles of SPEF1 and SPEF2 as biomarkers. Further studies are warranted to validate these biomarkers in retrospective patient cohorts to establish their clinical utility.

Background: Intravesical Bacillus Calmette-Guérin (BCG) is the standard treatment for intermediate-risk, high-grade, and high-risk non-muscle invasive bladder cancer (NMIBC). However, it is associated with adverse effects, potentially causing treatment interruptions or discontinuation.

Objectives: This study analyzed the tolerability and efficacy of induction BCG, with associated patient- and disease-related factors.

Methods: A retrospective analysis was conducted on BCG-naive patients diagnosed with high-grade NMIBC, who received induction BCG at our institution between 2011 and 2021. Tolerability was defined as the completion of a 6-week induction course of BCG without treatment interruption or discontinuation. Multivariable logistic regression was performed to determine risk factors associated with the inability to tolerate treatment.

Results: Induction BCG was given to 203 NMIBC patients, where 147 (72%) patients tolerated the treatment. Treatment interruptions occurred in 44 (22%) patients, while 12 (5.9%) patients discontinued the treatment. The median length of interruption was 1 week, primarily due to concerns about urinary tract infection (UTI) (n = 18, 41%) or gross hematuria (n = 5, 11%). No significant difference in 1-year recurrence rates was observed between those who tolerated BCG and those who did not (50% vs. 48%). Risk factors associated with the inability to tolerate induction BCG included male sex (odds ratio [OR] = 5.76, p < 0.01), hypertension (OR = 3.47, p = 0.02), and low pre-treatment hemoglobin levels (OR = 0.73, p = 0.03).

Conclusion: Inability to tolerate BCG occurred in 28% of patients, with 5.9% experiencing discontinuation. Interruptions were short, mostly concerning UTI, and rarely leading to discontinuation. Poor tolerability was associated with male sex, hypertension, and low pre-treatment hemoglobin levels, highlighting critical targets for reducing the risk of BCG interruption or discontinuation.

Background: Bladder pathophysiology encompasses a wide array of disorders, including bladder cancer, interstitial cystitis, overactive and underactive bladder, and bladder outlet obstruction. It also involves conditions such as neurogenic bladder, bladder infections, trauma, and congenital anomalies. Each of these conditions presents unique challenges for diagnosis and treatment. Recent advancements in artificial intelligence (AI) have shown significant potential in revolutionizing diagnostic methodologies within this domain.

Objective: This review provides an updated and comprehensive examination of the integration of AI into the diagnosis of bladder pathophysiology. It highlights key AI techniques, including machine learning and deep learning, and their applications in identifying and classifying bladder conditions. The review also assesses current AI-driven diagnostic tools, their accuracy, and clinical utility. Furthermore, it explores the challenges and limitations confronted in the implementation of AI technologies, such as data quality, interpretability, and integration into clinical workflows, among others. Finally, the paper discusses future directions and advancements, proposing pathways for enhancing AI applications in bladder pathophysiology diagnosis. This review aims to provide a valuable resource for clinicians, researchers, and technologists, fostering an in-depth understanding of AI's roles and potential in transforming bladder disease diagnosis.

Conclusion: While AI demonstrates considerable promise in enhancing the diagnosis of bladder pathophysiology, ongoing progresses in data quality, algorithm interpretability, and clinical integration are essential for maximizing its potential. The future of AI in bladder disease diagnosis holds great promise, with continued innovation and collaboration opening the possibility of more accurate, efficient, and personalized care for patients.

Background: Urodynamic study (UDS) is essential for assessing lower urinary tract function, but quality control methods remain limited. Statistical process control (SPC), a tool originally developed in manufacturing, has shown promise in healthcare for improving quality and reducing variability.

Objective: This study explored the application of SPC to analyze the typical value ranges (TVR) of urodynamic measurements.

Methods: A total of 84 urodynamic traces that met all inclusion criteria were included for analysis. We recorded the TVR for initial intravesical pressure (P_ves), initial abdominal pressure (P_abd), and initial detrusor pressure (P_det) from each enrolled UDS trace. These data were then compared with the standard TVR. In addition, we used the X-bar and S control charts of SPC for process performance analysis.

Results: The study included 20 females and 64 males, with an average age of 58.02 ± 16.09 years. Of the participants, 32 were diagnosed with neurogenic bladder dysfunction, and 52 were diagnosed with non-neurogenic bladder dysfunction. The average TVR for initial P_ves was 34.81 ± 10.78 cmH₂O, P_abd 30.92 ± 11.14 cmH₂O, and P_det 4.20 ± 3.73 cmH₂O. We further analyzed the data using scatter plots. In the X-bar control chart, the control limit (CL) was 22.48, the upper CL (UCL) was 32.04, and the lower CL (LCL) was 12.92. In the S control chart, the CL was 15.78, the UCL was 22.57, and the LCL was 8.9. Two cases exceeded the UCL in the X-bar control chart, and one case exceeded the UCL in the S control chart.

Conclusion: The clinical value of SPC in the quality review of UDS has been confirmed in previous studies. In this study, we preliminarily verified the use of SPC for continuous variable data, such as the TVR of UDS parameters. The results of this study need to be further validated in a larger sample size, multi-center, and prospective study.

Background: The disrupted gut microbiome has been found to be implicated in the development of interstitial cystitis/bladder pain syndrome (IC/BPS). Pentosan polysulfate (PPS) is an oral medication used for treating IC/BPS, acting as both an anti-inflammatory agent and a bladder barrier protector. However, the precise mechanisms by which the PPS-mediated modulation of the gut microbiome alleviates IC/BPS are not fully understood.

Objective: This study aimed to identify the key gut microbiota species and metabolites involved in PPS's protective effects against IC/BPS.

Methods: We employed a multifaceted approach, including 16S rDNA gene sequencing, antibiotic treatment, and fecal microbiota transplantation, to validate the dependency of PPS's protective effects on the gut microbiome. Furthermore, we performed a comprehensive metabolomic profiling using non-targeted metabolomics and liquid chromatography-tandem mass spectrometry.

Results: PPS significantly elevated the abundance of the xylan-degrading bacteria, Eubacterium xylanophilum group, which, through its interaction with the gut microbiome, markedly reduced inflammation and barrier damage induced by cyclophosphamide in IC/BPS. In addition, PPS significantly increased the level of ursodeoxycholic acid (UDCA), a secondary bile acid, demonstrating a strong correlation with the abundance of the E. xylanophilum group. Ex vivo supplementation with UDCA mitigated lipopolysaccharide-induced inflammation and barrier disruption in SV-HUC-1 cells by activating the TGR5 receptor.

Conclusion: PPS exerts its protective effects against IC/BPS by modulating the gut microbiome and its metabolites.

Background: Hyaluronic acid (HA) instillation has emerged as a potential alternative treatment for Bacillus Calmette-Guérin (BCG)-induced cystitis, a common complication of BCG intravesical therapy for non-muscle-invasive bladder cancer (NMIBC). BCG-induced cystitis presents with symptoms similar to bacterial infections, such as urinary urgency, frequency, and pain. Conventional treatments, such as BCG discontinuation, antibiotic therapy, and corticosteroid use, are often insufficient. HA therapy works by restoring the bladder's glycosaminoglycan layer, reducing inflammation, and promoting tissue repair.

Objectives: This narrative review assessed the efficacy and safety of HA in managing BCG-induced cystitis based on a literature search of PubMed, Google Scholar, and Cochrane databases, identifying seven relevant studies.

Conclusion: HA treatment has been associated with improvements in bladder symptoms, including reductions in pain, urgency, and frequency, as well as an increase in bladder capacity. Combination treatments with chondroitin sulfate or pirarubicin demonstrated superior outcomes compared to HA alone. While the studies reported minimal adverse effects, variability in study design, sample sizes, and follow-up durations limited the strength of the evidence. These findings suggest that HA can be safely administered to NMIBC patients alongside BCG therapy with minimal side effects and no adverse impact on treatment outcomes.