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Bhongir AV, Sampath S, Bonthapally RK, Gudivada KK, Ramaswamy G. Sequential Application and Post-Test Probability for Screening of Bladder Cancer Using Urinary Proteomic Biomarkers: A Review based Probabilistic Analysis. Asian Pac J Cancer Prev 2023; 24:2021-2027. [PMID: 37378932 PMCID: PMC10505882 DOI: 10.31557/apjcp.2023.24.6.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Bladder cancer is one of the most common cancers in the world, with men being affected more than women. Diagnosis by cystoscopy, cytology and biopsy is invasive. Urine cytology, a non-invasive modality is not sensitive. This study is undertaken to evaluate whether non- invasive urinary proteomic profiling is more sensitive, specific for bladder cancer. OBJECTIVE To evaluate the sensitivity and specificity of various urinary proteomic biomarkers as a screening tool for bladder cancer. METHODS PubMed database was searched from 4th December 2011 to 30th November 2021 using Mesh terms and n = 10,364 articles were found. PRISMA guidelines were followed and Review articles, animal studies, Urinary tract infections, non-bladder cancer and other irrelevant articles were excluded. All studies who have reported mean/median (SD/IQR), sensitivity, specificity, cut off values (ROC analysis) were included (n=5). Post-test probability of various biomarkers was calculated using sequential approach. Pooled analysis was depicted using Forest plot. RESULTS Analysis of diagnostic studies of bladder cancer showed the post-test probability of CYFRA21-1 was 36.6%. Using sequential approach, the panel of biomarkers CYFRA 21-1, CA-9, APE-1, COL13A1 has post-test probability of 95.10% to diagnose bladder cancer. Analysis of two observational studies with APOE (n= 447) showed non-significant increase of APO-E levels in bladder cancer cases (WMD: 66.41with 95% CI 52.70-185.51; p=0.27, I2 92.4%). CONCLUSION In patients presenting with hematuria, a panel of CYFRA 21-1, CA-9, APE-1, COL13A1 markers can be considered for screening of bladder cancer.
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Affiliation(s)
- Aparna Varma Bhongir
- Department of Biochemistry, All India Institute of Medical Sciences, Bibinagar, Telangana, India.
| | - Sangeetha Sampath
- Department of Biochemistry, All India Institute of Medical Sciences, Bibinagar, Telangana, India.
| | - Rohit Kumar Bonthapally
- Department of Biochemistry, All India Institute of Medical Sciences, Bibinagar, Telangana, India.
| | - Kiran Kumar Gudivada
- Department of Anaesthesia, All India Institute of Medical Sciences, Bibinagar, Telangana, India.
| | - Gomathi Ramaswamy
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bibinagar, Telangana, India.
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Chen JY, Zimmern PE. Vaginoscopy With Laser Treatment of Symptomatic Upper Vaginal Mesh Exposure After Prior Mesh Sacrocolpopexy. Urology 2023; 176:69-73. [PMID: 36906181 DOI: 10.1016/j.urology.2023.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To describe the technique of vaginoscopy with Holmium:YAG and Thulium laser treatment of upper vaginal mesh exposure after mesh sacrocolpopexy (MSC) as well as evaluate treatment efficacy. METHODS Following IRB approval, a chart review of all patients who underwent laser treatment of upper vaginal mesh exposure during vaginoscopy at a single institution between 2013 and 2022 was performed. Demographic information, previous mesh placement history, presenting symptoms, physical examination and vaginoscopy findings, imaging, laser type and settings, operating time, complications, and follow-up including examination and office vaginoscopy findings were extracted from electronic medical records. RESULTS Five patients and 6 surgical encounters were identified. All patients had a history of MSC and symptomatic mesh exposure at the vaginal apex, which was tented up and difficult to access by traditional transvaginal mesh excision. Five patients underwent vaginal mesh treatment with laser with no further vaginal mesh exposure on follow-up exam or vaginoscopy. One patient was found to have a small recurrence at 4 months and underwent a second treatment with negative findings on vaginoscopy 7.9 months post-operatively. There were no complications. CONCLUSION Vaginoscopy using a rigid cystoscope and laser treatment of upper vaginal mesh exposure using a Holmium:YAG or Thulium laser is a safe and quick method which led to definitive symptom resolution.
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Affiliation(s)
- Jessie Y Chen
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
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Lotan Y, Raman JD, Konety B, Daneshmand S, Schroeck F, Shariat SF, Black P, de Lange M, Asroff S, Goldfischer E, Efros M, Chong KT, Huang E, Chua HL, Wu QH, Yeow S, Lau W, Yong J, Eng M. Urinary Analysis of FGFR3 and TERT Gene Mutations Enhances Performance of Cxbladder Tests and Improves Patient Risk Stratification. J Urol 2023; 209:762-772. [PMID: 36583640 DOI: 10.1097/ju.0000000000003126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Cxbladder tests are urinary biomarker tests for detection of urothelial carcinoma. We developed enhanced Cxbladder tests that incorporate DNA analysis of 6 single nucleotide polymorphisms for the FGFR3 and TERT genes, in addition to the current 5 mRNA biomarkers and clinical risk factors. MATERIALS AND METHODS Two multicenter, prospective studies were undertaken in: (1) U.S. patients with gross hematuria aged ≥18 years and (2) Singaporean patients with gross hematuria or microhematuria aged >21 years. All patients provided a midstream urine sample and underwent cystoscopy. Samples were retrospectively analyzed using enhanced Cxbladder-Triage (risk stratifies patients), enhanced Cxbladder-Detect (risk stratifies patients and detects positive patients), and the combination enhanced Cxbladder-Triage × Cxbladder-Detect. RESULTS In the pooled cohort (N=804; gross hematuria: n=484, microhematuria: n=320), enhanced Cxbladder-Detect had a sensitivity of 97% (95% CI 89%-100%), specificity of 90% (95% CI 88%-92%), and negative predictive value of 99.7% (95% CI 99%-100%) for detection of urothelial carcinoma. Overall, 83% of patients were enhanced Cxbladder-Detect-negative (ie, needed no further work-up). Of 133 enhanced Cxbladder-Detect-positive patients, 59 had a confirmed tumor, of which 19 were low-grade noninvasive papillary carcinoma or papillary urothelial neoplasm of low malignant potential. In total, 40 tumors were high-grade Ta, T1-T4, Tis, including concomitant carcinoma in situ. Of the 74 patients with normal cystoscopy, 41 were positive by single nucleotide polymorphism analysis. Enhanced Cxbladder-Triage and enhanced Cxbladder-Detect had significantly better specificity than the first-generation Cxbladder tests (P < .001). CONCLUSIONS This study in ethnically diverse patients with hematuria showed the analytical validity of the enhanced Cxbladder tests.
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Affiliation(s)
- Yair Lotan
- University of Texas Southwestern, Dallas, Texas
| | - Jay D Raman
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Siamak Daneshmand
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Florian Schroeck
- White River Junction Veteran Affairs Medical Center, White River Junction, Vermont
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, New York
- Department of Urology, University of Texas Southwestern, Dallas, Texas
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Peter Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Scott Asroff
- New Jersey Urology, Mount Laurel Township, New Jersey
| | | | | | - Kian Tai Chong
- Surgi-TEN Specialists, Farrer Park Hospital, Singapore
- PanAsia Surgery, Mount Elizabeth Novena Specialist Centre, Singapore
| | - Eugene Huang
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore
| | - Hong Liang Chua
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore
| | - Qing Hui Wu
- Department of Urology, National University Hospital, Singapore
| | - Siying Yeow
- Department of Urology, Khoo Teck Puat Hospital, Singapore
| | - Weida Lau
- Department of Urology, Khoo Teck Puat Hospital, Singapore
| | - Jin Yong
- Department of Urology, Singapore General Hospital, Singapore
| | - Molly Eng
- Department of Urology, Khoo Teck Puat Hospital, Singapore
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Natale F, Campagna G, Marturano M, Caramazza D, Panico G, Vacca L, Torcia E, Cervigni M, Scambia G, Ercoli A. Is There a Role for Bladder Biopsy in the Diagnosis of Non-Hunner Lesions Interstitial Cystitis? Urol Int 2023; 107:257-262. [PMID: 35896088 DOI: 10.1159/000525849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Bladder pain syndrome/interstitial cystitis (BPS/IC) is either Hunner lesion interstitial cystitis (HL IC) or non-Hunner lesion interstitial cystitis (N-HL IC), differing in the presence of HLs on cystoscopy. Cystoscopy is essential in diagnosing HL but are bladder biopsies useful in N-HL IC patients? Our objective was to assess bladder biopsy in patients with N-HL IC, evaluating whether the count of mast cells (MCs) and percentage of activated MCs could measure severity. MATERIALS AND METHODS This is a single-centre retrospective study. INCLUSION CRITERIA diagnosis of BPS/IC by ESSIC definition; absence of HLs. Each patient had three bladder biopsies. STATISTICAL ANALYSIS χ2/Fischer's exact test; Wilcoxon signed-ranks test/Mann-Whitney U test. Statistical significance: p < 0.05. RESULTS We separated 48 women into Group 1 with <50% of MCs activated and Group 2 with >50%. We compared the results of the O'Leary-Sant questionnaire between the two groups and did not find any correlation between the severity of the pathology and either the MC count in the detrusor or the percentage of activated MCs in the lamina propria or detrusor. DISCUSSION/CONCLUSION These findings cast doubt on the usefulness of bladder biopsy for the evaluation of severity in N-HL IC.
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Affiliation(s)
- Franca Natale
- UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambi Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Campagna
- UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambi Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Monia Marturano
- UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambi Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniela Caramazza
- UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambi Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Panico
- UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambi Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Vacca
- UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambi Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Torcia
- UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambi Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mauro Cervigni
- Department of Urology, "La Sapienza" University, ICOT-Latina, Rome, Italy
| | - Giovanni Scambia
- UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambi Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alfredo Ercoli
- PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
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Herr H. Does Antimicrobial Prophylaxis in Patients With Specific Comorbidities Reduce the Risk of Infection After Simple Cystourethroscopy? Letter. Urol Pract 2023; 10:1. [PMID: 37103455 DOI: 10.1097/upj.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Harry Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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56
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Huele EH, Veenboer PW, Wessels FJ, Jonges TN, Meijer RP. Value of multiparametric magnetic resonance imaging for local staging of invasive urinary bladder tumours. Urol Oncol 2023; 41:49.e7-49.e12. [PMID: 36441069 DOI: 10.1016/j.urolonc.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Initial tumour staging in bladder cancer mainly relies on the histo-pathological outcome of the transurethral bladder tumour resection (TURBT) and imaging by means of a CT-scan (CT-intravenous urography; CT-IVU). The reported risk of understaging varies from 24-50%. To further improve the the evaluation of depth of invasion of the bladder tumour the application of magnetic resonance imaging (MRI) may be useful. To substantiate the additional value of this imaging modality the present observational study was designed. STUDY DESIGN This is a prospective observational study to analyse bladder tumour staging with multiparametric magnetic resonance imaging (mpMRI) in patients with a known bladder tumour, who are planned for radical cystectomy. STUDY POPULATION Patients with an invasive bladder cancer who are planned for radical cystectomy. INTERVENTION Patients were accrued during their visit to the outpatient department of urology. They underwent routine cystoscopy, laboratory tests (including serum Creatinin) and CT-IVU investigations and subsequently a mpMRI. MAIN STUDY PARAMETERS/ENDPOINTS To demonstrate the value of mpMRI in the initial staging of bladder tumours using radiological bladder tumour stage (T-stage) based on mpMRI and pathological bladder tumour stage based on 'whole-mount' histo-pathology after radical cystectomy. RESULTS Thirty-seven participants with known bladder tumours underwent mpMRI and subsequent cystectomy. After mpMRI 10 participants were diagnosed with non-muscle-invasive bladder cancer (NMIBC) and 27 participants with muscle-invasive bladder cancer (MIBC). In the 'whole-mount' pathology results 12 participants had NMIBC and 25 participants had MIBC. We found a sensitivity and specificity of 0.88 en 0.58 respectively, for the evaluation of MIBC. The positive and negative predictive value were 81% and 70% respectively. The diagnostic accuracy of mpMRI to differentiate between NMIBC and MIBC was 78%. CONCLUSIONS We found a sensitivity of 88% and a specificity of 58% for mpMRI to discriminate NMIBC from MIBC.
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Affiliation(s)
- Eline H Huele
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands
| | - Paul W Veenboer
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands
| | - Frank J Wessels
- Department Radiology, University Medical Center Utrecht, The Netherlands
| | - Trudy N Jonges
- Department Pathology, University Medical Center Utrecht, The Netherlands
| | - Richard P Meijer
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands.
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Sherwood B. Does Antimicrobial Prophylaxis in Patients With Specific Comorbidities Reduce the Risk of Infection After Simple Cystourethroscopy? Reply. Urol Pract 2023; 10:1-2. [PMID: 37103460 DOI: 10.1097/upj.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Brenton Sherwood
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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58
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Galhotra S, Zeng K, Hu C, Norton T, Mahnert N, Smith R, Mourad J. The Effect of Patient Positioning on Ureteral Efflux During Intraoperative Cystoscopy: A Randomized Controlled Trial. J Minim Invasive Gynecol 2023; 30:13-18. [PMID: 36103970 DOI: 10.1016/j.jmig.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 01/11/2023]
Abstract
STUDY OBJECTIVE To identify the relationship between patient position during surgery and time to confirmation of ureteral patency on cystoscopy. DESIGN Randomized controlled trial. SETTING Academic tertiary care medical center. PATIENTS OR PARTICIPANTS A total of 91 adult women undergoing laparoscopic (either conventional or robotic) hysterectomy between February 2021 and February 2022 were randomized to intervention (n = 45) or control (n = 46). Exclusion criteria included known kidney disease or urinary tract anomaly, current ureteral stent, pregnancy, malignancy, and recognized intraoperative urinary tract injury. INTERVENTIONS Subjects in the control group were placed in a 0° supine position during cystoscopy. Subjects in the intervention group were placed in a 20° angle in reverse Trendelenburg (RT) position during cystoscopy. MEASUREMENTS AND MAIN RESULTS The primary outcome, time to confirmation of bilateral ureteral patency, was measured at the time the second ureteral jet was viewed during intraoperative cystoscopy. There was no significant difference in mean time to confirmation (66.5 seconds in supine vs 67 seconds in RT, p = .2) nor in total cystoscopy time (111 seconds in supine vs 104.5 seconds in RT, p = .39). There were no significant differences in need for alternative modalities to aid in ureteral efflux visualization, delayed diagnosis of ureteric injury, and operative time. RT position seemed to have reduced the time to confirmation for the small group of patients with longer confirmation time (>120 seconds). CONCLUSION RT position does not change time to confirmation of bilateral ureteral patency compared with supine position. However, there may be a benefit in position change if time to confirmation is >120 seconds.
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Affiliation(s)
- Sheena Galhotra
- Department of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology, Banner University Medical Center, Phoenix, Arizona (all authors).
| | - Katie Zeng
- Department of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology, Banner University Medical Center, Phoenix, Arizona (all authors)
| | - Chengcheng Hu
- Department of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology, Banner University Medical Center, Phoenix, Arizona (all authors)
| | - Taylor Norton
- Department of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology, Banner University Medical Center, Phoenix, Arizona (all authors)
| | - Nichole Mahnert
- Department of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology, Banner University Medical Center, Phoenix, Arizona (all authors)
| | - Rachael Smith
- Department of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology, Banner University Medical Center, Phoenix, Arizona (all authors)
| | - Jamal Mourad
- Department of Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology, Banner University Medical Center, Phoenix, Arizona (all authors)
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Wu YL, Li ZQ, Wu AM. The Misdiagnosis of Intravesical Ectopic Prostatic Tissue as a Tumor. Urol Int 2022; 107:738-741. [PMID: 36566749 DOI: 10.1159/000528347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Ectopic prostatic tissue is rare, and it is usually only discovered by chance during imaging examinations or surgery. However, between 1967 and 2021, reports of ectopic prostatic tissue in the medical literature increased. It is rarely reported that ectopic prostatic tissue can be misdiagnosed as a nephrogenic adenoma (NA). This case study aimed to increase the awareness of ectopic prostatic tissue to improve its rates of diagnosis. This paper is focused on a 45-year-old male patient with a history of bladder lesions that were accidentally discovered through a health examination. A computed tomography scan revealed a homogeneous isoechoic mass in the posterior inferior wall of the bladder. At first, a transurethral cystoscopy revealed a smooth sessile mass covering the normal bladder mucosa, which was located in the middle of the interureteric ridge. The biopsy results suggested a possible intravesical NA. The mass was then completely resected under pneumovesicoscopy, and the pathological diagnosis was ectopic prostatic tissue. The clinical symptoms of ectopic prostatic tissue are similar to other bladder neoplasms, but there are too few characteristics available in imaging examinations to allow for an accurate diagnosis. Since ectopic prostatic tissue can present as a tumor in the bladder, urologists may easily misdiagnose the condition. Surgery is the basis of treatment for ectopic prostatic tissue, and it has a good prognosis.
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Affiliation(s)
- Yong-Lu Wu
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Zhi-Qin Li
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Ai-Ming Wu
- Department of Urology, Maoming People's Hospital, Maoming, China
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60
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Li B, Zeng X, Luo D, Ma Y, Li H, Wang K. Rigid ureteroscopy, a neglected choice for stent removal: a randomized controlled trial to compare rigid ureteroscopy, flexible cystoscopy, and rigid cystoscopy. Chin Med J (Engl) 2022; 135:2767-2769. [PMID: 36719364 PMCID: PMC9943833 DOI: 10.1097/cm9.0000000000002242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Boya Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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61
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Affiliation(s)
- Beate Schumacher
- Springer Medizin Verlag GmbH, Aschauer Str. 30, 81549, München, Germany
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62
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Mohamed G, Ghani Z, Lynn N, Masilamani M, Rowlands J. Vesicourachal diverticulum. Ann R Coll Surg Engl 2022; 104:e255-e257. [PMID: 35446699 PMCID: PMC9685905 DOI: 10.1308/rcsann.2021.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/03/2023] Open
Abstract
We report a rare complication involving a healthy 45-year-old male patient who underwent an emergency laparoscopic appendicectomy for acute perforated gangrenous appendicitis. The patient was catheterised pre- procedure and the ports were inserted under vision. Upon completion of the procedure, a 15 Fr Robinson drain was left in the pelvis and was fed through the suprapubic port hole. Postoperatively the patient developed worsening, generalised abdominal pain and high output from the drain. The patient was re-catheterised but the computed tomography (CT) cystogram did not show any injury to the bladder. The drain fluid creatinine was noted to be raised (>4,000), indicating that urine was leaking into the drain. Conventional cystogram confirmed a contrast leak from the dome around the drain. Flexible cystoscopy confirmed that the drain had transversed the vesicourachal diverticula. The drain was pulled back and converted to a suprapubic catheter with the patient subsequently being discharged. Vesicourachal diverticula is a rare and often asymptomatic anomaly. When undertaking laparoscopic surgery, precautions should be taken to prevent port site injury such as catheterising the patient to ensure the bladder is empty and inserting the ports under direct vision. It is safer to visualise muscle rather than peritoneum during port insertion. In this case, the bladder diverticula was noticed extraperitoneally. Though the indirect CT cystogram reported no injury, this was unreliable as the bladder was not distended which led to the subtle injury being missed. Traditional cystogram should be considered in cases with a negative CT cystogram and a strong suspicion of bladder injury.
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Affiliation(s)
- G Mohamed
- Shrewsbury and Telford Hospital NHS Trust, UK
| | - Z Ghani
- Shrewsbury and Telford Hospital NHS Trust, UK
| | - N Lynn
- Shrewsbury and Telford Hospital NHS Trust, UK
| | | | - J Rowlands
- Shrewsbury and Telford Hospital NHS Trust, UK
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63
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Kong C, Zhang S, Lei Q, Wu S. State-of-the-Art Advances of Nanomedicine for Diagnosis and Treatment of Bladder Cancer. Biosensors (Basel) 2022; 12:bios12100796. [PMID: 36290934 PMCID: PMC9599190 DOI: 10.3390/bios12100796] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 06/13/2023]
Abstract
Bladder cancer is a common malignant tumor of the urinary system. Cystoscopy, urine cytology, and CT are the routine diagnostic methods. However, there are some problems such as low sensitivity and difficulty in staging, which must be urgently supplemented by novel diagnostic methods. Surgery, intravesical instillation, systemic chemotherapy, and radiotherapy are the main clinical treatments for bladder cancer. It is difficult for conventional treatment to deal with tumor recurrence, progression and drug resistance. In addition, the treatment agents usually have the defects of poor specific distribution ability to target tumor tissues and side effects. The rapid development of nanomedicine has brought hope for the treatment of bladder cancer in reducing side effects, enhancing tumor inhibition effects, and anti-drug resistance. Overall, we review the new progression of nano-platforms in the diagnosis and treatment of bladder cancer.
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Affiliation(s)
- Chenfan Kong
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Shaohua Zhang
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
- Department of Urology, The Affiliated South China Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
| | - Qifang Lei
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
- Department of Urology, The Affiliated South China Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
| | - Song Wu
- Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
- Department of Urology, The Affiliated South China Hospital of Shenzhen University, Shenzhen University, Shenzhen 518000, China
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Yang Y, Wang J, Huang W, Wan G, Xia M, Chen D, Zhang Y, Wang Y, Guo F, Tan J, Liang H, Du B, Yu L, Tan W, Duan X, Yuan Q. Integrated Urinalysis Devices Based on Interface-Engineered Field-Effect Transistor Biosensors Incorporated With Electronic Circuits. Adv Mater 2022; 34:e2203224. [PMID: 35853614 DOI: 10.1002/adma.202203224] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Urinalysis is attractive in non-invasive early diagnosis of bladder cancer compared with clinical gold standard cystoscopy. However, the trace bladder tumor biomarkers in urine and the particularly complex urine environment pose significant challenges for urinalysis. Here, a clinically adoptable urinalysis device that integrates molecular-specificity indium gallium zinc oxide field-effect transistor (IGZO FET) biosensor arrays, a device control panel, and an internet terminal for directly analyzing five bladder-tumor-associated proteins in clinical urine samples, is reported for bladder cancer diagnosis and classification. The IGZO FET biosensors with engineered sensing interfaces provide high sensitivity and selectivity for identification of trace proteins in the complex urine environment. Integrating with a machine-learning algorithm, this device can identify bladder cancer with an accuracy of 95.0% in a cohort of 197 patients and 75 non-bladder cancer individuals, distinguishing cancer stages with an overall accuracy of 90.0% and assessing bladder cancer recurrence after surgical treatment. The non-invasive urinalysis device defines a robust technology for remote healthcare and personalized medicine.
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Affiliation(s)
- Yanbing Yang
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Jingfeng Wang
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Wanting Huang
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Guojia Wan
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Miaomiao Xia
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Duo Chen
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Yun Zhang
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Yiming Wang
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Fuding Guo
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Jie Tan
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
| | - Huageng Liang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bo Du
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Lilei Yu
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
| | - Weihong Tan
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
| | - Xiangfeng Duan
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, CA, 90095-1569, USA
| | - Quan Yuan
- Department of Cardiology, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, College of Chemistry and Molecular Sciences, School of Computer Science, Wuhan University, Wuhan, 430072, China
- Molecular Science and Biomedicine Laboratory (MBL), State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha, 410082, China
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Cheng PY, Huang YY, Jaw FS, Chung SD, Tsai CY. Diffused bladder wall calcification in a survivor with severe coronavirus disease 2019: A case report. Medicine (Baltimore) 2022; 101:e30314. [PMID: 36042663 PMCID: PMC9410584 DOI: 10.1097/md.0000000000030314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Bladder calcification is a rare presentation that was first interpreted to be related to a urea-splitting bacterial infection. Aside from infection, other hypotheses such as schistosomiasis, tuberculosis, cancer, and cytokine-induced inflammatory processes have also been reported. Severe coronavirus disease 2019 (COVID-19) is known for its provoking cytokine storm and uninhibited systematic inflammation, and calcification over the coronary artery or lung has been reported as a long-term complication. PATIENT CONCERNS We presented a 68 years old man who had persistent lower urinary tract symptoms after recovery from severe COVID-19. No urea-splitting bacteria were identified from urine culture. DIAGNOSIS Cystoscopy examination revealed diffuse bladder mucosal and submucosa calcification. INTERVENTIONS Transurethral removal of the mucosal calcification with lithotripsy. OUTCOMES The patient's lower urinary tract symptoms improved, and stone analysis showed 98% calcium phosphate and 2% calcium oxalate. No newly formed calcifications were found at serial follow-up. CONCLUSION Diffuse bladder calcification may be a urinary tract sequela of COVID-19 infection. Patients with de novo lower urinary tract symptoms after severe COVID-19 should be further investigated.
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Affiliation(s)
- Pai-Yu Cheng
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taiwan
- Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan
- *Correspondence: Pai-Yu Cheng, Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220, Taiwan (e-mail: )
| | - Yi-You Huang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taiwan
| | - Fu-Shan Jaw
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taiwan
| | - Shiu-Dong Chung
- Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan
- Department of Nursing, College of Healthcare & Management, Asia Eastern University of Science and Technology, Taiwan
- General Education Center, Eastern University of Science and Technology, Taiwan
| | - Chung-You Tsai
- Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taiwan
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Malinaric R, Mantica G, Lo Monaco L, Mariano F, Leonardi R, Simonato A, Van der Merwe A, Terrone C. The Role of Novel Bladder Cancer Diagnostic and Surveillance Biomarkers-What Should a Urologist Really Know? Int J Environ Res Public Health 2022; 19:ijerph19159648. [PMID: 35955004 PMCID: PMC9368399 DOI: 10.3390/ijerph19159648] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 05/20/2023]
Abstract
The aim of this review is to analyze and describe the current landscape of bladder cancer diagnostic and surveillance biomarkers. We researched the literature from 2016 to November 2021 to find the most promising new molecules and divided them into seven different subgroups based on their function and location in the cell. Although cystoscopy and cytology are still the gold standard for diagnosis and surveillance when it comes to bladder cancer (BCa), their cost is quite a burden for national health systems worldwide. Currently, the research is focused on finding a biomarker that has high negative predictive value (NPV) and can exclude with a certainty the presence of the tumor, considering missing it could be disastrous for the patient. Every subgroup has its own advantages and disadvantages; for example, protein biomarkers cost less than genomic ones, but on the other hand, they seem to be less precise. We tried to simplify this complicated topic as much as possible in order to make it comprehensible to doctors and urologists that are not as familiar with it, as well as encourage them to actively participate in ongoing research.
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Affiliation(s)
- Rafaela Malinaric
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
- Correspondence:
| | - Guglielmo Mantica
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
| | - Lorenzo Lo Monaco
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
| | - Federico Mariano
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
| | - Rosario Leonardi
- Department of Urology, Casa di Cura Musumeci GECAS, 95030 Gravina di Catania, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90133 Palermo, Italy
| | - André Van der Merwe
- Department of Urology, Tygerberg Academic Hospital, Stellenbosch University, Cape Town 7600, South Africa
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
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67
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Matuszczak M, Kiljańczyk A, Salagierski M. A Liquid Biopsy in Bladder Cancer—The Current Landscape in Urinary Biomarkers. Int J Mol Sci 2022; 23:ijms23158597. [PMID: 35955727 PMCID: PMC9369188 DOI: 10.3390/ijms23158597] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/27/2022] [Accepted: 07/30/2022] [Indexed: 02/06/2023] Open
Abstract
The non-muscle invasive bladder cancer tends to recur and progress. Therefore, it requires frequent follow-ups, generating costs and making it one of the most expensive neoplasms. Considering the expensive and invasive character of the current gold-standard diagnostic procedure, white-light cystoscopy, efforts to find an alternative method are ongoing. Although the last decade has seen significant advancements in urinary biomarker tests (UBTs) for bladder cancer, international guidelines have not recommended them. Currently, the paramount urgency is to find and validate the test with the best specificity and sensitivity, which would allow for the optimizing of diagnosis, prognosis, and a treatment plan. This review aims to summarise the up-to-date state of knowledge relating to UBTs and new developments in the detection, prognosis, and surveillance of bladder cancer and their potential applications in clinical practice.
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68
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Zahoor I, Asif M, Khan S, Haroon N. CONGENITAL SCAPHOID MEGALOURETHRA: REVISITING A RARE ANOMALY. J Ayub Med Coll Abbottabad 2022; 34:563-565. [PMID: 36377176 DOI: 10.55519/jamc-03-9596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Megalourethra is an infrequent malformation of the anterior urethra that is caused by the lack of corpus sponigosum and in severe cases is accompanied by the lack of corpora cavernosa as well. We report a five-year-old boy presented to us with scaphoid variety of megalourethra having complaints of ballooning of urethra during voiding. He was investigated with urethrogram and cystoscopy and subsequently repaired with Nesbitt Longitudinal Reduction Urethroplasty. He had smooth recovery postoperatively with normal voiding stream on follow up.
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Affiliation(s)
- Ilyas Zahoor
- Department of Urology, Lady Reading Hospital, Peshawar, Pakistan
| | - Mohammad Asif
- Department of Urology, Lady Reading Hospital, Peshawar, Pakistan
| | - Sarhad Khan
- Department of Urology, Lady Reading Hospital, Peshawar, Pakistan
| | - Naveed Haroon
- Department of Urology, Lady Reading Hospital, Peshawar, Pakistan
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69
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Kao KW, Cheng W, Chang YC. Chondroma of the urinary bladder: A case report. Medicine (Baltimore) 2022; 101:e29229. [PMID: 35608424 PMCID: PMC9276218 DOI: 10.1097/md.0000000000029229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/15/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Chondromas are benign tumors comprising cartilaginous tissue that commonly occur in the small bones of the hands and feet. Chondromas are extremely rare in extraskeletal soft tissues, and only six cases of bladder chondromas have been reported thus far. PATIENT CONCERNS A 75-year-old woman presented with abdominal pain and urinary symptoms, including increased frequency and a weak stream. DIAGNOSIS Cystoscopy revealed a well-defined bladder mass over the anterior bladder wall. The pathology report showed neoplastic chondrocytes within the hyalinized and focal myxoid matrix, and immunopositivity for S-100, leading to the seventh known diagnosis of bladder chondroma. INTERVENTIONS The tumor was endoscopically resected. The postoperative stay was uneventful, and 5 days later, the patient was discharged after the removal of the urinary catheter. OUTCOMES One month after surgery, repeated cystoscopy showed no recurrence of the bladder tumor, and the patient reported improvement in urinary symptoms and relief of lower abdominal pain. LESSONS Chondromas of the urinary bladder can present as urinary symptoms and abdominal pain in older patients. Transurethral resection is the treatment of choice.
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Affiliation(s)
- Kuo-Wei Kao
- Division of Urology, Department of Surgery, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Weiming Cheng
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
- Institute of Biopharmaceutical Science, School of Life Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Urology, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chin Chang
- Division of Pathology, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
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Okorie CL, Gatsby E, Schroeck FR, Ould Ismail AA, Lynch KE. Using electronic health records to streamline provider recruitment for implementation science studies. PLoS One 2022; 17:e0267915. [PMID: 35560153 PMCID: PMC9106149 DOI: 10.1371/journal.pone.0267915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare providers are often targeted as research participants, especially for implementation science studies evaluating provider- or system-level issues. Frequently, provider eligibility is based on both provider and patient factors. Manual chart review and self-report are common provider screening strategies but require substantial time, effort, and resources. The automated use of electronic health record (EHR) data may streamline provider identification for implementation science research. Here, we describe an approach to provider screening for a Veterans Health Administration (VHA)-funded study focused on implementing risk-aligned surveillance for bladder cancer patients. Methods Our goal was to identify providers at 6 pre-specified facilities who performed ≥10 surveillance cystoscopy procedures among bladder cancer patients in the 12 months prior to recruitment start on January 16, 2020, and who were currently practicing at 1 of 6 pre-specified facilities. Using VHA EHR data (using CPT, ICD10 procedure, and ICD10 diagnosis codes), we identified cystoscopy procedures performed after an initial bladder cancer diagnosis (i.e., surveillance procedures). Procedures were linked to VHA staff data to determine the provider of record, the number of cystoscopies they performed, and their current location of practice. To validate this approach, we performed a chart review of 105 procedures performed by a random sample of identified providers. The proportion of correctly identified procedures was calculated (Positive Predictive Value (PPV)), along with binomial 95% confidence intervals (CI). Findings We identified 1,917,856 cystoscopies performed on 703,324 patients from October 1, 1999—January 16, 2020, across the nationwide VHA. Of those procedures, 40% were done on patients who had a prior record of bladder cancer and were completed by 15,065 distinct providers. Of those, 61 performed ≥ 10 procedures and were currently practicing at 1 of the 6 facilities of interest in the 1 year prior to study recruitment. The random chart review of 7 providers found 101 of 105 procedures (PPV: 96%; 95% CI: 91% to 99%) were surveillance procedures and were performed by the selected provider on the recorded date. Implications These results show that EHR data can be used for accurate identification of healthcare providers as research participants when inclusion criteria consist of both patient- (temporal relationship between diagnosis and procedure) and provider-level (frequency of procedure and location of current practice) factors. As administrative codes and provider identifiers are collected in most, if not all, EHRs for billing purposes this approach can be translated from provider recruitment in VHA to other healthcare systems. Implementation studies should consider this method of screening providers.
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Affiliation(s)
- Chiamaka L. Okorie
- From Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
| | - Elise Gatsby
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, United States of America
| | - Florian R. Schroeck
- From Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
- White River Junction VA Medical Center, White River Junction, VT, United States of America
- Section of Urology Dartmouth Hitchcock Medical Center, Lebanon, NH, United States of America
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America
- Norris Cotton Cancer Center Dartmouth Hitchcock Medical Center, Lebanon, NH, United States of America
| | - A. Aziz Ould Ismail
- White River Junction VA Medical Center, White River Junction, VT, United States of America
| | - Kristine E. Lynch
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, United States of America
- * E-mail:
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Zheng P, Zhang J, Zhu Y, Guan X, Quan J, Li Q, Yi F. Comparative Analysis of the Efficacy of Transurethral Bipolar Plasma Needle Electrode and Ring Electrode in the Treatment of Non-Muscle-Invasive Bladder Cancer. Comput Intell Neurosci 2022; 2022:6044676. [PMID: 35602629 PMCID: PMC9122689 DOI: 10.1155/2022/6044676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/10/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Abstract
Bladder cancer is the most prevalent tumor of the urinary tract, ranking seventh in males and seventeenth in women. The gold standard for the definitive diagnosis and initial treatment of non-muscle-invasive bladder cancer is transurethral resection (TUR) of the bladder tumor. The ability to accurately detect disease, typically in the presence of hematuria as well as to detect early recurrent tumors in patients with a history of NMIBC, is critical to the successful treatment of non-muscle-invasive bladder cancer (NMIBC). Unfortunately, the current biomarker landscape for NMIBC is still evolving. Cystoscopy remains the gold standard, but it can still miss 10% of tumors. As a result, physicians frequently employ additional diagnostic tools to aid in the diagnosis of bladder cancer. The efficacy of transurethral bipolar plasma needle electrodes and ring electrodes in the treatment of non-muscle-invasive bladder cancer was compared and analyzed in this study. During our study, 100 patients with non-muscle-invasive bladder cancer admitted to our hospital between June 2019 and June 2020 were randomly assigned to a control group and an observation group, with 50 cases in each group. The observation group was given a bipolar plasma needle electrode, while the control group was given a bipolar plasma ring. Patients continued to receive bladder irrigation chemotherapy as well as traditional Chinese medicine (TCM) treatment as part of our treatment plan, while the control group received only bladder irrigation chemotherapy. Clinical factors such as operational blood loss, catheter indention time, length of hospital stay, and others were compared between the two groups. When the risk grades in the two groups were compared, the observation group had fewer medium- and high-risk grades than the control group, but the control group had more low-risk grades, with statistical significance (P < 0.05).
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Affiliation(s)
- Pei Zheng
- Yuncheng Central Hospital, Yanhu District, Yuncheng, Shanxi Province, China
| | - Jianhua Zhang
- Yuncheng Central Hospital, Yanhu District, Yuncheng, Shanxi Province, China
| | - Yahong Zhu
- Yuncheng Central Hospital, Yanhu District, Yuncheng, Shanxi Province, China
| | - Xiaodong Guan
- Yuncheng Central Hospital, Yanhu District, Yuncheng, Shanxi Province, China
| | - Jianwen Quan
- Yuncheng Central Hospital, Yanhu District, Yuncheng, Shanxi Province, China
| | - Qi Li
- Yuncheng Central Hospital, Yanhu District, Yuncheng, Shanxi Province, China
| | - Fen Yi
- Yuncheng Central Hospital, Yanhu District, Yuncheng, Shanxi Province, China
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Goergen DI, Freitas DMDEO. Virtual Reality as a distraction therapy during cystoscopy: a clinical trial. Rev Col Bras Cir 2022; 49:e20223138. [PMID: 35584530 PMCID: PMC10578813 DOI: 10.1590/0100-6991e-20223138-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 03/22/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to investigate whether virtual reality (VR) experience is associated with decreased pain sensation among patients who undergo rigid cystoscopy under local anesthesia. METHODS we performed a prospective, randomized, controlled study of 159 patients who were aleatorily enrolled into two groups: VR and control. VR experience intervention consisted of using a headset with a smartphone adapted to a virtual reality glasses where an app-video was played during the procedure. Main outcomes analyzed were pain, discomfort, heart rate variability, difficulty and duration of the cystoscopy. Statistical analyses were performed using a Student's t test, Mann-Whitney test and Chi-square test. A P<0.05 was considered to be statistically significant. RESULTS among 159 patients studied (VR group=80 patients; control group=79 patients), the mean age was 63,6 years and 107 (67,3%) were male. There was no statistically significant difference in baseline characteristics between the 2 groups. VR was significantly associated to decreased heart rate variability (6,29 vs 11,09 bpm, P<0,001) and lower duration of the procedure (5,33 vs 8,65 min, P<0,001). Also, when cystoscopies due to double-J extraction were excluded, VR experience was associated with reduced pain on the visual analog score of pain (3,26 vs 4,33 cm, P=0,023). CONCLUSIONS the use of VR as a distraction therapy while performing outpatient cystoscopies is safe, has no side effects, is associated with less pain and discomfort, and reduces length of procedure.
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Affiliation(s)
| | - Daniel Melecchi DE Oliveira Freitas
- - Hospital Nossa Senhora da Conceição, Urologia - Porto Alegre - RS - Brasil
- - Hospital Moinhos de Vento, Urologia - Porto Alegre - RS - Brasil
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73
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Lai LY, Tafuri SM, Ginier EC, Herrel LA, Dahm P, Maisch P, Lane GI. Narrow band imaging versus white light cystoscopy alone for transurethral resection of non-muscle invasive bladder cancer. Cochrane Database Syst Rev 2022; 4:CD014887. [PMID: 35393644 PMCID: PMC8990285 DOI: 10.1002/14651858.cd014887.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Disease recurrence and progression remain major challenges for the treatment of non-muscle invasive bladder cancer. Narrow band imaging (NBI) is an optical enhancement technique that may improve resection of non-muscle invasive bladder cancer and thereby lead to better outcomes for people undergoing the procedure. OBJECTIVES: To assess the effects of NBI- and white light cystoscopy (WLC)-guided transurethral resection of bladder tumor (TURBT) compared to WLC-guided TURBT in the treatment of non-muscle invasive bladder cancer. SEARCH METHODS We performed a comprehensive literature search of 10 databases, including the Cochrane Library, the Cochrane Database of Systematic Reviews, MEDLINE, Embase, several clinical trial registries, and grey literature for published and unpublished studies, irrespective of language. The search was performed per an a priori protocol on 3 December 2021. SELECTION CRITERIA We included randomized controlled trials of participants with suspected or confirmed non-muscle invasive bladder cancer. Participants in the control group must have received WLC-guided TURBT alone (hereinafter simply referred to as 'WLC TURBT'). Participants in the intervention group had to have received NBI- and WLC-guided TURBT (hereinafter simply referred to as 'NBI + WLC TURBT'). DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion/exclusion, performed data extraction, and assessed risk of bias. We conducted meta-analysis on time-to-event and dichotomous data using a random-effects model in RevMan, according to Cochrane methods. We rated the certainty of evidence for each outcome according to the GRADE approach. Primary outcomes were time to recurrence, time to progression, and the occurrence of a major adverse event, defined as a Clavien-Dindo III, IV, or V complication. Secondary outcomes included time to death from bladder cancer and the occurrence of a minor adverse event, defined as a Clavien-Dindo I or II complication. MAIN RESULTS: We included eight studies with a total of 2152 participants randomized to the standard WLC TURBT or to NBI + WLC TURBT. A total of 1847 participants were included for analysis. Based on limited confidence in the time-to-event data, we found that participants who underwent NBI + WLC TURBT had a lower risk of disease recurrence over time compared to participants who underwent WLC TURBT (hazard ratio 0.63, 95% CI 0.45 to 0.89; I2 = 53%; 6 studies, 1244 participants; low certainty of evidence). No studies examined disease progression as a time-to-event outcome or a dichotomous outcome. There was likely no difference in the risk of a major adverse event between participants who underwent NBI + WLC TURBT and those who underwent WLC TURBT (risk ratio 1.77, 95% CI 0.79 to 3.96; 4 studies, 1385 participants; low certainty of evidence). No studies examined death from bladder cancer as a time-to-event outcome or a dichotomous outcome. There was likely no difference in the risk of a minor adverse event between participants who underwent NBI + WLC TURBT and those who underwent WLC TURBT (risk ratio 0.88, 95% CI 0.49 to 1.56; I2 = 61%; 4 studies, 1385 participants; low certainty of evidence). AUTHORS' CONCLUSIONS: Compared to WLC TURBT alone, NBI + WLC TURBT may lower the risk of disease recurrence over time while having little or no effect on the risks of major or minor adverse events.
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Affiliation(s)
- Lillian Y Lai
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sean M Tafuri
- College of Medicine, California Northstate University, Elk Grove, California, USA
| | - Emily C Ginier
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey A Herrel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Philipp Maisch
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
- Department of Urology, University of Ulm, Ulm, Germany
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74
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Lozano F, Raventós CX, Carrión A, Trilla E. [Optimization biomarkers in the surveillance of non muscle invasive bladder cancer.]. ARCH ESP UROL 2022; 75:133-143. [PMID: 35332883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Bladder cancer is thefifth most common tumor in the world. Moreover, it isone of the most expensive due to its high recurrencerate. Urinary biomarkers for surveillance of non muscleinvasive bladder cancer is a promising and growingfield due to the invasiveness of the actual methods, basedon cystoscopy and cytology. Although current EuropeanGuidelines only consider the use of biomarkersin the low risk scenario as an alternative to cystoscopywhen the patient declines invasive methods for the follow-up after surgery, there is increasing evidence oftheir safety in high risk tumors. MATERIAL AND METHODS We have performeda review of the main urinary biomarkers, includingFDA-approved ones, protein-based and genetic biomarkers.We have also described the different options to incorporatethe biomarkers in the clinical practice. RESULTS There are not randomized control trialscomparing any biomarker with the gold standard follow-up. Most of the papers published so far are cohortstudies, limitating the evidence of the results. Biomarkerscan be used as an alternative of cystoscopy, in a noninvasive follow-up, or alternating both tests. There arefew economical studies comparing both options, but theevidence supports the efficiency of the main biomarkers. CONCLUSIONS Cystoscopy and cytology are the goldstandard for non muscle invasive bladder cancer surveillance.2021 European Guidelines suggest, for the firsttime, an alternative use of biomarkers in a concrete lowgrade scenario to avoid invasive explorations to patientswith low risk of progression. Paradoxically, biomarkers(mainly genetic ones) have a very good profile of sensitivityand negative predictive value in the high risk scenario.Although there is increasing evidence to supporttheir implementation, the lack of fase IV trials hinderstheir daily use.
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Affiliation(s)
- Fernando Lozano
- Servicio Urología. Hospital Universitario Vall d'Hebron. Vall d´Hebron. Barcelona. España. Universitat Autónoma de Barcelona. Barcelona. España
| | - Carles Xavier Raventós
- Servicio Urología. Hospital Universitario Vall d'Hebron. Vall d´Hebron. Barcelona. España. Universitat Autónoma de Barcelona. Barcelona. España
| | - Albert Carrión
- Servicio Urología. Hospital Universitario Vall d'Hebron. Vall d´Hebron. Barcelona. España. Universitat Autónoma de Barcelona. Barcelona. España
| | - Enrique Trilla
- Servicio Urología. Hospital Universitario Vall d'Hebron. Vall d´Hebron. Barcelona. España. Universitat Autónoma de Barcelona. Barcelona. España
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Marantidis J, Simhal RK, Stamatakis L, Sussman RD. Bladder diverticulum caused by primary bladder neck obstruction. BMJ Case Rep 2022; 15:e247124. [PMID: 35210226 PMCID: PMC8883201 DOI: 10.1136/bcr-2021-247124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Here, we report a case of a patient in their mid 30s who presented with an elevated creatinine and was found to have a massive bladder diverticulum. The patient underwent a robotic-assisted diverticulectomy. They were later found to have a primary bladder neck obstruction on video urodynamics, and subsequently, underwent bladder neck incision, leading to significant improvement in urinary symptoms. Primary bladder neck obstruction is an overlooked cause of bladder diverticulum. While cystoscopy and cross-sectional imaging are frequently used in the initial evaluation of bladder diverticula, in the absence of an anatomic obstruction such as prostate enlargement, video urodynamics should be performed to assess for primary bladder neck obstruction.
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Affiliation(s)
- Joanna Marantidis
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Rishabh Kumar Simhal
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Lambros Stamatakis
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Urology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Rachael D Sussman
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Urology, MedStar Washington Hospital Center, Washington, DC, USA
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76
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Lenis AT, Litwin MS. Does Artificial Intelligence Meaningfully Enhance Cystoscopy? J Natl Cancer Inst 2022; 114:174-175. [PMID: 34473299 PMCID: PMC8826502 DOI: 10.1093/jnci/djab180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrew T Lenis
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer
Center, New York, NY, USA
| | - Mark S Litwin
- Department of Urology, University of California Los Angeles, Los
Angeles, CA, USA
- Department of Health Policy & Management, Fielding School of Public Health,
University of California Los Angeles, Los Angeles, CA, USA
- Correspondence to: Mark S. Litwin, MD, MPH, Department of Urology, University
of California Los Angeles, 300 Stein Plaza, 3rd Floor, Los Angeles, CA, USA (e-mail:
)
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Sbizzera M, Descotes F, Arber T, Neuville P, Ruffion A. Bladder cancer detection in patients with neurogenic bladder: are cystoscopy and cytology effective, and are biomarkers pertinent as future diagnostic tools? A scoping review. World J Urol 2022; 40:1897-1913. [PMID: 35119523 DOI: 10.1007/s00345-022-03943-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/16/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To summarize the current state of knowledge on bladder cancer diagnosis and screening in neurogenic bladder patients, and to explore the potential contribution of biomarkers in this context. METHODS A scoping review was performed to retrieve cystoscopy and urinary cytology performance for bladder cancer detection in neurogenic bladder patients. We also retrieved information of certified urinary biomarkers in bladder cancer detection and their potential application for this specific population. RESULTS A total of 1092 articles were identified; 19 of them were included in the scoping review regarding cytology and cystoscopy performance in patients with neurogenic bladder and 33 were included as related to biomarkers in bladder cancer. No significant study stood out to recommend bladder cancer screening in this specific population using cytology and cystoscopy because of the scarcity of results, low level-of-evidence studies, and lack of studies specifically designed to assess the test performance in this population. Two biomarkers were retained as potential future diagnostic tools: FISH analysis to detect chromosomal changes, and PCR for TERT and FGFR3 promoter mutation detection, associated or not with KRAS mutation detection. CONCLUSION There is no sufficient quality data to support cystoscopy and urinary cytology as effective tools for the diagnostic and surveillance of bladder cancer in neurogenic bladder patients. FISH analysis to detect chromosomal changes, and PCR for TERT and FGFR3 promoter mutation detection, associated or not with KRAS mutation detection, stand out as candidates of interest for bladder cancer detection in this specific population and should be prospectively tested.
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Affiliation(s)
- Marc Sbizzera
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France.
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Françoise Descotes
- Department of Biochemistry and Molecular Biology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
| | - Théo Arber
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Paul Neuville
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
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Crocetto F, Barone B, Ferro M, Busetto GM, La Civita E, Buonerba C, Di Lorenzo G, Terracciano D, Schalken JA. Liquid biopsy in bladder cancer: State of the art and future perspectives. Crit Rev Oncol Hematol 2022; 170:103577. [PMID: 34999017 DOI: 10.1016/j.critrevonc.2022.103577] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 01/01/2023] Open
Abstract
Bladder cancer is the most common malignancy of the urinary tract. Cystoscopy represents the gold standard in the diagnosis of suspicious bladder lesions. However, the procedure is invasive and burdened by pain, discomfort and infective complications. Cytology, which represents an alternative diagnostic possibility is limited by poor sensitivity. Considering the limitations of both procedures, and the necessity to perform multiple evaluations in patients who are in follow-up for bladder cancer, an improved non-invasive methodology is required in the clinical management of this disease. Liquid biopsy, e.g. the detection of clinical biomarkers in urine, represent a promising novel and non-invasive approach that could overcome those limitations and be integrated into the current clinical practice. The aim of this review is to summarize the state of the art of this approach and the latest novelties regarding detection, prognosis and surveillance of bladder cancer.
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Affiliation(s)
- Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy.
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gian Maria Busetto
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Evelina La Civita
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carlo Buonerba
- Oncology Unit, Hospital "Andrea Tortora", ASL Salerno, Pagani, Italy
| | - Giuseppe Di Lorenzo
- Oncology Unit, Hospital "Andrea Tortora", ASL Salerno, Pagani, Italy; Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Jack A Schalken
- Department of Urology, Radboud University Medical Center, Nijmegen, Netherlands
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Abstract
Hematuria is not uncommonly seen among children. We describe the case of a 13-year-old boy who was diagnosed with urothelial carcinoma after presenting with persistent gross hematuria for 2 weeks. We highlight the importance of adequate workup for gross hematuria as it is often associated with an underlying pathology that could lead to significant morbidity if left undiagnosed.
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Affiliation(s)
- Han Lim Ong
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Han Jie Lee
- Department of Urology, Singapore General Hospital, Singapore
| | - Tze Kiat Ng
- Department of Urology, Singapore General Hospital, Singapore
| | - Te-Lu Yap
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore
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80
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Chiang CH, Chiang CH, Chiang CH. Methodological considerations for systematic review and meta-analysis of Xpert bladder cancer monitor. Urol Oncol 2021; 40:68-69. [PMID: 34848123 DOI: 10.1016/j.urolonc.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Cho-Han Chiang
- Master of Medical Sciences in Clinical Investigation program, Harvard Medical School, Harvard Medical School, Boston, MA; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cho-Hsien Chiang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cho-Hung Chiang
- Division of General Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, New Taipei City, Taiwan.
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81
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Streltsova OS, Boldyreva MN, Kiseleva EB, M MA, Lazukin VF. [Study of the structure and microflora of urethral tissues in urethral pain syndrome]. Urologiia 2021:41-49. [PMID: 34743430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
UNLABELLED Urethral pain syndrome (UPS) is characterized by the occurrence of persistent or recurrent pain in the urethra in the absence of a confirmed infection and other obvious local pathological changes. The study of its pathogenetic aspects is important first of all for understanding the causes of the disease, to prescribe effective treatment, specific recommendations for the prevention and treatment of this disease are also absent. This paper presents the advanced experience of our research group on the study of the urethral state by the in vivo cross-polarization optical coherence tomography (CP OCT) method, and also the results of the microbiota analysis in the urethral tissues. The purpose of the study is to search for the risk factors for UPS and the character of changes in the urethral tissues, using the data of: 1) concomitant pathology, 2) structural changes in the urethral wall in UPS in comparison with chronic cystitis of bacterial etiology 3) studying the microbiota of urethral tissues. MATERIALS AND METHODS The condition of the urethra was studied in 109 patients: 55 of them with UPS (group "US"), without clinical manifestations of inflammation; 41 - with chronic inflammation of the lower urinary tract of various origins (group "Inf"); in 14 patients with stones of the upper urinary tract without pyelonephritis, the urethra was taken as the norm (group "N"). All performed a clinical minimum of studies, also cystoscopy with the study of the bladder triangle, the neck of the bladder and the urethra by the method of in vivo tissue imaging - CP OCT. The device "OCT-1300U" with wavelength of 1300 nm is used. To determine the possible role of UPS disease background, the analysis of concomitant pathology preceding the development of UPS was performed. To analyze the relationship of changes in the urethral tissues with the composition of its microbiota, a PCR study of biopsies from the proximal segment of the urethra was performed in 13 patients with UPS. RESULTS Qualitative comparison of the thickness and character of the OCT signal of the urethral wall layers observed using CP OCT in the studied groups of patients allowed us to establish that the state of the epithelium and connective tissue structures of the mucous membrane in patients with UPS is not the norm, changes are similar to those in chronic inflammation. Changes in the character of the OCT signal were recorded in all parts of the urethra, but in the middle third they are most pronounced and most critical. In UPS, there is a brightly pronounced reorganization of the connective tissue stroma components. Pronounced fibrosis of subepithelial structures (increased signal brightness in the cross-channel compared to the norm) with their thickening was recorded in 48.2% of cases, and thinning/lack of visualization of the epithelial layer was detected in 20.5%, and in chronic inflammation 55.5% and 40.6% of cases, respectively. According to the results of PCR, only one patient had significant total bacterial contamination of the biopsy (TB=104.7). In all other cases, the total bacterial mass of the biopsies was at the level of negative control. CONCLUSIONS In patients with UPS, the presence of several concomitant, often chronic, diseases was revealed, which may be a premorbid background and one of the risk factors for the occurrence and maintenance of UPS. Pilot PCR studies of biopsies from the proximal segment of the urethra indicate that low values of bacterial contamination in the majority of patients with UPS do not exclude the possible role of bacteria in the development of the disease in some patients. The CP OCT method used in this study is currently the only one in vivo method of visualization of the urethral mucosa, which provides real-time images of structural changes in the epithelial (atrophy or hyperplasia) and connective tissue (active or latent inflammation with cellular infiltration or fibrosis) layers of the urethra, allowing better understanding of the pathogenesis of the disease and monitoring of therapy.
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Affiliation(s)
- O S Streltsova
- Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
- Nizhniy Novgorod, Russia
- National Research Centre Institute of Immunology FMBA of Russia, Moscow, Russia
| | - M N Boldyreva
- Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
- Nizhniy Novgorod, Russia
- National Research Centre Institute of Immunology FMBA of Russia, Moscow, Russia
| | - E B Kiseleva
- Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
- Nizhniy Novgorod, Russia
- National Research Centre Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Molvi A M
- Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
- Nizhniy Novgorod, Russia
- National Research Centre Institute of Immunology FMBA of Russia, Moscow, Russia
| | - V F Lazukin
- Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
- Nizhniy Novgorod, Russia
- National Research Centre Institute of Immunology FMBA of Russia, Moscow, Russia
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82
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Bangash M, Faruqui N, Muhammad AUI, Uddin Z. Leiomyoma Urinary Bladder, Mimicking Urothelial Cancer. J Ayub Med Coll Abbottabad 2021; 33:685-689. [PMID: 35124930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Leiomyoma of the urinary bladder is a rare bladder tumour, which is benign in nature. On presentation, it resembles urothelial cancer but it has an excellent prognosis. We reported two cases of urinary bladder leiomyoma. Both the patients presented with lower urinary tract symptoms (LUTS) and the patient in the second case also had painless haematuria. Bladder mass was detected initially on ultrasound and confirmed on contrast-enhanced computed tomography (CT). Transurethral resection of bladder tumour was performed in both cases and no recurrence was found on initial follow-up. But the second case had haematuria and recurrence on subsequent follow-up and managed by performing a partial cystectomy. Endoscopic management of bladder leiomyoma is a safe treatment option for bladder leiomyoma and if multiple recurrences noted with symptoms, then partial cystectomy can be considered. Histopathology is the only definitive way of establishing the diagnosis. These patients can be followed up initially with cystoscopy, and if no recurrence is detected, subsequent follow-up can be carried out with ultrasound.
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83
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Culpan M, Keser F, Acar HC, Otunctemur A, Kucuk EV, Erdem S, Ozer M, Sen UT, Degirmenci E, Ergul R, Atis RG, Yildirim A. Impact of delay in cystoscopic surveillance on recurrence and progression rates in patients with non-muscle-invasive bladder cancer during the COVID-19 pandemic. Int J Clin Pract 2021; 75:e14490. [PMID: 34117682 PMCID: PMC8420249 DOI: 10.1111/ijcp.14490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS A total of 407 patients from four high-volume centres with NMIBC that applied for follow-up cystoscopy were included in our study prospectively. Patients' demographics and previous tumour characteristics, the presence of tumour in follow-up cystoscopy, the pathology results of the latest transurethral resection of bladder tumour (if tumour was detected) and the delay in cystoscopy time were recorded. Our primary outcomes were tumour recurrences detected by follow-up cystoscopy and progression. Multivariate logistic regression analysis was performed using the possible factors identified with univariate analyses (P values ≤ .2). RESULTS A total of 105 patients (25.8%) had tumour recurrence in follow-up cystoscopy, and 20 (5.1%) of these patients had disease progression according to grade or stage. In multivariate analysis, the number of recurrences (OR: 1.307, P < .001) and the cystoscopy delay time (62-147 days, OR: 2.424, P = .002; >147 days, OR: 4.883, P < .001) were significant risk factors for tumour recurrence on follow-up cystoscopy; the number of recurrences (OR: 1.255, P = .024) and cystoscopy delay time (>90 days, OR: 6.704, P = .002) were significant risk factors for tumour progression. CONCLUSIONS This study showed that a 2-5 months of delay in follow-up cystoscopy increases the risk of recurrence by 2.4-fold, and delay in cystoscopy for more than 3 months increases the probability of progression by 6.7-fold. We suggest that cystoscopic surveillance should be done during the COVID-19 pandemic according to the schedule set by relevant guidelines.
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Affiliation(s)
- Meftun Culpan
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Ferhat Keser
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Hazal Cansu Acar
- Department of Public HealthCerrahpasa Faculty of MedicineIstanbul University‐CerrahpasaIstanbulTurkey
| | - Alper Otunctemur
- Department of UrologyProf. Dr. Cemil Tascioglu City HospitalUniversity of Health SciencesIstanbulTurkey
| | - Eyup Veli Kucuk
- Department of UrologyIstanbul Umraniye Training and Research HospitalUniversity of Health SciencesIstanbulTurkey
| | - Selcuk Erdem
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Murat Ozer
- Department of UrologyProf. Dr. Cemil Tascioglu City HospitalUniversity of Health SciencesIstanbulTurkey
| | - Ugur Tolga Sen
- Department of UrologyIstanbul Umraniye Training and Research HospitalUniversity of Health SciencesIstanbulTurkey
| | - Enes Degirmenci
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Rifat Ergul
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Ramazan Gokhan Atis
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Asif Yildirim
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
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84
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Choi E, Waldbillig F, Jeong M, Li D, Goyal R, Weber P, Miernik A, Grüne B, Hein S, Suarez-Ibarrola R, Kriegmair MC, Qiu T. Soft Urinary Bladder Phantom for Endoscopic Training. Ann Biomed Eng 2021; 49:2412-2420. [PMID: 34002287 PMCID: PMC8455490 DOI: 10.1007/s10439-021-02793-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023]
Abstract
Bladder cancer (BC) is the main disease in the urinary tract with a high recurrence rate and it is diagnosed by cystoscopy (CY). To train the CY procedures, a realistic bladder phantom with correct anatomy and physiological properties is highly required. Here, we report a soft bladder phantom (FlexBlad) that mimics many important features of a human bladder. Under filling, it shows a large volume expansion of more than 300% with a tunable compliance in the range of 12.2 ± 2.8 - 32.7 ± 5.4 mL cmH2O-1 by engineering the thickness of the bladder wall. By 3D printing and multi-step molding, detailed anatomical structures are represented on the inner bladder wall, including sub-millimeter blood vessels and reconfigurable bladder tumors. Endoscopic inspection and tumor biopsy were successfully performed. A multi-center study was carried out, where two groups of urologists with different experience levels executed consecutive CYs in the phantom and filled in questionnaires. The learning curves reveal that the FlexBlad has a positive effect in the endourological training across different skill levels. The statistical results validate the usability of the phantom as a valuable educational tool, and the dynamic feature expands its use as a versatile endoscopic training platform.
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Affiliation(s)
- Eunjin Choi
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Frank Waldbillig
- Department of Urology & Urosurgery, University Medical Centre Mannheim, Faculty of Medicine, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
| | - Moonkwang Jeong
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Dandan Li
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Rahul Goyal
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Patricia Weber
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
| | - Arkadiusz Miernik
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Britta Grüne
- Department of Urology & Urosurgery, University Medical Centre Mannheim, Faculty of Medicine, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
| | - Simon Hein
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Maximilian Christian Kriegmair
- Department of Urology & Urosurgery, University Medical Centre Mannheim, Faculty of Medicine, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
| | - Tian Qiu
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany.
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany.
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85
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Bahadur A, Mundhra R, Sherwani P, Kumar S. Robot-assisted partial cystectomy for bladder endometriosis: dual approach involving cystoscopy and robotic surgery. BMJ Case Rep 2021; 14:e244342. [PMID: 34429296 PMCID: PMC8386226 DOI: 10.1136/bcr-2021-244342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/04/2022] Open
Abstract
Bladder endometriosis accounts for 70%-85% cases of urinary tract endometriosis. A high index of suspicion is needed to diagnose this condition as most women have associated pelvic and menstrual complaints. The presence of cyclical haematuria along with tender anterior vaginal wall should alert the gynaecologist or urologist to consider this rare entity. Treatment is medical therapy followed by surgery when needed. Transurethral resection of endometriotic spot is the commonly used approach but to completely excise the endometriotic nodule, bladder resection at the site of nodule is needed along with repair of cut bladder margins. Herein, we describe a dual surgical approach where the margins of the endometriotic spot were delineated and cut using cystoscopy, followed by robotic approach to completely excise the nodule along with bladder repair. Robotic approach seems safer and easier in this complex surgery owing to dense adhesions in such cases.
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Affiliation(s)
- Anupama Bahadur
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajlaxmi Mundhra
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Sherwani
- Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sunil Kumar
- Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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86
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Ros C, de Guirior C, Rius M, Escura S, Martínez-Zamora MÁ, Gracia M, Peri L, Franco A, Carmona F. Accuracy of Transvaginal Ultrasound Compared to Cystoscopy in the Diagnosis of Bladder Endometriosis Nodules. J Ultrasound Med 2021; 40:1571-1578. [PMID: 33085096 DOI: 10.1002/jum.15537] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/30/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the accuracy of transvaginal ultrasound (TVUS) in predicting detrusor infiltration and ureteral meatus involvement in patients with bladder endometriosis (BE) to select which cystoscopic procedures could be avoided and, secondarily, to assess the relationship between symptoms and the characteristics of nodules and the association of BE with other forms of endometriosis. METHODS Patients with BE diagnosed by TVUS were classified according to detrusor infiltration: BE with partial involvement of the muscular layer (group 1) and total muscular layer involvement with bladder protrusion (group 2). We analyzed the accuracy of TVUS compared with subsequently performed cystoscopy, the correlation with symptoms, and the association with other forms of endometriosis. RESULTS Among the 22 patients included, TVUS showed 9 patients with BE nodules partially affecting the detrusor (group 1) with normal cystoscopic findings (TVUS negative predictive value, 100%). Transvaginal ultrasound detected 13 nodules with total involvement, all visible by cystoscopy (TVUS positive predictive value, 100%). Transvaginal ultrasound also identified ureteral orifices that were free of involvement at greater than 10 mm from the BE nodule in 21 of 22 women (TVUS sensitivity, 95%). Ultrasound criteria for adenomyosis and endometriosis in other locations were present in 20 of 22 patients. CONCLUSIONS Transvaginal ultrasound can identify the infiltration of BE nodules in the bladder wall and predict cystoscopic findings with great accuracy. Nodules that partially affect the muscular layer have normal cystoscopic findings, thereby obviating the need for this procedure. Bladder endometriosis nodules are commonly associated with other forms of endometriosis and do not usually affect the ureteral meatus.
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Affiliation(s)
- Cristina Ros
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Cristian de Guirior
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Mariona Rius
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Silvia Escura
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - María Ángeles Martínez-Zamora
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Lluís Peri
- Urologic Diagnosis Unit, Institut Clinic de Nefrologia i Urologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Agustín Franco
- Urologic Diagnosis Unit, Institut Clinic de Nefrologia i Urologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Endometriosis Unit, Institut Clínic de Ginecologia, Obstetrícia, i Neonatologia, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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88
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Abstract
PURPOSE OF REVIEW White light cystoscopy is the current standard for primary diagnosis and surveillance of bladder cancer. However, cancer changes can be subtle and may be easily missed. With the advancement of deep learning (DL), image recognition by artificial intelligence (AI) proves a high accuracy for image-based diagnosis. AI can be a solution to enhance bladder cancer diagnosis on cystoscopy. RECENT FINDINGS An algorithm that classifies cystoscopic images into normal and tumour images is essential for AI cystoscopy. To develop this AI-based system requires a training dataset, an appropriate type of DL algorithm for the learning process and a specific outcome classification. A large data volume with minimal class imbalance, data accuracy and representativeness are pre-requisite for a good dataset. Algorithms developed during the past two years to detect bladder tumour achieved high performance with a pooled sensitivity of 89.7% and specificity of 96.1%. The area under the curve ranged from 0.960 to 0.980, and the accuracy ranged from 85.6 to 96.9%. There were also favourable results in the various attempts to enhance detection of flat lesions or carcinoma-in-situ. SUMMARY AI cystoscopy is a possible solution in clinical practice to enhance bladder cancer diagnosis, improve tumour clearance during transurethral resection of bladder tumour and detect recurrent tumours upon surveillance.
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Affiliation(s)
- Erica On-Ting Chan
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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89
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Bryan RT, Liu W, Pirrie SJ, Amir R, Gallagher J, Hughes AI, Jefferson KP, Knight A, Nanton V, Mintz HP, Pope AM, Catto JWF, Patel P, James ND. Comparing an Imaging-guided Pathway with the Standard Pathway for Staging Muscle-invasive Bladder Cancer: Preliminary Data from the BladderPath Study. Eur Urol 2021; 80:12-15. [PMID: 33653635 DOI: 10.1016/j.eururo.2021.02.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/12/2021] [Indexed: 11/23/2022]
Abstract
Transurethral resection of bladder tumour (TURBT) is central to the diagnosis of muscle-invasive bladder cancer (MIBC). With the oncological safety of TURBT unknown, staging inaccuracies commonplace, and correct treatment of MIBC potentially delayed, multiparametric magnetic resonance imaging (mpMRI) may offer rapid, accurate, and noninvasive diagnosis of MIBC. BladderPath is a randomised trial comparing risk-stratified (5-point Likert scale) image-directed care with TURBT for patients with newly diagnosed BC. To date, we have screened 279 patients and randomised 113. Here we report on the first 100 participants to complete staging: 48 in pathway 1 (TURBT) and 52 in pathway 2 (mpMRI for possible MIBC, Likert 3-5). Fifty of 52 participants designated Likert 1-2 (probable NMIBC) from both pathways were confirmed as having NMIBC (96%). Ten of 11 cases diagnosed as NMIBC by mpMRI have been pathologically confirmed as NMIBC, and 10/15 cases diagnosed as MIBC by mpMRI have been treated as MIBC (5 participants underwent TURBT). The specificity of mpMRI for identification of MIBC remains a limitation. These initial experiences indicate that it is feasible to direct possible MIBC patients to mpMRI for staging instead of TURBT. Furthermore, a 5-point Likert scale accurately identifies patients with low risk of MIBC (Likert 1-2), and flexible cystoscopy biopsies appear sufficient for diagnosing BC. PATIENT SUMMARY: We are conducting a clinical trial to assess whether some bladder tumour surgery can be replaced by magnetic resonance imaging scans to determine the stage of the cancer in patients whose tumours appear to be invasive. Our early data suggest that this approach is feasible. The data also show that using a visual score ('Likert scale') can help to identify bladder tumours that are very unlikely to be invasive, and that taking a biopsy in the outpatient clinic when first inspecting the bladder via a camera (diagnostic flexible cystoscopy) is useful for confirming bladder cancer.
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Affiliation(s)
- Richard T Bryan
- Bladder Cancer Research Centre, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK; Action Bladder Cancer, UK
| | - Wenyu Liu
- Cancer Research UK Clinical Trials Unit, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sarah J Pirrie
- Cancer Research UK Clinical Trials Unit, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Rashid Amir
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Ana I Hughes
- Cancer Research UK Clinical Trials Unit, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Allen Knight
- Patient Representative, UK; Action Bladder Cancer, UK
| | | | - Harriet P Mintz
- The Medical School, University of Birmingham, Birmingham, UK
| | - Ann M Pope
- Cancer Research UK Clinical Trials Unit, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Prashant Patel
- Bladder Cancer Research Centre, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nicholas D James
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
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90
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Hughes T, Pietropaolo A, Jones P, Oderda M, Gontero P, Somani BK. Outcomes and Cost Evaluation Related to a Single-Use, Disposable Ureteric Stent Removal System: a Systematic Review of the Literature. Curr Urol Rep 2021; 22:41. [PMID: 34128107 DOI: 10.1007/s11934-021-01055-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To present the latest evidence related to the outcomes and cost of single-use, disposable ureteric stent removal system (Isiris). RECENT FINDINGS Our review suggests that compared to a reusable flexible cystoscope (re-FC), a disposable flexible cystoscope (d-FC) with built-in grasper (Isiris) significantly reduced procedural time and provided a cost benefit when the latter was used in a ward or outpatient clinic-based setting. The use of d-FC also allowed endoscopy slots to be used for other urgent diagnostic procedures. Disposable FCs are effective and safe for ureteric stent removal. They offer greater flexibility and, in most cases, have been demonstrated to be cost-effective compared to re-FCs. They are at their most useful in remote, low-volume centres, in less well-developed countries and in centres where large demand is placed on endoscopy resources.
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Affiliation(s)
- Thomas Hughes
- Urology Department, University Hospital Southampton NHS Trust, Tremona Road, Southampton, SO16 6YD, UK.
| | - Amelia Pietropaolo
- Urology Department, University Hospital Southampton NHS Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Patrick Jones
- Urology Department, University Hospital Southampton NHS Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Marco Oderda
- Division of Urology, Department of Surgical Sciences, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
| | - Bhaskar K Somani
- Urology Department, University Hospital Southampton NHS Trust, Tremona Road, Southampton, SO16 6YD, UK
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91
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Arlandis S, Bonillo MÁ, Franco A, Peri L, González-López R, Martínez-Cuenca E, Romero A, Müller-Arteaga C, García-Matres MJ. [ Cystoscopy in the assessment of patients with bladder pain syndrome: Results of a national multicenter observational study.]. ARCH ESP UROL 2021; 74:459-469. [PMID: 34080565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To study the use and results of cystoscopy and bladder hydrodistension in the objective assessment of patients with Bladder Pain Syndrome (BPS), in routine clinical practice. MATERIAL AND METHODS Observational, non-interventional, national, multicenter study carried out in Functional Urology and Urodynamic Units of Spain belonging to the IFU Group. 273 women with BPS who underwent cystoscopy at baseline as a diagnostic tool according to clinical criteria and following the routine clinical practice of each center, were studied. The pre and post hydrodistension findings and the scores of the symptom and Health-Related Quality of Life (HRQoL) questionnaires were described: BPIC-SS, PPBC, PGI-S and EQ-5D-5L. RESULTS The mean age (SD) was 59 (14) years with a high presence of bladder symptoms: increased voiding frequency (81.7%), nocturia (74%) and urgency (60.4%). 40.7% of cystoscopies were performed under anesthesia and 73.7% uses a standard rigid cystoscope. Hunner lesions were observed in 9.9% of the patients, hypervascularizations (46.2%), glomerulations (23.4%), mild bleeding (6.6%) and scars (2.2%). After hydrodistension, a greater number of grade 1 and 2 lesions were observed. In 51.6% of the patients there were no changes, but in 27.5% slight changes were observed and in 11.4% moderate or severe changes. Symptom and HRQoL questionnaire scores showed no association with cystoscopy findings before and after hydrodistension. CONCLUSIONS The value of the cystoscopic findings in the SDV has yet to be defined, although it plays a fundamental role in the differential diagnosis. In this observational study, we did not find a correlation of the cystoscopic findings with the symptoms of the patients, measured by validated questionnaires, nor with the HRQoL.
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Affiliation(s)
| | | | | | - Lluis Peri
- Hospital Universitario Clínic. Barcelona. España
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92
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Sánchez Verdes P, Fernández-Pello S, González Rodríguez I, Salgado Plonski JJ, Alonso Calvar L, Suárez Sal PJ, Rodríguez Villamil L. [Gross hematuria and usefulness of urinary cytology: Experience at hematuria one stop clinic.]. ARCH ESP UROL 2021; 74:470-476. [PMID: 34080566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To report the diagnostic accuracy and liability of the instrumentalized urine cytology in the preliminary study of monosyntomatic gross haematuria. METHODS A retrospective, descriptive and analytic study of the patients that complained of macroscopic hematuria at the one-stop clinic between 2011 and 2018. The complementary tests requested were: kidney/bladder ultrasounds, urethrocystoscopy and urinary instrumentalized cytology. All the urine cytology samples were examined by the same pathologist. RESULTS 1122 patients were reviewed with ultrasonography and cystoscopy. Bladder tumor was detected in 354 patients (31.5%) and other urological malignancies were found in 33 cases (2.9%). Urinary instrumentalized cytologies were collected in 804 patients (71.4%), being positive in 236 cases (29.4%). Sensitivity and specificity of urinary cytology for urothelial tumor detection were 55.1% and 85.7%, respectively. Cytology was positive in 181 patients (52.1%) with visible bladder tumors through cystoscopy, in 7 patients (0.87%) without visible bladder tumors. In 433 patients with ultrasonography and cystoscopy both negative, urine cytology was performed with a negative result (38.6%). CONCLUSION The usefulness of instrumentalized urinary cytology to diagnose urothelial tumors is restricted in terms of monosymptomatic gross haematuria one stop clinic. It allows the diagnosis of a very limited number of cases tumors and leaves a significant number of them out. In case of gross hematuria and negative imaging, urine cytology can be requested as a differed complementary.
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Affiliation(s)
- Pablo Sánchez Verdes
- Servicio de Urología. Hospital Universitario de Cabueñes. Gijón. Asturias. España
| | | | | | | | - Laura Alonso Calvar
- Servicio de Urología. Hospital Universitario de Cabueñes. Gijón. Asturias. España
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93
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Hussain M. Evolution of Urology Services in Pakistan. J Coll Physicians Surg Pak 2021; 31:746-748. [PMID: 34102797 DOI: 10.29271/jcpsp.2021.06.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/06/2021] [Indexed: 11/11/2022]
Abstract
Urology has been separated from its parent generic specialty at different times during the last 150 years in different countries. In Pakistan, from 1947 to 1970s, urology was part of surgery and was done by general surgeons. There were only two urology units from late 1950s to early 1960s. The actual rise of urology started with the introduction of trans-urethral resection of prostate (TURP) in 1980s with the introduction of endourology. Use of cystoscopy and retrograde ureteropyelography was in vogue much before TURP. The second era of modern endourology began with the introduction of percutaneous nephrostomy, ureteroscopy along with ESWL, and percutaneous nephrolithotomy in late 1980s and 1990s. Renal transplantation started in 1979 from living-related donors in public sector hospitals. Now, there are 19 centres in the country performing regular renal transplantions. Urology has undergone a dramatic change during the new millennium. There have been sub-specialties in urology, like paediatric urology, endourology, reconstructive urology, uro-oncology, laparoscopic and robotic urology. At present, there are 11 specialised kidney centres and institutes of urology in the country and 25 recognised urology centres for FCPS. More such centres and replication of the SIUT model is expected in Pakistan. Key Words: Urology, Endourology, Transplantation, Pakistan.
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Affiliation(s)
- Manzoor Hussain
- Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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94
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Broudeur L, Loubersac T, Le Normand L, Karam G, Branchereau J, Rigaud J, Perrouin-Verbe MA. New technique of robot-assisted laparoscopic artificial urinary sphincter implantation in female by a posterior approach with intraoperative cystoscopic monitoring. World J Urol 2021; 39:4221-4226. [PMID: 34050814 DOI: 10.1007/s00345-021-03739-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the early experience of a modified technique of robot-assisted artificial urinary sphincter (AUS) implantation in female, with a posterior approach to the bladder neck and intraoperative real-time cystoscopic monitoring. METHODS Retrospective monocentric study included all consecutive female who underwent a primary robot-assisted AUS implantation between 2017 and 2019. Real-time intraoperative cystoscopic monitoring was carried out to check the correct level of the dissection and to avoid any injury during bladder neck dissection. Perioperative and intraoperative data, functional outcomes and complications were assessed. Continence was defined as 0 to 1 pad per day. RESULTS Twenty-four patients were included, the median age was 66 years, 23/24 (96%) had previous SUI or prolapse surgery. Two conversions to open surgery and 2 modifications of the surgical technique with anterior dissection of the bladder neck were required due to major vesicovaginal adhesions. Overall, 20 patients underwent the robotic posterior approach. Eleven intraoperative complications in 10 patients (50%) occurred, including 7 bladder injuries 4 vaginal injuries, without the need to stop the procedure. The median hospital stay was 3 days (2-7). One AUS was removed at 1 year due to vaginal erosion. At last follow-up (median 26 months (22-36)), 95% of the devices were in place and activated and the continence rate was 84%. CONCLUSIONS Early functional results of robot-assisted AUS implantation with a posterior approach to the bladder neck and intraoperative cystoscopic monitoring are promising despite the high rate of intraoperative complications due to previous surgeries. Further evaluation of this technique is required.
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Affiliation(s)
- L Broudeur
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France.
| | - T Loubersac
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - L Le Normand
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - G Karam
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - J Branchereau
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - J Rigaud
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - M A Perrouin-Verbe
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
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95
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Waisbrod S, Natsos A, Wettstein MS, Saba K, Hermanns T, Fankhauser CD, Müller A. Assessment of Diagnostic Yield of Cystoscopy and Computed Tomographic Urography for Urinary Tract Cancers in Patients Evaluated for Microhematuria: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e218409. [PMID: 33970257 PMCID: PMC8111485 DOI: 10.1001/jamanetworkopen.2021.8409] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Microhematuria (MH) is a common finding that often leads to further evaluation for urinary tract cancers. There is ongoing debate about the extent to which patients with MH should be evaluated for cancer. OBJECTIVE To assess the diagnostic yield for detection of urinary tract cancers, specifically bladder cancer, upper tract urothelial carcinoma (UTUC), and kidney cell carcinoma, among patients evaluated for MH using cystoscopy and computed tomographic (CT) urography. DATA SOURCES MEDLINE, Scopus, and Embase were systematically searched for eligible studies published between January 1, 2009, and December 31, 2019. STUDY SELECTION Original prospective and retrospective studies reporting the prevalence of cancer among patients evaluated for MH were eligible. Two authors independently screened the titles and abstracts to select studies that met the eligibility criteria and reached consensus about which studies to include. Among 5802 records identified, 5802 articles were screened using titles and abstracts. After exclusions, 55 full-text articles were assessed for eligibility, with 39 studies selected for systematic review. DATA EXTRACTION AND SYNTHESIS This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Studies were quantitatively synthesized using a random-intercept logistic regression model. MAIN OUTCOMES AND MEASURES The primary outcome was diagnostic yield, defined as the proportion of patients with a diagnosis of urinary tract cancer (bladder cancer, UTUC, or kidney cell carcinoma) after presentation with MH. Studies were stratified by the percentage of cystoscopy and CT urography use and by high-risk cohorts. The diagnostic yields of CT urography and cystoscopy were calculated for each cancer type. RESULTS A total of 30 studies comprising 24 366 patients evaluated for MH were included in the meta-analysis. The pooled diagnostic yield among all patients was 2.00% (95% CI, 1.30%-3.09%) for bladder cancer, 0.02% (95% CI, 0.0%-0.15%) for UTUC, and 0.18% (95% CI, 0.09%-0.36%) for kidney cell carcinoma. Stratification of studies that used cystoscopy and/or CT urography for 95% or more of the cohort produced diagnostic yields of 2.74% (95% CI, 1.81%-4.12%) for bladder cancer, 0.09% (95% CI, 0.01%-0.75%) for UTUC, and 0.10% (95% CI, 0.04%-0.23%) for kidney cell carcinoma. In high-risk cohorts, the diagnostic yields increased to 4.61% (95% CI, 2.34%-8.90%) for bladder cancer and 0.45% (95% CI, 0.22%-0.95%) for UTUC. CONCLUSIONS AND RELEVANCE This study's findings suggest that, given the low diagnostic yield of CT urography and the associated risks and costs, limiting its use to high-risk patients older than 50 years is warranted. Risk stratification, as recommended by the recent American Urology Association guidelines on MH, may be a better approach to tailor further evaluation.
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Affiliation(s)
- Sharon Waisbrod
- Department of Urology, Spital-Limmattal, Schlieren, Switzerland
| | | | | | - Karim Saba
- Department of Urology, Kantonsspital Graubünden, Chur, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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96
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Davidov MI, Lyadov AA. [Foreign body in the urinary bladder intrauterine device]. Urologiia 2021:82-85. [PMID: 33960163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The article provides a rare observation of a 34-year-old woman who, 12 years before admission to a urological clinic, a gynecologist installed an intrauterine contraceptive device (IUD). The subject migrated into the abdominal cavity, and after 10 years the patient developed dysuria and hematuria. In October 2017, ultrasound and cystoscopy revealed the migration of IUD into the bladder. A foreign body was removed from the bladder - an IUD of a T-shape with the formation of a stone on it with a maximum size of 4.5 cm. During a follow-up examination after 2 years, pathology was not established.
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Affiliation(s)
- M I Davidov
- E.A. Vagner Perm State Medical University of MH RF
| | - A A Lyadov
- E.A. Vagner Perm State Medical University of MH RF
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Gutiérrez-Ruíz C, Franco-de-Castro A, Gil-Ugarteburu R, Casado-Varela J, Martínez-Barea V, Valero-Fernández EM, Arlandis-Guzmán S. [UPOINT phenotypic classification of a sample of female patients with bladder pain syndrome: Results of a national multicentric observational study.]. ARCH ESP UROL 2021; 74:369-382. [PMID: 33942728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To study the possibility of classifying patients with BPS by UPOINT phenotypes and their correlation with the results of different BPS diagnostic tools. MATERIAL AND METHODS: Epidemiological, observational, longitudinal and multicentric study performed according to clinical practice. A total of 319 women with BPS were included, 79 with new diagnosis and 240 in follow-up. Sociodemographic and clinical data were collected together with results of cystoscopy, biopsy and physical examination. Patients completed a 3-day Bladder Diary (3dBD) and Patient Reported Outcomes (PROs). All the patients were classified according to the 6 UPOINT domains and their distribution was described according to the clinical history, diagnostic tests, urinary symptoms and PROs' scores. RESULTS: 92.8% of the patients had affectation in more than one phenotype, however, there were no remarkable differences in the clinical and sociodemographic variables according to the number of affected domains. The percentage of patients with 3C classification was higher in the urinary (8.2%), organ-specific (9.0%) and neurological (10.9%) phenotypes. Around 90% had high voiding frequency, regardless of the phenotype. The improvement reported by the PROs was superior in the neurological and tenderness phenotypes. The worst scores were associated with a greater number of affected domains. CONCLUSIONS The present study is the first one carried out in Spain on a phenotypic classification of women with BPS, with data from routine clinical practice. The results point out that patients with several domains affected present more affectation on the BPS, worse HRQo Land higher anxiety.
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Affiliation(s)
| | - Agustín Franco-de-Castro
- Unidad de Diagnóstico Urológico. Servicio de Urología. Hospital Universitario Clínic. Barcelona. España
| | | | | | | | | | - Salvador Arlandis-Guzmán
- Sección de Urología Reconstructiva y Funcional. Servicio de Urología. Hospital Universitario y Politécnico La Fe. Valencia. España
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98
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Tailor VK, Morris E, Bhide AA, Fernando R, Digesu GA, Khullar V. Does cystoscopy method affect the investigation of bladder pain syndrome/interstitial cystitis? Int Urogynecol J 2021; 32:1229-1235. [PMID: 32955597 PMCID: PMC8139875 DOI: 10.1007/s00192-020-04512-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/19/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Cystoscopic investigation to identify associated histological findings of increased mast cells in the detrusor muscle has been recommended by the European Society for the Study of Bladder Pain Syndrome (ESSIC) in the investigation of bladder pain syndrome/interstitial cystitis (BPS/IC). The aim of this study was to identify if the cystoscopy approach impacts the biopsy results when investigating women presenting with symptoms of BPS/IC. METHODS We performed a single-centre retrospective analysis of 300 bladder biopsy reports from 2015 to 2018 from women undergoing cystoscopy for BPS/IC. Biopsies obtained using closed cup forceps through a flexible (FC) or rigid cystoscope (RC) were compared. RESULTS Fifty-eight FC biopsies were compared with 242 RC biopsies. FC biopsies had a smaller mean diameter (1.6 mm vs 2.9 mm p < 0.01) and volume (4.1 mm3 vs 9.6 mm3 p < 0.001) compared with RC biopsies. There was no significant difference in the histological depth of sampling to the muscularis propria. A total of 292 samples had CD117 immunohistochemical staining for mast cell count (MCC) analysis. The MCC/mm2 was significantly lower in FC biopsies (p < 0.01). Sixteen percent of FC samples compared with 60% of RC samples had a high MCC >28/mm2 (p < 0.01). There was no significant difference in positive microbiology culture between FC (21%) and RC (28%) sampling. CONCLUSION Rigid and flexible cystoscopy can be used to investigate BPS/IC as recommended by international societies. However, the biopsy method impacts the mast cell count analysis, which can influence diagnosis and management. Therefore, RC would be the optimal investigation.
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Affiliation(s)
- Visha K Tailor
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, 4th Floor Mary Stanford Building, London, W2 1NY, UK.
| | - Ellen Morris
- Imperial College School of Medicine, Kensington, London, SW7 2DD, UK
| | - Alka A Bhide
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, 4th Floor Mary Stanford Building, London, W2 1NY, UK
| | - Ruwan Fernando
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, 4th Floor Mary Stanford Building, London, W2 1NY, UK
| | - Guiseppe A Digesu
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, 4th Floor Mary Stanford Building, London, W2 1NY, UK
| | - Vik Khullar
- Department of Urogynaecology, Imperial College NHS Trust, St Marys Hospital, 4th Floor Mary Stanford Building, London, W2 1NY, UK
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99
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Dokubo II, Reeves F, Cashman S, Gnanapragasam VJ. Rationalising the use of investigation for urinary tract infections: Analysis of 700 patients and proposal for a diagnostic algorithm. Int J Clin Pract 2021; 75:e13977. [PMID: 33369808 DOI: 10.1111/ijcp.13977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS To evaluate the diagnostic yield of investigations performed on patients with a history of urinary tract infections (UTI). METHODS A retrospective review was conducted on patients who underwent cystoscopy and imaging for a history of UTI between 2014 and 2019 in a single UK teaching hospital. Data were collected on demographics, cystoscopy and radiological findings requiring further management. The cohort was stratified by age, gender and a confirmed history of recurrent UTI (rUTI). The subsequent algorithm was re-tested in a second cohort to validate its use. RESULTS Seven hundred patients were included in the primary analysis-427 female and 273 males. Three hundred and thirty-one met the criteria of rUTI. The median age was 64 years (18-97). Imaging abnormalities were equally frequent in men 6.3% (15/241) and women 8% (30/380) and the majority noted in patients aged ≥55 years, 30/45 (66.7%). Amongst those who did not meet the definition of rUTI, abnormal imaging was identified in 5%-7% regardless of age group and gender. Cystoscopy abnormalities (n = 24) were twice more likely in males, 5.5%(15/273) than females, 2%(9/427). About 88%(21/24) were identified in patients ≥55 years. There were no positive findings in women <55 years. Applying baseline imaging but confining cystoscopy to those aged ≥55 years and men with a confirmed history of rUTI would have saved 44% of procedures, missed no abnormalities with an overall diagnosis detection rate of 9.8% (69/700). This algorithm was validated in a separate cohort of 63 patients; applying it would have saved 46% (29/63) of cystoscopies with a positive diagnostic rate of 9.5% and no missed findings. CONCLUSION To our knowledge this is one of the largest studies reporting the outcomes of investigations for UTI and rUTI. Our result suggests that imaging is a useful baseline assessment, but cystoscopy should be limited to specific subgroups. We propose and validate a simple decision algorithm to manage investigations for referrals for UTI in secondary care.
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Affiliation(s)
- Ibifuro I Dokubo
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
| | - Felicity Reeves
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
| | - Sophia Cashman
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
- Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Cambridge, UK
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100
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Maruyama T, Mizuno K, Nishio H, Kato T, Hamakawa T, Ikegami Y, Yasui T, Hayashi Y. Antireflux endoscopic injection therapy in post-pubertal patients via techniques adopted for the dilated ureteral orifice: a retrospective single-center study. BMC Urol 2021; 21:70. [PMID: 33894751 PMCID: PMC8067324 DOI: 10.1186/s12894-021-00842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/06/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To investigate the efficacy and safety of endoscopic injection therapy for vesicoureteral reflux in post-pubertal patients with dilated ureteral orifice via modified hydrodistension implantation techniques. METHODS We retrospectively reviewed medical records including operational procedure and clinical course of all consecutive patients over 12 years old with a history of injection therapy. Endoscopic injection of dextranomer/hyaluronic acid copolymer was performed under hydrodistension implantation technique with some modifications in order to inject through dilated ureteral orifice align with the intramural ureter. Technical selections were done according to hydrodistension grade of the ureteral orifice. Voiding cystourethrography was evaluated at 3 months postoperatively. Hydronephrosis was evaluated using ultrasonography preoperatively until 6 months postoperatively. RESULTS From 2016 to 2019, 12 patients (all female, 16 ureteral units; median age 32 [range 15-61] years) underwent endoscopic injection therapy at one of our institutions. We have identified grade II vesicoureteral reflux in 5 ureters, grade III in 8, and grade IV in 3 ureters. Grade 3 ureteral-orifice dilation were presented in 12 ureters (75%), grade 2 in 3 and grade 1 in 1 ureter in the present cases. Postoperatively, vesicoureteral reflux was diminished to grade 0 in 12 ureteral units (75%), decreased to grade I in 3 (9%), and remained grade III in 1 (6%). Three patients reported dull flank pain for several days postoperatively and there was 1 case of acute pyelonephritis. Temporary hydronephrosis was confirmed in 3 ureteral units (19%) at 1 month postoperatively. Median follow-up duration was 23 (range 13-63) months long. Although, 3 patients were experienced f-UTI 1-2 times, repeated VCUG showed no VUR recurrence. CONCLUSIONS According to hydrodistension grade of the ureteral orifice, endoscopic injection therapy via modified hydrodistension implantation technique is an effective and safe treatment for vesicoureteral reflux in post-pubertal female patients with dilated ureteral orifice. While ureteral deformities or a history of anti-reflux surgery may increase the risks, these can be managed with appropriate methods that ensure sufficient mound appearance and height.
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Affiliation(s)
- Tetsuji Maruyama
- Department of Urology, Nagoya City East Medical Center, 2 Wakamizu-cho, Chikusa-ku, Nagoya, 464-8547, Japan
| | - Kentaro Mizuno
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hidenori Nishio
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Taiki Kato
- Department of Urology, Nagoya City East Medical Center, 2 Wakamizu-cho, Chikusa-ku, Nagoya, 464-8547, Japan
| | - Takashi Hamakawa
- Department of Urology, Nagoya City East Medical Center, 2 Wakamizu-cho, Chikusa-ku, Nagoya, 464-8547, Japan
| | - Yosuke Ikegami
- Department of Urology, Nagoya City East Medical Center, 2 Wakamizu-cho, Chikusa-ku, Nagoya, 464-8547, Japan
| | - Takahiro Yasui
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Yutaro Hayashi
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
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