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Neves Neto JF, Palomino Z, Mizuno Watanabe IK, Aguiar WF, Medina-Pestana JO, Soler R. Pretransplant defunctionalized bladder-overrated condition? Neurourol Urodyn 2018; 37:1559-1566. [PMID: 29357104 DOI: 10.1002/nau.23495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/19/2017] [Indexed: 11/11/2022]
Abstract
AIMS The objective of this study was to evaluate the expression of bladder receptors in patients with defunctionalized bladder (DB) and to assess voiding behavior after refunctionalization. METHODS A total of 68 pretransplant patients were divided in two groups: DB (diuresis <300 mL/24 h; n = 33) and NDB (non-DB; diuresis ≥300 mL/24 h; n = 35). A sample of mucosa and detrusor at the site of the future ureteral implantation was collected. The following receptors were assessed by real-time polymerase chain reaction (qRT-PCR): M2 , M3 , α1D , β3 , P2X2 , P2X3 , TRPV1, TRPV4, TRPA1, and TRPM8. At 3, 6, and 12 months after transplant patients answered IPSS and ICIQ-OAB questionnaires and filled a 3-day 24 h frequency/volume chart (FVC) at 6 and 12 months. RESULTS The expression of all receptors in the mucosa and in the detrusor was similar in both groups, except from α1D , which was overexpressed in the detrusor of DB relatively to NDB group. ICIQ-OAB symptom score was similar between the groups at 3, 6, and 12 months. There was a reduction of this score in both groups with time. The same pattern was found for IPSS score. Bother scores were similar between groups. No difference was observed for all FVC parameters between DB and NDB patients. CONCLUSION Gene expression of bladder receptors involved in micturition control was similar in patients with or without DB. Bladder behavior had a similar pattern independently of pretransplant residual diuresis. These findings question the relevance of the term DB in pretransplant patients.
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Affiliation(s)
- João F Neves Neto
- Division of Urology, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital do Rim, Fundação Oswaldo Ramos, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Zaira Palomino
- Hospital do Rim, Fundação Oswaldo Ramos, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Wilson F Aguiar
- Division of Urology, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital do Rim, Fundação Oswaldo Ramos, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jose O Medina-Pestana
- Hospital do Rim, Fundação Oswaldo Ramos, Universidade Federal de São Paulo, São Paulo, Brazil.,Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Roberto Soler
- Division of Urology, Universidade Federal de São Paulo, São Paulo, Brazil
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Elsayed M, Finn A, Dapaah-Afriyie K. Unusual organism causing pyocystis in an immunosuppressed haemodialysis patient. BMJ Case Rep 2016; 2016:bcr-2015-214264. [PMID: 27030457 DOI: 10.1136/bcr-2015-214264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 68-year-old man with end-stage renal disease and a history of orthotopic cardiac transplantation on chronic immune suppression therapy presented to the emergency department with fever and purulent urethral discharge. He was diagnosed with pyocystis (bladder abscess). Culture of the urethral discharge showedTrueperella bernardiae The patient improved after 3 days of bladder irrigation with normal saline and gentamicin. This case demonstrates that bladder abscess is a potential source of infection in an oliguric patient. This is the first report to describe the opportunistic pathogen,T. bernardiae, as the causative agent in pyocystis.
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Affiliation(s)
- Mohammad Elsayed
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Arkadiy Finn
- Department of Medicine, Warren Alpert School of Medicine, Brown University, The Miriam Hospital, Providence, Rhode Island, USA
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Stafford P, Prybys KM. Pyocystis and prostate abscess in a hemodialysis patient in the emergency department. West J Emerg Med 2015; 15:655-8. [PMID: 25247036 PMCID: PMC4162722 DOI: 10.5811/westjem.2014.5.22317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/09/2014] [Indexed: 11/16/2022] Open
Abstract
The urinary tract is an often forgotten and under-appreciated source of infection in anuric hemodialysis patients. Bladder abscess, also called pyocystis, is a severe complication of low urinary flow that can be difficult to detect, leading to delays in treatment and increased morbidity. The emergency physician should maintain a high suspicion for pyocystis, which can be quickly diagnosed by bedside ultrasound. We report a case of a hemodialysis patient with an initially minor presentation who developed sepsis secondary to pyocystis and prostate abscess.
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Affiliation(s)
- Phillip Stafford
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland
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Min Z. A forgotten complication of a defunctionalized urinary bladder: pyocystis. Intern Emerg Med 2014; 9:691-2. [PMID: 24554081 DOI: 10.1007/s11739-014-1060-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Zaw Min
- Department of Medicine, Division of Infectious Diseases, Allegheny General Hospital, Allegheny Health Network, 420 East North Avenue, East Wing, Suite 407, Pittsburgh, PA, 15212, USA,
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Lawrence A, Hu B, Lee O, Stone A. Pyocystis after urinary diversion for incontinence--is a concomitant cystectomy necessary? Urology 2013; 82:1161-5. [PMID: 23978370 DOI: 10.1016/j.urology.2013.06.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/20/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To review the incidence of defunctionalized bladder-related complications in patients who have had a supravesical urinary diversion for intractable urinary incontinence without concomitant cystectomy. MATERIALS AND METHODS We retrospectively analyzed the records of patients requiring urinary diversion for intractable urinary incontinence from 1996 to 2011 at our institution. Patients were excluded from the cohort if they had evidence of bladder outlet obstruction or a cystectomy at time of diversion, or had been diverted for active malignancy. Sixty patients underwent a supravesical urinary diversion without concomitant cystectomy for intractable urinary incontinence. The etiology of the urinary incontinence was overtly neurogenic in 28 patients and non-neurogenic in 32 patients. Patients had an average follow-up of 45 months (range, 9-96). The indications for surgery, previous surgical interventions, complications of surgery, and long-term outcomes, including the incidence of pyocystis and the need for secondary cystectomy in the postoperative period were reviewed. RESULTS Four of 60 patients (7%) experienced complications relating to the defunctionalized bladder; this included pelvic pain and pyocystis. Only 1 patient required admission to hospital for treatment of pyocystis, the remaining 3 patients were successfully managed as outpatients with oral antibiotics or analgesics. No patient required a secondary surgical procedure for the defunctionalized bladder. CONCLUSION Pyocystis and the need for a secondary cystectomy were rare complications in this cohort; we therefore believe that a concomitant cystectomy is unnecessary in patients undergoing supravesical urinary diversion for intractable urinary incontinence.
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Affiliation(s)
- Anna Lawrence
- Kulkarni Reconstructive Urology Center, Pune, Maharashtra, India.
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Kupś M, Słojewski M, Oszurek O, Sikorski A. Carcinoma in the inactive bladder - the dilemma of the forgotten organ. Cent European J Urol 2012; 65:38-9. [PMID: 24578923 PMCID: PMC3921762 DOI: 10.5173/ceju.2012.01.art12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 10/20/2011] [Accepted: 12/09/2011] [Indexed: 11/22/2022] Open
Abstract
Etiologic factors affecting bladder tumor have been well confirmed and it is widely recognized that carcinogenic substances in urine may play an important role in a pathogenesis. Carcinoma developing in a defunctionalized bladder, although uncommon, does occur. We report a case of a transitional cell carcinoma (TCC) found in a remaining bladder of a male patient and a review of the most relevant literature.
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Affiliation(s)
- Michał Kupś
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Oleg Oszurek
- Department of Genetics and Pathomorphology, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Sikorski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
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Abstract
Acute radiation cystitis occurs during or soon after radiation treatment. It is usually self-limiting, and is generally managed conservatively. Late radiation cystitis, on the other hand, can develop from 6 months to 20 years after radiation therapy. The main presenting symptom is hematuria, which may vary from mild to severe, life-threatening hemorrhage. Initial management includes intravenous fluid replacement, blood transfusion if indicated and transurethral catheterization with bladder washout and irrigation. Oral or parenteral agents that can be used to control hematuria include conjugated estrogens, pentosan polysulfate or WF10. Cystoscopy with laser fulguration or electrocoagulation of bleeding points is sometimes effective. Injection of botulinum toxin A in the bladder wall may relieve irritative bladder symptoms. Intravesical instillation of aluminum, placental extract, prostaglandins or formalin can also be effective. More-aggressive treatment options include selective embolization or ligation of the internal iliac arteries. Surgical options include urinary diversion by percutaneous nephrostomy or intestinal conduit, with or without cystectomy. Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen at higher than atmospheric pressure. The reported success rate of HBOT for radiation cystitis varies from 60% to 92%. An important multicenter, double-blind, randomized, sham-controlled trial to evaluate the effectiveness of HBOT for refractory radiation cystitis is currently being conducted.
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Affiliation(s)
- Shaun G Smit
- Department of Urology, University of Stellenbosch and Tygerberg Hospital, PO Box 19063, Tygerberg 7505, South Africa.
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Machado MG, Yoo JJ, Atala A. Defunctionalized bladders: effects before and after refunctionalization in an animal model. J Urol 2000; 164:1002-7. [PMID: 10958728 DOI: 10.1097/00005392-200009020-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Bladder behavior after refunctionalization is usually unpredictable. We comparatively analyze various aspects of bladder defunctionalization and subsequent refunctionalization using an animal model. MATERIALS AND METHODS A total of 18 rabbits were divided equally into 3 groups. Animals in group 1 underwent 2 successive surgical procedures, including bladder division and reattachment. Bladder division was performed by hemisecting the bladder from dome to trigone into a functioning and nonfunctioning chamber. Bladder reattachment was achieved by reanastomosing both hemibladders. Group 2 animals underwent sham operations, and group 3 animals were age matched normal controls. Serial urodynamic studies and fluoroscopic cystograms were performed in all animals. Gross, histochemical (hematoxylin and eosin, Masson's trichrome and Sirius red) and immunocytochemical (alpha-actin, collagen I and III) analyses, collagen content determination and organ bath studies were performed. RESULTS The defunctionalized hemibladders demonstrated lower wet weight, capacity and compliance compared to the functional contralateral and normal control bladders. Refunctionalization of the bladders resulted in a progressive recovery of capacity and compliance with time. The bladder contractile response and connective tissue-to-muscle ratio were abnormal in the defunctionalized segments but normalized after bladder refunctionalization. CONCLUSIONS Defunctionalization results in remarkable alterations in bladder growth, capacity, compliance and distribution of connective tissue. However, these bladders demonstrate an innate capacity to recover from these alterations following refunctionalization.
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Affiliation(s)
- M G Machado
- Department of Urology, Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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MACHADO MARCOSG, YOO JAMESJ, ATALA ANTHONY. DEFUNCTIONALIZED BLADDERS: EFFECTS BEFORE AND AFTER REFUNCTIONALIZATION IN AN ANIMAL MODEL. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67237-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- MARCOS G. MACHADO
- From the Department of Urology, Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - JAMES J. YOO
- From the Department of Urology, Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - ANTHONY ATALA
- From the Department of Urology, Children’s Hospital and Harvard Medical School, Boston, Massachusetts
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