Outcomes and cost analysis of patients with dementia in the intensive care unit: a population-based cohort study

BACKGROUND

Dementia is a neurological syndrome affecting the growing elderly population. While patients with dementia are known to require significant hospital resources, little is known regarding the outcomes and costs of patients admitted to the intensive care unit (ICU) with dementia.

METHODS

We conducted a population-based retrospective cohort study of patients with dementia admitted to the ICU in Ontario, Canada from 2016 to 2019. We described the characteristics and outcomes of these patients alongside those with dementia admitted to non-ICU hospital settings. The primary outcome was hospital mortality but we also assessed length of stay (LOS), discharge disposition, and costs.

RESULTS

Among 114,844 patients with dementia, 11,341 (9.9%) were admitted to the ICU. ICU patients were younger, more comorbid, and had less cognitive impairment (81.8 years, 22.8% had ≥ 3 comorbidities, 47.5% with moderate-severe dementia), compared to those in non-ICU settings (84.2 years, 15.0% had ≥ 3 comorbidities, 54.1% with moderate-severe dementia). Total mean LOS for patients in the ICU group was nearly 20 days, compared to nearly 14 days for the acute care group. Mortality in hospital was nearly three-fold greater in the ICU group compared to non-ICU group (22.2% vs. 8.8%). Total healthcare costs were increased for patients admitted to ICU vs. those in the non-ICU group ($67,201 vs. $54,080).

CONCLUSIONS

We find that patients with dementia admitted to the ICU have longer length of stay, higher in-hospital mortality, and higher total healthcare costs. As our study is primarily descriptive, future studies should investigate comprehensive goals of care planning, severity of illness, preventable costs, and optimizing quality of life in this high risk and vulnerable population.

Intraoperative use of electrical impedance spectroscopy for adenoid cystic carcinoma of the lacrimal gland: A case report

Key Clinical Message

Electrical Impedimetric Tumor Detection System is a novel and promising tool for fast intraoperative tumor delineation and accurate safe margin detection in orbital tumors.

Abstract

Adenoid cystic carcinoma (ACC) is a rare malignant tumor of epithelial origin, typically arising from the salivary and lacrimal glands. ACC is notorious for recurrence and a high rate of morbidity and mortality despite therapy. We presented a 48-year-old male patient with lacrimal gland ACC of the right orbit who underwent radical tumor resection and adjuvant radiotherapy. We applied a new diagnostic method, the Electrical Impedimetric Tumor Detection System, during surgery and tested its performance to enhance the precision of tumor resection. Two months after surgery, he underwent external radiation of 58 Gy in 29 fractions. He showed no tumor recurrence or metastasis in the 1-year follow-up visits. ITDS showed a precision of tumor and margin detection consistent with histopathology results. This novel ITDS may be a reliable system for fast intraoperative tumor delineation and accurate, safe margin detection in orbital tumors.

Hydroelectric actuator for 3-dimensional analysis of electrophoretic and dielectrophoretic behavior of cancer cells; suitable in diagnosis and invasion studies

Cancer is a cellular-based disease, so cytological diagnosis is one of the main challenges for its early detection. An extensive number of diagnostic methods have been developed to separate cancerous cells from normal ones, in electrical methods attract progressive attention. Identifying and specifying different cells requires understanding their dielectric and electric properties. This study evaluated MDA-MB-231, HUVEC, and MCF-10A cell lines, WBCs isolated from blood, and patient-derived cell samples with a cylindrical body with two transparent FTO (fluorine-doped tin oxide) plate electrodes. Cell mobility rates were recorded in response to these stimuli. It was observed that cancer cells demonstrate drastic changes in their motility in the presence and absence of an electric field (DC/AC). Also, solution viscosity's effect on cancer cells' capturing efficacy was evaluated. This research's main distinguished specification uses a non-microfluidic platform to detect and pathologically evaluate cytological samples with a simple, cheap, and repeatable platform. The capturing procedure was carried out on a cytological slide without any complicated electrode patterning with the ability of cytological staining. Moreover, this platform successfully designed and experimented with the invasion assay (the ability of captured cancer cells to invade normal cells).

High-Frequency (30 MHz-6 GHz) Breast Tissue Characterization Stabilized by Suction Force for Intraoperative Tumor Margin Assessment

A gigahertz (GHz) range antenna formed by a coaxial probe has been applied for sensing cancerous breast lesions in the scanning platform with the assistance of a suction tube. The sensor structure was a planar central layer and a metallic sheath of size of 3 cm² connected to a network analyzer (keySight FieldFox N9918A) with operational bandwidth up to 26.5 GHz. Cancer tumor cells have significantly higher water content (as a dipolar molecule) than normal breast cells, changing their polarization responses and dielectric losses to incoming GHz-based stimulation. Principal component analysis named S₁₁, related to the dispersion ratio of the input signal, is used as a parameter to identify malignant tumor cells in a mouse model (in vivo) and tumor specimens of breast cancer patients (in vitro) (both central and marginal parts). The results showed that S₁₁ values in the frequency range from 5 to 6 GHz were significantly higher in cancer-involved breast lesions. Histopathological analysis was the gold standard for achieving the S₁₁ calibration to distinguish normal from cancerous lesions. Our calibration on tumor specimens presented 82% positive predictive value (PPV), 100% negative predictive value (NPV), and 86% accuracy. Our goal is to apply this system as an in vivo non-invasive tumor margin scanner after further investigations in the future.

Intraoperative Assessment of High-Risk Thyroid Nodules Based on Electrical Impedance Measurements: A Feasibility Study

Precise diagnosis of thyroid nodules is challenging due to non-diagnostic/inconclusive results and uncertainties about the malignancy of follicular neoplasms (FNs), even in frozen-section pathology. Therefore, surgical management, especially in Bethesda III and IV categories, may be complicated, and sometimes a second surgery may be required. The Thyroid Nodule Impedance Measurement System (TN-IMS) consists of a metallic patch attached to submental skin and a G20 I.V. cannula inserted into the targeted nodules. Two impedance-based parameters named Z1kHz and impedance phase slope (IPS) in 100 kHz to 500 kHz of the thyroid nodules are recorded and compared with their histopathological results as the gold standard. TN-IMS was intra-surgically applied to 103 human thyroid nodules and normal thyroid tissues. A remarkable consistency between defined co-ranges of Z1kHz/IPS and the histopathological status of specimens was achieved (p < 0.001). Based on these measurements, it was concluded that intraoperative bioelectrical impedance scanning of thyroid nodules would be a helpful complementary approach to detecting high-risk excision-required thyroid nodules.

Intra-radiological pathology-calibrated Electrical Impedance Spectroscopy in the evaluation of excision-required breast lesions

PURPOSE

Evaluating a real-time complementary bioelectrical diagnostic device based on Electrical Impedance Spectroscopy(EIS) for improving breast imaging-reporting and data system (BIRADS) scoring accuracy, especially in high-risk or borderline breast diseases. The primary purpose is to characterize breast tumors based on their dielectric properties. Early detection of high-risk lesions and increasing the accuracy of tumor sampling and pathological diagnosis are secondary objectives of the study.

METHODS

The tumor detection probe (TDP) was first applied to the mouse model for electrical safety evaluations by electrical current measurement, then to 138 human palpable breast lesions undergo CNB, VAB, or FNA with the surgeon's requests. Impedance phase slope(IPS) in frequency ranges of 100 kHz to 500 kHz and impedance magnitude in f = 1kHz were extracted as the classification parameters. Consistency of radiological and pathological declarations for the excisional recommendation was then compared with the IPS values.

RESULTS

Considering pathological results as the gold standard, meaningful correlations between IPS and pathophysiological status of lesions recommended for excision (such as atypical ductal hyperplasia, papillary lesions, complex sclerosing adenosis, and fibroadenoma, etc.) were observed (p<0.0001). These pathophysiological properties may include cells size, membrane permeability, packing density, adenosis, cytoplasm structure, etc. Benign breast lesions showed IPS values greater than zero, while high-risk proliferative, precancerous, or cancerous lesions had negative IPS values. Statistical analysis showed 95% sensitivity with Area Under the Curve(AUC) equal to 0.92.

CONCLUSION

Borderline breast diseases and high-risk lesions that should be excised according to standard guidelines can be diagnosed with TDP before any sampling process. It is a precious outcome for high-risk lesions that are radiologically underestimated to BI-RADS3, specifically in younger patients with dense breast masses, challenging in mammographic and sonographic evaluations. Also, the lowest IPS value detects the most pathologic portions of the tumor for increasing sampling accuracy in large tumors.

SIGNIFICANCE

Precise detection of high-risk breast masses, which may be declared BI-RADS3 instead of BI-RADS4a. This article is protected by copyright. All rights reserved.

Intraoperative pathologically-calibrated diagnosis of lymph nodes involved by breast cancer cells based on electrical impedance spectroscopy; a prospective diagnostic human model study

BACKGROUND

Nodal status evaluation is a crucial step in determining prognostic factors and managing treatment strategies for breast cancer patients. Preoperative (CNB), intraoperative (SLNB), and even postoperative techniques (Formalin-Fixed Paraffin-Embedded sectioning, FFPE) have definite limitations of precision or sometimes are time-consuming for the result declaration. The primary purpose of this prospective study is to provide a precise complementary system for distinguishing lymph nodes (LNs) involved by cancerous cells in breast cancer patients intraoperatively.

METHODS

The proposed system, Electrical Lymph Scoring(ELS), is designed based on the dielectric properties of the under-test LNs. The system has a needle-shaped 2-electrode probe entered into SLNs or ALNs dissected from patients through standard surgical guidelines. Impedance magnitude in f = 1 kH (Z_1kHz) and Impedance Phase Slope in frequency ranges of 100 kHz-500 kHz (IPS) were then extracted from the impedance spectroscopy data in a cohort study of 77 breast cancer patients(totally 282 dissected LNs) who had been undergone surgery before (n = 55) or after (n = 22) chemical therapies (non-neoadjuvant or neoadjuvant chemotherapy). A new admittance parameter(Y_n^') also proposed for LN detection in neoadjuvant chemotherapy patients.

RESULTS

Considering the permanent pathology result as the gold standard checked by two independent expert pathologists, a significant correlation was observed between the presence of cancerous cells in LNs and individual ranges of the ELS electrical responses. Compared with normal LNs containing fatty ambient and immune cells, LNs involved by cancerous clusters would reduce the Z_1kHz and increase the IPS. These changes correlate with fat metabolism by cancer cells due to their Fatty Acid Oxidation (FAO) in LN, which results in different dielectric properties between high and low-fat content of normal and cancerous LNs, respectively.

CONCLUSIONS

By finding the best correlation between our defined impedimetric parameters and pathological states of tested LNs, a real-time intraoperative detection approach was developed for highly-sensitive (92%, P<0.001) diagnosis of involved sentinel or axillary LNs. The impact of real-time intraoperative scoring of SLNs would make a pre-estimation about the necessity of excising further LNs to help the surgeon for less invasive surgery, especially in the absence of frozen-section equipment.

Nanoporous platinum needle for cancer tumor destruction by EChT and impedance-based intra-therapeutic monitoring

Herein, we present a new design on the Single Needle Electrochemical Therapy (SNEChT) method by introducing some major improvements, including a nanoporous platinum electrode, tunable in situ anode size that depends on the width and location of the tumor, and the capability of measuring the efficacy of therapy based in intra-therapeutic impedance recording by the same EChT needle. It could have significant implications in optimizing EChT operative conditions. The nanoporous Pt electrode increased the interactive surface with a tumor, and produced a higher amount of current with lower stimulating DC voltage. The tunable anode size prevents the over-acidification of treated or non-desired lesions. Hence, this feature reduced the over distribution of tissue. Monitoring the impedance during the therapy clearly informs us about the local destruction of the tumor in each location. Thus, we can be informed about the threshold of tissue acidosis with the lowest electrical stimulation. The insertion of one needle with a tunable anode length for both precise therapy and impedance-based intra-therapeutic monitoring will shed new light on the applications of EChT.

Bioelectrical pathology of the breast; real-time diagnosis of malignancy by clinically calibrated impedance spectroscopy of freshly dissected tissue

In this paper, freshly (non-fixed) dissected tissues obtained from breast cancer surgery were impedimetrically and pathologically scanned, analyzed, and probable electro-pathological mutual matching was investigated. A new electrical model was proposed for pathological scores of breast lesions based on the theory of electric current dispersion by different types of biological tissues. This integrated handheld bioimpedance sensor named EPA would score the clearance or malignancy involvement of dissected tumor margins by introducing two crucial classification parameters named Z_1kHz and IPS (impedance phase slope in the frequency ranges of 100-500 kHz). EPA benefits from a precise signal recording and analysis method which leads to the detection of the presence of even about 5% distribution of premalignant cells among healthy breast tissue. EPA can be clinically used by pathologists, as a complementary device, for real-time diagnosis of suspicious margins of dissected tumors to declare more precise intraoperative diagnosis by scanning all around the dissected tissues. Each data sampling and analysis covers 2 mm of the surface in less than 5 s. Measurements on about 313 human breast tumor margins showed more than 90% accuracy and near 93% specificity for EPA as an independent diagnostic tool.

A double-blind, placebo-controlled trial related to the effects of melatonin on oxidative stress and inflammatory parameters of obese women

Obesity, the global epidemic health problem, results in chronic disorders. Melatonin supplementation may prevent the adverse health consequences of obesity. The aim of this study was to assess the effects of melatonin supplementation on inflammatory and oxidative stress parameters in obese women. In randomized, double-blind, placebo-controlled trial, 44 obese women were randomly assigned to melatonin (n=22) and placebo (n=22) groups. Subjects were supplemented with a daily dose of 6 mg melatonin or placebo with low calorie diet for 40 days. Serum TNF-α, IL-6, hsCRP, TAC, and MDA levels were assessed before and after intervention. In the melatonin group, mean serum TNF-α, IL-6, hsCRP, and MDA levels decreased significantly (p<0.05) from 3.52±0.72 pg/ml, 27.12±6.32 pg/ml, 2.54±0.49 mg/l, and 3.81±0.29 nmol/l to 1.73±0.07, 16.34±6.32, 1.67±0.27, and 2.79±0.29, respectively. Whilst in the placebo group the decrease in values were not statistically significant. Mean TAC level increased slightly (from 1.11±0.30 to 1.14±0.45 mmol/l) in the melatonin group whereas it decreased slightly (from 1.13±0.15 to 1.08±0.21 nmol/l) in the placebo group. Significant differences were observed only for TNF-α (p=0.02) and IL-6 (p=0.03) between the 2 study groups. Considering the improvements in inflammatory and oxidative stress factors in obese women, it seems that melatonin supplementation may provide beneficial effects in obesity treatment by ameliorating some of its complications. However, further studies are needed to make concise conclusions.

Circulating levels of interleukin-35 in patients with multiple sclerosis: evaluation of the influences of FOXP3 gene polymorphism and treatment program

The regulatory T (Treg) cells play a major role in the control of the autoimmunity and inflammation, and IL-35 has been described as an immunosuppressive cytokine that is mainly produced by CD4(+)FOXP3(+) Treg cells. The aim of this study was to evaluate the serum levels of IL-35 and a single nucleotide polymorphism (SNP), rs3761548, in FOXP3 gene in patients with multiple sclerosis. The blood samples were collected from 140 multiple sclerosis (MS) patients (including 51 untreated and 89 treated patients) and 140 healthy subjects as a control group. The serum levels of IL-35 were measured by ELISA. The DNA was analyzed for SNP rs3761548 in FOXP3 gene using SSP-PCR. There was no significant difference between untreated MS patients and control group regarding the mean serum levels of IL-35, although this parameter was higher in untreated patients. However, the mean serum level of IL-35 in treated MS patients was significantly higher than that in the control group (P < 0.008). The mean serum levels of IL-35 in patients who were treated with interferon-β, methylprednisolone, or with the both interferon-β and methylprednisolone were significantly higher than that in the healthy group (P < 0.01, P < 0.01, and P < 0.2, respectively). The frequencies of AA and AC genotypes at rs3761548 in the FOXP3 gene were significantly higher in MS group as compared with healthy subjects (P < 0.05). The frequency of CC genotype at rs3761548 was significantly lower in the MS group in comparison with healthy control subjects (P < 0.001). Moreover, the frequency of A allele was significantly higher whereas the frequency of C allele was significantly lower in MS patients in comparison to healthy subjects (P < 0.001). The mean serum level of IL-35 was significantly lower in MS patients or healthy subjects with AA genotype as compared with those with CC genotype at rs3761548 in FOXP3 gene (P < 0.01 and P < 0.001, respectively). These results showed higher serum levels of IL-35 in treated MS patients representing that the benefit effects of treatment may in part performed through the upregulation of the IL-35 production. The SNP rs3761548 may influence the susceptibility to MS disease and the serum levels of IL-35.

A distinct autosomal recessive ocular anomaly in Chaharborj, Islamic Republic of Iran

In Chaharborj, a village in north-eastern ofthe Islamic Republic of Iran, a high prevalence of congenital blindness (1.1%) has been reported. The clinical findings have not been fully described. We therefore assessed the clinical aspects of this condition in a case series of 20 congenitally blind patients and 24 of their parents. All patients had been blind since birth. There was anterior segment dysgenesis and retinal non-attachment in all patients. There were no systemic anomalies. Histopathologically, there was iridocorneal adhesion, normal angle structure and retinal dysplasia. No significant difference was found in the frequency of different HLA class I alleles compared with the general population. The anomaly causing congenital blindness in these patients has components of both anterior and posterior segment dysgenesis. It appears to be a distinct entity with an autosomal recessive pattern of inheritance.

Association between fat content of breast milk and maternal nutritional status and infants' weight in tabriz, iran

The aim of this study was to investigate the relationship between breast milk fat content with maternal anthropometric status, energy and macronutrient intake and weight for age Z-score of exclusively breastfed infants. Breast milk samples and information on energy and macronutrients intake (using 24-hour recall method for 3 days) were collected from 182 lactating women. Weight and height of mothers and infants were measured and the body mass index (BMI) and weight for age Z-score (WAZ) were calculated. The fat content of the milk samples was measured by the Gerber method. The mean daily energy intake was 2390 ± 405 kcal which was lower than the recommended values for mothers. The mean fat content of the milk samples was 3.52 ± 1.41 g/dl, which was significantly associated with dietary carbohydrate consumption (β= 0.39, P<0.004) and BMI (β= 0.28, P<0.02). A significant association between the WAZ of infants and maternal BMI (β= 0.36, P<0.001) was recorded. The WAZ of infants whose mothers' breast milk lipid content was more than 3 g/dl was significantly higher than those whose mothers had lower breast milk lipid content (P<0.031). Further studies need to be done on the effect of fat content of breast milk on infant's weight and how maternal factors regulate the composition of breast milk.

Determination of free L-carnitine levels in type II diabetic women with and without complications

BACKGROUND

Studies on the determination of carnitine levels and nutritional status in patients of type II diabetes.

OBJECTIVE

We designed this study to determine changes of serum-free L-carnitine in type II diabetic women.

DESIGN

A cross-sectional study (case-control study).

SETTING

Clinical of Endocrinology and Metabolism, Sina Hospital, Pharmacological Research Center, Tabriz Medical university, Iran.

PATIENTS AND METHODS

Taking into account the importance of the control of diabetes, in the present case-control study, the levels of serum-free L-carnitine, blood glucose and lipids, systolic and diastolic blood pressure, body mass index (BMI) and nutritional status assessed in the case and control groups which were selected by the simple sampling method. The control group (n=18) included patients with no complications and the case group (n=33) was grouped into three subgroups including patients with retinopathy, hyperlipidemia and neuropathy.

RESULTS

Study results indicated that the mean serum-free L-carnitine concentration in the case group was significantly lower than its mean concentration level in the control group, 39.63+/-8.99 vs 53.42+/-0.93 micromol/l, respectively (P<0.001). Serum-free L-carnitine in retinopathy, hyperlipidemia and neuropathy case subgroups were 39.03+/-9.89, 39.63+/-8.99 and 40.44+/-12.50 micromol/l, respectively (P>0.05). No significant difference was found between the serum-free carnitine levels of the case subgroups. The mean blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol levels and systolic and diastolic blood pressure were significantly higher in the case group than in the control group.

CONCLUSION

In this study, the mean serum-free L-carnitine levels in diabetic patients with complications was almost 25% lower than in diabetic patients with no complications. On the basis of the study results, carnitine supplementation in diabetic patients, especially in patients with diabetes complications, might be useful.

Preparing live donor for kidney donation

PURPOSE

In order to select the most appropriate donor and minimize psychological and physical complications in the kidney donors, it is of high importance to prepare the donor meticulously. The essential respective items are reviewed in this study.

MATERIALS AND METHODS

The available published literature and papers presented in Medline from 1983 to 2003 were reviewed.

RESULTS

One the sources of sources of kidney donation is the live donor which is mostly used in Iran. Similarly, due to long waiting lists of kidney recipients, live donor kidney transplantation have been increasingly used in developed countries. Consequently, several aspects of this issue have been considered and specific recommendations have been discussed; anatomy of the donor's kidney, age, ABO blood group, viral infections, weight, HLA type compatibility, psychological status, and diseases such as diabetes, ADPKD, and Alport syndrome should be evaluated in donation candidates.

CONCLUSION

Live donor kidney donation has the advantage of elective and programmed transplantation over cadaveric transplantation. However, removal of an intact organ from the body of a normal individual may lead to complications, as it may so in any other major surgical operation. Thus, it is strongly recommended to select the most appropriate donor patiently by a series of accurate evaluations.

Incisional hernia after renal transplantation and its repair with propylene mesh

PURPOSE

Kidney recipients are susceptible to incisional hernia. We studied predisposing factors for incisional hernia in our patients and the results of its repair with propylene mesh.

MATERIALS AND METHODS

From 1989 to 2002, 589 patients had undergone kidney transplantation in our hospital. Of these, patients who developed incisional hernia were evaluated in this study. The following data were collected from their records: age, gender, weight, age at graft rejection, surgical complications, treatment method, and the treatment results with propylene mesh.

RESULTS

Of 589 recipients, 16 (3%) developed incisional hernia in surgical site. The median interval between kidney transplantation and developing of incisional hernia was 48 (range 12 to 425) days. Predisposing factors were overweight, age over fifty years, and female gender (P <0.005). In four patients, hernia was small, and the repair was performed without using mesh. Three patients were reluctant to hernia repair, and in 9, due to the large size of hernia, repair was done using propylene mesh. Having these 9 patients treated with propylene mesh, 2 developed serous collection in surgical site, which were managed successfully with multiple punctures. Hernia recurrence or infection was not noted in these patients during 3 to 36 months follow-up periods.

CONCLUSION

Incisional hernia is not a rare entity after kidney transplantation. Predisposing factors, such as overweight, age over 50 years, and female gender have a role in its development. Also, repeated surgeries in kidney recipients can increase the risk of incisional hernia. Managing this complication with propylene mesh is a safe and effective method.

Epididymo-orchitis risk factors in traumatic spinal cord injured patients

STUDY DESIGN

Retrospective audit and interview-based study of a traumatic spinal cord injured cohort, assessing the incidence and risk of epididymo-orchitis (E-O).

OBJECTIVES

Assess the potential risk factors for E-O in this cohort (spinal cord injured patients).

SETTING

Janbazan Clinic for Spinal Cord Injuries, Mashad, Iran.

METHODS

A retrospective notes audit of 169 male traumatic spinal cord injured (SCI) patients was performed. In addition, interviews were performed to confirm any equivocal data. The following risk factors were assessed: history of recurrent urinary tract infections (UTIs), urethral stricture, urethral diverticuli, urinary fistula, urinary calculi, spinal injury type, neurogenic bladder type, autonomic dysreflexia, vesico-ureteral reflux, sphincterotomy, vasectomy, marriage status, bladder residual and emptying method, ejaculation, spinal injury level, micturation control, and muscular spasm, which included detrusor, external sphincter or lower limb spasm.

RESULTS

A total of 65 patients from our group (38.5%) had suffered E-O at least once. E-O presented on average, 3.9 years after the SCI. Patients with a history of muscular spasm appeared less likely to develop E-O (P<0.05). None of the vasectomised patients developed E-O. The relation between all the other factors and E-O were not significant.

CONCLUSIONS

Our study has shown that the presence of muscular spasm decreases the risk of E-O, although the mechanism remains unclear. Surprisingly, the other historical risk factors showed no clear relation with E-O occurrence.

Covered exstrophy and visceral sequestration with complete double bladder

A 13-year-old boy had a complete double bladder and urethra associated with an inferior abdominal lesion, which on histological examination proved to be a colonic remnant with no communication to the underlying bowel. This entity is one of the exstrophy/epispadias complex variants known as covered exstrophy with sequestered bowel. Although 4 cases of this anomaly have been reported in the literature, to my knowledge this is the first such case with a double bladder. Excision of the lesion and the incontinent bladder was performed, and the ureter was reimplanted in the contralateral continent bladder.