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PubMed2003

[Carcinomatous degeneration on augmentation ileocystoplasty for tuberculous bladder].

The development of cancer on the ileal graft after augmentation ileocystoplasty for benign bladder disease is a little known complication. The authors report a case of squamous cell carcinoma in the ileal bladder occurring 37 years after augmentation ileocystoplasty for tuberculous bladder, in a 68-year old patient. Carcinomatous degeneration is usually occurs more than ten years after cystoplasty. Patients treated by this operation must be submitted to annual cystoscopy combined with guided biopsies at the slightest doubt. This surveillance should be started between the 5th and the 10th postoperative year.

Aged↗

PubMed1993

Long-term urologic management of the patient with spinal cord injury.

The primary goal of bladder management in the patient with a spinal cord injury is to achieve adequate bladder drainage, low-pressure urine storage, and low-pressure voiding. This will help prevent urinary tract infections, bladder wall damage, bladder overdistention, vesicoureteral reflux, and stone disease. Bladder retraining is indicated in all patients with disorders of the spinal cord and the brain. The basic aim is to provide bladder drainage without indwelling catheters and, if possible, without leg bags. Bladder retraining is usually begun with intermittent catheterization, with the use of alpha blockers to improve drainage in patients who are wearing leg bags or with anticholinergic drugs to improve continence. However, bladder retraining may be contraindicated in patients with vesicoureteral reflux or stone disease and in patients with impending renal failure. It is therefore important to evaluate all patients with neurogenic bladder using urodynamics, nuclear scanning, renal ultrasound, and voiding cystourethrography. In patients with stone disease, intravenous urography may also be required. Understanding of the basic neurologic lesion and bladder dysfunction is therefore vital to bladder retraining or transurethral surgery to provide adequate voiding. The regular periodic follow-up of all patients is vital to protect renal function.

Autonomic Nervous System Diseases↗

PubMed2001

Nitric oxide synthase immunoreactivity in human bladder carcinoma.

AIMS: To study the expression of the endothelial and inducible isoforms of nitric oxide synthase (eNOS and iNOS, respectively) in human bladder carcinoma and schistosomal bladder disease, and to compare it with normal adult and fetal urothelium. Nitric oxide is thought to play a complex role in human carcinogenesis, but has only recently been investigated in bladder cancer. METHODS: Immunohistochemistry was performed on paraffin wax embedded sections of 33 human bladder carcinomas and five bladder carcinoma cell lines; in addition, seven schistosomal bladder cases and normal and fetal urothelium were investigated. In the cell lines enzymatic activity was examined by the NADPH diaphorase reaction. RESULTS: Immunoreactivity for eNOS was present in most cells of all 31 cases examined. Immunoreactivity for iNOS was less abundant and was seen in 23 of 25 cases. Similar findings were noted in schistosomal bladder cancer. In the normal bladder mucosa, eNOS immunoreactivity was found only in the superficial cell layer and iNOS was not expressed, whereas in the fetal urothelium immunoreactivity for both isoforms was seen in all cell layers. Enzymatic activity and immunoreactivity for eNOS and iNOS were evident in the five bladder carcinoma cell lines. CONCLUSIONS: It is possible that NOS plays a role in the differentiation of the transitional epithelium in fetal life, has a biological function in the adult bladder mucosa, and is involved in bladder carcinogenesis. eNOS and iNOS immunoreactivity do not differ in schistosomal and non-schistosomal bladder carcinoma, but resemble the pattern of expression typical of fetal urothelium.

Adult↗

PubMed1987

Correlation of histopathological, cytological and flow cytometric findings in neoplastic and nonneoplastic lesions of the bladder.

Biopsy diagnosis, urine cytology and flow cytometry features of urine and bladder washings were compared in 81 cases of benign and malignant bladder disease. Some patients were followed by urine cytology and flow cytometry during treatment of tumors. There was a good correlation of the 3 parameters in relatively high grade tumors (II and III) but an inconsistent appearance of cells in the urine diagnosable by either urine cytology or flow cytometry for low grade lesions. High grade flat neoplasms may be detectable by urine cytology and flow cytometry before they are visible on endoscopy. Flow cytometry may indicate urothelial proliferation before it is apparent on urine cytology. Exfoliative benign lesions are diagnosed readily by the combination of urine cytology and flow cytometry. In benign and malignant lesions shedding of viable cells and, therefore, accessibility to urine cytology and flow cytometry are inconsistent. The need for repeated examinations in the case of low grade lesions suggests that the method is not reliable for single test screening programs but it is a valuable means of followup in cases of suspected or diagnosed disease.

Biopsy↗

PubMed2002

The bladder acellular matrix graft in a rat chemical cystitis model: functional and histologic evaluation.

PURPOSE: We investigated the feasibility of augmentation in a diseased bladder with a bladder acellular matrix graft. MATERIALS AND METHODS: In 50 female Sprague-Dawley rats chemical cystitis was induced by intravesical instillation of HCl repeated monthly to maintain chronic inflammation. Urodynamic studies were performed in all rats 1 week after the induction of chemical cystitis and repeated at sacrifice. The 29 rats in the experimental group underwent partial cystectomy (50% or greater), followed by bladder acellular matrix graft augmentation, while the 21 controls underwent monthly HCl instillation only. The rats were sacrificed at 2 weeks, 1, 2 and 3 months, respectively. The bladder was removed and examined for histological changes. RESULTS: Urodynamic studies showed that bladder capacity and compliance were significantly higher in the grafted than in the control group (p = 0.008 and 0.006, respectively, at 3 months). Histological studies revealed urothelial and smooth muscle regeneration within the bladder acellular matrix graft at 1 month and nerve regeneration at 3. The number of mast cells was significantly lower in the grafted region than in the host bladder of all grafted rats (p <0.001). CONCLUSIONS: In this rat chemical cystitis model bladder augmentation with a bladder acellular matrix graft led to functional and histological improvement over diseased host bladder.

Animals↗

PubMed1999

Mitochondrial involvement in bladder function and dysfunction.

Benign bladder pathology resulting from prostatic hypertrophy or other causes is a significant problem associated with ageing in humans. This condition is characterized by increased bladder mass, decreased urinary flow rate, decreased compliance, and these and other changes in bladder function often subject patients to increased risk of urinary tract infection. While the physiologic attributes of benign bladder pathology have been extensively described in humans and in various animal model systems, the biochemical and molecular genetic bases for that pathology have only recently been investigated in detail. Studies demonstrate that mitochondrial energy production and utilization are severely impaired in bladder smooth muscle during benign bladder disease, and to a large extent this realization has provided a rational basis for understanding the characteristic alterations in urinary flow and compliance in bladder tissue. Recent investigations targeting the detailed molecular basis for impaired mitochondrial function in the disease have shown that performance of the organellar genetic system, and to a large extent that of relevant portions of the nuclear genetic system as well, is severely aberrant in bladder tissue. In this article, we discuss the physiologic aspects of benign bladder disease, summarize biochemical evidence for the altered mitochondrial energy metabolism that appears to underlie bladder pathology, review the structure and function of the mitochondrial genetic system, and discuss molecular genetic studies of that system which have begun to provide a mechanistic explanation for the biochemical and physiological abnormalities that characterize the disease. We also discuss areas for further research which will be critically important in increasing our understanding of the detailed causes of benign bladder pathology.

Aging↗

PubMed1983

[The pathologic urinary bladder in the sonographic image].

Intracavitary sonography proved to be advantageous with regard to the T-classification of urinary bladder tumours in comparison with conventional diagnostic methods. Besides the good practicability, the high degree of correspondence between sonography and histopathological findings is emphasized. In 97 patients with urothelial bladder cancer this method yielded 63% correct results. In 32% overstaging was noticed, possible factors of which were exemplified. Part of the sonographic failures can be avoided by means of technical manipulation (gain-modification) together with increasing experience of the examiner. In particular benign bladder disease, which can be sonographically confused with cancer, has to be considered. These cases indicate the need to correlate particular sonographic findings with histopathology.

Cystitis↗

PubMedDate not supplied

Double gall bladder with two disease processes.

A double gall bladder is a rare congenital anomaly which is usually diagnosed by preoperative ultrasonography. Either one, or both lobes, of the double gall bladder, may be diseased. We report a patient in whom the two lobes were affected by different disease processes, namely, cholesterosis, and cholelithiasis with mucocele.

Adult↗

PubMed2006

New frontiers in intravesical therapies and drug delivery.

OBJECTIVES: The intravesical route permits site-specific delivery of drugs with a reduced side-effect profile as compared to oral delivery systems, either by avoiding first-pass metabolism or by obtaining a local effect. We investigated mechanisms related to urothelium permeability and new physical and chemical developments in intravesical drug delivery that potentially permit successful treatment of several bladder dysfunction. METHODS: A literature review. RESULTS: Pharmacologic agents increasing urothelial permeability and useful for clinical purposes have been described, such as dimethylsulfoxide, protamine sulphate, chitosan, and nystatin. Among physical approaches, electromotive drug administration appears to be more effective than intravesical passive diffusion in delivering drugs through the urothelium into deeper layers of the bladder. Experimental and clinical reports demonstrated that electric current significantly increases the transport of local anaesthetics, mytomicin C, oxybutynin, resiniferatoxin, epinephrine, and dexamethasone. Among new chemical approaches, cell-penetrating peptides posses the ability to translocate macromolecular drugs across membranes of urothelial cells. The therapeutic benefits of sustained delivery afforded by thermosensitive hydrogel, which forms a depot for hydrophilic and hydrophobic drugs, have been demonstrated by delivering anti-inflammatory drugs. Liposomes improve the aqueous solubility of several hydrophobic drugs such as taxol, amphotericin, and capsaicin. CONCLUSIONS: Electromotive drug administration, new in situ delivery systems, and bioadhesive liposomes may make it possible to extend intravesical therapy and drug administration to many bladder diseases. Research to expand knowledge of the chemical and physical properties of the bladder and processes regulating drug transport across biologic membranes is needed to make this a reality.

Absorption↗

PubMed2002

Vanilloid receptor and detrusor instability.

Very recently, a membrane receptor (vanilloid receptor type 1 [VR-1]) sensitive to capsaicin or resiniferatoxin (RTX) was identified in small- and medium-sized dorsal root ganglion neurons that give rise to most unmyelinated sensory fibers. After vanilloid binding to VR-1, these neurons remain transiently desensitized; that is, less reactive to natural stimuli. It is this effect of vanilloid substances that is being investigated for its potential therapeutic utility. In the urinary bladder, VR-1-expressing fibers are extremely abundant in the mucosa and in the muscular layer. In the latter, VR-1 fibers are intimately apposed to smooth muscle cells. The demonstration, several years ago, that these fibers were involved in detrusor hyperreflexia of spinal origin and in bladder pain processing, justified the clinical application of intravesical capsaicin or RTX in humans with these bladder diseases. More recently, the experimental and clinical evidence that the same type of bladder sensory fibers were also involved in detrusor instability made a strong case for intravesical RTX assay in patients with idiopathic detrusor instability.

Animals↗

PubMed1990

A useful monoclonal antibody (BL2-10D1) to identify tumor cells in urine cytology.

The monoclonal antibody (MoAb) BL2-10D1 directed against a tumor-associated antigen of human bladder cancer was used to identify tumor cells obtained by bladder washing or voided urine. The reactivity of BL2-10D1 MoAb was detected by an immunoperoxidase method and evaluated in ten healthy donors and in a series of 65 patients. The 65 patients studied were divided into three groups: ten with nontumor bladder disease (group A); 36 with bladder carcinoma (group B); and 19 with a history of bladder neoplasia but no visible tumor at the time of cytologic sampling (group C). The results were compared with the standard cytologic diagnosis on Papanicolaou-stained preparations. Conventional cytologic study showed a high false-negative rate in low-grade tumors (transitional cell carcinomas [TCC] Grades 1 and 2, 1/4 and 4/17, respectively). All urine from patients with a histologically proved TCC Grade 1 were stained with BL2-10D1 MoAb. Cytologic findings from patients with TCC Grade 2 (17 cases) contained positive cells in 14 cases and failed to react in three cases. Furthermore, whereas urine from patients with TCC Grade 2 or 3 was not always stained with BL2-10D1 MoAb, all patients with dysplastic lesions (three cases) or carcinoma in situ (5 cases) showed a positive reactivity. Such results suggest that BL2-10D1 MoAb may be considered as a valuable adjunct to the classical methods of early detection and follow-up of bladder cancer. However, a larger scale study is needed for MoAb BL2-10D1 to be proposed as an aid to improve the diagnostic sensitivity of urine cytologic investigation in the follow-up of patients treated for recurring bladder cancer, and for the screening of workers exposed to potent bladder carcinogens.

Antibodies, Monoclonal↗

PubMed1988

Infected urachal cysts: a review of 10 cases.

Disorders of urachal remnants are uncommon. While a urachal cyst usually is asymptomatic, infection may mimic a variety of acute intra-abdominal or pelvic processes. We describe 10 patients in 2 distinct age groups (the young child and the young adult) with an infected urachal cyst. The presenting symptoms and signs in most patients included dysuria, severe lower abdominal pain and fever. In 7 patients the correct preoperative diagnosis was made. Diagnoses at referral included Crohn's disease, bladder carcinoma and pelvic inflammatory disease. A single procedure was performed in 7 cases and a staged technique was used in 3. The differential diagnosis of acute abdominal and pelvic pain or a midline lower abdominal mass in the pediatric or young adult age group should include infection of a urachal remnant.

Adult↗

PubMed1992

Economic costs of obesity.

Approximately 34 million US adults were obese in 1980. Obesity is associated with increased risk of noninsulin-dependent diabetes mellitus (NIDDM), hypertension, cardiovascular disease, gallbladder disease and cholecystectomy, and colon and postmenopausal breast cancer. Using a prevalence-based approach to cost of illness, we estimated the economic costs in 1986 attributable to obesity for these medical conditions. Indirect costs due to morbidity and mortality were discounted at 4%. Overall, the costs attributable to obesity were $11.3 billion for NIDDM, $22.2 billion for cardiovascular disease, $2.4 billion for gall bladder disease, $1.5 billion for hypertension, and $1.9 billion for breast and colon cancer. Thus a conservative estimate of the economic costs of obesity was $39.3 billion, or 5.5% of the costs of illness in 1986. Addition of costs due to musculoskeletal disorders could raise this estimate to 7.8%. The costs of treatment for severe obesity must be weighed against the improved health status and quality of life.

Health Care Costs↗

PubMed2003

Health effects in community residents near a uranium plant at Fernald, Ohio, USA.

OBJECTIVES: Health outcomes in persons who lived in the area surrounding a U.S. Department of Energy (DOE) uranium processing plant near Fernald, Ohio were evaluated using data of Fernald Medical Monitoring Program (FMMP) participants. METHODS: Residential history information was used to identify participants who lived in close proximity to the plant (less than 2 miles), in the direction of groundwater runoff (south of the plant), or used a well or cistern as a drinking water source. Standardized prevalence ratios (SPRs) for certain disease endpoints were calculated using the U.S. National Health Interview Survey(NHIS) and the National Health and Nutrition Examination Survey (NHANES) data files for comparison rates. RESULTS: Findings suggest that prior living within the Fernald exposure domain is related to increased prevalence of urinary system disease. Statistically significant elevations of bladder disease (standardized prevalence ratio or SPR = 1.32) and kidney disease (SPR = 2.15), including sub-categories, kidney stones (SPR = 3.98) and chronic nephritis (SPR = 2.03) were noted, as well as increased rates for hematuria and urethral stricture. In regression analyses with adjustment forage and sex, serum creatinine levels were increased in those who had lived close to the plant. Increased white blood cell count and hemoglobin levels, and decreased mean corpuscular volume were also found in those living less than 2 miles from the plant. Those who used a well or cistern for drinking water were found to have increased urinary microalbumin, red blood cell count and hematocrit. CONCLUSIONS: These preliminary findings will provide the basis for future hypothesis testing incorporating important determinants of exposure not included in this study, such as duration and calendar year of exposure, location relevant to prevailing wind direction, and age at exposure.

Adult↗

PubMed2006

Medical students and tobacco in 2004: a survey in Sousse, Tunisia.

OBJECTIVE: To assess the behaviour, knowledge and attitudes towards smoking among medical students in Sousse, Tunisia. DESIGN: A cross-sectional survey in classroom settings using a self-administered questionnaire was conducted at the School of Medicine during September 2004. RESULTS: The numbers of students who entered the first and the fifth years of medical training at the University of Sousse in 2004 and completed the questionnaire were respectively 120 and 110. The population age ranged from 18 to 21 years (mean 19 +/- 0.62 years) in first year students and from 22 to 30 years (mean 23 +/- 1.38 years) in fifth year students. The prevalence of daily smoking (both sexes combined) was 4.5% among first year students and 16.7% among final year students. The prevalence of daily smoking according to sex was 29.6% among boys and 0.7% among girls. Over 90% of students thought smoking was harmful to health, but there was considerable underestimation of its causal role in a number of diseases, notably coronary heart disease, bladder cancer and peripheral vascular disease. There were important defects in both knowledge and motivation regarding counselling patients to stop smoking. CONCLUSIONS: The results of this study may provide baseline data to develop an anti-smoking programme in the university.

Adolescent↗

PubMed1999

Elevated tryptase, nerve growth factor, neurotrophin-3 and glial cell line-derived neurotrophic factor levels in the urine of interstitial cystitis and bladder cancer patients.

PURPOSE: The 2 prominent features of interstitial cystitis are pain and increased numbers of mast cells in the bladder. In this pilot study we determined the concentration of soluble mediators associated with activation of sensory neurons and/or mast cells that were present in the urine. MATERIALS AND METHODS: The study groups included 4 interstitial cystitis patients, 7 kidney donors with no history of bladder disease as negative controls, 6 bladder cancer patients and 7 patients with urinary tract infection as reference controls. Urine samples were assayed for different soluble mediators using immunoassays for tryptase (a marker for mast cell activation), neurotrophic factors (markers of neuronal plasticity) and chemokines (markers of inflammatory cell activity). Results were normalized based on creatinine concentration. RESULTS: There was a marked increase in the average amounts of tryptase and 3 neurotrophic factors in patient urine. Interestingly, the mediator profile in the urine of bladder cancer patients was indistinguishable from that of interstitial cystitis patients with respect to these same 4 proteins. There was no difference between normal control and urinary tract infection urine samples. CONCLUSIONS: These findings may account for several clinical and pathological features found in interstitial cystitis and bladder cancer. Although preliminary due to the limited numbers of patients, they also suggest that increased levels of neurotrophin-3, nerve growth factor, glial cell line-derived neurotrophic factor and tryptase in the urine could serve as a basis for adjunct diagnosis, monitoring and treatment of interstitial cystitis.

Adult↗

PubMed1994

Does the mast cell have an intrinsic role in the pathogenesis of interstitial cystitis?

In order to examine the role of mast cells in the inflammatory bladder disease interstitial cystitis, mast cells isolated from the human bladder of normal and diseased tissue were challenged with a range of secretagogues. Calcium ionophore A23187 and anti-IgE caused histamine release from all bladder mast cells in a dose-related manner. Mast cells from the diseased tissue were far more responsive than those from the normal tissue. Mast cells from the muscle of normal bladder were responsive towards substance P and compound 48/80. However, mast cells from interstitial cystitis bladder did not release significant amounts of histamine with these two secretagogues.

Calcimycin↗

PubMed1985

A comparison of end versus loop stomas for ileal conduit urinary diversion.

We compared the loop and end stoma techniques for ileal conduit urinary diversion in 54 and 27 adults, respectively, with serious bladder disease during a 3-year interval. Followup by trained enterostomal therapists averaged nearly 2 years for all patients. Stenosis occurred in 12 end stomas (44 per cent) but not in any loop stomas. We believe that this result reflects the inherently better blood supply of the loop stoma, which we recommend over the end ileostomy for patients undergoing ileal diversion.

Adult↗