The Dome Wall of Bladder Acts as a Pacemaker Site in Detrusor Instability in Rats.

BACKGROUND The aim of this study was to confirm that the interstitial cells of Cajal (ICCs) in the dome wall of the bladder are pacemaker cells, and that the dome wall of the bladder acts as a pacemaker site in the detrusor instability (DI) rat model. MATERIAL AND METHODS The model of DI in Wistar rats was established and urodynamic studies measuring the bladder volume and pressure were performed. The detrusor excitability was investigated using the amplitude and frequency of phasic contraction of strips. The localization and quantity of ICCs was identified by immunohistochemistry and c-KIT protein expression in the rat bladder. PCR assay and Western blot were used to assess the expression of HCN2 and Cx43. RESULTS The bladder capacity, residual volume, voiding volume, and maximum voiding pressure were significantly increased in the DI group. The contraction frequency and amplitude of the strips from the dome of the bladder in the DI group were higher than the triangle, body, and base parts. Both the concentration of c-KIT positive ICCs cells and expression of the c-KIT protein in the dome wall were higher than in other parts of the bladder. The expression of HCN2 and Cx43 in each part of the DI rat group were obviously higher than each part in the control group. Compared to the body, base, and triangle parts, the expression of HCN2 and Cx43 in the dome wall were obviously higher in the DI group. CONCLUSIONS The quantity of ICCs was higher in the dome wall and the dome wall of bladder acts as a pacemaker site in the DI rat model.

A Multi-Center, Randomized, Blind, Controlled Clinical Trial of the Safety and Efficacy of Micro Radio Frequency Therapy System for the Treatment of Overactive Bladder.

Purpose: The purpose of this study was to evaluate the efficacy and safety of low power micro radiofrequency (RF) therapy (µRFthera®) through urethra in the treatment of overactive bladders (OAB) through a prospective, single-blind, placebo-controlled, multi-center clinical protocol. Materials and Methods: One hundred and fourteen patients with refractory OAB were randomized at 2:1 ratio, treatment to control undergoing same procedures except only the micro-RF treatment group at turned "on" setting in energy. Bladder diaries recorded during the screening period (3 days before enrollment) and during follow-up period on week 1, 3, and 7, respectively. The patients in control could choose receiving an energized treatment during extension stage. Results: The treatment efficacy was 76.1%. There was 49.80% rate improvement compared to control (95%CL 32.48%, 67.13%). The crude rate ration (RR) was 2.89, 95% CI (1.67-5.01) with p < 0.001 in uni-variate analysis, while the RR became 2.94, 95% CI (1.67-5.16) with p < 0.001 after adjusted potential confounding factors in multi-variate analysis. Statistically significant improvements have been demonstrated in the frequency of urination, urgency, nocturia, and quality of life (QoL) scores. Conclusions: Micro RF therapy is safe and effective for the treatment of OAB. The main treatment-related complications were catheterization related complications. Clinical Trial Registration: Zhejiang Device Registration Certificate No. 202090909, www.chictr.org.cn, Clinical Trial Accession Number: ChiCTR2100050096.

[Effects of sex hormones on bladder function and structure: experiment with ovariectomized female rats].

OBJECTIVE: To investigate the effects of sex hormones on bladder and mechanism thereof. METHODS: Sixty mature female SD rats underwent bilateral ovariectomy and then randomly divided into 6 groups: low dose estrogen group (OVX + E group) treated with estradiol benzoate 0. 25 mg/kg injected intramuscularly qod, high dose estrogen group (OVX + E 1 mg group) treated with estradiol benzoate 1 mg/kg, progesterone (P) group, treated with P 1 mg, OVX + E + P group treated with estradiol benzoate 0.25 mg/kg + progesterone 1 mg, d androgen group (OVX + T group) treated with testosterone propionate 3 mg/kg, and untreated ovariectomized group (OVX group) receiving no medication. Another 10 rats underwent sham operation. Four weeks later the rats were killed with their bladders and urethras taken out to undergo light and electron microscopy. RESULTS: The thickness of bladder wall of the OVX group was (0.97 +/- 0.11) mm, significant thinner than that of the sham operation group [(1.10 +/- 0.1) mm, P < 0.05)]. The thickness levels of bladder walls of the OVX + E and OVX + T groups were (1.23 +/- 0.12) mm and (1.26 +/- 0.12 mm) respectively, both significantly thicker than that of the OVX group (both P < 0.01). Wider spaces between the detrusor muscle fascicles and degeneration of detrusor muscle cells were seen in the bladder walls of the OVX group, and such phenomena were milder in the OVX + E and OVX + T groups, however, wider spaces between the detrusor muscle fascicles could be seen in the OVX + E + P group too. The hypertrophic effect on the detrusor muscle of the OVX + E 1 mg group was weaker than that of the OVX + E group, a lot of cytoplasmic vacuoles was seen in the 2 groups treated with E, especially the OVX + E 1 mg group. The bladder structure of the OVX + P group was similar to that of the OVX group. CONCLUSION: Endogenous testosterone level as well as estrogen level can significantly affect the bladder structure with a hypertrophic effect on bladder detrusor muscle. But higher doze of estrogen also has some unexpected effects which may destroy bladder structure. In addition, progesterone can compromise the effect of estrogen.

Laparoscopic colonic anastomosis using a degradable stent in a porcine model.

AIM: To explore the feasibility and safety of laparoscopic colonic anastomosis using a degradable stent in a porcine model. METHODS: Twenty Bama mini-pigs were randomly assigned to a stent group (n = 10) and control group (hand-sewn anastomosis, n = 10). The anastomotic completion and operation times were recorded, along with histological examination, postoperative general condition, complications, mortality, bursting pressure, and the average anastomotic circumference (AC). RESULTS: All pigs survived postoperatively except for one in the stent group that died from ileus at 11 wk postoperatively. The operation and anastomotic completion times of the stent group were significantly shorter than those of the control group (P = 0.004 and P = 0.001, respectively). There were no significant differences in bursting pressure between the groups (P = 0.751). No obvious difference was found between the AC and normal circumference in the stent group, but AC was significantly less than normal circumference in the control group (P = 0.047, P < 0.05). No intestinal leakage and luminal stenosis occurred in the stent group. Histological examination revealed that the stent group presented with lower general inflammation and better healing. CONCLUSION: Laparoscopic colonic anastomosis with a degradable stent is a simple, rapid, and safe procedure in this porcine model.

[Efficacy and safety of phosphodiesterase 5 inhibitors in the treatment of erectile dysfunction].

Phosphodiesterase 5 inhibitors are recommended as first-line treatment of erectile dysfunction in many guidelines, because of their convenience, higher efficacy, and less side-effects. Since its first launch in 1998, sildenafil has been currently the best investigated phosphodiesterase 5 inhibitor with respect to long-term trails and quantity. Clinical trials showed the efficacy of sildenafil compared with placebo in many of the groups of patients who have ED, including those with cardiovascular disease, diabetes mellitus, depression, radical prostatectomy and dialysis. Typically the adverse effects reported in patients from clinical trials of sildenafil have been mild to moderate, and commonly include flushing and dyspepsia and transient visual disturbances. This article summarized recent reports on efficacy and safety of phosphodiesters 5 inhibitors in the treatment of erectile dysfunction.

Early channel transurethral resection of the prostate for patients with urinary retention after brachytherapy.

OBJECTIVE: It is recommended that transurethral resection of the prostate (TURP) after brachytherapy should not be performed at an early stage after implantation. Herein we report our experiences and the results of channel TURP (cTURP) within six months post-implant for patients with refractory urinary retention. METHODS: One hundred and ninety patients with localized prostate cancer of clinical stages T1c to T2c were treated by brachytherapy as monotherapy at our institution from February 2009 to July 2013. Nine patients who developed refractory urinary retention and underwent cTURP within six months after brachytherapy were retrospectively reviewed and analyzed. RESULTS: The median interval between prostate brachytherapy and cTURP was three months (range 1.5 to 5.0 months). There were no intraoperative or postoperative complications and no incontinence resulting from the surgery. All urinary retention was relieved per the American Brachytherapy Society urinary symptom score. With a mean follow-up time of 16 months (range 6 to 26 months) after cTURP, no patient experienced biochemical recurrence. The mean serum prostate-specific antigen (PSA) of the patients who underwent cTURP was 0.42 ng/ml (range 0.08 to 0.83 ng/ml) at the end of their follow-up. CONCLUSIONS: Early cTURP was found to be safe and effective in relieving urinary retention after brachytherapy and could be performed without compromising its therapeutic efficacy.

Antitumor effects of human interferon-alpha 2b secreted by recombinant bacillus Calmette-Guérin vaccine on bladder cancer cells.

OBJECTIVE: Our objective was to construct a recombinant bacillus Calmette-Guérin vaccine (rBCG) that secretes human interferon-alpha 2b (IFNα-2b) and to study its immunogenicity and in vitro antitumor activity against human bladder cancer cell lines T24 and T5637. METHODS: The signal sequence BCG Ag85B and the gene IFNα-2b were amplified from the genome of BCG and human peripheral blood, respectively, by polymerase chain reaction (PCR). The two genes were cloned in Escherichia coli-BCG shuttle-vector pMV261 to obtain a new recombinant plasmid pMV261-Ag85B-IFNα-2b. BCG was transformed with the recombinant plasmid by electroporation and designated rBCG-IFNα-2b. Mononuclear cells were isolated from human peripheral blood (PBMCs) and stimulated with rBCG-IFNα-2b or wild type BCG for 3 d, and then cultured with human bladder cancer cell lines T24 and T5637. Their cytotoxicities were measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. RESULTS: BCG was successfully transformed with the recombinant plasmid pMV261-Ag85B-IFNα-2b by electroporation and the recombinant BCG (rBCG-IFNα-2b) was capable of synthesizing and secreting cytokine IFNα-2b. PBMC proliferation was enhanced significantly by rBCG-IFNα-2b, and the cytotoxicity of PBMCs stimulated by rBCG-IFNα-2b to T24 and T5627 was significantly stronger in comparison to wild type BCG. CONCLUSIONS: A recombinant BCG, secreting human IFNα-2b (rBCG-IFNα-2b), was constructed successfully and was superior to control wild type BCG in inducing immune responses and enhancing cytotoxicity to human bladder cancer cell lines T24 and T5637. This suggests that rBCG-IFNα-2b could be a promising agent for bladder cancer patients in terms of possible reductions in both clinical dosage and side effects of BCG immunotherapy.

Pure transperitoneal laparoscopic correction of retrocaval ureter.

BACKGROUND: Retrocaval ureter is a rare congenital abnormality. Operative repair is always suggested in cases of significant functional obstruction. Laparoscopic procedures have been employed as the minimally invasive therapeutic option for retrocaval ureter. However, the laparoscopic techniques for retrocaval ureter might be technically challenging to some surgeons. The aim of this article was to present our experience and surgical techniques of pure transperitoneal laparoscopic pyelopyelostomy and ureteroureterostomy in nine patients with retrocaval ureter. METHODS: A total of nine patients of retrocaval ureter underwent pure laparoscopic pyelopyelostomy or ureteroureterostomy. The operation was performed with the patients placed in the 70-degree lateral decubitus position via a three port transperitoneal approach with two 10-mm and one 5-mm ports. The distal part of the dilated renal pelvis was transected at the ureteropelvic junction and the ureter was relocated anterior to the inferior vena cava. The tension-free pyeloureteral or ureteroureteral anastomosis was completed with the intracorporal freehand suturing and in situ knot-tying techniques combined with interrupted and continuous fashion. A double J ureteral stent was inserted in an antegrade manner during laparoscopy. Intravenous urography or computerized tomography and renal ultrasonography were performed after 3 months postoperatively. RESULTS: All operations were completed laparoscopically, and no open conversion was required. The mean operative time was 135 minutes (range, 70 - 250 minutes), with minimal blood loss (less than 60 ml). No intra-operative complications or significant bleeding occurred. All patients presented mild postoperative pain and quick convalescence. The symptoms disappeared and hydronephrosis decreased substantially after surgery. CONCLUSIONS: Pure transperitoneal laparoscopic correction for retrocaval ureter was associated with an excellent outcome, minimal invasiveness and short hospital stay. It is technically feasible and reliable for retrocaval ureter treatment. Laparoscopic surgery could be the standard treatment for retrocaval ureter.

Colon metastasis of chromophobe renal cell carcinoma with sarcomatoid change.

We present a rare case of colonic metastasis of renal cell carcinoma (RCC) and review the literature. A 54-year-old male was referred to our hospital with a history of bloody stools and fever. A right kidney tumor measuring about 10 cm in diameter was found by abdominal computed tomography. Right radical nephrectomy and a right hemicolectomy with ileotransversostomy were performed. Pathological diagnosis was chromophobe RCC with sarcomotoid change involving the colon. Chromophobe RCC with sarcomotoid change is very rare.

A new plastic surgical technique for adult congenital webbed penis.

OBJECTIVE: To introduce a novel surgical technique for correction of adult congenital webbed penis. METHODS: From March 2010 to December 2011, 12 patients (age range: 14-23 years old) were diagnosed as having a webbed penis and underwent a new surgical procedure designed by us. RESULTS: All cases were treated successfully without severe complication. The operation time ranged from 20 min to 1 h. The average bleeding volume was less than 50 ml. All patients achieved satisfactory cosmetic results after surgery. The penile curvature disappeared in all cases and all patients remained well after 1 to 3 months of follow-up. CONCLUSIONS: Adult webbed penis with complaints of discomfort or psychological pressure due to a poor profile should be indicators for surgery. Good corrective surgery should expose the glans and coronal sulcus, match the penile skin length to the penile shaft length dorsally and ventrally, and provide a normal penoscrotal junction. Our new technique is a safe and effective method for the correction of adult webbed penis, which produces satisfactory results.

Metachronous contralateral testicular and bilateral adrenal metastasis of chromophobe renal cell carcinoma: a case report and review of the literature.

Chromophobe renal cell carcinoma (ChRCC) metastatic to the testis has not, to the best of our knowledge, been reported in the literature. Nor have there been reports of delayed bilateral adrenal metastasis of ChRCC. Here we report a case of metachronous contralateral testicular and bilateral adrenal metastasis of ChRCC in a 70-year-old man who underwent right radical nephrectomy for RCC six years ago. He was admitted to the hospital because of left intrascrotal enlargement of two-month duration. Ultrasonography revealed a mass in the upper pole of the left testis. Computed tomography (CT) showed irregular masses in the bilateral adrenal area. Left radical orchiectomy and laparoscopic bilateral adrenalectomy were performed. The pathologic examination showed metastatic ChRCC in the left testis and bilateral adrenal gland. Postoperative follow-up showed that the patient had survived for at least 56 months without recurrence. The case highlights the unique behavior of RCC with an unusual site of metastasis and favorable survival after multiple metastasectomy.

One case of leiomyosarcoma of the inferior vena cava treated with radical resection and vascular reconstruction.

A 48-year-old Chinese woman with primary leiomyosarcoma of the inferior vena cava (IVC) who succesfully underwent resection of a long length of the affected IVC and the right kidney together with graft replacement of the IVC is reported.