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1.
Investig Clin Urol ; 65(4): 368-377, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38978217

RESUMO

PURPOSE: This study identified risk factors for neurogenic lower urinary tract dysfunction (NLUTD) in patients with acute ischemic stroke (AIS) through multidimensional analysis of the medical records of patients, aiming to reduce the incidence of NLUTD, improve prognosis, and facilitate rehabilitation. MATERIALS AND METHODS: In this case-control study, patients with AIS were recruited from two tertiary general hospitals in Shenzhen, China, from March 2021 to October 2023. Patients were divided into NLUTD and non-NLUTD groups based on the presence and absence of NLUTD, respectively. Comparative analysis was performed using the Mann-Whitney U and chi-square tests, with significant variables being included in logistic regression analysis. RESULTS: Of the 652 participants enrolled in this study, 119 participants (18.3%) developed NLUTD. Bivariate analysis showed that 39 of 54 screened factors exhibited a significant correlation (p<0.05) with the incidence of NLUTD after AIS. Significant variables identified through logistic regression analysis included Glasgow coma scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) scores, anemia, aphasia, pneumonia, brainstem involvement, multiple lesions, urine clarity (CLA), random venous blood glucose (GLU) and hemoglobin (HGB) levels, and white blood cell (WBC) count. CONCLUSIONS: A total of 11 risk factors for NLUTD were identified in this study. This finding provides valuable guidance for reducing the incidence of NLUTD after AIS and improving the quality of life of patients.


Assuntos
AVC Isquêmico , Humanos , Masculino , Feminino , Fatores de Risco , China/epidemiologia , Estudos de Casos e Controles , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , AVC Isquêmico/epidemiologia , AVC Isquêmico/etiologia , AVC Isquêmico/complicações , Prevalência , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/epidemiologia , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/etiologia
2.
Cureus ; 16(5): e61310, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38983791

RESUMO

Bladder leiomyoma is a rare condition in pediatric and adolescent age groups, accounting for less than 1% of all bladder tumors, presenting a diverse array of histologic types and prevalence. Furthermore, bladder leiomyoma's prevalence is even more seldom with only five reported cases till the present day. Common presentation depends on the localisation and the affected layer in the bladder, urinary outlet or ureteral obstruction, irritative voiding symptoms, pelvic pain, and hematuria are the most common presentations of this condition. Diagnostic, treatment, and follow-up protocols in this entity are not well-established due to their rare occurrence in this age group. After complete surgical excision, the prognosis is excellent and the risk of recurrence is reported to be very low. Up to the present day, no instances of malignant transformation or metastasis have been documented in the literature. This case report aims to enhance current knowledge of the radiological, pathological, and clinical features of bladder leiomyoma in a 15-year-old female patient. The main complaint was lower urinary tract symptoms. An incidental solid bladder mass was discovered during the evaluation with ultrasound and magnetic resonance imaging (MRI). Afterwards, cystoscopy confirmed a 5-centimeter solid mass at the right wall of the bladder, and transurethral piecemeal resection was performed. The bladder mass was found to be intramural, and complete endoscopic resection was considered safe and efficient during the surgery. No complications or recurrence occurred in the postoperative setting.

3.
Cureus ; 16(6): e62467, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39022456

RESUMO

Intrauterine device (IUD) migration is a rare complication of IUD placement. The current case is of a 32-year-old lady who presented with pregnancy following IUD failure. Subsequent imaging revealed intravesical migration of the IUD. A cystoscopic evaluation revealed a bladder stone (encrusted IUD), with no breach in the bladder mucosa and no evidence of a fistulous opening. The encrustation was broken down, and an intact IUD was retrieved. This video report shows the management of a migrated IUD complicated by a bladder stone using cystoscopy that not only allowed for a combined diagnostic and therapeutic approach to the extraction of the IUD but also provided information regarding the involvement of the bladder wall and confirmed no extravesical protrusion of the device.

4.
J Pak Med Assoc ; 74(6): 1160-1162, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38948990

RESUMO

Bladder cancer is the ninth leading cause of death worldwide and 14th leading cause of death in Pakistan. The objective of this study was to determine the frequency of urothelial carcinoma in various age groups, its gender distribution, and grades. A total of 131 cases of urothelial carcinoma, received at Department of Pathology, Peshawar Medical College, Peshawar, between January 2017 to December 2022, were included in the study; of them 107 (81.6%) were males while 24 (18.3%) were females with a mean age of 62±13 years. The most common histological subtype was papillary urothelial carcinoma in 117(89.3%) cases, followed by Squamous and Glandular in 5(3.8%) cases. Majority of the urothelial carcinoma with high grade showed a statistically significant relation with muscle invasion 38 (50.66%). Males were four times more likely to have urothelial carcinoma while older age groups were more likely to have high grade urothelial carcinoma.


Assuntos
Carcinoma de Células de Transição , Centros de Atenção Terciária , Neoplasias da Bexiga Urinária , Humanos , Paquistão/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Centros de Atenção Terciária/estatística & dados numéricos , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/patologia , Carcinoma de Células de Transição/epidemiologia , Carcinoma de Células de Transição/patologia , Adulto , Gradação de Tumores , Idoso de 80 Anos ou mais , Invasividade Neoplásica , Carcinoma Papilar/epidemiologia , Carcinoma Papilar/patologia , Distribuição por Sexo , Distribuição por Idade , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia
6.
Elife ; 132024 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-38990208

RESUMO

Rare early-onset lower urinary tract disorders include defects of functional maturation of the bladder. Current treatments do not target the primary pathobiology of these diseases. Some have a monogenic basis, such as urofacial, or Ochoa, syndrome (UFS). Here, the bladder does not empty fully because of incomplete relaxation of its outflow tract, and subsequent urosepsis can cause kidney failure. UFS is associated with biallelic variants of HPSE2, encoding heparanase-2. This protein is detected in pelvic ganglia, autonomic relay stations that innervate the bladder and control voiding. Bladder outflow tracts of Hpse2 mutant mice display impaired neurogenic relaxation. We hypothesized that HPSE2 gene transfer soon after birth would ameliorate this defect and explored an adeno-associated viral (AAV) vector-based approach. AAV9/HPSE2, carrying human HPSE2 driven by CAG, was administered intravenously into neonatal mice. In the third postnatal week, transgene transduction and expression were sought, and ex vivo myography was undertaken to measure bladder function. In mice administered AAV9/HPSE2, the viral genome was detected in pelvic ganglia. Human HPSE2 was expressed and heparanase-2 became detectable in pelvic ganglia of treated mutant mice. On autopsy, wild-type mice had empty bladders, whereas bladders were uniformly distended in mutant mice, a defect ameliorated by AAV9/HPSE2 treatment. Therapeutically, AAV9/HPSE2 significantly ameliorated impaired neurogenic relaxation of Hpse2 mutant bladder outflow tracts. Impaired neurogenic contractility of mutant detrusor smooth muscle was also significantly improved. These results constitute first steps towards curing UFS, a clinically devastating genetic disease featuring a bladder autonomic neuropathy.


Assuntos
Dependovirus , Modelos Animais de Doenças , Técnicas de Transferência de Genes , Glucuronidase , Bexiga Urinária , Animais , Camundongos , Humanos , Bexiga Urinária/fisiopatologia , Glucuronidase/genética , Glucuronidase/metabolismo , Dependovirus/genética , Terapia Genética/métodos , Vetores Genéticos , Pseudo-Obstrução Intestinal/genética , Pseudo-Obstrução Intestinal/terapia , Pseudo-Obstrução Intestinal/fisiopatologia , Doenças Urológicas , Fácies
7.
Int J Urol ; 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38961545

RESUMO

OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of dose-dense gemcitabine and cisplatin (ddGC) as neoadjuvant chemotherapy for muscle-invasive bladder cancer (MIBC). METHODS: Patients with locally advanced MIBC (cT2aN0M0-cT4N1M0) who received ddGC between December 2017 and December 2023 were included. Regimens of ddGC with pegfilgrastim were administered every 2 weeks for 4 cycles, followed by radical cystectomy. The pathological complete response (CR) (pT0N0) and objective response (OR) (

8.
Cureus ; 16(6): e61498, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38952593

RESUMO

Uroperitoneum secondary to spontaneous bladder rupture is a rare cause of ascites associated with significant morbidity and mortality. It can be difficult to detect and is often initially mistaken for other, more common etiologies. We present the case of a 56-year-old female with a history of cervical cancer treated with chemotherapy and radiation, radiation proctitis, and diabetes mellitus who presented with subacute onset abdominal pain and distension, urinary retention, and nausea. She had been diagnosed with cervical squamous cell cancer 12 years prior to presentation and was successfully treated with two months of chemotherapy and radiation, and a presumed recurrence five years later was treated to remission with chemotherapy. The golden-yellow appearance of her ascitic fluid during diagnostic paracentesis raised suspicion for urinary ascites that was confirmed by an elevated ascites-to-serum creatinine ratio and computed tomography (CT) cystography. Subsequent CT cystogram demonstrated leakage of contrast from the bladder with a 0.5 cm irregularity noted at the bladder dome, potentially representing the site of extravasation. A Foley catheter was placed at the time of admission with an immediate output of 1 L of fluid. Subsequently, her abdominal distension significantly improved, and her creatinine began to downtrend. Gynecologic oncology and urology were consulted and determined that she was not a candidate for surgical intervention given the significance of her bladder scarring. Positron emission tomography (PET)/CT was performed and revealed no active cancer. At the time of discharge, she had no episodes of emesis. Additionally, her creatinine had fallen to 1.0 mg/dl. She was discharged with a Foley catheter with plans to follow up with outpatient urology. While relatively uncommon, uroperitoneum should be suspected in patients presenting with new-onset ascites who have risk factors for spontaneous bladder rupture such as pelvic irradiation. Uroperitoneum has a significant rate of mortality and morbidity. Ascites urea and creatinine studies, followed by a CT cystogram if these studies are abnormal, should be performed in any patient with risk factors for uroperitoneum. Patients should be managed with the placement of a Foley catheter and urology consultation for surgical evaluation.

9.
BMC Urol ; 24(1): 148, 2024 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-39020360

RESUMO

BACKGROUND: Bladder cancer (BC) and Renal cell carcinoma (RCC) are the most common urogenital cancers among both sexes, with a yearly global incidence of around 500 000 each. Both BC and RCC have been linked to diabetes. Poor glycemic control (malglycemia) is a serious consequence of diabetes and a possible consequence of systemic treatments used in BC and RCC. The objective of this study was to investigate the prevalence of diabetes and use of hospital-based care for malglycemia in people with BC or RCC. METHODS: This Swedish retrospective population-based register study used national health-data registers for longitudinal data on cancer incidence covering 15 years, use of hospital-based health care, and filled prescriptions of outpatient medications. Study endpoints included co-prevalence of diabetes in individuals with BC/RCC, healthcare resource utilization due to malglycemia, use of systemic corticosteroids, and changes in diabetes management for people with concomitant type 2 diabetes. RESULTS: We identified 36,620 and 15,581 individuals diagnosed with BC and RCC, respectively, between 2006 and 2019. The proportion of individuals registered with diabetes was 24% in BC and 23% in RCC. An association between BC/RCC and poor glycemic control was found, although the number of malglycemic events in hospital-based care were few (65/59 per 1000 individuals with diabetes and BC/RCC respectively with at least one event). An earlier switch to insulin-based diabetes management was observed in BC/RCC compared to matched individuals with type 2 diabetes but no cancer. The results also indicated an association between steroid treatment and poor glycemic control, and that systemic corticosteroids were more common among people with BC/RCC compared to diabetes controls. CONCLUSION: The high prevalence of diabetes and increased use of systemic corticosteroid treatment observed in this large national study highlights the need for specific clinical management, risk-assessment, and monitoring of individuals with BC/RCC and diabetes.


Assuntos
Carcinoma de Células Renais , Controle Glicêmico , Hospitalização , Neoplasias Renais , Neoplasias da Bexiga Urinária , Humanos , Suécia/epidemiologia , Masculino , Feminino , Neoplasias da Bexiga Urinária/epidemiologia , Idoso , Estudos Retrospectivos , Prevalência , Neoplasias Renais/epidemiologia , Pessoa de Meia-Idade , Carcinoma de Células Renais/epidemiologia , Hospitalização/estatística & dados numéricos , Idoso de 80 Anos ou mais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Adulto
11.
Int Neurourol J ; 28(2): 83-95, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38956768

RESUMO

Bladder cancer (BCa) is the most common malignancy of the urinary system. It has a high recurrence rate and requires longterm follow-up. Significant advances in BCa research have been made in recent years; however, the initial diagnosis and follow-up of BCa relies on cystoscopy, which is an invasive and expensive procedure. Over the past decade, liquid biopsies (e.g., blood and urine) have proven to be highly efficient methods for the discovery of BCa biomarkers. This noninvasive sampling method is used to analyze unique tumor components released into body fluids and enables serial sampling and longitudinal monitoring of tumor progression. Several liquid biopsy biomarkers have been studied extensively and have shown promising results in the clinical applications of BCa, including early detection, microscopic residual disease detection, recurrence prediction, and treatment response. Therefore, this review aims to provide an update on various new liquid biopsy markers and the advantages and current limitations of liquid biopsy in the diagnosis of BCa.

12.
Low Urin Tract Symptoms ; 16(4): e12529, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38956950

RESUMO

OBJECTIVES: This study aimed to evaluate the efficacy and safety of Vibegron for the treatment of residual overactive bladder (OAB) symptoms after laser vaporization of the prostate (photo-selective vaporization of the prostate, contact laser vaporization of the prostate, and thulium laser vaporization). METHODS: This randomized, open-label, parallel-group, single-center superiority trial with a 12-week observation (jRCTs071190040) enrolled male patients with OAB aged 40 years or older who had undergone laser vaporization of the prostate for not less than 12 weeks and not more than 1 year earlier. Patients were allocated to receive Vibegron 50 mg once daily or follow-up without treatment for 12 weeks. RESULTS: Forty-seven patients were enrolled between January 2020 and March 2023. The median age (interquartile range) was 75.5 (72.5-78.5) years for the Vibegron group and 76.5 (71.0-81.0) years for the control group. The intergroup difference in the mean change (95% confidence interval) in the 24-hour urinary frequency at 12 weeks after randomization was -3.66 (-4.99, -2.33), with a significant decrease for the Vibegron group. The Overactive Bladder Symptom Score, International Prostate Symptom Score, IPSS storage score, and Overactive Bladder Questionnaire score significantly improved for the Vibegron group. Voided volume per micturition also increased for the Vibegron group. CONCLUSIONS: The administration of 50 mg of Vibegron once daily for 12 weeks showed significant improvement compared with follow-up without treatment in bladder storage (OAB) symptoms after laser vaporization of the prostate for symptomatic benign prostatic hyperplasia.


Assuntos
Terapia a Laser , Bexiga Urinária Hiperativa , Humanos , Masculino , Idoso , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/tratamento farmacológico , Estudos Prospectivos , Terapia a Laser/métodos , Terapia a Laser/efeitos adversos , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/complicações , Resultado do Tratamento , Idoso de 80 Anos ou mais , Pirimidinonas , Pirrolidinas
13.
Neurourol Urodyn ; 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39010271

RESUMO

PURPOSE: The purpose of this guideline is to provide evidence-based guidance to clinicians of all specialties on the evaluation, management, and treatment of idiopathic overactive bladder (OAB). The guideline informs the reader on valid diagnostic processes and provides an approach to selecting treatment options for patients with OAB through the shared decision-making process, which will maximize symptom control and quality of life, while minimizing adverse events and burden of disease. METHODS: An electronic search employing OVID was used to systematically search the MEDLINE and EMBASE databases, as well as the Cochrane Library, for systematic reviews and primary studies evaluating diagnosis and treatment of OAB from January 2013 to November 2023. Criteria for inclusion and exclusion of studies were based on the Key Questions and the populations, interventions, comparators, outcomes, timing, types of studies and settings (PICOTS) of interest. Following the study selection process, 159 studies were included and were used to inform evidence-based recommendation statements. RESULTS: This guideline produced 33 statements that cover the evaluation and diagnosis of the patient with symptoms suggestive of OAB; the treatment options for patients with OAB, including Noninvasive therapies, pharmacotherapy, minimally invasive therapies, invasive therapies, and indwelling catheters; and the management of patients with BPH and OAB. CONCLUSION: Once the diagnosis of OAB is made, the clinician and the patient with OAB have a variety of treatment options to choose from and should, through shared decision-making, formulate a personalized treatment approach taking into account evidence-based recommendations as well as patient values and preferences.

14.
Int J Urol ; 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39010666

RESUMO

OBJECTIVES: To evaluate the clinical characteristics of oligometastatic disease (OMD) in metastatic urothelial carcinoma (mUC) with visceral metastases when classified into synchronous and metachronous metastases. METHODS: Of 957 cases of de novo mUC treated between 2008 and 2023, 374 with visceral metastases were analyzed. Cases were classified into OMD with up to three metastatic lesions and polymetastatic disease (PMD), and into synchronous and metachronous metastases. The clinical characteristics and overall survival (OS) for each group were analyzed. RESULTS: Overall, 196 (52.4%) had synchronous metastasis and 178 (47.6%) had metachronous metastasis. Median OS for synchronous metastases was significantly shorter than for metachronous metastases (12.1 months vs. 15.3 months, p = 0.011). Among the synchronous metastases, 48 (24.5%) were OMD and 148 (75.6%) were PMD. There was no significant difference in OS between the OMDs and PMDs (median 14.9 months vs. 11.7 months, p = 0.32), and only decreased albumin level was identified as a significant predictor of poor OS. Among the metachronous metastases, 64 (36.0%) were OMD and 114 (64.0%) were PMD. There was no significant difference in OS between the OMD and PMD (median 21.2 months vs. 15.0 months, p = 0.35), and no significant predictors of poor OS were identified. CONCLUSIONS: For mUC with visceral metastases, the timing of metastasis appearance was associated with prognosis, with synchronous metastases being a poorer prognostic factor compared to metachronous metastases. There was no prognostic difference between OMD and PMD with visceral metastases when classified into synchronous or metachronous metastases.

15.
Cureus ; 16(6): e62281, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39006633

RESUMO

Nephrogenic adenomas are benign lesions that develop within the urinary tract. Most often developing within the urinary bladder, these lesions have a debatable etiopathogenesis, with hamartoma, rest hyperplasia, and transplantation of renal tubular cells being the most widely accepted ones. Nephrogenic adenomas develop more often in adult males, and predisposing factors for their development are prior urinary system injury, infection, or malignancy, with a subset of cases developing in renal transplant patients. Herein, we present a case of a male patient in his seventies who initially presented to our institution with urinary disturbances and was subsequently diagnosed with low-grade, non-invasive urothelial carcinoma. After treatment, the patient remained disease-free for a period of seven calendar years. The current presentation was due to dysuria, and bladder endoscopy revealed a ureteral stricture and two small exophytic lesions neighboring the location of the previously treated urothelial carcinoma. Histology revealed complex papillary architecture and cystic spaces lined by a monolayer of monomorphous epithelial cells with foci of hobnail appearance. The papillary stroma consisted of edematous fibrous tissue with hyperemic blood vessels and focal infiltration by inflammatory cells. Based on the histological findings, the diagnosis of nephrogenic adenoma was established.

16.
Bio Protoc ; 14(13): e5027, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-39007162

RESUMO

Intravesical instillation is an efficient therapeutic technique based on targeted administration of a drug directly into the lesion for the treatment of bladder diseases. This is an alternative to traditional systemic administration of drugs. However, this technique requires repeated procedures, which can lead to even greater inflammation and infection of the urethra. To date, novel systems that allow prolonged drug retention in the bladder cavity are actively being developed. We recently reported a targeted drug delivery system based on the mucoadhesive emulsion microgels consisting of the natural component whey protein isolate. Such micron-sized carriers possess high loading capacity, a prolonged drug release profile, and efficient mucoadhesive properties to the bladder urothelium. As a continuation of this work, we present a protocol for the synthesis of mucoadhesive emulsion microgels. Detailed procedures for preparing precursor solutions as well as studying the physico-chemical parameters of microgels (including loading capacity and drug release rate) and the mucoadhesive properties using the model of porcine bladder urothelium are discussed. Precautionary measures and nuances that are worth paying attention to during each experimental stage are given as well. Key features • The protocol for the synthesis of mucoadhesive emulsion microgels based on whey protein isolate is presented. The experimental conditions of emulsion microgels synthesis are discussed. • Methods for studying the physico-chemical properties of mucoadhesive emulsion microgels (size of emulsion microgels particles, loading capacity, release kinetics) are described. • The method for assessing mucoadhesive properties of emulsion microgels is demonstrated using the porcine bladder tissue model ex vivo.

17.
Mol Biol Rep ; 51(1): 815, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39009695

RESUMO

BACKGROUND: Urinary bladder cancer (UBC)is a common tumor of the urinary tract. OBJECTIVES: To assess the diagnostic significance of IL6 rs1800796 gene polymorphism and IL6 serum level among Egyptian patients with UBC. DESIGN AND METHODS: One hundred patients with UBC were selected from the Mansoura Urology and Nephrology Center, in addition to 100 healthy control subjects; using PCR and ELISA techniques for IL6 detection. RESULTS: The rs1800796 GC, CC genotypes, and C allele were significantly more prevalent in the cases with bladder cancer compared to the healthy group (p < 0.001, = 0.021, < 0.001 respectively). There was a clear association between elevated levels of IL6 and bladder cancer versus the control group (median = 4.2, 0.89 respectively, p < 0.001). Serum IL6 levels showed significantly higher levels in patients carrying CC, followed by GC then GG genotypes. No significant association was found between IL6 rs1800796 gene polymorphism or serum level with demographic or laboratory data. CONCLUSION: It is suggested that there is a clear link between elevated IL6 levels as well as IL6 rs1800796 gene polymorphism with bladder cancer, suggesting their potential utility as biomarkers for the disease.


Assuntos
Predisposição Genética para Doença , Genótipo , Interleucina-6 , Polimorfismo de Nucleotídeo Único , Neoplasias da Bexiga Urinária , Humanos , Interleucina-6/genética , Interleucina-6/sangue , Egito/epidemiologia , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/sangue , Feminino , Polimorfismo de Nucleotídeo Único/genética , Masculino , Pessoa de Meia-Idade , Alelos , Estudos de Casos e Controles , Idoso , Adulto , Frequência do Gene/genética , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/sangue , Estudos de Associação Genética
18.
Surg Endosc ; 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39009729

RESUMO

BACKGROUND: To evaluate the perioperative, oncological, and functional outcomes of reproductive organ-preserving radical cystectomy (ROPRC) compared to standard radical cystectomy (SRC) in the treatment of female bladder cancer. METHODS: A systematic search was conducted in November 2023 across several scientific databases. We executed a systematic review and cumulative meta-analysis of the primary outcomes of interest, adhering to the PRISMA and AMSTAR guidelines. The study was registered in PROSPERO (CRD42024501522). RESULTS: The meta-analysis included 10 studies with a total of 2015 participants. ROPRC showed a significant reduction in operative time and postoperative fasting period compared to SRC (MD - 45.69, 95% CI - 78.91 ~ - 12.47, p = 0.007, and MD - 0.69, 95% CI - 1.25 ~ - 0.13, p = 0.02, respectively). Functional outcomes, both daytime continence rate (OR 4.94, 95% CI 1.53 ~ 15.91, p = 0.008) and nighttime continence rate (OR 5.91, 95% CI 1.94 ~ 18.01, p = 0.002), and sexual function measured by the Female Sexual Function Index (MD 5.72, 95% CI 0.19 ~ 11.26, p = 0.04), were significantly improved in the ROPRC group. There were no significant differences between ROPRC and SRC in terms of estimated blood loss, length of hospital stay, overall postoperative complications, minor complications or major complications. Oncologically, both procedures showed comparable outcomes with no significant differences in positive surgical margins, tumor recurrence rates, overall survival, cancer-specific survival, recurrence-free survival, or progression-free survival. CONCLUSIONS: ROPRC is a viable and effective alternative to SRC in female bladder cancer patients, offering enhanced functional outcomes and similar oncological safety. These findings suggest that ROPRC can improve the quality of life in female bladder cancer patients without compromising the efficacy of cancer treatment.

19.
Int J Mol Sci ; 25(13)2024 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-39000291

RESUMO

Urinary bladder cancer (BC) inflicts a significant impairment of life quality and poses a high mortality risk. Schistosoma haematobium infection can cause BC, and the urinary microbiota of BC patients differs from healthy controls. Importantly, intravesical instillation of the bacterium Bacillus Calmette-Guerin stands as the foremost therapy for non-muscle invasive BC. Hence, studying the receptors and signaling molecules orchestrating bacterial recognition and the cellular response in the context of BC is of paramount importance. Thus, we challenged Toll-like receptor 4 (Tlr4) and myeloid differentiation factor 88 (Myd88) knock-out (KO) mice with N-butyl-N-(4-hydroxylbutyl)-nitrosamine (BBN), a well-known urinary bladder carcinogen. Gut microbiota, gene expression, and urinary bladder pathology were followed. Acute exposure to BBN did not reveal a difference in bladder pathology despite differences in the animal's ability to recognize and react to bacteria. However, chronic treatment resulted in reduced cancer invasiveness among Myd88KO mice while the absence of functional Tlr4 did not influence BC development or progression. These differences correlate with a heightened abundance of the Faecalibaculum genus and the lowest microbial diversity observed among Myd88KO mice. The presented data underscore the important role of microbiota composition and MyD88-mediated signaling during bladder carcinogenesis.


Assuntos
Microbioma Gastrointestinal , Camundongos Knockout , Fator 88 de Diferenciação Mieloide , Transdução de Sinais , Receptor 4 Toll-Like , Neoplasias da Bexiga Urinária , Animais , Fator 88 de Diferenciação Mieloide/metabolismo , Fator 88 de Diferenciação Mieloide/genética , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/microbiologia , Neoplasias da Bexiga Urinária/metabolismo , Neoplasias da Bexiga Urinária/genética , Camundongos , Receptor 4 Toll-Like/metabolismo , Receptor 4 Toll-Like/genética , Butilidroxibutilnitrosamina/toxicidade , Carcinogênese , Bexiga Urinária/patologia , Bexiga Urinária/microbiologia , Bexiga Urinária/metabolismo , Feminino , Camundongos Endogâmicos C57BL , Microbiota , Humanos
20.
Insights Imaging ; 15(1): 139, 2024 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-38853219

RESUMO

OBJECTIVES: To investigate whether reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) with deep learning reconstruction (DLR) can improve the accuracy of evaluating muscle invasion using VI-RADS. METHODS: Eighty-six bladder cancer participants who were evaluated by conventional full field-of-view (fFOV) DWI, standard rFOV (rFOVSTA) DWI, and fast rFOV with DLR (rFOVDLR) DWI were included in this prospective study. Tumors were categorized according to the vesical imaging reporting and data system (VI-RADS). Qualitative image quality scoring, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and ADC value were evaluated. Friedman test with post hoc test revealed the difference across the three DWIs. Receiver operating characteristic analysis was performed to calculate the areas under the curve (AUCs). RESULTS: The AUC of the rFOVSTA DWI and rFOVDLR DWI were higher than that of fFOV DWI. rFOVDLR DWI reduced the acquisition time from 5:02 min to 3:25 min, and showed higher scores in overall image quality with higher CNR and SNR, compared to rFOVSTA DWI (p < 0.05). The mean ADC of all cases of rFOVSTA DWI and rFOVDLR DWI was significantly lower than that of fFOV DWI (all p < 0.05). There was no difference in mean ADC value and the AUC for evaluating muscle invasion between rFOVSTA DWI and rFOVDLR DWI (p > 0.05). CONCLUSIONS: rFOV DWI with DLR can improve the diagnostic accuracy of fFOV DWI for evaluating muscle invasion. Applying DLR to rFOV DWI reduced the acquisition time and improved overall image quality while maintaining ADC value and diagnostic accuracy. CRITICAL RELEVANCE STATEMENT: The diagnostic performance and image quality of full field-of-view DWI, reduced field-of-view (rFOV) DWI with and without DLR were compared. DLR would benefit the wide clinical application of rFOV DWI by reducing the acquisition time and improving the image quality. KEY POINTS: Deep learning reconstruction (DLR) can reduce scan time and improve image quality. Reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) with DLR showed better diagnostic performances than full field-of-view DWI. There was no difference of diagnostic accuracy between rFOV DWI with DLR and standard rFOV DWI.

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