Incorporation of Smooth Muscle Cells Derived from Human Adipose Stem Cells on Poly(Lactic-co-Glycolic Acid) Scaffold for the Reconstruction of Subtotally Resected Urinary Bladder in Athymic Rats.

BACKGROUND: The urinary tract can be affected by both congenital abnormalities as well as acquired disorders, such as cancer, trauma, infection, inflammation, and iatrogenic injuries, all of which may lead to organ damage requiring eventual reconstruction. As a gold standard, gastrointestinal segment is used for urinary bladder reconstruction. However, one major problem is that while bladder tissue prevents reabsorption of specific solutes, gastrointestinal tissue actually absorbs them. Therefore, tissue engineering approach had been attempted to provide an alternative tissue graft for urinary bladder reconstruction. METHODS: Human adipose-derived stem cells isolated from fat tissues were differentiated into smooth muscle cells and then seeded onto a triple-layered PLGA sheet to form a bladder construct. Adult athymic rats underwent subtotal urinary bladder resection and were divided into three treatment groups (n = 3): Group 1 ("sham") underwent anastomosis of the remaining basal region, Group 2 underwent reconstruction with the cell-free scaffold, and Group 3 underwent reconstruction with the tissue-engineered bladder construct. Animals were monitored on a daily basis and euthanisation was performed whenever a decline in animal health was detected. RESULTS: All animals in Groups 1, 2 and 3 survived for at least 7 days and were followed up to a maximum of 12 weeks post-operation. It was found that by Day 14, substantial ingrowth of smooth muscle and urothelial cells had occurred in Group 2 and 3. In the long-term follow up of group 3 (tissue-engineered bladder construct group), it was found that the urinary bladder wall was completely regenerated and bladder function was fully restored. Urodynamic and radiological evaluations of the reconstructed bladder showed a return to normal bladder volume and function.Histological analysis revealed the presence of three muscular layers and a urothelium similar to that of a normal bladder. Immunohistochemical staining using human-specific myocyte markers (myosin heavy chain and smoothelin) confirmed the incorporation of the seeded cells in the newly regenerated muscular layers. CONCLUSION: Implantation of PLGA construct seeded with smooth muscle cells derived from human adipose stem cells can lead to regeneration of the muscular layers and urothelial ingrowth, leading to formation of a completely functional urinary bladder.

Alum irrigation for the treatment of intractable haematuria.

Managing intractable haematuria is a daunting task. One cause of this condition is radiationinduced haemorrhagic cystitis. Several treatments for the condition have been proposed and one non-invasive option is alum irrigation. Here, we report on a 65-year-old woman with intractable haematuria secondary to radiation cystitis who was successfully treated with alum irrigation. Alum irrigation is safe, well tolerated and relatively cheap. A review of the literature and a comprehensive discussion on alum irrigation as treatment for haematuria is discussed here to create an awareness regarding this treatment option.

Anxiety Status and its Relationship with General Health Related Quality of Life among Prostate Cancer Patients in Two University Hospitals in Kuala Lumpur, Malaysia.

BACKGROUND: This study aimed to determine the prevalence of anxiety among prostate cancer patients, and to ascertain the association between stress status, socio-demographic, medical and surgical illness, current urinary problem and cancer status with general health-related quality of life (HRQOL) among these patients. METHODS: A hospital based, cross sectional study was conducted at Surgical Clinic, University Malaya Medical Centre (UMMC) and Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using universal sampling. RESULT: A total of 193 patients were recruited. The prevalence of anxiety was 25.4% (95%CI: 19.2 - 31.6). The anxiety ratings were mild anxiety (10.4%), moderate anxiety (13.6%) and severe anxiety (1.6%). The total quality of life among stress group was 59.2 ± 14.7 and among non-stress group was 73.9 ± 12.7. There was a significant negative weak correlation between anxiety score and total quality of life (rs=-0.534, P<0.001). In multivariable analysis, there was a significant difference in the total quality of life (QOL) among anxiety status [adj. mean diff. = -9.1 (95%CI: -15.2, -4.7)]. The adjusted mean difference was associated by age category of the patients (P<0.001); living partner (P<0.001); intermittency (P=0.035) and problem of hematuria during micturition (P=0.005). CONCLUSION: The prevalence of anxiety among prostate cancer was moderately high. Treating the urination problem as well as encouraging living with spouse/family may improve the quality of life among anxiety condition of these patients.

Outcomes and Safety of Retrograde Intra-Renal Surgery for Renal Stones Less Than 2 cm in Size.

BACKGROUND: Retrograde intra-renal surgery (RIRS) has been used to remove stones of less than 2 cm in the kidney. However, its role is not well defined. OBJECTIVES: The objective of this study was to evaluate the outcomes and safety of RIRS, used either as a primary or secondary procedure, and to analyze factors predicting the stonefree rate (SFR). PATIENTS AND METHODS: A retrospective analysis was performed on data from patients who underwent RIRS over a 10-year period (2002-2012). Stone size was measured as the surface area and was calculated according to the EAU guidelines. In cases of multiple stones, the total stone burden was calculated as the sum of each stone size. Stone burden was then classified as ≤ 80 mm(2) or > 80 mm(2). RIRS was classified as primary procedure or secondary procedure (after failed extracorporeal shockwave lithotripsy or percutaneous nephrolithotripsy).Stone clearance was defined as a complete absence of stones or stones < 4 mm, which were deemed insignificant on ultrasonography and plain radiography. RESULTS: The overall SFR for renal stones treated with RIRS in our center was 55.4%, and the complication rate was 1.5%, which consisted of one case of sepsis. The only factor affecting SFR in this study was the indication for RIRS. When performed as a primary operation, RIRS showed a significantly better SFR (64.3%). The SFR for lower pole stones was only 44.4%. There were no statistically significant effects of stone burden, radio-opacity, or combination with ureteral stones on SFR. CONCLUSIONS: RIRS should be used as the primary treatment for renal stones whenever possible.

Predicting Outcome of Trial of Voiding Without Catheter in Acute Urinary Retention with Intravesical Prostatic Protrusion

Background: Acute urinary retention (AUR) is one of the most serious complications of benign prostatic hypertrophy. This study was done to predict the outcome of trial of voiding without catheter (TWOC) in patients with AUR with intravesical prostatic protrusion (IPP) detected on transabdominal ultrasound. Other factors such as prostatic volume and patient’s age were also assessed. Method: Patients with a first episode of AUR secondary to benign prostatic hypertrophy were assessed with ultrasound following bladder catheterization. The IPP was measured and graded (grade 1 is 5 mm or less, grade 2 is 5–10 mm and grade 3 is more than 10 mm). Success of TWOC was then correlated with the degree of IPP. Results: A total of 32 patients with AUR were included in the study. Patients with grade 3 IPP were found to have a significant failure rate compared to grade 1 (P = 0.022) and grade 2 (P = 0.041). Conclusion: Intravesical prostatic protrusion is a useful predictor of success of TWOC in patients with AUR. Patients with grade 3 IPP on ultrasound would benefit from TWOC and warrant earlier definitive surgical treatment.

Ketamine-Associated Ulcerative Cystitis: A Case Report and Literature Review

Ketamine can be abused as a recreational drug, and there has been a recent surge in its usage. The effects of ketamine on the urinary system were unknown until the recent publication of a few case reports. Many doctors are still unaware of this new clinical entity, termed ketamineassociated ulcerative cystitis. We report a case that we encountered and discuss the diagnosis and disease management in addition to a review of the literature.