Imaging diagnosis and endoscopic treatment for ureteral fibroepithelial polyp prolapsing into the bladder.

OBJECTIVE: Fibroepithelial polyps of ureter prolapsing into the bladder are a rare urological condition. We report the imaging findings and our experience with endoscopic treatment for ureteral fibroepithelial polyps prolapsing into the bladder. PATIENTS AND RESULTS: Four patients with frank pain and hematuria were enrolled. Intravenous urography and computed tomography revealed a ureteral mass with filling defects in affected ureter and mild hydronephrosis. Endoscopic examination showed ureteral polyps prolapsing in the bladder. The histopathologic diagnosis on 4 cases was benign fibroepithelial polyps of ureter. The largest polyps (from 4-10 cm in length) were successfully resected and vaporized by Holmium: YAG laser. A double-pigtail ureteral stent at 7F was placed and left for 6 weeks after the procedure. Neither recurrence nor ureter stricture was observed after up to 12 years of follow-up. CONCLUSIONS: Ureteral malignancy must be excluded in cases where a ureteral mass is detected. Endoscopic management is recommended to minimize morbidity and complications in treatment of ureteral fibroepithelial polyps that prolapse into the bladder.

Solifenacin is able to improve the irritative symptoms after transurethral resection of bladder tumors.

OBJECTIVE: To evaluate the efficacy and safety of solifenacin in the management of irritative symptoms after transurethral resection of bladder tumors (TURBTs) with subsequent intravesical chemotherapy. METHODS: A total of 116 patients undergoing TURBT were randomly allocated into 2 groups, 58 patients in each group. Group 1 patients received solifenacin 5 mg, 6 hours before surgery and 5 mg per day, after surgery for 2 weeks, whereas group 2 patients received a placebo. Patients with low-risk non-muscle-invasive bladder cancer received immediate postoperative instillation of epirubicin. Patients with medium- or high-risk non-muscle-invasive bladder cancer received postoperative instillation twice within 2 weeks, once immediately following the operation and once on the eighth postoperative day. All patients completed bladder diaries before surgery, on the 1st, 7th, and 14th days after removal of the catheter with overactive bladder symptom scores completed preoperatively, and on the 7th and 14th days. Additionally, the incidence and severity of catheter-related bladder discomfort were recorded at 6, 12, 24, 48, and 72 hours after the surgery. RESULTS: The incidence and the severity of catheter-related bladder discomfort in group 1, compared with group 2, were significantly reduced (P<.05). There was a significant difference in overactive bladder symptom scores between the 2 groups (5.67 vs 7.86; P<.001). Episodes of daytime, frequency, nocturia, urgency, and urge urinary incontinence in group 1 were also significantly lower than in group 2 (P<.05). CONCLUSION: This study demonstrates that solifenacin can be beneficial for the management of irritative symptoms after TURBT with subsequent intravesical chemotherapy.

Better irrigation delivers better vision: an exploratory study of a novel continuous irrigation sheath for a flexible cystoscope.

OBJECTIVE: To evaluate the effectiveness of a novel continuous irrigation sheath (NCIS) for improving the vision of a flexible cystoscope under gross hematuria and to investigate whether this NCIS increases patient discomfort. METHODS: A model was designed and a trial was conducted to quantitatively evaluate the effectiveness of the NCIS in vitro. The trial was divided into a static and a dynamic trial. The main difference between these two parts of the trial was the presence of continuous hemorrhage. There were 3 levels for the irrigation condition: no irrigation (group 1), continuous irrigation without an outflow of water (group 2), and continuous irrigation with an outflow of water (group 3). Flexible cystoscopy was conducted under different conditions and repeated, and the main outcome measures, including field of flexible cystoscope's vision (FFCV) and definition of the pictures taken by the flexible cystoscope (DFC), were measured at 30, 60, 90 and 120 seconds. To investigate whether the NCIS increased patient discomfort, 36 patients were randomized into 2 groups to receive flexible cystoscopy with or without the NCIS. RESULTS: Compared with groups 1 and 2, the FFCV and DFC values were significantly increased in group 3; however, the FFCV was not significantly increased compared with group 2 in the static model. The pain scores between patients who received flexible cystoscopy with or without the NCIS did not differ significantly. CONCLUSION: The NCIS effectively improved the vision of a flexible cystoscope without increasing patient discomfort.

miRNA-100 inhibits human bladder urothelial carcinogenesis by directly targeting mTOR.

miRNAs are involved in cancer development and progression, acting as tumor suppressors or oncogenes. In this study, miRNA profiling was conducted on 10 paired bladder cancer tissues using 20 GeneChip miRNA Array, and 10 differentially expressed miRNAs were identified in bladder cancer and adjacent noncancerous tissues of any disease stage/grade. After being validated on expanded cohort of 67 paired bladder cancer tissues and 10 human bladder cancer cell lines by quantitative real-time PCR (qRT-PCR), it was found that miR-100 was downregulated most significantly in cancer tissues. Ectopic restoration of miR-100 expression in bladder cancer cells suppressed cell proliferation and motility, induced cell-cycle arrest in vitro, and inhibited tumorigenesis in vivo both in subcutaneous and in intravesical passage. Bioinformatic analysis showed that the mTOR gene was a direct target of miR-100. siRNA-mediated mTOR knockdown phenocopied the effect of miR-100 in bladder cancer cell lines. In addition, the cancerous metastatic nude mouse model established on the basis of primary bladder cancer cell lines suggested that miR-100/mTOR regulated cell motility and was associated with tumor metastasis. Both mTOR and p70S6K (downstream messenger) presented higher expression levels in distant metastatic foci such as in liver and kidney metastases than in primary tumor. Taken together, miR-100 may act as a tumor suppressor in bladder cancer, and reintroduction of this mature miRNA into tumor tissue may prove to be a therapeutic strategy by reducing the expression of target genes.