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3.
Medicine (Baltimore) ; 100(4): e24473, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530260

RESUMO

ABSTRACT: Tomoscintigraphic reconstruction in nuclear medicine assumes that the distribution of the tracer is unchanged in the volume of interest throughout the duration of the acquisition. This condition is however not met in early-phase bone scintigraphy and early-phase pelvic SPECT may display helical artifacts due to the filling of the bladder. Those artifacts may hamper proper interpretation of surrounding bone areas. The aim of this study was to construct a 4D digital pelvic phantom to simulate different acquisition protocols and optimize the acquisition.A 4D digital pelvic phantom was generated with a dynamic component consisting in an expanding bladder with 2 ureters and a static part consisting in the 2 kidneys, bone structures, and soft tissues. Projection data were obtained using an attenuated Radon transform function. Four acquisitions protocols were tested: 32 projections of 16 seconds (32-16-1), 32 projections of 8 seconds (32-8-1), 2 consecutive SPECT of 32 projections of 4 seconds (32-4-2) and 2 consecutive SPECT of 16 projections of 8 seconds (16-8-2). The optimal protocol was then tested on one patient.The amplitude of the artifacts was reduced with the 32-8-1, 32-4-2, and 16-8-2 protocols. The 16-8-2 protocol had the highest signal to noise ratio among those 3 protocols. The bladder artifact was visually markedly reduced on the patient acquisition with a 16-8-2 protocol.Two successive early-phase bone SPECT, with a lower number of projection than the usual protocol reduce the impact of the helical artifacts around the bladder.


Assuntos
Artefatos , Ossos Pélvicos/diagnóstico por imagem , Tomografia Computadorizada de Emissão/métodos , Bexiga Urinária/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imagens de Fantasmas , Melhoria de Qualidade
4.
Ecotoxicol Environ Saf ; 208: 111693, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33396024

RESUMO

Arsenic is a natural chemical element that is strongly associated with bladder cancer. Understanding the underlying mechanisms behind the association between arsenic and bladder cancer as well as identifying effective preventive interventions will help reduce the incidence and mortality of this disease. The epithelial-mesenchymal transition (EMT) and cancer stem cell (CSC) properties play key roles in cancer development and progression. Here, we reported that chronic exposure to arsenic resulted in EMT and increased levels of the CSC marker CD44 in human uroepithelial cells. Furthermore, IL-8 promoted a mesenchymal phenotype and upregulated CD44 by activating the ERK, AKT and STAT3 signaling. Phosphorylation of the human epidermal growth factor receptor 2 (HER2) was key for arsenic-induced IL-8 overexpression and depended on the simultaneous activation of the MAPK, JNK, PI3K/AKT and GSK3ß signaling pathways. We also found that genistein inhibited arsenic-induced HER2 phosphorylation and downregulated its downstream signaling pathways, thereby inhibiting progression of EMT, and reducing CD44 expression levels. These results demonstrate that the HER2/IL-8 axis is related to the acquisition of an EMT phenotype and CSCs in arsenic-treated cells. The inhibitory effects of genistein on EMT and CSCs provide a new perspective for the intervention and potential chemotherapy against arsenic-induced bladder cancer.


Assuntos
Arsênico/toxicidade , Células Epiteliais/efeitos dos fármacos , Transição Epitelial-Mesenquimal/efeitos dos fármacos , Interleucina-8/metabolismo , Células-Tronco Neoplásicas/efeitos dos fármacos , Receptor ErbB-2/genética , Bexiga Urinária/metabolismo , Arsênico/metabolismo , Linhagem Celular , Movimento Celular/efeitos dos fármacos , Movimento Celular/imunologia , Sobrevivência Celular/efeitos dos fármacos , Células Epiteliais/imunologia , Células Epiteliais/metabolismo , Transição Epitelial-Mesenquimal/imunologia , Humanos , Receptores de Hialuronatos/genética , Células-Tronco Neoplásicas/imunologia , Células-Tronco Neoplásicas/metabolismo , Fenótipo , Fosfatidilinositol 3-Quinases/metabolismo , Transdução de Sinais/efeitos dos fármacos , Bexiga Urinária/citologia
5.
Nat Commun ; 12(1): 184, 2021 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-33420073

RESUMO

Molecular stratification can improve the management of advanced cancers, but requires relevant tumor samples. Metastatic urothelial carcinoma (mUC) is poised to benefit given a recent expansion of treatment options and its high genomic heterogeneity. We profile minimally-invasive plasma circulating tumor DNA (ctDNA) samples from 104 mUC patients, and compare to same-patient tumor tissue obtained during invasive surgery. Patient ctDNA abundance is independently prognostic for overall survival in patients initiating first-line systemic therapy. Importantly, ctDNA analysis reproduces the somatic driver genome as described from tissue-based cohorts. Furthermore, mutation concordance between ctDNA and matched tumor tissue is 83.4%, enabling benchmarking of proposed clinical biomarkers. While 90% of mutations are identified across serial ctDNA samples, concordance for serial tumor tissue is significantly lower. Overall, our exploratory analysis demonstrates that genomic profiling of ctDNA in mUC is reliable and practical, and mitigates against disease undersampling inherent to studying archival primary tumor foci. We urge the incorporation of cell-free DNA profiling into molecularly-guided clinical trials for mUC.


Assuntos
DNA Tumoral Circulante/sangue , Genômica , Plasma , Neoplasias da Bexiga Urinária/sangue , Neoplasias da Bexiga Urinária/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/genética , Carcinoma de Células de Transição/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Prognóstico , Receptor ErbB-2/genética , Estudos Retrospectivos , Análise de Sobrevida , Bexiga Urinária , Proteína Grupo D do Xeroderma Pigmentoso/genética
6.
Zhonghua Yi Xue Za Zhi ; 101(2): 142-146, 2021 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-33455131

RESUMO

Objective: To explore the clinical value of ambulatory urodynamics monitoring (AUM) in the diagnosis and treatment of children with refractory monosymptomatic nocturnal enuresis (RMNE) by comparing the urodynamic parameters of AUM with those of conventional urodynamics (CUD). Methods: A total of 40 children (22 males and 18 females) diagnosed with RMNE in the First Affiliated Hospital of Zhengzhou University from May 2017 to September 2019 were collected. They were aged 9-16 years, and their frequency of nocturnal bed-wetting was≥2 times per week. CUD and one sleep cycle AUM were performed, respectively. Then, the urodynamic parameters were recorded and analyzed. Results: Five of the 40 children dropped out of the study because of the poor compliance. The age of children with RMNE was(12.6±2.1)years old, the ratio of male to female was 19∶16, and the severity of enuresis (enuresis frequency) was(4.2±1.7) times per week. Compared to the CUD group, the bladder compliance (BC) [(28.4±7.7) ml/cmH2O vs (23.6±6.1) ml/cmH2O(1 cmH2O=0.098 kPa)] and maximum detrusor pressure (Pmax.det) [(44.6±9.1) cmH2O vs (36.8±8.3) cmH2O] in the AUM group were significantly higher (P<0.05). The maximum flow rate (Qmax) [(19.6±7.2) ml/s vs (20.9±5.4) ml/s] and post void residual (PVR) [(9.5±5.7) ml vs (10.9±5.3) ml] between the two groups showed no statistically significant differences (P>0.05). Detrusor overactivity (DO) was detected in 27 cases (77.1%) during AUM and in 16 cases (45.7%) during CUD; the difference was statistically significant (P<0.05). Among them, 15 cases (42.9%) with DO were detected both in CUD and AUM, while 12 (34.3%) with DO were not detected in CUD. For the 15 cases with DO detected by both CUD and AUM, the frequency [(3.1±1.0) times/h vs (2.4±0.8) times/h] and maximum value of DO [(22.9±4.5) cmH2O vs (19.2±4.0) cmH2O] in the AUM group were both higher than those in the CUD group (P<0.05). Conclusions: Bladder dysfunction can be diagnosed in children with RMNE using AUM. Furthermore, AUM is more accurate than CUD in evaluating BC, Pmax.det, DO, and other parameters. For children with RMNE and with unsatisfactory CUD results, further AUM examination is recommended to clarify the etiology.


Assuntos
Enurese Noturna , Incontinência Urinária , Adolescente , Criança , Feminino , Humanos , Masculino , Monitorização Ambulatorial , Enurese Noturna/diagnóstico , Bexiga Urinária , Urodinâmica
7.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504516

RESUMO

A premenopausal patient in her late forties presented with a 15-year history of urinary incontinence starting shortly after a caesarean section performed for her fourth delivery and more recently associated episodic light haematuria and passage of clots per vagina. The haematuria was intermittent over several months and associated with per-vaginal bleeding. She had symptomatic anaemia. Flexible cystoscopy and MRI showed a vesicouterine fistula. She underwent a robotic-assisted hysterectomy and multi-layered repair of the bladder with omental interposition. She remained in the hospital for 4 days, though recovered well and underwent catheter removal at 14 days following a normal cystogram. At 3 months, she was well with no incontinence or urinary symptoms. This case demonstrates the need for vigilance in assessing patients with persistent incontinence, particularly in the context of prior caesarean section. It highlights the feasibility of robotic surgery for correcting these defects in a society where minimally invasive surgery is becoming the norm, and cosmesis is a priority for patients.


Assuntos
Cesárea , Diagnóstico Tardio , Complicações Pós-Operatórias/diagnóstico por imagem , Fístula Vesicovaginal/diagnóstico por imagem , Cistoscopia , Feminino , Humanos , Histerectomia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Robóticos , Bexiga Urinária/cirurgia , Incontinência Urinária/etiologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/cirurgia
8.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462051

RESUMO

There is a wide range of hymenal variants which exist and usually become apparent to women during puberty. Our case describes a 16-year-old woman with a previously undiagnosed hymenal septum who presented with a retained tampon within the urinary bladder. This case report discusses a rare presentation of a hymenal variant and highlights the importance of understanding the difference in pelvic examinations in children and adolescents when compared with adults and awareness of the different hymenal variants.


Assuntos
Corpos Estranhos/diagnóstico , Corpos Estranhos/etiologia , Hímen/anormalidades , Produtos de Higiene Menstrual , Bexiga Urinária , Adolescente , Feminino , Corpos Estranhos/cirurgia , Humanos
9.
Medicina (Kaunas) ; 57(1)2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33435420

RESUMO

Background and Objectives: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1-2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. Materials and Methods: Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). Results: Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. Conclusion: With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children.


Assuntos
Meios de Contraste , Técnicas de Diagnóstico Urológico , Ultrassonografia/métodos , Refluxo Vesicoureteral/diagnóstico por imagem , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Cistografia , Feminino , Humanos , Lactente , Injeções , Laparoscopia , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Politetrafluoretileno , Exposição à Radiação , Recidiva , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Hexafluoreto de Enxofre , Ureteroscopia , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle , Urografia , Refluxo Vesicoureteral/classificação , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/terapia , Adulto Jovem
10.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431473

RESUMO

A 26-year-old man underwent laparoscopic appendicectomy for acute appendicitis that was carried out uneventfully after initial urethral catheterisation to empty the bladder. Postoperatively, he developed oliguria associated with high drain output and elevated drain fluid creatinine. A contrast-enhanced computed tomography urography scan showed a small amount of contrast in the intraperitoneal space. A diagnostic laparoscopy performed for a suspected bladder injury revealed that the drain (inserted via the suprapubic port) had traversed the bladder. The drain was removed, and the bladder defects were repaired. The catheter was removed 2 weeks later uneventfully. It is important to recognise and avoid the urinary bladder during suprapubic port insertion during laparoscopic appendicectomy. This complication can be minimised via initial bladder decompression and introduction of the suprapubic port lateral to the umbilical ligaments. A high index of suspicion is required to diagnose a small bladder injury.


Assuntos
Apendicectomia/efeitos adversos , Apendicite/cirurgia , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Bexiga Urinária/lesões , Adulto , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/terapia , Masculino , Tomografia Computadorizada por Raios X , Urografia
11.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509879

RESUMO

A 58-year-old woman with a previous clam ileocystoplasty was referred to the urology department for the investigation of haematuria. CT urogram showed a large left-sided soft tissue mass arising from the bladder. Histological analysis of the shavings from transurethral resection revealed a G3pT2 transitional cell carcinoma and T4N1Mx adenocarcinoma. The patient was referred to oncology for the discussion of palliative chemotherapy; however, in the interim she deteriorated and was admitted to hospital with a post-renal acute kidney injury. A right-sided nephrostomy was inserted relieving her obstruction and she subsequently made a good recovery. This case report illustrates the difficulties in the long-term follow-up of patients having undergone what is now a rarely performed procedure. In the absence of regular cystoscopic follow-up post ileocystoplasty, malignancy may present late and with complications from advanced disease.


Assuntos
Adenocarcinoma/patologia , Carcinoma de Células de Transição/patologia , Íleo/transplante , Neoplasias Primárias Múltiplas/patologia , Transplantes/patologia , Neoplasias da Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Adenocarcinoma/diagnóstico por imagem , Anastomose Cirúrgica , Carcinoma de Células de Transição/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Transplantes/diagnóstico por imagem , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Incontinência Urinária de Urgência/cirurgia
12.
Acta Cir Bras ; 35(12): e351208, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503221

RESUMO

PURPOSE: To describe the anatomy of the swine urinary system using computed tomography and to discuss the role of this animal as an experimental model for urological procedures. METHODS: Three male Landrace pigs underwent computed tomography and the anatomy of the urinary system and renal circulation was analyzed and described. RESULTS: In all animals, 2 kidneys, 2 ureters and one bladder were identified. Each kidney presented a single renal artery vascularization, with a mean diameter on the right of 4.45 and 5.31 mm on the left (p < 0.0001) and single renal vein drainage, with a mean diameter on the right of 5.78 and 5.82 mm on the left (p = 0.0336). The average renal length was 9.85 cm on the right and 10.30 cm on the left (p < 0.0001). The average renal volume was 113.70 cm3 on the right and 109.70 cm3 on the left (p < 0.0001). The average length of the ureter was 19.78 cm on the right and 22.08 cm on the left (p < 0.0001). The average bladder volume was 423.70 cm3. CONCLUSIONS: The data obtained show similarities with human anatomy, suggesting the viability of the swine model for planning preclinical trials, basic research, refinement in experimental surgery and surgical training for urological procedures.


Assuntos
Ureter , Animais , Rim/diagnóstico por imagem , Rim/cirurgia , Artéria Renal , Suínos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos
13.
BMC Surg ; 21(1): 43, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468126

RESUMO

BACKGROUND: The prolapse of a ruptured and extruded bladder after vaginal hysterectomy is rare in clinical practice. We report the case of a significant mass that prolapsed from the vagina after a vaginal hysterectomy in a multiparous postmenopausal woman. CASE PRESENTATION: A 67-year old multiparous postmenopausal Chinese woman was found to have a significant mass extruding from the vagina after a vaginal hysterectomy. The mass was a ruptured and everted bladder, and the diagnosis was confirmed after physical and imaging examinations and urethral catheterization. The patient underwent an emergency operation for mass reduction, bladder repair, and partial colpocleisis under general anesthesia. She recovered without prolapse or urinary drainage complications after 35 months of follow-up. CONCLUSIONS: The present case serves as a guide for the management of patients with pelvic organ prolapse. The condition of patients should be carefully evaluated before surgery, and individualized operation should be performed. Careful postoperative follow-up is crucial for the timely exclusion of complications, especially in elderly patients with persistently increased abdominal pressure.


Assuntos
Cistostomia , Histerectomia Vaginal/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Bexiga Urinária/cirurgia , Incontinência Urinária/etiologia , Idoso , Feminino , Humanos , Pós-Menopausa , Resultado do Tratamento , Bexiga Urinária/diagnóstico por imagem , Cateterismo Urinário , Procedimentos Cirúrgicos Urológicos , Vagina/cirurgia
14.
Am J Vet Res ; 82(2): 144-151, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33480283

RESUMO

OBJECTIVE: To describe functional and anatomic changes of the lower urogenital tract of healthy male dogs during the sexually immature period and up to 2 years of age by urodynamic and morphometric assessment. ANIMALS: 6 sexually intact male Beagle littermates. PROCEDURES: Dogs underwent electromyography-coupled urodynamic tests, CT-assisted retrograde urethrography, prostatic washes, and blood sampling monthly from 4 through 12 months of age and then at 3-month intervals. Urodynamic and morphometric variables and serum canine prostate-specific esterase concentrations were analyzed by statistical methods. RESULTS: Integrated pressure of the urethra was significantly increased beginning at 8 months of age, compared with earlier time points. Urethral pressure peak amplitudes varied among anatomic regions. During bladder filling, few electromyographic signals were concurrent with urethral pressure peaks; these were most commonly detected in the penile portion of the urethra. Urethral length and prostate gland volume were significantly greater from 7 to 24 months of age than at younger ages. Urethral length was approximately 26 to 27 cm after 9 months, and prostate gland volume was approximately 11 to 12 cm3 after 11 months of age. Serum canine prostate-specific esterase concentrations correlated with prostate gland volume. Urinary bladder threshold volume was significantly increased at 6 months of age, compared with that at 4 months, with a maximum of 197.7 mL at 24 months. CONCLUSIONS AND CLINICAL RELEVANCE: Urethral resistance was acquired at approximately 8 months of age, when growth of the lower urinary tract was incomplete. Electromyographic and integrated pressure measurement results and the distribution and amplitude of urethral pressure peaks highlighted the potential role of the prostate gland and possibly the bulbocavernosus muscles in control of continence.


Assuntos
Urodinâmica , Sistema Urogenital , Animais , Cães , Masculino , Próstata , Uretra , Bexiga Urinária
15.
Orv Hetil ; 162(4): 135-143, 2021 01 24.
Artigo em Húngaro | MEDLINE | ID: mdl-33486465

RESUMO

Összefoglaló. Az alsó húgyutak fo funkciója a vizelet tárolása és ürítése, amely muködések zavara az úgynevezett alsó húgyúti tünetegyüttes kialakulásához vezet, ami a kiváltó októl függoen vizeletürítési zavarral és vizeletretencióval is járhat. Kezeletlen esetekben a felso húgyutak károsodása következik be a magas hólyagnyomás által kiváltott vesicoureteralis reflux következtében, amely ureter- és veseüregrendszeri tágulat kialakulására, illetve fertozésekre és koképzodésre hajlamosít. A vizelettárolási/vizeletürítési zavarokat három fo csoportba sorolhatjuk, úgymint stressz- (terheléses) inkontinencia , hiperaktív hólyag (nedves/száraz) és neurogén hólyag. A jelen összefoglaló közlemény tárgyát képezo neurogén hólyag egy gyujtofogalom, mely magában foglal minden, releváns neurológiai kórkép talaján kialakult vizelettárolási és vizeletürítési zavart. Mivel a húgyhólyag mellett a záróizomzat és a hátsó húgycso is érintett, ezt a kórképet napjainkban "neurogén alsó húgyúti diszfunkció" elnevezéssel is szokás illetni. A kórállapotot a neurológiai diszfunkciók széles spektruma okozhatja, kezdve a helyi funkcionális zavartól a helyi idegi sérülésen át a felso és alsó motoneuron-sérülésig vagy a centrális degeneratív folyamatokig. Az eltéro etiológia ellenére a klinikai tünetek rendszerint két alapveto klinikai típusban manifesztálódhatnak: túlmuködo (fokozott detrusorkontraktilitást okozó automata) hólyag vagy alulmuködo hólyag formájában. Tekintettel a neurogén alsó húgyúti diszfunkció következtében létrejövo felso húgyúti komplikációkra, a közlemény egyik célja a betegség diagnózisát segíto algoritmus bemutatása a legújabb nemzetközi szakirodalmi ismeretek alapján. A neurogén hólyag kezelése jobbára nem terjedhet ki a kiváltó ok kezelésére, ezért a jelen összefoglaló másik célja azon gyógyszeres és invazív terápiás beavatkozások összefoglalása, melyek a felso húgyutak védelmét szolgálják az alacsony hólyagnyomás fenntartása révén. Orv Hetil. 2021; 162(4): 135-143. Summary. Storage and urination are the main functions of the lower urinary tract and its lesions lead to the so-called lower urinary tract syndrome causing either urinary incontinence or retention. In untreated cases, the upper urinary tract becomes injured via a vesicoureteral reflux resulting from increased bladder pressure and resultant dilations of the ureter and the renal pelvis which predispose to infection and stone formation. Lower urinary tract storage/urination disorders can be classified as stress incontinence, hyperactive bladder (wet/dry) and neurogenic bladder. Neurogenic bladder which is the subject of this review, is a collective term that encompasses all urinary storage and emptying disorders which develop on the basis of neurological diseases. Being not only the bladder, but also the sphincter and posterior urethra (generally termed as the "bladder outlet") affected, nowadays this condition is referred to as "neurogenic lower urinary tract dysfunction". A wide range of neurological dysfunctions could contribute to the development of this condition, ranging from local dysfunction (autonomic dysreflexia) or local nerve injury to upper/lower motoneuron injury or central degenerative processes. Regardless of the diverse etiology, the clinical symptoms eventually manifest in two major forms, i.e., overacting (automatic bladder with increased detrusor contractility) and underactive bladder. Considering the severity of complication occurring in the upper urinary tract in response to the pathophysiological changes in the lower urinary tract, one of the aims of this paper was to present an algorithm aiming to build up a state of the art diagnosis of the disease based on current international literature data. Since treatment of the neurogenic bladder usually can not target elimination of the underlying cause, the other goal of the present paper is to summarize the pharmacological treatment regimen and invasive therapeutic interventions that protect the upper urinary tract by maintaining low pressure values in the bladder. Orv Hetil. 2021; 162(4): 135-143.


Assuntos
Bexiga Urinaria Neurogênica/terapia , Bexiga Urinária/fisiopatologia , Transtornos Urinários/terapia , Humanos , Pressão
16.
Urol Clin North Am ; 48(1): 103-112, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218584

RESUMO

Lower urinary tract reconstruction has traditionally been approached in an open fashion but select complications or disease processes may be suitable for robotic reconstruction, including bladder neck contractures, proximal urethral strictures, and genitourinary fistulas. Here, the authors discuss the novel techniques used and the feasibility of robotic reconstruction for these conditions. The robotic approach is relatively novel, and more data and studies will be required to make definitive statements regarding success rate and complications from the procedure. Preliminary data suggest that the robotic approach may offer comparable success compared with open techniques.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Uretra/cirurgia , Doenças Uretrais/cirurgia , Doenças da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Humanos , Obstrução Uretral/cirurgia , Fístula Urinária/cirurgia
17.
Urol Clin North Am ; 48(1): 45-50, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218593

RESUMO

"The robotic approach for radical cystectomy has become increasingly adopted by the urologic oncology community, as it has been shown to have equivalent oncologic outcomes with shorter hospital stay and fewer perioperative transfusions. Consensus guidelines from expert surgeons have been published to provide guidance on all aspects of how to implement the robotic approach in the urologic oncology clinic."


Assuntos
Cistectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Cistectomia/tendências , Humanos , Seleção de Pacientes , Assistência Perioperatória , Procedimentos Cirúrgicos Robóticos/tendências
18.
Urol Clin North Am ; 48(1): 51-70, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218594

RESUMO

Robotic-assisted radical cystectomy has gained increasing popularity over the past decade. Initially, the procedure was performed with extracorporeal urinary diversion given the technical challenges of the intracorporeal approach. Since then, innovative techniques have been described to facilitate bowel manipulation, assess ureteral and mesenteric vasculature, and perform ureteroenteric and urethro-ileal anastomosis. Overcoming the learning curve associated with intracorporeal urinary diversion can lead to decreased blood loss, shorter operative times, and faster convalescence, particularly with enhanced recovery protocols. Herein we review technical points, complications, outcomes, and future innovations in intracorporeal urinary diversion."


Assuntos
Cistectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Cistectomia/estatística & dados numéricos , Recuperação Pós-Cirúrgica Melhorada , Previsões , Humanos , Curva de Aprendizado , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Derivação Urinária/estatística & dados numéricos , Derivação Urinária/tendências
19.
Am J Physiol Renal Physiol ; 320(2): F174-F182, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33308017

RESUMO

Recent evidence revealed that Hunner-type interstitial cystitis (HIC) is a robust inflammatory disease potentially associated with enhanced immune responses and histologically characterized by epithelial denudation and lymphoplasmacytic infiltration with frequent clonal expansion of infiltrating B cells. To date, few animal models that reproduce the histological and clinical correlates of HIC have yet been established. In the present study, we aimed to develop a novel animal model for HIC via autoimmunity to the bladder urothelium using the transgenic mouse model (URO-OVA) that expresses the membrane form of the model antigen ovalbumin (OVA) as a self-antigen on the bladder urothelium. OVA-specific lymphocytes (splenocytes) were generated by immunization of C57BL/6 mice with OVA protein and injected intravenously into URO-OVA mice. The splenocytes from OVA-immunized C57BL/6 mice showed increased interferon (IFN)-γ production in response to OVA stimulation in vitro. URO-OVA mice adoptively transferred with OVA-primed splenocytes developed cystitis exhibiting histological chronic inflammatory changes such as remarkable mononuclear cell infiltration predominantly composed of T and B lymphocytes, increased vascularity, and mucosal hyperemia in the bladder at days 7-28 with a peak at day 21 tested. No systemic inflammation was found in cystitis-induced URO-OVA mice, nor was any inflammation found in wild-type C57BL/6 mice adoptively transferred with OVA-primed splenocytes. Along with bladder inflammation, URO-OVA mice demonstrated significantly increased pelvic nociceptive responses, voiding dysfunction, and upregulated mRNA expression levels for IFN-γ, tumor necrosis factor-α (TNF-α), and substance P precursor in the bladder. This model reproduces the histological and clinical features of human HIC, providing a novel model for HIC research.


Assuntos
Antígenos/imunologia , Doenças Autoimunes/patologia , Cistite/etiologia , Dor Pélvica/etiologia , Transtornos Urinários/etiologia , Urotélio/imunologia , Animais , Cistite/patologia , Cistite Intersticial/patologia , Citocinas/genética , Citocinas/metabolismo , Modelos Animais de Doenças , Regulação da Expressão Gênica/imunologia , Camundongos , Camundongos Transgênicos , Ovalbumina/imunologia , Dor Pélvica/patologia , Bexiga Urinária/patologia , Transtornos Urinários/patologia
20.
Clin Nucl Med ; 46(2): 161-163, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315674

RESUMO

ABSTRACT: A 75-year-old man with suspected prostate cancer underwent a 99mTc-MDP bone scan to exclude the possibility of bone metastasis. Scans revealed areas of increased tracer uptake in a symmetric distribution on both sides of the pelvis. Further SPECT/CT imaging showed focal 99mTc-MDP accumulation within 2 cystic lesions on both sides of the bladder. Subsequent x-ray cystography showed contrast agent filling within both cystic lesions, which suggested double bladder diverticula. Eventually, these 2 cystic lesions were confirmed by surgery and pathology as double congenital bladder diverticula.


Assuntos
Osso e Ossos/diagnóstico por imagem , Divertículo/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Bexiga Urinária/anormalidades , Idoso , Humanos , Masculino , Medronato de Tecnécio Tc 99m , Bexiga Urinária/diagnóstico por imagem
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