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1.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370935

RESUMO

We report the case of a 35-year-old woman who presented with recurrent macroscopic haematuria and known diagnosis of Klippel-Trenaunay syndrome. Imaging and cystoscopy identified an extensive venous malformation involving a large area of the bladder wall. Holmium laser therapy was ineffective at obtaining symptom control. Following a multidisciplinary team meeting, transvenous sclerotherapy with sodium tetradecyl sulphate was performed under image guidance. A reduction in venous density was observed on cystoscopy and the patient has had complete resolution of symptoms within 6 weeks and continued to be asymptomatic up to 24-month follow-up. We propose that transvenous sclerotherapy is considered first-line treatment in this clinical setting.


Assuntos
Hematúria/terapia , Síndrome de Klippel-Trenaunay-Weber/complicações , Escleroterapia/métodos , Malformações Vasculares/terapia , Veias/patologia , Administração Intravenosa , Adulto , Cistoscopia , Feminino , Hematúria/etiologia , Humanos , Síndrome de Klippel-Trenaunay-Weber/terapia , Lasers de Estado Sólido/uso terapêutico , Angiografia por Ressonância Magnética , Soluções Esclerosantes/administração & dosagem , Tetradecilsulfato de Sódio/administração & dosagem , Resultado do Tratamento , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Malformações Vasculares/diagnóstico , Malformações Vasculares/etiologia , Malformações Vasculares/patologia , Veias/diagnóstico por imagem , Veias/efeitos dos fármacos
2.
Nat Commun ; 11(1): 3953, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769974

RESUMO

Many important cell types in adult vertebrates have a mesenchymal origin, including fibroblasts and vascular mural cells. Although their biological importance is undisputed, the level of mesenchymal cell heterogeneity within and between organs, while appreciated, has not been analyzed in detail. Here, we compare single-cell transcriptional profiles of fibroblasts and vascular mural cells across four murine muscular organs: heart, skeletal muscle, intestine and bladder. We reveal gene expression signatures that demarcate fibroblasts from mural cells and provide molecular signatures for cell subtype identification. We observe striking inter- and intra-organ heterogeneity amongst the fibroblasts, primarily reflecting differences in the expression of extracellular matrix components. Fibroblast subtypes localize to discrete anatomical positions offering novel predictions about physiological function(s) and regulatory signaling circuits. Our data shed new light on the diversity of poorly defined classes of cells and provide a foundation for improved understanding of their roles in physiological and pathological processes.


Assuntos
Diferenciação Celular , Fibroblastos/fisiologia , Células-Tronco Mesenquimais/fisiologia , Miócitos de Músculo Liso/fisiologia , Pericitos/fisiologia , Animais , Separação Celular , Vasos Coronários/citologia , Matriz Extracelular/metabolismo , Fibroblastos/citologia , Citometria de Fluxo , Intestinos/irrigação sanguínea , Intestinos/citologia , Masculino , Camundongos , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/citologia , Músculo Liso Vascular/citologia , Miocárdio/citologia , Miócitos de Músculo Liso/citologia , Pericitos/citologia , RNA-Seq , Análise de Célula Única , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/citologia
3.
Korean J Radiol ; 21(2): 146-158, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31997590

RESUMO

Microvascular ultrasonographic imaging is the most recent and unique Doppler ultrasound technique. It uses an advanced clutter filter that can remove clutter artifacts and preserve the low-velocity microvascular flow signal. The potential advantages of microvascular ultrasonography are its superiority in detection and visualization of the small blood vessels in tissues, providing radiologists with more information on the vascular structures. Therefore, it has shown particular value in the clinical fields. The aim of this study was to provide microvascular ultrasonographic images for the tissue microvasculature, including the brain, thyroid gland, kidney, urinary bladder, small bowel, ovary, testis, lymph node, and hemangiomas in children, focusing on the comparison with conventional color Doppler ultrasonographic images.


Assuntos
Microvasos/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Criança , Doença de Graves/diagnóstico por imagem , Doença de Graves/patologia , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem
4.
Urologiia ; (5): 132-135, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808648

RESUMO

Three basic theories of the development of an overactive bladder that have experimental and clinical evidences have been described, including neurogenic, myogenic, and urothelial. Based on the results of the literature analysis, the authors suggested the existence of detrusor ischemic disease as a result of compressive impairment of its blood flow due to incomplete or short-term relaxation under overactivity or hydraulic compression of the vessels by excessive urine volume in case of hypoactive bladder.


Assuntos
Isquemia/fisiopatologia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/terapia , Bexiga Urinária/irrigação sanguínea , Hemodinâmica , Humanos , Contração Muscular/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/complicações , Micção/fisiologia , Urodinâmica/fisiologia , Urotélio
5.
Sci Rep ; 9(1): 16328, 2019 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-31705030

RESUMO

We tried to establish a reliable detrusor underactivity (DUA) rat model and to investigate pathophysiology of chronic bladder ischemia (CBI) on voiding behavior and bladder function. Adult male rats were divided into five groups. The arterial injury (AI) groups (AI-10, AI-20, AI-30) underwent vascular endothelial damage (VED) of bilateral iliac arteries (with 10, 20, and 30 bilateral repetitions of injury, respectively) and received a 1.25% cholesterol diet. The sham group underwent sham operation and received the same diet. Controls received a regular diet. After 8 weeks, all rats underwent unanesthetized cystometrogram. Bladder tissues were processed for organ bath investigation, immunohistochemistry staining, and genome-wide gene expression analysis. Awake cystometry analysis showed that frequency of voiding contractions and micturition pressure were lower in the AI-30 group than in sham group (p < 0.01). Contractile responses to various stimuli were lower in AI-20 and AI-30 groups (both p < 0.001). In the AI-20 and AI-30 groups, atherosclerotic occlusion in the iliac arteries, tissue inflammation, fibrosis, denervation, and apoptosis of bladder muscle were prominent compared to the sham. Mechanistically, the expression of purinergic receptor P2X-1 was reduced in the AI-30 group, and the genome-wide gene expression analysis revealed that genes related to IL-17 and HIF-1 signaling pathways including INF-γ receptor-1 and C-X-C motif chemokine ligand-2 were upregulated in the CBI-induced DUA rat model. A rat model of progressive VED successfully induced DUA. Abnormal tissue inflammation, fibrosis, denervation, and bladder muscle tissue apoptosis may be involved in CBI-induced DUA pathophysiology.


Assuntos
Endotélio Vascular/patologia , Artéria Ilíaca/patologia , Isquemia/genética , Músculo Liso/fisiopatologia , Bexiga Urinária/irrigação sanguínea , Animais , Regulação da Expressão Gênica , Genômica , Isquemia/patologia , Isquemia/fisiopatologia , Masculino , Ratos , Ratos Sprague-Dawley
7.
Int J Urol ; 26(12): 1149-1155, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31549769

RESUMO

OBJECTIVES: To examine whether electrical stimulation of the perineum inhibited urinary frequency in rats with pelvic venous congestion, and whether electrical stimulation influences spinal glycinergic/gamma-aminobutyric acid-ergic neurons. METHODS: Bilateral common iliac veins and bilateral uterine veins were ligated to create pelvic venous congestion rats. At 4 weeks after ligation, cystometry was carried out before and after electrical stimulation with/without intrathecal injection of strychnine (a glycine receptor antagonist) and/or bicuculline (a gamma-aminobutyric acid type A receptor antagonist). In addition, measurement of amino acid levels in the lumbosacral cord was carried out with/without electrical stimulation, and cystometry was carried out after oral administration of glycine. RESULTS: Continuous cystometry showed that the interval between bladder contractions was shorter in pelvic venous congestion rats than in sham rats. Electrical stimulation did not change cystometric parameters in sham rats, but the interval between bladder contractions was increased by electrical stimulation in pelvic venous congestion rats. Electrical stimulation increased the levels of glutamic acid, glycine, gamma-aminobutyric acid, and taurine in the lumbosacral cord of pelvic venous congestion rats. Intrathecal strychnine abolished the effects of electrical stimulation in pelvic venous congestion rats, and intrathecal administration of both strychnine and bicuculline shortened the interval between bladder contractions more than before electrical stimulation. Oral administration of glycine (3%) to pelvic venous congestion rats increased bladder capacity. CONCLUSIONS: Electrical stimulation of the perineum inhibits urinary frequency mainly through activation of spinal glycinergic neurons, and partly through activation of gamma-aminobutyric acid-ergic neurons in a rat model of pelvic venous congestion.


Assuntos
Terapia por Estimulação Elétrica/métodos , Neurônios GABAérgicos/fisiologia , Reflexo/fisiologia , Medula Espinal/citologia , Bexiga Urinária Hiperativa/terapia , Insuficiência Venosa/complicações , Administração Oral , Animais , Modelos Animais de Doenças , Feminino , Glicina/administração & dosagem , Glicina/metabolismo , Humanos , Períneo/inervação , Ratos , Ratos Sprague-Dawley , Fluxo Sanguíneo Regional/fisiologia , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/etiologia , Bexiga Urinária Hiperativa/fisiopatologia , Micção/fisiologia , Útero/irrigação sanguínea , Veias/fisiopatologia , Insuficiência Venosa/fisiopatologia
8.
Surg Laparosc Endosc Percutan Tech ; 29(6): 493-497, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31107856

RESUMO

BACKGROUND: The combined resection of the vesical artery (VA) in laparoscopic lateral pelvic lymph node dissection (L-LPLD) was reported to facilitate the safe dissection of metastatic lymph nodes. However, whether or not the combined VA resection affects the urinary function remains controversial. PURPOSE: The purpose of the present study was to examine the risk factors for the postoperative urinary dysfunction (PUD) after L-LPLD followed by total mesorectal excision and to clarify the effects of the combined VA resection in L-LPLD on PUD. PATIENTS AND METHODS: L-LPLD was performed in 95 patients with advanced rectal cancer at Saga University Hospital and Kyushu University Hospital from January 2013 to December 2017. The risk factors for PUD after L-LPLD were investigated. RESULTS: The univariate analysis revealed that the combined resection of the inferior vesical artery (IVA) was a risk factor for PUD. To examine by the type of IVA resection, the incidence of PUD significantly increased with the bilateral IVA resection, but the unilateral IVA resection induced PUD on the same level with the preservation of IVA. CONCLUSIONS: Bilateral IVA resection in L-LPLD could increase the incidence of PUD. Thus, if possible, the preservation of the unilateral IVA through L-LPLD should be considered.


Assuntos
Artérias/cirurgia , Colectomia/métodos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Neoplasias Retais/cirurgia , Bexiga Urinária/fisiopatologia , Micção/fisiologia , Humanos , Linfonodos/patologia , Metástase Linfática , Estadiamento de Neoplasias , Pelve , Período Pós-Operatório , Neoplasias Retais/diagnóstico , Neoplasias Retais/secundário , Estudos Retrospectivos , Bexiga Urinária/irrigação sanguínea
9.
Neurourol Urodyn ; 38(4): 1135-1141, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30843277

RESUMO

AIM: Bladder pain syndrome (BPS) is a complex disease which causes cognitive, behavioral, sexual, and emotional problems. Vascular factors related to bladder blood supply may be one of the etiologic cause of BPS. This study aims to investigate the bladder blood flow and internal iliac artery resistive indices of patients with BPS. METHODS: A total of 30 female patients with the diagnosis of BPS and 30 female as control group were enrolled in the study. Bilateral internal iliac arterial blood flow distal to uterine arteries were examined as the primary source of vesical arterial blood supply. Peak systolic velocities, end diastolic velocities, resistive indices, and flow volumes of internal iliac arteries were measured by color Doppler ultrasonography in a single-blind fashion. RESULTS: The blood flows volume of the right and left internal iliac arteries during empty and full bladder were significantly lower at BPS group compared with control (P < 0.05). Although the difference was not significant, the mean resistive index of right and left internal iliac arteries were lower at the control group ( P > 0.05). Aging decreased the bladder blood volume and both BPS and control group internal iliac artery blood volume decreased by aging. The decrease was more significant at the control group, but the internal iliac artery blood volume was still lower at patients with BPS compared with the control group. CONCLUSION: Arterial blood flow of bladder was lower at patients with BPS compared with the control group. The decrease in the vascular supply of bladder might be one of the related factors for the BPS etiology.


Assuntos
Cistite Intersticial/etiologia , Bexiga Urinária/irrigação sanguínea , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Cistite Intersticial/diagnóstico por imagem , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Pessoa de Meia-Idade , Método Simples-Cego , Ultrassonografia Doppler em Cores , Bexiga Urinária/diagnóstico por imagem
10.
J Urol ; 202(2): 290-300, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30865573

RESUMO

PURPOSE: We systematically characterized gene expression, inflammation and neovascularization in patients with interstitial cystitis/bladder pain syndrome to obtain biological evidence supporting diagnosis and classification. MATERIALS AND METHODS: We sequenced RNA obtained from bladder mucosal biopsies of 33 patients with 3 subtypes of interstitial cystitis/bladder pain syndrome, including Hunner lesions in 12, no Hunner lesions in 11 but with glomerulations and neither Hunner lesions nor glomerulations in 10, and 9 controls. Differentially expressed genes of each subtype were searched to identify subtype specific biological pathways and candidate genes important for pathogenesis. Candidate genes were validated by quantitative polymerase chain reaction and immunohistochemistry. Digital immunohistochemical quantification was performed to assess subepithelial lymphoplasmacytic cell and microvessel density. Relationships between candidate gene over expression and symptom severity were explored. RESULTS: Patients with Hunner lesions showed a distinct gene expression profile associated with significant up-regulation of biological processes involving immune responses and infection, and an increase in subepithelial lymphoplasmacytic cell and microvessel density. Over expression of 2 candidate genes, VEGF and BAFF, correlated with symptom severity. Meanwhile, the gene expression profiles of patients with the 2 subtypes without Hunner lesions were similar to those of controls. No difference in biological pathways or subepithelial lymphoplasmacytic cell and microvessel density were detected between these 2 subtypes and controls. CONCLUSIONS: Interstitial cystitis/bladder pain syndrome with Hunner lesions shows distinct genomic and histological features associated with immune responses and infection. In addition, VEGF and BAFF are potential disease biomarkers and therapeutic targets. This subtype should be considered separate from the syndrome.


Assuntos
Cistite Intersticial/classificação , Cistite Intersticial/genética , Perfilação da Expressão Gênica , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Cistite Intersticial/patologia , Feminino , Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Membrana Mucosa , Neovascularização Patológica , Análise de Sequência de RNA , Bexiga Urinária/irrigação sanguínea
11.
Can Assoc Radiol J ; 70(3): 254-263, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30922786

RESUMO

PURPOSE: The aim of study is to assess the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and correlation with tumour angiogenesis in evaluation of urinary bladder cancer. MATERIAL AND METHODS: The study included 81 patients with recent presumed diagnosis of bladder tumour or who came for follow up after management of histopathologically proven bladder cancer. All had DCE-MRI with time-signal intensity curve. The radiologic results then correlated with the histopathologic results using both haematoxylin and eosin stain and immuno-histochemical staining for localization and evaluation of CD34 immunoreactivity as a detector for the microvessel density (MVD) and tumour angiogenesis. RESULTS: Seventy-one cases were pathologically proven to be malignant: 41 cases (58%) showed type III time-signal intensity curve (descending); 22 cases (31%) showed type II (plateau); and 8 cases (11%) showed type I (ascending) curve. The sensitivity of DCE-MRI in stage T1 bladder tumour was 80%; in stage T2, it was (90.9%); and in stage T3, it was (96.9%). Overall accuracy of DCE-MRI in tumour staging was 89.5% and P = .001 (significant). Values more than the cutoff value = 76.13 MVD are cystitis with sensitivity (90%), specificity (91%), and P value is .001, which is statistically highly significant. CONCLUSION: There is a strong positive association between DCE-MRI (staging and washout slope of the time-signal intensity curve) with histopathologic grade, tumour stage, and MVD in bladder cancer. So, DCE-MRI can be used as reliable technique in preoperative predictions of tumour behavior and affect the planning of antiangiogenetic therapy.


Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Imagem por Ressonância Magnética/métodos , Neovascularização Patológica/diagnóstico por imagem , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/patologia , Sensibilidade e Especificidade , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Adulto Jovem
12.
J Tissue Eng Regen Med ; 13(6): 986-996, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30811857

RESUMO

Adipose tissue-derived stem cells (ADSCs) have shown effectiveness in treating diabetic bladder dysfunction (DBD). In the present study, ADSCs pretreated by defocused low-energy shock wave (DLSW) were first used to achieve better therapeutic effect. ADSCs were treated by DLSW prior to each passage. Secretions of vascular endothelial growth factor (VEGF) and nerve growth factor (NGF) were tested. Proliferation ability was examined by staining 5-ethynyl-2-deoxyuridine (EdU) and assessing expressions of proliferating cell nuclear antigen (PCNA) and Ki67. DBD rat model was created and subgrouped via therapeutic options of phosphate-buffered saline, ADSCs, pretreated ADSCs, and ADSCs lysate. Afterward, voiding functions were evaluated, and tissues were examined by histology. Neonatal rats received intraperitoneal injection of EdU. All rats were subgrouped and treated as narrated above. Bladder tissues were stained with EdU, Stro-1, and CD34. Results showed that shocked ADSCs were activated by secreting more VEGF and NGF, by higher EdU-retaining cells ratios, and by higher expressions of PCNA and Ki67 compared with unshocked ADSCs. Shocked ADSCs had the most effective efficacy in treating DBD by secreting the most VEGF and NGF to accelerate regenerations of revascularization and innervation. Migrations of EdU+ Stro-1+ CD34- endogenous stem cells to bladders were enhanced by injecting ADSCs. In conclusion, ADSCs pretreated by DLSW had potent therapeutic effect in treating DBD by secreting VEGF and NGF. Recruitment of endogenous stem cells was considered as an important mechanism in this regenerative process.


Assuntos
Tecido Adiposo/citologia , Diabetes Mellitus Experimental/fisiopatologia , Diabetes Mellitus Experimental/terapia , Transplante de Células-Tronco , Células-Tronco/citologia , Bexiga Urinária/fisiopatologia , Animais , Diferenciação Celular , Movimento Celular , Proliferação de Células , Rastreamento de Células , Tratamento por Ondas de Choque Extracorpóreas , Feminino , Miócitos de Músculo Liso/citologia , Neovascularização Fisiológica , Fator de Crescimento Neural/metabolismo , Ratos Sprague-Dawley , Regeneração , Som , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/inervação , Fator A de Crescimento do Endotélio Vascular/metabolismo
13.
Int J Urol ; 26(3): 414-422, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30659668

RESUMO

OBJECTIVE: To investigate the effectiveness of combination treatment of vascular targeted photodynamic therapy and anti-cytotoxic T-lymphocyte-associated antigen 4 immunotherapy in a mouse model of urothelial carcinoma. METHODS: We used C57BL/6 mice injected with murine bladder 49 cell line. Mice were randomly allocated into four treatment groups: vascular targeted photodynamic therapy only, anti-cytotoxic T-lymphocyte-associated antigen 4 only, combination therapy and control. We carried out three separate experiments that used distinct cohorts of mice: tumor growth and development of lung metastases monitored with bioluminescent imaging (n = 91); survival evaluated with Kaplan-Meier curves (n = 111); and tumor cell population studied with flow cytometry (n = 20). In a fourth experiment, we re-challenged tumors in previously treated mice and compared tumor growth with that of naïve mice. RESULTS: Combination therapy provided significant benefits over the other three treatment groups: prolonged survival (P < 0.0001), lower tumor signal (P < 0.0001) and decreased lung signal uptake (P ≤ 0.002). We also observed that mice previously treated with vascular targeted photodynamic therapy only or combination therapy did not present tumor growth after re-challenged tumors. CONCLUSIONS: Combination of vascular targeted photodynamic therapy with anti-cytotoxic T-lymphocyte-associated antigen 4 is an effective therapy in a urothelial carcinoma syngeneic mouse model. The present results suggest this therapy as a potential treatment option for both bladder and upper tract tumors in future clinical trials.


Assuntos
Antígeno CTLA-4/antagonistas & inibidores , Carcinoma de Células de Transição/terapia , Neoplasias Pulmonares/tratamento farmacológico , Fotoquimioterapia/métodos , Neoplasias da Bexiga Urinária/terapia , Animais , Antígeno CTLA-4/imunologia , Carcinoma de Células de Transição/irrigação sanguínea , Carcinoma de Células de Transição/imunologia , Carcinoma de Células de Transição/secundário , Linhagem Celular Tumoral/transplante , Modelos Animais de Doenças , Humanos , Medições Luminescentes , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/efeitos dos fármacos , Pulmão/efeitos da radiação , Neoplasias Pulmonares/irrigação sanguínea , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/secundário , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/efeitos dos fármacos , Bexiga Urinária/imunologia , Bexiga Urinária/efeitos da radiação , Neoplasias da Bexiga Urinária/irrigação sanguínea , Neoplasias da Bexiga Urinária/imunologia , Neoplasias da Bexiga Urinária/patologia
14.
World J Urol ; 37(10): 2175-2182, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30560299

RESUMO

PURPOSE: To evaluate the efficacy and outcome of superselective vesical arterial embolization in the management of severe intractable hematuria secondary to hemorrhagic cystitis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of nine patients with severe intractable hematuria treated with superselective vesical artery embolization at our institution between March 2003 and February 2015. There were six males and three females with a mean age of 56.1 years. Seven patients had transitional cell carcinoma (TCC) of urinary bladder and had undergone transurethral resection of bladder tumor and pelvic radiotherapy. One patient had synchronous renal pelvis and bladder TCC. One patient had aortoarteritis and was receiving cyclophosphamide therapy and another patient had carcinoma cervix post-pelvic radiotherapy. Following the failure of conservative management, superselective vesical artery catheterization and embolization was performed with 300-500-µ PVA particles in all patients. Coil embolization of inferior gluteal artery followed by particle embolization of vesical arteries was done in one patient in whom superior, inferior vesical and inferior gluteal arteries were arising as a trifurcation. RESULTS: The technical success rate was 100% with complete cessation of hematuria within 48 h in all patients. No significant complications were noted, except for post-embolization syndrome in one patient, which improved on symptomatic treatment. During a mean follow-up period of 14.45 months (ranging from 3-28 months), one patient had mild recurrent hematuria (at 2 months) which resolved spontaneously. CONCLUSIONS: Superselective vesical artery embolization is a safe and effective procedure in controlling intractable life-threatening hematuria in a select group of patients who have failed conventional treatment protocols. This procedure may be considered as the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.


Assuntos
Cistite/complicações , Embolização Terapêutica/métodos , Hematúria/etiologia , Hematúria/terapia , Hemorragia/complicações , Artérias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Bexiga Urinária/irrigação sanguínea
15.
Neurourol Urodyn ; 37(8): 2827-2832, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30106191

RESUMO

AIM: The mechanisms leading to the development of detrusor overactivity (DO) are still relatively poorly understood, however, animal studies suggest that atherosclerosis and reduced blood flow to the bladder may be one etiological pathway. Thus, the aim of this study was to evaluate signs of atherosclerosis in a large cohort of women with detrusor overactivity, using two precise measures of atherosclerotic vascular impairment, Ankle Brachial Index (ABI), and Brachial-ankle Pulse Wave Velocity (baPWV). METHODS: A prospective cohort study measuring ABI and baPWV of women with DO and controls was conducted. The ABI and baPWV were measured using an automated oscillometric blood pressure machine, to evaluate the degree of atherosclerosis in patients with DO and controls. Associations between ABI and baPWV and important confounding variables were assessed by a linear regression model. RESULTS: Ninety-eight women with DO, and 98 controls without any symptoms of DO were studied. Multivariate analysis showed an increase in left baPWV of approximately 96 cm/s units of velocity (95%CI 20.65-172.05, P = 0.01) is predicted significantly by the presence or absence of detrusor overactivity (as well by independent factors of age, diastolic blood pressure and body mass index). A similar effect was seen for right baPWV. CONCLUSIONS: On linear regression modeling, the presence of DO was a strong predictor for an increased PWV when controlling for age, BMI and diastolic blood pressure (DBP), thus supporting the hypothesis that atherosclerosis may contribute to the etiology of DO.


Assuntos
Aterosclerose/diagnóstico , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Aterosclerose/complicações , Aterosclerose/fisiopatologia , Índice de Massa Corporal , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Onda de Pulso , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia
16.
J Physiol ; 596(16): 3531-3552, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29873405

RESUMO

KEY POINTS: In the bladder suburothelial microvasculature, pericytes in different microvascular segments develop spontaneous Ca2+ transients with or without associated constrictions. Spontaneous Ca2+ transients in pericytes of all microvascular segments primarily rely on the cycles of Ca2+ uptake and release by the sarco- and endoplasmic reticulum. The synchrony of spontaneous Ca2+ transients in capillary pericytes exclusively relies on the spread of depolarizations resulting from the opening of Ca2+ -activated chloride channels (CaCCs) via gap junctions. CaCC-dependent depolarizations further activate L-type voltage-dependent Ca2+ channels as required for the synchrony of Ca2+ transients in pericytes of pre-capillary arterioles, post-capillary venules and venules. Capillary pericytes may drive spontaneous Ca2+ transients in pericytes within the suburothelial microvascular network by sending CaCC-dependent depolarizations via gap junctions. ABSTRACT: Mural cells in the microvasculature of visceral organs develop spontaneous Ca2+ transients. However, the mechanisms underlying the integration of these Ca2+ transients within a microvascular unit remain to be clarified. In the present study, the origin of spontaneous Ca2+ transients and their propagation in the bladder suburothelial microvasculature were explored. Cal-520 fluorescence Ca2+ imaging and immunohistochemistry were carried out on mural cells using mice expressing red fluorescent protein (DsRed) under control of the NG2 promotor. NG2(+) pericytes in both pre-capillary arterioles (PCAs) and capillaries developed synchronous spontaneous Ca2+ transients. By contrast, although NG2-DsRed also labelled arteriolar smooth muscle cells, these cells remained quiescent. Both NG2(+) pericytes in post-capillary venules (PCVs) and NG2(-) venular pericytes exhibited propagated Ca2+ transients. L-type voltage-dependent Ca2+ channel (LVDCC) blockade with nifedipine prevented Ca2+ transients or disrupted their synchrony in PCA, PCV and venular pericytes without dis-synchronizing Ca2+ transients in capillary pericytes. Blockade of gap junctions with carbenoxolone or Ca2+ -activated chloride channels (CaCCs) with 4,4'-diisothiocyanato-2,2'-stilbenedisulphonic acid disodium salt prevented Ca2+ transients in PCA and venular pericytes and disrupted the synchrony of Ca2+ transients in capillary and PCV pericytes. Spontaneous Ca2+ transients in pericytes of all microvascular segments were abolished or suppressed by cyclopiazonic acid, caffeine or tetracaine. The synchrony of Ca2+ transients in capillary pericytes arising from spontaneous Ca2+ release from the sarco- and endoplasmic reticulum appears to rely exclusively on CaCC activation, whereas subsequent LVDCC activation is required for the synchrony of Ca2+ transients in pericytes of other microvascular segments. Capillary pericytes may drive spontaneous activity in the suburothelial microvascular unit to facilitate capillary perfusion.


Assuntos
Sinalização do Cálcio , Cálcio/metabolismo , Capilares/fisiologia , Canais de Cloreto/metabolismo , Microvasos/fisiologia , Pericitos/fisiologia , Bexiga Urinária/fisiologia , Animais , Feminino , Junções Comunicantes , Masculino , Camundongos , Bexiga Urinária/irrigação sanguínea , Veias/fisiologia
17.
Neurourol Urodyn ; 37(8): 2425-2433, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29777585

RESUMO

AIMS: Chronic ischemia is a recognized factor in the pathophysiology of underactive bladder (UAB). Although relative ischemia (ie, low blood flow) is known to occur during filling, little is known regarding the pathophysiology that leads to UAB. Therefore, we developed an ex vivo functional porcine model to investigate the role of transient ischemia and whether autoregulation, a mechanism that maintains tissue oxygenation in certain vital organs, also exists in the bladder. METHODS: Using bladders from slaughtered pigs, we prepared an isolated perfused model where we studied the effects of bladder perfusion flow rate on perfusion pressure and tissue oxygenation during the filling phase. Bladders were perfused at an initial flow rate of 20 mL/min and then clamped in a sequentially decreasing stepwise manner down to no flow and back to the initial flow rate. RESULTS: We found a linear relationship between flow rate and perfusion pressure until the flow rate decreased below 5 mL/min at which point the vascular resistance decreased; however, tissue pO2 remained stable after an initial decline. CONCLUSIONS: These findings suggest that there may be an intrinsic autoregulatory mechanism in the bladder that allows it to undergo cyclic episodes of relative ischemia during its normal function. Factors that overcome this mechanism such as complete or chronic ischemia may be critical in the progression to detrusor underactivity and thereby highlight the importance of intervention during the early phases of this disease process.


Assuntos
Vasos Sanguíneos/fisiologia , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/fisiologia , Animais , Pressão Sanguínea/fisiologia , Modelos Animais de Doenças , Feminino , Homeostase , Técnicas In Vitro , Isquemia/fisiopatologia , Modelos Biológicos , Consumo de Oxigênio/fisiologia , Perfusão , Pressão , Suínos , Bexiga Inativa/fisiopatologia , Resistência Vascular/fisiologia
18.
J Pediatr Urol ; 14(5): 455-456, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29784454

RESUMO

Stomal prolapse is a known late complication of urinary diversions commonly used in urology. While rare, it can lead to ischemia, necrosis, and obstruction of the stoma, requiring urgent reduction before formal revision can be undertaken. Several measures can be attempted to reduce the prolapse including manual pressure and topical osmotic agents. One method that has not been reported in the urologic literature is the use of hyaluronidase. Herein, we report the first case in the literature of hyaluronidase usage to assist in reduction of an ischemic and obstructed prolapsed incontinent ileovesicostomy after manual compression failed.


Assuntos
Cistostomia , Hialuronoglucosaminidase/uso terapêutico , Ileostomia , Isquemia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Doenças da Bexiga Urinária/prevenção & controle , Bexiga Urinária/irrigação sanguínea , Incontinência Urinária/prevenção & controle , Pré-Escolar , Feminino , Humanos , Prolapso
20.
Urology ; 115: e7-e8, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29548866

RESUMO

Portosystemic collaterals are common sequelae of portal hypertension. These often present as gastroesophageal varices. Ectopic varices can rarely be seen in duodenum, jejunum, rectum, and sites of surgical anastomoses. Bladder varices are extremely rare presenting with recurrent hematuria, with only a few reported cases. We report here a management of an unusual case of hematuria managed with blood transfusion, intravenous terlipressin, and endoscopic N-butyl cyanoacrylate glue injection.


Assuntos
Embolização Terapêutica/métodos , Hematúria/etiologia , Hipertensão Portal/complicações , Bexiga Urinária/irrigação sanguínea , Varizes/etiologia , Varizes/terapia , Anti-Hipertensivos/uso terapêutico , Transfusão de Sangue , Embucrilato/uso terapêutico , Hematúria/terapia , Humanos , Hipertensão Portal/tratamento farmacológico , Cirrose Hepática Alcoólica/complicações , Masculino , Pessoa de Meia-Idade , Terlipressina/uso terapêutico , Adesivos Teciduais/uso terapêutico
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