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1.
Hinyokika Kiyo ; 66(11): 403-406, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33271658

RESUMO

We report a case of squamous cell papilloma of the urinary bladder, which is an extremely rare disease with only 15 cases reported in the Japanese and English literature. The case was in a 76-year-old woman. She was referred to the department of urology because multifocal tumors of the urinary bladder were found by computed tomographic scan during an examination for acute enteritis. Cystoscopy showed a nonpapillary flat tumor with whitish plaque on the left posterior wall, measuring 3 cm. Urinalysis and urine cytology revealed no abnormalities. Transurethral resection was performed. Histology revealed a papillary noninvasive squamous cell tumor with extensive keratinization on its surface. There were no nuclear atypia or evidence of koilocytotic change. Immunohistochemically, the tumor cells were negative for both p16 and p53. Based on the pathological findings, the tumor was diagnosed as squamous cell papilloma. The tumor recurred three month after the operation and she is being followed with no change observed for two and a half years.


Assuntos
Papiloma , Neoplasias da Bexiga Urinária , Idoso , Cistoscopia , Feminino , Humanos , Recidiva Local de Neoplasia
2.
JAMA ; 324(19): 1980-1991, 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33201207

RESUMO

Importance: Bladder cancer is a common malignancy in women and is the fourth most common malignancy in men. Bladder cancer ranges from unaggressive and usually noninvasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality. Observations: Advanced age, male sex, and cigarette smoking contribute to the development of bladder cancer. Bladder tumors can present with gross or microscopic hematuria, which is evaluated with cystoscopy and upper tract imaging depending on the degree of hematuria and risk of malignancy. Non-muscle-invasive tumors are treated with endoscopic resection and adjuvant intravesical therapy, depending on the risk classification. Enhanced cystoscopy includes technology used to improve the detection of tumors and can reduce the risk of recurrence. Patients with high-risk non-muscle invasive tumors that do not respond to adjuvant therapy with the standard-of-care immunotherapy, bacille Calmette-Guérin (BCG), constitute a challenging patient population to manage and many alternative therapies are being studied. For patients with muscle-invasive disease, more aggressive therapy with radical cystectomy and urinary diversion or trimodal therapy with maximal endoscopic resection, radiosensitizing chemotherapy, and radiation is warranted to curb the risk of metastasis and disease-specific mortality. Treatment of patients with advanced disease is undergoing rapid changes as immunotherapy with checkpoint inhibitors, targeted therapies, and antibody-drug conjugates have become options for certain patients with various stages of disease. Conclusions and Relevance: Improved understanding of the molecular biology and genetics of bladder cancer has evolved the way localized and advanced disease is diagnosed and treated. While intravesical BCG has remained the mainstay of therapy for intermediate and high-risk non-muscle-invasive bladder cancer, the therapeutic options for muscle-invasive and advanced disease has expanded to include immunotherapy with checkpoint inhibition, targeted therapies, and antibody-drug conjugates.


Assuntos
Antineoplásicos/uso terapêutico , Vacina BCG/uso terapêutico , Cistectomia , Imunoterapia , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Terapia Combinada , Cistectomia/efeitos adversos , Cistectomia/métodos , Cistoscopia , Feminino , Humanos , Masculino , Mutação , Invasividade Neoplásica , Fatores de Risco , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/patologia
3.
Medicine (Baltimore) ; 99(42): e22135, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080671

RESUMO

PURPOSE: We present a new approach for urine drainage in pediatric patients following laparoscopic pyeloplasty, the trans-uretero-cystic external urethral stent (TEUS). METHODS: We retrospectively identified 85 children who underwent laparoscopic pyeloplasty from July 2015 to June 2017. The included children were assigned to group A (double-J stent) or group B (TEUS). In group A, the double-J stent was removed by a cystoscopy under anesthesia after 1 month, while in group B, the external stent was removed after 5 to 7 days. We examined the durations of operation, hospital stay and the frequency of stent-related complications including urinary leakage, stent dislocation, stent occlusion, and urinary tract infection. RESULTS: The operation time was significantly longer for patients in group B than for those in group A. No significant difference was observed between the groups regarding stent-related complications. In group A, 4 patients need auxiliary stent re-insertion for the management of complications, 2 developed urinary tract infection, and 2 had stent occlusion. In group B, none needed auxiliary stent re-insertion for complications and avoided re-operation. CONCLUSIONS: In children, the outcome of external stent implantation was similar to that using double-J stent, and the use of the former approach may be beneficial for younger children.


Assuntos
Laparoscopia/métodos , Stents , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Criança , Pré-Escolar , Cistoscopia , Remoção de Dispositivo , Feminino , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Derivação Urinária/métodos
4.
Arch Esp Urol ; 73(7): 624-633, 2020 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32886077

RESUMO

OBJECTIVES: The utility and importance of the 3-day Bladder Diary (3dBD) for the diagnosis and management of patients with Bladder Pain Syndrome (BPS) was analyzed. MATERIAL AND METHODS: Epidemiological, observational, longitudinal and multicentric study, carried out under usual conditions of clinical practice. 37 Functional Urology and Urodynamics units included 329 women with BPS according to the criteria of the International Society for the Study of Bladder Pain Syndrome (ESSIC). Of all patients included, 319 were evaluable (79 with new diagnosis and 240 in follow-up). Sociodemographic and clinical variables were collected together with variables related to cystoscopy, biopsy and physical examination and BPS diagnostic tests. Patients completed the "Bladder Pain/Interstitial Cystitis - Symptom Score"(BPIC-SS), "Patient Global Impression of Severity" (PGI-S) and "EuroQoL-5D-5L" (EQ-5D-5L) questionnaires besides of the 3dBD. Results of the 3dBD were described according to urinary symptoms and the symptoms reported through questionnaires, in addition their association was studied. RESULTS: In anamnesis, 74.9% of patients reported increased Urinary Frequency (UF), 59.6% urgency and72.7% nocturia compared to 88.7%, 55.9% and 73.6% as reflected in the 3dBD. The highest correlation indexes (CI) were obtained between BPIC-SS and UF/24h (0.45) and between UF/24 h and PGI-S (-0.36) and EQ-5D-5L (-0.33). Mean voiding volume was higher in patients with better BPIC-SS score (163.72 (SD 68.02ml) y 154.1 (SD 70.63 ml)), at 6 and 12 months. CONCLUSIONS: 3dBD has proven to be a useful and complementary tool to the anamnesis in the evaluation of the repercussion of pain in the micturition pattern and for the differential diagnosis of the symptoms of BPS patients. It also allows to obtain complete and objective information about the symptoms. Although it is necessary to incorporate other tools that complete the clinical characterization of these patients.


Assuntos
Cistite Intersticial , Cistoscopia , Feminino , Humanos , Dor Pélvica , Urodinâmica
5.
Urologiia ; (4): 50-54, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897014

RESUMO

INTRODUCTION: Cystoscopy is one of the most common procedures in urology. There is no single approach to pain relief. In the literature, there are conflicting data on the efficiency of intra-urethral gels. The use of non-steroidal anti-inflammatory drugs, intravenous sedation, and nitric oxide analgesia has been described. Phenazopyridine has been known for a long time. Acting on the bladder mucosa, it has a local analgesic effect. AN evaluation of phenazopyridine intake prior to cystoscopy in order to decrease pain during procedure and facilitate subsequent urination was performed. MATERIALS AND METHODS: A total of 97 patients were included in the study. Indications for cystoscopy were as following: hematuria, lower urinary tract symptoms/pain, a need to remove ureteral stent. The patients were randomized into two groups. In the main group (n=50), phenazopyridine 200 mg was administered 20 minutes before cystoscopy and then at a dose of 200 mg every 8 hours (in total three doses) in combination with lidocaine gel. In the control group (n=47), only lidocaine gel was used. Heart rate was measured before and after the procedure. All patients were asked to complete a visual analogue scale (VAS) 3, 8 and 24 hours after cystoscopy with the assessment of the first urination. RESULTS: After cystoscopy, the difference between groups in VAS score was 27.7% in favor of the main group (p<0.001). After 3 hours, the average score in the main group was two times less than in the Control (p=0.012), while 3 and 8 hours after cystoscopy, the proportion of "zero" results was 10% and 0%, 28% and 4%, respectively, p<0.005. The heart rate after the procedure in the main group was 75.1 beats/min, compared to 77.9 beats/min in the control group (p=0.016). CONCLUSION: The intake of phenazopyridine allows to reduce pain intensity during and after cystoscopy and alleviate pain during first urination.


Assuntos
Cistoscopia/efeitos adversos , Fenazopiridina , Ureter , Humanos , Dor , Fenazopiridina/uso terapêutico
7.
PLoS One ; 15(8): e0237070, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822394

RESUMO

Bladder cancer (BCA) is relatively common and potentially recurrent/progressive disease. It is also costly to detect, treat, and control. Definitive diagnosis is made by examination of urine sediment, imaging, direct visualization (cystoscopy), and invasive biopsy of suspect bladder lesions. There are currently no widely-used BCA-specific biomarker urine screening tests for early BCA or for following patients during/after therapy. Urine metabolomic screening for biomarkers is costly and generally unavailable for clinical use. In response, we developed Raman spectroscopy-based chemometric urinalysis (Rametrix™) as a direct liquid urine screening method for detecting complex molecular signatures in urine associated with BCA and other genitourinary tract pathologies. In particular, the RametrixTM screen used principal components (PCs) of urine Raman spectra to build discriminant analysis models that indicate the presence/absence of disease. The number of PCs included was varied, and all models were cross-validated by leave-one-out analysis. In Study 1 reported here, we tested the Rametrix™ screen using urine specimens from 56 consented patients from a urology clinic. This proof-of-concept study contained 17 urine specimens with active BCA (BCA-positive), 32 urine specimens from patients with other genitourinary tract pathologies, seven specimens from healthy patients, and the urinalysis control SurineTM. Using a model built with 22 PCs, BCA was detected with 80.4% accuracy, 82.4% sensitivity, 79.5% specificity, 63.6% positive predictive value (PPV), and 91.2% negative predictive value (NPV). Based on the number of PCs included, we found the RametrixTM screen could be fine-tuned for either high sensitivity or specificity. In other studies reported here, RametrixTM was also able to differentiate between urine specimens from patients with BCA and other genitourinary pathologies and those obtained from patients with end-stage kidney disease (ESKD). While larger studies are needed to improve RametrixTM models and demonstrate clinical relevance, this study demonstrates the ability of the RametrixTM screen to differentiate urine of BCA-positive patients. Molecular signature variances in the urine metabolome of BCA patients included changes in: phosphatidylinositol, nucleic acids, protein (particularly collagen), aromatic amino acids, and carotenoids.


Assuntos
Detecção Precoce de Câncer/métodos , Análise Espectral Raman/métodos , Neoplasias da Bexiga Urinária/diagnóstico , Adulto , Idoso , Biomarcadores Tumorais/urina , Cistoscopia , Análise Discriminante , Feminino , Humanos , Masculino , Metaboloma , Metabolômica , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Urinálise/métodos , Neoplasias da Bexiga Urinária/patologia
8.
Sci Rep ; 10(1): 13495, 2020 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778771

RESUMO

Flexible cystoscopy under local anaesthesia is standard for the surveillance of bladder cancer. Frequently, several reusable cystoscopes fail to reprocess. With the new grasper incorporated single-use cystoscope for retrieval of ureteric stents, we explored the feasibility of using it off-label for diagnosis and the detection of bladder cancer. Consecutive diagnostic flexible cystoscopies between Mar 2016 and Nov 2018 were reviewed comparing the reusable versus the disposable cystoscopes. A total of 390 patients underwent 1211 cystoscopies. Median age was 61.5 years (SD 14.2, 18.8-91.4), males 331 (84.9%) and females 59 (15.1%). Indication for cystoscopy was prior malignancy in 1183 procedures (97.7%), haematuria 19 (1.6%) or bladder mass 7 (0.6%). There were 608 reusable and 603 disposable cystoscopies. There was no significant difference between groups at baseline in age, sex, BMI, smoking status, or prior tumor risk category. There was no significant difference in positive findings (123/608, 20.2% vs 111/603, 18.4%, p = 0.425) or cancer detection rates (95/608, 15.6% vs 88/603, 14.4%, p 0.574) among the two groups, respectively. We conclude that the disposable grasper integrated cystoscope is comparable to reusable cystoscope in the detection of bladder cancer.


Assuntos
Cistoscópios/tendências , Cistoscopia/métodos , Neoplasias da Bexiga Urinária/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistoscopia/instrumentação , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 697-700, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773804

RESUMO

OBJECTIVE: To investigate the effect of NBI assisted white light transurethral resection of bladder tumor (TURBT) in the treatment of bladder urothelial carcinoma and to summarize the experience of narrow band imaging (NBI) operation. METHODS: Patients with bladder urothelial carcinoma were selected, and TURBT was performed after anesthesia. First of all, the bladder tumor was found and resected under white light. Then we replaced with NBI, looked for suspicious lesions and resected them, The specimens excised under white light and NBI were collected separately. The number, location and pathological results of the lesions under white light were recorded, and the residual lesions under NBI were also recorded. To evaluate the effect of NBI, the ratio of residual bladder tumor was calculated. The cases were divided into three groups according to the time sequence. The clinical data of each group were collected and the learning curve of TURBT under NBI assisted white light was observed. RESULTS: A prospective study of 45 patients with bladder tumor from April 2018 to January 2020, including 32 males and 13 females, aged from 23 to 89 years, with an average age of 65.2 years. All the operations were successfully completed, without obvious complications after operation. Nine cases were single and 36 cases were multiple. The maximum diameter of the tumors was 0.5 to 4.0 cm, with an average of 2.2 cm. The histopathology of the resected tissue under white light was urothelial carcinoma, and 19 cases (42.2%) were pathologically positive by NBI resection. The 45 cases were divided into three groups according to the time sequence, 15 cases in each group. The true positive rate of NBI was 33.3%, 46.7% and 46.7%, respectively, and the false positive rate was 60.0%, 46.7% and 26.7%, respectively in the three groups. CONCLUSION: TURBT is an effective way to treat bladder urothelial cancer, NBI is an effective supplement of white light, which can increase the detection rate of bladder cancer and reduce post-operative recurrence. The NBI light source has a certain learning curve. With the increase of cases, the false-positive rate of NBI is gradually reduced. After the NBI operator has rich experience, the recognition degree of flat tumor is gradually improved under white light, and the residual rate of NBI is reduced after the removal under white light.


Assuntos
Autocontrole , Neoplasias da Bexiga Urinária , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Banda Estreita , Recidiva Local de Neoplasia , Estudos Prospectivos , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/cirurgia , Adulto Jovem
10.
Medicine (Baltimore) ; 99(28): e20825, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664075

RESUMO

INTRODUCTION: Primary bladder mucosa-associated lymphoid tissue (MALT) lymphoma is a rare tumor. To date, the PubMed database contains only 39 English articles covering 63 cases of primary bladder MALT lymphoma. Herein, we report a case of this disease and review the current literature. PATIENT CONCERNS: A 77-year-old woman presented with frequent urination, urinary urgency, and dysuria for 3 years. In the past 3 years, the patient's symptoms recurred and progressively worsened, and she was admitted to the hospital. DIAGNOSIS: A histopathological examination revealed the bladder mass as a tumor with high proliferation of atypical B-lymphocytes. Immunohistochemistry showed positive results for CD20, PAX-5, Ki-67, BCL-2, and CD21 and negative results for CD10, MUM1, TDT, and cyclin D1. These data supported the diagnosis of primary bladder MALT lymphoma. INTERVENTIONS: A transurethral resection of bladder tumor was performed to treat the disease. OUTCOMES: The patient was alive and healthy at the 15-month follow-up. CONCLUSION: Primary bladder MALT lymphoma is a rare disease and can be easily missed or misdiagnosed before achieving a histological confirmation. Surgery may be the best choice for both diagnosis and treatment.


Assuntos
Linfoma de Zona Marginal Tipo Células B/patologia , Neoplasias da Bexiga Urinária/patologia , Transtornos Urinários/etiologia , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Linfócitos B/patologia , Cistoscopia/métodos , Feminino , Humanos , Imuno-Histoquímica/métodos , Linfoma de Zona Marginal Tipo Células B/metabolismo , Linfoma de Zona Marginal Tipo Células B/cirurgia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/cirurgia , Transtornos Urinários/fisiopatologia , Adulto Jovem
11.
Medicine (Baltimore) ; 99(28): e21204, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664169

RESUMO

INTRODUCTION: Abundant myxoid stroma rarely occurs in urothelial carcinomas (UCs). We report an 83-year-old woman with UC of the urinary bladder with abundant myxoid stroma. We summarized the clinicopathological features, immunophenotype, diagnosis, and differential diagnosis of this type of bladder cancer, in order to improve the understanding of surgeons and pathologists. PATIENT CONCERNS: An 83-year-old female presented with hematuria and frequent micturition, without odynuria, hypogastralgia, or fever. DIAGNOSIS: The computed tomography scan demonstrated extensive tumors in the anterior wall of the bladder and a soft tissue shadow anterior to the sacrum. Cystoscopy showed massive wide-based tumors located on the anterior and lateral walls of the bladder, with no tumor involving the bladder neck. Multiple punch biopsies were performed, the histologic evaluation of which revealed a poorly differentiated invasive UCs with myxoid stroma. INTERVENTIONS: The patient underwent a laparoscopic radical cystectomy and cutaneous ureterostomy. OUTCOMES: The patient discharged without any complications. Histologic evaluation revealed an invasive UC; the most prominent feature was an abundant myxoid stroma that covered approximately 80% of the lesion and the tumor cells were arranged in cords, small nests, or a sheet-like structure. Immunohistochemically, the tumor cells were positive for CK19, CK20, VEGF, EGFR, p63, 34ßE12, MUC1, GATA3, uroplakin3, and TopII (rate = 15%), while the Ki-67 proliferation index was 10%. The myxoid stroma in the mesenchyme stained positively with AB-PAS and colloidal iron, and some tumor cells stained positive for colloidal iron. Considering the histologic, histochemical, and immunohistochemical findings, a diagnosis of UC with abundant myxoid stroma was made. After surgery, the regular follow-up was continued in clinic, and there was no recurrence for 2 years. CONCLUSION: Morbidity associated with UC with abundant myxoid stroma is very low. The diagnosis mainly depends on histopathological and immunohistochemical findings.


Assuntos
Carcinoma de Células de Transição/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias Urológicas/diagnóstico , Idoso de 80 Anos ou mais , Biópsia , Cistectomia , Cistoscopia , Diagnóstico Diferencial , Feminino , Humanos , Imunofenotipagem , Bexiga Urinária/patologia , Urotélio/patologia
12.
J Urol ; 204(6): 1270-1274, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32718203

RESUMO

PURPOSE: Our primary objective was to determine the incidence of extravasation on imaging at the time of catheter removal after ventral onlay buccal mucosal graft urethroplasty. MATERIALS AND METHODS: This is a single center retrospective cohort study of patients who underwent ventral onlay buccal mucosal graft bulbar urethroplasty from 2007 to 2017. Patients with imaging at the time of catheter removal were included. Urethroplasty success was defined as the ability to pass a 17Fr cystoscope at the time of followup cystoscopy. RESULTS: A total of 229 patients met the inclusion criteria, including 110 with a ventral onlay buccal mucosal graft and 119 with an augmented anastomotic urethroplasty with a mean stricture length of 4.4 cm. Imaging consisted of a voiding cystourethrogram in 210 and retrograde urethrogram in 19 patients at a median of 21.7 days after surgery. The incidence of extravasation was 3.1% (7/229). Of patients who had a documented followup cystoscopy (60%, 137/229), those with extravasation on imaging had a worse urethroplasty success rate (60%, 3/5) compared to those who did not (94%, 117/130) (p=0.047). On multivariate analysis those who had 5 or more endoscopic interventions were 9.6 times more likely to demonstrate extravasation (OR 9.6, p=0.0080). CONCLUSIONS: The incidence of radiological extravasation after ventral onlay using a single buccal mucosal graft, with or without augmented anastomotic urethroplasty, is 3.1%. Given this low rate it is reasonable to omit routine imaging at the time of Foley removal in this population. It appears that extravasation may be associated with a worse cystoscopic patency rate but does not lead to more complications.


Assuntos
Cistoscopia/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Cuidados Pós-Operatórios/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adulto , Cistoscopia/estatística & dados numéricos , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/transplante , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/cirurgia , Estreitamento Uretral/patologia , Cateterismo Urinário/instrumentação , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação
15.
J Urol ; 204(4): 817, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32703055
16.
BJU Int ; 126 Suppl 1: 18-26, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32558340

RESUMO

OBJECTIVE: To examine national trends in the medical and surgical treatment of benign prostatic hyperplasia (BPH) using Australian Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) population data from 2000 to 2018. PATIENTS AND METHODS: Annual data was extracted from the MBS, PBS and Australian Institute of Health and Welfare databases for the years 2000-2018. Population-adjusted rates of BPH procedures and medical therapies were calculated and compared in relation to age. Cost analysis was performed to estimate financial burden due to BPH. RESULTS: Overall national hospital admissions due to BPH declined between 2000 and 2018, despite an increased proportion of admissions due to private procedures (42% vs 77%). Longitudinal trends in the medical management of BPH showed an increased prescription rate of dutasteride/tamsulosin combined therapy (111 vs 7649 per 100 000 men) and dutasteride monotherapy (149 vs 336 per 100 000 men) since their introduction to the PBS in 2011. Trends in BPH surgery showed an overall progressive increase in rate of total procedures between 2000 and 2018 (92 vs 133 per 100 000 men). Transurethral resection of the prostate (TURP) remained the most commonly performed surgical procedure, despite reduced utilisation since 2009 (118 vs 89 per 100 000 men), offset by a higher uptake of photoselective vaporisation of prostate, holmium:YAG laser enucleation of prostate, and later likely due to minimally invasive surgical therapies including prostatic urethral lift and ablative technologies (including Rezum™). Financial burden due to BPH surgery has remained steady since 2009, whilst the burden due to medical therapy has risen sharply. CONCLUSION: Despite reduced national BPH-related hospitalisations, overall treatment for BPH has increased due to medical therapy and surgical alternatives to TURP. Further exploration into motivators for particular therapies and effect of medical therapy on BPH progression in clinical practice outside of clinical trials is warranted.


Assuntos
Hiperplasia Prostática/terapia , Fatores Etários , Idoso , Austrália , Cistoscopia/estatística & dados numéricos , Quimioterapia Combinada , Dutasterida/uso terapêutico , Custos de Cuidados de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Lasers de Estado Sólido/uso terapêutico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Utilização de Procedimentos e Técnicas , Prostatectomia/estatística & dados numéricos , Hiperplasia Prostática/cirurgia , Ablação por Radiofrequência/estatística & dados numéricos , Tansulosina/uso terapêutico , Ressecção Transuretral da Próstata/estatística & dados numéricos , Agentes Urológicos/uso terapêutico
17.
Clin Imaging ; 67: 37-48, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32516692

RESUMO

Urethral strictures are a relatively common affliction of men with the anterior urethra being most frequently affected. Anterior urethral strictures (AUS) typically present with obstructive voiding symptoms and appropriate management is often based on findings at cystourethroscopy and retrograde urethrography (RUG). In particular, determining the number, length, severity and location of urethral strictures is of pivotal importance. The accurate reporting of findings at RUG is dependent on a thorough knowledge of the urethral anatomy as well as recognizing periurethral structures that may opacify during the procedure. Obtaining a diagnostic, high-quality RUG study requires adherence to proper fluoroscopic technique as well as recognizing when to adjust or modify the technique to address pitfalls that may be encountered during the procedure. AUS may be treated by a variety of procedures including urinary diversion, transurethral procedures such as urethral dilation and internal urethrotomy and open surgical repair techniques termed urethroplasty. Some authors have recommended urethroplasty as first-line treatment given the high rate of stricture recurrence with other treatment options. Buccal mucosal grafts are a mainstay of modern urethroplasty. Familiarity with the commonly performed urethroplasty procedures allows radiologists to accurately assess the post-operative urethra thus guiding the management of these patients.


Assuntos
Estreitamento Uretral/diagnóstico por imagem , Adulto , Constrição Patológica , Cistografia , Cistoscopia , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Radiologistas , Recidiva , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/cirurgia , Estreitamento Uretral/cirurgia
18.
Urologiia ; (3): 39-45, 2020 Jun.
Artigo em Russo | MEDLINE | ID: mdl-32597584

RESUMO

AIM: To assess the effectiveness of hydroxyethyldimethyldihydropyrimidine (trade name Xymedone) in the treatment of chronic recurrent cystitis in women. MATERIALS AND METHODS: The study included 30 patients (the main group) with a confirmed diagnosis of chronic cystitis (HC) with a recurrence rate of at least 3 times a year, the average age of the patients was 46.0+/-2.7 years. The control group consisted of 30 age-comparable patients with a similar diagnosis, who underwent standard treatment for this disease. The article presents the results on the effectiveness of the use of hydroxyethyldimethyldihydropyrimidine (Xymedone) in the treatment of HC after anti-inflammatory and local treatment with collargol instillations, and the terms for the regeneration of the bladder mucosa are determined. To patients of the main group Xymedone was prescribed in a dose of 500 mg 3 times a day for 30 days after the completion of local treatment. Control cystoscopy was performed 15 and 30 days after the start of the drug, 3 days after its withdrawal. RESULTS: The planned treatment was completed by all 30 patients of the main group. After 15 days from the date of administration of Xymedone most of patients had no low urinary tract symptoms (LUTS), in comparison with the control group. Cystoscopy performed at this time allowed to establish a positive trend while taking Xymedone in the process of restoring the bladder mucosa after influence of collargol. Hyperemia in the neck and triangle area persisted in most patients, and only in 8 (26.6%) it decreased. Treatment with Xymedone was continued. After 30 days of drug intake laboratory parameters were according to normal values, a significant increase in functional capacity of the bladder (189,5+/-19,8 ml) and volume of urination (147,9+/-26,7 ml.) was detected, the thickness of the bladder wall in a state of filling in the averages was 3.5+/- 0.3 mm, which corresponded to the norm. Cystoscopy, performed 3 days after canceling of the drug, showed a slight hyperemia in the bladder neck area only in one patient. Recurrence of HC in the control group occurred within 6 months after completion of treatment in 15 (51%) women. In the main group there were no relapses during two years of dynamic follow-up. CONCLUSIONS: Hydroxyethyldimethyldihydropyrimidine, included in the therapy of HC, accelerates the regeneration of the bladder mucosa after local treatment of recurrent cystitis and shortens the period of its recovery, significantly lengthens the period of persistent remission.


Assuntos
Cistite/tratamento farmacológico , Adulto , Anti-Inflamatórios/uso terapêutico , Cistoscopia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva
19.
Urologiia ; (3): 137-138, 2020 Jun.
Artigo em Russo | MEDLINE | ID: mdl-32597601

RESUMO

The main dates of life and scientific and practical activity of Leopold Kasper are presented. The scientific views and thoughts of the scientist are analyzed. It is shown that after graduating in 1883 from the University of Berlin he specialized in urology under supervision of G. Thompson, P. Freyer, F. Guyon, I. Albarran and L. Dittel. L. Kasper was the founder of a large German urological school, the author of a large number of scientific works, including study dedicated to cystoscopy, endoscopic procedures, functional diagnosis of renal disorders, treatment of renal tuberculosis and urolithiasis, prostate diseases, transurethral galvanocaustics of bladder tumors, etc. He designed a special catheterization cystoscope (1895), which allowed for the first time to study differential functional ability of each kidney. It greatly facilitated the recognition and treatment of surgical pathologies of kidneys and upper urinary tract. In addition, L. Kasper improved and implemented into practice a functional renal test with fluoridzine and cryoscopic examination of urine obtained from each kidney separately after ureteral catheterization.


Assuntos
Urologistas , Urologia , Aniversários e Eventos Especiais , Cistoscopia , História do Século XX , Humanos , Masculino , Cateterismo Urinário
20.
Ann R Coll Surg Engl ; 102(8): e196-e197, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32436735

RESUMO

Bladder cancer is a rare disease in childhood; however, it is one of great clinical significance. Investigation and management follow a tailored approach, which is largely driven by clinical practice patterns in adult patients with the disease. We present the case of bladder cancer in a boy who presented to the primary care practitioner with visible haematuria. This case highlights the need for clinicians to consider malignancy as a possible cause for haematuria when assessing and investigating children with this presenting complaint.


Assuntos
Hematúria , Neoplasias da Bexiga Urinária , Adolescente , Cistoscopia , Hematúria/diagnóstico , Hematúria/etiologia , Hematúria/cirurgia , Humanos , Masculino , Atenção Primária à Saúde , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/cirurgia
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