Perivascular epithelioid cell tumors(PEComas)are a diverse group of mesenchymal neoplasms.While they have been described throughout the genitourinary system,PEComas are quite rare within the bladder.We present the cas...Perivascular epithelioid cell tumors(PEComas)are a diverse group of mesenchymal neoplasms.While they have been described throughout the genitourinary system,PEComas are quite rare within the bladder.We present the case of a 37-year-old male who presented in clot retention and was found to have a bladder PEComa.Staging images seemingly demonstrated solid tumor confinement to the bladder and pelvis.Intraoperative pathology revealed peritoneal metastasis.The patient underwent a pelvic mass excision and partial cystectomy.The patient had plans for adjuvant chemotherapy,but later returned to the hospital and passed away from acute hypoxic respiratory failure.展开更多
Robot-assisted radical cystectomy with intracorporeal urinary diversion(RARCICUD)has only recently been explored as a viable surgical option for patients with muscle-invasive bladder cancer seeking satisfactory oncolo...Robot-assisted radical cystectomy with intracorporeal urinary diversion(RARCICUD)has only recently been explored as a viable surgical option for patients with muscle-invasive bladder cancer seeking satisfactory oncologic control while benefiting from minimally invasive surgical techniques.Inspired by earlier open and laparoscopic work,initial descriptions of RARC-ICUD were published in 2003,and have since been followed by multiple larger case series which have suggested promising outcomes for our patients.However,the rate of adoption has remained relatively slow when compared to other robotassisted procedures such as the radical prostatectomy,likely owing to longer operative times,operative complexity,costs,and uncertainty regarding oncologic efficacy.The operative technique for RARC-ICUD has evolved over the past decade and several high-volume centers have shared tips to improve efficiency and make the operation possible for a growing number of urologists.Though there are still questions regarding economic costs,effectiveness,and generalizability of outcomes reported in published data,a growing dataset has brought us ever closer to the answers.Here,we present our current operative technique for RARC-ICUD and discuss the state of the literature so that the urologist may hold an informed discussion with his or her patients.展开更多
The aim of this study was to determine the impact that age and comorbidity status have on both overall and bladder cancer-specific survival of bladder cancer patients. We obtained medical information pertaining to a p...The aim of this study was to determine the impact that age and comorbidity status have on both overall and bladder cancer-specific survival of bladder cancer patients. We obtained medical information pertaining to a population of 528 patients with newly diagnosed bladder cancer from Chung-Ang University Hospital cancer registry. The Adult Comorbidity Evaluation-27 （ACE-27） test, which has been previously validated in adult cancer patients, was used to assess comorbidity. We evaluated differences in the demographic and clinical characteristics of included patients, as well as differences in the treatments they received after categorizing them by age. The median age at the time of bladder cancer diagnosis of the entire cohort was 63 years, and the median follow-up time was 97 months. Of the 528 patients who were included in our study, 303 had at least one comorbid condition and 249 died during the follow-up period. When patients were stratified by age, we found that older patients had a higher proportion of severe comorbidities （P 〈 0.01） than younger patients, and that a lower proportion of them underwent radical cystec- tomy for invasive bladder cancer （IBC） （P 〈 0.01）. By multivariate analysis, we found that older age was predictive of lower overall survival （OS） and bladder cancer-specific survival （BCSS） rates among patients with superficial bladder cancer （SBC） and of lower OS rates among patients with IBC. We also found that moderate-severe comorbidity status and treatment through a bladder-conserving approach were predictive of lower OS and cancer-specific survival rates among patients with IBC. The disparity between overall deaths and bladder cancer deaths was shown in SBC and increased along with age and higher comorbidity. Age and comorbidity were found to be independent predictive factors of OS and BCSS among bladder cancer patients, and explained the disparity that we observed between overall bladder cancer-specific mortality rates.展开更多
In a total of 83 UN specimens were investigated for proto-oncogene mutations, tumor supressor genes promoter methylation status and c-myc and Ki-67 expression. Point mutations in c-myc were detected in cases with high...In a total of 83 UN specimens were investigated for proto-oncogene mutations, tumor supressor genes promoter methylation status and c-myc and Ki-67 expression. Point mutations in c-myc were detected in cases with high grade and proliferation index. Mutated K-ras proto-onco- gene profiles were detected in 17 (21%) tumoral spiecemens that examined. Tumor specimens were also showed hypermethylated promoter domain for the SFRP2, MGMT tumor supressor genes. These findings showed the combine effect of mutated c-myc and K-ras oncogene and epigenetic inactivation of tissue specific tumor supressor genes (TS) play a crucial role in tumor progression and recurrence in UN carcinogenesis.展开更多
Introduction:Non–muscle-invasive bladder cancer(NMIBC)is a common malignancy worldwide.While Bacillus Calmette-Guérin(BCG)is standard of care for treatment for most patients with high-risk NMIBC,many will either...Introduction:Non–muscle-invasive bladder cancer(NMIBC)is a common malignancy worldwide.While Bacillus Calmette-Guérin(BCG)is standard of care for treatment for most patients with high-risk NMIBC,many will either not respond to BCG initially or will eventually develop BCG-unresponsive disease.A treatment option in BCG-unresponsive disease is nadofaragene firadenovec-vncg(Adstiladrin),a nonreplicating adenoviral vector–based gene therapy approved by the US Food and Drug Administration(FDA)for the treatment of adults with high-risk BCGunresponsive NMIBC with carcinoma in situ with or without papillary tumors.Objective:To review safety outcomes of participants who received the FDA-approved dose of nadofaragene firadenovec(3×10^(11)vp/mL)across phase 2(NCT01687244)and phase 3(NCT02773849)studies.Methods:Data from the phase 2 and phase 3 studies were collected and analyzed.The findings were reported using descriptive statistics to summarize the key outcomes observed across studies.Results:Common adverse events(AEs)among nadofaragene firadenovec recipients were leakage of fluid around the urinary catheter,fatigue,bladder spasm,chills,dysuria,and micturition urgency.Most study drug–related AEs were mild and localized,with no grade 4 or 5 study drug–related AEs observed in either study.Study drug–related AEs were generally transient,with most study drug–related AEs having a median duration of≤2.0 days in the phase 3 study.Discontinuation rates due to study drug–related AEs were low,with none(0%)in the phase 2 study and three(1.9%)in the phase 3 study.No specific postmarketing surveillance was required by the FDA besides routine pharmacovigilance monitoring;no new real-world safety signals have been observed.Conclusion:Nadofaragene firadenovec demonstrated a favorable and tolerable safety profile across its clinical study program,allowing for broad patient selection among those with high-risk BCG-unresponsive NMIBC.展开更多
Periodontitis has been proposed as a novel risk factor of genitourinary cancers:although periodontitis and genitourinary cancers are two totally distinct types of disorders,epidemiological and clinical studies,have es...Periodontitis has been proposed as a novel risk factor of genitourinary cancers:although periodontitis and genitourinary cancers are two totally distinct types of disorders,epidemiological and clinical studies,have established associations between them.Dysbiosis of oral microbiota has already been established as a major factor contributing to periodontitis.Recent emerging epidemiological evidence and the detection of oral microbiota in genitourinary organs indicate the presence of an oral-genitourinary axis and oral microbiota may be involved in the pathogenesis of genitourinary cancers.Therefore,oral microbiota provides the bridge between periodontitis and genitourinary cancers.We have carried out this narrative review which summarizes epidemiological studies exploring the association between periodontitis and genitourinary cancers.We have also highlighted the current evidence demonstrating the capacity of oral microbiota to regulate almost all hallmarks of cancer,and proposed the potential mechanisms of oral microbiota in the development of genitourinary cancers.展开更多
Hematuria due to locally advanced or metastatic bladder cancer is a common condition and is often a management problem.Percutaneous embolisation is a mini-invasive option to handle this situation.We report a case of a...Hematuria due to locally advanced or metastatic bladder cancer is a common condition and is often a management problem.Percutaneous embolisation is a mini-invasive option to handle this situation.We report a case of a patient with a metastatic bladder cancer and who presented with an abundant hematuria and severe anemia.After failure of endoscopic resections and“flush”of radiotherapy haemostatic and refusal of cystectomy by the patient,he was treated by superselective embolisation of bilateral superior bladder arteries with excellent immediate results.The technique is safe and effective in the short term.The longterm effectiveness requires further investigation.展开更多
BACKGROUND Neuroblastoma is an extracranial malignant tumor in children that is most often located in the adrenal gland and sympathetic ganglion.Here,we present a rare case of neuroblastoma originating from the urinar...BACKGROUND Neuroblastoma is an extracranial malignant tumor in children that is most often located in the adrenal gland and sympathetic ganglion.Here,we present a rare case of neuroblastoma originating from the urinary bladder.CASE SUMMARY A 3-year-old girl presented with lower abdominal pain with micturition.Ultrasound revealed a lower abdominal mass.Abdominal computed tomography scan displayed a solitary mass at the top of the urinary bladder.Blood levels of neuron-specific enolase and lactate dehydrogenase were elevated.We treated the child with partial cystectomy and six courses of chemotherapy,and the outcome at 4-year follow-up was unremarkable.CONCLUSION Neuroblastoma should be considered when tumors are located in the urinary bladder,especially in the dome;although this presentation is rare,the prognosis is very good.展开更多
Objective: The role of ureteroscopy in the diagnosis of upper tract urothelial carcinoma is yet to be fully determined. We aimed to provide an up to date evaluation of its role and the emerging technologies in the fie...Objective: The role of ureteroscopy in the diagnosis of upper tract urothelial carcinoma is yet to be fully determined. We aimed to provide an up to date evaluation of its role and the emerging technologies in the field.Methods: A literature search of the last two decades (from 24th May, 2001 to 24th May, 2021) was carried out identifying 147 papers for potential inclusion within this narrative review.Results: Diagnostic ureteroscopy is undeniably useful in its ability to visualise and biopsy indeterminate lesions, and to risk stratify malignant lesions that may be suitable for kidney sparing surgery. However, an increased risk of intravesical recurrence following nephroureterectomy when a prior diagnostic ureteroscopy has been performed, inadequate sampling at biopsy, complications from the procedure, and difficult ureteric access are all potential drawbacks. Furthermore, whilst generally an accurate diagnostic procedure, it risks missing carcinoma in-situ lesions. Despite this, evidence shows that routine use of ureteroscopy changes the management of patients in a large proportion of cases, preventing unnecessary surgery or facilitating kidney sparing surgery. The overall rate of complications is low, and improved biopsy techniques and the use of tissue biomarkers for improved staging and grading are encouraging. The risks of delays to definitive management and post-ureteroscopy intravesical recurrence do not seem to affect survival, and trials are in progress to determine whether intravesical therapy can mitigate the latter. Further promising techniques are being investigated to improve shortcomings, particularly in relation to improved diagnosis of carcinoma in situ and preoperative staging.Conclusion: Ureteroscopy has a role in the diagnosis of upper tract malignancy, though whether it should be used routinely is yet to be determined.展开更多
BACKGROUND Plasmacytoma is a rare neoplastic disorder that arises from B-lymphocytes.Solitary bladder plasmacytoma,a type of solitary extramedullary plasmacytoma,is even rarer.Treatments for solitary extramedullary pl...BACKGROUND Plasmacytoma is a rare neoplastic disorder that arises from B-lymphocytes.Solitary bladder plasmacytoma,a type of solitary extramedullary plasmacytoma,is even rarer.Treatments for solitary extramedullary plasmacytoma include surgery,chemotherapy,and radiation.However,there are no clinical trials or guidelines specifying which treatment might represent the gold standard.CASE SUMMARY We herein report a case of a 51-year-old woman with solitary bladder plasmacytoma(SBP).There remains no consensus regarding the optimal treatment for SBP.However,we successfully treated her with transurethral resection of bladder tumor followed by postoperative radiotherapy(50 Gy/25 F).The patient remained free of tumor recurrence at a 7-mo follow-up.CONCLUSION Radiation is the potential main treatment for SBP.However,surgery is also necessary.展开更多
Renal cell carcinoma can metastasize to virtually any organ, yet synchronous metastasis to the bladder is extremely rare. A 77-year-old woman presented with gross hematuria. Abdominal and chest computed tomography sho...Renal cell carcinoma can metastasize to virtually any organ, yet synchronous metastasis to the bladder is extremely rare. A 77-year-old woman presented with gross hematuria. Abdominal and chest computed tomography showed a bilateral renal masses, bladder dome mass, and multiple lung metastasis. Transurethral resection of the bladder tumor and sonography guided renal biopsy were performed. Both pathology diagnoses were clear cell renal cell carcinoma. Targeted therapy using pazopanib was administered to the patient without surgical resection of primary tumors and metastatic lung lesions. Herein, we report the synchronous metastasis of renal cell carcinoma to the bladder and lung.展开更多
AIM: To evaluate the perioperative and long term outcomes of cystectomy in obese patients.METHODS: This is a retrospective review of 580 patients for whom radical cystectomy(RC) was performed for primary urothelial bl...AIM: To evaluate the perioperative and long term outcomes of cystectomy in obese patients.METHODS: This is a retrospective review of 580 patients for whom radical cystectomy(RC) was performed for primary urothelial bladder cancer between November 1996-April 2013 at a single institution. Body mass index(BMI) was available for 424 patients who were categorized as underweight(< 18.5), normal(18.5-24.9), overweight(25.0-29.9), and obese(≥ 30). Baseline demographics, perioperative outcomes, and survival were assessed. Overall survival(OS) and disease specific survival(DSS) was estimated by Kaplan-Meier method. Medians were compared using the Mann-Whitney U Test. Categorical variables were compared using the χ2 test. A P-value of < 0.05 was considered statistically significant. Statistical analyses were performed using the Software Package for the Social Sciences(SPSS), Version 20(International Business Machines SPSS, Chicago, IL, United States). RESULTS: The median age of all patients was 69 years(inter-quartile range 60-75) and median followup was 23.4 mo(8.7-55.1). Patients were characterized as underweight [9,(2.1%)], normal [113,(26.7%)],overweight [160,(37.8%)], or obese [142,(33.5%)]. Estimated blood loss during RC was higher in the obese group(800 m L) as compared to the normal weight group(500 m L). However, need for transfusion(47.7% vs 52.1%), number of lymph nodes resected(32 vs 30), length of stay(9 d vs 8 d), and 30-d readmission(29.7% vs 25.2%) between obese and normal BMI patients were similar. Obese patients underwent ileal neobladder diversion in 42% of cases, compared to 24% of normal BMI patients(0.003). Normal BMI and obese patients had comparable urinary incontinence(21.4% vs 25.6%, P = 0.343), and need for intermittent catheterization(14.3% vs 5.2%, P = 0.685) at 2 years follow-up. Overall survival was better in obese compared to normal BMI patients on univariate analysis, with median survival of 67 mo vs 37 mo, respectively(P = 0.031). Disease specific survival in these populations followed the same Kaplan Meier curve, with the obese group having a significantly improved OS, P = 0.016. Underweight patients had a significantly worse prognosis, with a median overall survival of 19 mo(P = 0.018). Disease specific survival was significantly worse in the underweight group compared to the obese group, P = 0.007. On multivariate analysis underweight patients remained at increased risk for death(HR = 3.1, P = 0.006), as were older patients(HR = 1.6, P = 0.006), those with multiple nodal metastases(HR = 3.7, P = 0.007), and those who had received neoadjuvant chemotherapy(HR = 2.0, P = 0.015).CONCLUSION: Perioperative outcomes and survival following RC in obese patients is comparable with nonobese patients. Underweight patients have the worst OS and DSS.展开更多
930159 Transurethral microwave irradiationfor bladder neoplasm.YANG Xuehui(杨学辉),et al.Dept Urol,Beijing Milit Area GeneralHosp,100700.Natl Med J China 1992;72(9):531-533.Forty-two patients with bladder neoplasmwere...930159 Transurethral microwave irradiationfor bladder neoplasm.YANG Xuehui(杨学辉),et al.Dept Urol,Beijing Milit Area GeneralHosp,100700.Natl Med J China 1992;72(9):531-533.Forty-two patients with bladder neoplasmwere treated effectively by transurethral mi-展开更多
Objective To introduce an operation procedure and evaluate the continence diversion results of the modified ureterosigmoidostomy after radical cystectomy. Methods Fourteen cases of bladder cancer or prostate carcin...Objective To introduce an operation procedure and evaluate the continence diversion results of the modified ureterosigmoidostomy after radical cystectomy. Methods Fourteen cases of bladder cancer or prostate carcinoma were operated on with modified Sigma pouch from Feb, 1998 to Dec, 1999. A longitudinal incision about 25 cm on the sigmoid wall was done to form a low pressure pouch. The vertex of the new pouch was fixed to sacrum. Both ends of ureters were anastomosed side to side and to form a big nipple and inserted into the top of pouch for 2 to 3 centimeters.Results It took about sixty five minutes to create a new low pressure pouch after radical cystectomy. Early complication of was found in two cases postoperatively, and cured with temporary colonostomy. Hydronephrosis and hypokalemia in one patient were cured by percutaneous anterograde ureter dilatation with balloon and oral replacement of potassium salt. All patients displayed urinary continence. No symptomatic renal infection or hypercholoraemic acidosis occurred. Conclusion Modified ureterosigmoidostomy is a safe procedure of urinary diversion and provides a big volume, low intravesical pressure pouch. The patients are free from the troublesome urine bag, intermittert catheterization, and upper urinary tracts are protected effectively. The quality of life is satisfied.展开更多
文摘Perivascular epithelioid cell tumors(PEComas)are a diverse group of mesenchymal neoplasms.While they have been described throughout the genitourinary system,PEComas are quite rare within the bladder.We present the case of a 37-year-old male who presented in clot retention and was found to have a bladder PEComa.Staging images seemingly demonstrated solid tumor confinement to the bladder and pelvis.Intraoperative pathology revealed peritoneal metastasis.The patient underwent a pelvic mass excision and partial cystectomy.The patient had plans for adjuvant chemotherapy,but later returned to the hospital and passed away from acute hypoxic respiratory failure.
文摘Robot-assisted radical cystectomy with intracorporeal urinary diversion(RARCICUD)has only recently been explored as a viable surgical option for patients with muscle-invasive bladder cancer seeking satisfactory oncologic control while benefiting from minimally invasive surgical techniques.Inspired by earlier open and laparoscopic work,initial descriptions of RARC-ICUD were published in 2003,and have since been followed by multiple larger case series which have suggested promising outcomes for our patients.However,the rate of adoption has remained relatively slow when compared to other robotassisted procedures such as the radical prostatectomy,likely owing to longer operative times,operative complexity,costs,and uncertainty regarding oncologic efficacy.The operative technique for RARC-ICUD has evolved over the past decade and several high-volume centers have shared tips to improve efficiency and make the operation possible for a growing number of urologists.Though there are still questions regarding economic costs,effectiveness,and generalizability of outcomes reported in published data,a growing dataset has brought us ever closer to the answers.Here,we present our current operative technique for RARC-ICUD and discuss the state of the literature so that the urologist may hold an informed discussion with his or her patients.
文摘The aim of this study was to determine the impact that age and comorbidity status have on both overall and bladder cancer-specific survival of bladder cancer patients. We obtained medical information pertaining to a population of 528 patients with newly diagnosed bladder cancer from Chung-Ang University Hospital cancer registry. The Adult Comorbidity Evaluation-27 （ACE-27） test, which has been previously validated in adult cancer patients, was used to assess comorbidity. We evaluated differences in the demographic and clinical characteristics of included patients, as well as differences in the treatments they received after categorizing them by age. The median age at the time of bladder cancer diagnosis of the entire cohort was 63 years, and the median follow-up time was 97 months. Of the 528 patients who were included in our study, 303 had at least one comorbid condition and 249 died during the follow-up period. When patients were stratified by age, we found that older patients had a higher proportion of severe comorbidities （P 〈 0.01） than younger patients, and that a lower proportion of them underwent radical cystec- tomy for invasive bladder cancer （IBC） （P 〈 0.01）. By multivariate analysis, we found that older age was predictive of lower overall survival （OS） and bladder cancer-specific survival （BCSS） rates among patients with superficial bladder cancer （SBC） and of lower OS rates among patients with IBC. We also found that moderate-severe comorbidity status and treatment through a bladder-conserving approach were predictive of lower OS and cancer-specific survival rates among patients with IBC. The disparity between overall deaths and bladder cancer deaths was shown in SBC and increased along with age and higher comorbidity. Age and comorbidity were found to be independent predictive factors of OS and BCSS among bladder cancer patients, and explained the disparity that we observed between overall bladder cancer-specific mortality rates.
文摘In a total of 83 UN specimens were investigated for proto-oncogene mutations, tumor supressor genes promoter methylation status and c-myc and Ki-67 expression. Point mutations in c-myc were detected in cases with high grade and proliferation index. Mutated K-ras proto-onco- gene profiles were detected in 17 (21%) tumoral spiecemens that examined. Tumor specimens were also showed hypermethylated promoter domain for the SFRP2, MGMT tumor supressor genes. These findings showed the combine effect of mutated c-myc and K-ras oncogene and epigenetic inactivation of tissue specific tumor supressor genes (TS) play a crucial role in tumor progression and recurrence in UN carcinogenesis.
基金This work was supported by Ferring Pharmaceuticals Inc.
文摘Introduction:Non–muscle-invasive bladder cancer(NMIBC)is a common malignancy worldwide.While Bacillus Calmette-Guérin(BCG)is standard of care for treatment for most patients with high-risk NMIBC,many will either not respond to BCG initially or will eventually develop BCG-unresponsive disease.A treatment option in BCG-unresponsive disease is nadofaragene firadenovec-vncg(Adstiladrin),a nonreplicating adenoviral vector–based gene therapy approved by the US Food and Drug Administration(FDA)for the treatment of adults with high-risk BCGunresponsive NMIBC with carcinoma in situ with or without papillary tumors.Objective:To review safety outcomes of participants who received the FDA-approved dose of nadofaragene firadenovec(3×10^(11)vp/mL)across phase 2(NCT01687244)and phase 3(NCT02773849)studies.Methods:Data from the phase 2 and phase 3 studies were collected and analyzed.The findings were reported using descriptive statistics to summarize the key outcomes observed across studies.Results:Common adverse events(AEs)among nadofaragene firadenovec recipients were leakage of fluid around the urinary catheter,fatigue,bladder spasm,chills,dysuria,and micturition urgency.Most study drug–related AEs were mild and localized,with no grade 4 or 5 study drug–related AEs observed in either study.Study drug–related AEs were generally transient,with most study drug–related AEs having a median duration of≤2.0 days in the phase 3 study.Discontinuation rates due to study drug–related AEs were low,with none(0%)in the phase 2 study and three(1.9%)in the phase 3 study.No specific postmarketing surveillance was required by the FDA besides routine pharmacovigilance monitoring;no new real-world safety signals have been observed.Conclusion:Nadofaragene firadenovec demonstrated a favorable and tolerable safety profile across its clinical study program,allowing for broad patient selection among those with high-risk BCG-unresponsive NMIBC.
基金the Zhongnan Hospital of Wuhan University Science,Technology and Innovation Seed Fund(No.znpy2019011)the Fundamental Research Funds for the Central Universities(No.2042020kf0130)+1 种基金the Nature Science Foundation of Hubei Province(No.2019FFB03902)the Health Commission of Hubei Province Scientific Research Project(No.WJ2019H035).
文摘Periodontitis has been proposed as a novel risk factor of genitourinary cancers:although periodontitis and genitourinary cancers are two totally distinct types of disorders,epidemiological and clinical studies,have established associations between them.Dysbiosis of oral microbiota has already been established as a major factor contributing to periodontitis.Recent emerging epidemiological evidence and the detection of oral microbiota in genitourinary organs indicate the presence of an oral-genitourinary axis and oral microbiota may be involved in the pathogenesis of genitourinary cancers.Therefore,oral microbiota provides the bridge between periodontitis and genitourinary cancers.We have carried out this narrative review which summarizes epidemiological studies exploring the association between periodontitis and genitourinary cancers.We have also highlighted the current evidence demonstrating the capacity of oral microbiota to regulate almost all hallmarks of cancer,and proposed the potential mechanisms of oral microbiota in the development of genitourinary cancers.
文摘Hematuria due to locally advanced or metastatic bladder cancer is a common condition and is often a management problem.Percutaneous embolisation is a mini-invasive option to handle this situation.We report a case of a patient with a metastatic bladder cancer and who presented with an abundant hematuria and severe anemia.After failure of endoscopic resections and“flush”of radiotherapy haemostatic and refusal of cystectomy by the patient,he was treated by superselective embolisation of bilateral superior bladder arteries with excellent immediate results.The technique is safe and effective in the short term.The longterm effectiveness requires further investigation.
基金Supported by Science Technology Research Program of Zhejiang Province,No.2017C33047Scientific research project of Zhejiang education department,No.N20140124)Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2019KY093
文摘BACKGROUND Neuroblastoma is an extracranial malignant tumor in children that is most often located in the adrenal gland and sympathetic ganglion.Here,we present a rare case of neuroblastoma originating from the urinary bladder.CASE SUMMARY A 3-year-old girl presented with lower abdominal pain with micturition.Ultrasound revealed a lower abdominal mass.Abdominal computed tomography scan displayed a solitary mass at the top of the urinary bladder.Blood levels of neuron-specific enolase and lactate dehydrogenase were elevated.We treated the child with partial cystectomy and six courses of chemotherapy,and the outcome at 4-year follow-up was unremarkable.CONCLUSION Neuroblastoma should be considered when tumors are located in the urinary bladder,especially in the dome;although this presentation is rare,the prognosis is very good.
文摘Objective: The role of ureteroscopy in the diagnosis of upper tract urothelial carcinoma is yet to be fully determined. We aimed to provide an up to date evaluation of its role and the emerging technologies in the field.Methods: A literature search of the last two decades (from 24th May, 2001 to 24th May, 2021) was carried out identifying 147 papers for potential inclusion within this narrative review.Results: Diagnostic ureteroscopy is undeniably useful in its ability to visualise and biopsy indeterminate lesions, and to risk stratify malignant lesions that may be suitable for kidney sparing surgery. However, an increased risk of intravesical recurrence following nephroureterectomy when a prior diagnostic ureteroscopy has been performed, inadequate sampling at biopsy, complications from the procedure, and difficult ureteric access are all potential drawbacks. Furthermore, whilst generally an accurate diagnostic procedure, it risks missing carcinoma in-situ lesions. Despite this, evidence shows that routine use of ureteroscopy changes the management of patients in a large proportion of cases, preventing unnecessary surgery or facilitating kidney sparing surgery. The overall rate of complications is low, and improved biopsy techniques and the use of tissue biomarkers for improved staging and grading are encouraging. The risks of delays to definitive management and post-ureteroscopy intravesical recurrence do not seem to affect survival, and trials are in progress to determine whether intravesical therapy can mitigate the latter. Further promising techniques are being investigated to improve shortcomings, particularly in relation to improved diagnosis of carcinoma in situ and preoperative staging.Conclusion: Ureteroscopy has a role in the diagnosis of upper tract malignancy, though whether it should be used routinely is yet to be determined.
文摘BACKGROUND Plasmacytoma is a rare neoplastic disorder that arises from B-lymphocytes.Solitary bladder plasmacytoma,a type of solitary extramedullary plasmacytoma,is even rarer.Treatments for solitary extramedullary plasmacytoma include surgery,chemotherapy,and radiation.However,there are no clinical trials or guidelines specifying which treatment might represent the gold standard.CASE SUMMARY We herein report a case of a 51-year-old woman with solitary bladder plasmacytoma(SBP).There remains no consensus regarding the optimal treatment for SBP.However,we successfully treated her with transurethral resection of bladder tumor followed by postoperative radiotherapy(50 Gy/25 F).The patient remained free of tumor recurrence at a 7-mo follow-up.CONCLUSION Radiation is the potential main treatment for SBP.However,surgery is also necessary.
文摘Renal cell carcinoma can metastasize to virtually any organ, yet synchronous metastasis to the bladder is extremely rare. A 77-year-old woman presented with gross hematuria. Abdominal and chest computed tomography showed a bilateral renal masses, bladder dome mass, and multiple lung metastasis. Transurethral resection of the bladder tumor and sonography guided renal biopsy were performed. Both pathology diagnoses were clear cell renal cell carcinoma. Targeted therapy using pazopanib was administered to the patient without surgical resection of primary tumors and metastatic lung lesions. Herein, we report the synchronous metastasis of renal cell carcinoma to the bladder and lung.
文摘AIM: To evaluate the perioperative and long term outcomes of cystectomy in obese patients.METHODS: This is a retrospective review of 580 patients for whom radical cystectomy(RC) was performed for primary urothelial bladder cancer between November 1996-April 2013 at a single institution. Body mass index(BMI) was available for 424 patients who were categorized as underweight(< 18.5), normal(18.5-24.9), overweight(25.0-29.9), and obese(≥ 30). Baseline demographics, perioperative outcomes, and survival were assessed. Overall survival(OS) and disease specific survival(DSS) was estimated by Kaplan-Meier method. Medians were compared using the Mann-Whitney U Test. Categorical variables were compared using the χ2 test. A P-value of < 0.05 was considered statistically significant. Statistical analyses were performed using the Software Package for the Social Sciences(SPSS), Version 20(International Business Machines SPSS, Chicago, IL, United States). RESULTS: The median age of all patients was 69 years(inter-quartile range 60-75) and median followup was 23.4 mo(8.7-55.1). Patients were characterized as underweight [9,(2.1%)], normal [113,(26.7%)],overweight [160,(37.8%)], or obese [142,(33.5%)]. Estimated blood loss during RC was higher in the obese group(800 m L) as compared to the normal weight group(500 m L). However, need for transfusion(47.7% vs 52.1%), number of lymph nodes resected(32 vs 30), length of stay(9 d vs 8 d), and 30-d readmission(29.7% vs 25.2%) between obese and normal BMI patients were similar. Obese patients underwent ileal neobladder diversion in 42% of cases, compared to 24% of normal BMI patients(0.003). Normal BMI and obese patients had comparable urinary incontinence(21.4% vs 25.6%, P = 0.343), and need for intermittent catheterization(14.3% vs 5.2%, P = 0.685) at 2 years follow-up. Overall survival was better in obese compared to normal BMI patients on univariate analysis, with median survival of 67 mo vs 37 mo, respectively(P = 0.031). Disease specific survival in these populations followed the same Kaplan Meier curve, with the obese group having a significantly improved OS, P = 0.016. Underweight patients had a significantly worse prognosis, with a median overall survival of 19 mo(P = 0.018). Disease specific survival was significantly worse in the underweight group compared to the obese group, P = 0.007. On multivariate analysis underweight patients remained at increased risk for death(HR = 3.1, P = 0.006), as were older patients(HR = 1.6, P = 0.006), those with multiple nodal metastases(HR = 3.7, P = 0.007), and those who had received neoadjuvant chemotherapy(HR = 2.0, P = 0.015).CONCLUSION: Perioperative outcomes and survival following RC in obese patients is comparable with nonobese patients. Underweight patients have the worst OS and DSS.
文摘930159 Transurethral microwave irradiationfor bladder neoplasm.YANG Xuehui(杨学辉),et al.Dept Urol,Beijing Milit Area GeneralHosp,100700.Natl Med J China 1992;72(9):531-533.Forty-two patients with bladder neoplasmwere treated effectively by transurethral mi-
文摘Objective To introduce an operation procedure and evaluate the continence diversion results of the modified ureterosigmoidostomy after radical cystectomy. Methods Fourteen cases of bladder cancer or prostate carcinoma were operated on with modified Sigma pouch from Feb, 1998 to Dec, 1999. A longitudinal incision about 25 cm on the sigmoid wall was done to form a low pressure pouch. The vertex of the new pouch was fixed to sacrum. Both ends of ureters were anastomosed side to side and to form a big nipple and inserted into the top of pouch for 2 to 3 centimeters.Results It took about sixty five minutes to create a new low pressure pouch after radical cystectomy. Early complication of was found in two cases postoperatively, and cured with temporary colonostomy. Hydronephrosis and hypokalemia in one patient were cured by percutaneous anterograde ureter dilatation with balloon and oral replacement of potassium salt. All patients displayed urinary continence. No symptomatic renal infection or hypercholoraemic acidosis occurred. Conclusion Modified ureterosigmoidostomy is a safe procedure of urinary diversion and provides a big volume, low intravesical pressure pouch. The patients are free from the troublesome urine bag, intermittert catheterization, and upper urinary tracts are protected effectively. The quality of life is satisfied.
