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Kim SJ, Nang QG, RoyChoudhury A, Kern AJM, Sheth K, Jacobs M, Poppas DP, Akhavan A. Cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory neurogenic detrusor overactivity in children. J Pediatr Urol 2022; 18:314-319. [PMID: 35216926 DOI: 10.1016/j.jpurol.2022.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Treatment options for refractory neurogenic detrusor overactivity (NDO) in children include botulinum toxin type A (BTX-A) and augmentation cystoplasty (AC). Although BTX-A is accepted in contemporary pediatric urologic practice, cost and long-term outcomes data for BTX-A are limited relative to the gold standard, AC. The purpose of this study was to compare the projected 10-year costs of AC versus BTX-A. METHODS We performed a cost analysis from the payer perspective by computationally modeling treatment sequences by a Markov model. In the model, we used probabilities derived from published sources, and costs obtained at a tertiary medical center. The base case was a pediatric patient with refractory NDO. In the model, we assumed biannual BTX-A treatments. Treatment costs over 10 years were compared between immediate AC versus bridging therapy with BTX-A. Using the computational model, we simulated 100,000 instances of 10-year treatment cost for each of the two treatment modalities. The costs for the two treatment approaches were then compared using t-test and Wilcoxon test. RESULTS The projected median and mean 10-year cost of immediately AC were $51,798.72 (95% CI [$51,798.72, $327,483.80]) and $123,473.4 (SD: $98,085.23) respectfully, while the projected median and mean 10-year cost of bridging therapy with BTX-A prior to proceeding to AC as needed were $74,552.46 (95% CI [$53,188.56, $309,913.07]) and $124,858.80 (SD: $84,495.35) (p < 0.001). CONCLUSIONS For a typical index pediatric patient with NDO, bridging therapy with intravesical BTX-A is associated with an increased cost compared to immediate AC over a ten-year period.
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Affiliation(s)
- Soo Jeong Kim
- Division of Pediatric Urology, Texas Children's Hospital, Houston, TX, USA
| | - Quincy G Nang
- Institute for Pediatric Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Arindam RoyChoudhury
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | | | - Kunj Sheth
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Micah Jacobs
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dix Phillip Poppas
- Institute for Pediatric Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Ardavan Akhavan
- Institute for Pediatric Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
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2
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Hojjat A, Sabetkish S, Kajbafzadeh AM. Revascularized Pyelo-Uretero-Cystoplasty in Patients with Chronic Bladder Outlet Obstruction Due to Ectopic Ureterocele: A Safe Surgical Technique with Superior Continence Outcomes. J INVEST SURG 2021; 35:737-744. [PMID: 34139947 DOI: 10.1080/08941939.2021.1933271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To present the outcomes of revascularized pyeloureterocystoplasty with ureterocele unroofing in end stage bladder patients with duplex system and ureterocele. METHODS Thirteen patients with obstruction of intrauterine outlet from an ectopic obstructive ureterocele were included. Fourteen units of duplex systems underwent upper pole partial nephrectomy in conjunction with augmentation revascularized pyeloureterocystoplaty and ureterocele unroofing. The anterior and lateral walls of the ureterocele were excised before cystoplasty, and the resultant edges of the posterior wall were sutured to the bladder epithelium. Anastomosis of the upper pole vein and artery to the inferior iliac artery and the common iliac vein was performed. Detubularization of the whole ureter was performed with exception of the intramural ureteric part that kept tubularized for 'jet/turbulent' occurrence. Five patients (control group) underwent pyeloureterocystoplasty without revascularization. Patients underwent several evaluations in long-term follow-up. RESULTS Patients were all dry by day and night in our long-term follow-up. Urinary incontinence improved in patients with no need for re-augmentation technique. Vesicoureteral reflux subsided in all patients postoperatively except one, who was asymptomatic. After five years, median bladder capacity rose from 128.5 ml to 395 ml and bladder compliance showed significant improvement from 15 ml/cm H2O to 29 ml/cm H2O, in experimental group and remained stable for 24-36 months. Median bladder capacity did not rise significantly in control group. CONCLUSION Pyeloureterocystoplasty is an efficient choice in this type of patients, which may prevent the recurrence of hypocompliant bladders and prevent ischemia and subsequent fibrosis.
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Affiliation(s)
- Asal Hojjat
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shabnam Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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3
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Ravikumar R, Ross A, Khan MS, Khan G, Desai S. Metastatic Adenocarcinoma of the Bladder Presenting as Malignant Pleural Effusion: A Rare Presentation of Bladder Adenocarcinoma. Cureus 2021; 13:e15152. [PMID: 34178487 PMCID: PMC8216572 DOI: 10.7759/cureus.15152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Bladder cancers rarely are non-urothelial in origin. We present here, possibly the youngest case of a 35-year-old White female presenting with shortness of breath. She was found to have a malignant pleural effusion with unknown primary, eventually confirmed with genetic testing as metastatic adenocarcinoma of the urinary bladder with brain and lung metastasis. She was scheduled for palliative chemotherapy, however, passed away before it could be started. We highlight this rare case because of its unique presentation. Owing to similarity in receptors between adenocarcinoma and enteric cancer, similar chemotherapy regimens may be used for both. Unfortunately, treatment of metastatic disease remains highly controversial and needs to be studied further if there is an actual survival benefit to this or not.
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Affiliation(s)
| | - Astrid Ross
- Internal Medicine, Mercy Health, Toledo, USA
| | | | - Ghazal Khan
- Internal Medicine, University of Missouri, Kansas City, USA
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Wang J, Wu J, Moris D, Hayes B, Abraham SN, Cendales LC. Introducing a novel experimental model of bladder transplantation in mice. Am J Transplant 2020; 20:3558-3566. [PMID: 32282990 DOI: 10.1111/ajt.15912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 01/25/2023]
Abstract
Bladder dysfunction is a common clinical problem attributed to various conditions such as posterior urethral valves, neurogenic bladder, ureteral ectopy, or bladder exstrophy. Currently, the main therapeutic option for these dysfunctions is neobladder reconstruction with gastrointestinal tract segments. However, the latter was associated with significant long-term complications. To provide a new candidate of possible surgical solution for bladder dysfunction, we propose a novel orthotropic mouse bladder transplantation model. The donor bladder with abdominal aorta and inferior vena cava was isolated and orthotopically sutured to the recipient, whose bladder above the ureteral opening level was removed. The recipient mice showed more than 80% 6-month survival rate and comparable body weight to control mice. At both 1 month and 6 months posttransplant, the urine voiding behavior of recipient mice and control mice was monitored by cystometry. We found that the recipient mice displayed similar bladder pressure and urine secretion ability compared to control mice especially at 6 months posttransplant. Similarity of bladder structure between recipient and control mice was confirmed by histology. As a proof of principle, we tested our model in an allogeneic setting. Early acute rejection was noted after day 5 that was histologically more profound by day 10 posttransplant. These results indicate that the mouse bladder transplant is able to provide normal bladder function.
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Affiliation(s)
- Jun Wang
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jianxuan Wu
- Department of Immunology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Dimitrios Moris
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Byron Hayes
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Soman N Abraham
- Department of Immunology, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Linda C Cendales
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
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Azam A, Rottenberg G. Multimodality Imaging Findings Postcystectomy: Postoperative Anatomy, Surgical Complications, and Surveillance Imaging. Semin Ultrasound CT MR 2020; 41:392-401. [PMID: 32620229 DOI: 10.1053/j.sult.2020.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Various surgical techniques exist for urinary diversion post cystectomy and each have different imaging features. This diverse range of surgical procedures can make imaging interpretation difficult and so familiarity with the postoperative anatomy is essential. Multiple imaging modalities and techniques are available for the radiologist's assessment including fluoroscopic studies, computed tomography, magnetic resonance, and radionuclide imaging. Knowledge of when each of these modalities is indicated and the typical imaging appearances is essential for early identification of postoperative complications and detection of tumor recurrence. This information enables the radiologist to make an accurate and early diagnosis and subsequently guide the management pathway for these patients.
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Affiliation(s)
- Aishah Azam
- Department of Radiology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Giles Rottenberg
- Department of Radiology, Guy's and St Thomas' NHS Trust, London, United Kingdom.
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6
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Kadouri Y, Hachem F, Lakssir J, Sayegh H, Benslimane L, Nouini Y. [Primitive adenocarcinoma of the bladder: about 6 cases]. Pan Afr Med J 2020; 36:61. [PMID: 32733631 PMCID: PMC7371441 DOI: 10.11604/pamj.2020.36.61.20176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 11/11/2022] Open
Abstract
L´adénocarcinome primitif de la vessie est une variété rare de tumeurs vésicales qui représente moins de 2% des cancers de la vessie. Il semble atteindre préférentiellement le sexe masculin avec un sexe ratio de 3/1 et un âge moyen de survenu entre 60 ans et 70 ans. Sa présentation clinique est non spécifique et dominée par l´hématurie. La résection endoscopique de la vessie avec un examen anathomopathologique permet de poser le diagnostic. Le traitement de l´adénocarcinome primitif de la vessie reste sujet à de nombreuses controverses du fait de la rareté des cas rapportés dans la littérature. Cependant, le traitement de choix semble être une cystectomie totale avec curage ganglionnaire étendu. Nous rapportons une série de 6 cas d´adénocarcinome qui ont été traités et suivis au sein de notre formation. Notre analyse est basée sur l´évaluation des caractéristiques épidémiologiques, cliniques, anatomo-pathologiques, et thérapeutiques de l´adénocarcinome de la vessie, ainsi que sur l´étude des aspects évolutifs et des facteurs pronostiques.
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Affiliation(s)
- Youssef Kadouri
- Université Mohamed V, Faculté de Médecine et de Pharmacie de Rabat Maroc, Hôpital Ibn Sina, Service d´Urologie A, Rabat, Maroc
| | - Farouk Hachem
- Université Mohamed V, Faculté de Médecine et de Pharmacie de Rabat Maroc, Hôpital Ibn Sina, Service d´Urologie A, Rabat, Maroc
| | - Jihad Lakssir
- Université Mohamed V, Faculté de Médecine et de Pharmacie de Rabat Maroc, Hôpital Ibn Sina, Service d´Urologie A, Rabat, Maroc
| | - Hachem Sayegh
- Université Mohamed V, Faculté de Médecine et de Pharmacie de Rabat Maroc, Hôpital Ibn Sina, Service d´Urologie A, Rabat, Maroc
| | - Lounis Benslimane
- Université Mohamed V, Faculté de Médecine et de Pharmacie de Rabat Maroc, Hôpital Ibn Sina, Service d´Urologie A, Rabat, Maroc
| | - Yassine Nouini
- Université Mohamed V, Faculté de Médecine et de Pharmacie de Rabat Maroc, Hôpital Ibn Sina, Service d´Urologie A, Rabat, Maroc
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Budzyn J, Trinh H, Raffee S, Atiemo H. Bladder Augmentation (Enterocystoplasty): the Current State of a Historic Operation. Curr Urol Rep 2019; 20:50. [PMID: 31342172 DOI: 10.1007/s11934-019-0919-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper was to evaluate the current use of enterocystoplasty, a historical operation for bladder dysfunction but with continued and increasing modern relevance. RECENT FINDINGS Since the advent of third line neuromodulation techniques for neurogenic and idiopathic overactive bladder (OAB), the usage of enterocystoplasty has decreased. However, this procedure continues to be utilized in pediatric urology patients and the most refractory OAB patients. Adult urologist should be familiar with this operative technique in an effort to manage pediatric patients transitioning to adulthood. Minimally invasive techniques for this surgical procedure have been described with very limited outcome data. It is important for all urologists to be familiar with enterocystoplasty, both technically and with the unique needs of these patients postoperatively. Further studies evaluating the outcomes of this procedure in idiopathic overactive bladder patients and efforts to standardize recommendations for neurogenic bladder patients will help guide care in the future.
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Affiliation(s)
- Jeffrey Budzyn
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Hamilton Trinh
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Samantha Raffee
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA
| | - Humphrey Atiemo
- Henry Ford Health System, 2799 West Grand Blvd, K9, Detroit, MI, 48202, USA.
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Lopez-Beltran A, Montironi R, Raspollini MR, Cheng L, Netto GJ. Iatrogenic pathology of the urinary bladder. Semin Diagn Pathol 2018; 35:218-227. [DOI: 10.1053/j.semdp.2018.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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9
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Hayashi Y, Nishimura E, Shimizu S, Miyano G, Okawada M, Nagae I, Lane GJ, Katsumata K, Yamataka A, Tsuchida A. Sigmoidocolocystoplasty for neurogenic bladder reviewed after 20 years. J Pediatr Surg 2017; 52:2070-2073. [PMID: 29223546 DOI: 10.1016/j.jpedsurg.2017.08.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 08/28/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND/PURPOSE We report the current status of patients who underwent augmentation cystoplasty (AC) at least 20years previously. METHODS Surgical history, incidence of urinary tract infection (UTI) and bladder stones, vesicoureteral reflux (VUR), urine cytology, renal function, a colon cancer tumor marker (carcinoembryonic antigen: CEA), and patient outcomes were assessed. RESULTS Forty patients who underwent AC (mean age: 34.4years; mean follow-up time: 24.3years) were analyzed. Mean age at AC was 11years. Incidence of bladder stones was 30%. There were no incidences of carcinoma after AC, and CEA levels were not increased. Ureteral reimplantation (URI) was performed in 21 patients. URI performed at the same time as AC was successful in 14 cases (93%) and unsuccessful in 1 (7%) because of persistent VUR. UTI developed after AC in only 1 patient (2.5%) with persistent VUR. This patient required unilateral nephrectomy 18years after the AC because of repeated UTIs. Thirty-four patients (85%) were employed, and 4 (10%) were married. Two of the 19 female patients (11%) had experienced pregnancy and delivery. Five patients (13%) had mental disorders. CONCLUSION Ultra long-term follow-up suggests that AC is a safe procedure with manageable sequelae, although some mental health issues remain. TYPE OF STUDY Case series with no comparison group. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Yutaka Hayashi
- Department of General and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Emi Nishimura
- Department of General and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Satoko Shimizu
- Department of General and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Manabu Okawada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Itsuro Nagae
- Department of General and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Katsumata
- Department of General and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihiko Tsuchida
- Department of General and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
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10
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Mammadov E, Dervisoglu S, Elicevik M, Emir H, Soylet Y, Buyukunal SNC. Transition to adulthood with a bladder augmentation: histopathologic concerns. Int Braz J Urol 2017; 43:1152-1159. [PMID: 29039896 PMCID: PMC5734080 DOI: 10.1590/s1677-5538.ibju.2016.0548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 03/20/2017] [Indexed: 11/22/2022] Open
Abstract
Aim: To investigate the histopathologic changes in native bladder and gastrointestinal segment, the relation between histopathologic changes, type of operation and the period passed over operation in patients with bladder augmentation. Materials and methods: Twenty consecutive patients were enrolled in this study. Histopathologic evaluation of the cystoscopic mucosal biopsies from native bladder and enteric augment was performed in all patients. Results: Active or chronic non-specific inflammation of various degrees was found in all specimens except two. Metaplastic changes were detected in 3 patients. Two patients had squamous metaplasia (one focal, one extensive) and one patient had intestinal metaplasia. All metaplastic changes were found in native bladder specimens. The type of augmentation in patients with metaplastic changes were ileocystoplasty and sigmoidocystoplasty. No signs of malignancy were detected in any patient. Conclusion: The complexity of the disorders requiring bladder augmentation does not let the surgeons to draw a clear line between different groups of complications including malignancy formation. However, due to challenging course of the augmentation procedure itself, surgeons should be well aware of the possibility of malignancy development.
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Affiliation(s)
- Emil Mammadov
- Department of Pediatric Surgery, Near East University Medical Faculty, Turkey
| | - Sergulen Dervisoglu
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Elicevik
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Haluk Emir
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yunus Soylet
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - S N Cenk Buyukunal
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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11
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Systematic review of bladder cancer outcomes in patients with spina bifida. J Pediatr Urol 2017; 13:456.e1-456.e9. [PMID: 28687411 DOI: 10.1016/j.jpurol.2017.05.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/06/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND In patients with congenital bladder anomalies, bladder augmentation is used as a last resort to reduce intravesical pressure, but concerns about malignant transformation in augmented patients were first raised in the 1980s. The best evidence to date indicates that augmentation does not appear to increase the risk of bladder cancer in spina bifida patients. To date, oncologic outcomes from patients with spina bifida with and without augmentation have only been available in small case reports. OBJECTIVE To systematically evaluate factors in myelomeningocele patients with bladder cancer, including bladder augmentation, that contribute to overall survival (OS). STUDY DESIGN A systematic review using PubMed was conducted by cross referencing terms 'myelomeningocele,' 'cystoplasty,' 'bladder cancer' and respective synonyms according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Inclusion criteria were studies with patients with an underlying diagnosis of myelomeningocele and bladder cancer with data on age, stage, and mortality status. Studies were excluded for spinal cord injury, history of tuberculosis or schistosomiasis, or prior ureterosigmoidostomy. RESULTS Fifty-two patients were identified from 28 studies with a median age at bladder cancer diagnosis of 41 years (range 13-73); 37 (71%) presented with stage III or IV bladder cancer. Overall survival at 1 year and 2 years was 48.5% and 31.5%, respectively. Overall survival was different between those with and without augmentation (P = 0.009) by log-rank analysis. No between-group differences in OS were seen based on age, management with indwelling catheter, diversion with ileal conduit or being on a surveillance program. Only stage remained a significant predictor of OS on multivariate analysis (HR 2.011, 95% CI 1.063-3.804, P = 0.032). Secondary analysis was performed after removing patients with gastric augmentation (n = 8), and no difference in OS was seen between patients with (n = 8) and without augmentation (n = 36, P = 0.112). Of augmented patients, latency to development of bladder cancer was variable (Summary Figure). DISCUSSION Bladder cancer is a deadly diagnosis in patients with congenital bladder anomalies like spina bifida, and while overall prevalence of the two conditions occurring together is low, bladder cancer will go on to affect 2-4% of spina bifida patients. The present study examined overall survival, and further characterized outcomes in these patients. Presence of a bladder augment did not appear to worsen overall survival. CONCLUSIONS Patients with myelomeningocele who developed bladder cancer had aggressive disease. Augmentation did not worsen OS, based on cases reported in the literature. Risk of bladder cancer should be discussed with all myelomeningocele patients.
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12
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Wein AJ. Re: Risk of Malignancy after Augmentation Cystoplasty: A Systematic Review. J Urol 2017. [DOI: 10.1016/j.juro.2017.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Lopez-Beltran A, Paner GP, Montironi R, Raspollini MR, Cheng L. Iatrogenic changes in the urinary tract. Histopathology 2016; 70:10-25. [DOI: 10.1111/his.13090] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/16/2016] [Accepted: 09/18/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Antonio Lopez-Beltran
- Department of Pathology and Surgery; Faculty of Medicine; Cordoba Spain
- Champalimaud Clinical Center; Lisbon Portugal
| | - Gladell P Paner
- Departments of Pathology and Surgery; Section of Urology; University of Chicago; Chicago IL USA
| | - Rodolfo Montironi
- Section of Pathological Anatomy; Polytechnic University of the Marche Region; School of Medicine; Ancona Italy
| | - Maria R Raspollini
- Histopathology and Molecular Diagnostics. University Hospital Careggi; Florence Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
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14
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Çetinel B, Kocjancic E, Demirdağ Ç. Augmentation cystoplasty in neurogenic bladder. Investig Clin Urol 2016; 57:316-23. [PMID: 27617312 PMCID: PMC5017553 DOI: 10.4111/icu.2016.57.5.316] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/29/2016] [Indexed: 11/30/2022] Open
Abstract
The aim of this review is to update the indications, contraindications, technique, complications, and the tissue engineering approaches of augmentation cystoplasty (AC) in patients with neurogenic bladder. PubMed/MEDLINE was searched for the keywords "augmentation cystoplasty," "neurogenic bladder," and "bladder augmentation." Additional relevant literature was determined by examining the reference lists of articles identified through the search. The update review of of the indications, contraindications, technique, outcome, complications, and tissue engineering approaches of AC in patients with neurogenic bladder is presented. Although some important progress has been made in tissue engineering AC, conventional AC still has an important role in the surgical treatment of refractory neurogenic lower urinary tract dysfunction.
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Affiliation(s)
- Bülent Çetinel
- Department of Urology, Istanbul University, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Ervin Kocjancic
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Çetin Demirdağ
- Department of Urology, Istanbul University, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
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15
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Pediatric Bladder Reconstruction. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Robles MW, Rutgers JKL, Shanberg AM. Adenocarcinoma and Dysplasia in an Ileal Neobladder After Ileocystoplasty for Interstitial Cystitis. Int J Surg Pathol 2016; 12:63-5. [PMID: 14765277 DOI: 10.1177/106689690401200112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a 54-year-old woman with an adenocarcinoma of an ileal neobladder arising upon a background of ileal mucosal dysplasia. We believe that no case study or report has previously documented neobladder ileal mucosal dysplasia adjacent to an ileal neobladder adenocarcinoma. This observation supports the current hypothesis that ileal neobladders are dynamic environments for potential malignancy, and moreover, suggests a sequence of morphologic and molecular derangements similar to that seen in colorectal carcinoma. Those patients status post ileal neobladder are at risk for glandular dysplasia and malignancy and should be followed closely.
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Affiliation(s)
- M W Robles
- UCI Medical Center, Orange, and the Long Beach Memorial Medical Center, Long Beach, CA 92868, USA
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Altan M, Çıtamak B, Haberal HB, Söğütdelen E, Bozaci AC, Baydar DE, Doğan HS, Tekgül S. Invasive Squamous Carcinoma and Adenocarcinoma of an Unreconstructed Exstrophic Bladder with HPV Infection. Curr Urol 2016; 9:109-12. [PMID: 27390585 DOI: 10.1159/000442863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/02/2015] [Indexed: 11/19/2022] Open
Abstract
Bladder exstrophy is a complex abnormality and is traditionally treated within the early years of life. It is associated with an increased risk of bladder cancer, with 95% of the arising tumors being adenocarcinomas and 3 to 5% being squamous cell carcinomas. HPV infections are also associated with an increased risk of bladder cancer. This case represents a patient with bladder exstrophy that gave rise to coinciding squamous cell carcinoma and adenocarcinoma. Final pathology results showed an infection with HPV. We presented the management of the case and discussed the diagnosis and treatment methods for this patient.
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Affiliation(s)
- Mesut Altan
- Department of Urology, Hacettepe University, Ankara, Turkey
| | - Burak Çıtamak
- Department of Urology, Hacettepe University, Ankara, Turkey
| | | | | | | | | | | | - Serdar Tekgül
- Department of Urology, Hacettepe University, Ankara, Turkey
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Electrospun PLLA nanofiber scaffolds for bladder smooth muscle reconstruction. Int Urol Nephrol 2016; 48:1097-104. [DOI: 10.1007/s11255-016-1259-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/29/2016] [Indexed: 12/18/2022]
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Hayashi Y, Shiyanagi S, Nagae I, Ishizaki T, Kasuya K, Katsumata K, Yamataka A, Tsuchida A. A case of tubular adenoma developing after bladder augmentation: Case report and literature review. Int J Surg Case Rep 2015; 19:17-20. [PMID: 26706596 PMCID: PMC4756097 DOI: 10.1016/j.ijscr.2015.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/07/2015] [Accepted: 12/07/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We encountered a rare case of tubular adenoma developing after bladder augmentation. We here report our case as well as summarize reports in the literature on adenomas developing after bladder augmentation. PRESENTATION OF CASE A 23-year-old man came to our hospital for routine surveillance cystoscopy. He was born with a lipomyelomeningocele and neurogenic bladder with low bladder compliance, and hence his bladder was routinely emptied by clean intermittent catheterization. He was also treated with anticholinergic agents. However, because the patient's neurogenic bladder was unstable, he underwent sigmoidocolocystoplasty when he was 8-years old. After the bladder augmentation, he was examined annually by surveillance cystoscopy. On cystoscopy, a 5-mm pedunculated polyp was found on the front side of the sigmoid colon cap. Therefore, we performed snare polypectomy together with electrocoagulation under cystoscopy. The patient's final diagnosis was tubular adenoma (mild atypia) with no malignancy, as assessed by histopathology. There has been no evidence of recurrence after the polypectomy on routine surveillance cystoscopy. DISCUSSION To the best of our knowledge, there have been 11 cases of adenoma occurring after bladder augmentation reported in the literature, including our present case. There are several carcinogenic pathways associated with colorectal oncogenesis. Adenomas that are larger than 1.0cm in diameter with a marked villous component have a high risk of oncogenesis. CONCLUSION We believe that the early detection of carcinoma or adenoma and their treatment at an early stage is crucial. Therefore, we recommend routine surveillance cystoscopy for patients after bladder augmentation.
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Affiliation(s)
- Yutaka Hayashi
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Satoko Shiyanagi
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Itsuro Nagae
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tetsuo Ishizaki
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiko Kasuya
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
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Özdemir T, Arıkan A. Ureterocystoplasty in pediatric patients with unilateral nonfunctioning kidney. Turk J Urol 2015; 39:232-6. [PMID: 26328116 DOI: 10.5152/tud.2013.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 06/04/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Bladder augmentation with uroepithelium lined material yields an absence of mucus production, with reduced possibility of urinary infection and lithiasis. The utilization of the ureter in augmentation cystoplasty results in a uroepithelium-lined neobladder with all of the appropriate histologic layers. The purpose of this study was to assess the efficacy and safety of ureterocystoplasty in children with a small bladder capacity and low bladder compliance. MATERIAL AND METHODS Between January 1992 and August 2011, six females and eight males who were 3 to 13 years old (median age 6 years) and had a low-capacity, poorly compliant bladder underwent augmentation cystoplasty using dilated ureters. Unilateral non-functioning renal moiety draining into a massively dilated ureter was present in every patient. The etiology of hydroureteronephrosis was a neurogenic bladder secondary to meningomyelocele in five patients, a posterior urethral valve in four patients, an obstructive megaureter in three patients and ectopic obstructive ureterocele in two patients. RESULTS Mean age was 6 years (3-13 y). Clinical improvement regarding the resolution of reflux, a better bladder capacity and improved compliance was achieved in every patient. The increase in bladder capacity ranged from 84 cc (30 to 200) to 235 cc (150 to 420), with a mean increase of 318% (210 to 500). Marked improvement in compliance was also observed (from 1.2 to 5.1 mL/cm H2O, mean 2.4, to 22 to 50 mL/cm H2O, mean 41). No uninhibited bladder contractions were detected during a urodynamic study at 12 months postoperatively. CONCLUSION In patients with a low-capacity, poorly compliant bladder, augmentation cystoplasty using the ureter seems to be a viable alternative. Ureterocystoplasty results in a large-capacity, high-compliance bladder, without metabolic and infective complications, compared with other techniques of augmentation cystoplasty.
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Affiliation(s)
- Tunç Özdemir
- Department of Pediatric Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ahmet Arıkan
- Department of Pediatric Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
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Colorectal microcarcinoids in association with long-term exposure to urinary content: a case report and review of the literature. Case Rep Pathol 2015; 2015:806310. [PMID: 25922778 PMCID: PMC4398929 DOI: 10.1155/2015/806310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/16/2015] [Indexed: 12/20/2022] Open
Abstract
Long-term exposure of colonic mucosa to urinary content and its association with increased risk of infection, mechanical and biochemical irritation, and malignancy have been described in the literature. Existing case reports and studies depict the low but distinct risk of malignancy in gastrointestinal segments which come in contact with urinary content as a result of surgical correction of urinary tract abnormalities. However, these reports are largely limited to colonic adenocarcinoma and urothelial cell carcinoma. Late urointestinal carcinoma in patients with ileal incorporation into the urinary tract has also been reported. To the best of our knowledge, however, there is only one case report documenting neuroendocrine (NE) cell hyperplasia in colonic mucosa after long-term cystoplasty. Our case is the first to describe microcarcinoids and diffuse NE hyperplasia occurring in a patient with congenital anorectal anomalies, resulting in long-term exposure of colonic mucosa to fecal stream and urinary content. This case, in conjunction with the reported cases in the literature, raises the distinct possibility of an association between exposure of colonic mucosa to urine and long-term development of malignancy, including NE neoplasms.
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Biardeau X, Chartier-Kastler E, Rouprêt M, Phé V. Risk of malignancy after augmentation cystoplasty: A systematic review. Neurourol Urodyn 2015; 35:675-82. [DOI: 10.1002/nau.22775] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/04/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Xavier Biardeau
- Department of Urology; Lille University Hospital; Lille Nord de France University; Lille France
| | - Emmanuel Chartier-Kastler
- Department of Urology; AP-HP; Pitié-Salpêtrière Academic Hospital; Sorbonne Universités; Paris France
| | - Morgan Rouprêt
- Department of Urology; AP-HP; Pitié-Salpêtrière Academic Hospital; Sorbonne Universités; Paris France
- GRC-05; Institut Universitaire de Cancerologie (IUC); University Paris-6; Paris France
| | - Véronique Phé
- Department of Urology; AP-HP; Pitié-Salpêtrière Academic Hospital; Sorbonne Universités; Paris France
- GRC-05; Institut Universitaire de Cancerologie (IUC); University Paris-6; Paris France
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Kumar KVS, Mammen A, Varma KK. Multiple failed closure of bladder in children with vesical exstrophy: Safety and efficacy of temporary ileal patch augmentation in assisting bladder closure. J Indian Assoc Pediatr Surg 2014; 19:222-6. [PMID: 25336805 PMCID: PMC4204248 DOI: 10.4103/0971-9261.142014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The surgical approach to small bladder template in exstrophy bladder is difficult. Previously, many of these children underwent ureterosigmoidostomy and in recent times, the trend is to do a delayed primary closure. We have used ileal patch as a temporary cover for these small bladders with a view to encourage bladder growth and early results are encouraging. MATERIALS AND METHODS In five of the 45 children with bladder exstrophy managed by radical soft-tissue mobilization over 10 years, primary bladder closure was not possible due to repeated failed closures. A detubularized ileum was used to patch the bladder initially and after 4 months the patch was excised and bladder closure with sphincter repair was done in second stage. RESULTS In five children (three girls and two boys) the mean age at initial bladder closure was 14 months and mean age at ileal patch was 22 months. In four patients, the bladder grew facilitating closure and in one patient it failed. There were no complications with the use of gut in patch. CONCLUSION A temporary ileal patch seems promising in managing failed bladder closure in exstrophy patients. Long-term studies are needed before such a technique can be used in all patients with failed primary bladder closures.
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Affiliation(s)
- Kolar Venkatesh Satish Kumar
- Department of Neonatal and Pediatric Surgery, Malabar Institute of Medical Sciences, Calicut, Kerala, India ; Department of Child and Adolescent Health, Baby Memorial Hospital, Calicut, Kerala, India
| | - Abraham Mammen
- Department of Neonatal and Pediatric Surgery, Malabar Institute of Medical Sciences, Calicut, Kerala, India
| | - Karthikeya K Varma
- Department of Neonatal and Pediatric Surgery, Malabar Institute of Medical Sciences, Calicut, Kerala, India
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Reid S, Althunayan A, Capolicchio JP, Brimo F, Kassouf W. First case of invasive squamous cell carcinoma in a stoma of a Monti ileovesicostomy. Can Urol Assoc J 2014; 8:E654-6. [PMID: 25295141 DOI: 10.5489/cuaj.2093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report a very rare case of invasive squamous cell carcinoma (SCC) in the abdominal stoma of a Monti ileovesicostomy. Our patient underwent an uncomplicated Monti ileovesicostomy at age 16 for a neurogenic bladder. She presented 10 years later with difficulty catheterizing the stoma. A biopsy of peristomal tissue showed moderately differentiated SCC. A cystoscopy did not reveal any bladder tumours or suspicious lesions. A computed tomography (CT) scan of the abdomen and pelvis did not demonstrate metastasis. The patient underwent a complete en bloc resection of the stomal site, the Monti, a partial cuff of bladder, and 2 loops of bowel that were adherent to the Monti. Final pathology revealed pure invasive SCC arising around the stoma and negative surgical margins. Six months later, a follow-up CT scan showed no evidence of malignancy, while a cystoscopy revealed a small erythematous area in the posterior bladder wall. Urinary cytology was positive for SCC. Transurethral resection of the erythematous lesion with random bladder biopsies showed SCC in situ in the erythematous lesion and right lateral bladder wall. Staging workup was negative. The patient subsequently underwent a radical cystectomy and ileal conduit diversion with bilateral pelvic lymph node dissection. Final pathology on cystectomy specimen was SCC in situ without evidence of invasive carcinoma. The patient has remained in remission at the 3-year follow-up.
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Affiliation(s)
- Stephen Reid
- Division of Urology, McGill University, Montreal, QC
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Long-Term Outcomes Following Bladder Augmentation in Children with Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0268-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Avallone MA, Prince MK, Guralnick ML, O’Connor RC. Long-Term Enterocystoplasty Follow-Up: Metabolic and Neoplastic Concerns. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0266-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Talab SS, Kajbafzadeh AM, Elmi A, Tourchi A, Sabetkish S, Sabetkish N, Monajemzadeh M. Bladder reconstruction using scaffold-less autologous smooth muscle cell sheet engineering: early histological outcomes for autoaugmentation cystoplasty. BJU Int 2014; 114:937-45. [DOI: 10.1111/bju.12685] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Saman S. Talab
- Section of Tissue Engineering and Stem Cells Therapy; Pediatric Urology Research Center; Tehran Iran
| | | | - Azadeh Elmi
- Section of Tissue Engineering and Stem Cells Therapy; Pediatric Urology Research Center; Tehran Iran
| | - Ali Tourchi
- Section of Tissue Engineering and Stem Cells Therapy; Pediatric Urology Research Center; Tehran Iran
| | - Shabnam Sabetkish
- Section of Tissue Engineering and Stem Cells Therapy; Pediatric Urology Research Center; Tehran Iran
| | - Nastaran Sabetkish
- Section of Tissue Engineering and Stem Cells Therapy; Pediatric Urology Research Center; Tehran Iran
| | - Maryam Monajemzadeh
- Department of Pathology; Children's Medical Center; Tehran University of Medical Sciences; Tehran Iran
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Landa Juárez S, Fernández AMC, Castro NR, De La Cruz Yañez H, Hernández CG. Laparoscopic Ureterocystoplasty with Mitrofanoff System. J Laparoendosc Adv Surg Tech A 2014; 24:422-7. [DOI: 10.1089/lap.2013.0290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sergio Landa Juárez
- Pediatric Urology Department, Pediatric Hospital CMN SXXI, Mexican Social Security Institute, Mexico City, Mexico
- Pediatric Surgery Department, Médica Sur Hospital, Mexico City, Mexico
| | - Ana María Castillo Fernández
- Pediatric Urology Department, Pediatric Hospital CMN SXXI, Mexican Social Security Institute, Mexico City, Mexico
| | | | - Hermilo De La Cruz Yañez
- Pediatric Urology Department, Pediatric Hospital CMN SXXI, Mexican Social Security Institute, Mexico City, Mexico
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Hsu LN, Lin SE, Luo HL, Chang JC, Chiang PH. Double-barreled Colon Conduit and Colostomy for Simultaneous Urinary and Fecal Diversions: Long-term Follow-up. Ann Surg Oncol 2014; 21 Suppl 4:S522-7. [DOI: 10.1245/s10434-013-3478-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Indexed: 01/22/2023]
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Adenoma-carcinoma Sequence in the Bladder After Augmentation Cystoplasty. Urol Case Rep 2014; 2:73-4. [PMID: 26955550 PMCID: PMC4733006 DOI: 10.1016/j.eucr.2014.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 01/31/2014] [Indexed: 11/28/2022] Open
Abstract
We present a case of a 64-year-old woman showing multistep progression from adenoma to adenocarcinoma in the bladder 46 years after augmentation ileocystoplasty. She underwent augmentation ileocystoplasty for tuberculous contracted bladder at 18 years. After 44 years, tubulovillous adenomas were found and resected at the ileovesical anastomosis site. After 2 more years, bladder tumors recurred and revealed adenocarcinomas. Finally, radical cystectomy was required because of frequent recurrence and tumor extensiveness. To our knowledge, this is the first case demonstrating adenoma-carcinoma sequence histopathologically in the bladder after augmentation cystoplasty, indicating multistep carcinogenesis similar to intestinal carcinogenesis.
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Kumar S, Sharma R, Bera MK. Dilatation and curettage of urinary bladder: A rarity. Adv Biomed Res 2014; 3:31. [PMID: 24592378 PMCID: PMC3928834 DOI: 10.4103/2277-9175.124682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 07/16/2013] [Indexed: 12/02/2022] Open
Abstract
Twenty-eight-year-old female while undergoing a medical termination of pregnancy (MTP) encounter complete urethral loss and massive bladder curettage. After resuscitation, she developed continuous urinary leakage followed by progressive decline in urine output. Case is highlighted here because of the massive vesico-urethral trauma because of MTP, leading to permanent urinary diversion.
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Affiliation(s)
- Suresh Kumar
- Departments of Urology, Institute of Kidney Disease and Research Centre, Institute of Transplant Sciences (IKDRC-ITS), Ahmedabad, India
| | - Ritu Sharma
- Department of Gynecology and Obstetrics, NRS Medical College, Kolkata, India
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Jednak R. The evolution of bladder augmentation: from creating a reservoir to reconstituting an organ. Front Pediatr 2014; 2:10. [PMID: 24575395 PMCID: PMC3918659 DOI: 10.3389/fped.2014.00010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/26/2014] [Indexed: 01/20/2023] Open
Abstract
Bladder augmentation was first described in 1899. The goal at the time was to establish the ideal method to create a simple capacious reservoir for the safe storage of urine. That simple idea has over the last 100 years grown into one of the most dynamic areas in Pediatric Urology. Creative minds and hands from individuals in multiple disciplines have led us from creating a reservoir to the threshold of recreating a functional organ. In this review, we look at the historical evolution of bladder augmentation and how it exponentially grew in scope from those initial descriptions of intestinocystoplasty to the work being reported today in the field of tissue engineering.
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Affiliation(s)
- Roman Jednak
- Division of Pediatric Urology, The Montreal Children's Hospital, McGill University Health Centre , Montreal, QC , Canada
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Kaplan AG, Ghoniem GM. Long-Term Outcomes of Augmentation Enterocystoplasty with a Catheterizable Channel in the Adult Neurogenic Population. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0210-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Seromuscular grafts for bladder reconstruction: extra-luminal demucosalisation of the bowel. Urology 2013; 80:1147-50. [PMID: 23107403 PMCID: PMC3494834 DOI: 10.1016/j.urology.2012.07.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 07/30/2012] [Accepted: 07/30/2012] [Indexed: 12/01/2022]
Abstract
Objective To develop a robust sterile, fully demucosalized and vascularized seromuscular patch for use as an adjunct to novel bioengineering techniques aimed at augmenting, reconstructing, or replacing the bladder because of endstage disease. To eliminate deep colonic epithelial crypts to prevent the possibility of colonocyte regrowth. To maintain sterility by excluding the possibility of contamination from the bowel contents. Methods Pilot studies were performed on euthanized pigs to optimize the technique, with tissue samples examined by immunohistochemistry. In vivo, vascularized seromuscular colonic flaps were created from the bowel exterior in 7 large white hybrid pigs. The dissection was facilitated by placing an inflated Foley catheter within the colonic lumen. The seromuscular ends were approximated with 5/0 Vicryl sutures and excess mucosa intussuscepted within the lumen. Demucosalized flaps were used to augment the bladder by composite cystoplasty and were examined immunohistochemically at 3 months. Results Pilot studies showed that the technique was successful in creating seromuscular segments with no epithelial remnants. When applied surgically, the seromuscular flaps survived and showed no evidence of colonocyte regrowth at 3 months. Conclusion Extraluminal dissection creates robust seromuscular flaps and prevents both regrowth by colonic epithelial cells and contamination of the tissue by exposure to the bowel contents. This technique should find application in a range of bladder reconstruction techniques, including composite cystoplasty and autoaugmentation.
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Biers SM, Venn SN, Greenwell TJ. The past, present and future of augmentation cystoplasty. BJU Int 2011; 109:1280-93. [PMID: 22117733 DOI: 10.1111/j.1464-410x.2011.10650.x] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
What's known on the subject? And what does the study add? There is a wealth of evidence on the development, indications, outcomes and complications of augmentation cystoplasty (AC). Over the last decade, new evidence has been emerging to influence our clinical practice and application of this technique. AC is indicated as part of the treatment pathway for both neurogenic and idiopathic detrusor overactivity, usually where other interventions have failed or are inappropriate. The most commonly used technique remains augmentation with a detubularised patch of ileum (ileocystoplasty). Controversy persists over the role of routine surveillance following ileocystoplasty for the detection of subsequent bladder carcinoma; however the indication for surveillance after gastrocystoplasty is clearer due to a rising incidence of malignancy in this group. Despite a reduction in the overall numbers of AC operations being performed, it clearly still has a role to play, which we re-examine with contemporary studies from the last decade.
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Affiliation(s)
- Suzanne M Biers
- Department of Urology, Leicester General Hospital, Leicester, UK.
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Abstract
INTRODUCTION To review the incidence and risks of bladder cancer following gastrointestinal augmentations done for congenial anomalies in childhood. MATERIALS AND METHODS A literature search using PubMed and Ovid Medline search engines was performed. MeSH terms evaluated were; bladder augmentations, enterocystoplasty, gastrocystoplasty, spina bifida, spinal dysraphism, myelodysplasia, neural tube defects, posterior urethral valves and bladder exstrophy were cross referenced with the terms, bladder cancer and urinary bladder neoplasm. All patients who developed a bladder cancer following a bladder augmentation for a congenital anomaly were reviewed. RESULTS A total of 20 cases of bladder cancer following augmentations for congential anomalies, were identified, 9 arose following ileal cystoplasty, 3 following colocystolasty and 8 following gastrocystoplasty. The incidence of cancer developing per decade following surgery was 1.5% for ileal/colonic and 2.8% for gastric bladder augmentations. The majority of cancers developing within the augmented bladder are at advanced stages at the time of diagnosis (60%; 12/20 cases were ≥T3 at diagnosis). Several of the cases that developed occurred in patients exposed to known carcinogenic stimuli and/or arose in bladders with a known predisposition to carcinoma. CONCLUSION Patients augmented with ileal or colonic segment for a congenital bladder anomaly have a 7-8 fold and gastric augments a 14-15 fold increased risk for the development of bladder cancer over standard norms. Published data is however unable to determine if gastrointestinal bladder augmentation is an independent risk factor for cancer over the inherent risk of cancer arising from a congenitally abnormal bladder.
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Affiliation(s)
- Douglas A Husmann
- Department of Urology 7, Gonda, Mayo Clinic Rochester, MN 55905, USA
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Higuchi TT, Fox JA, Husmann DA. Annual endoscopy and urine cytology for the surveillance of bladder tumors after enterocystoplasty for congenital bladder anomalies. J Urol 2011; 186:1791-5. [PMID: 21944100 DOI: 10.1016/j.juro.2011.07.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE It is currently recommended that patients with congenital bladder anomalies managed by enterocystoplasty undergo annual surveillance with urine cytology and endoscopy. We reviewed our experience with this protocol and suggest modifications based on this experience. MATERIALS AND METHODS A total of 65 patients 10 years or more after enterocystoplasty were placed on an annual surveillance protocol consisting of interval medical history, renal-bladder ultrasound, serum B12, electrolytes, creatinine, urinalysis, urine cytology and endoscopy. RESULTS Of the 65 patients 50 (77%) with enterocystoplasty (ileal in 40 and colonic in 10) remain on the protocol. Median age at the initiation of surveillance was 28 years (range 24 to 40) with a median time from augmentation of 15 years (range 12 to 29). During the first 5 years of surveillance 26 of 250 cytology results (10.5%) were suspicious for cancer. Further evaluation revealed no evidence of malignancy. Specificity for cytology was 90% with unknown sensitivity. Of 250 surveillance endoscopic evaluations 4 lesions (1.6%) were identified and biopsied/removed. Pathological evaluation revealed 1 adenomatous polyp, 1 squamous metaplasia and 2 nephrogenic adenomas. Due to the low event rate and high cost routine cytology and endoscopy were discontinued after each patient completed 5 years of followup and annual evaluations were maintained. No tumors developed during the median surveillance interval of 15 years (range 12 to 20). Currently median patient age is 42 years (range 36 to 59) and median time since augmentation is 27 years (range 23 to 40). CONCLUSIONS Due to the low incidence of malignancy, lack of proven benefit and enhanced cost containment we recommend that annual surveillance endoscopy and cytology be discontinued.
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Loeser A, Neumann M, Kocot A, Vergho DC, Spahn M, Riedmiller H. Serum carcino-embryonic antigen (CEA) and its possible use as tumor marker for secondary tumors in urinary intestinal reservoirs. Urol Oncol 2011; 31:644-8. [PMID: 21803617 DOI: 10.1016/j.urolonc.2011.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 02/08/2011] [Accepted: 02/22/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Serum carcino-embryonic antigen (CEA) has become a useful tumor marker in patients with colorectal adenocarcinoma. Patients who undergo uroenteric reconstruction, such as urinary diversion (UD), have an increased risk of developing malignant changes in their UD. We compared serum CEA levels in patients with different types of UD, evaluating long-term CEA changes and assessing its potential for use as a tumor marker of malignant transformation in the UD. MATERIALS AND METHODS Serum CEA was evaluated 3 to 122 months after surgery in 177 patients with different types of UD and retrospectively analyzed. The normal range for CEA was 0.2-3.4 μg/l. No patient had a history of colorectal cancer. RESULTS A total of 443 CEA samples from 177 patients were evaluated. CEA was elevated (up to 32 μg/l) in 122 samples (27.5%) from 59 patients (33.3%). Patients with Mainz Pouch II had significantly higher CEA levels (P = 0.037) than patients with other forms of UD. CEA levels increased significantly in the study population during follow-up (P = 0.0000007). Five of the patients (2.8%) developed a secondary neoplasm, 4 of whom had elevated CEA. Three neoplasms (urothelial cancer) were located outside the UD. Only 2 tumors were actually located in the UD: an urothelial cancer at the uretero-colonic anastomosis of the UD with normal CEA levels, and a colonic adenoma at the bottom of the UD with elevated CEA levels. No patient had adenocarcinoma in the UD. CONCLUSION Elevated serum CEA is a common finding in patients with UD using bowel segments (33.3%), especially in patients with rectal reservoirs. Serum CEA has a tendency to increase over time in patients with UD but is not a valuable marker of secondary neoplasms in these patients.
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Affiliation(s)
- Andreas Loeser
- Department of Urology and Paediatric Urology, Central Laboratory, Julius-Maximilians-University Medical School, Wuerzburg, Germany.
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Abstract
Objectives: In this review, we discuss the treatment of refractory overactive bladder (OAB) that has not adequately responded to medication therapy and we propose an appropriate care pathway to the treatment of OAB. We also attempt to address the cost of OAB treatments. Materials and Methods: A selective expert review of the current literature on the subject of refractory OAB using MEDLINE was performed and the data is summarized. We also review our experience in treating refractory OAB. The role and outcomes of various treatment options for refractory OAB are discussed and combined therapy with oral anticholinergics is explored. Emerging remedies including intravesical botulinum toxin injection and pudendal neuromodulation are also reviewed, along with conventional surgical options. Results: In general behavioral therapy, pelvic floor electrical stimulation, magnetic therapy and posterior tibial nerve stimulation (PTNS), have shown symptom decreases in 50-80% of patients with OAB. Depending on the study, combination therapy with oral anticholinergics seems to improve efficacy of behavioral therapy and PTNS in approximately 10-30%. In multicenter, long-term randomized controlled trials, sacral neuromodulation has been shown to improve symptoms of OAB and OAB incontinence in up to 80% of the patients treated. Studies involving emerging therapies such as pudendal serve stimulation suggest that there may be a 15-20% increase in efficacy over sacral neuromodulation, but long-term studies are not yet available. Another emerging therapy, botulinum toxin, is also showing similar success in reducing OAB symptoms in 80-90% of patients. Surgical approaches, such as bladder augmentation, are a last resort in the treatment of OAB and are rarely used at this point unless upper tract damage is a concern and all other treatment options have been exhausted. Conclusion: The vast majority of OAB patients can be managed successfully by behavioral options with or without anticholinergic medications. When those fail, neuromodulation or intravesical botulinum toxin therapies are successful alternatives for most of the remaining group. We encourage practitioners responsible for the care of OAB patients to gain experience with these options. More research is needed to assess the cost-effectiveness of various OAB treatments
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Affiliation(s)
- Ronald W Glinski
- Center for Continence Care and Female Urology, Metro Urology Specialists, 2550 University Avenue West, Suite 240N, St. Paul, MN 55114
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Bladder augmentation using tissue-engineered autologous oral mucosal epithelial cell sheets grafted on demucosalized gastric flaps. Transplantation 2011; 91:700-6. [PMID: 21301400 DOI: 10.1097/tp.0b013e31820e0170] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND At present, autologous intestinal segments are often used for bladder reconstruction. However, the gastrointestinal mucosa often causes various complications. METHODS Oral mucosal tissues were obtained from the buccal cavity of beagle dogs. Primary oral mucosal epithelial cells were cultured on temperature-responsive culture dishes with a mitomycin C-treated 3T3 feeder layer for 2 weeks. Cultured epithelial cells were harvested as contiguous sheets by reducing the temperature to 20°C. The study consisted of three groups. In group 1, oral mucosal epithelial cell sheets were autografted on demucosalized gastric flaps. Next, the gastric flaps with the oral mucosal epithelial cell sheets were used for bladder reconstruction. Bladder reconstruction was once immediately and then 5 days after epithelial cell sheet grafting in groups 2 and 3, respectively. Three weeks after bladder reconstruction, the gastric flaps with the oral mucosal epithelial cell sheets were examined by immunohistology. RESULTS Flaps grafted with oral mucosal epithelial cell sheets showed epithelial regeneration in groups 1 and 3. Regenerated epithelia were stratified and similar to native oral mucosa. However, the regenerated epithelium was absent from the reconstructive segment, and urothelial ingrowth was observed in group 2. Macroscopically, all reconstructive segments showed contracture. CONCLUSIONS We successfully performed a bladder reconstruction using oral mucosal epithelial cell sheet-grafted flaps that exhibited epithelial regeneration. Further study should consider shrinkage prevention.
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Padmanabhan P. Bladder Augmentation and the Risk of Carcinoma. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cell cycle control and DNA damage response of conditionally immortalized urothelial cells. PLoS One 2011; 6:e16595. [PMID: 21305048 PMCID: PMC3030598 DOI: 10.1371/journal.pone.0016595] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 01/06/2011] [Indexed: 11/25/2022] Open
Abstract
Background Children with complex urogenital anomalies often require bladder reconstruction. Gastrointestinal tissues used in bladder augmentations exhibit a greatly increased risk of malignancy, and the bladder microenvironment may play a role in this carcinogenesis. Investigating the influences of the bladder microenvironment on gastrointestinal and urothelial cell cycle checkpoint activation and DNA damage response has been limited by the lack of an appropriate well-differentiated urothelial cell line system. Methodology/Principal Findings To meet this need, we have developed a well-differentiated conditionally immortalized urothelial cell line by isolating it from the H-2Kb-tsA58 transgenic mouse. These cells express a thermosensitive SV40 large T antigen that can be deactivated by adjustment of cell culture conditions, allowing the cell line to regain normal control of the cell cycle. The isolated urothelial cell line demonstrates a polygonal, dome-shaped morphology, expresses cytokeratin 18, and exhibits well-developed tight junctions. Adaptation of the urothelial cell line to hyperosmolal culture conditions induces expression of both cytokeratin 20 and uroplakin II, markers of a superficial urothelial cell or “umbrella cell.” This cell line can be maintained indefinitely in culture under permissive conditions but when cultured under non-permissive conditions, large T antigen expression is reduced substantially, leading to increased p53 activity and reduced cellular proliferation. Conclusions/Significance This new model of urothelial cells, along with gastrointestinal cell lines previously derived from the H-2Kb-tsA58 transgenic mouse, will be useful for studying the potential mechanisms of carcinogenesis of the augmented bladder.
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Rosenberg S, Pizov G, Gofrit ON, Pode D. Adenocarcinoma in an Augmented Bladder: Result of a Sequential Dysplastic Process. J Clin Oncol 2011; 29:e1-2. [DOI: 10.1200/jco.2010.30.8981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shilo Rosenberg
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Galina Pizov
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N. Gofrit
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dov Pode
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Kocot A, Spahn M, Loeser A, Lopau K, Gerharz EW, Riedmiller H. Long-Term Results of a Staged Approach: Continent Urinary Diversion in Preparation for Renal Transplantation. J Urol 2010; 184:2038-42. [DOI: 10.1016/j.juro.2010.06.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Arkadius Kocot
- Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany
| | - Martin Spahn
- Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany
| | - Andreas Loeser
- Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany
| | - Kai Lopau
- Department of Nephrology, Julius-Maximilians-University Medical School, Würzburg, Germany
| | - Elmar W. Gerharz
- Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany
| | - Hubertus Riedmiller
- Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany
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Chun YW, Lim H, Webster TJ, Haberstroh KM. Nanostructured bladder tissue replacements. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2010; 3:134-145. [PMID: 20730887 DOI: 10.1002/wnan.89] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The interaction between cells or tissues and natural or synthetic materials which mimic the natural biological environment has been a matter of great interest in tissue engineering. In particular, surface properties of biomaterials (regardless of whether they are natural or synthetic) have been optimized using nanotechnology to improve interactions with cells for regenerative medicine applications. Specifically, in vivo and in vitro studies have demonstrated greater bladder tissue growth on polymeric surfaces with nanoscale to submicron surface features. Improved bladder cell responses on nanostructured polymers have been correlated to unique nanomaterial surface features leading to greater surface energy which influences initial protein interactions. Moreover, coupled with the observed greater in vitro and in vivo bladder cell adhesion as well as proliferation on nanostructured compared to conventional synthetic polymers, decreased calcium stone formation has also been measured. In this article, the importance of nanostructured biomaterial surface features for bladder tissue replacements are reviewed with thoughts on future directions for this emerging field.
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Affiliation(s)
- Young Wook Chun
- Division of Engineering, Brown University, Providence, RI, USA
| | - Hojean Lim
- Department of Neuroscience, College of William and Mary, Williamsburg, VA, USA
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Teapot Ureterocystoplasty and Ureteral Mitrofanoff Channel for Bilateral Megaureters: Technical Points and Surgical Results of Neurogenic Bladder. J Urol 2010; 183:1168-74. [DOI: 10.1016/j.juro.2009.11.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Indexed: 11/17/2022]
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