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Chin FW, Chan SC, Veerakumarasivam A. Homeobox Gene Expression Dysregulation as Potential Diagnostic and Prognostic Biomarkers in Bladder Cancer. Diagnostics (Basel) 2023; 13:2641. [PMID: 37627900 PMCID: PMC10453580 DOI: 10.3390/diagnostics13162641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/27/2023] Open
Abstract
Homeobox genes serve as master regulatory transcription factors that regulate gene expression during embryogenesis. A homeobox gene may have either tumor-promoting or tumor-suppressive properties depending on the specific organ or cell lineage where it is expressed. The dysregulation of homeobox genes has been reported in various human cancers, including bladder cancer. The dysregulated expression of homeobox genes has been associated with bladder cancer clinical outcomes. Although bladder cancer has high risk of tumor recurrence and progression, it is highly challenging for clinicians to accurately predict the risk of tumor recurrence and progression at the initial point of diagnosis. Cystoscopy is the routine surveillance method used to detect tumor recurrence. However, the procedure causes significant discomfort and pain that results in poor surveillance follow-up amongst patients. Therefore, the development of reliable non-invasive biomarkers for the early detection and monitoring of bladder cancer is crucial. This review provides a comprehensive overview of the diagnostic and prognostic potential of homeobox gene expression dysregulation in bladder cancer.
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Affiliation(s)
- Fee-Wai Chin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia;
| | - Soon-Choy Chan
- School of Liberal Arts, Science and Technology, Perdana University, Kuala Lumpur 50490, Malaysia
| | - Abhi Veerakumarasivam
- School of Medical and Life Sciences, Sunway University, Bandar Sunway 47500, Selangor, Malaysia
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Kitamura K, Isotani S, Muto S, Horie S. Efficacy of pembrolizumab in a rare type of bladder cancer arising 25 years after augmentation cystoplasty. BMJ Case Rep 2022; 15:e244719. [PMID: 35354571 PMCID: PMC8968561 DOI: 10.1136/bcr-2021-244719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 11/04/2022] Open
Abstract
We report using the checkpoint inhibitor, pembrolizumab, as part of a multimodal treatment plan in a 36-year-old man with a rare bladder cancer arising 25 years after augmentation cystoplasty (sigmoid colonic cystectomy for neuropathic bladder was performed at 9 years old). On a regular clinic visit for clean intermittent catheterisation, the patient presented with gross haematuria and was diagnosed with urothelial carcinoma with sarcomatoid change. Gemcitabine and cisplatin-based neoadjuvant chemotherapy was unsuccessful, and pembrolizumab infusions (200 mg every 3 weeks) were initiated. A partial response was confirmed after six courses of pembrolizumab, with significant tumour shrinkage. A radical cystoprostatectomy and ileal conduit construction was performed, and pathology revealed no evidence of malignancy (ypT0, N0). The patient was successfully treated with the anti-programmed death-1 inhibitor, pembrolizumab, which was curative after total cystectomy. Further research is required to elucidate the potential role of checkpoint inhibitors in bladder cancers arising after augmentation cystoplasty.
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Affiliation(s)
- Kosuke Kitamura
- Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Urology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Shuji Isotani
- Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Satoru Muto
- Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Shigeo Horie
- Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Lopez-Beltran A, Cimadamore A, Montironi R, Cheng L. Molecular pathology of urothelial carcinoma. Hum Pathol 2021; 113:67-83. [PMID: 33887300 DOI: 10.1016/j.humpath.2021.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022]
Abstract
The current personalized oncology era has witnessed significant efforts to integrate clinical, pathological, and molecular classifications. The growing need for molecular biomarkers to feed personalized oncology, together with the unprecedented wealth of knowledge on the molecular basis of bladder cancer, has led to a novel approach to this disease, incorporating molecularly generated data in clinical practice for locally advanced or metastatic disease. Translational research allows a better understanding of the early events in the development of urothelial carcinoma in the urinary bladder. Thus, mutations in the KMT2D and KDM6A chromatin-modifying genes confer competitive advantages that drive cells to colonize larger regions of the urothelium. Additional mutations in TP53, PIK3CA, FGFR3, or RB1 genes then trigger the process of malignant transformation in the urothelium. In the current review, we provide an overview of what could be the expected transition from the morphology-based classification to a combined, molecularly enriched reporting of clinically meaningful parameters aiming to promote personalized oncology of urothelial carcinoma.
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Affiliation(s)
- Antonio Lopez-Beltran
- Department of Morphological Sciences, Cordoba University Medical School, Cordoba, E-14004, Spain.
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, 60126, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, 60126, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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Stein R, Bogaert G, Dogan HS, Hoen L, Kocvara R, Nijman RJM, Quaedackers J, Rawashdeh YF, Silay MS, Tekgul S, Radmayr C. EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management. Neurourol Urodyn 2019; 39:498-506. [PMID: 31794087 DOI: 10.1002/nau.24248] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/16/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Treatment in children and adolescents with a neurogenic bladder is primarily conservative with the goal of preserving the upper urinary tract combined with a good reservoir function of the bladder. However, sometimes-even in childhood-conservative management does not prevent the development of a low-compliant bladder or overactive detrusor. MATERIAL & METHODS After a systematic literature review covering the period 2000-2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. RESULTS In these patients, surgical interventions such as botulinum toxin A injections into the detrusor muscle, bladder augmentation, and even urinary diversion may become necessary to preserve the function of the upper (and lower) urinary tracts. The creation of a continent catheterizable channel should be offered to patients with difficulties performing transurethral clean intermittent catheterization. However, a revision rate of up to 50% needs to be considered. With increasing age continence of urine and stool becomes progressively more important. In patients with persistent weak bladder outlets, complete continence can be achieved only by surgical interventions creating a higher resistance/obstruction at the level of the bladder outlet with a success rate of up to 80%. In some patients, bladder neck closure and the creation of a continent catheterizable stoma is an option. CONCLUSION In all these patients close follow-up is mandatory to detect surgical complications and metabolic consequences early.
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Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Guy Bogaert
- Department of Urology, University of Leuven, Belgium
| | - Hasan S Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Lisette Hoen
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Radim Kocvara
- Department of Urology, First Faculty of Medicine in Praha, General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | | | - Mesrur S Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
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Perrouin-Verbe MA, Léon P, Denys P, Mongiat-Artus P, Chartier-Kastler E, Phé V. Long-term functional outcomes of augmentation cystoplasty in adult spina bifida patients: A single-center experience in a multidisciplinary team. Neurourol Urodyn 2018; 38:330-337. [PMID: 30350892 DOI: 10.1002/nau.23857] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/23/2018] [Indexed: 12/19/2022]
Abstract
AIM To report the very long-term functional outcomes of augmentation cystoplasty (AC) in adult spina bifida patients. METHODS All consecutive adult spina bifida patients who underwent AC between 1991 and 2008 were enrolled. Early postoperative complications (Clavien-Dindo classification) and long-term outcomes (voiding modalities, urodynamic parameters, renal function, continence, and quality of life) were assessed. RESULTS Twenty-eight patients with a median age of 20 years (IQR 17-25) were included. They all underwent AC with a supratrigonal cystectomy (SC). The median follow-up was 13.6 years (IQR 6-16.5). Thirteen early postoperative complications (12 grade I-II, 1 grade III) were observed in 11 patients (39%). Eight patients (29%) had upper urinary tract infections managed with antibiotics, with 2 patients requiring ureteral stents. Bladder stones occurred in 2 patients (7%) and were managed with endoscopy and cystostomy. One bladder perforation was reported. One bladder cancer was observed 26 years after surgery. Creatinine clearance and all urodynamic parameters were significantly improved post-operatively. The overall complication and reoperation rates were 57% and 14%, respectively. At last follow up, the continence rate was 71% (n = 20), with 93% (n = 26) performing intermittent self-catheterization. Quality of life was improved for 71% of patients. CONCLUSION In adult spina bifida population, AC is a high-risk procedure with an overall complication rate of 57% and a reoperation rate of 14%. However, AC is beneficial to the overall health of the patients since it provides a satisfying continence rate, an improvement of quality of life, and long-term protection of the upper urinary tract.
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Affiliation(s)
- Marie-Aimée Perrouin-Verbe
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Priscilla Léon
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France
| | | | - Emmanuel Chartier-Kastler
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Phé
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
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Chang J, Yao M, Li Y, Zhao D, Hu S, Cui X, Liu G, Shi Q, Wang Y, Yang Y. MicroRNAs for osteosarcoma in the mouse: a meta-analysis. Oncotarget 2018; 7:85650-85674. [PMID: 27852052 PMCID: PMC5356766 DOI: 10.18632/oncotarget.13333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 09/25/2016] [Indexed: 01/18/2023] Open
Abstract
Osteosarcoma (OS) is the most common primary malignant bone carcinoma with high morbidity that happens mainly in children and young adults. As the key components of gene-regulatory networks, microRNAs (miRNAs) control many critical pathophysiological processes, including initiation and progression of cancers. The objective of this study is to summarize and evaluate the potential of miRNAs as targets for prevention and treatment of OS in mouse models, and to explore the methodological quality of current studies. We searched PubMed, Web of Science, Embase, Wan Fang Database, VIP Database, China Knowledge Resource Integrated Database, and Chinese BioMedical since their beginning date to 10 May 2016. Two reviewers separately screened the controlled studies, which estimate the effects of miRNAs on osteosarcoma in mice. A pair-wise analysis was performed. Thirty six studies with enough randomization were selected and included in the meta-analysis. We found that blocking oncogenic or restoring decreased miRNAs in cancer cells could significantly suppress the progression of OS in vivo, as assessed by tumor volume and tumor weight. This meta-analysis suggests that miRNAs are potential therapeutic targets for OS and correction of the altered expression of miRNAs significantly suppresses the progression of OS in mouse models, however, the overall methodological quality of studies included here was low, and more animal studies with the rigourous design must be carried out before a miRNA-based treatment could be translated from animal studies to clinical trials.
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Affiliation(s)
- Junli Chang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Yao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yimian Li
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dongfeng Zhao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shaopu Hu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuejun Cui
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gang Liu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Qi Shi
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongjun Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanping Yang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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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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Shelmerdine SC, Lorenzo AJ, Gupta AA, Chavhan GB. Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses. Radiographics 2017; 37:1872-1891. [DOI: 10.1148/rg.2017170031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Susan C. Shelmerdine
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
| | - Armando J. Lorenzo
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
| | - Abha A. Gupta
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
| | - Govind B. Chavhan
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
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10
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Bower WF, Christie D, DeGennaro M, Latthe P, Raes A, Romao RLP, Taghizadeh A, Wood D, Woodhouse CRJ, Bauer SB. The transition of young adults with lifelong urological needs from pediatric to adult services: An international children's continence society position statement. Neurourol Urodyn 2016; 36:811-819. [PMID: 27177245 DOI: 10.1002/nau.23039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 04/28/2016] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Children with urinary tract disorders managed by teams, or individual pediatricians, urologists, nephrologists, gastroenterologists, neurologists, psychologists, and nurses at some point move from child-centered to adult-centered health systems. The actual physical change is referred to as the transfer whilst the process preceding this move constitutes transition of care. Our aims are twofold: to identify management and health-service problems related to children with congenital or acquired urological conditions who advance into adulthood and the clinical implications this has for long-term health and specialist care; and, to understand the issues facing both pediatric and adult-care clinicians and to develop a systems-approach model that meets the needs of young adults, their families and the clinicians working within adult services. METHODS Information was gleaned from presentations at an International Children's Continence Society meeting with collaboration from the International Continence Society, that discussed problems of transfer and transitioning such children. Several specialists attending this conference finalized this document identifying issues and highlighting ways to ease this transition and transfer of care for both patients and practitioners. RESULTS The consensus was, urological patients with congenital or other lifelong care needs, are now entering adulthood in larger numbers than previously, necessitating new planning processes for tailored transfer of management. Adult teams must become familiar with new clinical problems in multiple organ systems and anticipate issues provoked by adolescence and physical growth. During this period of transitional care the clinician or team assists young patients to build attitudes, skills and understanding of processes needed to maximize function of their urinary tract-thus taking responsibility for their own healthcare needs. Preparation must also address, negotiating adult health care systems, psychosocial, educational or vocational issues, and mental wellbeing. CONCLUSIONS Transitioning and transfer of children with major congenital anomalies to clinicians potentially unfamiliar with their conditions requires improved education both for receiving doctors and children's families. Early initiation of the transition process should allow the transference to take place at appropriate times based on the child's development, and environmental and financial factors. Neurourol. Urodynam. 36:811-819, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Wendy F Bower
- SubAcute Services, Royal Park Campus, The Royal Melbourne Hospital, Melbourne, Australia
| | - Deborah Christie
- Consultant Clinical Psychologist, University College London Hospitals NHS Trust
| | - Mario DeGennaro
- Department of Nephrology Urology, Head, Division of Urology and Urodynamics, Bambino Gesù Children Hospital, Roma, Italy
| | - Pallavi Latthe
- Consultant Obstetrician and Gynaecologist, Birmingham Women's NHS Foundation Trust, Birmingham, United Kingdom
| | - Ann Raes
- Professor and Pediatric Nephrologist, Ghent University Hospital and Ghent University, Belgium, Europe
| | - Rodrigo L P Romao
- Assistant Professor of Surgery and Urology, IWK Health Centre, Dalhousie University Halifax, Nova Scotia, Canada
| | - Arash Taghizadeh
- Consultant Pediatric Urologist, Evelina London Children's Hospital and Guy's Hospital, London, United Kingdom
| | - Dan Wood
- Consultant in Adolescent and Reconstructive Urology, University College London Hospitals
| | | | - Stuart B Bauer
- Department of Urology, Harvard Medical School and Senior Associate, Boston Children's Hospital
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Abstract
The population of patients with congenital genitourinary disorders has unique healthcare demands that require an additional interpersonal and medical skillset. Adults with congenital neurogenic bladder may have complex urinary anatomy, abnormal bladder function and atypical voiding mechanisms. While initial surgery and care of these patients is typically managed by a pediatric urologist, growth and development into adulthood necessitates transition of care to an adult care team. Failure of transition to adult care has been demonstrated to result in lower quality healthcare and increased risk of developing preventable complications.
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Affiliation(s)
- Christopher J Loftus
- 1 Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, USA ; 2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - Hadley M Wood
- 1 Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, USA ; 2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
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12
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Miranda EGD, Miranda CTCBCD, Lopes AIP, Santana DM, Lemos Filho JEP, Diniz TP, Silva JF, Waisberg J. Expression of P53, HER2 and Ki67 proteins in rats subjected to bladder augmentation with stomach, colon and ileum. Acta Cir Bras 2016; 31:44-52. [PMID: 26840355 DOI: 10.1590/s0102-865020160010000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/23/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To study the expression of HER2, p53 and Ki67 proteins in cystoplasties. METHODS Sixty rats were distributed randomly into three groups of 20 animals. Bladder augmentation was held to increase with ileum (Group I), colon (Group II) and stomach (Group III). Tissue samples of neobladder was collected from each rat to its own control. The animals were sacrificed after 12 weeks. The neobladder was withdrawn for immunohistochemistry analysis of p53, HER2 and Ki67 expression. Wilcoxon and Mann-Whitney tests were used for statistical study. RESULTS There were no significant changes in the expression of p53 and HER2 proteins. It was observed significant increase (p<0.0001) in Ki67 expression in all groups, when compared with their respective controls. When the study groups were compared with each other, there was increase of cell proliferation in the largest gastrocystoplasties in respect of ileocystoplasties (p=0.004) and colocystoplasties (p=0.003). CONCLUSION We observed significant increase of cell proliferation characterized by Ki67 protein in the digestive tract of the ileocystoplasties, the colocystoplasties and the gastrocystoplasties and this increase was significantly greater in gastrocystoplasties.
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14
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Loftus C, Wood H. Emerging Concepts in Transitional Care of Congenital Genitourinary Reconstructions. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0326-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Abstract
Neurogenic bladder dysfunction due to spinal cord injury poses a significant threat to the well-being of patients. Incontinence, renal impairment, urinary tract infection, stones, and poor quality of life are some complications of this condition. The majority of patients will require management to ensure low pressure reservoir function of the bladder, complete emptying, and dryness. Management typically begins with anticholinergic medications and clean intermittent catheterization. Patients who fail this treatment because of inefficacy or intolerability are candidates for a spectrum of more invasive procedures. Endoscopic managements to relieve the bladder outlet resistance include sphincterotomy, botulinum toxin injection, and stent insertion. In contrast, patients with incompetent sphincters are candidates for transobturator tape insertion, sling surgery, or artificial sphincter implantation. Coordinated bladder emptying is possible with neuromodulation in selected patients. Bladder augmentation, usually with an intestinal segment, and urinary diversion are the last resort. Tissue engineering is promising in experimental settings; however, its role in clinical bladder management is still evolving. In this review, we summarize the current literature pertaining to the pathology and management of neurogenic bladder dysfunction in patients with spinal cord injury.
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Affiliation(s)
- Waleed Al Taweel
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Raouf Seyam
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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16
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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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Molecular characteristics of urothelial neoplasms in children and young adults: a subset of tumors from young patients harbors chromosomal abnormalities but not FGFR3 or TP53 gene mutations. Mod Pathol 2014; 27:1540-8. [PMID: 24743222 DOI: 10.1038/modpathol.2014.48] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/25/2014] [Accepted: 01/26/2014] [Indexed: 01/12/2023]
Abstract
Urothelial neoplasms in children and young adult patients are rare and hypothesized to have a lower rate of recurrence and progression than those of older adults. Because of their rarity, data regarding molecular abnormalities in these tumors are limited. We studied molecular characteristics of urothelial neoplasms from patients under age 30 years using UroVysion fluorescence in situ hybridization (chromosomes 3, 7, 17, and 9p21) and DNA mutational analysis for the FGFR3 and TP53 genes. Seventeen tumors were identified in patients 6-26 years of age, including low-grade papillary urothelial carcinoma (n=10), high-grade papillary urothelial carcinoma (n=5), urothelial papilloma (n=1), and papillary urothelial neoplasm of low malignant potential (n=1). No tumor demonstrated mutation of FGFR3 or TP53. Chromosomal abnormalities were detected only in patients aged ≥19 years: two low-grade urothelial carcinomas had loss of 9p21 as a sole chromosomal abnormality and three high-grade urothelial carcinomas had other or multiple chromosomal abnormalities. Under age 19 years, no tumor showed molecular abnormalities with either method (five low-grade papillary urothelial carcinomas and one each of high-grade papillary urothelial carcinoma, papillary urothelial neoplasm of low malignant potential, and urothelial papilloma). Our results support the idea that mutations of the FGFR3 and TP53 genes are rare or absent in urothelial neoplasms of young patients. In contrast, chromosomal abnormalities detected by UroVysion fluorescence in situ hybridization are sometimes present in patients above 19-20 years of age. This finding supports the recently proposed hypothesis that an age of 19-20 years separates distinct molecular pathways of urothelial carcinogenesis.
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Szymanski KM, Misseri R, Whittam B, Adams CM, Kirkegaard J, King S, Kaefer M, Rink RC, Cain MP. Mortality after bladder augmentation in children with spina bifida. J Urol 2014; 193:643-8. [PMID: 25072178 DOI: 10.1016/j.juro.2014.07.101] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE Renal failure has been a leading cause of death for children with spina bifida. Although improvements in management have increased survival, current data on mortality are sparse. Bladder augmentation, a modern intervention to preserve renal function, carries risks of morbidity and mortality. We determined long-term mortality and causes of death in patients with spina bifida treated with bladder augmentation. MATERIALS AND METHODS We retrospectively reviewed the records of patients with spina bifida who underwent bladder augmentation between 1979 and 2013. Those born before 1972 or older than 21 years at augmentation were excluded. Demographic and surgical data were collected. Outcomes were obtained from medical records, death records and the Social Security Death Index. Fisher exact and Wilcoxon rank-sum tests and Kaplan-Meier plots were used for analysis. RESULTS Of 888 patients in our bladder reconstruction database 369 with spina bifida met inclusion criteria. Median followup was 10.8 years. A total of 28 deaths (7.6%) occurred. The leading causes of mortality were nonurological infections (ventriculoperitoneal shunt related, decubitus ulcer fasciitis, etc) and pulmonary disease. Two patients (0.5%) died of renal failure. No patient died of malignancy or bladder perforation. Patients with a ventriculoperitoneal shunt had a higher mortality rate than those without a shunt (8.9% vs 1.5%, p = 0.04). CONCLUSIONS Previously reported mortality rates of 50% to 60% in patients with spina bifida do not appear to apply in children who have undergone bladder augmentation. On long-term followup leading causes of death in patients with spina bifida after bladder augmentation were nonurological infections rather than complications associated with augmentation or renal failure.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana.
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - Cyrus M Adams
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - Jordan Kirkegaard
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - Shelly King
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, Indiana
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Unique clinicopathologic and molecular characteristics of urinary bladder tumors in children and young adults. Urol Oncol 2013; 31:414-26. [DOI: 10.1016/j.urolonc.2010.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 08/02/2010] [Indexed: 01/22/2023]
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Bladder autoaugmentation with protective autologous uterine flap. Experimental study in the rat. Int J Surg 2013; 11:270-4. [PMID: 23385290 DOI: 10.1016/j.ijsu.2013.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/24/2013] [Accepted: 01/26/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Enterocystoplasties are associated to complications. We developed a surgical technique for bladder autoaugmentation using autologous uterine flap in the rat, to try and improve the post-surgical evolution. METHODS 36 female Wistar rats were randomly allocated into following groups: Group 1: Control (n = 12) for analytical parameters, Group 2: Sham-operation hysterocystorrhaphy (n = 12) and Group 3: Bladder autoaugmentation with autologous uterine flap (n = 12). Two weeks after surgery ultrasound examination of the bladder was performed. At 8 weeks and 24 weeks, blood and urine samples were taken. Post-mortem evaluation was performed and urogenital apparatus removed for gross and microscopic examination. The statistical analysis was done using the Kruskall-Wallis and the extension of the Fisher's exact test. Significance was set at 5% (p < 0.05). RESULTS Serum chemistry, blood count and peripheral blood smears, electrolytes and urinary parameters were all within the normal range for the rat. No abnormal findings were observed during ultrasound examination. There was no mortality or other surgical complications. Post-mortem evaluation revealed no dilation of bladder, uterus or upper urinary tract. Uroliths were not observed. Histology of the augmented area demonstrated an excellent union between the bladder and the protective uterine flap. A normal urothelial layer was maintained. CONCLUSIONS The use of autologous uterine flap to perform bladder autoaugmentation in the rat proved a safe and suitable surgical technique to augment the bladder. The major advantage is the avoidance of the complications observed in other surgical techniques for bladder augmentation, like enterocystoplasties, where gastrointestinal tract epithelium is incorporated into the urinary tract.
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Groth TW, Mitchell ME, Balcom AH. Polyps in continent catheterizable bladder channels. J Pediatr Urol 2013; 9:46-50. [PMID: 22226995 DOI: 10.1016/j.jpurol.2011.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 11/23/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We describe our experience with polyps encountered in bladder continent catheterizable channels. MATERIAL AND METHODS An IRB-approved retrospective study was conducted on all patients at Children's Hospital of Wisconsin with continent catheterizable channels managed by a single physician over a 16-year time period. RESULTS Fifty-five patients were identified with bladder channels. During a median follow-up of 7 years (range 3-16 years), 20% (11/55) of bladder channels developed polyps. The time to diagnosis of a polyp in bladder channels from initial surgery ranged from 3 months to 8 years (median of 29 months). Fifty-five percent (6/11) of patients who developed bladder polyps were symptomatic. All patients' symptoms resolved after treatment by endoscopic resection. Forty-five percent (5/11) of polyps recurred after resection. The time of recurrence ranged from 4 months to 7 years (median of 19 months). Polyps were universally benign inflammatory granulomatous tissue. CONCLUSION This is the first series reporting the incidence of polyps in bladder catheterizable channels. Patients with continent catheterizable bladder channels can develop symptomatic polyps in their channels, of unknown long-term significance and risk.
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Affiliation(s)
- Travis W Groth
- Pediatric Urology, Children's Hospital of Wisconsin, Medical College of Wisconsin, 999 N. 92nd St., Ste C330, Milwaukee, WI 53226, USA.
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Vaidyanathan S, Selmi F, Soni B, Hughes P, Singh G, Pulya K, Oo T. Pyonephrosis and urosepsis in a 41-year old patient with spina bifida: Case report of a preventable death. Patient Saf Surg 2012; 6:10. [PMID: 22613462 PMCID: PMC3407709 DOI: 10.1186/1754-9493-6-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 05/21/2012] [Indexed: 11/29/2022] Open
Abstract
Background Urological complications are the major cause of ill health in patients with spina bifida. Urinary sepsis accounted for the majority of admissions in patients with spina bifida. As the patient grows older, changes occur in the adult bladder, leading to increases in storage pressure and consequent risk of deterioration of renal function, which may occur insidiously. Case presentation A 34-year-old male spinal bifida patient had been managing neuropathic bladder by penile sheath. Intravenous urography revealed normal kidneys. This patient was advised intermittent catheterisations. But self-catheterisation was not possible because of long, overhanging prepuce and marked spinal curvature. This patient developed repeated urine infections. Five years later, ultrasound examination of urinary tract revealed hydronephrotic right kidney with echogenic debris within the collecting system. There was no evidence of dilatation of the ureter near the vesicoureteric junction. The left kidney appeared normal. There was no evidence of calculus disease seen in either kidney. Indwelling urethral catheter drainage was established. Two years later, MAG-3 renogram revealed normal uptake and excretion by left kidney. The right kidney showed little functioning tissue. Following a routine change of urethral catheter this patient became unwell. Ultrasound examination revealed hydronephrotic right kidney containing thick hyper-echoic internal septations and debris in the right renal pelvis suspicious of pyonephrosis. Under both ultrasound and fluoroscopic guidance, an 8 French pig tail catheter was inserted into the right renal collecting system. 150 ml of turbid urine was aspirated immediately. This patient developed large left pleural effusion, collapse/consolidation of the left lower lobe, a large fluid collection in the abdomen extending into the pelvis and expired twenty days later because of sepsis and respiratory failure. Conclusion Although penile sheath drainage may be convenient for a spina bifida patient and the carers, hydronephrosis can occur insidiously. With recurrent urine infections, hydronephrotic kidney can become pyonephrosis, which is life-threatening. Therefore, every effort should be made to carry out intermittent catheterisations along with antimuscarinic drug therapy.
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Affiliation(s)
- Subramanian Vaidyanathan
- Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN, UK.
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Shuto M, Seyama A, Gotoh Y, Kamada K, Nakamura M, Warigaya K, Watanabe H, Ueno M, Shimizu M, Fukuda T, Murata SI. Significant Correlation between Chromosomal Aberration and Nuclear Morphology in Urothelial Carcinoma. Acta Histochem Cytochem 2012; 45:25-33. [PMID: 22489102 PMCID: PMC3317491 DOI: 10.1267/ahc.11048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 11/16/2011] [Indexed: 12/22/2022] Open
Abstract
We aimed to identify whether there is any correlation between chromosomal/genetic changes, nuclear morphology and the histological grade of urothelial carcinomas of the urinary bladder. Morphometry and multicolour fluorescence in situ hybridisation (FISH) techniques were applied to 250 cells in five low-grade cases and 350 cells in seven high-grade cases of urothelial carcinoma. Compared with low-grade carcinomas, most high-grade cases showed larger and more variable nuclear size, more frequent polysomy of centromere enumeration probes (CEPs) 3, 7 and 17, and the loss of the 9p21 locus. The number of CEP signals in cells was increased as the nuclear area of the cells became larger. Cells with gains in two or more types of CEP had significantly larger nuclei than cells with normal FISH signal patterns. In conclusion, the present study indicates that there was a correlation between nuclear morphology and chromosomal/genetic changes which were related to histological grading. Thus, we show that differences in the chromosomal/genetic aberrations present in low- and high-grade tumours can affect not only nuclear morphology but also the histopathological and clinical behaviour of urothelial carcinomas.
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Affiliation(s)
- Masayo Shuto
- School of Medical Technology and Health, Faculty of Health and Medical Care, Saitama Medical University
- Department of Uro-Oncology, International Medical Center, Saitama Medical University
| | - Atsushi Seyama
- Department of Pathology, International Medical Center, Saitama Medical University
| | - Yoshiya Gotoh
- Department of Pathology, International Medical Center, Saitama Medical University
| | - Kouichi Kamada
- Department of Pathology, International Medical Center, Saitama Medical University
| | - Masaru Nakamura
- Department of Pathology, International Medical Center, Saitama Medical University
| | - Kenji Warigaya
- Department of Human Pathology, Wakayama Medical University
| | - Hiroshi Watanabe
- School of Medical Technology and Health, Faculty of Health and Medical Care, Saitama Medical University
| | - Munehisa Ueno
- Department of Uro-Oncology, International Medical Center, Saitama Medical University
| | - Michio Shimizu
- Department of Pathology, International Medical Center, Saitama Medical University
| | - Toshio Fukuda
- Department of Histopathology and Cytopathology, School of Health Sciences, Gunma University
| | - Shin-ichi Murata
- Department of Pathology, International Medical Center, Saitama Medical University
- Department of Human Pathology, Wakayama Medical University
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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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Hafez AT. Detrusor wraparound for bladder neck reconstruction in cohort of children with bladder exstrophy. Urology 2011; 78:881-5. [PMID: 21777961 DOI: 10.1016/j.urology.2011.04.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 03/29/2011] [Accepted: 04/08/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the outcome of the detrusor wraparound bladder neck technique of bladder neck reconstruction in 28 children with bladder exstrophy. METHODS The records of all patients with bladder exstrophy who underwent detrusor wraparound bladder neck were reviewed. A total of 28 consecutive patients were identified and included 21 boys and 7 girls, with a mean age at surgery of 8.3 years. All patients had undergone previous exstrophy closure (17 staged and 11 complete). Of the 28 patients, 8 (29%) had undergone previous endoscopic injection of a bulking agent at the bladder neck. At surgery, 13 patients (46%) required concomitant ileocystoplasty and a continent outlet. Continence was defined as complete dryness with no urine leakage either through the urethra or the continent outlet. RESULTS The mean follow-up duration was 31 months (range 13-48). All augmented patients were continent using clean intermittent catheterization through the outlet. Complete dryness was achieved in 20 (71%) of 28 patients. However, the continence rate was only 47% in the nonaugmented group compared with 100% in the augmented group. Six of the incontinent children underwent bladder neck injection using a bulking agent but dryness was achieved in only 1 (17%). CONCLUSION The detrusor wraparound bladder neck technique is a viable option for bladder neck reconstruction for incontinent children after exstrophy closure. However, bladder augmentation and continent outlet construction are the pillars of optimal success. Injection of bulking agent at the bladder neck for failure has had poor success.
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Affiliation(s)
- Ashraf T Hafez
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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Dapena L, Dapena I, Regadera J, Gaspar MJ, González-Peramato P. Histerocystoplasty: a novel surgical procedure in the rat. J Surg Res 2011; 175:157-62. [PMID: 21529834 DOI: 10.1016/j.jss.2011.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/27/2011] [Accepted: 03/02/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Enterocystoplasties are associated to complications. To avoid them, different types of tissue templates have been used to augment the bladder and induce native bladder regeneration. MATERIALS AND METHODS A novel surgical technique for bladder reconstruction using autologous uterine tissue was evaluated in a rat model. Forty-two female Wistar rats were randomly allocated into three groups: sham-operation hysterocystorrhaphy (n = 12), hysterocystoplasty (n = 18), and control (n = 12). Two weeks after surgery, ultrasound examination of the bladder was performed. At 2, 4, or 6 mo after surgery, the rats were anesthetized and blood and urine samples were taken. They were then euthanized and post-mortem and histologic examination were performed. Ultrasound examination, analytical parameters and weight control, as well as gross and histologic examination were performed in all the operated animals. The statistical analysis was performed using Kruskal-Wallis and the extension of Fisher's exact tests. Significance was set at 5% (P < 0.05). RESULTS Serum chemistry, blood count and peripheral blood smears, electrolytes, and urinary parameters were all within the normal range for the rat. Histologic sections of the surgically augmented zone between the bladder and uterine horn demonstrated urothelial epithelization, providing adequate coverage of the transition area in 72.22% of the rats that underwent hysterocystoplasty. CONCLUSIONS The hysterocystoplasty was technically viable in all the cases and proved to be an easy and safe surgical model for bladder reconstruction. All animals were healthy after surgery and all systemic parameters analyzed were within normal physiologic range for the rat.
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Affiliation(s)
- Lidia Dapena
- Department of Biomedicine, University of Leon, Leon, Spain.
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Heinzle C, Sutterlüty H, Grusch M, Grasl-Kraupp B, Berger W, Marian B. Targeting fibroblast-growth-factor-receptor-dependent signaling for cancer therapy. Expert Opin Ther Targets 2011; 15:829-46. [PMID: 21375471 DOI: 10.1517/14728222.2011.566217] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Fibroblast growth factors (FGF) exert a combination of biological effects that contribute to four of the six essential hallmarks of cancer. It is no surprise that FGF-dependent signaling has increasingly moved to the center of cancer therapy research during the past decade. This is illustrated by the large number of publications focusing on various aspects of this theme that have been published in the past 5 years. AREAS COVERED Information from these sources as well as ongoing work from the authors' groups is used to outline the physiological functions of FGF signaling and to highlight how the high oncogenic effects of deregulated FGFs and FGFRs derive from their physiological functions. The biological effect of deregulated FGFR signaling in malignant diseases is described and the current state of therapeutic targeting of FGFR is summarized. EXPERT OPINION Strategies for targeting FGFR-signaling for cancer therapy are very promising, but need to be carefully developed based on the physiological roles of FGF signaling. Preventive measures may be necessary for protection from FGF-related side effects. Combined targeting of several receptor tyrosine kinases or combination with other therapies may be a useful way of avoiding or ameliorating side effects. FGF-related markers of prognosis and therapy response still need to be investigated.
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Affiliation(s)
- Christine Heinzle
- Medical University Vienna, Institute of Cancer Research, Department of Medicine 1, Vienna,Austria
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Haugsten EM, Wiedlocha A, Olsnes S, Wesche J. Roles of fibroblast growth factor receptors in carcinogenesis. Mol Cancer Res 2010; 8:1439-52. [PMID: 21047773 DOI: 10.1158/1541-7786.mcr-10-0168] [Citation(s) in RCA: 229] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The fibroblast growth factor receptors (FGFR) play essential roles both during development and in the adult. Upon ligand binding, FGFRs induce intracellular signaling networks that tightly regulate key biological processes, such as cell proliferation, survival, migration, and differentiation. Deregulation of FGFR signaling can thus alter tissue homeostasis and has been associated with several developmental syndromes as well as with many types of cancer. In human cancer, FGFRs have been found to be deregulated by multiple mechanisms, including aberrant expression, mutations, chromosomal rearrangements, and amplifications. In this review, we will give an overview of the main FGFR alterations described in human cancer to date and discuss their contribution to cancer progression.
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Affiliation(s)
- Ellen Margrethe Haugsten
- Department of Biochemistry, Institute for Cancer Research, The Norwegian Radium Hospital, Montebello, 0310 Oslo, Norway.
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