Primary bladder closure and bladder neck reconstruction in classical bladder exstrophy

The surgical results of 28 consecutive initial bladder closures and 25 consecutive initial bladder neck reconstructions performed for classical bladder exstrophy at our hospital between 1975 and 1982 are presented. Partial bladder prolapse occurred in 2 cases and complete wound dehiscence never occurred following the initial primary bladder closure. Urinary continence following bladder neck reconstruction was assessed from parental interviews. An excellent surgical result was defined either as achievement of a daytime dry interval for more than 3 hours or less than 1 incontinent episode per day. According to these parameters, an excellent surgical result was achieved in 86 and 80 per cent of children, respectively. In 21 children evaluated with excretory urograms between 1/2 and 6 years after bladder neck reconstruction 10 per cent of the renal units showed significant hydronephrosis and deterioration of function. The 2 patients who had upper tract deterioration were not followed postoperatively at our institution and the diagnosis of bladder outlet obstruction was delayed when excretory urograms were not obtained during the first postoperative year. This review of the surgical results following primary bladder closure and bladder neck reconstruction for classical bladder exstrophy demonstrates that secure abdominal wall closure and urinary continence can be achieved with minimal morbidity and with infrequent deterioration of renal function following staged functional bladder closure.     

Transurethral bladder neck operation in neurogenic bladder

86 adults with bladder outlet obstruction and neurogenic bladder underwent bladder neck resection or incision to establish effective vesical emptying or damping of detrusor reflex activity. Follow-up examinations revealed a good effect on flow, reflux and hydronephrosis, infection rate and symptoms such as frequency, dysuria, nocturia and urgency. Since 1974, bladder neck incision is preferred; resection remains for selected cases only.     

Lipomatosis of the bladder presenting as bladder cancer

A case of bladder lipomatosis in an 81-year-old man is presented. The preoperative diagnosis was bladder tumor. A transurethral resection of the bladder was performed and a pathological examination revealed lipomatosis of the bladder. This entity is extremely rare and, to our knowledge, this is the second case reported in the English published works.     

Prosthetic urinary bladder implantation to facilitate bladder regeneration

A temporary artificial bladder was implanted in 15 female dogs undergoing total or subtotal cystectomy. One or two months after implantation, the prosthesis was removed. In three dogs sacrificed 6 months after prosthesis implantation, a new urinary reservoir was identified. Two dogs failed to develop a urinary reservoir, and both ureters anastomosed directly to the top of a dilated urethra. Seven dogs died from complications (infection, urine leakage, etc). Three additional dogs are alive and well 2.5 months after implantation, and in these animals a new urinary reservoir has been demonstrated by cystography. Histologic examination of the new urinary reservoir revealed a thin lining of transitional cell-like epithelium and an underlying attenuated muscle layer. The ability of the canine species to generate a functioning urinary reservoir after total or subtotal cystectomy may hold promise for eventual clinical application in humans.     

保留膀胱手术治疗肌层浸润性膀胱癌临床分析

目的:探讨肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC)行保留膀胱手术治疗的可行性及临床价值。方法:回顾性分析43例MIBC患者的临床资料:男28例,女15例,年龄45～88岁,平均62岁。其中38例(88.4%)行经尿道膀胱肿瘤电切除术(transurethral resection of bladder tumor,TURBT),5例(11.6%)行膀胱部分切除术;术后均行膀胱灌注化疗或放疗。结果:术后病理分期:T236例(83.7%),T37例(16.3%);病理分级:G14例(9.3%),G231例(72.1%),G38例(18.6%)。术后随访6～126个月,平均63.2个月;首次复发为3～20周,平均10.2周,复发次数1～8次,平均3.7次;共行2～9次TURBT,平均3.5次,其中25例(58.1%)于≥3次TURBT后出现病理性进展,9例(20.9%)于术后复发次数≥3次后改行根治术;2例(4.7%)死于非膀胱癌疾病,1例(2.3%,病理为T2G1)于首次术后126个月死于膀胱癌多发转移。结论:对于MIBC,可选择性行以TURBT为主加放化疗的保留膀胱手术治疗,但具有反复复发及进展倾向;首次复查膀胱镜时间需提前到术后4～8周,远期疗效需进一步评估。     

Leiomyoma of the urinary bladder with bladder stone

Leiomyoma of the urinary bladder is a rare benign mesenchymal tumour. We describe here a case of leiomyoma of the urinary bladder in a 65-year-old gentleman who presented with haematuria, passage of clots and combined obstructive and irritative urinary symptoms. The investigations revealed a vesical calculus and a mass on the left lateral wall of the urinary bladder. Cystolitholapaxy and transurethral resection of the tumour was performed. Histopathological report of the resected tumour revealed a leiomyoma of the urinary bladder. So far, a leiomyoma of the urinary bladder and a concomitant vesical calculus have not been described in literature.     

膀胱出口梗阻大鼠膀胱过度活动的研究

目的:建立膀胱出口梗阻大鼠模型,诱发逼尿肌不稳定(DI),研究膀胱出口梗阻伴发膀胱过度活动的病理生理学特征。方法:选择38只成年SD雌性大鼠,随机分为模型组和对照组,结扎膀胱颈部建立膀胱出口梗阻模型。建模后3、6、9、12周采用BL-410生物机能实验系统测定膀胱压,以充盈期出现DI作为膀胱过度活动存在的标准,记录并计算DI阳性率和频率、最大排尿压(MVP)、最大膀胱容量(MCC)、膀胱顺应性(BC)和剩余尿量(PVR)。用光镜观察建模不同时期膀胱组织的病理学改变。结果:模型组大鼠3、6、9、12周DI阳性率分别为37.50%、75.00%、75.00%、62.50%。MVP、MCC、BC、PVR和DI频率较对照组增高(P<0.01),第9周大鼠PVR、MVP、MCC高于第3、6和12周。不同时期病理学改变呈现出膀胱容量增加、肌层逐渐增厚和纤维化的过程。结论:膀胱出口梗阻与逼尿肌不稳定的发生具有潜在的相关性,其病理学改变和尿流动力学参数反映了膀胱的病理生理学特点。     

Spontaneous extraperitoneal bladder perforation caused by bladder carcinoma

We show a case of spontaneous extraperitoneal vesical perforation due to presence of a bladder cancer with urotelial origin.     

Present status on bladder replacement--colon bladder replacement]

Bladder replacement using a detubularized right colonic segment was successfully performed on 22 male patients with bladder cancer after radical cystectomy. There were 10 early postoperative complications and one of them required reoperation. Urodynamic studies, performed on 16 patients, showed a low pressure reservoir at a large capacity without any involuntary spikes in every case. Of the 16 patients, 4 were nocturnally enuretic and 1 was partially continent. The other 11 patients (68.8%) were totally continent and voiding well, except one who was on intermittent self-catheterization. The incidence of urinary reservoir infections in patients treated with colon bladder replacement was investigated in 18 patients. The incidence rate of bacteriuria was 5.6% and the positive rate of pyuria was 27.8%. The detection rate of bacteriuria and pyuria was significantly low in patients after colon bladder replacement. These findings indicate that colon bladder replacement can be an ideal option for selected patients with bladder cancer.