碱化利多卡因膀胱灌注治疗储尿期膀胱功能障碍的临床研究

目的 探索储尿期膀胱功能障碍的治疗方法,评估碱化利多卡因膀胱灌注在治疗储尿期膀胱功能障碍的临床疗效与安全性,同时通过测定尿液中神经生长因子(nerve growth factor,NGF)的变化找到该类疾病的生物学标志物,为指导治疗与预后判定提供客观依据.方法 收集60例储尿期膀胱功能障碍病例为研究对象,按病种分4组,每组15例:膀胱过度活动组(A),间质性膀胱炎组(B),氯胺酮相关性膀胱炎组(C),抗癌化学药物灌注引起的相关性膀胱炎组(D).60例均采用麻醉下行膀胱镜检查,术后第1天开始行碱化利多卡因扩张性灌注方法进行治疗,每天3次,疗程5d.评估每组治疗前、后下尿路症状及其相关指标变化(OABSS评分、0'Leary-Sant评分及生活质量评分QOL、尿NGF、尿动力学检查等).结果 60例患者均完成治疗及随访,治疗后1个月每组与其对应组治疗前相比:OABSS评分、0'Leary-Sant评分、生活质量评分(QOL)、尿NGF、尿动力学检查比较差异有统计学意义(P＜0.05).结论 碱化利多卡因膀胱灌注治疗储尿期膀胱功能障碍疗效明显,是一种简单、价廉、有效、安全的治疗方法;尿NGF可以作为储尿期膀胱功能障碍系列疾病的生物学标志物,对指导治疗与预后判定具有巨大、潜在的应用价值.     

地塞米松联合碱化利多卡因膀胱灌注治疗氯胺酮相关性膀胱炎的疗效观察

【摘要】 目的 观察地塞米松联合碱化利多卡因膀胱灌注治疗氯胺酮相关性膀胱炎的疗效。方法 8例确诊为氯胺酮相关性膀胱炎经戒断吸食氯胺酮、抗生素治疗等常规治疗无效,而拒绝行膀胱水灌注及注射肉毒素的男性患者,用地塞米松及碱化利多卡因行规律膀胱灌注,比较治疗前及治疗1周及3周后患者的排尿情况、OABSS评分等症状改善情况。 结果 8例患者经治疗后症状明显改善,排尿日记显示治疗1周后患者日间排尿次数由(20.5±7.8)次减至(5.6±2.3)次(P<0.05),夜间排尿次数由(15.5±3.2)次减少至(3±1.2)次(P<0.05),尿量由(30.4±12.4)mL/次增加至(50±10.1)mL/次(P<0.05)。OABSS评分由治疗前的(10.7±1.5)分减至治疗后的(5.2±1.3)分(P<0.05)。8例患者均未出现药物不良反应。 结论 地塞米松联合碱化利多卡因膀胱灌注治疗氯胺酮相关性膀胱炎安全、药物普及且费用低,在短期内是有效的,对拒绝行手术治疗的患者,可考虑使用。     

碱化利多卡因膀胱灌注治疗氯胺酮相关性膀胱炎

目的 探讨碱化利多卡因膀胱灌注扩张治疗氯胺酮相关性膀胱炎的临床价值.方法 2008-2009年收治氯胺酮相关性膀胱炎7例.男6例,女1例.平均年龄26(19～38)岁.其中复发病例3例共10次.患者均有氯胺酮滥用史,伴有严重尿频、尿急、尿痛等下尿路症状(LUTS);白天排尿间隔时间(20±15)min,夜尿12～20次,每次尿量(50±15)ml.B超检查示膀胱壁增厚、容积缩小;上尿路积水3例.尿动力学检查功能性膀胱容量平均50(20～100)ml,Qmax3.7～10.8 ml/s,残余尿量0～24 ml.膀胱感觉敏感性增高、顺应性下降3例.蛛网膜下腔加硬膜外麻醉下行膀胱镜检查术,见膀胱黏膜呈广泛出血样改变.患者均在麻醉下行膀胱水压扩张、术后留置硬膜外导管镇痛和2%碳酸利多卡因20 ml加5%碳酸氧钠10 ml膀胱灌注并口服清除氧自由基药物等综合治疗.结果 2例膀胱活检提示慢性炎症伴肉芽肿样增生改变.膀胱灌注治疗7～10 d后患者LUTS均明显改善,膀胱容量平均(150±30)ml,排尿间隔(85±25)min,Qmax(11.5±3.8)ml/s,夜尿3～5次.3例复发者重复上述治疗.平均随访7(2～17)个月,患者症状均明显好转,每次排尿量平均(250±80)ml,夜尿0～2次.结果 麻醉状态下以碱化利多卡因膀胱灌注扩张能迅速、有效地增加膀胱容量,改善LUTS,是治疗氯胺酮相关性膀胱炎一种简单有效的方法.     

丝裂霉素膀胱灌注热化疗治疗T1G3膀胱尿路上皮癌的疗效分析

目的:探讨丝裂霉素膀胱灌注热化疗治疗T_1G_3膀胱尿路上皮癌的疗效及安全性。方法:76例原发性或复发性T_1G_3膀胱尿路上皮癌患者,均行经尿道膀胱肿瘤电切术,40例患者术后接受单独丝裂霉素进行膀胱灌注治疗,36例患者接受术后予丝裂霉素进行膀胱灌注热化疗。随访时间24个月。分析两种治疗方法的无复发生存期和无进展生存期。结果:在76例患者中,单纯膀胱灌注化疗组肿瘤复发率及进展率分别为35%及22.5%,膀胱灌注热化疗组复发率及进展率分别为13.9%和5.6%。两组比较差异有统计学意义。(P=0.034及P=0.036)。Kaplan-Meier分析显示两种治疗方法无复发生存率及无进展生存率差异有统计学意义(P=0.027及P=0.047)。结论:T_1G_3膀胱尿路上皮癌TURBT术后予MMC膀胱灌注热化疗治疗是安全,有效的。能有效降低T_1G_3膀胱尿路上皮癌术后复发和肿瘤进展风险。     

膀胱灌注化疗对输尿管尿路上皮癌根治术后复发膀胱癌的影响

目的:探讨膀胱灌注化疗对输尿管尿路上皮癌根治术后复发膀胱癌的影响。方法:对原发性输尿管尿路上皮癌患者术后膀胱灌注化疗及膀胱癌复发情况进行统计分析。结果:术后行膀胱灌注化疗的膀胱癌复发率为20.8%(16/77),未接受膀胱灌注化疗的复发率为55.1%(27/49),两者相比差异有统计学意义(P0.05)。G1肿瘤接受灌注治疗的复发率为8.0%(2/25),未接受灌注治疗的复发率为40.0%(6/15),两者相比差异有统计学意义(P0.05);G2肿瘤接受灌注治疗的复发率为20.6%(7/34),未接受灌注治疗的复发率为55.0%(11/20),两者相比差异有统计学意义(P0.05);G3肿瘤接受灌注治疗的复发率为38.9%(7/18),未接受灌注治疗复发率为71.4%(10/14),两者相比差异无统计学意义(P0.05)。术后24小时内灌注的复发率为18.2%(4/22),术后2周开始行膀胱灌注的复发率为21.8%(12/55),两者相比差异无统计学意义(P0.05)。结论:输尿管尿路上皮癌术后膀胱灌注化疗能有效降低膀胱内尿路上皮癌的复发。G1、G2肿瘤患者术后膀胱灌注化疗预防术后复发膀胱癌的效果较G3肿瘤好。UTUC术后膀胱灌注化疗主要参考BUC的方案进行,尚未形成统一标准,今后需要进一步探讨。     

不使用抗生素的膀胱肿瘤患者膀胱灌注BCG可根治菌尿

对于患有无症状菌尿的膀胱肿瘤患者使用BCG膀胱灌注治疗是安全有效的,同时BCG在膀胱内所诱导的免疫应答反应是否能根治菌尿感染呢?作者展开了相关研究,这一研究将90例接受BCG膀胱内灌注的高危膀胱肿瘤患者作为实验组,95例未接受BCG膀胱灌注而行膀胱镜检密切观察的低危患者作为对照组,两组患者均通过尿常规诊断有菌尿(细菌数>104或>105 CFU/ml)并不使用抗生素治疗。BCG治疗组治疗方案为BCG膀胱灌注每周1次,持续6周,首次灌注3个月后行膀胱镜活检;膀胱镜镜检观察对照组患     

碱化利多卡因联合肝素膀胱灌注治疗膀胱疼痛综合征/间质性膀胱炎215例报告

目的 评估碱化利多卡因联合肝素膀胱灌注治疗膀胱疼痛综合征/间质性膀胱炎(PBS/IC)的疗效. 方法门诊治疗215例女性PBS/IC患者,年龄28～69岁,平均(46.1±17.5)岁.临床表现为下腹酸胀/疼痛、夜尿次数多及尿频、尿急.采用碱化利多卡因联合肝素膀胱灌注治疗,将2%利多卡因20 ml+肝素3.75万U+5%碳酸氢钠5 ml的混合液缓慢注入膀胱内,保留45～60 min.每周灌注2次,疗程12～16周.患者治疗前后均行O'Leary-Sant IC问卷表评分.结果 215例随访3～18个月,平均9个月.0'Leary-Sant平均症状评分(ICPI)治疗前为(12.5±4.9)分,治疗3个月后降为(6.5±3.6)分(P＜0.01);问题评分(ICSI)治疗前为(7.4±3.1)分,治疗后降为(3.2±2.0)分(P＜0.01).其中下腹酸胀/疼痛的改善率为71.3%(139/195),夜尿次数改善率为65.3%(109/167),尿频尿急改善相对不明显,为22.9%(24/105).治疗中未见明显不良反应.结论 应用碱化利多卡因联合肝素膀胱灌注能有效改善PBS/IC的临床症状,尤其能明显改善下腹酸胀/疼痛和夜尿次数多的症状,是一种安全有效的方法.     

膀胱水扩张加膀胱灌注治疗间质性膀胱炎疗效观察

目的膀胱水扩张加膀胱灌注治疗间质性膀胱炎(interstitial cystitis,IC)的临床疗效观察。方法对6例间质性膀胱炎患者行膀胱水扩张及膀胱灌注,分析治疗前、治疗12周后、治疗6个月后间质性膀胱炎症状指数(interstitial cystitissym ptomatic in-dex,ICSI)和问题指数(interstitial cystitis problem index,ICPI)。结果 6例患者均获得满意随访,疗效显著2例、有效3例、无效1例,总有效率为83.3%(5/6)。治疗12周后及治疗6个月后ICSI和ICPI评分均较治疗前明显降低,差异具有统计学意义(P<0.05)。结论膀胱水扩张联合大剂量肝素、碳酸氢钠及利多卡因膀胱灌注治疗间质性膀胱炎具有创伤小、临床疗效显著、价格低廉等优点,具有一定的推广应用价值。     

膀胱灌注化疗预防输尿管尿路上皮细胞癌术后再发膀胱癌

目的 探讨膀胱灌注化疗对不同级别输尿管尿路上皮细胞癌患者行肾、输尿管及膀胱袖状切除术后再发膀胱癌的影响.方法 对194例原发性输尿管尿路上皮癌患者的临床资料进行回顾性研究,比较术后2年内各级别肿瘤患者中吡柔比星灌注组与未灌注组的膀胱癌复发率.结果 行根治性肾、输尿管及膀胱袖状切除术2年后,灌注组复发率23.9%(28/117)明显低于未灌注组的39.0%(30/77),差异有统计学意义(P＜0.05).其中G1肿瘤灌注患者复发率为5.0%(1/20),未灌注患者复发率14.3%(3/21),差异无统计学意义(P＞0.05);G2肿瘤灌注患者复发率21.4%(12/56)明显低于未灌注组的43.9%(18/41)(P＜0.05);G3肿瘤灌注患者复发率36.6%(15/41),未灌注患者复发率60.0%(9/15),差异无统计学意义(P＞0.05).结论 对于原发性输尿管尿路上皮癌患者,术后膀胱灌注化疗可预防输尿管尿路上皮癌患者术后膀胱癌的发生.尤其对G2肿瘤患者,术后膀胱灌注化疗可有效预防肿瘤的膀胱内复发;但其对G1及G3肿瘤患者无明显预防作用.     

表柔比星与吉西他滨膀胱灌注化疗对浅表性膀胱尿路上皮癌术后复发及安全性的影响

目的比较表柔比星与吉西他滨膀胱灌注化疗对浅表性膀胱尿路上皮癌术后复发及安全性的影响。方法遴选本院2014年3月至2017年3月收治并接受TURBT治疗的300例浅表性膀胱尿路上皮癌患者作为研究对象,根据术后灌注化疗药物选择随机分为表柔比星组和吉西他滨组各150例,并对患者进行为期2年的随访,观察两组患者术后化疗复发情况及化疗期间不良反应。结果表柔比星组患者术后6、12、24个月的复发例数分别为3、10、14例,总复发率为18.0%;吉西他滨组患者术后6、12、24个月的复发例数分别为3、8、13例,总复发率为16.0%,两组患者总复发率比较差异无统计学意义(χ^2=0.617,P=0.362)。表柔比星组总不良反应发生率为49.33%(53/150),吉西他滨组总不良反应发生率为26.67%(40/150),两组总不良反应发生率比较,差异有统计学意义(χ^2=5.52,P=0.023)。结论表柔比星与吉西他滨膀胱灌注化疗对预防浅表性膀胱尿路上皮癌术后复发的效果相当,但吉西他滨膀胱灌注产生的不良反应少,患者耐受性较好,值得临床推广。     

Ureteral complications after intravesical formalin instillation

Results of formalin therapy for hemorrhage owing to post-radiation cystitis have been studied with special reference to the frequency and severity of ureteral complications. Gross bleeding stopped in 25 of 27 patients within 48 hours. However, 5 patients became anuric immediately after the instillation and in another 7 patients a transient increase in the serum creatinine level was observed. Urinary diversion was necessary in 11 of the 27 patients. The complication rate in the present study is considerably higher than reported previously. Complications may be explained by vesicoureteral reflux of a too strong formalin-alcohol solution. To avoid future complications we suggest that 1) a high diuresis should be induced peroperatively, 2) a 1 to 2 per cent formalin solution without alcohol should be used and 3) the instillation pressure should not exceed 15 cm. water.     

Intraperitoneal spillage of formalin after intravesical instillation

Intravesical instillation of formalin appears to be a method of choice in the control of massive hematuria following radiation cystitis. It is generally described as a safe, cheap, effective procedure. We report a case of intraperitoneal spillage of formalin and describe the metabolic and extensive medical problems encountered in the four-week period following the incident before the patient's death.     

早期吡柔比星膀胱灌注与常规膀胱灌注预防浅表性膀胱癌术后复发的疗效及毒性比较的Meta分析

目的比较吡柔比星早期膀胱灌注与常规灌注对表浅性膀胱癌术后复发的预防和毒性作用。方法检索国内外关于术后吡柔比星早期膀胱灌注与常规灌注治疗表浅性膀胱癌的比较研究,按预设的标准进行筛选纳入5项研究进行质量评价,并提取数据进行Meta分析。结果吡柔比星早期膀胱灌注对预防浅表性膀胱癌术后复发的疗效优于常规灌注组,差异有统计学意义,其优势比及95%可信区间分别为0.45、0.26～0.77（P=0.003〈0.05）。治疗毒性主要是尿路刺激征/腺性膀胱炎。Meta分析显示总的尿路刺激征的发生率在早期灌注组较常规灌注组显著降低,其优势比及95%可信区间分别为0.63、0.41～0.95（P=0.03〈0.05）。结论吡柔比星早期膀胱灌注预防浅表性膀胱癌复发的疗效明显优于常规灌注,毒性作用显著低于常规灌注组。因纳入研究有限,建议进行大样本、长期随访的高质量临床试验,提供更佳循证证据。     

Granulomatous balanoposthitis after intravesical Bacillus-Calmette-Guerin instillation therapy

We report a rare case of granulomatous balanoposthitis after intravesical Bacillus-Calmette-Guerin (BCG) instillation therapy in a 58-year-old man, which followed transurethral resection (TUR) for recurrent bladder cancer, when his anterior urethra was slightly narrow and his foreskin was with phimosis. Intravesical BCG instillation therapy was started for prophylaxis of recurrent bladder cancer after TUR. Multiple painless firm papules on glans penis, edema in the foreskin and low-grade fever appeared after the seventh instillation, for which the single antituberculous agent isoniazid (300 mg/day) was administered. Biopsy of the papules on glans penis and foreskin revealed granulomatous balanoposthitis. Low-grade fever normalized and the papules disappeared within 1 week. The patient continued chemotherapy with isoniazid for the next 12 months. There was no recurrence of bladder cancer or balanoposthitis for 15 months and to date.     

Acute tubular necrosis following intravesical instillation of formalin

Intravesical instillation of formalin in a patient with transitional cell carcinoma of the bladder and radiation cystitis was followed by acute renal failure due to acute tubular necrosis. Formic acid, which is a metabolic product of formalin, has been postulated as the pathogenetic agent responsible for acute tubular necrosis.     

Intra-operative pulmonary embolism after intravesical instillation of formalin

Intra-operative pulmonary embolism is a rare and severe complication which is difficult to diagnose. A case is reported in which this condition occurred after intravesical instillation of formalin during radical cystectomy under general anaesthesia. Formalin may be related to formation of intravascular thrombi and result in pulmonary embolism.     

The fate of bacillus Calmette-Guerin after intravesical instillation

PURPOSE: Long-term activation of immunocompetent cells of the bladder wall as well as case reports of systemic infections some months or years after intravesical bacillus Calmette-Guerin (BCG) therapy imply that mycobacteria may persist in the body. Therefore. we investigated the fate of BCG in patients after uncomplicated intravesical instillation therapy. MATERIAL AND METHODS: A total of 49 patients were included in the study, from whom various numbers of specimens were used for mycobacterial culture and molecular biological detection techniques. In 23 patients who received a total of 128 instillations urine, sputum, venous blood and bladder biopsies were screened for BCG by acid-fast staining and culture at different times before and after instillation. From 16 of the 23 patients and from an additional 26 a total of 180 bladder biopsies obtained at intervals 3 to 30 months after instillation were screened for mycobacterial 16S ribosomal DNA by a nested polymerase chain reaction protocol. RESULTS: No viable BCG was found in venous blood or in 127 of 128 sputum specimens before and 2 hours after instillation. Two of 56 bladder biopsies were culture positive. In urine BCG was detected in 96.4% of the specimens after 2 hours and in 67.9% after 24 hours after instillation. The number of positive specimens decreased and it was 27.1% on day 7 immediately before the next instillation. In 14 of 44 bladder biopsies (31.8%) mycobacterial ribosomal DNA was found within 1 week after the sixth instillation. A positive polymerase chain reaction was evident up to 24 months in between 4.2% and 37.5% of the investigated biopsies. After 30 months no ribosomal DNA was evident in the 6 samples available for testing. CONCLUSIONS: Nontraumatic intravesical instillation of BCG is not accompanied by systemic mycobacterial spread. Local persistence during the instillation course is evident since viable BCG is commonly found in the urine. Long lasting and persistent BCG DNA in the bladder wall may account for long-term immuno-activation. However, the remaining BCG may be a possible source of late systemic infections.     

Papillary necrosis. Result of intravesical instillation of formalin

The management of patients with intractable bleeding from radiation or cyclophosphamide cystitis can create a serious dilemma. However, the use of intravesical formalin shows promise of gaining popularity. A case in which this procedure was used successfully is described. The possible complications of this type of therapy are cited; therefore, it must be approached with caution particularly in respect to dosage.     

A case of shock following intravesical formalin instillation]

A case of shock following intravesical formalin instillation for massive bladder hemorrhage owing to post-radiation cystitis is reported. A 79-year-old woman had been treated with external irradiation for cancer of the uterine body in 1981. She was suffering from massive hematuria after hysterectomy in 1988. No hemostatic procedures were effective. Then we instilled 10% formalin into her bladder. After the instillation she entered a state of allergic shock.