经尿道电切后化疗药物灌注治疗腺性膀胱炎疗效的系统评价

目的系统评价经尿道电切后化疗药物灌注治疗腺性膀胱炎的有效性和安全性。方法计算机检索MEDLINE、Cochrane图书馆、EMbase、VIP、CNKI和CBM等数据库,查找经尿道电切后吡柔比星或丝裂霉素灌注治疗腺性膀胱炎的随机对照试验(RCT)和病例-对照研究(CCS),检索时限均从2001年1月至2011年12月。由2位研究者按照纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan5.0.1软件进行Meta分析。结果纳入11篇文献(5个RCT和6个病例对照研究),共1 032例腺性膀胱炎患者。试验组为经尿道电切术后加用化疗药物灌注,共535例,按灌注药物不同分为吡柔比星(7个研究,347例)和丝裂霉素(4个研究,188例)两个亚组。对照组为单纯经尿道电切,共497例。①经尿道电切后采用吡柔比星灌注治疗可以提高短期和长期治愈率,减少短期和长期复发率,但在短期和长期好转率方面,两组差异无统计学意义。安全性方面,吡柔比星的尿路刺激征发生率与对照组相当,但血尿发生率更高。②经尿道电切后采用丝裂霉素灌注治疗可以提高长期治愈率,减少长期复发率,但在短期治愈率、好转率、复发率及长期好转率方面,两组差异无统计学意义。安全性方面,丝裂霉素的尿路刺激征发生率和血尿发生率均与对照组相当。敏感性分析结果显示,对部分结局指标,不同类型的研究结果不一致。结论现有有限证据显示,经尿道电切术后采用吡柔比星或丝裂霉素灌注治疗能提高腺性膀胱炎的长期治愈率,减少长期复发率,但使用吡柔比星更容易出现血尿。由于不同类型的研究结果不一致,导致Meta分析结果不稳定,存在与未来研究结果不符的高度可能性,因此目前尚不能肯定经尿道电切后化疗药物灌注治疗腺性膀胱炎是否比单纯电切的疗效更好,尚需开展更多高质量、大样本的随机对照试验加以验证。     

Increased bladder permeability in interstitial cystitis/painful bladder syndrome

The definition of interstitial cystitis (IC) has evolved over the years from being a well-defined entity characterized by diagnostic lesion (Hunner’s ulcer) in the urothelium to a clinical diagnosis by exclusion [painful bladder syndrome (PBS)]. Although the etiology is unknown, a central theme has been an association with increased permeability of the bladder. This article reviews the evidence for increased permeability being important to the symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) and in treating the disorder. Recent work showing cross-communication among visceral organs is also reviewed to provide a basis for understanding IC/PBS as a systemic disorder of a complex, interconnected system consisting of the bladder, bowel and other organs, nerves, cytokine-responding cells and the nervous system.     

Chronic hematuria and abdominal pain

An 18-year-old Asian woman with a history of substance abuse presented to the Emergency Department with right-sided abdominal pain and hematuria of several months duration. Physical examination revealed right upper quadrant and suprapubic tenderness. Liver function tests were normal. Urinalysis showed: large blood, 30–50 red blood cells/high-powered field, and no bacteria. She underwent a CT of the abdomen and pelvis following oral and intravenous contrast.     

经尿道半导体激光汽化术治疗出血性放射性膀胱炎

目的 评价经尿道半导体激光汽化术治疗出血性放射性膀胱炎的临床疗效.方法 选取2014年7月至2015年12月18例因盆腔肿瘤放疗引起的出血性放射性膀胱炎患者接受经尿道半导体激光汽化术,术后进行随访,观察疗效.结果 所有患者术后肉眼血尿均消失,随访6~22个月,平均(14.4±4.2)个月,1例术后3个月出现轻微肉眼血尿,未予治疗,血尿自行消失,4例患者术后出现尿频、尿急、尿痛等膀胱刺激症状,对症治疗后症状消失.结论 经尿道半导体激光汽化术治疗出血性放射性膀胱炎疗效确切,不良反应小,具有良好的临床价值.     

经尿道电切和激光治疗腺性膀胱炎的疗效观察

对52例经病理活检证实的腺性膀胱炎患者,分别采用经尿道电切和激光烧灼两种方法进行治疗。其中,电切治疗28例,激光治疗24例。结果:本组共治愈41例,好转9例,无效2例,治愈率为78.8％,有效率为96.2％。其中,电切治疗治愈率为82.1％;激光治愈率为75％。经尿道电切和激光烧灼一次治疗的治愈率分别为75％和41.7％,两者差异显著(x~2检验,P<0.05)。结论:经尿道电切和激光烧灼是目前治疗腺性膀胱炎较为有效的方法,电切的一次性治愈效果优于激光。     

腺性膀胱炎(附30例报告)

目的 总结腺性膀胱炎发病特点,提高腺性膀胱炎诊治水平。方法 回顾分析３０例腺性膀胱炎病例资料、诊断、检查和治疗方法的应用及预后特点。结果 ６３０例中１１例行经尿道电切术,有效率８２％。术后病理发现伴有组织恶变者２例。保守治疗者中２例未经特殊治疗,自然痊愈。结论 膀胱镜检查结合组织活检对腺性膀胱炎的早期诊断具有重要意义;经尿道电切或电灼术是主要的治疗方法。     

腺性膀胱为的影像学诊断

目的 探讨腺性膀胱炎的影像诊断要点。方法 对２４例经膀胱镜及病理确诊为腺性膀胱炎患者的临床、膀胱镜、ＣＴ及静脉尿路造影（ＩＶＵ）检查进行回顾性分析。结果 临床表现为血尿１１例,尿路刺激症状９例,排尿困难８例,肾功能减退２例;胱镜检查２２例,表现为菜花样改变１１例水肿与滤泡样改变８例,黏膜粗糙３例。１８例行Ｂ超,１２例诊断为膀胱占位;行ＩＶＵ检查１５例,其中１０例诊断为膀胱占位,并经ＣＴ证实。２４种     

Urinary tract infections in women

Urinary tract infection (UTI) is the most common extraintestinal infectious disease entity in women worldwide, and perhaps one of the most formidable challenges in clinical practice given its high prevalence, frequent recurrence, and myriad associated morbidities in the setting of rapidly evolving antimicrobial resistance. Achieving timely symptom relief and infection control and preventing morbidity, growth of resistant organisms, and recurrent infection are often difficult. This article reviews epidemiology and pathogenesis of urinary tract infection in women; characterizes common patterns of infection, clinical red flags, and appropriate laboratory testing and imaging; explores emerging patterns of antimicrobial resistance; and reviews the updated guidelines for the treatment of uncomplicated UTI in women.