脐尿管癌的临床特征及预后相关因素分析

目的:探讨脐尿管癌的临床特征及预后影响因素。方法:回顾性分析2011年8月至2019年11月郑州大学第一附属医院收治的35例脐尿管癌患者的临床资料。男23例,女12例,男女比例为1.92∶1。平均年龄(52.1±13.9)岁,中位年龄55岁。有吸烟史8例,饮酒史3例。合并高血压病5例,糖尿病5例,冠心病2例,脑梗死1例...     

膀胱非上皮性肿瘤的诊治

目的 总结膀胱非上皮性肿瘤的诊治经验。方法 对1953～2002年收治的28例膀胱非上皮性肿瘤患者的诊治情况进行总结、分析。结果 膀胱非上皮性肿瘤的主要临床表现为血尿、盆腔肿块、尿频、排尿困难等症状。主要辅助检查为B超、CT、膀胱镜检查及镜下活检。本组28例中,经术后病理检查,恶性肿瘤17例(占61．7％),有7种病理类型,分别为膀胱横纹肌肉瘤、膀胱小细胞癌、膀胱平滑肌肉瘤、膀胱恶性淋巴瘤、膀胱恶性纤维组织细胞瘤、膀胱脂肪肉瘤、膀胱黑色素瘤;良性11例(占39．3％),有4种病理类型,分别为膀胱海绵状血管瘤、膀胱壁纤维瘤、膀胱平滑肌瘤、膀胱嗜铬细胞瘤。11例良性肿瘤均完整切除或电灼、电切。17例恶性肿瘤中,膀胱部分切除术7例、膀胱全切除术9例、无法切除1例,有7例恶性肿瘤因复发多次行手术切除。17例恶性肿瘤患者均获随访,3年存活率47．0％(8／17)。结论 膀胱非上皮性肿瘤临床少见,病理类型复杂,恶性居多且预后较差,良性肿瘤预后较好。术前诊断率低,膀胱镜下深部活检可提高诊断率。手术是该病的主要治疗方法。良性肿瘤应完整切除,恶性肿瘤应争取广泛切除,结合其病理特点辅助放化疗可能提高疗效。     

非血吸虫性膀胱鳞状细胞癌诊疗和预后分析(附21例报告)

目的:探讨非血吸虫性膀胱鳞状细胞癌的病因、诊断、治疗及预后情况。方法:回顾分析21例经术后病理检查证实为膀胱鳞癌患者的临床资料,包括其临床症状、检查、治疗及预后情况,对其预后情况进行相关的统计分析。结果:21患者中主要症状表现为血尿、膀胱刺激症状、泌尿系感染等。患者1年、2年及5年生存率分别为55%、30%和5%,中位生存期16.1个月。初次就诊时T1期0例,4例发现盆腔淋巴结转移,1例发现肺部转移。接受根治性膀胱全切的患者生存期明显长于未行根治性膀胱全切的患者。随着T分期的增高,患者生存期逐渐减短;盆腔淋巴结转移的4例患者分别于术后8、10、11、18个月死亡,而未发现淋巴结转移的患者中有6例存活至少2年或以上,最长者目前随访75个月仍生存;不同肿瘤分级患者生存期无明显差异。部分患者接受放化疗等辅助治疗,但对患者预后改善不明显。结论:膀胱鳞癌预后差,早期诊断很重要,应尽早行根治性膀胱全切+盆腔淋巴结清扫术以改善患者预后,放化疗在膀胱鳞癌治疗中的作用仍需进一步探讨。     

MICROPAPILLARY BLADDER CARCINOMA: A CLINICOPATHOLOGICAL STUDY OF 20 CASES

PURPOSE: Micropapillary bladder carcinoma is rare, with only 18 cases reported to date. We report 20 additional cases with long-term followup. MATERIALS AND METHODS: A total of 680 patients with an initial diagnosis of bladder carcinoma in western Sweden in 1987 and 1989 were prospectively registered. The clinical records of all 816 patients with bladder cancer treated at Sahlgrenska University Hospital with external beam irradiation between 1962 and 1989 were reviewed. The histopathological material was reviewed and immuno-histochemical analyses were performed on 20 cases identified with micropapillary bladder carcinoma. RESULTS: The incidence of micropapillary bladder carcinoma was 0.7%. Mean patient age at diagnosis was 69 years (range 45 to 82) and the male-to-female ratio was 2.3:1. All but 5 patients had stage T3a disease or higher. There was no difference in stage or prognosis between the 5 prospectively identified patients and those treated with external beam irradiation. Only 2 patients had micropapillary bladder carcinoma as the only pattern, while 1 had 10% and the remainder had 20 to 95% micropapillary bladder carcinoma. Transitional cell carcinoma was noted in 17 patients and 5 had areas of gland forming adenocarcinoma. Carcinoma in situ was noted in 13 patients and 15 had lymphatic invasion. Only 5 patients survived 5 years, 1 of whom died of bladder cancer after 7 years. Radiation and chemotherapy did not seem to be effective. CONCLUSIONS: The light microscopic appearance, which is strikingly similar to ovarian papillary serous carcinoma, and immunohistochemical staining pattern lend some support to the theory that micropapillary bladder carcinoma is a variant of adenocarcinoma. Since even the focal presence of micropapillary bladder carcinoma is associated with a poor prognosis, recognition of this entity is important. Due to its rarity, the optimal treatment of micropapillary bladder carcinoma needs to be determined in a multicenter study.     

脐尿管疾病的诊治研究及文献复习(附14例报告)

目的：探讨脐尿管疾病的诊断与治疗方法。方法：根据病史并结合经脐孔或膀胱美蓝灌注试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查方法诊断为脐尿管异常疾病14例，并进行相应手术治疗。结果：手术及病理检查证实为脐尿管瘘并感染2例。脐尿管囊肿并感染5例。脐尿管窦道并感染5例。原发性脐尿管鳞状细胞癌1例。患者术后排尿正常。8～18d痊愈出院。1例脐尿管瘘并感染者拒绝手术出院。结论：经脐孔或膀胱美蓝灌注试验、膀胱镜检查、瘘管造影、B超、CT等辅助检查为脐尿管疾病有效的诊断措施；手术范围应以尽可能彻底切除脐尿管及其异常组织为宜。     

Mucinous adenocarcinoma of the bladder

Mucinous adenocarcinoma is a rare entity within the group of primary adenocarcinoma of the bladder which represent 0.5-2% of all malignant epithelial bladder tumours. In spite of the rarity of this tumoral type; it is a poor prognosis entity mainly due to its diagnosis especially in advanced stage of the disease. There is no general agreement on the treatment of adenocarcinoma of bladder. Not withstanding surgery would be the only curative treatment, although unfortunately, it is curative in just a few cases. We report six cases with mucinous adenocarcinoma of the bladder attended in our Department in the last ten years (january 1991-december 2001). In one of them a radical cystectomy was performed, while transurethral resection with or without adjuvant treatment was practiced in the other one. Only one patient is alive today, namely, the one where the tumour not invade the muscular tissue. These findings show the discouraging results of this entity closely intertwined with the pathologic stage.     

Recurrent urinary incontinence: cystomanometry--conditio sine qua non?

The value of cystometry in the diagnosis of recurrent urinary incontinence is to differentiate between urge and stress incontinence. This is possible through determination of detrusor hyperactivity characterized by uninhibited detrusor contractions. Cystometry is necessary since neither history nor clinical examination can differentiate between urge and stress incontinence. Both types of incontinence are in many patients found together and factors causing stress incontinence, for instance coughing, may also cause spontaneous, uninhibited detrusor contractions. The diagnosis of detrusor hypoactivity is also important although lack of detrusor contractions is not identical to lack of contractility. In only 50% of patients are detrusor contractions present following correction of the urinary incontinence and increase of urethral resistance. In the other half of the patients, lack of detrusor contractility remains. There is evidence that a so-called micturition-stop-test may allow a prognosis in cases of lack of bladder contractility. Cystometry is, therefore, a conditio sine qua non although it only gives information concerning the function of the detrusor. Concerning the evaluation of the bladder outlet, additional radiological and urodynamic examinations are necessary.     

Long-term followup and outcome of continent catheterizable vesicocstomy using the Rink modification

PURPOSE: Multiple techniques have been described to create a Mitrofanoff channel in the pediatric population. A small subset of patients only requires creation of a catheterizable channel without bladder augmentation. These patients are ideal candidates for a procedure that avoids the use of intestine, especially in the absence of a suitable appendix. We used a modification of the Casale vesicostomy, as described by Rink, to create a continent vesicostomy in these children. We report our long-term experience with this technique. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all patients who underwent continent vesicostomy at our institution between 1992 and 2000. Patient diagnosis, stomal site, associated bladder procedures, stomal continence, followup and complications associated with continent vesicostomy were documented. RESULTS: Of the 31 patients who underwent continent vesicostomy, as described by Rink, 14 were female and 17 were male. Average age was 9 years (range 2.5 to 22). Primary diagnosis included neuropathic bladder in 15 cases, the prune-belly syndrome in 6, cloacal exstrophy/anomaly in 5 and other in 5. The stoma was placed in the lower abdomen in 17 patients, in the umbilicus in 7 and in a neoumbilicus in 7. Simultaneous procedures included ureteral reimplantation in 8 cases, bladder augmentation in 5, bladder neck surgery in 4 and reduction cystoplasty in 2. Mean followup was 41 months. All patients achieved excellent stomal continence. Complications included stomal stenosis requiring revision in 14 cases (45%). Stenosis developed in 60% of the patients with neuropathic bladder and in 86% with an umbilical stoma. Eventually 6 patients underwent conversion to an alternative catheterizable channel. CONCLUSIONS: Continent vesicostomy can be performed successfully when there is any underlying bladder pathology with 100% stomal continence. Despite the higher rate of stomal problems with this type of Mitrofanoff channel we think that continent vesicostomy is a reasonable alternative in patients with a large bladder requiring only catheterizable channel creation. Because of the excellent results reported with the Monti-Yang technique, we would currently recommend this procedure over continent vesicostomy when bowel is used for bladder reconstruction.     

膀胱内翻性乳头状瘤16例的诊治与预后

目的：探讨膀胱内翻性乳头状瘤（1PB）的发病特点,提高对其诊治及预后的认识。方法：回顾性分析16例IPB的临床资料,复习相关文献,并随访患者。16例均行经尿道膀胱肿瘤切除术（TURBT）,14例术后行膀胱内即刻灌注一次,其中9例继续行膀胱规律灌注1年,另2例未行膀胱灌注。结果：全部病例术后病理诊断均为IPB,其中1例合并低度恶性潜能。随访6个月～5年无复发。结论：膀胱内翻性乳头状瘤是非浸润性泌尿上皮良性肿瘤,TURBT是其标准治疗方法,单纯IPB行TURBT术后无需行膀胱灌注化疗,但需定期随访观察。     

膀胱混合癌的临床特征

目的:探讨膀胱混合癌的临床特征。方法:回顾性分析1990年6月~2004年8月收治的16例膀胱混合癌患者的临床资料,对该病的临床表现,诊断和治疗以及预后情况进行讨论。结果:膀胱混合癌16例,占同期230例膀胱恶性肿瘤的6.9%,其中移行、鳞状细胞混合癌7例,移行、腺细胞混合癌4例,移行、鳞状、腺细胞混合癌3例,鳞状、腺细胞混合癌2例。多数患者以膀胱刺激症为主要临床表现,治疗以膀胱全切为主,术后1、3和5年的生存率分别为81.3%、56.3%和12.5%。结论:膀胱混合癌以膀胱刺激症状为主要临床表现,恶性程度高,早期诊断困难。根治性全膀胱切除术有助于提高生存率。     

174例原发性输尿管癌的临床分析

目的 探讨原发性输尿管癌的诊断、治疗、病理学特点和预后。方法 对1971年1月至2002年7月我所经手术病理检查诊断为原发性输尿管癌174例患者的临床发病、病理学资料、诊断、治疗及随访结果进行回顾性分析。结果 30年来输尿管癌病例数呈明显增加趋势。本组男99例,女75例,平均发病年龄63．7岁。阳性率较高的术前检查有逆行尿路造影、CT、磁共振水成像、输尿管镜检查,阳性率分别为87．8％(86／98),96．0％(48／50),95．8％(23／24)和87．0％(20／23)。手术以肾、输尿管全长切除和输尿管入口处膀胱袖状切除术为主,共131例(75．3％)。组织学分型,移行细胞癌171例(98．3％),其中Ta-2和G1、2肿瘤各占70％以上(122／174,126／174)。160例(92．0％)获随访,随访时间2～216个月。术后总的5年生存率53．1％(52／98),总的10年生存率30．5％(18／59)。术后发生膀胱癌38例(23．8％),发生对侧输尿管癌6例(3．8％)。结论 原发性输尿管癌预后不良,肿瘤分期、分级是决定预后的主要因素,应提高术前诊断的准确性。     

Malignant non-urothelial neoplasms of the urinary bladder: a review

OBJECTIVES: Non-urothelial bladder tumors frequently present a diagnostic and therapeutic challenge. We review the peer-reviewed literature to summarize the available evidence on the etiology, diagnosis and optimal management of malignant non-urothelial bladder tumors. METHODS: A comprehensive MEDLINE database search was performed. In addition, the proceedings of recent national and international urological and cancer society meetings were reviewed. RESULTS: Primary non-urothelial bladder tumors are rare in Europe and North America representing less than 5% of all bladder lesions combined. A large number of risk factors have been implicated in the etiology of non-schistosomiasis-related squamous cell carcinoma, yet their exact pathomechanism remains poorly defined. Squamous cell carcinoma, adenocarcinoma, small cell carcinoma, sarcoma and carcinosarcoma/sarcomatoid tumors share an unfavorable prognosis despite aggressive surgical management that relates both to an aggressive biological behaviour as well as to an often times advanced stage at the time of diagnosis. Inflammatory pseudotumors are benign tumors of uncertain histogenesis that may mimic sarcomas. Paraganglioma, primary melanoma and lymphoma represent additional, exceedingly rare bladder tumors. CONCLUSIONS: The systematic investigation of most non-urothelial bladder tumors is limited by the rarity of these lesions. A concerted effort of multiple institutions linked together in a national or international tumor registry will be necessary to advance our understanding of these tumors, evaluate treatment strategies and optimize patient outcome in the future.     

A case of leiomyoma of urinary bladder with relapse from the external urethral orifice--clinical analysis of leiomyoma of urinary bladder in Japan

A 22-year-old female visited our hospital with complaints of pollakisuria and dysuria on July 3, 1987. Cystoscopy revealed a tumorous lesion in the urinary bladder. On July 8, 1987, she had urinary retention because of relapse of the tumor from the external urethral orifice. Under the diagnosis of urinary bladder tumor, tumorectomy was performed. The resected tumor had a steel, smooth surface, was elastic soft, red-purple and 7 g in weight. Pathological examination demonstrated the tumor to be composed of spindle-like cells, which showed no mitotic figures. Therefore, the tumor was diagnosed as leiomyoma of urinary bladder. In the literature, 67 cases of leiomyoma of the urinary bladder have been reported so far in Japan. The patients ages ranged from the 2nd to 8th decade, the peak age being the 4th decade. The sex ratio was 5 to 2, females being predominant. Chief complaints were hematuria, pollakisuria and dysuria, but prolapse of the tumor from the external urethral orifice was rare, only 3 cases including our case being reported thus far. Tumorectomy (34 cases, 27%) or partial cystectomy (16 cases, 27%) was performed in many cases, because it was benign. The prognosis was good, and there have been no reports stating that it become malignant.     

Hydatid cyst of the kidney

Hydatidosis is an endemic disease caused by the larval form of Echinococcus Granulosus. Renal involvement represents less than 5% of confirmed cases. It remains clinically silent for a long time, and only presents at the stage of complications. Diagnosis is suspected on the basis of epidemiological, clinical, radiological and biological data. There are various clinical presentations. Hydaturia, which is observed in 10 to 30% of the cases, is the only pathognomonic feature. Diagnostic accuracy has been improved since the wide use of ultrasonography. Computed tomography and magnetic resonance imaging are helpful tools to confirm the diagnosis. The treatment is mainly based on surgery. The resection of the prominent dome remains the standard option as it allows preservation of the kidney. Total nephrectomy should be proposed only in case of renal destruction. The percutaneous management, which includes puncture, aspiration, injection, and reaspiration, can be performed in very selected cases. However, the results of this technique are still under debate.     

长期留置导尿患者膀胱鳞癌的特征

目的回顾性分析长期留置导尿患者其膀胱鳞状细胞癌的临床特点,提高对这一较少见疾病的认识.方法以肿瘤、癌、膀胱癌、鳞状细胞癌、膀胱造口术和脊髓损伤作为关键词或主题词于 PubMed 数据库检索关于膀胱鳞状细胞癌的相关文章并加以分析.结果检索到1967年至2015年共89篇相关文章,其中29篇入选.涉及患者80例,患者诊断膀胱鳞癌时的平均年龄为55岁.留置导尿管持续时间为(23．9±10．3)年.留置导尿的主要原因是脊髓损伤(90％).与典型的移行细胞癌相比,通过膀胱镜或尿细胞学检查均仅能确定32．5％的肿瘤病变.膀胱鳞癌患者平均生存时间为(84±23．97)个月,95％可信区间为37．01~130．99个月.2年总生存率为67％,5年生存率为52％,10年生存率为40％.生存时间与疾病的分期、患者的年龄、留置导尿持续时间和治疗方式显著相关(P ＜0．05);存活时间最长的是分期为 T1~2、诊断膀胱癌时年龄≥50岁以及采用根治性膀胱切除和/或放射治疗的患者(P ＜0．05).多变量分析表明,患者的年龄、留置导尿持续时间和治疗方案是影响生存的独立预测指标(P ＜0．05).结论长期留置导尿的膀胱鳞癌患者总体预后差,预后有赖于肿瘤的早期诊断.对高危患者定期行膀胱镜检查并随机活检,有望早期诊断长期留置导尿的膀胱癌患者.根治性膀胱切除与辅助放射治疗是目前最有效的治疗方式.     

膀胱鳞状细胞癌30例

目的：提高对膀胱鳞状细胞癌（ＳＣＣ）的诊治水平。方法：回顾性分析３０例本病患者的临床资料,结合文献进行讨论,结果：膀胱部分切除术６例中,３年以上无复发者３例;ＴＵＲＢＴ术６例中,３年以上无复发者２例。膀胱全切术１８例中,３年以上无复发者６例。全组至今生存５年以上者共５例。结论：膀胱ＳＣＣ浸润性强,恶性程度高,预后不良,早期诊断及时手术能提高患者的５年生存率。     

The value of lymphography in the management of bladder cancer.

228 bilateral pedal lymphograms in patients with bladder cancer have been correlated with the features of the primary bladder tumour and patient survival. In 70 cases, radiographic findings were correlated with operative node histology. The results show that it is not possible to predict accurately which cases have lymphatic spread without this investigation. Positive lymphograms were found in 91 cases, and were associated with a very poor prognosis. Only 6% of patients with unilaterally involved iliac nodes survived 5 years, and all patients with bilateral iliac or para-aortic disease died within 3 years. Histological correlation was found in 90% of cases, and the results indicate that this investigation slightly underestimates the incidence and extent of microscopic lymphatic metastases. It is concluded that this investigation is essential in planning the treatment of infiltrating bladder tumours.     

Clinical study of bladder injury

Since bladder injury has no specific clinical symptoms, accurate diagnosis at first consultation is relatively difficult. To elucidate the clinical characters type of injury, clinical symptoms, laboratory findings, methods of therapy and diagnosis, we reviewed 15 patients with bladder injury over a 9-year-period 1990-1998 (10 were traumatic injuries and 5 spontaneous injuries). We found no specific clinical symptom of bladder injury. Bladder injury may occur anywhere in the bladder wall, but most commonly occurred at the dome of the bladder (60.0%). Gross hematuria was not seen in 40.0% of the cases. The accuracy of diagnosis at first consultation was relatively low (46.7%) and the tendency to make a misdiagnosis as acute abdomen on digestive organs was found. Of the traumatic injuries 60% were afflicted in the drunken state, so alcohol intoxication was considered as an important enviromental factor of bladder injury. Surgical repair of injury sites was employed in 11 cases (73.3%: 7 were intraperitoneal injuries, 4 were extraperitoneal injuries), 4 cases were managed with indwelling urethral catheter. With appropriate treatment, the prognosis is excellent.     

膀胱小细胞癌的病理组织学特点及其诊治

目的:探讨膀胱小细胞癌病理组织学特点及其诊断与治疗。方法:回顾分析6例膀胱小细胞癌患者的临床和病理资料,6例患者行经尿道膀胱肿瘤电切术2例,膀胱部分切除术1例,行膀胱全切术2例,单纯化疗1例。5例患者接受2～6疗程化疗。结果:6例随访3个月～3年,1例患者术后生存2年至今,5例均因肿瘤转移死亡,平均生存时间14.8个月。结论:膀胱小细胞癌分化程度低、恶性程度高、易早期转移、预后差,主要依靠病理组织学检查确诊,现有治疗方法不足以将其治愈,手术联合化疗是目前主要的治疗方法,分子靶向治疗是未来治疗的主要手段。     

膀胱非移行细胞肿瘤的诊断与治疗(附18例报告)

目的：提高膀胱非移行细胞肿瘤的诊治水平。方法：结合文献对收治的１８例膀胱非移行细胞肿瘤的诊断与治疗进行讨论。结果：１８例膀胱非移行细胞肿瘤占同期３５２例膀胱肿瘤的５．１％。其中良性非移行细胞肿瘤３例（１６．７％）,恶性非移行细胞肿瘤１５例（８３．３％）,后者以鳞癌、腺癌及其与移行细胞癌混合癌为主,占７３．３％,且临床分期Ｔ３期以上者亦占７３．３％。以血尿和膀胱刺激症状为主要临床表现。治疗以膀胱全切