Bladder tumor occurring in the contracted bladder following urinary tract tuberculosis

We report a case of bladder squamous cell carcinoma which occurred in the contracted bladder following urinary tract tuberculosis 20 years earlier. The patient came to our hospital complaining of gross hematuria, so we suspected recurrence of urinary tract tuberculosis. We administered rifampicin and ethanbutol. However, urine culture was negative and urine cytology was positive. Following internal urethrotomy, cystoscopy was performed and a bladder tumor was found. Although in this case there was a long time lag between urinary tract tuberculosis and bladder tumor, it was very difficult to make an exact diagnosis. It would have been even more difficult if there had been coexistence of active tuberculosis. We discuss the points of diagnosis and treatment.     

A case of transitional cell carcinoma of the bladder with active urinary tract tuberculosis

A 63-year-old man was admitted to our hospital complaining of painful urination. Urinalysis demonstrated pyuria and microscopic hematuria. Cystoscopy revealed the bladder tumor and the reddish mucosa. Transurethral biopsy was performed and the pathological examination showed transitional cell carcinoma in the bladder tumor and epithelioid granuloma in the reddish mucosa. Acid-fast bacilli smeas of urine sample and urine culture of Mycobacterium tuberculosis were positive. Therefore the treatment of urinary tuberculosis was started and the patient received intra-arterial chemotherapy combined with radiation. After the therapy, radical cystectomy and bilateral cutaneous ureterostomies were performed. Pathological study revealed transitional cell carcinoma and epithelioid granuloma in the removed bladder. The reports of urinary epithelial carcinoma with urinary tract tuberculosis were rare and, including our case, the 10 cases in Japanese literature are reviewed.     

Diagnostic aspects of bladder angiography in urinary bladder tuberculosis

Histopathological and angiographic findings were correlated in 6 cases of tuberculosis of the urinary bladder. The number of vessels was only slightly increased in the initial and fibrotic stages, whereas hypervascularization was observed in the exudative and productive stages. Otherwise the angiographic changes were nonspecific. Thus it was not possible to distinguish tuberculous cystitis from cystitis of other genesis, and in some instances from tumours of the urinary bladder either.     

尿流改道术后尿路结石的治疗

目的 探讨尿流改道术后尿路结石的治疗方法.方法 选取20例既往因膀胱癌接受尿流改道的尿路结石患者(肾结石6例,输尿管结石5例,储尿囊结石9例),接受个性化的治疗:其中经皮肾取石术8例,经皮肾顺行输尿管软镜碎石术3例,储尿囊流出道入路手术5例,经皮膀胱穿刺人路手术3例,开放取石1例.结果 手术时间60～130min,平均104min;术后结石清除率90％(18/20);术后发热4例(20％o),其中l例经皮肾镜技术(PCNL)术后液胸,行胸腔闭式引流.结论 针对尿流改道术后的尿路结石患者,采取个性化治疗方案,能够有效的清除尿路结石.     

Impact of overactive bladder and lower urinary tract symptoms on sexual health in Japanese women

Introduction and hypothesis  

This study aims to assess whether lower urinary tract symptoms (LUTS) affect sexual function in Japanese females.     

Management of the obstructed urinary tract associated with neurogenic bladder dysfunction

The child with neurogenic bladder dysfunction may suffer from lower urinary tract obstruction, which, if untreated, can result in upper urinary tract deterioration. It is prudent to identify those newborns and infants who are at risk for upper urinary tract deterioration and advise an appropriate treatment protocol. In order to identify those children at risk, a thorough examination is required, along with appropriate upper urinary tract imaging studies and urodynamic assessment of the bladder. Infants and children at risk for upper tract deterioration are those who have intermittent or continuous detrusor pressure elevation above 40 cm H2O. We have identified the safe period, which is the time during which the bladder remains at a pressure lower than 40 cm H2O. Our management protocol for each child is individualized and based on increasing the safe period. The safe period can be increased with a combination of intermittent catheterization, administration of medications, and, in some cases, surgical reconstruction. With compulsive evaluation and intensive management, many of the previous upper urinary tract changes associated with the obstructed neurogenic bladder can be averted. With the above factors in mind, we have defined the period of bladder filling and storage where the pressure is below 40 cm H2O as the safe period. The ideal bladder for maintenance of normal upper tracts would have a long safe period and low voiding pressure. Our treatment protocol for the neurogenic bladder is therefore dependent on identifying those children who have very short or nonexistent safe periods. These are the children who are at risk for upper tract deterioration.     

Treatment of urinary tract infection with cefixime

Cefixime (CFIX) was administered orally in the treatment of 59 cases of urinary tract infection (UTI). According to the response criteria defined by the Japanese UTI committee, the rate of clinical efficacy for 26 cases of uncomplicated cystitis was 96.2%. The rate of clinical effectiveness of five patients with complicated UTI and five with uncomplicated pyelonephritis was 80.0%. In the other 23 cases which did not meet the response criteria, the efficacy rate was also high. The results indicated that CFIX was an effective drug for the treatment of UTI.     

Interrelationships of bladder compliance with age, detrusor instability, and obstruction in elderly men with lower urinary tract symptoms

Data on the interrelationships of bladder compliance (BC), detrusor instability (DI), and bladder outflow obstruction (BOO) in elderly men with lower urinary tract symptoms (LUTS) are scarce and were therefore assessed in this study. Principle inclusion criteria for this study were men aged > or = 50 years suffering from LUTS as defined by an International Prostate Symptoms Score (IPSS) of > or = 7 and a peak flow rate (Qmax) of < or = 15 ml/sec. Patients with previous surgery of the bladder, prostate, or urethra as well as a pathological neurourological status were excluded from this study. The following parameters were studied in all patients: IPSS, prostate volume calculated by transrectal ultrasonography, free uroflow study, post-void residual volume determined by transurethral catheterization, and a multichannel pressure flow study (pQS). A group of 170 men were included in the analysis. The mean BC in the overall group was 32 +/- 2 ml/cm H2O (mean +/- standard error of the mean [SEM]; range, 4-100 ml/cm H2O). In 36.5% of patients, BC was significantly reduced (< or = 20 ml/cm H2O), and in a further 37.1%, it ranged from 20 to 40 ml/cm H2O. BC decreased statistically significantly (p < 0.05) in patients with advanced age, lower Qmax, higher voiding pressures, and larger prostates. In men with DI (n = 61), mean BC was significantly lower (22 +/- 3 ml/cm H2O) compared to those without (37 +/- 3 ml/cm H2O; p = 0.001; n = 109). Patients with severe BOO as defined by a linear passive urethral resistance relationship of > or = 3 (n = 109), had a significantly lower BC (23 +/- 2 ml/cm H2O) compared to those without or minimal obstruction only (39 +/- 3 ml/cm H2O; p = 0.0002; n = 61). Stepwise logistic regression analysis revealed that DI, a low bladder capacity, and a high maximum detrusor pressure were independent predictors of markedly reduced BC (< 20 ml/cm H2O). BC is decreased in elderly men with high voiding pressures, BOO, and DI. The mechanism leading to the reduction of BC under these circumstances is largely unknown and could result from cytostructural alterations of the detrusor and changes in detrusor innervation.     

Case report of primary carcinoma in situ in upper urinary tract and review of the Japanese literature

A case of carcinoma in situ (CIS) in the right renal pelvis in a 71-year-old women is reported. The patient was admitted because of macroscopic hematuria. Drip infusion pyelography showed a filling defect (coagulum) in the right renal pelvis. Other abnormal findings were not made. Malignancy was suspected by cytology examination in both voiding urine and that obtained by catheter from the right pelvis. A right total nephroureterectomy was performed. Macroscopic abnormal findings were only of the coagulum in the renal pelvis. Pathologic examination showed CIS in the renal pelvis. We studied the features, pattern of recurrence, and prognosis of 19 cases of primary CIS in the upper urinary tract in the Japanese literature. A slight higher frequency was reported for women than for men. When the CIS was in the ureter, abnormal roentgenological findings, such as stenosis, filling defects, or a dilated ureter, were common (77%), contrary to expectation. But when the CIS was in the pelvis, such findings were rare. Urine cytology examination was positive in 95% of the patients. In four of the 19 patients, a recurrence was found. In all four patients, the first recurrence was in the bladder within 2 years of surgery. The kind of recurrent bladder tumors varied with the patients. The prognosis with recurrence was poor. If signs of recurrence were not recognized within 2 years of surgery, the prognosis was good.     

Reconstruction of the lower urinary tract for neurogenic bladder: lessons from the adolescent age group.

Of 42 adolescents with neurogenic bladder who presented for lower urinary tract reconstruction, 4 patients with severe spina bifida were unfit for major surgery. Five patients had a simple undiversion; 4 of these had a poor outcome because of unpredicted sphincter incontinence (1 patient) or instability (3). A total of 26 patients had an enterocystoplasty. All 7 patients who had a substitution cystoplasty had a good result, as did 3 males with a clam cystoplasty. Nine of 16 females had a poor result from a clam procedure. In 3 the problem lay with self-catheterisation difficulties. One each had persistent hyper-reflexia and sphincter incontinence. Four had hyper-reflexia on sexual intercourse. Overall, 42% of females had problems from the retained bladder segment. Seven patients had continent urinary diversions. The results were good, although 2 Kock nipples required revision. Surgery was well tolerated. There was a 21% re-operation rate for complications. Pre-operative investigation correctly predicted sphincter competence and the need for self-catheterisation in 79 and 86% respectively.     

Treatment of carcinoma in situ of the urinary bladder with BCG

In a prospective study 55 patients with primary or secondary carcinoma in situ of the bladder were treated with BCG. With an overall response rate of 85%, results reported by other authors can be confirmed. In relationship with the effectiveness of the treatment, the side-effects can be considered as acceptable. Therapy failure suggests extravesical or invasive carcinoma.