Overactive bladder: diagnosis and management

Overactive bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. Whilst a number of women may be managed based on a clinical diagnosis alone urodynamic studies may be useful in those women with complex or refractory symptoms. In the first instance all women will benefit from a conservative approach using bladder retraining although a number will require antimuscarinic therapy. For those women with persistent symptoms following medical therapy alternative treatment modalities such as intravesical Botulinum Toxin, neuromodulation or reconstructive surgery may be considered. This review, whilst giving an overview of the syndrome, will focus on a practical clinical approach to managing women with symptoms of overactive bladder (OAB).     

Vaginal estrogen therapy and overactive bladder symptoms in postmenopausal patients after a tension-free vaginal tape procedure: a randomized clinical trial

OBJECTIVE: To evaluate whether the frequency of overactive bladder (OAB) symptoms increases in menopause patients after a tension-free vaginal tape (TVT) procedure, and to determine if topical estrogen therapy can help prevent these symptoms. DESIGN: After undergoing a preoperative assessment, enrolled patients were randomly allocated to receive TVT plus postoperative vaginal estrogen therapy (ET group) or TVT without adjunctive medical treatment (No ET group). The pre- and postoperative assessments included: acquisition of a urogynecologic history with standardized questions regarding urinary function (including a 10-grade visual analogue scale score), urogynecologic clinical examination, and urodynamic assessment. Follow-up assessments were performed at 1, 3, and 6 months after surgery. RESULTS: Fifty-six of 59 patients were evaluable; 28 received topic vaginal estrogen after surgery (ET group) and 28 did not receive adjunctive medical treatment (No ET group). The overall OAB syndrome rate in menopause patients (No ET group) was 7% (2 of 28 patients) at baseline and 32% (9 of 28 patients) 6 months after surgery (P = 0.04). At the 6-month follow-up assessment, the incidence of urinary urgency was 4% (1 of 28 patients) and 29% (8 of 28 patients) in the ET and No ET groups, respectively (P = 0.01). Differences in frequency and nocturia were not statistically significant. Analysis of the visual analogue scale scores revealed that at the 6-month follow-up assessment, urgency significantly improved in the ET group compared with the No ET group (0.23 +/- 1.0 vs 2.30 +/- 3.7, respectively; P = 0.02). CONCLUSIONS: The TVT procedure seems to increase the frequency of OAB syndrome in menopause patients. Vaginal estriol therapy significantly reduces symptoms of urinary urgency, has a high rate of patient satisfaction, and can be used to treat postmenopausal women for at least 6 months after a TVT procedure.     

缩泉丸对膀胱过度活动症大鼠膀胱充盈期盆神经放电的影响

 目的: 研究缩泉丸对膀胱过度活动症(OAB)大鼠膀胱容量、压力及盆神经放电的影响,探讨缩泉丸对OAB大鼠膀胱感觉功能的作用。方法: SD雌性大鼠分别进行膀胱出口梗阻手术以复制OAB模型,随机分为OAB模型组、假手术组和缩泉丸高、中、低剂量组,给药4周后,以尿动力仪观察灌注过程中膀胱容量、压力及非排尿性收缩的变化,以多通道生理记录仪检测灌注过程中盆神经放电的变化。结果: OAB大鼠盆神经放电模式表现为放电频率先于压力达到峰值,而后压力达到峰值时,放电频率趋于平台或下降。OAB模型大鼠膀胱充盈过程中盆神经放电频率明显增强,膀胱压力上升,容量增加,非排尿性收缩增多;缩泉丸的干预能降低盆神经的放电冲动,减少神经放电增强引起的逼尿肌非排尿性收缩,降低膀胱压力,并呈剂量依赖性。结论: 缩泉丸对OAB大鼠膀胱感觉功能的调节可能是其治疗OAB的机制之一。     

Psychometric assessment of female overactive bladder syndrome and antimuscarinics-related effects

Objectives

To investigate the characteristics of psychological distress (PD), personality traits, and family support in women with overactive bladder syndrome (OAB), and the effects of antimuscarinic treatment.

Study design

Women with and without OAB (age- and body mass index [BMI]-matched control group) were prospectively enrolled; they recorded bladder diaries, underwent urodynamic studies, and completed PD, personality traits, and filled family support questionnaires before and after antimuscarinic treatment. OAB women underwent treatment with tolterodine or solifenacin for 12 weeks. The control group completed questionnaires.

Main outcome measures

The differences in PD, personality traits, and family support scores between both groups, and the changes after antimuscarinic treatment in OAB women.

Results

Eighty-five women with OAB (tolterodine, n = 42; solifenacin, n = 43) and 65 without OAB completed the studies. Linear regression analysis with age and BMI adjustment revealed: coefficients of OAB were significant (all P < 0.05) for somatic complaints (mean: 0.87 vs. 0.63, coefficient = 0.21), obsessive–compulsive symptoms (0.69 vs. 0.44, coefficient = 0.25), anxiety symptoms (0.42 vs. 0.27, coefficient = 0.14), General Symptom Index (GSI, 0.48 vs. 0.33, coefficient = 0.14), neuroticism (9.23 vs. 5.17, coefficient = 3.73), and extroversion–introversion (13.64 vs. 15.25, coefficient = −1.73). Anxiety symptoms (0.42 vs. 0.36) and GSI (0.48 vs. 0.39) improved after antimuscarinics (all P < 0.05). High Overactive Bladder Symptom Score questionnaire score (coefficient = −0.39), low hostility score (coefficient = 2.11), and high additional symptoms score (coefficient = −1.46) were associated with good therapeutic effect (all P < 0.05).

Conclusions

OAB women experience more PD, neuroticism, and introversion than asymptomatic women, and antimuscarinics could improve PD.     

托特罗定可有效降低肾移植后导尿管引起的膀胱刺激症状*☆

背景：肾移植后需要长期留置导尿管,易引起膀胱刺激症状。 目的：应用膀胱过度活动症评分表评价肾移植后留置导尿管引起的膀胱刺激症状,同时评价托特罗定降低膀胱刺激症状的有效性。 方法：研究纳入102例亲属活体肾移植受者,肾移植后留置尿管,分别给予托特罗定    4 mg/d或相同剂量的安慰剂。采用膀胱过度活动症评分表评价受者不同时间的膀胱刺激症状。 结果与结论：随着尿管留置时间的延长,肾移植患者尿频及急迫性尿失禁的发生频率及程度逐渐增加。应用托特罗定后,患者尿频及急迫性尿失禁的发生频率及程度明显下降。说明肾移植后常规应用托特罗定可有效降低患者的膀胱刺激症状。      

Relationship between serum cholinesterase level and urinary bladder activity in patients with or without overactive bladder and/or neurogenic bladder

We compared the serum cholinesterase (ChE) level and various parameters between patients with or without overactive bladder (OAB) and/or neurogenic bladder (NB). A total of 258 patients who met the following criteria were enrolled: the presence/absence of OAB and/or NB was documented, laboratory data were available, and liver and renal functions were normal. Patients were divided into the 3 groups: 1) a NB+/OAB+ group who had both NB and OAB, 2) a NB-/OAB+ group who had OAB alone, and 3) an OAB- group who did not have OAB. The relationship between the presence of OAB and various biochemical parameters were examined, as well as the therapeutic outcome in relation to the same biochemical parameters. Forty-three patients had both NB and OAB (NB+/OAB+), 66 patients had OAB without NB (NB-/OAB+), and 149 patients had no OAB (OAB-). Serum ChE, total protein, and albumin levels were lower in the NB-/OAB+ group than the NB+/OAB+ group or the OAB- group. In the NB-/OAB+ group, a higher serum albumin or ChE level was associated with a better therapeutic outcome. These results suggest that a decrease of serum ChE level is related to the occurrence of OAB and the poor response to treatment in OAB patients without NB.     

The management of overactive bladder refractory to medical therapy

Overactive bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. Whilst many women may be initially managed using a clinical diagnosis alone a number will fail primary therapy and will require further investigation. Those women with refractory symptoms following initial conservative and medical therapy may benefit from alternative treatment modalities including intravesical Botulinum toxin, neuromodulation or reconstructive surgery.     

The ameliorating effect of exogenous melatonin on urinary bladder function in hyperosmolar bladder overactivity and its influence on the autonomic nervous system activity

This study was designed to investigate the effects of melatonin on the bladder hyperactivity in hyperosmolar-induced overactive bladder (OAB) rats. Additionally, the influence of melatonin on the autonomic nervous system (ANS) using heart rate variability (HRV) analysis was assessed. 40 rats were divided into four groups: I--control (n = 12), II--rats with hyperosmolar OAB (n = 6), III--rats with melatonin pretreatment and hyperosmolar OAB (n = 6) and IV--control with melatonin pretreatment (n = 6). In group III and IV melatonin in dose of 100 mg/kg was given. HRV measurements in 10 rats, as follow: control (n = 2), control after melatonin treatment (n = 2), rats with hyperosmolar OAB without (n = 3), and after (n = 3) melatonin treatment were conducted. This study demonstrates marked influence of melatonin on urinary bladder activity in hyperosmolar-induced OAB rats. These rats showed significantly reduced the detrusor motor overactivity resulting in the improvement of cystometric parameters after melatonin treatment when compared to the control, as follow: a significant increase of intercontraction interval (70%) and functional bladder capacity (67%), as well as a decrease of the basal pressure, detrusor overactivity index and motility index of 96%, 439% and 40%, respectively. ANS activity analysis revealed sympathetic overactivity in OAB rats, and parasympathetic superiority in melatonin treated OAB rats. Melatonin treatment in rats with hyperosmolar OAB (group III) caused significant increase of nuHF parameter (from 51.00 +/- 25.29 to 76.97 +/- 17.43), as well as a decrease of nuLF parameter (from 49.01 +/- 25.26 to 23.03 +/- 17.43) and LF/HF ratio (from 1.280 +/- 0.980 to 0.350 +/- 0.330). In conclusion, melatonin suppresses hyperosmolar OAB, and modulates ANS activity by inhibition of the sympathetic drive. Therefore, melatonin may become a useful agent for OAB management.     

Psychometric assessment of female overactive bladder syndrome and antimuscarinics-related effects

ObjectivesTo investigate the characteristics of psychological distress (PD), personality traits, and family support in women with overactive bladder syndrome (OAB), and the effects of antimuscarinic treatment.Study designWomen with and without OAB (age- and body mass index [BMI]-matched control group) were prospectively enrolled; they recorded bladder diaries, underwent urodynamic studies, and completed PD, personality traits, and filled family support questionnaires before and after antimuscarinic treatment. OAB women underwent treatment with tolterodine or solifenacin for 12 weeks. The control group completed questionnaires.Main outcome measuresThe differences in PD, personality traits, and family support scores between both groups, and the changes after antimuscarinic treatment in OAB women.ResultsEighty-five women with OAB (tolterodine, n = 42; solifenacin, n = 43) and 65 without OAB completed the studies. Linear regression analysis with age and BMI adjustment revealed: coefficients of OAB were significant (all P < 0.05) for somatic complaints (mean: 0.87 vs. 0.63, coefficient = 0.21), obsessive–compulsive symptoms (0.69 vs. 0.44, coefficient = 0.25), anxiety symptoms (0.42 vs. 0.27, coefficient = 0.14), General Symptom Index (GSI, 0.48 vs. 0.33, coefficient = 0.14), neuroticism (9.23 vs. 5.17, coefficient = 3.73), and extroversion–introversion (13.64 vs. 15.25, coefficient = −1.73). Anxiety symptoms (0.42 vs. 0.36) and GSI (0.48 vs. 0.39) improved after antimuscarinics (all P < 0.05). High Overactive Bladder Symptom Score questionnaire score (coefficient = −0.39), low hostility score (coefficient = 2.11), and high additional symptoms score (coefficient = −1.46) were associated with good therapeutic effect (all P < 0.05).ConclusionsOAB women experience more PD, neuroticism, and introversion than asymptomatic women, and antimuscarinics could improve PD.     

Autonomic dysfunction and arterial stiffness in female overactive bladder patients and antimuscarinics related effects

Objectives

To investigate the characteristics of autonomic function and arterial stiffness of OAB women, their relations with urodynamic parameters, and the impact of antimuscarinics on the above parameters.

Study design

A total of 85 OAB women and another 65 women without OAB were selected. Forty-two OAB women who enrolled before March 2009 were treated with tolterodine for 12 weeks, and another 43 OAB women who enrolled thereafter were treated with solifenacin.

Main outcome measures

The differences of the heart rate variability, cardio-ankle vascular index (CAVI) and ankle-brachial pressure index (ABI) between OAB and asymptomatic women, and their changes after 12 weeks’ antimuscarinics for OAB women.

Results

OAB women had higher low frequency/high frequency ratios (LF/HF) (OAB: 1.5 ± 1.1 vs. the control: 1.1 ± 0.7, P = 0.04). Nonetheless, CAVI and ABI did not differ between OAB and the control group. The square root of the mean squared differences of successive NN intervals (RMSSD) is associated with nocturia (Spearman's ρ = 0.23, P = 0.049), LF is associated with urgency episodes (Spearman's ρ = 0.28, P = 0.01), and maximum urethral closure pressure is negatively associated with CAVI (Spearman's ρ = −0.26, P = 0.02). After 12 weeks’ treatment, a decrease of RMSSD, HF, CAVI and an increase of LF/HF were found in the tolterodine group but not in the solifenacin group.

Conclusions

OAB women have higher severity of autonomic dysfunction with sympathetic predominance. Tolterodine may improve arterial stiffness but may deteriorate autonomic dysfunction to more sympathetic predominance. Thus, tolteridine should be used for OAB with caution in women with preexisting symptoms of autonomic dysfunction.     

Microvascular remodelling after endurance training with Co2+ treatment in the rat diaphragm and hind-leg muscles

This study was designed to examine the changes in capillary geometry, especially the distribution of arteriolar and venular capillaries, in the skeletal muscles of female Wistar rats after endurance training with and without chronic CoCl(2) administration. Four groups of rats were used: non-treated sedentary, non-treated training, Co(2+)-treated sedentary, and Co(2+)-treated training. Exercise training by running lasted for 5 weeks at 25 m/min on a 20% gradient, 10-60 min/d, 5 d/week. The Co(2+)-treated rats drank water containing 0.01% CoCl(2) for 5 weeks. Morphological findings were obtained from the soleus (SOL), deep (PLd) and superficial (PLs) portions of plantaris, and diaphragm (DIA) muscles. Co(2+) administration significantly increased the blood hemoglobin concentration by approximately 25% with and without training. Only in DIA, the Co(2+) treatment alone significantly increased total capillary density and the capillary-to-fiber ratio (C : F) (p<0.05). Both training groups with and without Co(2+) administration showed a significant increase in the C : F in SOL and PLd (p<0.05). In PLd, the increase was significantly greater in the Co(2+)-treated training group than in the non-Co(2+)-treated training group (p<0.05). Training significantly increased the proportion of arteriolar capillaries while it decreased that of venular capillaries in both SOL and PLd (p<0.05). These changes were also observed in PLd after training with Co(2+). The densities of VEGF-positive and TGF-beta1-positive capillaries remained unchanged in all muscle portions examined after either Co(2+) administration or exercise training. These results suggest that chronic Co(2+) administration causes adaptive changes in the oxygen transport system in respiratory muscle and facilitates exercise-induced angiogenesis in hind-leg muscles.     

Expressional evaluation of vascular endothelial growth factor (VEGF) protein in urinary bladder carcinoma patients exposed to cigarette smoke

Angiogenesis is a fundamental process in tumor growth and metastasis. Expression of vascular endothelial growth factor (VEGF) as prognostic indicator has been documented in many types of human tumors. However, the mechanisms responsible for angiogenesis in urinary bladder carcinoma patients are not well defined. Certain carcinogens in tobacco cause DNA damage and may produce specific mutations. In order to investigate the relationship between tobacco smoking, altered patterns of VEGF expression and apoptosis, we have analyzed a group of 125 incident patients with transitional cell carcinoma and 100 cases of control with inflammatory lesions of the bladder. We assessed VEGF overexpression by the use of anti- VEGF antibody through immunohistochemistry, and apoptosis by TUNEL Assay. Expression of VEGF and apoptosis was noticed in 43.2% and 52.8% cases respectively. Both VEGF and apoptosis increased with increasing tumor grade. Apoptosis was seen to be significantly higher in both sexes in the age group of ≥ 50 years (p<0.05) but expression of VEGF was significantly higher among males in the age group of ≥ 50 years (p<0.05). We observed an insignificant association between cigarettes smoking and VEGF overexpression (p>0.05) and significant association with apoptosis. These data support the hypothesis that certain carcinogens derived from cigarette smoking may induce VEGF mutations and apoptosis which in turn are involved in early steps of bladder carcinogenesis.     

Alteration of muscarinic and purinergic receptors in urinary bladder of rats with cyclophosphamide-induced interstitial cystitis

We characterized muscarnic and purinergic receptors and urodynamic parameters in the bladder of cyclophosphamide (CYP)-treated rats to clarify the mechanisms involved in the pathophysiology of interstitial cystitis (IC). In the cystometry of CYP-treated rats compared with control rats, the micturition interval and micturition volume were significantly (55% and 77%, respectively) decreased and the frequency of micturition and basal pressure were significantly (3 and 2.3 times, respectively) increased. These changes in urodynamic parameters may characterize the detrusor overactivity occurring in CYP-treated rats. The maximal number of binding sites (B(max)) for specific binding of [N-methyl-(3)H]scopolamine methyl chloride ([(3)H]NMS) and alphabeta-methylene ATP [2,8-(3)H]tetrasodium salt ([(3)H]alphabeta-MeATP) was significantly (43% and 31%, respectively) decreased in the bladder of CYP-treated rats compared with control rats. On the other hand, the apparent dissociation constant (K(d)) for neither radioligand was significantly altered by the CYP treatment. K(i) value for the inhibition of bladder [(3)H]NMS binding by antimuscarinic agents (oxybutynin, tolterodine, darifenacin, and AF-DX 116) did not differ significantly between control and CYP-treated rats. The inhibition constant (K(i)) for the inhibition of bladder [(3)H]alphabeta-MeATP binding by purinergic antagonists (A-317491, PPADS) was significantly higher in CYP-treated rats than control rats. In conclusion, CYP treatment has been shown to cause down-regulation of pharmacologically relevant (muscarinic and purinergic) receptors in the bladder of rats. Thus, the present study offers further pharmacological evidence that both muscarinic and purinergic mechanisms contribute significantly to the urinary dysfunction due to IC.     

The effect of testosterone alone and testosterone + estradiol therapy on bladder functions and smooth muscle/collagen content in surgically menopause induced rats

ObjectivesThe aim of the study was to investigate the effect of testosterone alone and testosterone + estradiol therapy on bladder functions and smooth muscle/collagen content in surgically menopause induced rat model.MethodsThe study included 34 female Sprague-Dawley rats, and the rats were divided into four groups. After bilateral oophorectomy, during a 60 days period, six rats received IM saline injection for one time, as a control group, and nine rats received testosterone undecanoate 100 mg/kg IM for one time, and nine rats received testosterone undecanoate 100 mg/kg IM for one time + daily 0.50 mg nasal spray of 17β estradiol. Ten rats were taken as sham group. Urodynamic studies were performed in all groups before and after the study. The rats were sacrificed after 60 days, and cystometric findings and smooth muscle/collagen ratio of the bladders were compared between the groups.ResultsIncrease in maximal bladder capacity and compliance were significantly higher in the testosterone treatment group and testosterone + estradiol treatment group than in the control group (p = 0.01 and p = 0.002, respectively for bladder capacity; p = 0.04 and p = 0.005, respectively for bladder compliance). Smooth muscle/collagen ratio of the bladders was significantly higher in the testosterone and testosterone + estradiol treatment groups than in the control group (p = 0.04 and p = 0.008, respectively).ConclusionsThis study shows that bladder functions may deteriorate in postmenopausal period. In addition to estrogen replacement therapy, testosterone has a significant role to increase bladder smooth muscle, leading to improvement in bladder functions in postmenopausal women with urogenital system dysfunction.     

You are what you eat: The impact of diet on overactive bladder and lower urinary tract symptoms

Overactive bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. The symptoms associated with OAB are common and whilst not life threatening are known to have a significant impact on the quality of life (QoL).     

干扰Yes相关蛋白表达调控Wnt/β-catenin信号通路影响膀胱癌细胞凋亡

目的:探讨干扰Yes相关蛋白(YAP)的表达对膀胱癌细胞凋亡的影响及机制。方法:以膀胱癌细胞T-24为研究对象,分为正常对照(control)组、siRNA阴性对照(siRNA-NC)组和YAP siRNA组。分别以real-time PCR和Western blot实验检测转染后各组细胞中YAP的mRNA和蛋白表达水平,MTT法检测细胞活力,流式细胞术检测细胞凋亡情况,Western blot检测β-连环蛋白(β-catenin)和c-Myc表达水平。用Wnt/β-catenin信号通路抑制剂FH535处理YAP siRNA组细胞,并用MTT法检测细胞活力,流式细胞术检测细胞凋亡。结果:YAP siRNA组YAP的mRNA和蛋白水平均明显低于control组(P0.05)。YAP siRNA组的细胞活力及c-Myc和β-catenin水平均明显低于control组(P0.05),而细胞凋亡率明显高于control组(P0.05)。与未经FH535处理的YAP siRNA组细胞相比,YAP siRNA组的细胞经FH535处理后细胞活力明显下降,细胞凋亡率升高,差异有统计学意义(P0.05)。结论:干扰YAP表达能够通过抑制Wnt/β-catenin信号通路激活而抑制膀胱癌细胞活力,并促进膀胱癌细胞凋亡。     

Heart rate variability in overactive bladder experimental model

Introduction

Two main pathophysiological concepts of overactive bladder (OAB) are postulated: the neurogenic and myogenic theories. Autonomic nervous system (ANS) dysfunction is also involved in OAB pathophysiology. The purpose of our study was to estimate ANS activity by heart rate variability (HRV) assessment in two OAB experimental models evoked by cyclophosphamide administration: acute (AOAB) and chronic (COAB) overactive ones.

Material and methods

In the AOAB model, an i.p. dose of cyclophosphamide was administered (200 mg/kg body weight) while the COAB model received 4 times the i.p. administration of cyclophosphamide (75 mg/kg body weight). In each subject, after urethane anaesthesia (1.2 g/kg body weight), 20-minute ECG recordings (PowerLab) were performed with subsequent HRV analysis.

Results

Most of the differences in time domain analysis parameters were insignificant, except those concerning SDNN and rMSSD (p < 0.05). In frequency analysis, a power decrease of all standard spectral components was revealed in both OAB groups. In AOAB, TP (1.43 ±1.21 vs. 7.92 ±6.22 in control; p < 0.05) and VLF (0.95 ±1.08 vs. 6.97 ±5.99 in control; p < 0.05) showed significant power decrease, whereas the COAB group was mostly characterized by LF (0.09 ±0.15 vs. 0.34 ±0.33 in control; p < 0.05) and HF (0.25 ±0.29 vs. 0.60 ±0.41 in control; p < 0.05) decrease.

Conclusions

The ANS disturbances, found as standard spectral parameter abnormalities, were demonstrated in both AOAB and COAB. When this finding is analysed, together with the lack of statistically significant differences in normalized nLF and nHF powers, the VLF changes seem to play an essential role, probably reflecting the progression in bladder inflammatory changes.     

New developments in the medical management of overactive bladder

Overactive bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. Whilst the majority of women will benefit from initial management with conservative and behavioural intervention a significant number will require medical therapy. Antimuscarinics are currently the most widely prescribed drugs for OAB although very often persistence with medication is limited due to lack of efficacy or intolerable adverse effects.     

膀胱尿路上皮癌中候选生物标志物转录因子21的甲基化机制及意义

目的 探讨膀胱尿路上皮癌中候选生物标志物转录因子21（TCF21）甲基化的意义。 方法 选择2016年10月~2017年10月间疑似膀胱癌患者142例,其中经病理学检测确诊为膀胱癌80例为研究组,经病理学检测确诊为非膀胱癌共62例为对照组。另选择同期进行体检的健康者尿标本40例作为健康组。检测研究组膀胱癌组织、癌旁组织、对照组病灶组织中TCF21甲基化水平,并检测研究组、对照组和健康组尿液中TCF21甲基化水平,分别比较膀胱癌组织、尿液中TCF21甲基化水平与临床病理特点间的关系,并分析两者对于膀胱癌的诊断效能。 结果 膀胱癌组织TCF21甲基化水平显著高于癌旁组织和对照组（P<0.05）,研究组尿液TCF21甲基化水平显著高于对照组和健康组（P<0.05）。男性、年龄>60岁、高的TNM分期和高分级的膀胱癌患者膀胱癌组织和尿液中TCF21甲基化水平更高（P<0.05）。膀胱癌组织与尿液中TCF21甲基化水平对膀胱癌均有较高的诊断意义,且两者的诊断意义差异无显著性（P>0.05）。 结论 TCF21基因在膀胱癌组织和膀胱癌患者尿液中均具有较高的甲基化水平,并且与病理特点相关,膀胱癌组织和膀胱癌患者尿液对于膀胱癌均具有较高的诊断意义。