Primary bladder closure and bladder neck reconstruction in classical bladder exstrophy

The surgical results of 28 consecutive initial bladder closures and 25 consecutive initial bladder neck reconstructions performed for classical bladder exstrophy at our hospital between 1975 and 1982 are presented. Partial bladder prolapse occurred in 2 cases and complete wound dehiscence never occurred following the initial primary bladder closure. Urinary continence following bladder neck reconstruction was assessed from parental interviews. An excellent surgical result was defined either as achievement of a daytime dry interval for more than 3 hours or less than 1 incontinent episode per day. According to these parameters, an excellent surgical result was achieved in 86 and 80 per cent of children, respectively. In 21 children evaluated with excretory urograms between 1/2 and 6 years after bladder neck reconstruction 10 per cent of the renal units showed significant hydronephrosis and deterioration of function. The 2 patients who had upper tract deterioration were not followed postoperatively at our institution and the diagnosis of bladder outlet obstruction was delayed when excretory urograms were not obtained during the first postoperative year. This review of the surgical results following primary bladder closure and bladder neck reconstruction for classical bladder exstrophy demonstrates that secure abdominal wall closure and urinary continence can be achieved with minimal morbidity and with infrequent deterioration of renal function following staged functional bladder closure.     

人乳头瘤病毒与膀胱癌相关性的研究

目的:进一步证实人乳头瘤病毒(HPV)与膀胱癌的相关性。方法:采用高敏感聚合酶链反应(PCR)技术检测42例膀胱癌组织标本,并用20例前列腺增生症患者之正常膀胱组织标本作对照。结果:膀胱癌HPV感染率为52.4%,正常膀胱组织标本HPV感染率为10.0%,其中1例阳性者1年后发生膀胱癌。结论:HPV感染与膀胱癌有一定的相关性,并在膀胱癌的发生中起着相关作用。     

The valve bladder syndrome: pathophysiology and treatment with nocturnal bladder emptying.

PURPOSE: We determine the etiology and treat the specific pathophysiology of the valve bladder syndrome. MATERIALS AND METHODS: Defined as persisting or progressive severe hydroureteronephrosis without residual or recurrent obstruction, the valve bladder syndrome developed in 18 boys who underwent successful ablation of the posterior urethral valve. Serial radiographic, renal function, renographic, urodynamic and perfusion studies were performed for a mean time of 11 years. RESULTS: The cause of the valve bladder syndrome proved to be sustained bladder over distention due to a combination of polyuria with 24-hour urine volume greater than 2 l. in 10 boys, impaired bladder sensation in 18 and residual urine volume in 14. Treatment of over distention during the daytime alone was unsuccessful. Nocturnal bladder emptying was performed with an indwelling nighttime catheter, intermittent nocturnal catheterization and/or frequent nocturnal double voiding. Hydronephrosis markedly improved once nocturnal bladder emptying was started and was comparable to the results after urinary diversion. CONCLUSIONS: The valve bladder syndrome is not due to a permanent prenatal alteration in bladder anatomy and function. Instead, it appears to result from sustained postnatal bladder over distention due to a combination of polyuria, impaired bladder sensation and residual urine volume, which represent sequelae of prenatal valve injury. These factors synergize to prevent bladder normalization after valve ablation and progressively reduce functional bladder capacity to maintain bladder over distention. Bladder decompensation, upper tract dilation, and renal injury develop and characterize the valve bladder syndrome. Because current therapy, including intermittent catheterization, leaves the bladder full throughout the night, it remains markedly over distended. Nocturnal bladder emptying is the specific antidote for this pathophysiological situation, and results in prompt and impressive improvement or elimination of hydronephrosis in these and similar groups of patients. This response to nocturnal bladder emptying suggests that the bladder is not the primary cause for the valve bladder syndrome.     

Biochemical and morphological effects of bladder pumping on the urinary bladder in rats

AIMS: To study the influence of bladder pumping on the urinary bladder in 44 female rats. METHODS: Under halothane anesthesia, a urethral catheter was inserted into the bladder of 27 rats, and air (0.4-0.8 mL) was pumped in and out of the bladder at 0.5 cycles/second for a period of 5 minutes. Twenty-four hours after pumping, the bladder was harvested for measurement of the tissue levels of myosin, actin, and nerve growth factor, as well as for electron microscopy. In nine of the 27 rats, cystometry was performed without anesthesia before and 1, 7, 30, and 90 days after bladder pumping. The remaining 17 rats that did not undergo pumping were anesthetized and their bladders were harvested as a control. RESULTS: Bladder pumping increased the bladder capacity and decreased the maximum bladder contraction pressure, but did not increase the residual volume. Bladder pumping also increased the tissue level of nerve growth factor and decreased the levels of myosin and actin. Electron microscopy showed degeneration of bladder smooth muscle cells and nerve fibers after bladder pumping, as well as derangement and disruption of collagen fiber bundles in the bladder wall. These functional and morphological effects of pumping disappeared within 90 days. CONCLUSIONS: Bladder pumping therapy appears to have various effects on the bladder wall collagen fiber bundles, smooth muscle cells, and nerves.     

Lipomatosis of the bladder presenting as bladder cancer

A case of bladder lipomatosis in an 81-year-old man is presented. The preoperative diagnosis was bladder tumor. A transurethral resection of the bladder was performed and a pathological examination revealed lipomatosis of the bladder. This entity is extremely rare and, to our knowledge, this is the second case reported in the English published works.     

Rare variant of bladder exstrophy associated with urethral, bladder, and colonic duplication

Urethral duplication, bladder duplication, and bladder exstrophy are rare congenital urinary tract anomalies. We present an extremely rare case of complete urethral and bladder duplication in a boy with bladder exstrophy, omphalocele, and colonic duplication. Bladder augmentation was subsequently performed using the left exstrophic bladder as a patch to augment the right duplicated bladder.     

BCA7基因在膀胱癌和正常膀胱组织中的表达

目的:明确BCA7mRNA和蛋白在膀胱癌组织和癌旁正常组织中的表达情况。方法:通过荧光定量PCR方法对42对膀胱癌患者标本(包括癌组织和癌旁组织)的BCA7mRNA进行分析。通过蛋白电泳分析检测膀胱癌癌组织和癌旁正常组织中BCA7蛋白水平。并运用免疫组化对67对膀胱癌及癌旁正常组织切片进行染色分析。结果:荧光定量PCR结果显示BCA7在癌组织表达水平明显高于癌旁组织(P<0.05)。蛋白电泳分析结果显示BCA7蛋白在膀胱癌组织内呈高表达,而配对的癌旁正常组织内未见表达。67对癌及癌旁组织切片免疫组化显示,癌组织BCA7表达水平高于癌旁组织(P<0.001)。结论:BCA7mRNA和蛋白在膀胱癌中特异高表达,提示BCA7基因可能在膀胱癌发生、发展中的作用及对膀胱癌早期诊断、术后监测和预测预后具有重要的作用。     

HRG-1基因在膀胱癌和正常膀胱组织中的表达

目的观察HRG-1基因在膀胱正常组织和膀胱癌组织中的表达,探讨HRG-1基因表达与膀胱肿瘤病理分级和临床分期的关系。方法应用免疫组化SP法检测63例膀胱癌和28例膀胱正常组织石蜡标本中HRG-1表达情况,并进行相关临床病理分析。结果在正常膀胱组织和膀胱癌组织中HRG-1表达有显著性差异（P〈0.05）;HRG-1的阳性表达与膀胱癌病例分级、临床分期之间有显著性差异（P〈0.05）。结论 HRG-1基因在膀胱癌组织中表达水平显著提高,提示该基因可能对膀胱肿瘤病理分级和临床分期有一定的指导意义。     

Experimental bladder tumor

Experimental bladder tumor was reviewed in this paper. Many investigators have been studying on the bladder carcinogenesis since occupational bladder cancers were reported. Main object in research for bladder cancer was to identify and remove environmental causes and various factors related to the development of bladder cancer. Human bladder cancers can be classified into papillary non-invasive and nodular invasive cancer. The establishment of an animal model of bladder cancer similar to human bladder cancer is important to clarify the natural history of this disease and obtain basic data on its clinical diagnosis and treatment. Bladder carcinogenesis has been known to occur in a two-stage process: initiation and promotion. Recently inhibitory effects on the bladder carcinogenesis were also studied. In this paper we described the results that have been obtained in our laboratory concerning animal bladder carcinomas.     

Relationship between the size of the bladder template and the subsequent bladder capacity in bladder exstrophy

AimThe aim of this study is to evaluate the relationship between the size of the bladder template in infants born with bladder exstrophy and the subsequent bladder capacity at the age of 1 and 5 years.Materials and MethodsInfants with bladder exstrophy were photographed at birth, and 2 parallel lines were drawn transversally on the photograph across the anterior-superior iliac spines and on the bladder template. The ratio between the 2 lines was calculated, and the bladder templates categorized as (a) small (≥4), (b) medium (3-4), and (c) large (<3). Bladder capacity was subsequently measured at 1 and 5 years and considered satisfactory when 60 mL or greater at the age of 1 year and 100 mL or greater at the age of 5 years.ResultsSixteen patients were identified. At the age of 1 and 5 years, 81% and 94% had achieved a satisfactory bladder capacity, irrespective of their original template group. Nonetheless, those in group C still showed significantly larger capacities at the age of 5 years than those in groups A and B (P < .05).ConclusionBladder exstrophy patients, who undergo a successful primary closure, can achieve satisfactory capacities despite smaller bladder templates at birth.     

经尿道膀胱肿瘤电切术后膀胱灌注吡柔比星治疗浅表性膀胱肿瘤42例报告

目的探讨吡柔比星膀胱灌注对治疗浅表性膀胱癌术后复发的预防效果。方法42例患者,在行经尿道膀胱肿瘤电切术（TURBt）术后定期经导尿管给予膀胱内灌注吡柔比星30mg／40ml,每周1次,每次膀胱内保留60min,共8次,术后3个月行1次膀胱镜检查。结果共有4例复发。42例患者有不同程度的膀胱区不适,3例症状较重。结论吡柔比星膀胱内灌注预防肿瘤术后复发疗效显著、安全、可靠。     

膀胱出口梗阻大鼠膀胱过度活动的研究

目的:建立膀胱出口梗阻大鼠模型,诱发逼尿肌不稳定(DI),研究膀胱出口梗阻伴发膀胱过度活动的病理生理学特征。方法:选择38只成年SD雌性大鼠,随机分为模型组和对照组,结扎膀胱颈部建立膀胱出口梗阻模型。建模后3、6、9、12周采用BL-410生物机能实验系统测定膀胱压,以充盈期出现DI作为膀胱过度活动存在的标准,记录并计算DI阳性率和频率、最大排尿压(MVP)、最大膀胱容量(MCC)、膀胱顺应性(BC)和剩余尿量(PVR)。用光镜观察建模不同时期膀胱组织的病理学改变。结果:模型组大鼠3、6、9、12周DI阳性率分别为37.50%、75.00%、75.00%、62.50%。MVP、MCC、BC、PVR和DI频率较对照组增高(P<0.01),第9周大鼠PVR、MVP、MCC高于第3、6和12周。不同时期病理学改变呈现出膀胱容量增加、肌层逐渐增厚和纤维化的过程。结论:膀胱出口梗阻与逼尿肌不稳定的发生具有潜在的相关性,其病理学改变和尿流动力学参数反映了膀胱的病理生理学特点。     

Effect of bladder volume, gender and body position on the shape and position of the urinary bladder

OBJECTIVE: The optimal design of bladder volume-monitoring equipment, e.g. regarding transducer design and software algorithms, depends greatly on the shape and position of the bladder or on potential changes due to body position and bladder volume. The purpose of this study was to study the influence of body position, bladder volume and gender on the shape and position of the bladder. MATERIAL AND METHODS: MRI scans of 11 young volunteers were performed during changes in posture. Images were recorded in the transverse and frontal planes and repeated four to six times through the bladder-filling cycle from empty to full. The position of the bladder midpoint was measured in the three planes. Moreover, to account for shape, the compactness of the cross-section of the bladder was calculated based on its perimeter and area. The effect of body position and gender was analyzed using repeated-measures ANOVA and the independent samples t-test, respectively. RESULTS: No significant effect of body position on bladder position or shape was found. Gender was shown to have a significant impact on both the position and shape of the bladder: the female bladder was positioned more caudally and was less compact in the transverse plane than the male bladder. Furthermore, there was significant cranial-dorsal movement of the bladder during filling. CONCLUSION: No significant changes in the position or shape of the bladder were observed during changes in body position in young subjects, regardless of bladder volume or gender. However, changes in both parameters were found due to bladder filling.     

膀胱平滑肌细胞与膀胱脱细胞基质的生物相容性研究

目的:研究膀胱平滑肌细胞与膀胱脱细胞基质(BAM)的生物相容性。方法:分离培养兔膀胱平滑肌细胞,采用α-平滑肌肌动蛋白(α-SMA)抗体进行鉴定。将以1×10 5个/mL的单细胞悬液均匀接种于制备BAM支架上,通过与单独培养的膀胱平滑肌细胞作对照,绘制两组细胞生长曲线图,对比观察两条生长曲线的差异性。 ...     

Differential expression of bladder neurotrophic factor mRNA in male and female rats after bladder outflow obstruction

PURPOSE: We validated a male rat model of bladder outflow obstruction and compared the expression of bladder neurotrophic factor mRNA in male and female rats 6 weeks after bladder outlet obstruction. MATERIALS AND METHODS: We examined the proximal urethra in male Wistar rats. Urethral lumen reducing ligatures were placed in 15 females and 19 males, while 10 male and 10 female controls underwent sham surgery. Awake cystometry was performed 6 weeks after surgery. Ribonuclease protection assay was used to measure changes in bladder neurotrophic factor mRNA expression in the 2 sexes. RESULTS: Average bladder capacity in rats with bladder outlet obstruction increased 3-fold in males and 4.4-fold in females compared with controls, while bladder weight increased 2.2 and 4.3-fold, respectively. Filling and threshold pressure increased significantly and nonvoiding bladder contractions were recorded in 100% of female and 80% of male rats with bladder outlet obstruction. An 8-fold increase in bladder brain derived neurotrophic factor mRNA was noted in each sex after obstruction. A 2-fold increase in bladder nerve growth factor mRNA after obstruction was only observed in females. CONCLUSIONS: This male rat model of bladder outlet obstruction was created by placing lumen reducing ligatures at the urethrovesical junction. The dramatic increase in bladder brain derived neurotrophic factor mRNA expression and differential expression of nerve growth factor mRNA in male and female rats with bladder outlet obstruction suggest that additional neurotrophic factors may contribute to the lower urinary tract neuroplasticity associated with bladder outlet obstruction and this contribution may be gender dependent.     

Novel biomarkers of bladder decompensation after partial bladder obstruction

AIMS: Partial bladder outlet obstruction (PBOO) results in marked contractile, biochemical, and histological alterations in the bladder. Our aim was to determine the time course of progressive PBOO in the rabbit and to find parameters that marked the shift to decompensation. MATERIALS AND METHODS: Twenty-four rabbits were subjected to 1, 2, 4, and 8 weeks of PBOO. Sham operated rabbits served as controls. At each time period, cystometry was performed and individual bladder strips were used for contractility studies. Full-thickness sections of bladder body from each rabbit were fixed in formalin and used to determine the vascular density and nerve density. The balance of the bladder body was separated between muscle and mucosa and was analyzed for superoxide dismutase (SOD) and catalase (CAT) activities. RESULTS: Bladder weight increased progressively and all contractile responses were reduced significantly over the course of obstruction. Markedly increased bladder weight and very large bladder volumes indicated decompensation. Nerve density was marked decreased in decompensated bladders. Similarly, SOD activity in muscle decreased progressively and was markedly lower in decompensated bladders. Although CAT activity of the muscle increased after 2-4 weeks of obstruction, it decreased markedly in decompensated bladders. CONCLUSION: This study shows that prolonged PBOO causes progressive deterioration in the rabbit bladder with decompensation after 8 weeks. Markedly decreased nerve density and severely reduced SOD and CAT activities are associated with the shift from compensated to decompensated function of the bladder. They may be excellent biomarkers of decompensation.     

Leiomyoma of the urinary bladder with bladder stone

Leiomyoma of the urinary bladder is a rare benign mesenchymal tumour. We describe here a case of leiomyoma of the urinary bladder in a 65-year-old gentleman who presented with haematuria, passage of clots and combined obstructive and irritative urinary symptoms. The investigations revealed a vesical calculus and a mass on the left lateral wall of the urinary bladder. Cystolitholapaxy and transurethral resection of the tumour was performed. Histopathological report of the resected tumour revealed a leiomyoma of the urinary bladder. So far, a leiomyoma of the urinary bladder and a concomitant vesical calculus have not been described in literature.     

Functional improvement in spinal cord injury-induced neurogenic bladder by bladder augmentation using bladder acellular matrix graft in the rat

Spinal cord injury (SCI) rostral to the lumbosacral level causes bladder hyperreflexia and detrusor-sphincter dyssynergia (DSD), which are accompanied by bladder hypertrophy. We hypothesize that bladder augmentation using a bladder acellular matrix graft (BAMG) can improve the function of SCI-mediated neurogenic bladder. In female rats (n = 35), SCI was induced by transection of the spinal cord at the lower thoracic level. Eight weeks following spinalization, bladder augmentation using BAMG was performed after hemicystectomy of the hypertrophic bladder. Cystometrography was performed at 8 weeks after spinalization and again at 8 weeks after augmentation. Several urodynamic parameters were measured and the grafted bladder was histologically evaluated. Thirty one rats were alive 8 weeks after spinalization. Twenty two (71%) rats developed hyperreflexic bladders and nine (29%) rats had underactive bladders before bladder augmentation. Twenty six rats survived until 8 weeks after augmentation. Urodynamic parameters showed improvement in some bladder functions in both hyperreflexic and underactive bladders after augmentation. In addition, bladder compliance was increased in hyperreflexic bladders and decreased in underactive bladders. Bladder augmentation decreased bladder capacity in high-capacity rats and increased it in low-capacity rats. Histological evaluation showed complete regeneration of BAMG in SCI-induced neurogenic bladder at 8 weeks after augmentation. This is the first report suggesting that the voiding function in SCI-induced neurogenic bladder can be improved by augmentation using BAMG. Improved voiding function was accompanied by histological regeneration of BAMG.     

色素上皮细胞衍生因子在膀胱癌旁黏膜及膀胱癌中的表达及其临床意义

目的 研究色素上皮细胞衍生因子(pigment epithelium derived factor,PEDF)在膀胱癌旁黏膜及膀胱中的表达变化及其意义.方法 收集在本院确诊为膀胱癌并且接受手术治疗患者的膀胱癌组织及癌旁组织,采用RT-PCR检测组织水平PEDF的mRNA表达差异,Western Blot及免疫组化IHC检测不同临床分期膀胱癌组织中PEDF的蛋白水平,并且比较了其同VEGF、MMP-2、MMP-9、MMP-12的相对表达.通过临床收集相应生理参数数据,分析PEDF同不同临床生理参数的相关性.结果 PEDF在膀胱癌旁黏膜中的表达水平无论是mRNA水平还是蛋白水平均显著高于膀胱癌组织(P＜0.05),并且临床Ⅰ期和Ⅱ期的膀胱癌组织中PEDF的表达水平显著高于Ⅲ期、Ⅳ期(P＜0.05),相关性分析表明,PEDF的阳性率同膀胱癌临床分期、淋巴结转移显著相关(P＜0.05),同其他生理参数无显著相关性(P＞0.05).结论 PEDF的表达差异同膀胱癌的发生和发展可能存在一定的相关性,具有一定的临床意义.