壁间型膀胱平滑肌瘤十例患者诊治经验的初步探讨

目的通过对壁间型膀胱平滑肌瘤的诊疗进行回顾性分析,初步探讨其临床诊疗方式。方法回顾性分析2010年1月至2019年1月于徐州医科大学附属医院泌尿外科行手术治疗壁间型膀胱平滑肌瘤10例患者资料。其中男性1例,女性9例,年龄33~51(44±6)岁。其中5例患者以膀胱刺激症状为主要临床表现,1例患者以下腹痛为主要表现,还有4例患者无明显临床症状,患者发病时间1周至2年,平均4.9个月。患者泌尿系彩超检查发现膀胱壁上形态规则、表面覆盖黏膜高回声的低回声包块。CTU检查为膀胱壁均质样实性肿块,边界清楚、光滑,无侵蚀表现,膀胱壁走形自然,且壁周脂肪间隙清晰,膀胱内可见充盈缺损。膀胱镜检查可见瘤体表面黏膜常完整连续,可见局部稍向膀胱内隆起。根据患者肿瘤部位、大小,10例患者分别采用经尿道平滑肌瘤剜除术和腹腔镜下平滑肌瘤剜除术,3例患者术中冰冻切片示:膀胱平滑肌瘤。结果10例患者中有临床症状者:其中5例以膀胱刺激症状为主诉的患者术后症状明显缓解,表现为下腹部疼痛症状的患者术后腹痛症状消失,所有患者术后均未发生并发症,术后随访4~24个月(平均16个月)均未见肿瘤复发且未诉漏尿等常见并发症。结论泌尿系彩超,CTU等影像学检查与膀胱镜相结合是诊断壁间型膀胱平滑肌瘤的主要手段,经尿道肿瘤剜除术、腹腔镜下肿瘤剜除术是治疗壁间型膀胱平滑肌瘤安全有效的手术方式且预后较好。     

腹腔镜肿瘤剜除术治疗浆膜下型膀胱平滑肌瘤的临床体会

目的探讨腹腔镜肿瘤剜除术治疗浆膜下型膀胱平滑肌瘤的疗效及安全性。 方法回顾性分析2010年9月到2016年11月腹腔镜治疗膀胱浆膜下平滑肌瘤8例患者资料,其中男性5例,女性3例,年龄31~65（平均47±10）岁,主诉为膀胱刺激症状者3例,下腹痛者2例,无临床症状、体检发现者3例。病程1周至3年,平均21个月。所有患者术前均行尿常规、超声、CT尿路成像（CTU）、膀胱镜等检查,尿常规均正常。 结果8例患者均行腹腔镜膀胱肿瘤剜除治疗且完整剜出肿块,快速病理均示平滑肌瘤,术后病理示膀胱平滑肌瘤,其中7例患者因膀胱黏膜完好未予缝合。手术时间40~70（53±10）min,术中出血20~50（34±10）ml,术后随访3~12个月（平均7.5个月）均未见肿瘤复发且未诉尿瘘等常见并发症。 结论对于浆膜下型膀胱平滑肌瘤,腹腔镜下膀胱肿瘤剜除术是安全、有效的手术方法。     

多发性膀胱平滑肌瘤误诊为子宫内膜异位症1例并文献复习

目的提高对膀胱平滑肌瘤的认识,探讨其诊治方法。方法分析1例误诊为子宫内膜异位症的多发性膀胱平滑肌瘤患者的临床资料,并在文献复习的基础上对两种疾病的发病情况、临床表现、诊断及治疗方法进行讨论。结果患者经手术治愈,随访18个月,未见复发。结论膀胱颈部平滑肌瘤与子宫内膜异位症均可导致膀胱刺激症状和慢性盆腔痛,诊断主要依靠影像学检查,而剖宫产术导致的膀胱与宫颈粘连可造成诊断上的困难。两病治疗均首选手术,预后良好。     

Leiomioma vesical

ObjectiveMesenchymal benign tumours of the urinary bladder are rare and account for 1%-5% of all bladder tumours. The leiomyoma is the most common and constitute 46.6% of this group. 25 cases have been described in the national literature. We report an additional case of leiomyoma of the bladderCase ReportA 53 year-old man with a chronic history of urinary frequency and microscopic hematuria. Physical examination was normal. An excretory urography demonstrated a filling defect in the right bladder wall. The cistoscopy confirmed the tumour, covered with normal bladder mucosa. The echography showed a solid tumour. A computerised tomography scan and magnetic resonance showed a sessile lesion in the right bladder wall with low-intermediate intensity signal and with normal signal of muscle, mucosa and perivesical fat. The clinical diagnosis was leiomyoma of the bladder. Partial cystectomy was done and the histological diagnosis confirmed the clinical diagnosisConclusionsThe leiomyoma of the bladder is a rare tumour however it should be considered in the differential diagnosis before surgical treatment     

膀胱平滑肌瘤的诊断与治疗(附21例报告并文献复习)

目的:探讨膀胱平滑肌瘤的临床特点、诊治方法及预后。方法:回顾性分析21例膀胱平滑肌瘤患者的临床资料及术后随访,并复习相关文献。结果:本组21例患者分别采用膀胱部分切除、膀胱肿瘤剜除和经尿道膀胱肿瘤电切术治疗,术后病理诊断均为膀胱平滑肌瘤,术后随访9个月～8年,均无肿瘤转移或复发。结论:膀胱平滑肌瘤系泌尿系少见的良性肿瘤。结合影像等资料能够初步诊断,确诊依靠膀胱镜检查及病理活检,治疗以手术为主,预后良好。     

膀胱平滑肌瘤误诊为子宫肌瘤1例并文献复习

目的:探讨膀胱平滑肌瘤的临床特点和诊治方法。方法:回顾性分析1例误诊为子宫肌瘤的膀胱平滑肌瘤患者的临床资料,患者女,50岁,尿频、尿急2个月余,间断无痛肉眼血尿10天。CT扫描示膀胱后壁有一2.6cm×3.1cm均质肿块突向膀胱内,界限清楚。行开放手术剜除肿瘤。结果:病理诊断为膀胱平滑肌瘤。术后患者恢复良好,排尿刺激症状消失。结论:膀胱平滑肌瘤与子宫肌瘤均为良性肿瘤,女性多发。二者均可出现膀胱刺激症状和下腹疼痛,不易鉴别。超声是较为敏感的诊断工具,而CT和MRI更有助于鉴别诊断和治疗方法的选择。两病治疗均首选手术,预后良好。     

Leiomyoma of the bladder causing bilateral hydronephrosis: a case report

We report a case of bladder leiomyoma with marked bilateral hydronephrosis caused by chronic urinary retention. Surgical finding was that the mass was smooth, fist-sized and had a thin stalk connected to the bladder wall. The tumor was completely removed. Histopathological diagnosis was leiomyoma of the bladder and the post-operative course was uneventful.     

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.     

Repair of a fistula between the bladder and the perineal skin by femoral gracilis flap interposition

The successful repair of a fistula between the bladder and the perineal skin using a femoral gracilis flap is reported. A 70-year-old woman, who 10 years previously had undergone a total hysterectomy for uterine cancer, developed a fistula between the bladder and the perineal skin after she underwent Mile's operation for rectal cancer. Initially, an attempt was made to repair the fistula by the transabdominal approach. This failed, probably because of the lack of supporting tissue between the bladder and the perineal skin. The second repair was performed with plastic surgeons. A secure three-layer bladder closure was accomplished. A right femoral gracilis flap was developed and rotated 180 degrees to fill the defect in the skin and subcutaneous tissue. Four weeks after surgery, cystography revealed no fistula or urinary leakage and the drainage catheter was removed. Femoral gracilis flap interposition was successful for repair of a fistula between the bladder and the perineal skin when there was no supporting tissue due to extensive exenteration in the surgical removal of rectal cancer and after other repair procedures had been unsuccessful.     

Leiomyomas of the female urethra and bladder: a report of five cases and review of the literature

Through the experience of five cases of leiomyoma developed in the female bladder and urethra with a review of the literature, we have made an effort to characterize the association of symptom with the size and location of the tumor and demonstrate an appropriate treatment. The study population was composed of patients who underwent surgery for bladder or urethral leiomyoma in our hospital from March 1990 to April 2005. Their medical records were reviewed retrospectively concerning the symptom, size and location of leiomyoma, the result of cystoscope and radiological examination, surgical method, pathologic report, complications, and recurrence. Four cases were diagnosed as urethral leiomyoma and one case as bladder leiomyoma. All patients with urethral leiomyoma were admitted for the chief complaint of a palpable tumor. When the tumor size was small, if it was located on the lateral side of the urethra, it was asymptomatic, but if located in the midline, it presented irritative or obstructive symptom. When it was big, if located on the lateral side, it presented irritative rather than obstructive symptom, and if located in the midline, it presented obstructive symptom. One case of bladder leiomyoma was discovered incidentally during ultrasonic exam. In all five cases, surgical removal was performed and complications or recurrence were not detected afterwards. Bladder and urethral leiomyomas are very rare and cause diverse manifestations from asymptomatic to irritative or obstructive symptom. It is presumed that the location and size of the tumor are associated with symptom. Unless it is the case with severe hemorrhage or obstructive acute renal failure, immediate surgery is not required. However, it is desirable to distinguish leiomyoma from malignant or other benign tumors by surgical biopsy or removal.     

Male bladder leiomyoma: a case report]

A case of leiomyoma of the urinary bladder in a 40-year-old man is reported. Enucleation of the tumor was performed, because transurethral resection-biopsy revealed a bladder leiomyoma. Ninety nine cases of a bladder leiomyoma have been reported in Japan, but male cases are rare.     

膀胱平滑肌瘤:附8例报告

目的 探讨膀胱平滑肌瘤的临床特点及诊治疗效.方法 对8例膀胱平滑肌瘤患者的临床资料进行回顾性分析.结果 8例患者,男性3例,女性5例,平均年龄42岁(27岁～71岁).经尿道膀胱肿瘤电切(TURBT)3例,开放膀胱部分切除术2例,肿瘤剜除2例,腹腔镜膀胱肿瘤剜除1例.8例患者随访10～75个月未见肿瘤复发.结论 膀胱平滑肌瘤临床罕见,手术效果满意,手术方式的选择应根据肿瘤大小和位置决定,腹腔镜手术创伤小、恢复快,将成为一种有效的手术替代方式.     

经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤初探

目的 探讨经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤的疗效及安全性。 方法 回顾性分析6例黏膜下型膀胱平滑肌瘤患者的临床资料。男2例,女4例。年龄32 ～ 78岁,平均59岁。表现为排尿梗阻3例,排尿刺激症状1例,肉眼血尿1例及无临床症状、体检发现1例。病程1周～4年,平均23个月。B超检查均发现膀胱内占位性病变,肿瘤平均最大直径3.0(2.0 ～3.5)cm。CT检查示肿瘤形态完整,增强后较均匀轻度强化。4例IVU检查发现膀胱充盈缺损。6例膀胱镜检查均提示膀胱黏膜下占位,黏膜表面光滑。6例均行膀胱镜下穿刺活检病理检查,诊断为膀胱平滑肌瘤,后行经尿道膀胱肿瘤剜除术（2例位于侧壁、体积较小肿瘤以激光剜除,4例体积较大肿瘤以电切镜剜除）。肿瘤基底部活检后,电灼肿瘤基底及创缘。 结果 6例手术均顺利完成,无膀胱穿孔等并发症。术后患者均排尿通畅,排尿刺激症状明显缓解,血尿消失。术后中位随访时间58(4～158)个月,未见肿瘤复发或转移。 结论 病理检查是确诊黏膜下型膀胱平滑肌瘤的主要手段。经尿道肿瘤剜除术治疗黏膜下型膀胱平滑肌瘤安全有效。     

Leiomyoma of urinary bladder: report of a case

A case of leiomyoma of the urinary bladder in a 46-year-old woman is reported. The patient was referred to us because of incidental finding of a mass in the bladder. Cystoscopy revealed a protruding tumor covered with normal-appearing urothelium on the right posterior wall of the bladder. The tumor was well-demarcated from adjacent organs on echography and computed tomographic scan. Transurethral biopsy revealed a bladder leiomyoma. Partial cystectomy was performed. The patient is now apparently free of disease 7 months after the operation.     

Renal leiomyoma with extensive cystic degeneration

An extremely rare case of renal leiomyoma presenting as a cystic mass is reported. It is thought that leiomyoma degenerated into a cyst.     

Successful closure of a bladder neck fistula complicated by urethral and vaginal stenosis, using oxidized cellulose (Surgicel) for reinforcement

We describe a case of a bladder neck fistula in a 25-year-old lady presenting with true urinary incontinence, vaginal constriction and induration, with vaginal length reduced to only 1.5 cm. There was an 8-mm fistula involving upper urethra and bladder neck, with fibrosis all around. Using Schuchardt incision, the fistula was reached and mobilization tried. As there was less available tissue, a 3×2-cm layer of oxidized cellulose was stitched between the bladder and the vaginal mucosa for reinforcement and to achieve a watertight closure of fistula.     

Our experience in the Martius method of closing the vesicovaginal fistula

Sometimes after delivery, gynecological or other surgeries, radiological therapy, or destructions of vesico-vaginal septum due to the tumor or trauma, the unnatural communication between the bladder and vagina occurs. Those are fistulas that occur after the delivery (tocogenic) caused by the prolonged delivery or some obstetrics operations. Some fistulas are high, coming from the fundus of the bladder, medium, if they come just behind the trigonum of the bladder, and low, if they are in the level of trigonum and the neck of the bladder. The purpose of this paper is to show the operative technique of elimination of medium and low vesicovaginal fistula and the results of the treatment. Material and method The elimination of the vesicovaginal fistula by original Martius technique is done through vagina. The catheter is inserted through the fistula (figure 1). Than the mucosis of the vagina is cut around the fistula and the vaginal wall is separated from the bladder. The catheter is pulled out and the fistula on the bladder is sown with resorptive stitches. Than the labia maiora nearer to the fistula is cut along from Mons Veneris to the middle and the lipoid tissue is taken with vascular pedicle (figure 2). This tissue is put between the bladder and the vagina and fixed with resorptive stitches. After that the vagina is sown by single stitches. The labia maiora that was cut is also sown by single stitches (figure 3). Than the catheter is inserted in the bladder that should stay there for four weeks. This is the method we used to make surgery in twenty patients with vesicovaginal fistula. The first one had the fistula as the result of the Caesarean section. She was operated twice through the bladder without success. The second patient was a fourteen years old girl that cut herself on the glass and damaged anal sfincter, rectum, vagina and the bladder. The fistula appeared later in the level of trigonum of the bladder. The other eighteen patients got fistula after hysterectomy. All patients were treated as described above and fistulas disappeared. The first patient had another baby a year after the operation by Caesarean section. The other patients have regular miction (figure 4 and 5). Discussion and the conclusion Vesicovaginal fistula are serous complications, for the patients and for the doctors. The only treatment of the vesicovaginal fistula is surgical. If any damage of the bladder occurs during any operation it should be treated immediately, otherwise the fistula will appear. The treatment depends of the localization of the fistula. Low fistulas and some medium and urethrovaginal fistulas should be approached through vagina and according to our experience Martius's method is very efficient. The only important thing is when the fistula is detected to wait at least for two or three months for the fistula to "consolidate" and also to cure the infection.     

Leiomyoma of the urinary bladder: report of three cases

We report 3 cases of leiomyoma of the urinary bladder. One patient was a 57-year-old female. Magnetic resonance imaging (MRI) revealed a small tumor, and cystoscopy revealed a submucosal tumor on the left wall. Partial cystectomy was performed, and she has had no recurrence for 10 months. Two females who were aged 68 years and 52 years, were referred to our hospital with the complaint of pain of meatus of urethra, and pollakisuria, respectively. Transurethral resection of bladder tumor (TURBT) was performed, and they have had no recurrence for more than 3 and 4 years, respectively. Histological examination in the three cases showed a leiomyoma of the urinary bladder. To our knowledge, there are 151 cases of leiomyoma of the urinary bladder reported in the literature in Japan.     

Immediate postoperative complications of combined penetrating rectal and bladder injuries

BACKGROUND: Combined penetrating trauma involving the rectum and bladder has been associated with increased postoperative morbidity. Specific complications resulting from these injuries include colovesical fistula, urinoma, and abscess formation. METHODS: A retrospective review of Temple University Hospital trauma database was performed. Patients were categorized by having an isolated rectal (n = 29), isolated bladder (n = 16), or combined injury (n = 24). Records were reviewed for sex, age, site of injury, location of rectal and bladder injuries, operative intervention, fistula formation, urinoma formation, abscess formation, time to urinary catheter removal, length of intensive care unit stay, and length of hospital stay. RESULTS: Patient sex and age did not differ significantly between groups, nor was there a significant difference in location of rectal injury between groups. Presacral drainage was utilized in all patients with extraperitoneal injuries. Fecal diversion was performed in all patients, except two with intraperitoneal rectal injuries. Omental flap interposition between rectal and bladder injuries was utilized in one patient. No significant difference was noted in immediate postoperative complications between groups including fistula, urinoma, and abscess formation. However, all cases of colovesical fistula (n = 2) and urinoma (n = 2) formation were noted in those patients with rectal and posterior bladder injuries. CONCLUSIONS: Combined rectal and bladder injuries were not associated with an increase in immediate postoperative complications compared with isolated rectal and bladder injuries. However, postoperative fistula and urinoma formation occurred only in patients with a combined rectal and posterior bladder injury. Consequently, these patients may benefit from omental flap interposition between injuries to decrease fistula and urinoma formation.     

A case of leiomyoma of the urinary bladder in a woman with the chief complaint of total urinary retention

Benign nonepithelial tumor of the urinary bladder is very rare. We experienced a case of a 33-year-old woman who complained of total urinary retention. Vaginal examination revealed a hen's egg sized retrovesical tumor. IVP revealed a filling defect on the cystogram. Cystoscopy revealed protrusion of left side of the bladder neck and intact mucosa. Transvaginal needle biopsy of the tumor was done, and pathohistological diagnosis of the tumor was done, and pathohistological diagnosis of the specimen was leiomyoma. The tumor was intramural type and was resected. It was 5.5 X 5 X 5 cm in size, weighed 80 g, and pathohistological diagnosis was leiomyoma of the urinary bladder. 57 cases of leiomyoma of the urinary bladder including this case have been reported in Japan. No special method of diagnosing leiomyoma of the urinary bladder exists, but in some cases, needle biopsy is very effective.