经尿道膀胱镜电切或电凝治疗膀胱黏膜白斑的疗效观察

目的：观察经膀胱镜电切或电凝治疗膀胱黏膜白斑的临床效果。方法：将68例膀胱黏膜一斑忠行随机分成两组,32例行电切术,36例行电凝术。每3个月随访决定是否行下一次治疗。治愈后随访12～36个月。结果：两组一次性治愈率分别为60％和26％,两次和三次性治愈率两组无明显差别。随访期间,两组分别有3例和5例复发。结论：经尿道膀胱镜电切或电凝术是治疗膀胱黏膜白斑有效的治疗疗法,其中电切术一次性治愈率高于电凝术。     

基于转录组学膀胱癌临床预后模型的构建

目的：筛选膀胱癌预后相关基因，建立膀胱癌预后评分模型。方法：通过UCSC Xena平台下载癌症基因组图谱（TCGA）数据库、基因型和基因表达量关联数据库（GTEx）中406例膀胱癌患者的临床信息和膀胱癌组织RNA测序数据，以及28名健康对照者正常膀胱组织RNA测序数据。采用加权基因共表达网络分析（WGCNA）、单因素Cox回归分析、LASSO回归分析和多因素Cox回归分析筛选膀胱癌预后相关基因并建立预后模型，结合Kaplan-Meier生存曲线、受试者操作特征曲线（ROC曲线）验证模型的准确性。结果：分析得到膀胱癌相关差异表达基因共2308个。WGCNA拟合得到6个基因模块，筛选出对膀胱癌预后有显著作用的基因829个。运用单因素Cox回归与LASSO回归分析筛选出24个与膀胱癌患者预后相关的基因，多因素Cox回归分析训练集数据得到9个作为独立预测因子的基因，分别是 ADCY9、 MAFG_DT、 EMP1、 CAST、 PCOLCE2、 LTBP1、 CSPG4、 NXPH4、 SLC1A6，以此建立膀胱癌患者预后预测模型。训练集中高风险组和低风险组3年存活率分别为31.814%和59.821%，测试集中高风险组和低风险组3年存活率分别为32.745%和68.932%，模型预测训练集和测试集患者预后的ROC曲线下面积均在0.7以上。 结论：本研究建立的模型对膀胱癌高风险和低风险人群的生存情况具有较好的预测能力。     

岛状股前外侧皮瓣修复青春期后膀胱外翻腹壁缺损

目的:探讨一种皮瓣转移修复青春期后膀胱外翻耻骨上腹壁缺损的方法.方法:设计以旋股外侧动脉降支为血管蒂的岛状股前外侧皮瓣,掀起皮瓣后经过皮下隧道将其转移至耻骨上腹壁缺损处.对2例青春期后膀胱外翻患者,均以此法进行治疗,转移皮瓣面积为(9 cm×11 cm)～(10 cm×15 cm).结果:临床治疗2例,转移皮瓣均成活良好,外形恢复满意.结论:青春期后膀胱外翻患者多经历数次手术修复,无局部及邻近组织可利用,岛状股前外侧皮瓣是修复耻骨上腹壁缺损的理想的远位皮瓣.     

Evaluating and understanding combination therapy decision drivers for the treatment of overactive bladder in the United States

ObjectiveTo understand factors guiding overactive bladder (OAB) therapy selection and experience with combination therapy (antimuscarinics and beta-3 agonists).MethodsCross-sectional surveys of OAB patients and OAB-treating physicians in the USA were conducted. Patients receiving monotherapy with antimuscarinics were categorized by OAB treatment history: monotherapy only; third-line procedures (e.g., onabotulinumtoxinA injections) and combination therapy; third-line therapy only; and combination therapy only. The patient survey assessed therapy choice drivers and barriers, treatment satisfaction and sociodemographic/clinical characteristics. The physician survey assessed drivers of and barriers to OAB treatment choices.ResultsOf 200 patients, 86.5% reported involvement in treatment decision-making; doctor’s recommendation was the most frequently considered factor (84.4%). Most patients (71%) were unaware of combination therapy. The primary reason why those patients aware of combination therapy had not used it (N = 43/200; 21%) was physician recommendation of other treatments (69.8%). For physicians (N = 50), the most frequently considered factors when prescribing OAB treatment were effectiveness (92.0%) and side effects (84.0%); 70% prescribed combination therapy, primarily for symptom severity (82.9%). The main reasons for not prescribing combination therapy were cost/insurance coverage (80%) and lack of information (53.3%).ConclusionsShared decision-making guided treatment decisions; the main considerations were treatment safety and efficacy.     

经尿道膀胱肿瘤电切术与膀胱部分切除术治疗膀胱肿瘤的效果对比

目的：探讨经尿道膀胱肿瘤电切术和膀胱部分切除术治疗膀胱瘤的临床效果。方法选取2012年7月~2014年7月在本院治疗的44例膀胱肿瘤患者作为研究对象,根据手术类型将其分为对照组(12例)和观察组(32例)。对照组行膀胱部分切除术,观察组行经尿道膀胱肿瘤电切术。比较两组术中、术后的各项指标以及并发症发生率。结果观察组术中出血量显著少于对照组,手术时间、术后膀胱冲洗时间、尿管留置时间和住院时间显著短于对照组,差异有统计学意义(P<0.05);观察组术后并发症发生率为6.25%,显著低于对照组的41.67%,差异有统计学意义(P<0.05)。结论经尿道肿瘤电切术治疗膀胱肿瘤可减少术中出血量,降低术后并发症发生率。     

一种新的循环肿瘤细胞检测平台在膀胱癌诊疗中的初步应用

目的 初步探索一种新的循环肿瘤细胞(CTC)检测平台在膀胱癌诊疗中的应用.方法 选取膀胱癌患者10例为试验组,健康志愿者5例为对照组.10例患者均接受经尿道膀胱肿瘤电切术.术前分别取试验组和对照组的外周全血样本10 ml、尿液样本10 ml,术后再次取试验组的外周全血、尿液样本各10 ml.使用Celsee PREP 400TM循环肿瘤细胞检测平台分别检测所有样本中所含CTC,对比术前试验组与对照组血、尿样本中的CTC,对比试验组术前、术后的CTC.随访12个月,监测患者是否出现复发或进展.结果 试验组术前血样本中均发现CTC,中位数为4个(1~9个);对照组均未发现CTC.试验组术后血样本中,8例(80%)发现CTC,中位数为1.5个(1~4个),2例(20%)未发现CTC.膀胱癌患者术前与术后血样本中的CTC比较,差异有统计学意义(P=0.014).尿液样本因杂质堵塞微通道而无法检测样本中的CTC.随访1年,患者无疾病进展/复发生存率为80%.结论 Celsee PREP 400TM循环肿瘤细胞检测平台可有效检测血样本中的CTC,值得进一步探索其在膀胱癌诊疗中的应用.     

经尿道内括约肌切除术在神经源性膀胱患者中的应用及长期随访研究

目的:治疗神经源性膀胱的首要两大目的即保护上尿路功能,获得或保持最恰当的尿控能力,但目前缺乏完美的治疗方法.为评价经尿道内括约肌切除术在神经源性膀胱患者中的应用及长期效果,行本研究.方法:回顾性分析2010年6月-2019年6月在我院接受经尿道内括约肌切除术治疗的17例神经源性膀胱患者的临床资料,其中男9例,女8例,年...     

Efficacy,safety, and tolerability of mirabegron in patients aged ≥65 yr with overactive bladder wet: a phase IV,double-blind,randomised, placebo-controlled study (PILLAR)

BackgroundThe majority of patients with overactive bladder (OAB) are aged >65 yr. There has been no prospectively designed study assessing treatment efficacy with the β3-adrenoreceptor agonist, mirabegron, specifically in this age group.ObjectiveA phase IV study comparing flexibly dosed mirabegron versus placebo in elderly patients with OAB and urgency incontinence.Design, setting, and participantsCommunity-dwelling patients aged ≥65 yr with OAB for ≥3 mo.InterventionFollowing a 2-wk placebo run in, patients with one or more incontinence episodes, three or more urgency episodes, and an average of eight or more micturitions/24 h were randomised 1:1 to double-blind 25 mg/d mirabegron or matched placebo, for 12 wk. After week 4 or 8, the dose could be increased to 50 mg/d mirabegron/matched placebo based on patient and investigator discretion.Outcome measurements and statistical analysisCoprimary endpoints: change from baseline to end of treatment (EOT) in the mean numbers of micturitions/24 h and incontinence episodes/24 h. Secondary endpoints: change from baseline to EOT in the mean volume voided/micturition, mean number of urgency episodes/24 h, and mean number of urgency incontinence episodes/24 h. Analysis of covariance (ANCOVA) was used for the mean number of micturitions/24 h, mean volume voided/micturition, and mean number of urgency episodes/24 h. Stratified rank ANCOVA was used for the mean numbers of incontinence episodes/24 h and urgency incontinence episodes/24 h.Results and limitationsStatistically significant improvements were observed for mirabegron versus placebo in change from baseline to EOT in the mean number of micturitions/24 h, mean number of incontinence episodes/24 h, mean volume voided/micturition, mean number of urgency episodes/24 h, and mean number of urgency incontinence episodes/24 h. Safety and tolerability were consistent with the known mirabegron safety profile.ConclusionsMirabegron efficacy, safety, and tolerability over 12 wk were confirmed in patients aged ≥65 yr with OAB and incontinence.Patient summaryWe examined the effect of mirabegron compared with placebo in people aged 65 yr or older with overactive bladder and incontinence. Mirabegron improved the symptoms of overactive bladder compared with placebo. Side effects were similar to those already known for mirabegron.     

Pilot study of intravesical instillation of two new generation anthracycline antibiotics in prevention of superficial bladder cancer recurrence

Background Superficial bladder cancer accounts for 60%-70% of all bladder cancer cases in China, when treatment consists of only transurethral resection of the bladder tumor （TUR-BT）, recurrence and progresses in the bladder are observed in some patients. There are numerous reports of trials of intravesical instillation of anticancer agents with the objective of lowering this recurrence rate. The aim of this study was to compare the prophylactic efficacy and safety of epirubicin （EPI）, pirarubicin （THP） and hydroxycamptothecin （HCPT） in superficial bladder cancer.Methods This study enrolled a total of 189 patients who had been diagnosed with superficial bladder cancer during the period from 2004 through 2007 at Beijing Friendship Hospital. All patients were randomly allocated to one of three treatment groups. Patients in group A received 29 doses of EPI 30 mg/30 ml, patients in group B received 29 doses of THP 30 mg/30 ml, and patients in group C received 29 doses of HCPT 30 mg/30 ml, over a period of 24 months.Results The recurrence-free rate in the 2 anthracycline treatment groups （A and B） were significantly better than that of the HCPT treatment group. In the safety evaluation, the incidences of pollakiuria, pain on urination, dysuria, hematuria,and contracted bladder were not significantly different between groups A and B, but some were significantly higher in groups A and B than that in group C.Conclusion The efficacy of EPI and THP was significantly better than HCPT in the prevention of bladder cancer recurrence.