The utility of tumour markers in assessing the response to chemotherapy in advanced bladder cancer

In patients with advanced bladder cancer receiving chemotherapy, early assessment of response can avoid unnecessary toxicity. The aim of this study was to assess the role of tumour markers in monitoring response. Serum levels of one or more of markers beta human chorionic gonadotrophin (betahCG), carcinoembryomic antigen (CEA), CA125 and CA19.9 were measured in 74 patients with advanced bladder cancer receiving chemotherapy from 1992 to 1997. Forty-three of 74 (58%) of patients had at least one raised marker (1.5 times upper limit of normal range). This was more common in patients with extra-pelvic disease than in those with disease confined to the pelvis (P = 0.002). Thirty-eight of 78 (49%) assessable patients had a radiological response. Neither clinical response (P = 0.81) nor survival (P = 0.16) differed between marker-negative and marker-positive patients. Clinical response was strongly related to marker response in the 35 comparable patients (P = 0.0001). No patient had a clinical response without response of at least one marker. Ninety per cent of patients who achieved a marker response had done so by 8 weeks. Monitoring of tumour markers in patients with advanced bladder cancer can help predict the response to chemotherapy.     

Residual bladder dysfunction 2 to 10 years after acute transverse myelitis

OBJECTIVE: Acute transverse myelitis (ATM) is a relatively rare condition in children. The recovery rate is reported to be generally complete. In the current study, the long-term urological outcome of children with ATM was assessed. METHODOLOGY: The medical records of children with ATM admitted to Queen Mary Hospital, Hong Kong, over the last 15 years, were reviewed. RESULTS: The median age of the five children with ATM at the time of onset was 6 years (range = 2-12 years). The median length of follow up was 5 years (2-10 years). Four children recovered completely from paraparesis; two had no urinary symptoms with normal micturition. However, video-urodynamic studies 3 years after the acute onset revealed that four out of the five children, including one without any urinary symptom, suffered from residual bladder dysfunction - two from contractile neurogenic bladder and two from intermediate type of neurogenic bladder. CONCLUSION: Residual bladder dysfunction is common in children suffering from ATM despite improvement of paraparesis and apparent lack of urological symptoms. Long-term follow up of urological function in these patients is recommended.     

Cavernous hemangioma of the urinary bladder in an 8-year-old child

An 8‐year‐old boy was admitted to Ehime University Hospital, Ehime, Japan, for the further investigation of a 5‐month episode of gross hematuria accompanied by lower abdominal pain. Magnetic resonance imaging revealed a solid tumor measuring 3 cm in diameter of the bladder wall. Cystoscopy demonstrated a red, wide‐based, nodular tumor situated on the dome of the bladder. Histological examination of tissue taken at hot biopsy showed fibrolipoma. In consideration of potential malignancy, a partial cystectomy was carried out after informed consent was given. Histological examination of the resected specimen showed it to be cavernous hemangioma.     

A case of granular cell tumor of the bladder successfully managed with extraperitoneal laparoscopic surgery

Granular cell tumor is a benign neoplasm which frequently occurs in the oral cavity, skin, and subcutaneous tissue. Granular cell tumor of the bladder is an extremely rare disease, and only nine cases have been reported. We present here an additional case of granular cell tumor occurring in the bladder. Unlike the other tumors reported, this tumor extruded into the Retzius' cavity. Therefore, the tumor was successfully excised through extraperitoneal laparoscopic surgery. The patient was free from recurrence 40 months after surgery. The small tumor located in Retzius' cavity could be managed with extraperitoneal laparoscopic surgery.     

用聚合酶链反应技术检测膀胱癌病毒基因

用聚合酶链反应（ＰＣＲ）技术对６８例膀胱癌及１５例正常膀胱粘膜中第１６、１８型人乳头瘤病毒（ＨＰＶ＿１６、１８）ＤＮＡ进行了检测。结果表明，新鲜及石蜡包埋的癌组织ＨＰＶ＿１６ＤＮＡ的阳性率分别为５３．８％及６６．７％，ＨＰＶ＿１８ＤＮＡ的阳性率为４．４％。ＨＰＶ＿１６ＤＮＡ在癌组织中出现与恶性度及浸润深度有一定关系。正常粘膜有少量ＨＰＶ＿１６ＤＮＡ存在。从正常粘膜到癌组织，ＨＰＶ＿１６ＤＮＡ检出率逐渐增高，反映出其存在较为广泛及在癌变中的作用。     

BLADDER TUMOURS IN CHINESE: A 6 YEAR STUDY

Specimens from 334 Chinese patients who underwent surgical treatment for bladder tumours over a 6 year period were studied retrospectively. Transitional cell carcinoma (TCC) accounted for 91.3% of all the bladder tumours. The male to female ratio was 3:1 and the mean age was 69 years. Papillary TCC, which represented 67.5% of all TCC, were more often of a lower grade compared to non-papillary tumours. The staging of tumours was done for the 102 cystectomy specimens with TCC only. Among these, 28% were superficial while 72% were muscle-invasive and the papillary TCC usually presented at an earlier stage. Infiltration into the prostate gland was identified in 11% of male patients while coexisting adenocarcinoma of the prostate was observed in another 4.2%. Other types of carcinoma were uncommon. Squamous cell carcinoma, adenocarcinoma and small cell carcinoma accounted for 2.7, 1.8 and 0.6% of all bladder tumours, respectively. A rare case of sarcomatoid carcinoma was also found, but no true sarcoma was documented in this series. Benign lesions included five inverted papillomas, three nephrogenic adenomas, two paragangliomas and one haemangioma.     

The streamtest cup: a new uroflow device

Objectives. To create an inexpensive, simple, accurate, and noninvasive device to evaluate the character of a male’s urinary stream.Methods. The results of a formal in-office uroflow study performed on 50 symptomatic men were compared with those of the same men using the Streamtest cup.Results. All men with a urine flow of 12 mL/s or greater reached or exceeded the red line on the Streamtest cup. No patient whose stream was less than 11 mL/s was able to reach the red line.Conclusions. Uroflowmetry is an excellent study in diagnosing, managing, and monitoring the treatment of urinary obstructive disease secondary to benign prostatic hyperplasia. The Streamtest cup can provide both the patient and the physician with a clinically accurate visual assessment of an individual’s urine flow at a significant cost savings over other testing means. The Streamtest cup when compared with a formal in-office uroflow study provided clinically similar results in separating obstructive uropathy from a normal urinary flow.     

大鼠泌尿生殖系溶脲脲原体感染的病理变化

溶脲脲原体（ＵＵ）是泌尿生殖道较常见的病原体，且与不育有关。为探究其感染的病理变化，作者模拟上行性感染途径，将ＵＵ从大鼠膀胱注入，对照组则注入ＵＵ无菌培养液。注射后３周解剖大鼠，发现大鼠睾丸有缩小趋势，但有个体差异；睾丸切片镜检发现明显病理变化，睾丸间质、曲细精管等组织广泛嗜酸性变及生精细胞变性融合成多核巨细胞等现象，感染３周后较明显。大鼠膀胱内软结石的形成很可能是ＵＵ感染后磷酸盐结石的基础。     

Bladder Dysfunction in Patients with Benign Prostatic Hyperplasia: Relevance of Cystometry as Prognostic Indicator of the Outcome after Prostatectomy

Background: We correlated cystometric findings to the clinical features of benign prostatic hyperplasia (BPH) and compared them in terms of outcome after prostatectomy.
Methods: Cystometric findings obtained from 78 patients who underwent prostatectomy were correlated with clinical features in BPH patients. In 41 consecutive patients of this group, prospective periodical cystometry was also performed.
Results: Low bladder compliance correlated significantly with an increase in age and prostate volume, detrusor instability and impaired contractility. Low compliance also correlated with irritative symptoms, decreased maximum flow rate, increased post-void residual urine and an increase in the American Urological Association symptom score. Postoperative persistent incontinence was associated with low bladder compliance and detrusor instability. In a prospective study, bladder dysfunction was not completely restored in 53% of patients examined at a mean interval of 7.7 months after prostatectomy.
Conclusions: Among the cystometric parameters investigated, low compliance was the most relevant to the clinical features of BPH and had some predictive value for the outcome after prostatectomy. In about half of the BPH patients with bladder dysfunction preoperatively, this condition was irreversible for a significant period of time after prostatectomy, in spite of surgical relief of the infravesical obstruction.     

Ultrasound in the diagnosis and management of urinary tract disorders in the fetus

Ultrasonic echography allows display of the fetal kidneys and urinary bladder from the 16th week of pregnancy, and the possibility of detection of a number of major congenital abnormalities of the urinary tract from that time. In the second half of pregnancy ultrasound has the key role in monitoring the progress of previously diagnosed abnormalities, particularly those of an obstructive nature. Sonologists thereby have an increasing responsibility in the obstetric care of the patient not only in the narrow field of diagnosis but in the wider field of management. Examples of conservative and surgical management of obstructive lesions are given.