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Journal: International journal of urology : official journal of the Japanese Urological Association

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OBJECTIVES: The objective was to evaluate the diagnostic accuracy of cystoscopy assisted by narrow-band imaging compared with white-light imaging for non-muscle-invasive bladder cancer. METHODS: An electronic database search of PubMed, Embase, the Cochrane Library, Ovid and Web of Science was carried out for all articles comparing narrow-band imaging with white-light imaging cystoscopy in the detection of non-muscle-invasive bladder cancer. The review process followed the guidelines of the Cochrane Collaboration. RESULTS: Seven studies with prospectively collected data including a total of 1040 patients were identified, and 611 patients with 1476 tumors were detected by biopsy. In the patient- and tumor-level analysis, an additional 17% of patients (95% confidence interval, 10-25%) and an additional 24% of tumors (95% confidence interval, 17-31%) were detected by narrow-band imaging, respectively. In the patient- and tumor-level analysis, significantly higher detection rates using narrow-band imaging (rate difference 11%; 95% confidence interval 5-17%; P < 0.001; and rate difference 19%; 95% confidence interval 12-26%; P < 0.001, respectively) rather than white-light imaging were found. On the tumor level, an additional 28% of carcinoma in situ was detected (95% confidence interval 14-45%) by narrow-band imaging, and a significantly higher detection rate (rate difference 11%; 95% confidence interval 1-21%; P = 0.03) was found. The false-positive detection rate of tumor level did not differ significantly between the two techniques. CONCLUSIONS: Cystoscopy assisted by narrow-band imaging detects more patients and tumors of non-muscle-invasive bladder cancer than white-light imaging, and it might be an additional or alternative diagnostic technique for non-muscle-invasive bladder cancer.

Concepts: Cancer, Carcinoma in situ, Evidence-based medicine, Cochrane Collaboration, Systematic review, Cochrane Library, Neoplasm, MEDLINE

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OBJECTIVE: To compare lingual and buccal mucosa graft urethroplasty for anterior urethral stricture with respect to intraoperative, postoperative parameters and urethroplasty outcome. METHODS: From January 2011 to December 2011, a total of 30 patients with anterior urethral stricture whereas group 2 underwent dorsal onlay buccal mucosa graft urethroplasty. Patients were evaluated for postoperative, tongue protrusion, oral opening, and difficulty in speech and swallowing pain score. Surgical outcome was evaluated with pre- and postoperative work-up involving retrograde urethrogram, uroflow and urethroscopy. RESULTS: Mean age, stricture length and overall pain score were comparable in two groups. All the patients were mostly pain free by postoperative day 7. Group 1 patients had significant difficulty in speech and delayed return to normal diet as compared with group 2. The group 2 patients had a significant reduction in oral opening for the first week after surgery. In group 1, approximately 20% patients (with bilateral lingual grafts and stricture length >7 cm) complained of a change in speech character with restricted tongue movement in the long term, whereas there was no significant long-term morbidity in group 2. At mean follow up of 14.5 months, urethroplasty outcome was comparable in the two groups with one failure in group 1, and two failures in group 2. CONCLUSION: Lingual mucosa graft urethroplasty provides outcomes equivalent to those of buccal mucosa graft urethroplasty. Postoperative morbidity and long-term change in speech make it a second choice for strictures >7 cm, only for cases where buccal mucosa graft is unavailable.

Concepts: Mouth, Term, Urethral stricture, Tongue, Lingual nerve, Buccal mucosa, Urethroplasty

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OBJECTIVE: To examine the effects of Kampo extracts on the process of urinary stone formation. METHODS: A total of 14 Kampo extracts (10 μg/mL) were examined in vitro by assessing whether they could inhibit two critical steps in the early process of calcium oxalate stone formation, namely crystal aggregation and crystal adhesion to the renal tubular epithelium of Madin-Darby canine kidney cells. The inhibitory effect of the extracts on stone formation was examined by using a rat model. RESULTS: Sanshishi and Takusha showed a strong inhibitory effect on the calcium oxalate monohydrate crystal aggregation (84.5% and 64.2%, respectively) and on the crystal adhesion to Madin-Darby canine kidney cells (88.2% and 54.6%, respectively). As pretreatment of Madin-Darby canine kidney cells with these two Kampo extracts did not show any inhibitory effect on crystal adhesion, they were considered to mainly affect the crystal surface to block crystal adhesion to Madin-Darby canine kidney cells. Gorin-san, containing both Sanshishi and Takusha, showed significantly stronger inhibitory activities at lower concentrations compared with Chorei-to, which contains Takusha. Finally, Sanshishi showed a prophylactic effect on calcium oxalate crystal deposition in the rat model. CONCLUSIONS: These findings suggest that Gorin-san, which contains Sanshishi and Takusha, might be used for the prophylaxis of urolithiasis in humans.

Concepts: Kidney, Urine, Effect, Urinary system, Ureter, Affect, Kidney stone, Calcium oxalate

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Intractable hematuria is a common and severe complication in patients with inoperable bladder carcinoma. The aim was to provide an overview of therapeutic options for such cases, and analyze their effectiveness and risk profile, so a systematic literature search of peer-reviewed papers published up to September 2012 was carried out. Various options are available to treat hematuria in patients with inoperable bladder cancer; these include orally administered epsilon-aminocaproic acid, intravesical formalin, alum or prostaglandin irrigation, hydrostatic pressure, urinary diversion, radiotherapy, embolization and intraarterial mitoxantrone perfusion. These treatment options are associated with different prospects of success, risks and side-effects. Well-designed and large studies comparing options are completely lacking. Despite various treatment options, management of intractable hematuria in patients with inoperable bladder cancer remains a challenge, and most of the reported methods should be seen as experimental. Interventional radiology and alum instillation seem to be suitable alternative options for patients who, after critical consideration, cannot be treated by irrigation, transurethral resection or palliative cystectomy.

Concepts: Cancer, Urology, Urinary bladder, Bladder cancer, Cystitis, Hematuria, Cystectomy, Interventional radiology

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OBJECTIVES: To measure interleukin-6 levels in a protamine sulfate-induced chronic cystitis rat model treated with hyaluronic acid, and to study the correlation among interleukin-6, bladder inflammatory degree and voiding frequency. METHODS: A chronic cystitis model was created in female rats by using long-term intermittent intravesical protamine sulfate (0.5 mL, 30 mg/mL). Then, hyaluronic acid (0.5 mL, 0.8 mg/mL) was also instilled intravesically in the rats. Interleukin-6 levels were analyzed with immunohistochemistry, real-time reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay. Hematoxylin-eosin staining was carried out to examine bladder inflammatory degree based on a four-point scoring system (from 0 - none to 3 - severe). Voiding patterns were investigated by cystometrography. RESULTS: According to cystometrography, protamine sulfate-induced rats had significantly shorter intercontraction intervals and less bladder capacity (P < 0.001). The bladder tissue of the rats showed severe chronic inflammation. Immunohistochemistry, reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay showed significantly higher expression of interleukin-6 (P < 0.001). After intravesical administration of hyaluronic acid, both intercontraction intervals and bladder capacity increased significantly (P < 0.001), whereas both bladder inflammatory degree and interleukin-6 levels decreased significantly (P < 0.001). Furthermore, there was a strong correlation between interleukin-6 levels and inflammatory degree (r = 0.727, P < 0.001), and also between interleukin-6 levels and voiding frequency (r = -0.761, P < 0.001). CONCLUSIONS: Intravesical administration of hyaluronic acid decreases interleukin-6 levels, as well as the severity of bladder inflammation and voiding frequency in a rat model of chronic cystitis. Interleukin-6 levels closely correlate with the inflammatory degree and voiding frequency. Thus, they can be regarded as an assessment measure of therapeutic impact.

Concepts: Antibody, DNA, Polymerase chain reaction, Molecular biology, Urinary bladder, Real-time polymerase chain reaction, ELISA, Cystitis

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To analyze the efficacy of hyperbaric oxygen for the treatment of radiation-induced hemorrhagic cystitis and to identify factors associated with successful treatment.

Concepts: Oxygen, Medical treatments, Decompression sickness, Diving medicine, Hyperbaric medicine, Oxygen toxicity, Undersea and Hyperbaric Medical Society, Oxygen mask

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To examine the risk of diabetes mellitus within a 5-year period among patients with nephrolithiasis undergoing percutaneous nephrolithotomy .

Concepts: Diabetes mellitus, Diabetes

3

To describe the feasibility of a novel cell-based endoscopic technique using buccal epithelium, expanded and encapsulated in a thermoreversible gelation polymer scaffold for the treatment of urethral stricture.