A Literature Review of Phantom Bladder Perforation: The Curious Case of Bladder Lipoma

Mycoplasma and Ureaplasma Molecular Testing Does Not Correlate with Irritative or Painful Lower Urinary Tract Symptoms.

Inverted urothelial papilloma (IP) is an uncommon urothelial neoplasm. We aimed to determine the clinicopathologic characteristics of IP of the bladder and its association with prostate volume and lower urinary tract symptoms (LUTS). From 1994 to 2008, 53 patients with urinary IP underwent transurethral resection of the bladder tumor (TURBT) at our institution. We reviewed the clinicopathologic characteristics of IP of the bladder and its association with prostate volume and LUTS. The patient population consisted of 46 men and 7 women with a mean age of 56 years (male to female ratio 6.6:1). The most common presenting symptom was LUTS (33 men and 3 women). Of the 33 men with LUTS, the mean prostate volume before TURBT was 48.1 cc (range 21.8-109.3 cc). IP was found incidentally in 14 men on transrectal ultrasonography (TRUS) and in 2 men during transurethral prostate resection. In IP located on the bladder neck of patients with benign prostatic hyperplasia (BPH), significantly higher obstructive symptoms and larger prostate volumes than that of other located IP with BPH were observed. This is the largest series of cases of urinary bladder IP reported from Korea. Despite the absence of agreement of its etiology, its presenting symptoms were related to LUTS and benign prostatic enlargement. TRUS may be helpful, especially in unresponsive patients with LUTS despite medical treatment.

Bladder cancer is one of the most common cancers of the urinary tract. The two available treatments for this malignancy are laser and Transurethral Resection of the Bladder Tumor (TURBT). The aim of this study was to compare the different parameters of these two methods. A systematic search was performed on PubMed, Scopus and Google Scholar between 2000 and 2021. All articles related to non-muscle invasive bladder cancer (NMIBC) were extracted. All analyses were performed using R-studio statistical software version 1.0.136. In total, 11 studies that reported tumor recurrence in two methods were evaluated. A total of 626 and 742 patients were treated with laser and TURBT, respectively. Tumor recurrence, duration of operation, hospitalization and catheterization in laser therapy were significantly lower than TURBT. In addition, the incidence of complications was lower in patients treated with laser. The incidence of obturator nerve reflex, bladder perforation and postoperative bladder irrigation was significantly higher in patients treated with TURBT. Only in relation to postoperative urethral stricture, no significant difference was observed between the two treatment methods. Laser therapy compared to TURBT in patients with NMIBC has fewer complications and faster recovery. Also, the risk of tumor recurrence in laser therapy is less than TURBT.

Ectopic tissue is rarely found in the bladder for adults. Currently, there have been reports of ectopic prostate and colon tissue in the bladder. These ectopic tissues are manifested as a bladder mass and cause lower urinary tract symptoms. However, the ectopic corpus cavernosum in the bladder has never been reported, and its clinical characteristics and treatment have not been explored yet. A 3-year-old boy was admitted to the hospital due to 1 month of urinary frequency. The physical examination was unremarkable. Urine analysis from other hospitals showed an elevated urine white blood cell count of 17.9/ul. In addition, ultrasound indicated a possible bladder mass. CT and MRI showed a well-margined lesion (1.9×1.9 cm) in the bladder trigone. Through preoperative imaging, we diagnosed a bladder tumor (inclined towards benign). The transurethral resection of the bladder tumor was performed. Unfortunately, the surgery was unsuccessful due to the difficulty in removing the excised tissue through the urethra. Subsequently, bladder incision and tumor resection were performed. The tumor was successfully removed. Surprisingly, the postoperative pathology showed that the tumor tissue was corpus cavernosum. The pathological diagnosis was ectopic corpus cavernosum in the bladder. No complications were found after the operation, and no recurrence was observed during follow-up. The ectopic corpus cavernosum in the bladder has never been reported for children, which is presented as a benign tumor with rapid proliferation and large size. Surgery is recommended. However, the transurethral resection of bladder tumors is difficult to perform due to narrow urethra and limited surgical instruments. Bladder incision and tumor resection may be preferred.

Objectives: To study the presentation and natural course of cystitis cystica et glandularis. Methods: A retrospective analysis of patients with histopathologically confirmed cystitis cystica et glandularis from March 2016 to March 2018 who at least completed their 2 years’ follow-up was performed. Perioperative details along with the last available follow-up were included in the analysis. Results: A total of 10 patients were included. The mean age (± standard deviation) was 33.4 (±14.0) years and nine (90%) were men. The most common presentation was storage and voiding lower urinary tract symptoms (80%) along with haematuria (40%) and dysuria (20%). Four patients had the presence of hydronephrosis in preoperative imaging, of which three patients had bilateral mild hydroureteronephrosis. All the patients underwent transurethral resection of the bladder tumour as all were diagnosed with urinary bladder mass on preoperative imaging. All the patients had a trigonal lesion with a bullous appearance partially obstructing the bladder neck. Six patients underwent double J stenting in the perioperative period. The mean (± standard deviation) follow-up duration was 32.8 (±7.5) months. Patients were kept on regular surveillance with imaging and cystoscopy as indicated. Eight patients (80%) developed recurrence in the follow-up period. The mean number of recurrences was 1.5 (±1.1). One of the patients had to undergo augmentation ileocystoplasty with bilateral ureteric reimplantation because of the recurrent lesion with small contracted bladder, while another patient underwent cystectomy with urinary diversion owing to recurrence and refractory lower urinary tract symptoms. Besides, there was no evidence of malignancy after this entity in any of the patients. Conclusion: Cystitis cystica et glandularis is a rare clinic pathological entity which often mimics bladder tumour. Cystitis cystica et glandularis is common in men and often presents with lower urinary tract symptoms. Transurethral resection forms the mainstay of treatment. However, it is often associated with upper tract hydronephrosis. Its controversial premalignant nature compounded with recurrence and risk of upper tract deterioration warrants close surveillance. Level of evidence: 4

Transurethral resection of the bladder tumor (TURBT) followed by intravesical instillation therapy is the standard treatment for non-muscle invasive bladder cancer (NMIBC). One of the factors that may affect the risk of recurrence after TURBT is the quality of surgery that may vary between individual surgeons. While there has been a large number of studies demonstrating the ability to reduce the risk of recurrence of NMIBC with different types of the intravesical therapy, less attention was paid to the quality of TURBT in improving long-term treatment results. The aim of the study is to evaluate the effect of the quality of TURBT on the recurrence rate of NMIBC based on surgeon experience. The study is a double blinded prospective randomized study conducted on 50 patients with NMIBC. who underwent 126 procedures (50 primary cystoscopies ,26 restaging cystoscopies and 50 check cystoscopies at three months). All Treatment-naive patients with NMIBC candidate for TURBT were included, with exclusion of patients with previous history of TURBT, previous open bladder surgery, patients with urethral stricture, patients with muscle invasive bladder cancer. And patients who lost follow up. Patients were randomized by closed envelope into two groups; Group A included 25 patients who underwent TURBT by a senior surgeon (more than 5 years' experience), and Group B included 25 patients underwent TURBT by a qualified junior surgeon (less than 5 years' experience). Restaging cystoscopy at 2-6 weeks (if indicated) and follow up cystoscopy at three months were performed by another senior surgeon (who was blinded to the name of the first surgeon). No statistically significant difference was found between both groups regarding the incidence of complications (urethral injury, bladder perforation, ureteric injury, obturator reflex), Group B showed a statistically significant longer operative time, postoperative irrigation time, more hemoglobin loss, longer hospital stay, and higher 3 months' recurrence rates. Moreover, senior surgeons' specimens were more likely to include detrusor muscles. surgeon's experience has significant impact on the quality of TURBT and risk of recurrence of NMIBC. With less operative time, less hemoglobin drop, and less hospital stay.

IntroductionNon-muscle invasive bladder cancer (NMIBC) is one of the most expensive cancers to treat, driven by high recurrence rates and disease progression. Mortality rates in the UK for all bladder cancers have remained relatively stable over the past decade. NMIBC can be curatively treated with transurethral resection of the bladder tumour (TURBT). Despite international evidence-based guidelines on the TURBT procedure and postoperative single instillation of mitomycin-C, TURBT quality continues to vary widely. RESECT will be the first ever international study of TURBT surgery evaluating the achievement of TURBT quality indicators globally and assessing if audit and performance feedback can improve surgical outcomes.MethodsRESECT is a prospective, multicentre international observational cohort study. Collaborators at each site will collect data using REDCap about local TURBT practice, early recurrence rates and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators. Advertisement for the study launched in 2020.ResultsAs of October 1st, 2020, 524 collaborators have registered to participate. Collaborators represent 334 centres from 54 countries, with the highest number of centres from the United Kingdom (133), Spain (17), and India (16). 50.8% are trainees, 30.3% consultants, and 17.2% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.ConclusionRESECT has attracted many collaborators internationally from consultants and trainees at all stages. RESECT has significant potential to positively impact TURBT practice, health economics and ultimately improve outcomes for patients with NMIBC globally.

Background: The average age of diagnosis for bladder cancer is 73 and about 75 percent of all bladder cancers are non-muscle invasive at initial diagnosis. It is recommended that non-muscle invasive bladder cancers (NMIBC) should be treated with transurethral resection of the bladder tumor (TURBT) followed by chemotherapy. However, there is no large-scale study from real-world databases to show the effectiveness of chemotherapy on the survival of older adults with NMIBC that have undergone TURBT. This study aimed to investigate the effects of chemotherapy on survival among older NMIBC patients with TURBT. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), we performed analyses of cancer-specific mortality and overall mortality comparing chemotherapy versus no chemotherapy after TURBT. Coarsened exact matching was performed to balance the baseline patient characteristics. Cox proportional hazards and Kaplan-Meir analyses were used to evaluate survival outcomes. Results: A total of 3,222 matched patients with 1,611 in each arm (chemotherapy and no chemotherapy) were included in our study. After adjusting for covariates, multivariable Cox regression analyses show chemotherapy was associated with lower cancer-specific mortality (HR 0.63; 95% CI 0.42-0.94; p value 0.024). However, chemotherapy did not have any effect on overall mortality (HR 0.84; 95% CI 0.65-1.07; p value 0.159). The Kaplan-Meier curves show the protective effects of chemotherapy on cancer specific survival (p=0.032), but not on overall survival (p=0.34). Conclusion: Chemotherapy improved cancer specific survival among older patients with non-muscle invasive bladder cancer undergoing TURBT surgery, but it had no effect on overall survival. There is a need for more granular level real-world data on chemotherapy regimens and dosage to effectively investigate the effects of chemotherapy on the survival of older patients with NMIBC that have undergone TURBT.

Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-up

We appreciate the opportunity to respond to the erudite commentary by Drs. Freedland and Aronson (1) regarding our manuscript examining associations between C-reactive protein levels and development of lower urinary tract symptoms (LUTS) and other urologic outcomes (2). The authors correctly note that the associations we found of elevated C-reactive protein levels with irritative LUTS and peak fl ow rates were restricted to only the most rapid worsening of these outcomes. Because C-reactive protein is a very nonspecific marker of systemic inflammation, it may be that inflammation in the urogenital tract needs to be substantial before systemic inflammatory markers are affected; consequently, this possibility may be why we saw associations of only elevated C-reactive protein levels with the most rapid increases in irritative LUTS and the most rapid declines in peak flow rates. Therefore, we completely agree with the authors that better markers of inflammation that are more proximal to the urologic system could substantially enhance our understanding of the role of inflammation in the development of LUTS and prostatic enlargement. Additionally, as noted by the authors (1), inflammation found in prostate biopsies has been only weakly associated with either irritative or obstructive symptoms (3). It is clear that LUTS may develop even in the absence of increases in prostate volume, and it is possible that inflammation in other components ofthe urogenital system could play an important role in the development of LUTS. Unfortunately, prostate biopsies are invasive, and the question of how to measure inflammation in the bladder, the bladder neck, or even the urethra remains perplexing. The discovery of inflammatory markers that are tightly linked to inflammation in the urogenital tract but that could be tested from serum or urine would be extremely useful in furthering our understanding of how prostatic versus nonprostatic inflammation might contribute to the development of LUTS. Drs. Freedland and Aronson (1) also note that prospective trials of antiinflammatory medications to treat established LUTS or prostatic enlargement have been disappointing. However, the benefit of antiinflammatory agents might be realized in primary rather than secondary prevention of these conditions. It is possible that inflammation may play a role in the development of LUTS or prostatic enlargement, but, once these conditions are established, antiinflammatory agents might have little effect in alleviating these conditions. Intervening earlier in the pathogenic process might help prevent their development. Indeed, the authors note the recent study in which statins were associated with a reduction in prostate-specific antigen levels in healthy men, suggesting an effect on the prostate (4). Additionally, in our own cohort, we previously found that long-term nonsteroidal antiinflammatory drug use was associated with a decreased likelihood of developing LUTS and an enlarged prostate (5). Future studies could help determine whether inhibiting inflammatory processes before LUTS or prostatic enlargement is established might be useful in preventing these conditions.

RECURRENCE AND PROGRESSION OF STAGE T1, GRADE 3 TRANSITIONAL CELL CARCINOMA OF THE BLADDER FOLLOWING INTRAVESICAL IMMUNOTHERAPY WITH BACILLUS CALMETTE-GUERIN

Transurethral resection of the bladder tumor (TURBT) is a standard procedure in bladder cancer management. TURBT has two main goals: to resect completely all the tumor lesions in healthy tissues and to provide high-quality specimen to facilitate accurate diagnosis. To achieve these goals, urologists make use of several options to maximize the efficiency of the procedure. To make tumor detection as effective as possible, the European Association of Urology guidelines recommend using enhanced visualization methods such as photodynamic diagnostics (PDD) and narrow-band imaging (NBI). Novel en bloc technique enables one to provide specimens of a higher quality and to increase recurrence-free survival. Also, the use of new energy sources such as lasers helps to decrease bleeding and prevent several complications after TURBT, e.g., obturator nerve reflex and bladder perforation. This article summarizes the options available to enhance the TURBT procedure and reports on the latest data on their feasibility for clinical practice.

To explore the advantages and limitations of holmium laser resection of the bladder tumor (HOLRBT) versus standard transurethral resection of the bladder tumor (TURBT) in the treatment of non-muscle-invasive bladder cancer (NMIBC), the eligible studies were selected from the following databases: PubMed, Cochrane Library, and Embase. Studies comparing HOLRBT and TURBT for patients with NMIBC were included. The outcomes of interest were time of operation, catheterization and hospitalization, rates of recurrence, and perioperative complications, including obturator nerve reflex, bladder perforation, bladder irritation, and urethral stricture. Results of all data were compared and analyzed by Review Manager 5.3. A total of 9 comparative studies were finally included for this analysis. Pooled data demonstrated that HOLRBT significantly reduced the time to catheterization and hospitalization, the rate of recurrence in 2years of follow-up, obturator nerve reflex, bladder perforation, and bladder irritation, compared with those in TURBT, respectively. However, no significant difference found between HOLRBT and TURBT in the time of operation, rate of recurrence in 1-year follow-up, and urethral stricture. The results of this research reached that HOLRBT would be a better choice than TURBT for patients with NMIBC.

BackgroundThe gold standard treatment for non-muscle invasive bladder cancer (NMIBC) is transurethral resection of the bladder tumor (TURBT). En bloc transurethral resection is a new method for non-muscle invasive bladder cancer that may improve some shortcomings of TURBT. The aim of this systematic review and meta-analysis was to compare the perioperative and prognostic outcomes of en bloc transurethral resection and TURBT for NMIBC.MethodsLiterature searches were conducted using PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), WanFang Data (WanFang) and VIP Information Network (VIP). We only included randomized controlled trials (RCTs). We used the Cochrane risk of bias 2.0 tool and modified Jadad scale to assess the quality of the literature. Statistical analyses were conducted using Review Manager 5.3 software (RevMan) and Stata SE software.ResultsWe included 16 RCTs comprising 1,505 patients (experimental group: 827; control group: 678). There were no significant differences between en bloc transurethral resection and TURBT in operation time [standard mean difference (SMD) =−0.21, 95% confidence interval (CI): −0.70 to −0.28, P=0.40] and 3-month recurrence rate [relative risk (RR) =0.14, 95% CI: 0.02–1.08, P=0.06]. Compared with TURBT, en bloc transurethral resection significantly decreased 6-month recurrence rate (RR =0.43, 95% CI: 0.26–0.69, P<0.001), 1-year recurrence rate (RR =0.36, 95% CI: 0.25–0.53, P<0.001), positive number of the biopsy at the tumor base (RR =0.17, 95% CI: 0.07–0.43, P<0.001), vesical perforation (RR =0.22, 95% CI: 0.11–0.43, P<0.001), obturator nerve reflex (RR =0.39, 95% CI: 0.18–0.83, P=0.01), postoperative complications (RR =0.10, 95% CI: 0.02–0.41, P=0.002), hemorrhage (SMD =−2.13, 95% CI: −2.89 to −1.37, P<0.001), hospital stay [mean difference (MD) =−2.14, 95% CI: −2.81 to −1.47, P<0.001], bladder irrigation time (SMD =−2.80, 95% CI: −3.36 to −2.24, P<0.001), and catheterization period (SMD =−1.77, 95% CI: −2.63 to −0.91, P<0.001).ConclusionsCompared with TURBT, en bloc transurethral resection appears to be a better treatment option for NMIBC.

Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization