Bladder Atrophy Research Articles

Successful kidney transplantation improves atrophic bladder capacity and function within 3 months in long-term dialysis patients.

Successful kidney transplantation improves atrophic bladder capacity and function within 3 months in long-term dialysis patients.

Apatinib induces zebrafish hepatotoxicity by inhibiting Wnt signaling and accumulation of oxidative stress.

Apatinib, a small-molecule VEGFR2-tyrosine kinase inhibitor, has shown potent anticancer activity in various clinical cancer treatments, but also different adverse reactions. Therefore, it is necessary to study its potential toxicity and working mechanism. We used zebrafish to investigate the effects of apatinib on the development of embryos. Zebrafish exposed to 2.5, 5, and 10 μM apatinib showed adverse effects such as decreased liver area, pericardial oedema, slow yolk absorption, bladder atrophy, and body length shortening. At the same time, it leads to abnormal liver tissue structure, liver function and related gene expression. Furthermore, after exposure to apatinib, oxidative stress levels were significantly elevated but liver developmental toxicity was effectively ameliorated with oxidative stress inhibitor treatment. Apatinib induces down-regulation of key target genes of Wnt signaling pathway in zebrafish, and it is found that Wnt activator can significantly rescue liver developmental defects. These results suggest that apatinib may induce zebrafish hepatotoxicity by inhibiting the Wnt signaling pathway and up-regulating oxidative stress, helping to strengthen our understanding of rational clinical application of apatinib.

Lower Urinary Tract Symptoms and Urodynamic Findings in Hemodyalisis Patients

Urodynamics is the more accurate diagnostic tool to assess functional alterations of lower urinary tract. International guidelines provide specific indications to adopt this test for the evaluation algorithm of patients with lower urinary tract symptoms. Although recent innovations in diagnostic methodologies, especially regarding ultrasounds, have reduced the use of urodynamics compared to the past, this procedure retains its importance in specific conditions, such as in patients with neurogenic lower urinary tract dysfunction, when symptoms do not improve after first line therapeutic approaches, especially in cases of complicated urinary incontinence and bladder outlet obstruction. Among patients’ cathegories who are often requested to provide urodynamic data are those undergoing hemodialysis. In these subjects urinary symptoms often develop reducing quality of life and increasing the risk of severe sistemic complications. Furthermore, bladder outlet obstruction and other alterations that increase the risk of vesico-ureteral refluxes and chronic urinary retention have to be excluded before a kidney transplant. Urodynamics can properly assess lower urinary tract dysfunction of patients undergoing hemodialysis, who are often oliguric and anuric, and therefore suffering for bladder atrophy with impaired function. This alteration is frequently responsible for recurrent inflammatory disorders of the lower urinary tract. Considering these aspects and lack of data provided by Literature on this topic, aim of this study was to assess the prevalence of lower urinary tract symptoms in a cohort of patients undergoing hemodialysis and to investigate their urodynamic findings. The results show that lower urinary tract symptoms are prevalent in patients attending our hemodialysis center, being inflammatory disorders the most represented as a consequence of bacterial urinary tract infections. Lower urinary tract symptoms, especially urinary burning, frequency, urgency and nocturia, resulted to be the third reason for seeking medical assistance by patients, following cardiovascular and respiratory symptoms. Urodynamics showed in all patients a reduced cystometric capacity, often associated with reduced compliance and detrusor overactivity; pressure / flow studies provided evidence either of bladder outlet obstruction and underactive detrusor.

A Case of Multiple Radiation-related Complications during Long-term Follow-up after Sacral Ulcer Surgery

We report the clinical course of a patient who developed a sacral radiation ulcer 19 years after treatment for cervical cancer. The patient's postoperative course after a free latissimus dorsi muscle flap transfer was favorable, but various late radiation complications, including rectal perforation, a rectal fistula, sacral necrosis, a rectointestinal fistula, and sacroiliac joint osteomyelitis, occurred within 11 years. Plastic surgeons who treat such ulcers need to know that patients may develop other serious radiation-related complications. Being aware of these complications will allow appropriate measures to be taken and aid decisions regarding future surgical strategies. More careful assessment of sacral necrosis and bone resection may have ameliorated some of the complications. When encountering similar patients, we believe that careful magnetic resonance imagery (MRI) and intraoperative evaluation are warranted, as sacral necrosis may be detectable in some patients.

Allograft Vesicoureteral Reflux after Kidney Transplantation.

Allograft vesicoureteral reflux (VUR) is a leading urological complication of kidney transplantation. Despite the relatively high incidence, there is a lack of consensus regarding VUR risk factors, impact on renal function, and management. Dialysis vintage and atrophic bladder have been recognized as the most relevant recipient-related determinants of post-transplant VUR, whilst possible relationships with sex, age, and ureteral implantation technique remain debated. Clinical manifestations vary from an asymptomatic condition to persistent or recurrent urinary tract infections (UTIs). Voiding cystourethrography is widely accepted as the gold standard diagnostic modality, and the reflux is generally graded following the International Reflux Study Committee Scale. Long-term transplant outcomes of recipients with asymptomatic grade I-III VUR are yet to be clarified. On the contrary, available data suggest that symptomatic grade IV-V VUR may lead to progressive allograft dysfunction and premature transplant loss. Therapeutic options include watchful waiting, prolonged antibiotic suppression, sub-mucosal endoscopic injection of dextranomer/hyaluronic acid copolymer at the site of the ureteral anastomosis, and surgery. Indication for specific treatments depends on recipient’s characteristics (age, frailty, compliance with antibiotics), renal function (serum creatinine concentration < 2.5 vs. ≥ 2.5 mg/dL), severity of UTIs, and VUR grading (grade I-III vs. IV-V). Current evidence supporting surgical referral over more conservative strategies is weak. Therefore, a tailored approach should be preferred. Properly designed studies, with adequate sample size and follow-up, are warranted to clarify those unresolved issues.

Living Donor Kidney Transplantation for a Recipient after 41 Years of Hemodialysis

Due to atrophic bladder, patients undergoing long-term dialysis experience vesicoureteral reflux and complicated urinary tract infections after kidney transplantation. A 58-year-old woman underwent living donor kidney transplantation after 41 years of dialysis. She had no contraindications, with good cardiac function and minimal artery calcification despite the long history of hemodialysis. Immunosuppression was initiated with tacrolimus, mycophenolate mofetil, prednisolone, and basiliximab. Ureteroneocystostomy with an antireflux technique was carefully conducted as her bladder volume was 15 mL. The postoperative clinical course was uneventful with immediate graft function. The bladder volume gradually increased to 81 mL at discharge, 3 weeks postoperatively. The patient was initially depressed due to frequent urination early post-transplant but recovered soon after as the bladder volume gradually increased to 400 mL. The patient has not yet reported a urinary tract infection episode. This case highlights living donor kidney transplantation-induced recovery of bladder function with careful ureteroneocystostomy, despite the long dialysis history.

Lenvatinib exposure induces hepatotoxicity in zebrafish via inhibiting Wnt signaling

Lenvatinib is a multi-kinase inhibitor for widely treating thyroid cancer. However, little studies have been done about it or its toxicity on embryonic development of vertebrate. In this study, we used zebrafish to assess the effect of lenvatinib on early embryonic development. Exposure of zebrafish embryos to 58, 117, 176 nM lenvatinib induced abnormal embryonic development, such as decreased heart rate, pericardial edema, delayed yolk absorption, and bladder atrophy. Lenvatinib exposure reduced liver area and down-regulated liver developmental related genes. The proliferation of hepatocytes and the expression of apoptosis-related genes were significantly reduced.by Lenvatinib. Furthermore, the imbalance of liver metabolism and abnormal liver tissue structure were observed in adult zebrafish after Lenvatinib exposure. Oxidative stress was up-regulated by lenvatinib and astaxanthin partially rescued hepatic developmental defects via downregulating oxidative stress. After lenvatinib exposure, Wnt signaling was down-regulated, and activation of Wnt signaling partially rescued hepatic developmental defects. Therefore, these results suggested that lenvatinib might induce zebrafish hepatotoxicity by down-regulating Wnt signaling related genes and inducing oxidative stress. This study provides a reference for the potential hepatotoxicity of lenvatinib during embryonic development and raises health concern about the potential harm of exposure to lenvatinib for foetuses.

Epispadias in a 32-Year-Old Patient with Congenital Malformatiom: Bladder-Epispadias Exstrophy at Birth

Bladder atrophy and / or epispadias This is an orphan genetic malformation affecting one child in 30 to 40 thousand births. This malformation requires immediate surgical management in a specialized center. Many interventions will be essential in order to resolve urinary and genital problems. Treatment protocols vary, but are still based on three essential steps: closing the bladder in the neonatal period; reconstruction of the urethra and penis in boys; bladder emptying and continence surgery. If the first two stages are well mastered, the last remains a challenge, because the techniques in force are unable to restore the active and complex mechanisms that manage bladder emptying and the maintenance of dryness between two bladder emptying. We now have to resolve to create passive subbladder resistance associated with intermittent multi-daily catheterization in order to preserve the upper urinary tract, which remains the first priority.

Increasing bladder capacity and vesicoureteral reflux in pediatric kidney transplant patients.

To investigate the frequency of vesicoureteral reflux, and the relationship of pretransplant decreased bladder capacity and post-transplant vesicoureteral reflux in children undergoing kidney transplantation. A voiding cystourethrography was carried out in 172 pediatric kidney transplantation recipients before, and 4months after, transplantation to evaluate bladder capacity and vesicoureteral reflux. The correlation of post-transplant vesicoureteral reflux with pretransplant bladder capacity, vesicoureteral reflux in the native kidney and the method of ureteral reimplantation (intravesical/extravesical) was analyzed. Atrophic bladder was defined as having ≤50% functional bladder capacity (age in years+2)×25 (mL) or ≤150mL in patients aged >10years. Bladder capacity increased remarkably after transplantation in both post-transplant vesicoureteral reflux- group (from 180 to 253mL) and vesicoureteral reflux+ group (from 82 to 171mL). Voiding cystourethrography showed vesicoureteral reflux in 12 cases of kidney transplantation (7%; grade1: 2, grade2: 3, grade3: 7). Pretransplant atrophic bladder was an independent risk factor of post-transplant vesicoureteral reflux (P=0.004, hazard ratio 9.5). There was no difference in renal function between the vesicoureteral reflux- group and vesicoureteral reflux+ group at 4months to 5years post-transplantation. Pretransplant atrophic bladder is a risk factor of post-transplant vesicoureteral reflux in pediatric patients. However, bladder capacity can remarkably increase after transplantation, and kidney function in the post-transplant vesicoureteral reflux+ group is stable.

Loop ureterocystoplasty for multiple reimplantation failures of refluxing megaureter to atrophic bladder: A novel technique and its long term outcome

We encountered a 9-year-old boy with a small bladder who had previously undergone multiple ureteroneocystostomies for unilateral refluxing megaureter. He underwent excision of the affected non-functioning kidney and ureterocystoplasty used the dilated regional ureter, in which the loop shaped urinary bladder was reconstructed without detubularization of the dilated ureter. The long-term postoperative course has been satisfactory. There have been no reports of ureterocystoplasty used a dilated ureter after multiple ureteroneocystostomies and none describing ureterocystoplasty in which the ureter was looped. This case is presented herein.

Decreasing the Incidence of Postoperative Urinary Retention and Incontinence With Total Joint Replacement Patients After Spinal Anesthesia in the Postanesthesia Care Unit: A Quality Improvement Project

Patients with postoperative urinary retention (POUR) can develop bladder atrophy, urinary incontinence, and hypertension. The purpose of this quality improvement project was to implement standardized guidelines for bladder scanning for patients who have total knee or hip replacement to decrease POUR and incontinent episodes. A retrospective descriptive study was implemented in a 425-bed Magnet community hospital. Patients were bladder scanned within the first hour of postanesthesia care unit admission. Straight catheterization was performed for those who had more than 400mL of retained urine. The protocol included both total knee and total hip replacement surgeries with spinal anesthesia. Compliance with scanning, percentages with POUR, and incontinent episodes were reviewed. POUR was detected in 46% of total knee replacement patients and 36% of total hip replacement patients. Incontinence rates for knee replacement patients decreased by 14% and by 2% for patients with total hip replacements. A bladder scanning protocol decreases postoperative incontinence. Bladder scanning also helps to decrease POUR by decreasing the potential risk of complications.

End-To-Side Versus End-to-End Uretero-Ureteral Anastomosis in Kidney Transplant Recipients With Disused Atrophic Bladder

BackgroundExtravesical Lich-Gregoir ureteroneocystostomy (UC) is the most widely used method for urinary reconstruction during kidney transplantation. Sometimes it is difficult to perform UC in cases with disused atrophic bladder. Pyelo-ureteral anastomosis (PUA) and uretero-ureteral anastomosis (UUA) may be preferred to UC for these patients. MethodsWe retrospectively reviewed the charts of 833 kidney transplant recipients operated on by our transplantation team between July 2010 and November 2014. The patients were divided into two groups: Group I consisted of 16 patients who underwent end-to-side UUA and Group II consisted of 20 patients who underwent end-to-end UUA. The two groups were compared in terms of efficacy, safety, and graft function. ResultsAs we performed end-to-side UUA as a relatively new technique compared with end-to-end UUA, the post-transplantation follow-up period of Group II was significantly longer than Group I (P = .000), but all the patients in both groups had at least 1 year of follow-up. Because the first two patients in Group II, who underwent native ureteral ligation without nephrectomy, developed hydronephrosis in their native kidneys, requiring nephrectomy in the post-transplantation period, we performed native nephrectomy in all of the remaining patients in this group. That is why the mean operative time was significantly longer in Group II compared with Group I (P = .000). There was no significant difference between the two groups in terms of postoperative surgical complications, post-transplantation urinary infections, and graft function. ConclusionEnd-to-side UUA without native ureteral ligation is a safe surgical technique for urinary tract reconstruction during kidney transplantation in patients with disused atrophic bladder.

Atrophic bladder in long-term dialysis patients increases the risk for urological complications after kidney transplantation.

To evaluate the risk for urological complications after kidney transplantation at a single medical center in Japan. In the present study, 408 kidney recipients (255 men, 153 women) were enrolled. There were 349 living and 59 deceased donors. The average age of the recipients was 42.5±13.5years, and the average pretransplant dialysis period was 71.8±88.2months. Ureteroneocystostomy was carried out on 347 patients, and ureteroureterostomy on 61 patients. We investigated the relationship between pretransplant duration of dialysis and bladder capacity, and examined the risk factors for urological complication. We also evaluated the incidence of vesicoureteral reflux in 191 recipients who underwent ureteroneocystostomy during transplantation. The preoperative duration of dialysis therapy showed a significant negative correlation with bladder capacity (R2 =0.33, P<0.001). The overall urological complication rate was 3.4% (14 patients), including urinary leakage (12 patients) and ureteral stricture (two patients). Univariate analysis showed that atrophic bladder, long-term dialysis therapy, deceased donor and ureteroureterostomy were associated with a higher incidence of urological complications (odds ratio 8.05, 4.43, 3.42 and 3.35; P<0.01, P=0.01, P=0.04 and P=0.04, respectively). Furthermore, multivariate analysis showed that atrophic bladder was the only significant factor associated with urological complications (odds ratio 10.37; P=0.01). Among 191 recipients, vesicoureteral reflux was observed in 32 (16.8%). The incidence of vesicoureteral reflux was significantly higher in patients with atrophic bladder. Bladder atrophy in renal transplant recipients after long-term dialysis therapy is associated with a higher risk of urological complications.

A Case Diagnosed as Iatrogenic Vesical Tuberculosis 4 Years after Intravesical Immunotherapy Using Bacillus Calmette-Guérin (BCG) for the Treatment of Bladder Carcinoma

We report a case of iatrogenic vesical tuberculosis diagnosed 4 years after intravesical immunotherapy using Bacillus Calmette- Guérin (BCG) for the treatment of bladder carcinoma. A 72-year-old man underwent a transurethral resection (TUR) of multiple noninvasive urothelial carcinomas and intravesical BCG infusion (40 mg/week) for 7 weeks to prevent the recurrence of bladder carcinoma. BCG infusion therapy was terminated because of the appearance of Reiter's syndrome, including arthritis of the left toe joint, conjunctivitis and non-gonococcal urethritis as complications. The patient suffered from repeated cystitis, bladder atrophy and urethral stenosis. The cystitis improved with the administration of antibiotics (Levofloxacin) but persisted without a complete cure. Four years later, a cystoscopy revealed mucosal erosion and a white coating. An acid-fast bacteria examination of a urine sample using bacteria incubation and DNA PCR revealed the presence of Mycobacterium bovis. Finally, anti-tuberculosis therapy (INH＋REP＋EB) was initiated after the patient was diagnosed as having iatrogenic bladder tuberculosis resulting from BCG immunotherapy. The tuberculosis bacteria subsequently disappeared from the urine samples, and the gross appearance of the bladder mucosa improved. Bladder carcinoma has not recurred to date. Intravesical BCG infusion therapy has a good anti-tumor effect and can help prevent tumor recurrence after TUR therapy in case of noninvasive bladder carcinoma. However, there is a risk of severe complications arising from the BCG infusion. In the present case, an adequate bacteria examination was not performed, even though antibiotics were repeatedly administered for cystitis. In particular, the patient was not tested for the presence of acid-fast bacteria for 4 years after the intravesical BCG infusion therapy. Furthermore, among patients who received anti-bacteria therapy for repeated cystitis after BCG infusion, a bacteria examination including bacteria incubation, was not ordered in 19 out of 30 cases treated at our hospital over the past 5 years. In conclusion, bacteria examination, including tests for acid-fast bacteria, should be immediately performed when repeated and/or persistent cystitis occurs after BCG infusion therapy.

Advantages and Disadvantages of Pre-emptive Kidney Transplantation: Results From a Single Transplantation Center

BackgroundThere is a growing tendency to perform pre-emptive kidney transplantation (PKT). However, less research has been performed on outcomes of PKT and kidney transplantation (KT) after long-term dialysis (LD). MethodsTo elucidate advantages of PKT to KTLD, 96 patients who underwent living-donor KT at our university from 2000 to 2011 were enrolled for this study: 64 patients in the PKT0 (0 months dialysis) group; 14 patients in the PKT-3 group (less than 3 months dialysis); 18 patients in the LD (dialysis > 120 months) group. All recipients were assessed for patients' survival, graft survival, urinary tract infection, laboratory data, episodes of acute rejection, cytomegalovirus-related diseases, and other significant infectious diseases which required hospitalization. ResultsAlthough there were no significant differences in 5-year graft survival (93.8% in PKT0, 85.7% in PKT-3, and 83.7% in control), 5-year patient survival is better in the PKT0 group (96.9%) and the PKT-3 group (92.9%) compared to 88.9% in the control group. Urinary tract infection is clearly correlated with the LD group (44.4% in the LD group vs 19.2% in the PKT group) primarily due to atrophic bladder and subsequent vesicoureteral reflux. Slightly higher rates of acute rejection were found in the PKT groups (30.8% vs 26.3%). ConclusionThis study revealed that there are both advantages and disadvantages of PKT. It is clear, therefore, that PKT can be recommended for end-stage renal disease patients provided enough attention is paid to the onset of acute rejection.

Urinary Tract Reconstruction Using Uretero-Ureteral End-To-Side Anastomosis in Kidney Transplant Recipients

BackgroundIn kidney transplant recipients, the most widely used method for the reconstruction of the urinary pathway is ureteroneocystostomy, which may be difficult in cases with disused atrophic bladder. In this study, we evaluated kidney transplant recipients who underwent uretero-ureteral end-to-side anastomosis (UUA) in urinary reconstruction due to disused atrophic bladder. MethodsTo clarify the effectiveness of this method, we retrospectively reviewed the clinical records of kidney transplant recipients in our hospital. ResultsA total of 9 recipients with urinary reconstruction using UUA were evaluated. All of these patients had a history of long-term hemodialysis before transplantation, accompanied by complete anuria and small capacity of the bladder. In 4 patients, cranial native ureter was ligated, whereas it was not ligated in the remaining 5 patients. In 2 of 4 patients with cranial ligation, hydronephrosis developed in the native kidney with no further treatment being required. No patients experienced urinary tract complications including hydronephrosis in the graft, urine extravasation, or urinary tract infection in the follow-up period (757.6 ± 491.3 days). Allograft function was maintained well in all patients (serum creatinine level, 1.08 ± 0.23 mg/dL). ConclusionsAlthough UUA is not a routine method of urinary reconstruction in kidney transplantation, it can be safely performed and should be a surgical option, especially for recipients with disused atrophic bladder. The ligation of cranial native ureter may lead to hydronephrosis of the native kidney, and it is tentatively concluded that UUA without native ureteral ligation is clinically feasible.

Bladder Volume Change and Post-Transplant Vesicoureteral Reflux (VUR) in Pediatric Recipients With Atrophic Bladder After Kidney Transplantation.

Background Children with CKD have high prevalence of atrophic bladder due to disused situation and inadequate bladder-cycling after long-term dialysis and congenital urinary tract anormaly. Small capacity bladder have potential risks of ureterocystoneostomy. We retrospective reviewed our surgical outcome of ureterocystoneostomy and bladder volume change at 4 months after kidney transplantation in pediatric recipients with atrophic bladder. Methods Between 2000 and 2012, 153 pediatric renal transplant recipients were performed kidney transplantation with evaluation of bladder size using voiding cystography before and 4 months after transplantation. Patients with neurogenic bladder were excluded. Definition of atrophic bladder volume is less than 50% of estimated bladder capacity(30×(age+1)) under 10 years old and less than 150ml over 10 years old. Result Seventy-two (47.1%) pediatric recipients showed atrophic bladder (42 males and 30 females). Average age of transplants is 7.2±5.3 years old. Average height is 107.2±22.8cm and weight is 19.2±10.9kg. Mean bladder volume is 46.0±35.1ml at pre-transplant and 164±80.4ml at 4 months after transplant. The bladder capacity of pre-transplant atrophic bladder significantly increased approximately 3 times at 4 months after transplantation regardless of pre-transplant age, bladder volume and body weight. There is a significant difference of the incidence of post-transplant vesicoureteral reflux(VUR) in the graft between the atrophic baladder and the normal group(14.1%: 1.2%). Procedures of ureterocystoneostomy in the atrophic bladder group were intravesical(P-L) method (n=37), extravesical(L-G) method(n=34) and uretero-ureterostomy(n=1). There is no significant difference of prevalence of VUR in the graft kidney between P-L and L-G method(13.5%(n=5); 14.7%(n=5)). However, there is a significant difference of the incidence of VUR among pre-transplant bladder capacity(0-50ml:19.6%, 50-100ml:4.8%,100-150ml:0%). Conclusion Pediatric kidney recipients had high prevalence of atrophic bladder, and the improvement of bladder volume is excellent without special procedure of ureterocystoneostomy and pre-transplant management in pediatric recipients. However there is potential high risk of VUR in recipients with atrophic bladder.

Editorial Comment from Dr Kitamura to Cystectomy and urinary diversion as management of treatment-refractory benign disease: The impact of preoperative urological conditions on perioperative outcomes

As removal of the bladder followed by urinary reconstruction impairs the quality of life (QOL) of patients, cystectomy should be indicated when the benefits surpass the loss of QOL. This means that the primary diseases requiring cystectomy must be severe and oppressive for patients; for example, radiation cystitis with uncontrollable hemorrhage, treatment-refractory vesicovaginal or rectovesical fistula, atrophic bladder and so on. It is possible that the procedures in cystectomy for such benign diseases require high technical skill levels compared with those in radical cystectomy for bladder cancer, but it might depend on the primary disease. There has been no report with a large series regarding morbidity and mortality of cystectomy for benign diseases because of their rarity. Cohn et al. evaluated early and late complications after cystectomy for patients with treatment-refractory benign disease, and attempted to determine associations between the preoperative condition, including the etiology, and such outcomes. All patients with radiation-induced fistula experienced complications within 30 days after the cystectomy, and half of them were Clavien grade III or more. At 90 days, 50% of the patients with radiation-induced fistula still had the preoperative problems, whereas 83% of the rest of the cohort experienced resolution. The authors commented that the morbidity of cystectomy for benign disease might be similar to that seen in radical cystectomy, and increased in particularly complex and comorbid patients with radiation-induced fistula. Although this article has the limitations of being a retrospective review with the probability of underestimation of complications and a small number of participants that do not allow multivariate analysis, it provides informative suggestions for clinical practice. According to recent reports regarding complications of radical cystectomy after radiation therapy, morbidity rates were acceptable and slightly higher than for non-irradiated participants. Unlike salvage cystectomy after radiotherapy as a bladder-preserving strategy, however, cystectomy for patients with uncontrollable radiation-induced fistula is a challenging operation, as shown in this paper. Should we, then, avoid carrying out cystectomy for patients with radiation-induced fistula? To answer this question, much longer follow up and outcome data should be analyzed. Whether the patients who underwent cystectomy for treatment of radiation-induced fistula finally received the real benefits of cystectomy with urinary diversion must be of interest to many urologists.

CHANGES IN THE URINARY BLADDER MORPHOLOGY, MAST CELL POPULATION AND ESTROGEN RECEPTOR ALPHA EXPRESSION FOLLOWING OVARECTOMY AND CHRONIC ESTROGEN REPLACEMENT THERAPY IN ALBINO RATS

11 Acta Endocrinologica (Buc), vol. IX, no. 1, p. 11-22, 2013 *Correspondence to: Dr. Flaviu Alexandru Tabaran, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Department of Pathology, Manastur Street, Nr.3-5, Cluj-Napoca, Cluj, 400372, Romania, E-mail: flaviu_tabaran@yahoo.com Abstract Context. The inflammatory disorders of the urinary bladder represent one of the most frequent disorders associated with hormonal unbalances caused by menopause. The involvement of estrogens and mast cells in this complex mechanism mediated by neuro-hormonal pathway is well known, but the pathogenesis through which the hormonal deprivation is affecting the Estrogen Receptor expression and is predisposing to urinary bladder inflammatory changes is still argued. Objective. To determine the structural changes associated with surgically induced menopause, and the effect of estrogen replacement therapy (ERT) in the urinary bladder morphology, mast cell population and Estrogen Receptor (ERα) expression. Subjects and methods. The effect of ovariectomy and ERT was monitored by quantifying the number of mast cells and the structural changes that the urinary bladder suffers. By immunohistochemistry we assessed the changes of the Estrogen Receptor Alpha (ERα) expression in the urothelium and detrusor muscle. The study was carried out on ovariectomised female rats over a period of 42 days. Results. The main alterations associated with the hormonal deprivation were represented by the growth in number of the bladder mast cells, atrophy of the urothelium and amplification of the expression of ERα from the urothelium, but not from the detrusor muscle. ERT significantly decreased the tissue expression for ERα, reduced the severity of bladder atrophy and the number of mast cells. Conclusions. The estrogenic hormonal substitution can diminish the severity of the atrophic, inflammatory and ERα changes in bladder disorders associated with ovarectomy in rat.

Laparoscopic Approach for an Intra-Abdominal Kidney Allograft Nephrectomy After Pediatric Transplantation: A Case Report

We report a case of minimally invasive nephrectomy of a kidney transplanted into the abdominal cavity in a child. A 15-year-old girl underwent transplantation with a cadaveric donor kidney due to congenital pyelonephritis, vesicoureteral reflux, and secondary bladder atrophy. The transplant was complicated by hyperacute rejection, cytomegalovirus infection, and anastomotic stenosis of the Bricker neobladder. After recurrent urinary tract infections, the patient was reintroduced to hemodialysis in 2010. After pneumo-peritoneum, we placed 2 10-mm trocars in the hypochondrium and left side and 2 5-mm in the left iliac fossa and right upper quadrant. The transplanted kidney was skeletonized, the artery and vein were cut to the end-to-side anastomoses to the juxta-renal aorta and cava using an automatic 35-mm, stapler, and the ureter was dissected and closed with clips. Via a Pfannestiel minilaparotomy we extracted the allograft. The patient was discharged on the third postoperative day. After 4 months of follow-up, she is alive an on dialysis. Laparoscopic nephrectomy of a kidney transplanted into the abdominal cavity is feasible and safe in centers with skilled minimally invasive techniques.