Benign Bladder Research Articles

Continent urinary diversion.

We present a review on the current options for continent urinary diversion and their different indications on the basis of patient selection. In current clinical practice continent urinary diversion is being used world-wide in patients undergoing radical cystectomy and in severe cases of benign bladder pathologies. We also discuss the specific complications of continent urinary diversion and highlight the need to rigorously monitor these patients in the long- term specifically in terms of their renal function and cancer recurrence.

Urethral obstruction from dislodged bladder Diverticulum stones: a case report

BackgroundSecondary urethral stone although rare, commonly arises from the kidneys, bladder or are seen in patients with urethral stricture. These stones are either found in the posterior or anterior urethra and do result in acute urinary retention. We report urethral obstruction from dislodged bladder diverticulum stones. This to our knowledge is the first report from Nigeria and in English literature.Case presentationA 69 year old, male, Nigerian with clinical and radiological features of acute urinary retention, benign prostate enlargement and bladder diverticulum. He had a transurethral resection of the prostate (TURP) and was lost to follow up. He re-presented with retained urethral catheter of 4months duration. The catheter was removed but attempt at re-passing the catheter failed and a suprapubic cystostomy was performed. Clinical examination and plain radiograph of the penis confirmed anterior and posterior urethral stones. He had meatotomy and antegrade manual stone extraction with no urethra injury.ConclusionsUrethral obstruction can result from inadequate treatment of patient with benign prostate enlargement and bladder diverticulum stones. Surgeons in resource limited environment should be conversant with transurethral resection of the prostate and cystolithotripsy or open prostatectomy and diverticulectomy.

Outcomes Following Radical Cystectomy for Nested Variant of Urothelial Carcinoma: A Matched Cohort Analysis

We evaluated oncological outcomes after radical cystectomy in patients with the nested variant of urothelial carcinoma and compared survival to that in patients with pure urothelial carcinoma of the bladder. We identified 52 patients with the nested variant who were treated with radical cystectomy between 1980 and 2004. Pathological specimens were re-reviewed by a single genitourinary pathologist. Patients were matched 1:2 by age, gender, ECOG (Eastern Cooperative Oncology Group) performance status, pathological tumor stage and nodal status to patients with pure urothelial carcinoma. Survival was estimated using the Kaplan-Meier method and compared with the log rank test. Patients with the nested variant had a median age of 69.5 years (IQR 62, 74) and a median postoperative followup of 10.8 years (IQR 9.3, 11.2). Nested variant cancer was associated with a high rate of adverse pathological features since 36 patients (69%) had pT3-T4 disease and 10 (19%) had nodal invasion. Eight patients (15%) with nested variant cancer received perioperative chemotherapy. When patients with the nested variant were matched to a cohort with pure urothelial carcinoma, no significant differences were noted in 10-year local recurrence-free survival (83% vs 80%, p = 0.46) or 10-year cancer specific survival (41% vs 46%, p = 0.75). The nested variant of urothelial carcinoma is associated with a high rate of locally advanced disease at radical cystectomy. However, when stage matched to patients with pure urothelial carcinoma, patients with the nested variant did not have an increased rate of recurrence or adverse survival. Further studies are required to validate these findings and guide the optimal multimodal treatment approach to these patients.

Expression analysis and clinical significance of CXCL16/CXCR6 in patients with bladder cancer

The interactions between chemokines and their receptors are closely involved in the progression and metastasis of cancer. We hypothesized that the CXCL16-CXCR6 ligand-receptor system plays an important role in bladder cancer progression. To evaluate this hypothesis, the expression levels of CXCL16 and CXCR6 were evaluated in 160 patients, including 155 patients with bladder cancer and 5 patients with benign bladder disease. The tissues were analyzed by immunohistochemical (IHC) staining and real-time reverse-transcription polymerase chain reaction. We compared the expression of CXCL16/CXCR6 in bladder cancer and benign bladder disease. The expression of CXCR6 was increased in patients with bladder cancer compared with benign bladder disease in RT-PCR. The mRNA expression levels of CXCL16 and CXCR6 were 1.75×10(-2) and 1.99×10(-2) in benign bladder tissue and 1.39×10(-2) and 2.32×10(-2) in bladder cancer tissue, respectively. In IHC staining, the expression of CXCL16/CXCR6 in bladder cancer tissues was higher compared with benign bladder tissues. On multivariate analysis, the IHC staining of CXCL16 was correlated with the 2004 WHO grade and lymphovascular invasion (P=0.021 and P=0.011, respectively). CXCR6 was correlated with the 1973 WHO grade (P=0.001), 2004 WHO grade (P<0.001), pathological T stage (P=0.002) and perineural invasion (P=0.031). However, Cox regression analysis revealed that the expression of CXCL16 and CXCR6 was not correlated with cancer recurrence and cancer-specific survival (P=0.142 and P=0.324, respectively). The expression of CXCL16/CXCR6 was higher in bladder cancer compared to benign disease and correlated with aggressive cancer behavior. Based on our results, the CXCL16/CXCR6 axis appears to be important in the progression of bladder cancer. Thus, CXCL16 and CXCR6 serve as potential therapeutic targets.

Identification of urinary Gc-globulin as a novel biomarker for bladder cancer by two-dimensional fluorescent differential gel electrophoresis (2D-DIGE)

Improving the early detection rate and surveillance of bladder cancer remains a great challenge in medicine. Here, we identified sixteen proteins including Gc-globulin (GC) in urine from bladder cancer patients and normal controls by two-dimensional fluorescent differential gel electrophoresis (2D-DIGE) and matrix-assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF/TOF MS). Bioinformatics analyses indicated GC played important roles in the regulation of growth, apoptosis, death and epidermal growth factor receptor activity. The GC expression patterns in urine or tissue from cases and controls were further quantified by western blotting, immunohistochemical staining and enzyme-linked immunosorbent assay (ELISA). ELISA quantification by correcting for creatinine expression showed GC-Cr was significantly increased in bladder cancer patients than in benign bladder damages cases and normal controls (1013.70±851.25 versus 99.34±55.87, 105.32±47.81 ng/mg, respectively). Receiver operating characteristic (ROC) analysis suggested that at 161.086 ng/mg urinary GC, bladder cancer could be detected with 92.31% sensitivity and 83.02% specificity, and 1407.481 ng/mg with 82.61% sensitivity and 88.24% specificity could be used for the detection of infiltrating urothelial carcinoma of bladder cancer. Taken together, we identified GC as a potential novel urinary biomarker for the early detection and surveillance of bladder cancer.

Characterization of silodosin and naftopidil in the treatment of bladder dysfunction in the spontaneously hypertensive rat

As increasing evidence suggest that α(1)-blockers prevent benign prostatic hyperplasia related overactive bladder and nocturia in the human, we investigated the effects of silodosin and naftopidil on hypertension-related bladder dysfunction in the spontaneously hypertensive rat (SHR) model. Twelve-week-old male SHRs received no treatment or treatment with silodosin (100 µg/kg, p.o.) or naftopidil (10 or 30 mg/kg, p.o.) once daily for 6 weeks. Wistar rats were used as normotensive controls. After 6-week treatment, voiding functions were estimated by metabolic cages (dark- and light-cycle separately) and cystometric studies. Furthermore, the bladder blood flow (BBF) was measured employing the hydrogen clearance method. SHRs showed significant increases in micturition frequency, and decreases in BBF and single voided volume in both metabolic cages and cystometrograms compared to the Wistar group. Treatment with silodosin normalized the decreased BBF, and treatment with naftopidil increased the BBF in a dose-dependent manner in the SHR group. Although treatment with silodosin and the high dose of naftopidil significantly inhibited micturition frequency in one day, only treatment with the high dose of naftopidil significantly inhibited micturition frequency and urine production in the light-cycle compared to the non-treated SHRs. Although treatment with silodosin and the high dose of naftopidil significantly increased single voided volume, only treatment with silodosin significantly inhibited non-voiding contractions in the cystometrgrams. Our data suggest that both silodosin and naftopidil improve hypertension-related bladder dysfunction in the SHR, and naftopidil but not silodosin improves urinary frequency in the light-cycle due to inhibition of urine production.

Hyperkalemia and cardiac arrest in patient during transurethral resection of the prostate

The transurethral resection of prostate (TURP) syndrome is caused by excessive absorption of hypotonic bladder irrigating fluid.Excessive absorption of hypotonic fluid can result in hyponatremia,hyposmolality,water intoxication,respiratory and circulatory failure,etc.This case report described the management of cardiac arrest after TURP in a 73-years-old man with benign prostatic hyperplasia and bladder tumors. The patient developed ventricular fibrillation and cardiac arrest might be due to intraoperative hyperkalemia and hyponatremia.After cardiopulmonary-cerebral resuscitation and advanced life support,the patient was stabilized.Further analysis of the pathophysiological changes of TURP syndrome will be needed for its prevention and treatment Key words: Transurethral resection of prostate; General anesthesia; Hyperkalemia; Hyponatremia; Cardiac arrest

Resistive Index of Prostate Capsular Arteries: A Newly Identified Parameter to Diagnose and Assess Bladder Outlet Obstruction in Patients with Benign Prostatic Hyperplasia

We evaluated the association of the resistive index of the prostate capsular arteries and bladder outlet obstruction severity in men with benign prostatic hyperplasia. A total of 74 patients histologically diagnosed with benign prostatic hyperplasia were ultimately enrolled in this prospective study. Urodynamics were performed by a urologist to determine bladder outlet obstruction. Baseline parameters measured in patients with benign prostatic hyperplasia were the prostate capsular artery resistive index, International Prostate Symptom Score, quality of life score, total prostate and transition zone volume, and the transition zone index. ROC curves were produced to calculate the ROC AUC and evaluate the diagnostic performance of the prostate capsular artery resistive index, International Prostate Symptom Score, obstructive symptoms, total prostate and transition zone volume, and the transition zone index for bladder outlet obstruction. Significant difference between patients with and without bladder outlet obstruction was observed in the resistive index, which showed the highest coefficient with the degree of obstruction (r = 0.712, p <0.0001). At a cutoff of 0.69 the resistive index distinguished patients with and without bladder outlet obstruction with 78% sensitivity and 86.4% specificity. The prostate capsular artery resistive index had the maximum AUC of 0.823. The prostate capsular artery resistive index is significantly higher in patients with benign prostatic hyperplasia related bladder outlet obstruction than in those without such obstruction. The resistive index might serve as a novel indicator to diagnose and assess bladder outlet obstruction in patients with benign prostatic hyperplasia.

Detection of hyaluronidase RNA and activity in urine of schistosomal and non-schistosomal bladder cancer

Diagnosis of bladder cancer is done by cystoscopy and cytology. In the last decade, many urine-based tests for bladder cancer have been developed and tested in different populations. Hence, it was relevant to assess the diagnostic significance of urinary hyaluronidase RNA and its enzyme activity in bladder cancer. Seventy patients with bladder cancer, 56 patients with benign bladder lesions, and 49 healthy controls were enrolled in this study. Voided urine samples from all subjects were used for estimation of urinary HAase RNA by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) and determination of its enzymatic activity by zymography. There was a significant difference in the mean ranks and positivity rates of HAase RNA expression (P < 0.01) and its enzymatic activity among the three investigated groups: malignant, benign, and normal (P < 0.01). In detecting bladder cancer, the sensitivity of urine cytology (42.83 %) was improved to 100 % when combined with urinary Hyal RNA or Hyal enzyme activity. Detection of urinary Hyal RNA and its enzyme activity is promising noninvasive tests with high sensitivities and specificities for detection of bladder cancer.

P-0155 Incidental Carcinoma of Gallbladder: Audit of Experience From a Tertiary Care Cancer Centre in North India

ABSTRACT Introduction Laparoscopic cholecystectomy is the most common surgery performed for symptomatic benign gall bladder disease. Carcinoma may be detected after histological examination of simple cholecystectomy (laparoscopic / open) (called incidental carcinoma of gall bladder, ICGB). The incidence of ICGB ranges from 0.3 to 2.9%. According to literature, the incidence of carcinoma gall bladder is high in northern India and laparoscopic or open cholecystectomy is done widely in patients with benign gall bladder disease. There is limited literature regarding management and outcomes of ICGB. We performed an audit of patients undergoing exploration for radical cholecystectomy in patients with ICGB. Methods A retrospective review was performed of the data from the prospective maintained computerized database of all patients who have undergone simple cholecystectomy elsewhere and presented to the department of Surgical Oncology with ICGB from November 1995 to January 2009 for completion radical cholecystectomy. Statistical analysis was done using SPSS software. Descriptive analyses of the data were done. Chi-square test was used to compare proportions of categorical covariates. A p-value of 0.05 was considered significant. Kaplan-Meier analysis was done for survival analysis. Results Forty-two patients with incidental CGB were re-explored with plan for completion radical cholecystectomy. Eighteen (43%) and 24 (57%) patients had undergone laparoscopic or open simple cholecystectomy for benign gallbladder disease respectively. The median age was 46 years (range 25 to 69 years). M:F ratio was 1:6. The median time of re-exploration after initial surgery was 65 days (range of 19 to 145 days). Twenty-four (57%) patients were operable and underwent radical cholecystectomy. Eighteen (43%) patients were found inoperable due to locally advanced unresectable or metastatic disease. Thirteen patients with high-risk histopathological features received adjuvant concurrent chemoradiotherapy. Among the 24 patients who could undergo a completion radical cholecystectomy, 11 developed recurrence over a median period of 11 months. Finally 13 (31%) patients were alive and disease free at median follow-up time of 14 months (range 8-86 months).Those patients explored before 3 months had a decreased chance of having inoperable disease than those explored after 3 months (33% vs 67%, p Conclusion Incidental carcinoma of gall bladder is supposed to be associated with good prognosis group in-view-of early stage at detection. However, our experience has shown that approximately half of ICGB were operable at definitive surgical exploration and 1/3rd of those undergo exploration benefit in the long-term. The reason for this high recurrence may be due to spillage of bile and tumor during laparoscopic simple cholecystectomy, increased chances of locally advanced disease after a delayed re-exploration and highly aggressive disease. Re-exploration before 3 months have a better operability and recurrence free survival rate than after 3 months.

Magic angle spinning NMR spectroscopic metabolic profiling of gall bladder tissues for differentiating malignant from benign disease

Gall bladder tissue specimens obtained from 112 patients were examined by high resolution magic angle spinning (HR-MAS) NMR spectroscopy. Fifty one metabolites were identified by combination of one and two-dimensional NMR spectra. To our knowledge, this is the first report on metabolic profiling of gall bladder tissues using HR-MAS NMR spectroscopy. Metabolic profiles were evaluated for differentiation between benign Chronic Cholecystitis (CC, n = 66) and xantho-granulomatous cholecystitis (XGC, n = 21) and malignant gall bladder cancer (GBC, n = 25). Increase in choline containing compounds, amino acids, taurine, nucleotides and lactate as common metabolites were observed in malignant tissues whereas lipid content was found low as compared to benign tissues. Principal component analysis obtained from the NMR data showed clear distinction between CC and GBC tissue specimens; however, 27 % of XGC tissues were classified with GBC. The partial least square discriminant analysis (PLS-DA) multivariate analysis between benign (CC, XGC) and malignant (GBC) on the training data set (CC; n = 51, XGC; n = 15, GBC; n = 19 tissues specimens) provided 100 % sensitivity and 94.12 % specificity. This PLS-DA model when executed on the spectra of unknown tissue specimens (CC; n = 15, XGC; n = 6, GBC; n = 6) classified them into the three histological categories with more than 95 % of diagnostic accuracy. Non-invasive in vivo MRS technique may be used in future to differentiate between benign (CC and XGC) and malignant (GBC) gall bladder diseases.

Expression and Potential Clinical Significance of Urothelial Cytodifferentiation Markers in the Exstrophic Bladder

We characterize the urothelium from patients with classic bladder exstrophy-epispadias complex for the expression of proteins associated with urothelial differentiation, and discuss a potential impact of urothelial phenotype on the structural and functional properties of the bladder template following bladder closure. From 2005 to 2010 bladder biopsies from 32 infants with bladder exstrophy-epispadias complex obtained at primary bladder closure were collected. After histological assessment immunochemistry was used to investigate the expression of uroplakin IIIa, cytokeratin differentiation restricted antigens CK13 and CK20, and tight junction protein claudin 4. Overall tissue morphology showed gross alterations with inflammatory, proliferative and metaplastic changes in most specimens. Sections of intact epithelium were present in 78% of biopsies. With respect to urothelial phenotype, CK13 was expressed in all specimens, whereas UPIIIa and CK20 were absent in 76% of the tissues examined. Of the biopsies 52% revealed an irregular expression pattern of tight junction protein Cl-4. This is the first study to our knowledge to characterize the urothelium from infants with bladder exstrophy-epispadias complex for the expression of urothelial differentiation associated antigens. Our findings suggest urothelial differentiation changes in a majority of exstrophic bladders, at least at primary bladder closure. Although the underlying etiology remains to be established, abnormal urothelial differentiation may result in a dysfunctional urothelial barrier with implications for the structural and functional properties of the bladder template. Despite the study limitations, our preliminary findings provide a platform for further investigation of the significance of the urothelium for the exstrophic bladder.

Outpatient Simultaneous Treatment of Benign Prostatic Hyperplasia and Bladder Lithiasis with GreenLight™ and Holmium Laser

To evaluate our experience in the combined treatment of benign prostatic hyperplasia (BPH) and bladder lithiasis with GreenLight(™) and holmium laser, respectively, on an outpatient basis. From August 2006 to May 2009, 20 patients with prostatic hyperplasia and bladder lithiasis were treated. First, the lithiasis was treated, and then the GreenLight laser vaporization of the prostate was performed, both at the same surgical time and under general anesthesia. Discharge of patients was scheduled 3 to 4 hours after completion of the procedure. The procedure was simultaneously completed in 19 of 20 patients. The mean stone size was 2.3 (1-4) cm, and the mean prostate volume was 56.5 (30-108) cc. The mean operating time was 115 (50-190) minutes. There was a significant percentage change in maximum flow, postmicturition residual volume, and International Prostate Symptom Score, which were 129.5%, 88.4%, and 68.3%, respectively. All patients were stone free after the procedure. The combined transurethral treatment of BPH associated with bladder lithiasis by means of GreenLight laser vaporization and holmium laser lithotripsy on an outpatient basis can be performed safely and yields excellent results.

Clinical results between single incision laparoscopic cholecystectomy and conventional 3-port laparoscopic cholecystectomy: prospective case-matched analysis in single institution

PurposeThe aim of our study was to compare single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) with respect to clinical outcomes.MethodsPatients with less than a 28 body mass index (BMI) and a benign gall bladder disease were enrolled in this study. From January 2011 to February 2012, 30 consecutive patients who underwent SILC were compared with 30 patients who underwent CLC during the same period. In this study, all operations were performed by one surgeon. In each group, patient characteristics and perioperative data were collected.ResultsThere was no significant difference in the preoperative characteristics. There was no significant difference in the postoperative laboratory result (alanine aminotransferase, aspartate aminotransferase, and alanine aminotransferase), number of conversion and complication cases, and length of hospital stay. The operation time was significantly longer in the SILC group (78.5 ± 17.8 minutes in SILC group vs. 34.9 ± 5.75 minutes in CLC group, P < 0.0001). The total nonsteroidal antiinflammatory drug usage during perioperative period showed significantly higher in SILC groups (162 ± 51 mg in the SILC group vs. 138 ± 30 mg in the CLC group), but there was no statistically significant difference in opioid usage between two groups. The postoperative pain score was significantly higher in the SILC group at second, third, and tenth postoperative day. Satisfaction of postoperative wound showed superiority in SILC group.ConclusionSILC seems to be an acceptable alternative to CLC with acceptable results. However, it is not enough to propose any real benefits of SILC when compared with CLC in terms of operation time and postoperative pain.

Estimating the quality-of-life impact and cost-effectiveness of alpha-blocker and anti-muscarinic combination treatment in men with lower urinary tract symptoms related to benign prostatic hyperplasia and overactive bladder

Objective:A 12-week clinical trial (TIMES) demonstrated that therapy with tolterodine extended release (TOL) + tamsulosin (TAM) provides clinical benefits vs TOL or TAM monotherapy or placebo (PBO) in men with lower urinary tract symptoms (LUTS) including overactive bladder (OAB). The present analysis estimated the costs and quality-adjusted life-years (QALYs) associated with these therapies from the perspective of the UK healthcare system.Methods:TIMES cohorts receiving TOL, TAM, TOL + TAM, or PBO were followed from therapy initiation to 12 weeks. A decision-tree model was used to extrapolate the 12-week results to 1 year (including need for surgery owing to treatment failure at 12 weeks) and to track patients’ outcomes (symptoms, utility, and costs). Because TIMES did not include costs and QALYs, data from the EpiLUTS epidemiologic survey (12,796 males) were used to model a mathematical relationship between LUTS (daytime and nocturnal frequency, urgency episodes, urgency urinary incontinence episodes, and International Prostate Symptom Score [IPSS]), quality-of-life, and utility. This was used to convert improvements in TIMES patients’ LUTS into utility scores and QALYs. The model included drug and surgery procedure costs and hospital length of stay.Results:Incremental QALYs of TOL + TAM vs PBO, TAM, and TOL were 0.042, 0.021, and 0.013, and corresponding incremental costs were £189, £223, and −£70, respectively, resulting in cost-utility ratios for TOL + TAM of £4508/QALY gained compared with PBO and £10,381/QALY gained compared with TAM. TOL + TAM combination therapy was both more effective and cost-saving compared with TOL. Univariate sensitivity analyses showed that patient utility was most responsive to changes in drug efficacy on IPSS and urgency episodes. Changing the percentage of patients undergoing surgery did not substantially affect model outcomes. The main limitation of the study was that the relation between LUTS and patient utility was based on an indirect association.Conclusions:TOL + TAM combination therapy appears to be cost-effective compared with TOL or TAM monotherapy or PBO in male patients with LUTS.

Metabolomic profiling reveals potential markers and bioprocesses altered in bladder cancer progression.

Although alterations in xenobiotic metabolism are considered causal in the development of bladder cancer, the precise mechanisms involved are poorly understood. In this study, we used high-throughput mass spectrometry to measure over 2,000 compounds in 58 clinical specimens, identifying 35 metabolites which exhibited significant changes in bladder cancer. This metabolic signature distinguished both normal and benign bladder from bladder cancer. Exploratory analyses of this metabolomic signature in urine showed promise in distinguishing bladder cancer from controls and also nonmuscle from muscle-invasive bladder cancer. Subsequent enrichment-based bioprocess mapping revealed alterations in phase I/II metabolism and suggested a possible role for DNA methylation in perturbing xenobiotic metabolism in bladder cancer. In particular, we validated tumor-associated hypermethylation in the cytochrome P450 1A1 (CYP1A1) and cytochrome P450 1B1 (CYP1B1) promoters of bladder cancer tissues by bisulfite sequence analysis and methylation-specific PCR and also by in vitro treatment of T-24 bladder cancer cell line with the DNA demethylating agent 5-aza-2'-deoxycytidine. Furthermore, we showed that expression of CYP1A1 and CYP1B1 was reduced significantly in an independent cohort of bladder cancer specimens compared with matched benign adjacent tissues. In summary, our findings identified candidate diagnostic and prognostic markers and highlighted mechanisms associated with the silencing of xenobiotic metabolism. The metabolomic signature we describe offers potential as a urinary biomarker for early detection and staging of bladder cancer, highlighting the utility of evaluating metabolomic profiles of cancer to gain insights into bioprocesses perturbed during tumor development and progression.

Evaluation of bladder microvasculature with high-resolution photoacoustic imaging

We explored the potential of an emerging laser-based technology, photoacoustic imaging (PAI), for bladder cancer diagnosis through high-resolution imaging of microvasculature in the bladder tissues. Imaging results from ex vivo canine bladders demonstrated the excellent ability of PAI in mapping three-dimensional microvasculature in optically scattering bladder tissues. By comparing the results from human bladder specimens affected by cancer to those from the normal control, the feasibility of PAI to differentiate malignant from benign bladder tissues was also explored. The distinctive morphometric characteristics of tumor microvasculature can be seen in the images from cancer samples, suggesting that PAI may allow in vivo assessment of neoangiogenesis that is closely associated with bladder cancer generation and progression. By presenting subsurface morphological and physiological information in bladder tissues, PAI, when performed in a similar way as in conventional endoscopy, provides an opportunity for improved diagnosis, staging, and treatment guidance of bladder cancer.

Diagnostic value of urinary CK-20 RNA and VEGF in bladder cancer

The present study was carried out to evaluate the diagnostic value of urinary cytokeratin 20 (CK-20) RNA and vascular endothelial growth factor (VEGF) in comparison with urine cytology in the detection of bladder cancer. This study included 80 patients with bladder cancer, 20 patients with bilharzial bladder lesions and 20 normal volunteers as control group. CK-20 RNA in urine sediment was detected by reverse transcription polymerase chain reaction (RT-PCR). VEGF in urine supernatant was detected by ELISA and confirmed by western blotting (WB). The median value of VEGF and positivity rates of both VEGF and CK-20 in bladder cancer group was significantly higher as compared to benign bladder lesions group and normal control group. There was no significant association between the postivity rates of CK-20 and VEGF with any of the Clinicopathological factors except a significant positive association between VEGF positivity and clinical stage. The overall sensitivity, specificity, positive predictive value, negative predictive value were; 66.25%, 92.5%, 94.46%, 57.81% for VEGF, 65.2%, 70%, 80.65%, This article was taken from Ph.D thesis submitted by Ekram Fadl Al-Eryani To: Faculty of Medicine-Ain Shams University. 2005 48.28% for voided urine cytology, and 83.7%, 100%, 100%, 75.47% for CK-20 respectively. Combined sensitivity of cytology, VEGF and CK-20 RNA reached (96.25%) and was higher than the combined sensitivity of cytology and VEGF (90%), or cytology and CK-20 RNA (92.5%), or VEGF and CK-20 (91.25%). These results indicate that VEGF can be quantitively measured in urine of bladder cancer patients, and its combined use with cytology increases its sensitivity.Keywords: Bilharziasis; VEGF; Cytology; Bladder cancer; CK-20

A New Index of Voiding Dysfunction in Men with Benign Prostatic Hyperplasia Undergoing Transurethral Resection of The Prostate Adds Superior Information to the Traditional Maximum Flow Rate (Qmax)

Introduction: To compare Q_max and a new index of voiding dysfunction (D) obtained from free flow (FF) and intubated flow (IF) in men before and after trans-urethral resection of prostate (TURP). Material and Methods: Preoperative FF and IF of benign prostatic hyperplasia patients with bladder outlet obstruction were studied for Q_max and D, and compared to a series of post-TURP FF in the same patients obtained at interval follow-ups. Analysis was done in a blinded fashion. D was computed with the VBN® software. Results: From 24 fully studied patients, preoperative D values were similar (p = 0.61) for FF (25.6 ± 7.4) and IF (26.8 ± 7.1). Postoperatively, D values (9.6 ± 8.6) dropped (p = 0.001) and were more stable than Q_max. Range dispersion between D and Q_max for two successive FF postoperatively in a same patient was 4 times larger for Q_max over D. Conclusion: D values from FF or IF were similar preoperatively but markedly reduced after TURP. This more stable index compared to Q_max may offer an alternative approach to gauge the voiding performance of a symptomatic patient with benign prostatic hyperplasia and bladder outlet obstruction.

Symptom-based diagnosis of overactive bladder: an overview

The current definition of overactive bladder (OAB) is "urgency, with or without urge incontinence, usually with frequency and nocturia in the absence of an underlying metabolic or pathologic condition." Urgency, in turn, is defined as a "sudden, compelling desire to pass urine that is difficult to defer." While these definitions provide the framework for making a clinical diagnosis of OAB, they rely on subjective assessment of the symptoms by the patient. As well, the symptoms of OAB can be similar to those seen in other conditions, such as urinary tract infection, benign prostatic enlargement and bladder cancer. These other potential diagnoses should be ruled out in a noninvasive manner before making a diagnosis of OAB.