Bladder Wall Research Articles

Bladder-sparing therapy in a case report of huge muscle-invasive bladder IMT treated with 1470 nm diode laser en bloc resection followed by laparoscopic partial cystectomy

BackgroundBladder inflammatory myofibroblastic tumor (IMT) is a rare intermediate malignancy. Muscle-invasive bladder IMT is associated with a high risk of recurrence and metastasis, and bladder-sparing treatments for this condition are still under exploration. This case aims to evaluate the therapeutic efficacy of 1470 nm diode laser transurethral en bloc resection (ERBT) followed by laparoscopic partial cystectomy in the treatment of muscle-invasive bladder IMT.Methods and resultsA 23-year-old male patient presented with painless terminal gross hematuria and was treated at Shandong Provincial Hospital of Shandong First Medical University. Computed tomography urography (CTU) and magnetic resonance imaging (MRI) identified a large tumor on the anterior bladder wall with muscle layer invasion, measuring approximately 5.0 × 3.9 × 4.3 cm. The patient underwent 1470 nm laser ERBT, followed by laparoscopic partial cystectomy 35 days later. Pathological examination following 1470 nm laser resection confirmed the diagnosis of an IMT with malignant potential, showing anaplastic lymphoma kinase (ALK) positivity, a Ki-67 index of 20% in hotspot regions, and ALK gene rearrangement detected by fluorescence in situ hybridization (FISH). Pathology after the secondary laparoscopic partial cystectomy showed tumor invasion into the superficial muscle layer, with negative margins at the resection site. MRI and cystoscopy showed no recurrence during 1 year follow-up.ConclusionThis case presents a patient with a huge muscle-invasive bladder IMT who received bladder-sparing therapy through 1470 nm diode laser ERBT followed by laparoscopic partial cystectomy. During subsequent follow-ups, the patient showed good recovery with no signs of recurrence, providing a promising treatment concept for bladder-sparing therapy in muscle-invasive bladder IMT.

Pre-operative Difficulty Assessment of Elective Laparoscopic Cholecystectomy: Validation of a Scoring System

Laparoscopic cholecystectomy (LC) is performed all over the world, which is now considered as the gold standard procedure for management of cholelithiasis. Despite its safety standard, sometimes surgeons encounter various difficulties during this surgical procedure. A prospective, observational study was conducted in the Department of Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh, from December 2018 to June 2019, to identify various risk factors and their correlations with likely difficulty in patients admitted for elective laparoscopic cholecystectomy. All the patients were admitted before surgery and routine preoperative procedures were done. The difficulty was predicted by a scoring system that included clinical, biochemical and sonological indicators with a maximum score of 25 and those were compared with per operative findings. A total of 200 individuals were assessed and analyzed. Age>50, BMI >30, history of acute attack, prolonged symptom duration, and previous abdominal surgery showed a statistically significant predictive association. Biochemical predictors also showed a similar trend with elevated WBC, total bilirubin, ALT, AST, and ALP. Radiologically, gall bladder wall thickness, pericholecystic collection, impacted stone, and fibrosed gall bladder were observed as significant factors. A preoperative score £ 5 provided easy dissection, less operating time, and a good outcome while a score of 6 or more was indicative of difficult laparoscopic cholecystectomy. Preoperative scoring and risk stratification can be used to predict difficult laparoscopic cholecystectomy. High-risk patients may be informed beforehand regarding the possibility of conversion to open surgery. Surgeons and hospital administration also may have to schedule the operating time and team appropriately. It also helps surgeons to be aware of probable complications in high-risk patients based on preoperative scoring. Mugda Med Coll J. 2024; 7(2): 102-107

Focal or diffuse bladder wall thickness on bladder computed tomography indicates more severe bladder wall inflammation in patients with interstitial cystitis.

The classification of different phenotypes of interstitial cystitis/ bladder pain syndrome (IC/BPS) provides different pathophysiology and associated treatment strategies. Most clinical studies have focused on bladder symptoms and cystoscopic findings. This study analyzed bladder wall thickness (BWT) and compared bladder conditions, urinary biomarkers, and histopathology among patients of IC/BPS with different BWT. A total of 182 patients with cystoscopy-proven IC/BPS underwent abdominal computed tomography (CT) before intervention. The BWT on CT was classified as smooth, focal thickness, and diffuse thickness. Clinical symptoms, urodynamic findings, cystoscopic characteristics, presence of Hunner's lesion, urinary biomarkers, and bladder histopathology were compared among the three subgroups. Among the patients, 85 had smooth, 64 had focal, and 33 had diffuse BWT. There was a significant trend of patients with focal and diffuse BWT being significantly older with higher symptom scores, smaller bladder capacity, higher grade of glomerulations, and incidence of Hunner's IC. Pathological findings revealed that patients with diffused BWT, followed by those with focal thickness, had the greatest uroepithelial cell denudation and plasma cell infiltration. Patients with diffuse BWT has higher rate of inflammatory cell infiltration, nerve bundle hyperplasia, and granulation tissue. The urinary levels of tumor necrosis factor-alpha and oxidative stress biomarkers in IC/BPS patients with different BWT were significantly higher than those in the controls. BWT in CT scans can reflect chronic inflammation of the bladder wall in patients with IC/BPS, which is clinically relevant for the diagnosis and treatment of IC subtypes.

Bladder Mucosa Harvested with Holmium Laser for Treatment of Urethral Strictures: Does the Graft Have its Tissue Integrity Preserved?

The aim of this study is to evaluate the integrity and the microstructural characteristics of the bladder mucosa graft harvested using a minimally invasive technique with the Holmium laser (Ho-YAG) for the treatment of urethral stricture. We studied patients with urethral strictures greater than 2 cm, with a urethroplasty indication. The patients were submitted to urethroplasty with the dorsal onlay reconstruction by a single surgeon. After the urethral dissection we use the Ho-YAG laser with a 550µg end fire laser fiber to obtain a fragment of bladder mucosa for the graft confection. A fragment of the bladder mucosa was fixed in a 10% buffered formalin to HE and Masson's trichrome analysis for the tissue integrity. Five sections were stained, and five fields of each section were selected. We used the Image J software, version 1.46r, loaded with its own plug-in to determine tissue integrity. We studied 11 patients (Mean age= 47.64); 9 (81.8%) with bulbar stricture and 2 (18.2%) with penile stricture (mean size = 4.63mm). The mean of bladder graft size was 53.64mm and the meantime of harvesting was 47.63 minutes. The histological study of the bladder wall graft showed an organization in accordance with normal standards, with the presence of an intact urothelium in the bladder graft. The submucosal layer is preserved, joining the detrusor to the urothelium and the collagen and elastic fibers are well organized. The graft harvested from the bladder uroepithelium using Ho-YAG has its histological integrity preserved, which makes this technique a viable option for reconstructive surgery. However, more studies are needed to establish its long-term efficacy and safety of this new technique.

The value of magnetic resonance imaging in predicting vesicovaginal fistula in cervical cancer with bladder invasion treated with definitive chemoradiotherapy.

To assess the predictive value of magnetic resonance imaging for vesicovaginal fistula development in cervical cancer patients with bladder invasion treated with definitive chemoradiotherapy. A retrospective review was conducted of the medical records of 43 cervical cancer patients with bladder invasion between 1999 and 2015. Bladder invasion was confirmed through magnetic resonance imaging (scores ≥3) or cystoscopic findings, with or without biopsy. Treatment included weekly cisplatin plus pelvic external beam radiotherapy, with extended-field radiotherapy. After external beam radiotherapy, patients received intracavitary brachytherapy or an external beam boost. Vesicovaginal fistula was diagnosed based on reported symptoms and relevant imaging tests during follow-up. The median follow-up period was 67.4months. The 5-year disease-free and overall survival rates were 66.4%, and 71.8%, respectively. Vesicovaginal fistula developed in five patients (12.8%), with three cases occurring within 1year post-treatment and two others at 16.7 and 64.5months, respectively. In multivariate analysis, the height of bladder wall involvement on magnetic resonance imaging was the only significant predictor of vesicovaginal fistula (p=0.041). Specifically, Vesicovaginal fistula occurred in 25% of cases when bladder wall involvement was ≥20.3mm, in 50% of cases at ≥31.1mm, and in 75% of cases at ≥41mm. The height of bladder wall involvement on magnetic resonance imaging is a significant predictor of vesicovaginal fistula formation in cervical cancer patients with bladder invasion. This finding can aid clinicians in better predicting this complication, improving patient counseling and management strategies.

Urinary Continence After Robot-Assisted Laparoscopic Radical Prostatectomy Using the Peritoneal Fixation Technique.

The Retzius-sparing technique for prostate cancer has shown favorable continence recovery outcomes. Magnetic resonance imaging after Retzius-sparing showed that the bladder anterior wall is widely connected to the abdominal wall, which contributes to urinary continence. We aimed to evaluate whether the Peritoneal Fixation technique, which involves suturing the anterior bladder wall onto the abdominal wall above the pubic bone, contributes to the recovery of urinary continence. Patients who underwent robot-assisted laparoscopic radical prostatectomy between May and September 2023 were included in the study. We investigated urinary incontinence on the day of catheter removal and 1 month postoperatively. The posterior urethral angle was evaluated at rest and under abdominal pressure. A total of 54 patients who underwent the Peritoneal Fixation technique (n = 27) and conventional surgery (n = 27) were included. The continence acquisition rate on the day after catheter removal was significantly higher in the Peritoneal Fixation group (40.7%) than in the conventional group (7.4%) (p < 0.05). At 1 month postoperatively, the Peritoneal Fixation group showed favorable results, with a continence rate of 44.4% compared with 29.6% in the conventional group (p = 0.26). The change in the posterior urethral angle at rest and during abdominal pressure significantly differed between the Peritoneal Fixation and conventional groups (-3.0° vs. 2.7°; p < 0.05), indicating that the urethra is being pushed from the rectal side in the Peritoneal Fixation group. The use of the Peritoneal Fixation technique for prostate cancer suggests the potential for achieving favorable urinary continence outcomes.

Renal scarring in children with febrile urinary tract infection.

The authors aim to evaluate characteristics of children with fUTI and results of renal bladder ultrasonography (RBUS) and late dimercaptosuccinicacid (DMSA) scan. This study is designed as retrospective analysis of RBUS and DMSA reports of children with fUTI. Age, gender, number of fUTI, presence of constipation and vesicouretheral reflux (VUR) were recorded. The study included 160 children with fUTI with a median age of 7 years (6 months 18 years old). The majority of children in this study were girls (86.3 %), older than 60 months (73.1 %) and had one episode of fUTI. The recurrence rates of UTI were similar in both girls and boys. The total rate of constipation was 21.9 %. The rate of renal scarring on DMSA was 16.9 %. The rates of renal scarring were similar at three age groups and both genders. The rate of renal scarring was higher in children with recurrent UTI compared to those with one episode of fUTI (26.4 % and 12.5 %, respectively; p = 0.04). The rate of constipation in children with renal scarring and normal DMSA was similar (p = 0.07). The rate of trabeculation and thick bladder wall was higher in children with renal scarring at DMSA than children with no renal scarring (p = 0.03). The present study demonstrated that 16.9 % of children with fUTI had renal scarring. The rates of renal scarring were similar in both gender and age groups. Children with recurrent UTI and abnormal bladder results at RBUS had higher rates of renal scarring.

Value of comprehensive evaluation of bladder structure and function in children by multi-modal ultrasound

To comprehensively evaluate the structure and function of the bladder wall in children using multi-modal ultrasound (MMU). A total of 110 children without urinary symptoms admitted to the First Affiliated Hospital of Zhengzhou University from January 2022 to June 2023 were included prospectively. MMU was performed and the vesical volume (VV), bladder wall thickness (BWT), shear wave velocity (SWV) of the anterior wall, resistance index (RI) and vascularization index (VI) were measured in the filled and emptied bladder respectively, and the ultrasound bladder compliance (UBC) was also calculated. The differences in MMU parameters in children among different bladder states, age groups and sexes and the correlation between age and different MMU parameters were analyzed. The age of 110 children was (6.4±3.5) years, of which 60 were boys (54.5%). The VV [127.00 (79.00, 219.50) vs 6.65 (5.10, 9.60) ml, P<0.001] and SWV [(2.25±0.36) vs (1.54±0.20) m/s, P<0.001] of filling condition were higher than that of emptying condition, while BWT [(2.52±0.25) vs (6.72±0.74) mm, P<0.001] and VI [(4.36±0.52)% vs (8.15±1.75) %, P<0.001] were lower than that of emptying condition. There were no significant differences in VV, BWT, SWV, RI, VI and UBC between boys and girls under either bladder emptying or filling conditions (all P>0.05). BWT in emptying condition, VV and BWT in filling condition all increased with age (r was 0.706, 0.891 and 0.298, respectively, and all P<0.05). MMU in children contributes to the comprehensive evaluation of bladder wall, and the influence of age and bladder filling state should be considered when evaluating MMU parameters.

Fluid intake and recurrence and progression risk of patients with non-muscle-invasive bladder cancer.

To evaluate the association of pre- and post-diagnosis fluid intake with non-muscle-invasive bladder cancer (NMIBC) recurrence and progression risk. Data were used from the multicentre prospective cohort study UroLife. Participants reported pre-diagnosis fluid intake at 6 weeks (food frequency questionnaire [FFQ]) (n = 1322) and post-diagnosis fluid intake at 3 and 15 months (FFQ and 4-day 24-h fluid diaries) (n = 1275) after diagnosis. Multivariable proportional hazard regression models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of fluid intake with risk of first and multiple recurrence(s) and progression. During a median overall follow-up of 4.6 years, 474 patients had one or more recurrence and 142 had progression. A higher first recurrence risk was observed for patients with the highest pre-diagnosis fluid intakes (≥2300 vs 1500-1900 mL/day: HR 1.38, 95% CI 1.07-1.79), but not for those with the highest post-diagnosis fluid intakes. HRs were similar for multiple recurrence risk. For progression, each 150 mL/day increase in both pre- and post-diagnosis fluid intake was consistently associated with an increased risk (post-diagnosis [3 months] FFQ-based: HR 1.05, 95% CI 1.01-1.09 and diary-based: HR 1.04, 95% CI 0.99-1.09). High fluid intakes may be associated with higher NMIBC recurrence and especially progression risk. These findings lack a clear explanation but may be related to extensive expansion of the bladder wall or urinary symptoms. Further research is warranted. Meanwhile, these findings do not support recommending high(er) fluid intakes to patients with NMIBC to decrease their recurrence or progression risk.

Advancements in the management of overactive bladder in women using nano-botulinum toxin type A: A narrative review

Abstract Intravesical injections of botulinum toxin type A (BTX-A) are effective for treating refractory overactive bladder (OAB) in women. However, the adverse effects linked to the injections, such as hematuria, pain, and infection, and need for repeated injections can lower patient compliance and make the treatment inconvenient. Hence, urologists are actively pursuing less invasive and more convenient methods for the intravesical delivery of BTX-A. Advances in nanotechnology have facilitated noninvasive intravesical drug delivery. Currently, liposomes, hydrogels, nanoparticles, and many other forms of carriers can be used to enhance bladder wall permeability. This facilitates the entry of BTX-A into the bladder wall, allowing it to exert its effects. In this review, the feasibility and efficacy of liposomes, thermosensitive hydrogels, and hyaluronic acid-phosphatidylethanolamine for the treatment of OAB in women are discussed along with recent animal experiments on the use of nanotechnology-delivered BTX-A for the treatment of OAB in female rat models. Although the clinical efficacy of nanocarrier-encapsulated BTX-A for the treatment of OAB in women has not yet matched that of direct urethral muscle injection of BTX-A, improvements in certain symptoms indicate the potential of bladder instillation of nanocarrier-encapsulated BTX-A for future clinical applications. Consequently, further research on nanomaterials is warranted to advance the development of nanocarriers for the noninvasive delivery of BTX-A in the bladder.

The effect of combined use of oxybutynin and fulguration in children with PUV: experience in a tertiary center in Bangladesh

Aims: Posterior Urethral Valve (PUV) is a common congenital urethral obstruction leading to significant morbidity. Despite successful fulguration of posterior urethral valve, the bladder dysfunction persists in most of the cases. Oxybutynin, an anticholinergic drug is commonly used to manage this bladder dysfunction. This study aimed to assess the impact of oxybutynin on bladder and urinary tract function in children with valve fulguration. Methods: A retrospective observational study was conducted on 41 children who underwent PUV fulguration at a tertiary care center in Bangladesh between 2020 and 2023. All subjects received oxybutynin for at least 6 months post-fulguration. Bladder wall morphology, hydronephrosis, vesicoureteral reflux (VUR), and post void residues (PVR) were assessed. Side effects of oxybutynin were also documented. Results: All patients had bilateral hydroureteronephrosis (HUN), except one, who was with unilateral HUN during primary diagnosis. Complete resolution of bilateral HUN was seen in Renal USG 14 patients at 6 months post fulguration. Correction of VUR documented in 13 units out of 32 units. Mean serum creatinine decreased to 0.52 ± 0.22from 0.73 ± 0.52 within 6 months of fulguration. Four patients exhibited significant PVR, leading to clean intermittent catheterization (CIC) initiation. Conclusion: Combined with PUV fulguration and oxybutynin therapy appears to be effective in improving bladder function. Further prospective studies incorporating urodynamic evaluations are warranted to validate these findings.

Clinical Translation of a Dual-Integrin αvβ3- and CD13-Targeting PET Tracer.

Angiogenesis is essential in the development and progression of tumors. This study aimed to investigate the clinical application of 68Ga-labeled heterodimeric peptide (68Ga-HX01) targeting integrin αvβ3 and CD13 in tumor neovascularization. Six healthy volunteers were recruited to study the biodistribution, pharmacokinetics, and radiation of 68Ga-HX01. Twelve patients with various malignancies were enrolled to seek the preliminary clinical value of 68Ga-HX01. In healthy volunteers, SUVs of each major organ on 68Ga-HX01 PET were measured. The clinical data, lesion numbers, and uptake were recorded in patients. The integrin αvβ3 and CD13 expression of the resected tumors was checked via immunohistochemistry staining. With a mean injected dose of 167.98 ± 26.32 MBq, 68Ga-HX01 was well tolerated and safe without side effects in 6 healthy volunteers. The radiation absorbed effective dose of 68Ga-HX01 was 1.94 × 10-2 mSv/MBq, and the urinary bladder wall held the highest absorbed effective dose (0.15 ± 5.87 × 10-2 mSv/MBq). In 12 patients with various malignancies, 68Ga-HX01 PET could clearly visualize the lesions from the surrounding tissues. The SUVmax values in tumors were significantly higher than those in the surrounding tissues (P < 0.05). A positive correlation trend between tumor SUVmax and semiquantitative integrin αvβ3 and CD13 expression was determined (P < 0.05). For clinical use, 68Ga-HX01 is safe with low radiation absorbed effective dose. It also indicates the efficiency of dual integrin αvβ3 and CD13-targeting PET radiotracer in tumor diagnosis, which may assist in patient prognosis and selecting eligible patients for antiangiogenic therapy.

Safety, Biodistribution, and Radiation Dosimetry of the 68Ga-Labeled Minigastrin Analog DOTA-MGS5 in Patients with Advanced Medullary Thyroid Cancer and Other Neuroendocrine Tumors.

Several exploratory studies have demonstrated the feasibility of cholecystokinin-2 receptor (CCK2R) targeting in patients with medullary thyroid carcinoma (MTC) and other neuroendocrine tumors (NETs). We report the results of a prospective phase I/IIA pilot study (clinicaltrials.gov NCT06155994) conducted at our center with the 68Ga-labeled peptide analog DOTA-DGlu-Ala-Tyr-Gly-Trp-(N-Me)Nle-Asp-1-Nal-Phe-NH2 (68Ga-DOTA-MGS5). Methods: Six patients with advanced MTC and 6 patients with gastroenteropancreatic and bronchopulmonary NETs confirmed by previous PET/CT imaging with other PET tracers received a single dose of 180 MBq of 68Ga-DOTA-MGS5. The first 6 patients enrolled in the study were included in the dosimetry evaluation, and safety was assessed in all 12 patients. PET/CT imaging was performed at different time points after injection to perform dosimetric calculations and to determine the optimal imaging time window. In addition, blood and urine samples were collected for pharmacokinetic assessments. Results: The administration of 68Ga-DOTA-MGS5 was well tolerated, with minor adverse drug reactions occurring only in 3 patients. 68Ga-DOTA-MGS5 was cleared rapidly from the blood, with less than 21% of the injected activity present in blood 215 ± 10 min after injection. Tracer elimination occurred mainly through the kidneys, with a cumulative urinary excretion greater than 40% 3 h after injection. A high percentage of intact radiopeptide was confirmed in plasma. The highest absorbed dose was found for the urinary bladder wall, the stomach wall, and the kidneys, with an effective dose of 0.023 ± 0.007 mSv/MBq. The time points of 1 and 2 h after injection proved to be optimal for PET/CT imaging. In the 6 patients included in the dosimetry evaluation, local metastasis was confirmed in 2 patients with advanced MTC, whereas only 1 of 4 patients with gastroenteropancreatic NETs was positive in 68Ga-DOTA-MGS5 PET/CT. Conclusion: Besides confirming the safety of administration, within the phase I part of the prospective clinical trial, an acceptable effective whole-body dose, an overall favorable biodistribution, and the feasibility of cholecystokinin-2 receptor imaging could be shown for 68Ga-DOTA-MGS5.

Increased Afferent Nerve Firing Is Correlated With the Detection of Bladder Wall Micromotion in a Perfused Ex-Vivo Porcine Model.

Observable autonomous rhythmic changes in intravesical pressure, termed bladder wall micromotion, is a phenomenon that has been linked to urinary urgency, the key symptom in overactive bladder (OAB). However, the mechanism through which micromotion drives urinary urgency is poorly understood. In addition, micromotion is inherently difficult to study in human urodynamics due to challenges distinguishing it from normal cyclic physiologic processes such as pulse rate, breathing, rectal contractions, and ureteral jetting. Therefore, the goal of this study was to create a reproducible model of micromotion using an ex-vivo perfused porcine bladder, as well as to describe the relationship between micromotion and afferent nerve signaling. Porcine bladders were reanimated using ex-vivo perfusion with a physiologic buffer. The pelvic nerve adjacent to the bladder was dissected, grasped with micro-hook electrodes and electroneurogram (ENG) signals were recorded at 20 kHz. Bladders were catheterized and intravesical pressure measurements were taken using a Laborie XT Urodynamics system. Bladders were filled to a fixed volume of 300 mL and control measurements were recorded. The bladders were then washed with 0.001 M carbachol (CCh) solution and refilled to 300 mL to induce micromotion, which was detected as rhythmic changes in intravesical pressure. ENG amplitude was calculated in μV, and nerve firing rate was calculated as number of spikes above baseline threshold per minute. Micromotion was induced by carbachol in 12/25 (48.4%) of trials as rhythmic changes in intravesical pressure after the instillation of carbachol but not in any control period. A fast Fourier transform (FFT) algorithm showed average peak dominant frequency component amplitude was significantly higher during the carbachol period when compared to the control period (0.47 vs. 0.01 cm-H2O, p < 0.0001). Peak waveform frequency (1.13 vs. 1.54 cycles/min, p > 0.05) did not differ between control and carbachol periods. With regard to afferent nerve signaling, normalized average amplitude (0.66 ± 0.24 vs. 0.05 ± 0.08 μV) and firing rate (0.68 ± 0.28 vs. 0.18 ± 0.22 spike/min) for all bladders was significantly greater in the carbachol period when compared to the control period (p < 0.001). Micromotion can be induced using instillation of carbachol in a perfused ex-vivo porcine bladder. Increased afferent nerve firing is observed during periods of micromotion. Thus, micromotion may drive afferent nerve signaling and may potentially contribute to urinary urgency, detrusor overactivity, and OAB. The development of an experimental ex-vivo porcine model for micromotion provides a reproducible method to study bladder micromotion and its potential role in the pathophysiology of urinary urgency and voiding dysfunction.

Effectiveness of Y-V-plasty for refractory bladder neck stenosis after transurethral prostate surgery.

To evaluate the surgical and patient-reported outcomes of YV-plasty in patients with refractory bladder neck stenosis (BNS) following transurethral prostate surgery. This retrospective study reviewed five patients who underwent YV-plasty for BNS between January 2021 and October 2023. The surgical procedure involved a midline lower abdominal incision to expose the bladder neck. A V-shaped incision was made in the anterior bladder wall to create a bladder flap. The bladder neck was then incised from the apex of the V-shape to the healthy urethra, forming a Y-shaped incision. Fibrotic tissue was excised, and the posterior side of the urethra and bladder were anastomosed. The bladder flap was mobilized and sutured to the healthy urethra using 4-0 PDS interrupted sutures. Follow-up assessments included uroflowmetry, postvoid residual urine volume measurement (PVR), and questionnaires on daily pad use and patient satisfaction. Success was defined as cystourethroscope passage through the anastomosis without resistance and no need for additional procedures. The median patient age was 69. All patients had a history of failed endoscopic treatments. The median follow-up was 13 months, with all considered successful. The median postoperative maximum flow rate was 26.6 mL/s, and the median PVR was 12 mL. Postoperatively, two (40%) were pad-free, and three (60%) used 1-2 pads daily. Three (60%) patients were 'very satisfied,' one (20%) 'satisfied,' while one (20%) was 'dissatisfied.' Y-V-plasty is an effective option for refractory BNS, improving urinary function and quality of life.

MRI Signs Associated With Bladder Injury During Cesarean Delivery in Severe Placenta Accreta Spectrum Disorders.

Bladder injury during cesarean delivery (CD) in pregnant women with severe placenta accreta spectrum (PAS) disorders mostly occurs in the dissection of vesico-uterine space. Placental MRI may help to assess the risk of bladder injury preoperatively. To identify the high-risk MRI signs of bladder injury during CD in women with severe PAS. Retrospective. One hundred sixty-seven women with surgically confirmed severe PAS, defined as to increta or percreta, who underwent planned CD and available placental MRI. 1.5 Tesla, half-Fourier single-shot turbo spin echo sequence and true fast imaging with steady state free precession sequence. Presence of following imaging features of the vesico-uterine region were independently evaluated by three radiologists (with 8, 8, and 15 years of experience, respectively): vesico-uterine space hypervascularity, vesico-uterine space without chemical shift line, bladder wall interruption with hyperintense nodularity, bladder tenting, and uterine-placental bulge. Univariable analyses (Chi-square or Fisher's exact test) and multivariable regression analyses were used. A P value <0.05 was considered significant. Thirty-three of the women (19.8%) experienced bladder injury during CD. MRI features were significantly more frequent in the bladder injury group compared with the no bladder injury group: 69.7% vs. 26.9% in vesico-uterine space hypervascularity, 57.6% vs. 21.6% in absent chemical shift line in the vesico-uterine space, 18.2% vs. 1.5% in bladder wall interruption with hyperintense nodularity, 39.4% vs. 14.9% in bladder tenting, and 78.8% vs. 39.6% in uterine-placental bulging. Vesico-uterine space hypervascularity, absent chemical shift line, and uterine-placental bulge were independently associated with the risk of bladder injury (odds ratios: 4.190, 3.555, and 3.569, respectively). Vesico-uterine space hypervascularity, vesico-uterine space without chemical shift line and uterine-placental bulge were associated with bladder injury during CD in women with severe PAS. Bladder injury is a serious complication of cesarean delivery in pregnant women with severe placenta accreta spectrum, frequently resulting in massive hemorrhage, bladder dysfunction and severe infection. Accurate prenatal assessment is important to minimize these adverse consequences. This study showed that MRI features, including vesico-uterine space hypervascularity, vesico-uterine space without chemical shift line and uterine-placental bulge, were independently associated with bladder injury. These high-risk MRI signs may serve as effective means for prenatal assessment of bladder injury. This study would broaden the application of MRI in severe placenta accreta spectrum. 3 TECHNICAL EFFICACY: Stage 2.

Bladder ultrasound in the differential diagnosis of variably-aetiologic chronic recurrent cystitis

Introduction. In recent years, there has been a shift in the perspective on the pathogenic basis of infectious and inflammatory diseases of the lower urinary tract. This change is due to the paradigm of non-sterility of urine and the urinary tract. As a result, the long-held view of the etiological structure, pathogenesis, and methods of diagnosis and treatment is being revised. Objective. To study ultrasound changes in the bladder wall of patients with chronic recurrent cystitis (CRC) depending on the etiologic factor. Materials &amp; Methods. The prospective study involved 177 sexually active women aged 20 – 45 years who had previously been diagnosed with CRC during an exacerbation. Depending on the etiologic factor, they were divided into three groups: Group 1 (n = 96) — papillomavirus CRC (PV-CRC), Group 2 (n = 70) — bacterial CRC (B-CRC), and Group 3 (n = 11) — candidal CRC (C-CRC). To perform a bladder ultrasound, scanner «Philips En Visor» CHD was used using in the B-mode. Results. The study data analysis on the bladder volume in patients of groups 1 and 2 showed significant differences from the results of group 3. When assessing the ultrasound data for residual urine, no clinically significant deviations were found in any of the groups. Regarding the bladder wall thickening, there are reliable differences between the studied groups: in most patients from group 1 and almost all patients in group 3, the bladder wall thickness exceeded standard values. Conclusion. CRC is a multi-causal disease, and the etiological factor determines its pathogenetic basis. Ultrasound examination of the bladder can serve as a screening method for CRC, providing clues about the nature of infectious and inflammatory processes in the bladder.

Development of a unique crosslinked glycosaminoglycan for soft tissue repair: Treatment of interstitial cystitis/bladder pain syndrome.

Chemical modification of naturally derived glycosaminoglycans (GAGs) expands their potential utility for applications in soft tissue repair and regenerative medicine. Here we report the preparation of a novel crosslinked chondroitin sulfate (~200 to 2000 kilodaltons) that is both soluble in aqueous solution and microfilterable. We refer to these materials as "SuperGAGs." One can further conjugate these materials with diverse capture agents to further modify polymer properties and add new capabilities. A representative material (GLX-100) demonstrated durable restoration of bladder impermeability in a gold standard animal model of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). Histologic examination of the animal bladders treated with a GLX-100 SuperGAG conjugated to biotin as a reporter demonstrated that the residence time of GLX-100 is superior to chondroitin sulfate (a product that is currently used for clinical treatment of patients with IC/BPS). As expected, this novel crosslinked GAG biopolymer was restricted to the luminal surface of the bladder wall. In this communication we describe a simple and versatile synthesis of a crosslinked glycosaminoglycan (GAG) biopolymer for soft tissue repair. Chondroitin sulfate (~12 kD) was crosslinked to form a water soluble and microfilterable polymer with approximately 200 to 2000 kD molecular weight. The synthesis presented here allows for control of molecular weight while avoiding formation of an extended block gel. Moreover, the procedure enables further chemical modification of the SuperGAG through the selection of a capture agent. A set of agents have been used, demonstrating the preparation of a family of SuperGAGs with diverse capabilities. We can optimize polymer properties, adjust adherence to various tissues, add reporters, and engage the biochemistry of surrounding tissues with peptides and other bioactives.

PAROTITIS WITH ORCHITIS IN ACUTE HCV- A RARE ASSOCIATION

Case report:A male of fourteen years, having non-significant past history, was detected to be sufferingfrom acute hepatitis C virus (HCV) infection, presented with acuteonset of gradually progressive bilateral painful enlargement of parotid glands which was followed by bilateral painful orchitis. His HCV RNA quantitative load was 765421 I.U./ml with hyperbilirubinemia and transaminitis.The ultrasound abdomen revealed mild hepatomegaly with gall bladder wall oedema suggestive of acute hepatitis. He had no evidence of cirrhosis as evidenced by normal Fibroscan score of 6.5. At the time of first consultation, his mental status was normal without any fever but was having mild nausea and generalized weakness. His bilateral parotid glands were enlarged and painful for last one week. He also developed bilateral painful orchitis after five days of developing parotitis. He was started on antiviral treatment for hepatitis C for total of 12 weeks duration but his bilateral parotitis and orchitis subsided within three weeks of starting of treatment. He completed his 12 weeks antiviral treatment and later on achieved 12 weeks sustained virological response (SVR), as evidenced by complete absence of HCV RNA on polymerase chain testing (PCR) report. He has been followed for one and half year and repeat HCV RNA test and clinical examination for relapse is non-contributory. Conclusion:Our case reportis an uncommon extrahepatic manifestation of acute HCV case of bilateral parotitis in an acute hepatitis C patient. There is paucity of data regardingparotitis and orchitis with acute hepatitis C infection, hence merits vigil for the same by the treating health care specialist.

Peculiarities of endoscopic treatment of vesicoureteral reflux in children

Background. Vesicoureteral reflux is a disease of the bladder-ureter joint, caused by a violation of the closing mechanism of the lower part of the urinary tract, as a result of which a certain amount of urine transported through the ureter into the bladder, under the influence of intravesical pressure, constantly or periodically returns (regurgitation) to the upper urinary tract in the direction of the kidney. According to the literature, vesicoureteral reflux affects approximately 1% of all children, according to various sources. Purpose – is to highlight the importance of the pathology of vesicoureteral reflux using data from the literature and own observations. Materials and Methods. 31 patients who were diagnosed with VUR were included in the study. Previously, these children were examined in the conditions of somatic departments of Vinnitsia Regional Pediatric Clinical Hospital. Patients underwent endoscopic correction of VUR using gels (Nubiplant, Vantrix, Deflux, Dexell) according to the STING method. Results. An analysis of the medical records of 31 inpatients who were treated in the surgical department of the Vinnytsia Regional Pediatric Clinical Hospital from 2019 to 2023 was conducted. During the stay in the hospital, the patient underwent a diagnostic examination (taking an anamnesis, general blood and urine tests, determining the level of urea and creatinine; ultrasound of the kidneys, micturition cystoureterography, if necessary – excretory urography, echocardiography). Endoscopic treatment was performed – endovesical injection of a volume-forming gel into the submucosal part of the refluxing ureter (above the ureter, into the bladder wall) – the STING (Subureteric Teflon Injection) variant. Conclusions. VUR is a fairly common pathology among children, which has a multifactorial nature. The variety of manifestations, the high prevalence of this pathology and the severity of complications require early diagnosis and determination of treatment tactics. Regarding the gender distribution of the pathology, it should be noted that girls are sick more often than boys. Unilateral and bilateral VUR occurs with the same frequency, while reflux of the II–III stages occurs most often. The maximum morbidity was observed at the age of 6 to 9 years, and from 0 to 3 years. In 35–60% of cases, reflux causes sclerotic changes in the kidney, secondary shrinkage of the kidney. According to the literature, nephrosclerosis due to chronic pyelonephritis in VUR is formed in 30–60% of cases, which leads to the development of the terminal stage of chronic renal failure in 25–60% of patients, due to a decrease in the functional renal reserve, as an indicator of the compensatory capabilities of the kidneys. Most research suggests that endoscopic and surgical intervention are the best treatment methods for VUR with frequent manifestations of infection.