Bladder Washings Research Articles

膀胱洗浄液細胞診で推定しえた G-CSF 産生膀胱癌の 1 例

背景 : Granulocyte-colony stimulating factor (G-CSF) 産生腫瘍はさまざまな臓器に発生し, 予後不良である. 今回, G-CSF 産生膀胱癌の 1 例を報告する.

The Effectiveness and Safety of Transurethral (Bipolar) Plasmakinetic Resection of Prostate Combined with Thulium Laser for Large Benign Prostatic Hyperplasia (>80ml).

To evaluate the clinical curative effect and safety of transurethral (bipolar) plasmakinetic resection of theprostate (PKRP) combined with thulium laser in the treatment of large prostates (> 80mL). From January 2014 to December 2015, 61 patients with benign prostate hyperplasia(BPH) were treated with PKRP combined with thulium laser (n = 25) or PKRP only (n = 36). We retrospectivelyanalyzed the perioperative status of patients status during 3-month follow-up. There was no significant difference between the two groups before treatment (P > .05). PKRP combinedwith thulium laser was significantly superior to PKRP in terms of surgical duration, intraoperative blood loss,postoperative bladder washing time, postoperative complications and time of hospital stay (P < .05). There were nosignificant improvements at international prostatic symptom score (IPSS), quality of life (QOL), maximum flowrate (Qmax), and post-void residual (PVR) urine between two groups after 3 months (P > .05). PKRP combined with thulium laser is superior than PKRP only for better surgical duration, lessbleeding, higher efficiency and much quicker recovery. It may be a better choice for the treatment of BPH withlarge prostate (> 80mL).

English

Objectives: Urine cytology is an easy to perform non-invasive screening test forpatients who are suspected of having urinary tract malignancy. Urothelial carcinoma constitutesapproximately 90% of all primary tumors of urinary bladder.1 High-grade urothelial carcinomasare represented by well characterized cytological features. Whereas cytological features forlow-grade urothelial carcinomas show considerable overlap with features secondary to chronicinflammation, calculi, indwelling catheters or effects of intra-vesical chemotherapy.2 Thepurpose of this study is to find an appropriate set of cytological features of shed urothelial cellsthat will be useful to differentiate low-grade urothelial carcinoma cells from atypical urothelialcells secondary to non-neoplastic conditions. Study Design: Retrospective study. Setting:Charsada Teaching Hospital affiliated with Jinnah Medical College Peshawar. Period: 2010to 2015. Methods: All cases of urine and bladder washing cytology were retrieved for threediagnostic categories namely: low-grade urothelial carcinoma (LGUC), high-grade urothelialcarcinoma (HGUC), and “atypical urothelial cells”; for which histological diagnoses were alsoavailable. These cases were reviewed for cell clusters with smooth or irregular communityborders, cytoplasm texture, nucleomegaly, high nucleus to cytoplasm ratios (N/C ratio),presence of nucleoli, nuclear membrane irregularity, and chromatin texture. Results: Cellclusters with smooth borders were common in reactive changes, whereas irregular communityborders were seen in low-grade urothelial carcinomas and dyscohesive pattern was a featureof HGUC. The increase in N/C ratio ›2:1 was always associated with malignancy. The nuclearmembrane irregularity was also a strong indicator of malignancy. Cytoplasmic homogeneityand nuclear hyperchromasia were more prominent and consistently seen in high-gradeurothelial carcinomas. Conclusions: The study showed that nuclear membrane irregularity,nucleomegaly and high N/C ratio of › 2:1 were the most consistent features found in LGUC.These features can be used with high certainty to differentiate LGUC (malignant) from atypicalurothelial cells (non-neoplastic).

Cytologic persistence of malignant cells after transurethral resection of bladder tumors: Implications for concomitant manipulation of the urinary tract at the time of endoscopic resection.

The current study was conducted to determine the feasibility of cytologically clearing the bladder of tumor cells after transurethral resection of bladder tumor (TURBT) and aggressive serial bladder washing. A prospective pilot sample of 20 patients with known bladder masses was enrolled before undergoing TURBT. Preoperative cytology and 4 postoperative cytology specimens were assessed for malignant cells between serial bladder washes. Surgeons assessed tumor grade visually at the time of TURBT. Surgeons were able to differentiate high-grade disease with limited accuracy (75% sensitivity, 92% specificity, 85% negative predictive value, and 86% positive predictive value). For patients with low-grade disease (12 patients), cytology was atypical in 25% of patients immediately before TURBT and was negative after serial washings in all patients. In patients with high-grade disease (8 patients), approximately 75% had cytology consistent with high-grade urothelial carcinoma immediately before TURBT and only 1 patient was cleared cytologically after serial bladder washings. In patients with high-grade disease, serial bladder washing after TURBT does not appear to clear malignant cells as detected by cytology. This theoretical oncologic risk should be weighed when considering concomitant upper tract procedures such as retrograde pyelography. Future work is needed to quantify risk. Cancer Cytopathol 2017;125:114-119. © 2016 American Cancer Society.

The efficacy and safety of HoLEP and TURP in the treatment of patients with benign prostatic hyperplasia

Objectives To analyze the short-term effects of holmium laser enucleation of the prostate(HoLEP) and transurethral resection of the prostate(TURP) in the treatment of benign prostatic hyperplasia. Methods 120 patients with prostatic hyperplasia in our hospital were randomly divided into 2 groups from January 2011 to December 2014. The patients in group A underwent HoLEP, while the group B underwent TURP. Quality of life score (QOL), maximum urinary flow rate (Qmax), the international prostate symptom score (IPSS) and efficacy of two groups were recorded and compared between perioperative period and 1, 6, 12 months after operation. Results There were no statistically significance in quality of life scores, maximum urinary flow rate, the international prostate symptom score, the prostate weight and residual urine volume between the two groups before operation (t=0.665, 0.441, 0.639, 0.758, 0.778, P=0.508, 0.660, 0.524, 0.660, 0.524). The bleeding in the surgery, the average incidence of hyponatremia, the bladder indwelling catheter and washing time was(78.25 ±25.78) mL, 5%, (2.37 ± 1.35) d, (1.25±0.49) d in group A, respectively. And the group B was(136.78 ±29.45) mL, 25%, (5.34±2.02) d, (2.54±0.78) d, respectively. Group B was significantly higher than group A(P<0.05). At the same time, quality of life scores, maximum urinary flow rate, the international prostate symptom score 1, 6, 12 months after operation were improved than before treatment, and the indicators in group A were improved than group B(P<0.05). Conclusions The efficacy and safety of HoLEP in the treatment of patients with benign prostatic hyperplasia are better than that of TURP. It is a good treatment for benign prostatic hyperplasia. Key words: Prostatic Hyperplasia; Laser Therapy; Electrosurgery

The positive predictive value of "suspicious for high-grade urothelial carcinoma" in urinary tract cytology specimens: A single-institution study of 665 cases.

"The Paris System" proposes a 7-tier classification system for urine cytology. Establishing the risk of malignancy (ROM) associated with these diagnostic categories is essential to determine the appropriate management of patients. The objective of this study was to determine the ROM associated with the "positive" and "suspicious" categories. The authors searched their electronic records for urine cytology specimens that had been diagnosed as "positive" or "suspicious" for high-grade urothelial carcinoma within an 11-year time frame. Then, the ROM was determined for these specimens within a 6-month follow-up interval. The cytologic diagnoses were correlated with surgical biopsy results, follow-up cytology results, and/or fluorescence in situ hybridization (FISH) results. In total, 662 specimens (487 "positive" and 175 "suspicious"), corresponding to 387 patients (295 men and 92 women), were included. The majority of specimens were collected by bladder washing (568 of 662 specimens; 85.4%) and for the indication of surveillance (601 of 662 specimens; 82%). On follow-up, bladder washing specimens were positive more often positive than voided urine specimens (466 of 570 [81.8%] vs 60 of 92 [65.2%]; P = .0005), and surveillance specimens were more often positive than specimens collected for other indications (82% vs 54.1%). The overall positive predictive value was higher for positive specimens than for suspicious specimens (365 of 461 [79.2%] vs 83 of 150 [55.3%]; P < .0001). Diagnoses of suspicious for high-grade urothelial carcinoma, as used at the authors' institution, have an ROM that is high but is lower than that for the "positive" category. Therefore, the authors suggest keeping the 2 categories separate, although management should be aggressive in both groups. Cancer Cytopathol 2016;124:811-9. © 2016 American Cancer Society.

Outcome of PCNL- Success &amp;Complications

Percutaneous nephrolithotomy (PCNL) is now considered as the standard treatment for large and complex renal stones. The outcomes of PCNL can be interpreted in terms of success and complication rates. Recent attempts to report complication rates of PCNL have focused on stratifying them by severity by use of the Clavien Dindo grading system. The Guy's Stone Score (GSS) used to classify the burden of stones. This was a prospective study conducted by the department of Urology, NIMS hospital, Jaipur. In study of 508 PCNL cases, overall stone free status achieved in 88.72% of cases. Stone free status for GSS 1- 100%, GSS 2- 93.95%, GSS 3- 79.5%, GSS 4-39. In GSS 4 all cases were of staghorn calculus. Post- operative complications classified by the modified Clavien Dindo grading system. Fever was most common complication encountered (32.39%). Other frequent complications were haematuria requiring blood transfusion (24.88%), perinephrostomy urine leak (17.37%) and UTI requiring change of antibiotics (11.26%). Pneumothorax, post-operative JJ stent placement and clot retension requiring bladder wash were rare. Grade 4 and 5 complications were not encountered in our study.

Bladder cancer diagnosis from bladder wash by Fourier transform infrared spectroscopy as a novel test for tumor recurrence.

This study proposes Fourier Transform Infrared (FTIR) spectroscopy as a more sensitive, rapid, non-destructive and operator-independent analytical diagnostic method for bladder cancer recurrence from bladder wash than other routinely used urine cytology and cystoscopy methods. A total of 136 patients were recruited. FTIR spectroscopic experiments were carried out as a blind study, the classification results of which were then compared with those of cytology and cystoscopy. Firstly, 71 samples (n=37; bladder cancer and n=34; control) were studied with transmittance FTIR spectroscopy. After achieving successful differentiation of the groups, to develop a more rapid diagnostic tool and check the reproducibility of the results, the work was continued with different samples (n=65 as n= 44;bladder cancer and n=21; control), using the reflection mode (ATR) of FTIR spectroscopy by a different operator. The results revealed significant alterations in moleculer content in the cancer group. Based on the spectral differences, using transmittance FTIR spectroscopy coupled with chemometrics, the diseased group was successfully differentiated from the control. When only carcinoma group was taken into consideration a sensitivity value of 100% was achieved. Similar results were also obtained by ATR-FTIR spectroscopy. This study shows the power of infrared spectroscopy in the diagnosis of bladder cancer.

S&T-48 FEASIBILITY OF EGFR EVALUATION IN BLADDER WASHINGS OF PATIENTS AFFECTED BY NON MUSCLE-INVASIVE BLADDER CANCER.

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-48 FEASIBILITY OF EGFR EVALUATION IN BLADDER WASHINGS OF PATIENTS AFFECTED BY NON MUSCLE-INVASIVE BLADDER CANCER. Vincenzo Serretta, Fabrizio Di Maida, Cristina Scalici Gesolfo, Gabriele Tulone, Antonina Graziella Cangemi, Alessandro Perez, Antonio Russo, Marco Moschini, and Renzo Colombo Vincenzo SerrettaVincenzo Serretta More articles by this author , Fabrizio Di MaidaFabrizio Di Maida More articles by this author , Cristina Scalici GesolfoCristina Scalici Gesolfo More articles by this author , Gabriele TuloneGabriele Tulone More articles by this author , Antonina Graziella CangemiAntonina Graziella Cangemi More articles by this author , Alessandro PerezAlessandro Perez More articles by this author , Antonio RussoAntonio Russo More articles by this author , Marco MoschiniMarco Moschini More articles by this author , and Renzo ColomboRenzo Colombo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2877AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Epidermal Growth Factor Receptor (EGFR) overexpression has been recognized as a marker of biological aggressiveness in several malignant neoplasms. EGFR studies on non-muscle invasive bladder cancer (NMIBC) are lacking. Urothelial EGFR status after TUR could provide useful information about the risk of recurrence and progression. The aim of our study was to investigate the feasibility of EGFR evaluation in bladder washings of patients affected by NMIBC correlating its expression to European Association of Urology (EAU) risk classes. METHODS A prospective double-blinded study included patients undergoing adjuvant intravesical therapy for NMIBC and age-matched healthy controls. A cellular pellet was obtained and stored at -80°C. Isolation of cellular RNA was performed using a miRNeasy Mini Kit (Qiagen®) and DNA derived from reverse transcription was used to perform gene expression analysis by a Real Time PCR according to ??Ct method. RESULTS Fifty-eight patients and 21 controls entered the study. One hundred fifty-three samples were collected. A useful pellet was obtained in 50 patients (86.2%) and 18 controls (85.7%). The mean EGFR expression in 50 NMIBC was 1.94 folds (range: 0.10-8.00). Compared with healthy controls (EGFR=1), 40 patients (80%) were positive for EGFR. Particularly, in 18 patients (36%) EGFR was overexpressed (EGFR>1.94) with a mean value of 3.61 folds (range: 2.00-8.00). According to EAU risk groups, EGFR expression was evaluated in low, intermediate and high risk patients respectively. In 20 high risk NMIBC the mean EGFR expression resulted 2.45 folds and 10 of them (50%) presented significant up-regulation with a mean value of 4.10 folds (range: 2.30-8.00). CONCLUSIONS Our preliminary study demonstrates the feasibility of EGFR determination in bladder washings of patients affected by NMIBC after TUR, during adjuvant treatment and subsequent follow-up. A useful pellet was available in more than 85% of patients, with evidence of up-regulation in 36% of them. Within the high risk category, a significant overexpression of EGFR, mean value of 4.16 folds, was detected. EGFR overexpression might identify a subgroup of high risk tumors inclined to progression despite of intravesical therapy and could represent an additional prognostic factor to select candidates for early radical cystectomy. Acknowledgement: We wish to thank The GSTU Foundation for the administrative support © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e327-e328 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Vincenzo Serretta More articles by this author Fabrizio Di Maida More articles by this author Cristina Scalici Gesolfo More articles by this author Gabriele Tulone More articles by this author Antonina Graziella Cangemi More articles by this author Alessandro Perez More articles by this author Antonio Russo More articles by this author Marco Moschini More articles by this author Renzo Colombo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Long-term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration.

BackgroundWe desire to review our experience with bladder augmentation in spina bifida patients followed in a transitional and adult urologic practice. This paper will specifically focus on three major complications: bladder calculi, the most frequent complication found following bladder augmentation, perforation of the augmentation, its most lethal complication and finally we will address loss of renal function as a direct result of our surgical reconstructive procedures.MethodsWe reviewed a prospective data base maintained on patients with spina bifida followed in our transitional and adult urology clinic from 1986 to date. Specific attention was given to patients who had developed bladder calculi, sustained a spontaneous perforation of the augmented bladder or had developed new onset of renal scarring or renal insufficiency (≥ stage 3 renal failure) during prolonged follow-up.ResultsThe development of renal stones (P<0.05) and symptomatic urinary tract infections (P<0.0001) were found to be significantly reduced by the use of high volume (≥240 mL) daily bladder wash outs. Individuals who still developed bladder calculi recalcitrant to high volume wash outs were not benefited by the correction of underlying metabolic abnormalities or mucolytic agents. Spontaneous bladder perforations in the adult patient population with spina bifida were found to be directly correlated to substance abuse and noncompliance with intermittent catheterization, P<0.005. Deterioration of the upper tracts as defined by the new onset of renal scars occurred in 40% (32/80) of the patients managed by a ileocystoplasty and simultaneous bladder neck outlet procedure during a median follow-up interval 14 years (range, 8–45 years). Development of ≥ stage 3 chronic renal failure occurred within 38% (12/32) of the patients with scarring i.e., 15% (12/80) of the total patient population. Prior to the development of the renal scarring, 69% (22/32) of the patients had been noncompliant with intermittent catheterization. The onset of upper tract deterioration (i.e., new scar formation, hydronephrosis, calculus development, decrease in renal function) was silent, that is, clinically asymptomatic in one third (10/32 pts).ConclusionsThis paper documents the need for high volume bladder irrigations to both prevent the most common complication following bladder augmentation, which is the development of bladder calculi and to reduce the incidence of symptomatic urinary tract infections. It provides a unique perspective regarding the impact of substance abuse and patient non-compliance with medical directives as being both the most common cause for both spontaneous bladder rupture following augmentation cystoplasty and for deterioration of the upper tracts. These findings should cause the surgeon to reflect on his/her assessment of a patient prior to performing a bladder augmentation procedure and stress the need for close follow-up.

Lavado vesical de bovinos com hematúria enzoótica: padronização de técnica de colheita, obtenção de amostras e avaliação citopatológica

RESUMO A hematúria enzoótica bovina é uma doença crônica que causa neoplasias na bexiga, e o exame citopatológico poderia auxiliar no diagnóstico precoce. Objetivou-se padronizar a técnica de colheita, obtenção de amostras e avaliação citopatológica do lavado vesical de bovinos com hematúria enzoótica bovina. Foram utilizadas 10 vacas, adultas, distribuídas em dois grupos. No grupo A foi recuperado todo o líquido vesical infundido, no grupo B foi recuperado apenas o último lavado. Os lavados foram submetidos à avaliação citopatológica. Apesar do volume final de líquido vesical ter sido maior no grupo A, em relação ao número de células, não houve diferença significativa (p &gt; 0,05) entre os grupos. A quantidade de células inflamatórias e células epiteliais obtidas por amostra revelou que nos dois grupos todos os animais apresentavam mais células inflamatórias do que epiteliais, entretanto, não houve diferença entre o tipo de colheita realizada. As células epiteliais foram encontradas em 60% dos casos e as alterações morfológicas observadas foram discretas, não sendo possível classificar nenhuma amostra como hiperplásica ou neoplásica. Os dados deste estudo permitiram concluir que o exame citopatológico do lavado vesical de bovinos pode auxiliar no diagnóstico da hematúria enzoótica bovina e que os dois métodos de colheita empregados mostraram-se adequados para obtenção de amostras viáveis. A avaliação citopatológica permitiu a identificação de lesões não neoplásicas predominantemente inflamatórias. Acredita-se que a utilização de técnicas moleculares com biomarcadores em amostras citológicas seria importante para detectar precocemente lesões pré-neoplásicas ou neoplásicas nesses animais.

Clinical value of digital image analysis in the diagnosis of urinary bladder cancer, particularly in aggressive tumors: a preliminary report.

The aim of the project was to evaluate the clinical value of a computer analysis of cytological specimen images obtained from urine and bladder washing samples. Three sample types (voided urine, catheterized urine and bladder washing) from 59 patients with primary or recurrent tumor were analyzed. All patients underwent cystoscopy and biopsy or resection. The histological results were compared with the results of the image analyzing computer system of collected urine samples. The consistency between the computer diagnosis and the clinical or histological diagnosis both in the presence and absence of cancer was as follows: 77% for voided urine samples, 72.5% for catheterized urine samples and 78% for bladder washing samples. The specificity of the method at the standard pathology level was 71%, and the sensitivity was 83%. The positive and negative predictive values (PPV and NPV) were 87.5% and 63% respectively. The sensitivity for G3 or CIS or T2 or T3 tumors reached nearly 100%. Computer analysis of urine provided correct diagnoses in cancer and control patients with the sensitivity of 83% and specificity of 71% and gave excellent results in aggressive tumors such as T2, T3, G3 and in CIS.

Giant Vesical Calculus Formation as a Complication of Augmentation Cystoplasty.

A 44-year-old female presented with the history of recurrent UTI and intermittent hematuria. She underwent augmentation ileocystoplasty for small capacity bladder 19years back. Patient was on clean intermittent catheterization (CIC) since then. Abdominal radiograph and ultrasonography showed the large vesical calculus. Open cystolithotomy was done, and a yellowish brown hard stone weighing 1025g was removed. Chemical analysis revealed struvite stone. Postoperative period was uneventful. Regular bladder wash, lifelong surveillance and follow-up is advisable.

Do We Need Surveillance Urethro-Cystoscopy in Patients with Neurogenic Lower Urinary Tract Dysfunction?

PurposeTo examine the value of surveillance urethro-cystoscopy in patients with neurogenic lower urinary tract dysfunction (NLUTD) in regard to the conflicting literature as it is generally agreed that patients with NLUTD are at increased risk for bladder cancer.Materials and MethodsIn a cross-sectional study, a consecutive series of 129 patients (50 females, 79 males, mean age 51, range 18–88) suffering from NLUTD for at least 5 years was prospectively investigated using urethro-cystoscopy and bladder washing cytology at a single university spinal cord injury (SCI) center.ResultsDue to suspicious urethro-cystoscopy and/or bladder washing cytology findings, 13 (10%) of 129 patients underwent transurethral resection of the bladder lesion and/or random bladder biopsies. Overall, 9 relevant histological findings were found in 5% (7/129) of our patients: bladder melanosis (n = 1), nephrogenic adenoma (n = 3), keratinizing squamous metaplasia (n = 1), intestinal metaplasia (n = 3), and muscle-invasive adenocarcinoma of the bladder (n = 1).ConclusionsUsing surveillance urethro-cystoscopy, we found relevant histological findings in 5% of our patients suffering from NLUTD for at least 5 years. Thus, surveillance urethro-cystoscopy might be warranted, although the ideal starting point and frequency remain to be determined in further prospective studies.

Tumour location adjacent to the ureteric orifice in primary Ta/T1 bladder cancer is predictive of recurrence

Objective: The aim of this study was to evaluate tumour growth located around the ureteric orifice (LUO) at primary diagnosis of Ta/T1 urinary bladder cancer in relation to effects on recurrence and progression. Materials and methods: Clinical and pathological characteristics of patients diagnosed with primary Ta/T1 urinary bladder cancer from 1992 to 2007 were recorded prospectively. Location of the primary tumour and growth around the ureteric orifice (within 1 cm) were recorded and correlated with recurrence and progression during further follow-up. Hazard ratios (HRs) were estimated using Cox regression with 95% confidence intervals (CIs) in both univariate and multivariate analysis. Results: The study included 768 evaluable patients with a median follow-up of 60 months. Recurrence was observed in 478 patients (62%) and progression in 71 (9%). Growth of a primary tumour adjacent to the ureteric orifice was associated with recurrence (HR = 1.28, 95% CI = 1.07–1.54) but not progression (HR = 1.04, 95% CI = 0.65–1.67). The most common location of the first recurrence was the posterior bladder wall (29%). Other locations in the bladder did not predict recurrence or progression. Additional factors affecting recurrence were tumour size greater than 15 mm, T1 tumour category, multiplicity, malignant or missing/not representative bladder wash cytology and surgery performed by residents. Conclusions: A primary tumour located around the ureteric orifice was predictive of recurrence, which could be taken into account in future follow-up schedules.

Postmortem cytology: Alive and well in the practice of autopsy and forensic pathology.

Postmortem cytology: Alive and well in the practice of autopsy and forensic pathology.

Tissue engineering for human urethral reconstruction: systematic review of recent literature.

BackgroundTechniques to treat urethral stricture and hypospadias are restricted, as substitution of the unhealthy urethra with tissue from other origins (skin, bladder or buccal mucosa) has some limitations. Therefore, alternative sources of tissue for use in urethral reconstructions are considered, such as ex vivo engineered constructs.PurposeTo review recent literature on tissue engineering for human urethral reconstruction.MethodsA search was made in the PubMed and Embase databases restricted to the last 25 years and the English language.ResultsA total of 45 articles were selected describing the use of tissue engineering in urethral reconstruction. The results are discussed in four groups: autologous cell cultures, matrices/scaffolds, cell-seeded scaffolds, and clinical results of urethral reconstructions using these materials. Different progenitor cells were used, isolated from either urine or adipose tissue, but slightly better results were obtained with in vitro expansion of urothelial cells from bladder washings, tissue biopsies from the bladder (urothelium) or the oral cavity (buccal mucosa). Compared with a synthetic scaffold, a biological scaffold has the advantage of bioactive extracellular matrix proteins on its surface. When applied clinically, a non-seeded matrix only seems suited for use as an onlay graft. When a tubularized substitution is the aim, a cell-seeded construct seems more beneficial.ConclusionsConsiderable experience is available with tissue engineering of urethral tissue in vitro, produced with cells of different origin. Clinical and in vivo experiments show promising results.

Higher Expression of miR-182 in Cytology Specimens of High-Grade Urothelial Cell Carcinoma: A Potential Diagnostic Marker

Objective: MicroRNAs (miRs) are short noncoding RNA molecules that posttranscriptionally modulate protein expression. There are distinct miR alterations characterizing urothelial cell carcinoma (UCC) of the urinary bladder. Study Design: In this study, we investigate the possibility of using miR as a noninvasive marker in the screening of UCC. The total RNA was extracted from 75 cytology specimens including bladder or renal washings and voided urines. Cases comprise UCC (21 high grade and 6 low grade), 25 normal controls and 23 cases with a history of UCC but negative at the time of testing (negative with a positive history). The expressions of miR-96, miR-182, miR-183, miR-200c, miR-21, miR-141 and miR-30b were determined using quantitative TaqMan real-time PCR. Results and Conclusion: This study shows that the level of miR-182 is higher in cytology specimens from high-grade UCC patients as compared to normal controls. Measuring miR-182 may provide a potential alternative or adjunct approach for screening high-grade UCC.

It's only infection prevention, but infection prevention is all we have.

Catheter associated urinary tract infections (CAUTI) are supposedly a very common cause of nosocomial infection in the Intensive Care Unit (ICU).[1] Pyuria and bacteruria are, however, inevitable in every patient who has a Foley's Catheter in place for a few days. It is, therefore, difficult to separate catheter associated bacteruria from true CAUTI.[2] In our country, ventilator associated pneumonia and central line associated blood stream infections (CLABSI) remain the main bug bears in the ICU. Many of the episodes of CAUTI occur after the patient has been transferred out of the ICU after removal of the catheter (especially if the catheter has been removed prematurely and the patient needs re catheterization). Even so, the incidence of true CAUTI is probably over estimated. In this Issue Jain et al.[3] have studied the knowledge and attitude of doctors and nurses towards prevention of CAUTI in a Tertiary Care Hospital. Irrespective of the true incidence of CAUTI, this is an important study. The focus of this study was CAUTI, but the findings of this study are a reflection of the knowledge and attitudes of Health Care Workers (HCW) toward prevention of any nosocomial infection. If a similar study were done about hospital acquired pneumonia or about CLABSI, it is unlikely that the results would be any less depressing. It is interesting to note that the HCW were reasonably good at identifying effective methods of preventing urinary tract infections. They however were very poor at identifying the noneffective methods (metal cleaning, bladder wash, prophylactic antibiotics, etc.). Many useless, expensive and potentially harmful practices are unfortunately therefore still being followed in many ICUs in our country. This is also probably the reason why many other useless practices such as fumigation, removal of foot wear, restriction of visitors, etc., continue to be popular. This study was conducted in a tertiary care hospital, one shudders to think of the results of a similar survey in smaller hospitals. It is a small mercy that HCW in the ICU performed slightly better than the others. This is probably because intensive care is the only speciality, which gives some importance to infection prevention. It is also heartening to note that most of those surveyed recognized that infection prevention should be a priority. They also recognized the importance of education. Preventive medicine has never got the importance it deserves in the medical and nursing curriculum. It is the “Cinderella,” the neglected step sister. This needs to change. Preventive medicine needs a godmother, “Cinderella” needs to be transformed. Infection prevention should be part of the curriculum at both under graduate and postgraduate level (irrespective of specialty). There should be at least one question related to infection control in the qualifying examinations. While seeking renewal of registration, it must become mandatory for a physician to have attended at least one continuing medical education on infection prevention each year. Hospitals must dedicate a minimum of 1-day each year to re-educating and re training their staff in infection prevention. Unfortunately, increased knowledge does not always translate into better practice. In a study performed in a premier teaching hospital in India, doctors scored better than nurses in knowledge of infection prevention practices, but performed much worse when it came to practice of these measures.[4] In a study from South India, after an education program, in spite of an increase in knowledge scores, doctors were the least compliant of the HCW in infection control practices. Several studies have shown that doctors are the worst offenders when it comes to hand washing.[5] Why do doctors have such a poor attitude towards infection control? A major share of the blame must go to the senior doctors. The average age of the respondents in this study was quite low, the results would probably have been more dismal if more senior personnel had been surveyed. Junior doctors and even other HCW tend to copy the behavior and attitudes of the Senior doctors. Unfortunately until recently Senior doctors have been very poor role models at least as far as infection prevention is concerned. Fortunately, intensive care is a relatively young specialty with relatively younger more enlightened leaders. It is their responsibility to lead by example.[6] In these days of “Bad Bugs, No Drugs,” infection prevention is all we have.

The role of collecting bladder wash fluid before biopsy procedure to help the cytological diagnosis of residual tumor.

Background:Urinary cytology has low sensitivity and specificity in urinary neoplasm.Aim:We planned to assess whether the examination of bladder washing before biopsy (WBB) plays a role in better cytologic diagnosis of bladder wash fluid collected after biopsy procedure (WAB) in papillary urothelial neoplasms.Materials and Methods:We included 36 patients with papillary lesion of bladder. Prior to the biopsy, the bladder is washed and fluid is collected for cytology; later transurethral resection (TUR) is performed, then bladders are washed again and the fluid is separately collected for cytology. Both fluids were centrifuged and stained with May-Grünwald Giemsa (MGG). First the WAB slides were evaluated and diagnosed. After evaluation of the WBB slides, the WAB slides were rediagnosed. Presence of cellularity, papillary structure, fusiform cells, background bleeding, and cytolysis in WBB and WAB were evaluated separately.Results:We determined that 31 WBB samples were hypercellular, and 12 of them remained as hypercellular in WAB. Papillary structures were observed in 20 WBB samples; and in one WAB cytology. In 29 cases where no fusiform cells are identified in WBB, 22 showed fusiform cells in WAB. Cytolysis in WABs was noted in 15 cases whose WBBs did not show cytolysis. The decrease in cellularity, papillary structure (P < 0.001, both), cytolysis (P = 0.008), and fusiform cells (P < 0.001) were statistically significant. After seeing the WBB slides, we reevaluated the WAB slides. Out of the eight out of 36 (22.2%) samples diagnosed with degeneration previously, five (62.5%) samples were rediagnosed as benign, two (25%) as cytologic atypia which favor reactive, and one (12.5%) as malignant.Conclusion:Due to the better quality, initial evaluation of WBB may help more effective diagnoses of WAB slides.