Bladder Research Articles

Replacing manual planning with automatic iterative planning for locally advanced rectal cancer VMAT treatment.

To develop and implement a fully automatic iterative planning (AIP) system in the clinical practice, generating volumetric-modulated arc therapy plans combined with simultaneous integrated boost technique VMAT (SIB-VMAT) for locally advanced rectal cancer (LARC) patients. The designed AIP system aimed to automate the entire planning process through a web-based service, includingauxiliary structuregeneration,plan creation,field configuration,plan optimization,dose calculation, andplan assessment. The system was implemented based on theEclipse scriptingapplication programming interface and an efficientiterative optimization algorithm was proposed to reduce the required iterations in the optimization process. To verify the performance of the implemented AIP system, we retrospectively selected a total of 106 patients and performed dosimetric comparisons between the automatic plans (APs) and the manual plans (MPs), in terms of dose-volume histogram (DVH) metrics, homogeneity index (HI), and conformity index (CI) for different volumes of interest. The AIP system has successfully created 106 APs within clinically acceptable timeframes. The average planning time per case was 36.8±6.5 min, with an average iteration number of 6.8(±1.1) in plan optimization. Compared to MPs, APs exhibited better performance in the planning target volume conformity and hotspot control ( ). The organs at risk (OARs) sparing was significantly improved in APs, with mean dose reductions in the femoral heads, the bone marrow, and the SmallBowel-Avoid of 0.53Gy, 1.18Gy, and 1.00Gy, respectively ( ). Slight improvement was also observed in the urinary bladder and the small bowel . Additionally, quality variation between plans from different planners was observed in DVH metrics while the APs represented better plan quality consistency. An AIP system has been implemented and integrated into the clinical treatment planning workflow. The AIP-generated SIB-VMAT plans for LARC have demonstrated superior plan quality and consistency compared with the manual counterparts. In the meantime, the planning time has been reduced by the AIP approach. Based on the reported results, the implemented AIP framework has been proven to improve plan quality and planning efficiency, liberating planners from the laborious parameter-tuning in the optimization phase.

NEUROENDOCRINE TUMORS OF THE GENITOURINARY TRACT - A CLINICAL AND PATHOLOGIC REVIEW

Abstract Introduction/Objective Neuroendocrine tumors (NETs) of the genitourinary (GU) tract are rarely seen during daily surgical pathology sign-out sessions and comprise a heterogeneous group of neoplasms. We undertook a retrospective study to assess the clinical and pathologic characteristics of this unusual group of neoplasms involving the GU tract. Methods/Case Report We performed a retrospective review of the surgical pathology files for NETs of the GU tract between July 1993 and December 2021. Chart review was performed for the clinical and pathologic findings. Results (if a Case Study enter NA) A total of 26 patients were identified. There were 18 males and 8 females ranging in age from 43 to 94 years (mean age 69 years). 19/26 (73%) cases were primary tumors; 9 bladder small cell carcinoma, 5 prostatic small cell carcinoma, 4 bladder paragangliomas, and 1 case of small cell carcinoma of the renal pelvis. 7/26 (27%) cases were metastatic tumors; 5 Merkel carcinoma (3 urinary bladders, 2 testes), and 2 small cell carcinoma of the lung to the kidney. Conclusion The majority of NETs of the GU are primary and urinary bladder to be the most common site. Merkel cell carcinoma appears to have a tendency to metastasize to the GU tract, especially to the testis.

Rare Seminal Vesicle Cystadenoma: Case Report and Literature Review

Abstract Introduction/Objective Primary neoplasms of seminal vesicles (SV) are rare, with the majority being metastatic tumors, often from prostatic carcinoma. SV cystadenoma is an exceedingly rare benign epithelial tumor that arises from the remnants of the Mullerian duct. The tumor formed of cysts of variable sizes lined by bland cuboidal epithelium. Herein we present a case of SV cystadenoma in a 38-year-old male, underscoring its rarity and risk of progression to higher grades, as outlined in literature review. Methods/Case Report A 38-year-old male with a history of left atrophic kidney and intermittent pelvic pain due to recurrent obstruction of the SV. Pelvic Magnetic Resonance Imaging revealed a 5.3 cm benign unilocular cyst within the SV, along the posterior aspect of the urinary bladder. The patient underwent successful laparoscopic excision of the left SV. Gross examination of the excised SV demonstrated a 3.5X 2.7X 1.5 cm cyst within the SV. Microscopic examination displayed a benign cyst lined by single to multiple layers of cuboidal epithelium, surrounded by unremarkable SV stroma. The epithelial lining cells exhibited round nuclei with inconspicuous nucleoli, lacking dysplasia. Immunohistochemistry revealed positive staining for cytokeratin 7 and PAX 8 in the epithelial cells, whereas prostatic specific antigen staining was negative. Results (if a Case Study enter NA) NA Conclusion Cystadenoma and mixed epithelial stromal tumors of the SV (MEST) are rare entities, with approximately 30 reported cases. This case demonstrates classic histologic features consistent with low-grade MEST, as per recently proposed grading criteria. Notably, a recent case report has suggested a potential for malignant transformation to high-grade dysplasia and adenocarcinoma in SV cystadenoma, as evidenced by focal epithelial dysplasia.

An Alternative Approach for Treating Female Underactive Bladders with Chronic Urine Retention: A Pilot Study on Combined Transvaginal Ultrasound-Guided Botulinum Toxin A External Sphincter Injection and Transurethral Incision of the Bladder Neck.

Background: Treating an underactive bladder (UAB) is challenging. Previously, we introduced a more precise method of transvaginal ultrasound-guided botulinum toxin A (BoNT-A) injection into the external urethral sphincter as a treatment option for patients with UABs. Although many patients experience good results, those with an UAB and excessive residual urine still require catheterization. Therefore, we developed a new method that combines transvaginal ultrasound-guided BoNT-A injection with a transurethral bladder neck incision. Methods: A prospective study was conducted on 16 patients who experienced symptoms of UAB and chronic urine retention. The treatment consisted of a combination of transvaginal ultrasound-guided BoNT-A injection and a transurethral incision of the bladder neck (TUI-BN). The primary objective was to assess the efficacy of this combined treatment in improving symptoms in women with UABs. Results: Our study demonstrated significant improvements after treatment, including increased voiding volume, decreased post-void residual (PVR) urine, and improved voiding efficiency. The frequency of clean intermittent catheterization (CIC) decreased at 1 and 3 months post-surgery, along with improvements in the AUA symptoms score and the Patient Perception of Bladder Condition (PPBC) score. Conclusions: Our study showed significant improvements in the surgical treatment of UABs using a combination of transvaginal ultrasound-guided BoNT-A and TUI-BN.

Clinical value of transperineal ultrasound in evaluating the effects of different delivery methods on the primipara pelvic floor structure and function

To evaluate the effects of different delivery methods on the pelvic floor structure and function among primiparas by transperineal ultrasound, with a view to providing guidance for early postpartum intervention. Primiparas who underwent postpartum examination with transperineal ultrasound were recruited. Subjects were divided according to mode of delivery (vaginal and cesarean delivery). General information (including age, pre-pregnancy BMI and neonatal weight) were collected, and transperineal ultrasound was performed to measure such indicators as the levator hiatus areas in resting, constrictive anal and maximum Valsalva states, the posterior vesicourethral angles and distances between vesical neck and posterior inferior margin of pubic symphysis in resting and maximum Valsalva states, as well as the vesical neck mobility and urethral rotation angle in maximum Valsalva state. The inter-group differences in ultrasound indicators between the resting and Valsalva states were compared to analyze the postpartum incidences of pelvic floor dysfunctions like stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse in primiparas. The levator hiatus areas in resting, constrictive anal and maximum Valsalva states were all larger in the vaginal delivery group than in the cesarean delivery group (P < 0.05). Compared to the cesarean delivery group, the vaginal delivery group exhibited larger posterior vesicourethral angles in resting and maximum Valsalva states (P < 0.05). The distances between vesical neck and posterior inferior margin of pubic symphysis were greater in the cesarean delivery group than in the vaginal delivery group at both resting and maximum Valsalva, with that at maximum Valsalva showing significant inter-group difference (P < 0.05). The vaginal delivery group exhibited greater vesical neck mobility and urethral rotation angle at maximum Valsalva compared to the cesarean delivery group (P < 0.05). The incidences of stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse were all higher in the vaginal delivery group than in the cesarean delivery group, with the stress urinary incontinence and bladder prolapse incidences showing significant inter-group differences (P < 0.05). With transperineal ultrasound, various pelvic floor indicators of primiparas can be clearly measured and, through these ultrasound indicators, the effects of different delivery methods on the pelvic floor function can be evaluated, which is conducive to early clinical detection and intervention of postpartum pelvic floor dysfunctions, thus facilitating the early postpartum treatment.

Exploring the Role of miR-132 in Rat Bladders and Human Urothelial Cells during Wound Healing

Urinary bladder wound healing shares many features with skin healing, involving several molecular players, including microRNAs (miRs). This study investigated the role of miR-132 in urothelial cells. We analyzed miR-132 expression in rat bladder using in situ hybridization and conducted gain and loss of miR-132 function assays in primary human urothelial cells (HUCs). These assays included cell proliferation and migration studies. To explore the regulation of miR-132 expression, cells were treated with wound-healing-related factors such as interleukin 6 (IL-6), interleukin 10 (IL-10), and transforming growth factor beta-1 (TGF-β1). Predictive bioinformatics and a literature review identified potential miR-132 targets, which were validated through real-time polymerase chain reaction (RT-PCR) and Western blot analysis. miR-132 was found to promote cellular proliferation and migration during the early stages of urothelial wound repair. Its expression was modulated by key cytokines such as IL-6, IL-10, and TGF-β1. miR-132 played a crucial role in urothelial wound healing by enhancing cell proliferation and migration, regulated by cytokines, suggesting its action within a complex regulatory network. These findings highlight the therapeutic potential of targeting miR-132 in bladder injury repair, offering new insights into bladder repair mechanisms.

The Orexin OX2 Receptor-Dependent Pathway Is Implicated in the Development of Overactive Bladder and Depression in Rats Exposed to Corticosterone.

In the present study, we wanted to check whether TCS OX2 29 (TCS), a potent selective antagonist of OX2 receptors, would have positive effects in an animal model of detrusor overactivity co-existed with the depression-like state in Wistar male rats. The forced swim test with the measurement of spontaneous locomotor activity, conscious cystometry, determination of c-Fos expression in central micturition areas, and a set of biochemical analyses (with the use of urine, hippocampus, bladder urothelium, and detrusor muscle of tested animals) were carried out. The outcomes showed that a 7-day administration of TCS (3 mg/kg/day, subcutaneously) normalizes the cystometric parameters corresponding to overactivity of the detrusor and reverses the pro-depressive response. Furthermore, the antagonism of OX2 receptors restored the abnormal levels of overactive bladder markers (i.e., ATP, CGRP, OCT3, TRPV1, ROCK1, and VAChT), diminished neuronal overactivity in central micturition areas (i.e., pontine micturition center, ventrolateral periaqueductal gray, and medial preoptic area) as well as restored the altered hippocampal levels of CRF, cytokines (IL-1β, IL-6, IL-10, and TNF-α), and growth factors (BDNF and NGF) that reflected biochemical disturbances detected in depressed people. It seems that our findings open new perspectives regarding the implication of the orexin system in the functioning of the urinary bladder and in the pathophysiology of depression.

Copper Nanoparticles Green-Formulated byCurcuma longa Extract Induce Apoptosis via P53 and STAT3 Signaling Pathways in Bladder Carcinoma Cell.

The study outlines the production of new copper nanoparticles infused with Curcuma longa extract to trigger apoptosis through P53 and signal transducer and activator of transcription 3 (STAT3) signaling pathways in bladder carcinoma cells. The structural characteristics of the nanoparticles that were synthesized were analyzed through various sophisticated methods such as transmission electron microscopy (TEM), field emission-scanning electron microscopy (FE-SEM), energy dispersive X-ray spectroscopy (EDX), and Fourier transform infrared spectroscopy (FT-IR). During the antioxidant evaluation, the IC50 values for copper nanoparticles and butylated hydroxytoluene (BHT) against 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radicals were found to be 116µg/mL and 31µg/mL, respectively. The cells treated with copper nanoparticles underwent evaluation through 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay for 48h to determine their anticancer properties on TCCSUP bladder carcinoma cell. The TCCSUP cell line exhibited an IC50 of 290µg/mL when exposed to copper nanoparticles. The viability of malignant cells decreased upon treatment with copper nanoparticles. Furthermore, the copper nanoparticles presence led to a 65-75% increase in cell apoptosis, along with an increase in Bax and cleaved caspase-8 and a decrease in the Bcl-2. Furthermore, the copper nanoparticles presence resulted in the suppression of colony formation. Notably, the molecular pathway analysis in cells treated with copper NPs demonstrated an increase in p53 expression, along with a decrease in the expression of both total and phosphorylated STAT3. This offers that p53 and STAT3 play a crucial role in the biological efficacies induced by the nanoparticles in human carcinoma cells. The data of our research suggest that copper NPs could have significant potential as an anticancer treatment for human bladder carcinoma cells.

Synergistic Proliferation Effects of Xanthohumol and Niflumic Acid on Merkel and Glioblastoma Cancer Cells: Role of Cell Membrane Interactions

The objective of our research was to determine the effects of xanthohumol (XN), a flavonoid isolated from hops (Humulus lupulus), and the anti-inflammatory drug niflumic acid (NA), separately and in combination with each other, on the proliferation of human cancer cells. Additionally, so as to understand the mechanism underlying the anticancer properties of the tested compounds, their effects on the biophysical parameters of a model membrane were assessed. The cells were incubated with XN and NA at various concentrations, either individually or in combination with each other. Cell proliferation was quantified using the sulforodamine B (SRB) assay. In addition, the IC50 values for niflumic acid and xanthohumol applied separately were determined by cell proliferation tests for the following human cancer cell lines: 5637 (urinary bladder carcinoma), A-431 (epidermoid carcinoma), UM-SCC-17A (head and neck squamous carcinoma), SK-MEL-3 (melanoma), MCC13 (Merkel cell cancer), and A172 (glioblastoma), in comparison with the mouse normal fibroblasts (BALB/3T3 clone A31). The results show that the two-compound combinations of XN and NA significantly decreased the proliferation of cancer cells in a dose-dependent manner, and the effects were stronger than the additive responses to XN and NA individually. The membrane studies revealed a synergistic effect on the membrane rigidity when using the mixture of XN and NA, which may explain the observed increase in anticancer activity for the combined XN and NA. Our results suggest that NSAIDs, such as niflumic acid, may be a promising strategy for co-application with xanthohumol as anticancer drugs.

Pre-Hydration and a Forced Diuresis Protocol for 18F-FDG PET/CT Yielded an Optimal Effect on Primary Pelvic Malignancies.

Background: Positron emission tomography (PET) with 18F-FDG is being used more frequently to evaluate primary pelvic tumors (PTs). However, a standardized hydration protocol is essential for an optimal diuretic effect and constant results. Methods: We reviewed 109 patients with PTs who had undergone 18F-FDG PET/CT examinations between November 2006 and April 2013. Four different protocols were used: (a) no hydration (group 1); (b) oral hydration (800 mL) after an early scan (group 2); (c) intravenous (IV) hydration (500 mL) during an early scan followed by oral hydration (800 mL) and IV furosemide (20 mg) after an early scan (group 3); and (d) oral hydration (800 mL) before an FDG injection followed by the protocol from group 3 (group 4). The maximum standardized uptake (SUVmax) of the urinary bladder (UB) and PTs and the PT/UB SUVmax ratios were examined. Results: The UB SUVmax of group 4 was significantly lower in the early scan compared to that in the other three groups. Group 4 had a significantly higher PT/UB SUVmax ratio in the early scan than the other three groups, and it also had a 52.5% positivity rate for PTs. Conclusions: The pre-hydration plus forced diuresis protocol yielded the optimal effect of UB radiotracer washout and had the best PT/UB SUVmax ratio in both scans.

Primary lymphoma of mucosa associated lymphoid tissue (MALT lymphoma) in the urinary bladder mimicking recurrent urinary tract infection: a case report and literature review

We report the case of a 79-year-old woman with primary lymphoma of mucosa-associated lymphoid tissue (MALT) in the urinary bladder. The patient, with urinary frequency, urgency and suprapubic pain had several emergency room visits due to recurrent urinary tract infection. Both sonogram and cystoscopy identified bladder tumors near the bladder neck. An abdominal contrast-enhanced computed tomography scan revealed a polypoid lesion on the anterior bladder wall without enlarged lymph nodes. Transurethral resection of the bladder tumor was conducted. The pathology report confirmed extranodal marginal zone MALT lymphoma. The clinical stage was IEA. Follow-up imaging reported residual bladder tumors, prompting adjuvant radiotherapy. The patient was treated successfully and was disease-free at the 9-month follow-up visit. Primary lymphoma is an uncommon pathological subtype. Its clinical and radiological differentiation from urothelial carcinoma (UC) can be challenging, but treatment strategies differ significantly. A definitive diagnosis relies on histopathology and immunohistochemistry. Typically, bladder lymphoma has a favorable prognosis, but further research is required to identify the optimal treatment.

A Gallbladder Ceratomyxidae (Myxozoa: Bivalvulida) Parasite Described In Pimelodella cristata (Müller & Troschel, 1848) From the Eastern Amazon.

The Myxozoa class is characterized by parasites that have valves joined by a suture line and polar capsules containing eversible spiral filamento and this class is considered an obligate parasite. The genus Ceratomyxa has approximately 300 species described in fish, both marine and freshwater fish, mainly infecting the gallbladder, but also occurring in the urinary bladder. This study describes a new species of Ceratomyxa in the Amazon region for Pimelodella cristata. For these analyses, the fish were desensitized by means of a medullary section with the aid of a sharp metallic instrument. With the fish desensitized, the entire body surface was examined under a binocular stereoscopic microscope. The gallbladder fragments were collected and fixed in Davidson for histological analyses and in ethanol for molecular analyses. This parasite was found in the host's gallbladder, with elongated spores in a decreasing shape in sutural view, measuring 1.64 ± 0.6μm in length and 17.13 ± 2.6μm in width. The polar capsules had a spherical shape of equal size and measured 1.36 ± 0.17μm in length and 0.9 ± 0.05μm in width, and each polar capsule contained 4 to 5 turns. Morphological and phylogenetic analyzes denote that this is a new species of the genus Ceratomyxa.

Ansurethral Removal of Vesical Fungal Bezoar Using Ho:YAG LASER—A Case Report

Fungal bezoars are extremely rare in the urinary bladder, and there is limited literature regarding the modality of management. We report a case, where the piecemeal removal of a vesical fungal bezoar was performed using Ho:YAG LASER. A 60-year-old man presented with lower urinary tract symptoms and on evaluation was diagnosed with vesical calculus. On cystoscopy, a white-colored, smooth contoured ball was identified in the bladder. The effective endourological modalities for the removal of fungal bezoar require mention in the literature. This case report demonstrates the possibility and efficiency of Ho:YAG LASER in the endourological retrieval of fungal bezoar in the bladder. The rarity of the diagnosis results in difficulty in prompt management.

Novel Method of Measuring Pelvic Floor Muscle Motion May Improve Accessibility of Pelvic Floor Muscle Coordination Training.

Pelvic floor muscle ultrasound is an important clinical tool for improving motor coordination and even strength. Although the gold standard approach involves transperineal probe placement, this is not always feasible with sensitive populations, requires privacy owing to probe placement, and additional sonography training. This article introduces a novel transabdominal method for measuring pelvic floor muscle motion that incorporates a reference point within the bladder. The hypothesis is that the novel measurement will correlate positively with transperineal measurements. A total of 55 women (15 nulliparous, 40 parous; 20 continent, 35 incontinent) performed pelvic floor muscle contraction and strain. Transabdominal ultrasound measured bladder diagonal length (BDL) and transperineal ultrasound measured bladder neck height (BNH), levator plate length (LPL), and levator plate angle (LPA). Spearman's test measured the correlation between the measurement outcomes and an independent t test compared outcomes based on parity and stress urinary incontinence symptom status. Spearman's correlation showed moderate positive correlations between the pelvic floor measurements for both tasks, which reduced slightly when grouping by parity and symptom status. Group differences were significant for BDL during the muscle contraction, factoring in SUI symptoms (p = 0.019) and parity status (p = 0.005) and LPL during contraction, factoring in parity status (p = 0.033). BDL correlates with BNH, LPL, and LPA with slightly reduced correlation when factoring in parity and continence status. The advantages of the method include accessibility for sensitive populations, nontraditional positions due to the anatomical reference point, functional locations due to limited privacy needs, and minimal training required for pelvic floor therapists to incorporate into rehabilitation.

The Therapeutic Effect of Monopolar Radiofrequency Therapy on Urinary Symptoms and Sexual Function.

Objectives: Stress urinary incontinence (SUI) negatively affects the quality of life and sexual function in women. This study aimed to evaluate the efficacy of radiofrequency (RF) therapy in reducing SUI symptoms and its impact on sexual function. Methods: Thirty-four women with SUI were enrolled and underwent a single RF treatment session using the Viveve® System (Viveve Medical Inc., USA) with parameters of 90 J/cm2 and 220 pulses per hour. Assessments at baseline and 6 months post treatment included perineal ultrasound and personal interviews to evaluate lower urinary tract symptoms and sexual function. Urodynamic studies, voiding diaries, and questionnaires such as the Female Sexual Function Index (FSFI), Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) measured outcomes. Results: RF therapy significantly improved sexual function, with higher FSFI scores in all domains except pain at 6 months. SUI symptoms were significantly reduced, as indicated by improved scores on OABSS, UDI-6, IIQ-7, and ICIQ-SF, alongside better voiding diary results. Anatomical changes included reduced bladder neck mobility, decreased vaginal width, and a reduced rotation angle of the proximal urethra. Conclusions: RF therapy is effective and safe for treating mild to moderate SUI and enhances sexual function, potentially due to changes in vaginal topography. These results suggest RF therapy as a viable non-surgical option for managing SUI and improving sexual health.

Signet ring cell carcinoma of the urinary bladder presenting with carcinocythemia and skeletal metastasis: A case report

Cancer of unknown primary accounts for approximately 3 &amp;ndash; 5% of all malignancies and is typically associated with a dismal prognosis. We describe a 65-year-old man who presented with skeletal metastasis and circulating tumor cells exhibiting signet ring (SR) morphology. The patient was diagnosed with SR cell carcinoma (SRCC) through a bone marrow biopsy. This case report aimed to emphasize the importance of clinicians&amp;rsquo; awareness of SRCC of the urinary bladder. The primary site of tumor origin was not identified as antemortem. The patient died 2 months after being admitted for pulmonary embolism. At autopsy, the urinary bladder was determined to be the primary site of the tumor. Primary SRCC of the urinary bladder is extremely rare. There are currently no established consensus guidelines for its management. Surgery continues to be the primary treatment option when the condition is localized.

Effects of Intraoperative Opioid Use and a Combined Anesthesia Protocol in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder—A Single-Center Experience

Background: An increased intraoperative opioid dose seems to lead to worse outcomes in several types of cancer. We assessed the effect of intraoperatively administered opioids as well as the type of anesthesia on survival, recurrence rates and major perioperative outcomes in patients who underwent radical cystectomy (RC) for urothelial carcinoma of the urinary bladder. Methods: We included patients who underwent open RC at our center between 2015 and 2022. The role of the type and dosage of intraoperative opioid agents, such as remifentanil, sufentanil and morphine milligram equivalents (MME), as well as the type of anesthesia (intravenous only versus intravenous/epidural), was assessed regarding perioperative and long-term outcomes after RC. Results: A total of 508 patients with a median age of 73 years (IQR: 64–78) were included. Overall, 92 (18%) patients received intravenous anesthesia, whereas 416 (82%) received combined anesthesia. At a median follow-up of 270 days (IQR: 98–808), 108 (21%) deaths and 106 (21%) recurrences occurred. Combined anesthesia was associated with better survival (HR:0.63, 95% CI: 0.4–0.97, p = 0.037) and lower intensive care unit admission rates (OR: 0.49, 95% CI: 0.31–0.77, p = 0.002) in the univariate analysis (unadjusted). The type and dosage of intraoperative opioid agents did not affect long-term survival and recurrence rates, as well as major perioperative outcomes. Nevertheless, the findings of our study were limited by its single-center, retrospective design. Conclusion: The use of intraoperative opioids was not associated with worse outcomes in our cohort, while the use of additional epidural anesthesia seems to be beneficial in terms of overall survival and intensive care unit admissions. Nevertheless, further research is mandatory to validate the safety of opioids in patients undergoing RC.

Is It Possible to Regenerate the Underactive Detrusor? Part 1 Molecular and Stem Cell Therapies Targeting the Urinary Bladder and Neural Axis ICI-RS 2024.

Detrusor muscle weakness is commonly noted on urodynamics in patients with refractory voiding difficulty. No approved therapies have been proven to augment the strength of a detrusor voiding contraction. This subject was discussed by a think-tank at the International Consultation on Incontinence- Research Society (ICI-RS) meeting held in Bristol, June 2024. The discussions of the think-tank are being published in two parts. This first part discusses molecular and stem cell therapies targeting the urinary bladder and the neural axis. Senescence of the urothelium and extracellular ATP acting through P2X3 receptors might be important in detrusor underactivity. Several molecules such as parasympathomimetics, acotiamide, ASP8302, neurokinin-2 agonists have been explored but none has shown unequivocal clinical benefit. Different stem cell therapy approaches have been used, chiefly in neurogenic dysfunction, with some studies showing benefit. Molecular targets for the neural axis have included TRPV-4, Bombesin, and serotoninergic receptors and TAC-302 which induces neurite growth. Several options are currently being pursued in the search for an elusive molecular or stem cell option for enhancing the power of the detrusor muscle. These encompass a wide range of approaches that target each aspect of the contraction mechanism including the urothelium of bladder and urethra, myocyte, and neural pathways. While none of these have shown unequivocal clinical utility, some appear promising. Lessons from other fields of medicine might prove instructive. Not necessary. Not a clinical trial.

Siddha Management of Geriatric Urolithiasis (Kallataippu- XA) - A Single Case Report

Introduction: Kallataippu (NSMC-XA, Urolithiasis or Nephrolithiasis) is one of the most common emerging urological disorders worldwide with an increasing frequency in geriatric patients (&gt;65 years). Siddha system provides oral medications for the management of urolithiasis which is non-invasive and cost effective. Method: A 68-year-old patient approached the OPD with complaints of episodic flank pain radiating from the loin to the groin region, pain, and an urge to urinate. On interrogation, the patient gave a history of poor water intake. Ultrasound scan of the abdomen revealed the renal calculi measuring 3 mm noted in the mid-pole calyx of the right kidney, 4 mm in the upper pole calyx of the left kidney and the Urinary bladder is partially distended with a 4.0 mm thickened wall. It was diagnosed as Kallataippu (XA- Urolithiasis) based on signs and symptoms and investigational reports. The patient was administered a combination of medicines based on the Siddha line of treatment. Result: In the first follow-up, the patient informed that he experienced moderate pain and disturbance in the urine flow and the first stone was expelled out through urine on the second follow-up. The patient got moderate relief from pain in the abdomen and did not experience dysuria, and the second stone was expelled through urine on the third follow-up. The patient was asked to take CT-KUB on the fourth follow-up. The reported case has a prospective follow-up for 6 months and was found to be free of renal stone-related complaints. Conclusion: The present work suggests that the combination of Siddha drugs markedly worked well on the disintegration and expulsion of the calculi in the geriatric age.

Evaluation of the Effect of Vaginal Delivery on Stress Urinary Incontinence and Bladder Neck Mobility with Transperineal Ultrasonography

Aim: Stress urinary incontinence is a common and distressing situation in females, impacting emotional and psychological well-being by interrupting sexual, physical, and social forms of life. Perineal trauma, especially at childbirth, is one of the most common contributing factors. The objective of this research is assessing the impact of vaginal delivery, a factor known to elevate the likelihood of postpartum stressxincontinence, on bladder neck mobility. This evaluation will be conducted utilizing transperinealxultrasonography, a noninvasivexand well-toleratedxdiagnostic technique. Materials and Methods: In our study, 116 patients who gave birth in our hospital between January 2020 and May 2022 were evaluated retrospectively. The presence of stress urinary incontinence and transperineal ultrasonography data of all patients were examined from the patient files. To evaluate changes in bladder neck motility, ultrasound measurements made both prenatally and postnatally were evaluated retrospectively. Results: With regard to the demographic values of the patients, a statistically significant difference was seen in terms of the presence of urinary incontinence when multiparous and primiparous patients were compared with patients in the cesarean section group (p:0.01). There was a significant difference in ΔDx, ΔDy, and M values for the cesarean delivery group as compared to both the primiparous and multiparous vaginal delivery groups (p