Cystitis Glandularis Research Articles

Development and validation of a predictive nomogram for the risk of recurrence in patients with cystitis glandularis.

BackgroundMost patients with cystitis glandularis (CG) suffer from recurrence after primary treatment. Therefore, we performed this multicenter study to clarify the recurrent risk factors and constructed a predictive nomogram for the risk of recurrence. Also, we try to investigate the correlation between CG and bladder cancer.MethodsConsecutive patients with pathologically confirmed CG were divided into training and validation sets. Clinicopathological characters were collected from electronic medical records. Uni- and multivariate logistic regression analyses were used to identify independent risk factors of CG recurrence in the training set. The predictive nomogram was developed by incorporating these independent factors and histological subtype. The performance of the nomogram was assessed and validated with respects to its calibration, discrimination, and clinical usefulness. The risk of developing subsequent bladder cancer was analyzed from the follow-up data.ResultsUltimately, 278 eligible patients were included and were allocated to a training set (n=190) and a validation set (n=88). Of them, 165 (59.35%) patients experienced CG recurrence, and none showed evidence of subsequent bladder carcinoma during a median (IQR) follow-up time of 27 months (14–57 months). Results of multivariate analysis showed that urinary infections, long-term indwelling catheter usage, urinary calculus, squamous metaplasia, and atypical hyperplasia were independent risk factors of CG recurrence. The C-index (95% CI) of the nomogram was 0.76 (0.69–0.83) in the training set and 0.72 (0.61–0.83) in the validation set. A decision curve analysis (DCA) demonstrated that this predictive nomogram was clinically useful.ConclusionsWe developed and validated a nomogram to predict the individualized risk of CG recurrence. Also, we demonstrated that neither intestinal nor typical CG increased the consequent risk of bladder cancer during the follow-up period.

Nadir bir olgu sunumu: Mesanenin intestinal metaplazisi

Intestinal metaplasia of the bladder, characterized by the presence of an intestinal-type epithelium in the urothelium, is a glandular proliferation and extremely rare benign lesion. The pathogenesis of this uncommon entity is unclear, and its role as a precursor of adenocarcinoma is controversial. We present a case of a 45-year-old man admitted with macroscopic hematuria and mucosuria. Ultrasound showed a 32×25×6 mm hypoechoic nodule with regular contours on the posterior wall. Histopathological examination following transurethral resection revealed an intestinal metaplasia against a background of cystitis glandularis.

Glandular-type inverted papilloma of urinary bladder – Report of a unique case with immunohistochemistry

Inverted papilloma of urothelium is a rare benign tumour accounting for 1-2% of all the urothelial lesions. Morphologically, these are of two main subtypes - trabecular and glandular, of which the former subtype is most frequently encountered compared to the latter. The glandular subtype closely mimics cystitis glandularis and urothelial carcinoma with inverted growth pattern. We discuss a case of a 27-year-old male presenting with hematuria. On cystoscopy, he was found to have a bladder mass which was diagnosed as glandular-type of inverted papilloma on histopathology. The image illustrates the histopathology for easy identification and early diagnosis of this rare entity.

Network analysis, and human and animal studies disclose the anticystitis glandularis effects of vitamin C.

Our present study aimed to unravel the therapeutic biotargets of vitamin C (VC) against cystitis glandularis (CG), and to elucidate the molecular mechanisms for VC treating CG. Network pharmacology was used to predict therapeutic targets of VC against CG, and to identify molecular mechanisms. In addition, further human and animal studies were designed to validate the bioinformatic findings through biochemical tests, computerized tomography scans, and immunostaining assays. In bioinformatic analyses, pathogenic targets of CG and putative targets of VC were identified, respectively. An interaction network between biological target and functional protein was produced before screening and collecting the key therapeutic targets of VC against CG, biological processes, and signaling pathways. In addition, ingenuity pathway analysis with cloud platform indicated that anti-CG mechanisms of VC were achieved through modulating a cluster of molecular pathways, such as tumor necrosis factor (TNF) pathway. Meanwhile, 18 core targets of VC against CG were identified, and the most important TNF, interleukin-6 (IL6), and Jun biotargets were obtained, respectively. In further validation in human study, cellular TNF-α, IL6, and c-Jun expressions in patient's CG samples were elevated significantly, accompanied with detectable urinary tract infection. Beneficially, VC-dosed CG mice resulted in downregulated expressions of endogenous TNF-α, IL6, and c-Jun in blood and bladder samples. Collectively, these bioinformatic findings and experimentative data uncover the therapeutic targets and biological mechanisms of VC for treating CG, in which the key biomarkers of TNF-α, IL6, and c-Jun may be the potential molecules for treating CG in clinical application.

UCA1 promotes cell viability, proliferation and migration potential through UCA1/miR-204/CCND2 pathway in primary cystitis glandularis cells

Cystitis glandularis (CG) is an unusual proliferative disorder of the urinary bladder. Increasing evidences demonstrated that long non-coding RNAs (lncRNAs) play important roles in a variety of cellular progresses. However, there are rarely reports about the role and underlying molecular mechanism of lncRNAs in CG. In this study, we firstly isolated the primary cells from the tissues of CG and adjacent normal tissues, and found that UCA1 was up-regulated in the primary CG cells (pCGs). Then, we showed that knock out of UCA1 reduced the cell viability, inhibited the cell proliferation and restrained the migration potential and overexpression of UCA1 promoted that in pCGs. Furthermore, we demonstrated that UCA1 played its role via sponging of the miR-204 in pCGs. In addition, we illustrated that miR-204 exerted its function via targeting CYCLIN D2 (CCND2) 3′UTR at mRNA level in pCGs. Ultimately, we revealed the role and regulation of UCA1/miR-204/CCND2 regulatory axis in pCGs. In summary, our study, for the first time, revealed the role and underlying mechanism of an lncRNA UCA1 in CG, providing a potential biomarker and therapeutic target for human CG.

Sex steroid hormone receptors in bladder cancer: Usefulness in differential diagnosis and implications in histogenesis of bladder cancer

ObjectiveIn rare cases, differential diagnosis between bladder cancer (BC) and gynecological tract cancer (GTC) is difficult because of anatomical proximity and morphological similarity. We analyzed expression status of sex steroid hormone receptors in BC in this study. First, we investigated their usefulness as a histological marker for differential diagnosis. Second, we considered their roles in BC histogenesis. MethodsEstrogen receptor α (ERα) and progesterone receptor (PgR) expression was investigated by immunohistochemistry in 125 BCs obtained by transurethral resection or biopsy, then in nonneoplastic background mucosa (trigone, fundus, and dome) of 33 total cystectomy samples. They were evaluated as positive when ≥ 1% of 500 subject cells were immunoreactive with moderate or strong intensities. ResultsERα and PgR were positive in 38.4% and 3.2% of BCs, respectively, suggesting that ERα status alone could not definitely differentiate between BC and GTC. ERα expression was not significantly associated with age and sex of BC patients and histopathology of BCs. Although not significant, ERα expression was more frequent in higher grade (G1/G2 vs. G3/G4; P = 0.143) and marginally associated with advanced stage of BCs (pTis/pTa/pT1 vs. pT2/pT3, P = 0.056). ERα expression was significantly more frequent in background mucosa with ERα-positive BC (In the epithelium and stroma; both P < 0.001). ERα expression was continuously observed from normal to malignant epithelium in some cases. Although not significant, Brunn's nest or cystitis glandularis was more frequent in background mucosa with ERα-positive BC (P = 0.218). Analyses of nonneoplastic mucosa in cystectomy revealed that ERα was more frequently positive in urothelium of trigone, a predilection site for cystitis glandularis, than those of fundus and dome, with a significant difference between trigone and dome (P = 0.034). These data suggest that chronic inflammation may up-regulate ERα in the background epithelium, especially in trigone, and ERα expression in BC might be the reflection of bladder epithelium from which BC arose. ConclusionsUsefulness of ERα was limited in differential diagnosis between BC and GTC. ERα up-regulation might not play a critical role in the development of BC because it was already noted in the background bladder mucosa.

Cystitis glandularis (intestinal type) in cattle: Pathological and immunohistochemical characterization

Cystitis glandularis (intestinal type) in cattle: Pathological and immunohistochemical characterization

AB065. Confocal laser endomicroscopy for diagnosing malignant bladder tumour: a pilot study

BackgroundTo perform an exploratory investigation on confocal laser endomicroscopy (CLE) in the diagnosis of malignant bladder tumour.MethodsFrom June 10 to July 11, 2017, patients initially diagnosed with bladder cancer by cystoscopy were hospitalised and had undergone white light cystoscopy (WLC) + CLE examination followed by transurethral resection of bladder tumour (TURBT) on suspected lesions. WLC and CLE imaging results were recorded and validated by pathologic specimens.ResultsLesions confirmed by histopathology were 3 low-grade non-invasive papillary urothelial carcinomas, 1 high-grade non-invasive papillary urothelial carcinoma, 1 low-grade invasive urothelial carcinoma, 1 high-grade invasive urothelial carcinoma, 1 carcinoma in situ (CIS), 1 high-grade dysplasia, 1 cystitis glandularis, 1 chronic inflammation, and 1 scar tissue. For CLE images in the normal urothelium, three layers of cells with different presentation were observed, namely, the superficial umbrella cells, the intermediate cells smaller in size and uniformly shaped, and the capillary network in the lamina propria. For non-invasive urothelial carcinoma, tumour cells appeared as papillary lesions growing from fibrovascular cores, with low-grade cells appearing monomorphic and more cohesively arranged, and high-grade cells relatively pleomorphic, more disorganised and with tortuous blood vessels in the fibrovascular core. For invasive urothelial carcinoma, tumour cells invaded the lamina propria, with uniform appearances, poor cohesion and indistinct cellular borders, and high-grade ones were more pleomorphic. CIS and inflammation both appeared as erythematous patch-like flat lesions under WLC and sometimes difficult to differentiate. Under CLE, the former appeared as dysplastic and disorganised cells with indistinct cellular borders, with intact lamina propria, and inflammatory cells were discovered as infiltrative clusters in the lamina propria that were uniformly shaped and loosely connected. Dysplasia appeared somewhat similar compared with CIS under WLC, but with lower cellular irregularity as confirmed with pathology. Cellular appearance and structure in scar tissue were similar to that in the normal urothelium, but superficial umbrella cells were more likely absent, with thinner cell layers, and inflammatory infiltration was sometimes discovered in the lamina propria.ConclusionsCLE provides real-time cellular imaging of the urothelium, and shows promising potential for clinical diagnosis, especially in differentiating flat urothelial lesions. Large prospective studies are required for further validation.

Inflammatory cells infiltration status in bladder submucosa of patients with cystitis glandularis and its clinical significance

Objective To analyze the infiltration of inflammatory cells under the mucosa of female cystitis glandularis and the different inflammatory infiltration in different clinical pathological types of cystitis glandularis. Methods Immunohistochemical method was used to detect the bladder mucosal tissue samples of 10 female patients confirmed cystitis glandularis admitted from June 2016 to October 2016.The results of immunohistochemical staining were collected and statistically analyzed by the automatic microscopy and image analysis system.In addition, the clinical data and tissue sample of 49 cases of cystitis glandularis treated from December 2006 to August 2017 were collected. Age of 49 patients was (34.4±7.5) years old and BMI was (21.9±4.2) kg/m2. There were 19 cases of hypertension and 18 cases of diabetes. According to the cystoscopic manifestations, follicular edema type, papilloma type, and intestinal adenomatosis type were defined as high risk. Chronic inflammatory type and mucosa unchanged type were defined as low risk. Immunohistochemical staining was used to detect tissue samples, to compare the general data of different types of cystitis glandularis and the degree of infiltration of bladder mucosal inflammatory cells. Results T lymphocytes were highly expressed in 10 patients, and B lymphocytes and plasma cells were not expressed or extremely low(P 0.05). The OABSS of high-risk group(10.4±2.6)was significantly higher than that of low-risk group(7.1±2.1, P<0.01). QOL of high-risk group(4.9±0.9)was significantly higher than that of low-risk group(4.1±0.8, P<0.01). Qmax of high-risk group was (11.4±3.6) ml/s, significantly lower than that of low-risk group[(15.8±3.8)ml/s, P<0.01]. The positive number of T lymphocytes of high-risk group was (173.5±26.8), which was significantly higher than that of low-risk group(119.5±21.2, P<0.01). Conclusions T lymphocytes infiltration is the major phenomenon in bladder submucosa of female patients with cystitis glandularis. The inflammatory infiltration by T lymphocytes could be associated with patient’s symptom and bladder’s pathological changes. Key words: Cystitis glandularis; T lymphocyte; Immunohistochemistry; nonresolving inflammation

Confocal laser endomicroscopy for diagnosing malignant bladder tumour: a pilot study

Objective To perform an exploratory investigation on confocal laser endomicroscopy (CLE) in the diagnosis of malignant bladder tumour. Methods From June 10 to July 11, 2017, 6 male bladder cancer patients underwent white light cystoscopy (WLC)+ CLE examination, aging 64-86 years (median 72 years). All patients received TURBT on suspected lesions. WLC and CLE imaging results were recorded and validated by pathologic specimens. Results Lesions confirmed by histopathology were 3 low grade non-invasive papillary urothelial carcinomas, 1 high grade non-invasive papillary urothelial carcinoma, 1 low grade invasive urothelial carcinoma, 1 high grade invasive urothelial carcinoma, 1 carcinoma in situ (CIS), 1 high grade dysplasia, 1 cystitis glandularis, 1 chronic inflammation, and 1 scar tissue. For CLE images in the normal urothelium, three layers of cells with different presentation were observed, namely, the superficial umbrella cells, the intermediate cells smaller in size and uniformly shaped, and the capillary network in the lamina propria. For non-invasive urothelial carcinoma, tumour cells appeared as papillary lesions growing from fibrovascular cores, with low grade cells appearing monomorphic and more cohesively arranged, and high grade cells relatively pleomorphic, more disorganised and with tortuous blood vessels in the fibrovascular core. For invasive urothelial carcinoma, tumour cells invaded the lamina propria, with uniform appearances, poor cohesion and indistinct cellular borders, and high grade ones were more pleomorphic. CIS and inflammation both appeared as erythematous patch-like flat lesions under WLC and sometimes difficult to differentiate. Under CLE, the former appeared as dysplastic and disorganised cells with indistinct cellular borders, with intact lamina propria, and inflammatory cells were discovered as infiltrative clusters in the lamina propria that were uniformly shaped and loosely connected. Dysplasia appeared somewhat similar compared with CIS under WLC, but with lower cellular irregularity as confirmed with pathology. Cellular appearance and structure in scar tissue was similar to that in the normal urothelium, but superficial umbrella cells were more likely absent, with thinner cell layers, and inflammatory infiltration was sometimes discovered in the lamina propria. Conclusions CLE provides real-time cellular imaging of the urothelium, and shows promising potential for clinical diagnosis, especially in differentiating flat urothelial lesions. Large prospective studies are required for further validation. Key words: Bladder cancer; Cystoscopy; Confocal laser endomicroscopy; Pathological diagnosis

Processing techniques and safety analysis for transurethral resection of bladder lesions

Objective To evaluate the processing techniques and safety of ureteral stent after transurethral resection (TUR) of bladder lesions involving the ureteral orifice. Methods From January 2010 to August 2016, 42 cases of non-muscle invasive bladder tumor and 18 cases of glandular cystitis including 44 male and 16 female aged from 32 to 81 years(mean 55 years) were treated by TUR. Twenty-three cases of bladder tumor had single tumor and 19 cases had multiple tumors, and 37 cases were primary and 5 cases were recurrent. All the patients without preoperative hydronephrosis revealed by imageological examination.The lesions were resected into the deep muscle layer and involved ureteral orifice were resected during the procedure and after that a Double-J ureteral stent was placed in all cases.When looked for the ureteral orifice, we followed the ureteral peristalsis step by step, and found " concentric circles" muscle tissue.Then we used the guide wire as a guide for ureteral stenting. All the patients received one immediate intravesical instillation of 50 mg pirarubicin after TUR, and further scheme of adjuvant intravesical instillation was made according to the pathological diagnosis. Ureteral stents were removed 8~10 weeks after TUR, imageological examination were performed every three months. Results The operations were successful without complications. No serious adverse reaction occurred in adjuvant intravesical instillation chemotherapy. During the follow-up period of 4~60 months, no ureteral stricture and hydronephrosis occurred in all patients with ureteral stent, and the resected ureteral orifices recovered well with normal appearance and ejecting urine. Conclusions The ureteral orifice usually need to be removed during TUR for bladder lesions, and the way we following the ureteral peristalsis to resect the ureteral orifice is effective.Ureteral stenting after TUR of bladder lesions involving the ureteral orifice can prevent stricture at the ureterovesical junction without increasing the risk of tumor cell seeding along the upper urinary tract. Key words: Cystectomy; Urethra; Electrosurgery; Ureter

Cystitis Glandularis: A Rare Benign Condition Presenting as Bladder Tumor

Cystitis glandularis or glandular metaplasia of the urinary bladder, is a benignreactive metaplasia of the urothelium, which occurs in the context of chronic irritation, in less than 2% of the general population. It is a condition in most casesasymptomatic, but also characterized by nonspecific symptoms and paraclinical findings, which is why this condition is underdiagnosed. Its evolution is mainly focused on the risk of malignant degeneration. This condition affects men much more commonly than women. Two forms of cystitis glandularis are recognized: typical and intestinal form. They differ in their histology, incidence, difficulty of diagnosis, and possible association with adenocarcinoma of the bladder. Diagnosis of certainty is histological by careful analysis of chips from bladder endoscopic resection. This rare pathology is managed by endoscopic bladder resection, with repeated cystoscopy as a monitoring tool. Extensive surgical is needed in severe or recurrent cases. We present here-in a case of a female patient having cystitis glandularis presenting with lower urinary tract symptoms. We review equally data reported in literature. To the best of our knowledge our case represents the fourth case of cystitis glandularis affecting a female patient reported in the English literature so far.

Diagnostic value of glucose transporter 1 (glut-1) expression in nested variant of urothelial carcinoma

Nested variant is bland-looking but aggressive subtype of urothelial carcinoma (UC). Cases having significant muscle invasion do not cause problems but small and superficial biopsies may be challenging due to morphological similarities between nested variant urothelial carcinoma and benign urothelial lesions. We studied Glucose transporter 1 (GLUT-1), which is an integral membrane protein providing glucose pass through plasma membrane down its concentration gradient, to see if it is useful for the differential diagnosis. Twenty five cases of nested variant urothelial carcinoma and a control group consisting of 12 cases of cystitis glandularis, cystitis cystica and 4 cases of inverted papilloma were stained with GLUT-1 immunohistochemically. Membranous staining was scored on a scale of 0 to +3. Eleven of 25 nested variant UC cases showed a score of 2 and 14 of them showed a score of 3 on immunostaining with GLUT-1. Two cases showed a score of 1 and 10 cases did not show any staining in the control group. Our results showed that GLUT-1 may be a helpful marker when morphological separation cannot be made between nested variant UC and benign urothelial leisons. We also think that anti-GLUT-1 antibody treatment may be an option in the targeted treatment of nested variant.

Urodynamic characteristics of pelvic lipomatosis with glandular cystitis patients correlate with morphologic alterations of the urinary system and disease severity.

To explore urodynamic characteristics and their clinical value in pelvic lipomatosis (PL) patients. We reviewed the clinical information of 84 PL patients. A voiding pressure-flow study was used to classify patients into nonoutlet obstruction (NOO), latter-half-section obstruction (LHSO), or whole-section bladder outlet obstruction (BOO) groups. Urinary morphologic features were measured by imaging examination and cystoscopy. A unique LHSO that presented as sudden increasing detrusor pressure (Pdet) and decreasing flow rate in the latter half of voiding was observed for 52.4% (44 of 84) patients. Overall, 27.4% (23 of 84 patients) were diagnosed with BOO with whole-section increasing Pdet and decreasing flow rate. According to the morphologic feature analyses, the NOO patients had the largest angle of anteroposterior vesical walls (P < 0.001) and the least severe thickened bladder trigone (P = 0.015). The external compression at the bladder neck and thickened bladder trigone caused a prolonged and strictured bladder outlet tract (see the Supplementary video). There were 0, 5, and 4 urinary diversions performed in the NOO, LHSO, and BOO groups at diagnosis (P = 0.055). No patients in the NOO group, seven in the LHSO group, and two patients in the BOO group had disease progression at follow-up. Two LHSO patients and one BOO patients without hydronephrosis at diagnosis developed to hydronephrosis during follow-up. Morphologic alterations of the urinary system of PL patients lead to unique LHSO or BOO on UDS. The presences of LHSO and BOO are associated with disease severity and progression.

Identification and Validation of Gene Expression Patterns in Cystitis Glandularis Patients and Controls

Our aim was to investigate differences in gene expression in bladder tissues between cystitis glandularis (CG) patients and healthy controls. Subsequent RNA was isolated from urinary bladder samples from CG patients and healthy controls, followed by RNA sequencing analysis. There were 4263 differentially expressed genes in urinary bladder between CG patients and controls, and 8 genes were verified with real-time PCR, Western blot, and enzyme-linked immunosorbent assay (ELISA) analysis. Gene set enrichment analysis (GSEA) revealed that 25 signaling pathways were upregulated in CG patients, and 17 signaling pathways were found upregulated in healthy controls. The mRNA expression levels of the indicated genes, including CCND1, CCNA1, EGFR, AR, CX3CL1, CXCL6, and CXCL1, were significantly increased in urinary bladder from CG and bladder cancer (BC) patients compared with healthy controls, while TP53 was decreased. CX3CL1, CXCL6, and CXCL1 concentrations in peripheral blood from CG and BC patients were significantly increased compared with healthy controls. The protein expression levels of CCND1, EGFR, and AR were significantly increased in urinary bladder from CG and BC patients compared with healthy controls. In conclusion, the gene expression profile of CG patients has established a foundation to study the gene mechanism of CG and BC progression.

Intestinal Type of cystitis glandularis mimicking bladder tumor- case report and review of literature

Cystitis Glandularis of Intestinal type is an uncommon proliferative disorder with metaplastic alteration of the urothelium showing mucous secreting intestinal glands in the urinary bladder. An association of Adenocarcinoma with longstanding intestinal metaplasia of urothelium is controversial. Due to lack of this evidence and prognosis, we report a case of a 16-year-old male presenting with dysuria and a space occupying lesion in the bladder masquerading as a tumor mass. Cystoscopy revealed a well-circumscribed irregular nodal growth arising from the anterior wall of the bladder. Transurethral resection of the mass was performed and the histopathology suggested Cystitis Glandularis of Intestinal Type.

Badder invasive transitional cell carsinoma, which improves from cystitis cystica and glandularis; ıs cystitis cystica and glandularis is a precancerous lesion ?

Badder invasive transitional cell carsinoma, which improves from cystitis cystica and glandularis; ıs cystitis cystica and glandularis is a precancerous lesion ?

Involvement of cancer-derived IgG in the proliferation, migration and invasion of bladder cancer cells.

It is widely accepted that immunoglobulin (Ig), the classical immune molecule, is extensively expressed in many cell types other than B-cells (non-B-IgG), including some malignant cells. The expression of Ig in malignant cells has been associated with a poor prognosis. In the present study, immunohistochemical analysis detected strong positive staining of IgG in three bladder cancer cell lines, the cancer cells in 77 bladder cancer patient samples and the cells in 3 cystitis glandularis tissue samples, while negative staining was observed in 4 specimens of normal transitional epithelial tissues. Importantly, functional transcripts of IgG with unique VHDJH rearrangement patterns were also found in bladder cancer cells. The knockdown of IgG in bladder cancer cell lines using small interfering RNA significantly inhibited the proliferation, migration and invasion of the cells. Notably, high IgG expression, as determined by immunostaining, was significantly correlated with a high histological grade and recurrence. The results of the present study suggested that IgG expression is involved in the malignant biological behavior and poor prognosis of bladder cancer. Therefore, IgG may serve as a novel target for bladder cancer therapy.

Preliminary study of diffusion-weighted MRI in the preoperative diagnosis of cystitis glandularis

To assess the efficacy of diffusion-weighted (DWI) magnetic resonance imaging (MRI) in distinguishing cystitis glandularis (CG) from bladder urothelial carcinoma. Ultrasound, computed tomography (CT), conventional MRI, and DWI of 30 patients with histopathologically confirmed CG were analysed retrospectively and the imaging findings were correlated to the findings at histology. Ultrasound was non diagnostic in 11/18 and misdiagnosed malignancy in 7/18; CT was non diagnostic in 6/10 and misdiagnosed malignancy in 4/10; MRI was non diagnostic in 0 and misdiagnosed malignancy in 4/5 respectively. One patient with diffuse bladder wall thickening was correctly diagnosed as CG at MRI. All six patients who underwent additional DWI were accurately diagnosed as having CG with no or minimal reduction of diffusion. Diffusion is not reduced or shows minimal reduction in CG. DWI may aid the differential diagnosis of CG.

Modified ureterosigmoidostomy (Mainz Pouch II) urinary diversion: 10 years experience and follow-up

Objective To report 10 years experience in modified ureterosigmoidostomy (Mainz Pouch Ⅱ) urinary diversion and evaluate its long-term outcome. Methods From October 2004 to December 2014, 248 patients , including 205 men and 43 women, had underwent Mainz Pouch Ⅱ urinary diversion at 26 institutions in Gansu Province, China.The median age at surgery was 61 years, ranged from 15 to 79 years, Among those patients, 239 patinets were diagnosed as bladder invasive urothelial carcinoma, including urothelial carcinoma in 230, squamous cell carcinoma in 6, adenocarcinoma in 2 and leiomyosarcoma in 1. 200 male patients underwent the radical vesico-prostsectomy. 39 female patients underwent the exenteration of total pelvis with bilateral pelvic lymadenectomy. For one paitent with urethral squamous cell carcinoma, exenteration of total pelvis, urethra resection and bilateral pelvic lymadenectomy were performed at the same time. Simple cystectomy were performed in 5 patients, including bladder retraction as a consequence of urinary tuberculosis, exstrophy bladder, interstitial cystitis, glandular cystitis and refractory vesicovaginal fistula. Bricker ileal conduit urinary diversion was transformed to Mainz Pouch Ⅱ in three patients. Clinical data and early complications were retrospective analysis. Data on long-term complications, continent status, urinary frequency and patient's quality of life were investigated by follow-up. Results The median operative time for urinary diversion is 120 minutes (ranging from 90 to 150 minutes). The median estimated blood loss was 800 ml (ranging from 400 to 2 500 ml). Seven patients (7/248, 2.8%) died in the perioperative period. Early complications were noticed in 66 patients (66/248, 26.6%), such as intestinal fistula(6/248, 2.4%), pulmonary infection(5/248, 2.0%), ileal obstruction (4/248, 1.6%), pyelonephritis(4/248, 1.6%), deep venous thrombosis(2/248, 0.8%), pelvic infection(2/248, 0.8%), wound dehiscence (10/248, 4.0%), superficial wound infections (30/248, 12.1%), hemorrhagic shock(1/248, 0.4%), myocardial infarction (1/248, 0.4%) and rectovaginal fistula (1/248, 0.4%). Thirty-seven patients (15.4%, 37/241) were lost during follow-up and eighty-five (41.7%, 85/204) passed away. 119 patients were followed from 7 to 126 months (mean 46 months). Late complications occurred in 29.4% of patients (60/204), including uretero-intestinal anastomotic stricture (20/204, 9.8%, 24 of 400 renoureteric units, 6.0%), recurrent pyelonephritis (12/204, 5.9%), delayed ileal obstruction (11/204, 5.4%), symptomatic metabolic acidosis (11/204, 5.4%), incisional hernia (5/204, 2.5%), pelvic infection (1/204, 0.5%). The overall quality of life was described as 'fully satisfied' by 20 patients (20/119, 16.8%), 'moderately satisfied' by 87 patients (87/119, 73.1%) and 'Poorly satisfied' by 12 patients (12/119, 10.1%). At the end of follow-up, three patients were excluded due to conversion to permanent nephrostomy. The other patients were continent at day time. Completely continence was achieved in 92 of 116 (79.3%) patients during the day and night. Conclusions Mainz Pouch Ⅱ is a simple and feasible procedure to achieve continent urinary diversion, with excellent continence rate and good quality of life. When the patient refused to have an incontinent urinary diversion, it may be used as a convenient and satisfactory alternative for cystectomized patients who are not suitable for orthotopic urinary diversion due to bladder cancer invasion into prostate or urethra. Key words: Ureterosigmoidostomy; Urinary diversion; Mainz Pouch Ⅱ; Surgical complications; Follow up