Bladder Irritation Research Articles

LOWER URETERIC STONES

Aims & Objectives: Placement of a ureteral stent is routinely done followed byureteroscopy. Recently, many researchers have questioned routine stenting after ureteroscopyfor management of distal ureteric stones? We report our outcomes of a randomized studycomparing ureteroscopy with and without placement of stents for management of distalureteric stones. Study Design: Randomized controlled trial. Setting: Department of Urology,Jinnah Hospital/ Allama Iqbal Medical College, Lahore. Period: March 2013 to February, 2015.Materials & methods: Total 155 patients were prospectively divided into three groups to receivea double J stent (Group I, 54 patients), ureteral stent (Group II, 50 patients) and no stent (GroupIII, 51 patients), underwent ureteroscopic treatment of distal ureteric stones. Characteristics ofstones, operation time, postoperative pain, lower urinary tract symptoms, and analgesia needfor postoperative pain, hospitalization, stone free rate and late postoperative complicationswere all studied. Results: There were no significant differences in preoperative data. Therewas no statistical significant difference between three groups regarding hematuria, fever, flankpain, urinary tract infection and re-hospitalization. At 48 hours and 1 week, frequency/ urgencyand dysuria were significantly less group III. When comparing Group I and Group III, patientswith double J stent has statistically significant more bladder pain 0, frequency/ urgency 0,dyusuria 0 and need of analgesia 0. All patients of the three groups assessed postoperativelyby imaging did not suffer any obstruction or ureteral stricture. Conclusion: Uncomplicatedureteroscopy without stent placement for treatment of distal ureteral stones is a safe procedure.Patients without stents have significantly fewer irritative bladder symptoms and are not at riskof complications.

Early Stent Removal After Kidney Transplantation: Is it Possible?

BackgroundThe most important surgical complications of renal transplantation are stenosis and obstruction of the ureterovesical anastomosis. Routine use of ureteral stents can prevent this complication, but the optimal time for ureteral stent use is still controversial.ObjectivesThe purpose of this study is to compare the benefits and complications of early and delayed stent removal after surgery. Early ureteral stent removal can decrease some complications, such as urinary tract infections (UTIs), bladder irritation symptoms, persistent hematuria, and the risk of stent crusting; its benefits include easier stent removal and shorter hospitalization time.Patients and MethodsAll patients who underwent kidney transplantation from May 2011 until March 2012 in Modarres Hospital were included in this study. We classified the patients into three groups, based on time of stent removal (10, 20, and 30 days after transplantation).ResultsNinety-one patients were studied; urologic complications (hydroureteronephrosis and urinoma) in these three groups were analyzed and showed no statistical significant difference.ConclusionsWe can remove the ureteral stent earlier after kidney transplantation with no increase in the prevalence of surgical complications.

English

Aims & Objectives: Placement of a ureteral stent is routinely done followed byureteroscopy. Recently, many researchers have questioned routine stenting after ureteroscopyfor management of distal ureteric stones? We report our outcomes of a randomized studycomparing ureteroscopy with and without placement of stents for management of distalureteric stones. Study Design: Randomized controlled trial. Setting: Department of Urology,Jinnah Hospital/ Allama Iqbal Medical College, Lahore. Period: March 2013 to February, 2015.Materials & methods: Total 155 patients were prospectively divided into three groups to receivea double J stent (Group I, 54 patients), ureteral stent (Group II, 50 patients) and no stent (GroupIII, 51 patients), underwent ureteroscopic treatment of distal ureteric stones. Characteristics ofstones, operation time, postoperative pain, lower urinary tract symptoms, and analgesia needfor postoperative pain, hospitalization, stone free rate and late postoperative complicationswere all studied. Results: There were no significant differences in preoperative data. Therewas no statistical significant difference between three groups regarding hematuria, fever, flankpain, urinary tract infection and re-hospitalization. At 48 hours and 1 week, frequency/ urgencyand dysuria were significantly less group III. When comparing Group I and Group III, patientswith double J stent has statistically significant more bladder pain 0, frequency/ urgency 0,dyusuria 0 and need of analgesia 0. All patients of the three groups assessed postoperativelyby imaging did not suffer any obstruction or ureteral stricture. Conclusion: Uncomplicatedureteroscopy without stent placement for treatment of distal ureteral stones is a safe procedure.Patients without stents have significantly fewer irritative bladder symptoms and are not at riskof complications.

A novel treatment approach prolonging survival in an uncommon metastatic primary bladder adenocarcinoma.

Primary bladder adenocarcinoma (PBA) is an epithelial malignancy with pure glandular differentiation, without evidence of typical urothelial (transitional cell) carcinoma. PBA is rare, accounting for 0.5%-2% of all malignant bladder neoplasms, and it is seen more frequently in men than in women and is commonly diagnosed in the sixth decade of life.¹⁻³ Clinical presentation includes hematuria and symptoms of bladder irritation.² PBA is common in schistosomiasis-endemic regions and among patients with congenital bladder exstrophy (ectopia vesicae); it mostly arises in the trigone and posterior bladder wall.⁴ In contrast, urachal adenocarcinomas arise within urachal remnants (residual tissues from the embryonic allantoic stalk connecting the umbilicus and bladder), close to the dome and anterior wall of the bladder. Morphologically, PBA is classifed into enteric and nonenteric types, which includes mucinous, signetring cell variant, clear-cell type, hepatoid, and mixed forms.² Currently, there is no standard of care in the management of PBA. We present the case of a patient with metastatic PBA with intestinal differentiation and wild-type KRAS, who was treated with colorectal cancer regimens.

Long-term effects of Bacilles Calmette-Guerin perfusion therapy for elderly patients with upper urinary tract urothelial carcinoma in situ.

404 Background: According to several guidelines, the standard therapy for carcinoma in situ (CIS) of the upper urinary tract is total nephroureterectomy. However, it is difficult to determine a treatment strategy for elderly patients. Bacillus Calmette-Guerin (BCG) therapy has already been established as a treatment for non-muscle invasive bladder cancer. However, although there are several reports indicating the effectiveness of BCG perfusion therapy for the upper urinary tract CIS, it has not been established yet. We conducted a retrospective study to assess the long-term effects of BCG perfusion therapy for the upper urinary tract CIS for elderly patients. Methods: We treated 34 patients with upper urinary tract CIS at our clinic between August 2004 and March 2015. 29 patients (22 men and 7 women) with the age of 65 years or older were enrolled. 11 subjects had the entire urinary tract CIS, 8 had bilateral, 10 had unilateral CIS of the upper urinary tract. The average period of observation was 45.5 months ( 5 to 151 ), and the average subject age was 76.5 years (66 to 90 ). We used a double-J catheter for 22 cases, a transvesical single-J catheter whose curl was positions in an upper calyx for 6 cases, and a straight ureteral catheter inserted for ureterocutaneostomy for 1 case. We used 80 mg of BCG for the first 4 cases, 40 mg for the late 25 cases. The BCG treatment was given once a week for consecutive 6 weeks. Urine cytology was performed to assess the treatment validity. Results: Urine cytology tests became negative in 22 of the 29 subjects (75.9%) who underwent upper urinary tract perfusion therapy. Among these 22 subjects who had negative tests, 6 subjects had a recurrence in their upper urinary tracts. Side effects were observed in 28 subjects (89.7%), and the most common side effect was bladder irritation. Localized renal tuberculosis which was successfully treated with conservative therapy was seen in two cases. Conclusions: BCG perfusion therapy for the upper urinary tract CIS is safe and effective for elderly patients. Results also suggested that this could be one of the effective treatment options. However, we have to be careful for severe side effects.

Urinary Bladder Adenocarcinoma Metastatic to the Abdominal Wall: Report of a Case with Cytohistologic Correlation.

We report a case of adenocarcinoma metastatic to the abdominal wall in a 71-year-old man with a history of primary bladder adenocarcinoma. CT-guided core biopsy was performed; imprints and histologic sections showed malignant glands lined by tumor cells with hyperchromatic nuclei and prominent nucleoli, infiltrating through skeletal muscle. Immunohistochemistry revealed positivity for CK7, membranous/cytoplasmic β-catenin, caudal-type homeobox transcription factor 2 (CDX2), and α-methylacyl coenzyme A racemase and negativity for CK20, p63, prostate-specific antigen (PSA), and prostate-specific acid phosphatase (PSAP). These findings were interpreted as metastatic adenocarcinoma, consistent with bladder primary. Primary bladder adenocarcinoma is a rare malignancy arising within glandular metaplasia and is associated with cystitis cystica and cystitis glandularis. Predisposing factors include bladder exstrophy, schistosomiasis, and other causes of chronic bladder irritation. This tumor is divided into intestinal, clear cell, and signet ring cell subtypes. Treatment involves radical cystectomy with pelvic lymph node dissection, and prognosis is unfavorable. Primary bladder adenocarcinoma should be differentiated from urachal adenocarcinoma, which arises from urachal remnants near the bladder dome, and secondary adenocarcinoma, or vesical involvement by adenocarcinoma from a different primary. CK7, CK20, CDX2, thrombomodulin, and β-catenin can help distinguish primary bladder adenocarcinoma from colonic adenocarcinoma; PSA and PSAP can help distinguish primary bladder adenocarcinoma from prostate adenocarcinoma.

Holmium laser transurethral resection of bladder tumor: Our experience.

Purpose:To compare the safety and efficiency of conventional monopolar and holmium laser en bloc transurethral resection of bladder tumor (CM-TURBT and HoL-EBRBT) while managing primary nonmuscle-invasive bladder cancer.Materials and Methods:From January 2012 to October 2015, fifty patients with primary nonmuscle-invasive bladder cancer underwent endoscopic surgery. Among them, 27 patients underwent CM-TURBT and 23 patients underwent HoL-EBRBT. Clinical data, included preoperative, operative, and postoperative management and follow-up, were recorded.Results:Patient demographics and tumor characteristics in both groups were compared before surgery. There was no significant difference in operative duration among the groups. Compared with the CM-TURBT group, HoL-EBRBT group had less intraoperative and postoperative complications, including obturator nerve reflex (P < 0.01), bladder perforation (P < 0.01), as well as bleeding and postoperative bladder irritation (P < 0.01). There were no significant differences among the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoL-EBRBT group had less catheterization and hospitalization time than those in the CM-TURBT group (P < 0.01), and there were no significant differences in each risk subgroup as well as the overall recurrence rate among the CM-TURBT and HoL-EBRBT groups.Conclusions:HoL-EBRBT might prove to be preferable alternatives to CM-TURBT management of nonmuscle-invasive bladder cancer. HoL-EBRBT however did not demonstrate an obvious advantage over CM-TURBT in tumor recurrence rate.

Clinical, Etiological and Antibiotic Susceptibility Profiles of Community-Acquired Urinary Tract Infection in a Western Hemisphere of Baghdad

Background: In majority of community-acquired urinary tract infection (CA-UTI) cases, physicians can prescribe empirical therapy without a pretreatment urine culture especially in resource poor settings, where the cost of urine culture is more than cost of treatment itself. Objective: With growing problem of drug resistance globally as well as data on CA-UTI in Iraq are scare. We conduct this study to analyze clinical presentation, etiology and antibiotic sensitivity of bacteria causing community acquired urinary tract infection (CA-UTI). Material and Methods: Outpatients urine cultures and clinical presentations were collected from April 2012 to October 2012. A positive urine culture was defined as growth of a single bacteria with colony count of more than 100,000 CFU/ml and disk diffusion technique was performed to determine antibiotics susceptibility of isolated bacteria species. Clinical symptoms, causative uropathogens and their antibiotic sensitivity were recorded. Results: Of 299 urine cultures processed, a positive urine culture was detected in 100 subjects. Dysuria and bladder irritability (frequency and urgency) were the most common clinical presentation. 39% of isolated bacteria was Escherichia coli and Staphylococcus strains (30%). The isolated uropathogens showed a substantial sensitivity reduction to most of test antibiotics. Conclusion: Clinical presentation had a minor role in diagnosis of CA-UTI and this study revealed that E. coli and Staphylococcus strains were most prevalent isolated uropathogens. Susceptibility test showed there was a high sensitivity to nitrofurantoin, amikacin and imipenem.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.352-358

Research progress of hemorrhagic cystitis after hematopoietic stem cell transplantation

Hemorrhagic cystitis (HC) is one of the common complications of hematopoietic stem cell transplantation (HSCT). And its clinical features are hematuria, accompanied by urinary frequency, urgency, urine pain and other bladder irritation symptoms. Early onset hemorrhagic cystitis (EOHC) mainly results from uroepithelial injury induced by irradiation/chemotherapy during conditioning regimen particularly high-dose cyclophosphamide. With the use of mesna, the incidence decreased significantly. Late onset hemorrhagic cystitis (LOHC) is usually associated with viral infection and immune dysfunction, but the treatment of LOHC remains a challenge. As the HSCT is extensively used, the researches on diagnosis and treatment of HC are increasing. This article reviews literatures on the etiology, pathogenesis, diagnosis and treatment of HC. Key words: Cystitis; Hematopoietic stem cell transplantation; Etiology

Visualized intravesical floating hydrogel encapsulating vaporized perfluoropentane for controlled drug release

Intravesical drug delivery is the main strategy for the treatment of bladder disorders. To reduce the relief arising from frequent intravesical instillation, mucoadhesive hydrogel was used for the controlled release of the drug. However, the viscosity of mucoadhesive gel might cause severe urinary obstruction and bladder irritation. To solve all these problems, a floating hydrogel delivery system was developed using perfluoropentane (PFP) as the floating agent. After intravesical instillation of the floating hydrogel, the increased temperature in bladder vaporized PFP, resulting in the generation of microbubbles in the hydrogel. Then, it can float in urine to avoid the urinary obstruction and bladder irritation. In this study, systematic experiments were conducted to investigate the influences of PFP vaporization on the morphology and floating ability of hydrogels. The floating process is much milder and safer than other floating methods published before. In addition, PFP had been used as contrast agent, which affiliated the monitoring of gels during the operation. Therefore, this new drug delivery system addresses the problems of conventional intravesical instillation and is promising for clinic use.

Managing the adverse events of intravesical bacillus Calmette-Guérin therapy.

This paper provides recommendations on the management of complications arising from intravesical treatment with bacillus Calmette–Guérin (BCG) for nonmuscle-invasive bladder tumors. There is minimal recommendations currently available as randomized trials on the side effects of intravesical BCG are lacking and severe complications are usually described in case reports only. All physicians giving intravesical BCG should be aware of the possible complications that could arise and how to treat these. The incidence of bladder irritation, general malaise, and fever is very high, while severe complications remain rare. Approximately 8% of patients have to stop treatment because of these complications. BCG infections and reactions can occur anywhere in the body, and may happen straight away or even several months or years after BCG treatment, making early diagnosis difficult. Additionally, correct diagnosis is hampered by the uncertain appearance of BCG in tissue and body fluid. An essential step in the management complications arising from BCG is written information for both the family doctor and the patient on the possible adverse events and their management. Recent data demonstrated that none of the earlier advocated methods to prevent BCG toxicity are valid: lowering the dose, tuberculostatic drugs, or oxybutynin. Severe complications are treated with three or four tuberculostatics over 3–12 months, depending on the severity of the situation. Corticosteroids are an essential therapy in BCG septicemia. Nonsteroidal anti-inflammatory drugs and corticosteroids can manage efficiently the immunological complications.

Combined Dietary Recommendations, Desmopressin, and Behavioral Interventions May Be Effective First-Line Treatment in Resolution of Enuresis.

Nocturnal enuresis (NE) is a very common multifactorial pediatric disorder and in children with­out any other lower urinary tract symptoms is defined as monosymptomatic NE (MNE). Pharmacologi­cal, psychological/behavioral, and alternative interventions are commonly used and the first-line drug ther­apy for patients with MNE is desmopressin (dDAVP) but the response rate is less than 40-60% and the relapse rate is about 50-80% after treatment. Many studies show that some foods and beverages can promote diuresis or bladder irritability, which in some people can exacerbate bladder symptoms and NE. The pres­ent study aimed to compare the efficacy of combined specific dietary advices and dDAVP vs dDAVP alone. We enrolled in the study 172 patients affected by MNE between January 2013 and May 2014, of these 35 were excluded. The inclusion criterion was primary MNE and exclusion criteria included non-MNE, secondary MNE and lactose intolerance. Children were treated with dDAVP at a dose of 120 μg a day and were randomized to receive dietary recommendations. They were asked to fill out a char­ter depicting their wet and dry nights for the period of treatment. Sixty-seven patients were randomly as­signed to receive dDAVP and dietary advices (group A) and 70 patients to receive dDAVP alone (group B). We included in our study 137 children, 102 (74.5%) male, and 35 (25.5%) female, aged be­tween 5 and 14 years. Our results show a higher response rate and a lower number of relapse in group A vs group B with 67.2% of responders in group A vs 58.6% in group B, after 3 months of ther­apy and 31.1% of relapse in group A vs 46.3% in group B one month, after the end of treatment. Our results show the effectiveness of specific dietary advices in the manage­ment of primary MNE. However further studies are needed to determine whether the differ­ence between therapy with combined dietary recommendations and dDAVP vs dDAVP alone.

Abstract 808: Cystine stones as a potential cause of bladder cancer in Slc3a1 knockout male mice

Abstract Bladder cancer is the sixth leading cause of cancer in the United States. Patients with bladder stones are at an increased risk for developing bladder cancer. Bladder stones are an established cause of bladder irritation and inflammation. Proliferative and phenotypic changes induced by chronic inflammation are the proposed etiology for the development of bladder cancer in individuals with chronically irritated bladders. The purpose of this study was to identify the early genetic changes associated with bladder inflammation that may be associated with the development of bladder cancer. Slc3a1 knockout male mice develop cystine bladder stones from the second month of life. Prior investigations demonstrated bladder inflammation in these mice, which may closely mimic inflammation inducing the earliest stages of bladder cancer in humans. To investigate changes in cell structure, proliferation, and differentiation, we performed PCR expression arrays on tissue from bladders of Slc3a1 knockout mice and compared them to wild-type mice. We tested genes in the uroplakin (UP), cytokeratin (CK), and tissue inhibitor of mellatoprotease (TIMP) families of proteins, as well as genes involved in EMT. We localized expression of selected markers by immunofluorescence. Results demonstrated pronounced alterations in expression of E-cadherin, TIMP-1, TIMP-2, UP1A, UP2, UP3A, UP3B and CK 14 and CK17. E-cadherin and TIMP proteins are involved in cell motility underpinning epithelial-mesenchymal transition. CKs are structural proteins believed to be indicative of the stem-cell population in urothelial cancers. Metastatic potential and stem-cell behavior are key features of cancer cells, and expression changes in genes underpinning these functions may represent the earliest steps in the progression to bladder cancer. Prior studies had shown UP2 to be up-regulated in bladder cancer, suggesting that it could serve as a marker for the disease. We found up-regulation of UP2, as well as up-regulation of UP1A, UP3A, and UP3B in our model, indicating that changes in expression of these genes may occur before the disease is clinically evident. Thus, they have the potential to serve as biomarkers for this disease in its early, silent stages. Genetic changes discovered in Slc3a1 knockout mice may closely mirror the early cellular changes seen in bladder cancer. Our study has provided insight into the earliest genes exhibiting altered expression by inflammation-induced changes in the bladder, including a set of potential biomarkers for early detection of the disease. These genes require in-depth analysis to identify the mechanistic contribution of each one to the development and progression of bladder cancer in the hopes of generating molecular targets for future therapy. Citation Format: Kathleen M. Capaccione, Min Yang, Lourdes Serrano, Jay A. Tishfield, Amrik Sahota. Cystine stones as a potential cause of bladder cancer in Slc3a1 knockout male mice. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 808. doi:10.1158/1538-7445.AM2015-808

Retrovesical hydatic cyst : About 4 cases

The hydatid cyst is a real public health problem in Tunisia. The retrovesical localization is rare. It is considered an aberrant or ectopic location defined by the development of the parasite in the subvesical and retrovesical fat. From 2004 to 2013, 4 patients with retrovesical hydatid cyst were hospitalized and operated in the Department of Urology at the Charles Nicolle hospital of Tunis in Tunisia. The average patient age was 40.75 years (range: 23-76). Signs of bladder irritation were the most frequent presenting complaint. No cases of hydaturia were noted. The diagnosis was made on the ultrasound and the computed tomographic urography. Hydatid serology was positive for 3 patients. In 3 cases, a hydatid cyst of the liver was associated. A total cysto-pericystectomy was performed for 1 patient, for others it was partial. The postoperative course was uneventful. No urinary fistula or infection of the residual cavity was observed. One patient had a retroperitoneal cyst recurrence requiring reoperation. Retrovesical location of hydatid cyst is rare and treatment is primarily surgical.

Analysis on the characteristics and distress of symptoms in patients with bladder perfusion chemotherapy after resection of bladder cancer

Objective To discuss the extent and characteristics of symptoms and symptom distress, and find the individualized management for patients undergoing bladder perfusion chemotherapy after transurethral bladder resection of bladder tumor. Methods The general information questionnaire, M. D. Anderson Symptom Inventory (MDASI) and additional entries were used to investigate 84 patients undergoing bladder perfusion chemotherapy after transurethral bladder resection of bladder tumor. After individualized treatment, scores of symptoms were observed. Results Symptom score of patients in this group was (3.12±1.02), which was at the mild level. Symptoms subscale score entries sorted successively as poor appetite, fatigue, disturbed sleep, nausea, and vomiting. Symptom distress score was (2.85±2.02), which was at the mild level. Distress subscale score in the order of entries were work, mood and general activity, enjoyment of life, walking and relationship. Added entries score in the order were burning sensation in the bladder, bladder irritation and gastrointestinal reactions. Scores of some symptoms were significantly lower than before (P<0.05). Conclusions Symptom distress is prevalent in patients undergoing bladder perfusion chemotherapy after transurethral bladder resection of bladder tumor, prompting that the intervention should be individualized according to the patient′s symptom distress features to alleviate their symptoms distress. Key words: Bladder cancer; Bladder perfusion; Chemotherapy; Symptom distress; Individualized treatment

The role of steroid treatment in intractable cystitis glandularis: A case report and literature review

Cystitis glandularis is a proliferative disease of the urinary bladder epithelium. It is rare in children. We report a case of a 23-year-old female with intractable macroscopic hematuria and severe irritative bladder symptoms persisting for 13 years. The patient, who had undergone open and endoscopic bladder surgery at various medical centres, is currently being followed up at our clinic. Cystoscopy revealed multiple edematous papillary tumours on the bladder neck, trigone, and lateral wall on both sides and she underwent transurethral resection of the bladder tumour. The pathological diagnosis was cystitis glandularis in accordance with the histopathological reports obtained from the other medical centres. Her condition was resistant to transurethral resection, partial cystectomy, intravesical mitomycin, and bacillus Calmette-Guerin (BCG) treatment; it eventually could have affected the upper urinary tract. Oral steroid treatment was given for 6 months; after treatment, her symptoms improved and the cystoscopy revealed a dramatic improvement in her condition.

795 Direct activation of TRPV1 by acrolein as trigger of acute bladder irritation

795 Direct activation of TRPV1 by acrolein as trigger of acute bladder irritation

Comparison of efficacy and tolerance of short-duration open-ended ureteral catheter drainage and tamsulosin administration to indwelling double J stents following ureteroscopic removal of stones

To evaluate the efficacy of short-duration, open-ended ureteral catheter drainage as a replacement to indwelling stent, and to study the effect of tamsulosin on stent-induced pain and storage symptoms following uncomplicated ureteroscopic removal of stones. Prospective randomised study. School of Medical Sciences and Research, Sharda University, Greater Noida, India. Patients who underwent ureteroscopic removal of stones for lower ureteral stones between November 2011 and January 2014 were randomly assigned into three groups. Patients in group 1 (n=33) were stented with 5-French double J stent for 2 weeks. Patients in group 2 (n=35) were administered tablet tamsulosin 0.4 mg once daily for 2 weeks in addition to stenting, and those in group 3 (n=31) underwent 5-French open-ended ureteral catheter drainage for 48 hours. All patients were evaluated for flank pain using visual analogue scale scores at days 1, 2, 7, and 14, and for storage (irritative) bladder symptoms using International Prostate Symptom Score on days 7 and 14, and for quality-of-life score (using International Prostate Symptom Score) on day 14. Of the 99 patients, visual analogue scale scores were significantly lower for groups 2 and 3 (P<0.0001). The International Prostate Symptom Scores for all parameters were lower in patients from groups 2 and 3 compared with group 1 both on days 7 and 14 (P<0.0001). Analgesic requirements were similar in all three groups. Open-ended ureteral catheter drainage is equally effective and better tolerated than routine stenting following uncomplicated ureteroscopic removal of stones. Tamsulosin reduces storage symptoms and improves quality of life after ureteral stenting.

Long-term effects of Bacilles Calmette-Guerin perfusion therapy for upper urinary tract urothelial carcinoma in situ.

343 Background: Bacillus Calmette-Guerin (BCG) therapy has already been established as a treatment for muscle noninvasive bladder cancer. Although there are several reports indicating the effectiveness of BCG perfusion therapy for the upper urinary tract urothelial carcinoma in situ(CIS), it is not well established yet. We conducted a retrospective study to assess the long-term effects of BCG perfusion therapy for the upper urinary tract CIS. Methods: Thirty-one subjects (24 male, 7 female) who received BCG perfusion therapy for the upper urinary tract CIS from December 1997 to December 2013 were enrolled. 11 subjects had the entire urinary tract CIS, 8 had bilateral, 12 had unilateral CIS of the urinary tract. The average period of observation was 49.9 months (ranging from 5 to 196 months), and the average subject age was 74.8 years (ranging from 56 to 90 years). We used a double-J catheter for 22 cases, a transvesical single-J catheter whose curl was positions in an upper calyx for 8 cases, and a straight ureteral catheter inserted for ureterocutaneostomy for 1 case. We used 80 mg of BCG for the first five cases, 40 mg for the late 26 cases. Urine cytology was performed to assess the treatment validity. Results: Of the 31 cases, the treatment protocol was completed in 27 cases. Urine cytology tests became negative in 25 of the 31 subjects (80.7%) who underwent upper urinary tract perfusion. Among these 22 subjects who had negative tests, 8 subjects had a recurrence in their upper urinary tracts. Side effects were observed in 28 subjects (90.3%), and the most common side effect was bladder irritation. Localized renal tuberculosis, which was successfully treated with conservative therapy, was seen in two cases. Conclusions: BCG perfusion therapy for the upper urinary tract CIS is effective. However, severe side effects are possible, and careful observation is essential while using this therapy.

Pyeloplasty for hydronephrosis: Issues of double J stent versus nephrostomy tube as drainage technique.

Aims:To compare the efficacy, complications, cost analysis and hospital stay between two methods of drainage of the kidney: double J (DJ) stent versus nephrostomy tube following open pyeloplasty for ureteropelvic junction obstruction hydronephrosis.Patients and Methods:This was a prospective randomized study of 20 patients in each group over 14 months. Pre and post-operative (3 months) function and drainage were assessed by ethylenedicysteine scan and intravenous urogram.Results:Both groups showed similar good improvement in function and drainage. Nephrostomy group had significantly longer hospital stay (P < 0.001) but incurred less cost. Complications with nephrostomy included tube breakage (n = 1) and urine leak after tube removal (n = 2). DJ stents were associated with stent migration (n = 4), increased frequency of micturition (n = 9), dysuria (n = 4) and urinary tract infection (n = 1).Conclusion:Both methods of drainage did not interfere with improvement after pyeloplasty. Minor complications were more with DJ stent (P = 0.0003). Although overall cost of treatment was more with stents, they reduced length of hospital stay. Optimal length of stent is essential to reduce complications secondary to migration and bladder irritation.