Posterior Bladder Research Articles

An Adverse Outcome Pathway Approach Linking Retinoid Signaling Disruption to Teratogenicity and Population-Level Outcomes

Recent research efforts in endocrine disruption have focused on evaluating non-EATS (estrogen, androgen, thyroid, and steroidogenesis) pathways. Retinoid signaling disruption is noteworthy because of its teratogenic effects and environmental relevance. However, current environmental risk assessments are limited in their ability to evaluate impacts on individuals and populations. This study characterizes an Adverse Outcome Pathway (AOP) network linking retinoid signaling disruption to teratogenicity and survival in zebrafish. We identified Retinoic Acid Receptor (RAR) overactivation as the molecular initiating event leading to key events including craniofacial (CFM) and tail (TM) malformations, posterior swim bladder (SB) non-inflation, impaired swimming performance, and reduced feeding, ultimately resulting in decreased survival. Our study (1) determines critical sensitivity windows for CFM, posterior SB non-inflation, and TM, (2) provides quantitative measurements for CFM and TM, and (3) defines impacts on higher biological levels including food ingestion, swimming, and survival. Results show that all-trans retinoic acid (ATRA) induces strong teratogenic effects with sensitivity windows between 4-48 hours post fertilization (hpf) for CFM, TM, and posterior SB non-inflation. TM is the most sensitive indicator, with EC50 of 0.2 - 0.26 µg/L across exposure windows 4-48, 4-72, 4-96, and 4-120 hpf. Besides inducing known malformations, ATRA impaired posterior SB inflation with EC50 of 1 - 1.21 µg/L across the same exposure windows. ATRA exposure (1 µg/L) resulted in 50% food ingestion inhibition at 7 days post fertilization (dpf) and 10% survival at 14 dpf. This study provides a regulatory-relevant framework linking developmental effects to population outcomes, highlighting ecological risks and needs for improved risk assessments.

Amniotic bladder therapy: study of micronized amnion/chorion for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) at 6months.

Intravesical application of birth tissue has been reported to inhibit inflammation, alleviate collagen fiber accumulation, and enhance bladder tissue generation. We have previously reported that intra-detrusor micronized amnion monolayer (AM) injections provide short-term clinical improvement in refractory IC/BPS patients. Herein, we evaluate the therapeutic responses and adverse events of micronized amnion/chorion bilayer (AC) in patients with refractory IC/BPS with 6months follow-up. Fifteen patients affected by IC/BPS who failed conventional therapy received 100mg of reconstituted micronized AC was injected intra-detrusor via cystoscopy under general anesthesia, using a 23-gauge needle. Twenty 0.5-mL injections were administered into the lateral and posterior bladder walls, avoiding the dome and trigone. Changes in interstitial cystitis symptom index (ICSI), Interstitial cystitis problem index (ICPI), Bladder pain/ interstitial cystitis symptom score (BPIC-SS) and Overactive Bladder Assessment Tool (OAB), from baseline to 6months post-injection were evaluated retrospectively.The safety of injections was analyzed. Fifteen total refractory IC/BPS patients with an average age of 41.1 ± 14.5years were included in the study, receiving intra-detrusor injections of 100mg of micronized AC. One month after injections, significant improvement in IC/BPS symptom scores was noted in all patients. All patients maintained a sustained clinical response at 6months post-injection. No product-related adverse events were observed. Our findings indicate that the AC formulation significantly reduces time to symptom relief in patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS) and maintains a sustained response up to 6months post-injection. These results suggest a promising clinical benefit of using an amnion/chorion bilayer product for treating IC/BPS. Further research is needed to confirm these findings and assess the long-term durability of this treatment approach. This study represents the first evidence supporting the clinical advantages of an amnion/chorion bilayer product in managing IC/BPS.

Uterine layers hypervascularization in atypical placentation: the comparison of magnetic resonance imaging with vascular pathomorphology

Rationale: One in five women worldwide delivers through cesarean section, which is associated to a high rate of placenta previa and abnormal placenta attachment to the uterine wall. The grade of placenta accreta spectrum (PAS) correlates with blood loss volume, which could be related to vascularization characteristics. Up to now, there have been no studies on the diagnostic value of magnetic resonance criteria for hypervascularization of the uterine wall and their correlation with an assumed grade of PAS according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Also, abnormal vessels location and their wall structure have not been studied with state-of-the-art pathomorphological methods. Aim: To develop a classification for various types of the uterine wall hypervascularization depending on the depth of placental invasion assessed by magnetic resonance imaging (MRI). Methods: We retrospectively analyzed medical files of 66 patients aged 18 to 45 years, who were assumed to have PAS based on their sonography results. To clarify the extent and localization of the placental invasion, all patients had MRI performed at 24 to 32 weeks of gestation. In all patients, the PAS grade was verified pathologically; in 30 of them (45,5%), a detailed pathological examination was additionally performed. The PAS grades were classified according to Morbidly Adherent Placenta Imaging Reporting and Data System (MAPI-RADS). The MRI data were correlated with the PAS (FIGO) grade estimated from intraoperative data and with intraoperative blood loss. At the final study step, the MRI data was correlated with abnormal pathomorphology, with the assessment of the degree of vascularization and the visual picture of abnormal uteroplacental vasculature. Results: We have proposed a classification of MRI signs of hypervascularization in the lower uterine segment correlating with the depth of placenta accreta. Type 1. Single small vessels in the myometrium, medium caliber arteries in the projection of the uterine serosa (normal variation for the 3rd trimester of gestation). Type 2. Numerous small confluent vessels, mainly in the uteroplacental region, and retroplacental hematomas (typical for placenta accreta, or FIGO PAS 1). Type 3. Intrauterine hypervascularization with a deficient myometrium thickness, predominantly vessels of the middle layer (typical for placenta increta, or FIGO PAS 2). Type 4. Thinning of the lower uterine segment due to significant bulging of the placenta in the presence of curved anastomosing vessels of vast caliber over 4 mm (typical for placenta increta – FIGO PAS 2, as well as placenta percreta – FIGO PAS 3a). Type 5. Hypervascularization outside the uterus, over its surface and in the parametrial tissues: at the border with the bladder, uterine isthmus, including signs of fibrosis and growing into the posterior bladder wall (typical for various grades of placenta percreta – FIGO PAS 3b, 3c). Conclusion: The proposed classification of uterine wall hypervascularization in accordance with the grades of placenta accreta spectrum (FIGO PAS) could be useful for its practical implementation by radiologists.

EP118 - Chronic Vesicouterine Fistula (Youssef's syndrome) Complete Opening of Anterior Uterine Wall in the Urinary Bladder: A- very rare case

Abstract Background Vesicouterine fistula is an uncommon urogenital condition typically following Caesarean sections (C/S). Youssef syndrome, characterized by haematuria, amenorrhea, and urinary incontinence, poses a diagnostic challenge and demands comprehensive assessment. Case report We present a case of a 40-year-old woman with persistent urine incontinence and haematuria for three years post her fourth C/S. Clinical evaluation revealed periodic lower abdominal pain, haematuria, amenorrhea, and urine incontinence. sonography was normally reported, while cystoscopy revealed a complete 5x2 cm opening between the anterior uterine wall and the posterior bladder wall, confirming Youssef syndrome. After a course of antibiotic therapy, surgical intervention was planned. Transabdominal total hysterectomy, partial cystectomy, and repair were performed following meticulous anatomical delineation using cystoscopy. The procedure involved dissecting the vesicouterine attachment, performing partial cystectomy, and eventually total hysterectomy. Closure of the urinary bladder defect with absorbable sutures and a negative leak test concluded the surgery. The patient showed no postoperative complications, with follow-ups at 6 and 12 months indicating complete recovery without complaints.

Simultaneous primary posterior urethral valves ablation and bladder neck incision may decrease kidney and bladder failure in long-term follow-up in patients with bladder neck hypertrophy and poor bladder function at presentation: report of 301 cases

ObjectivesTo investigate the effects of bladder neck incision (BNI) and primary valves ablation on long-term kidney and bladder function in children with posterior urethral valves (PUV) and bladder neck hypertrophy (BNH).Patients and methodsFrom 1997 to 2016, a total of 1381 children with PUV were referred to our tertiary hospital. Of these patients, 301 PUV patients with bladder neck hypertrophy need concurrent BNI and valve ablation. All patients were followed up every 3–6 months on regular basis in first 2 post-surgical years and annually then after. The paired t-test and chi-square test were used to perform statistical analysis with p value < 0.05 defined as the level of significance.ResultsMean age at diagnosis was 7.22 ± 2.45 months (ranging from 7 days to 15 months) with a mean follow-up of 5.12 ± 2.80 years. The incidence of hydronephrosis was decreased from 266 (88.3%) at the baseline to 73 (24.3%) patients in long-term follow-up. At baseline, 188 (62.5%) patients were diagnosed with VUR, which decreased to 20 (6.6%) individuals at the end of follow-up. Bladder and renal function were improved in follow-ups following concomitant PUV ablation and BNI. No Myogenic failure was depicted in all patients with BNH. No ureteric reimplantation was needed during the two decades follow-up.ConclusionSimultaneous valve ablation with BNI may present further profits in children with PUV and BNH particularly cases of BNH with poor bladder function at the time of presentation. This method can improve the results of urodynamic and imaging studies after the surgery. We hypothesize every child with PUV presentation who has concurrent vesicoureteral reflux, CKD or persistent hydrourethronephrosis may suffer from secondary bladder neck obstruction. This secondary bladder outlet obstruction must be managed through BNI as the surgical relief.

Early life-history stages of the olive barb, Systomus sarana (Hamilton), and a key ontogenetic systematic character of Smiliogastrinae.

The current study aims to uncover the early life-history stages of Systomus sarana, a medium-sized smiliogastrin cyprinid important for aquaculture in South Asia. The fish were effectively bred in captivity by administering 0.25 mL of breeding hormone per kilogram of fish. The spawning occurred 8.54 ± 0.55 h after the injection, and the eggs were phyto-lithophilic with a pale yellow color and a diameter of 1.49 ± 0.04 mm. Hatching occurred 17 h after fertilization, and the yolk-sac larvae of 3.43 ± 0.08 mm total length (TL) were adhering to the plant parts and other substrata with the cement glands on the forehead. On the third day, with complete absorption of the yolk sac and the disappearance of the attachment organ, the pre-flexion larvae measured 5.3 ± 0.11 mm TL. On the eighth day, the flexion larvae measured 6 ± 0.4 mm TL with a well-inflated posterior swim bladder, and the post-flexion larvae, at 11 days post-hatching (dph), developed a two-chambered gas bladder. The juvenile stage, on day 21 post-hatching, was marked by the loss of the median finfolds and the appearance of black blotches on the caudal, subdorsal, and supra-anal regions. The commencement of squamation and the appearance of the rudiments of maxillary barbels distinguished the juvenile stage. The subadults measuring 4.6 ± 0.36 cm TL had finished squamation and completely lost the subdorsal and supra-anal blotches. We propose that the presence of subdorsal blotches is a distinctive ontogenetic and systematic feature of larval and juvenile forms of smiliogastrin barbs.

Clinical case of delivery of a pregnant woman with Placenta previa/percreta 3с by modified cesarean section technique

Placenta accreta spectrum (PAS) is a severe obstetric pathology, in which placental tissue invades the myometrium. According to the current classification of FIGO (2019), depending on the depth of placental tissue invasion, PAS is divided into Placenta accreta – about 75% of cases, Placenta increta – 15% and Placenta percreta – up to 10% of all cases.The most severe cases associated with the delivery of pregnant women with Placenta percreta, especially with placental tissue sprouting not only the myometrium of the front wall of the uterus, but also the back wall of the urinary bladder or parametrial and paracervical tissue, which according to the FIGO classification are defined as cases of Placenta percreta with a degree of severity 3b and 3c. These are the most dangerous cases of the development of severe hemorrhagic complications, coagulopathic disorders, and the occurrence of intraoperative complications with damage to adjacent organs, primarily the bladder and intestines due to hysterectomy.This article presents for the general public of obstetricians and gynaecologists the analysis of a clinical case in a pregnant woman with complete presentation and placental ingrowth into the prostatic parametrial tissue and partial adhesion to the posterior bladder wall (Placenta previa/percreta 3c).The use of a modified interiliac incision of the anterior abdominal wall, medical and technical support with the use of modern energies (radio wave scalpel, argon plasma tissue coagulation) to minimize the volume of blood loss were described. The intervention was carried out at the main clinical base of the Department of Obstetrics and Gynaecology No. 1, the Kyiv Regional Perinatal Centre.

Comparison of Short-Term Complications of Hemostatic Powders and Surgical on Posterior Bladder Bleeding During Hysterectomy: A Randomized Clinical Trial

Comparison of Short-Term Complications of Hemostatic Powders and Surgical on Posterior Bladder Bleeding During Hysterectomy: A Randomized Clinical Trial

MR defecography in assessing stress urinary incontinence with or without symptomatic pelvic organ prolapse.

Utilize magnetic resonance defecography (MRD) to analyze the primary pelvic floor dysfunctions in patients with stress urinary incontinence (SUI) associated with pelvic organ prolapse (POP), and in SUI patients with asymptomatic POP. We performed MRD in both SUI and POP subjects. As a primary analysis, the functional MR parameters were compared between the isolated POP and POP combined SUI groups. As a secondary analysis, the functional MR data were compared between the POP combined SUI and the SUI with asymptomatic POP (isolated SUI) groups. MRD noted the main characteristics of SUI combined moderate or severe POP, including the shorter closed urethra length (1.87cm vs. 2.50cm, p < 0.001), more prevalent urethral hypermobility (112.31° vs. 85.67°, p = 0.003), bladder neck funneling (48.28% vs. 20.51%, p = 0.020), lower position of vesicourethral junction (2.11cm vs. 1.67cm, p = 0.030), and more severe prolapse of the posterior bladder wall (6.26cm vs. 4.35cm, p = 0.008). The isolated SUI patients showed the shortest length of the closed urethra (1.56cm vs. 1.87cm, p = 0.029), a larger vesicourethral angle (153.80° vs. 107.58°, p < 0.001), the more positive bladder funneling (84.85% vs. 48.28%, p = 0.002) and a special urethral opening sign (45.45% vs. 3.45%, p < 0.001). Patients with SUI accompanying POP primarily exhibit excessive urethral mobility and a shortened urethral closure. SUI patients with asymptomatic POP mainly show dysfunction of the urethra and bladder neck, characterized by the opening of the urethra and bladder neck and a shortened urethral closure.

Is Immobilization Technique Associated With Postoperative Pubic Rami Diastasis Following Bladder Exstrophy Closure?

Pelvic osteotomies relieve tension of the bladder and fascial closures during bladder exstrophy repair. Multiple techniques for postoperative immobilization of the pelvis and lower extremities have been described. The primary aim of this study was to assess differences in short and long-term changes in pubic rami diastasis when comparing Bryant traction to spica cast immobilization. Secondary aims included a comparison of length of stay, skin-related complications, and urologic outcomes. We performed a single-institutional retrospective review of bladder exstrophy patients younger than 18 months of age who underwent posterior pelvic osteotomy and bladder exstrophy closure from April 2005 to April 2020. Short-term and long-term pubic rami diastasis were defined as postoperative measurements ≤6 months and ≥12 months, respectively. Secondary outcomes included length of stay, pressure ulcer, skin rash/abrasion, urethrocutaneous fistula, and bladder or fascial dehiscence rates. Multivariable logistic regression assessed for an association between immobilization type and degree of diastasis while controlling for age at the time of diastasis measurement and sex. Fifteen patients underwent Bryant traction and 36 patients underwent spica cast immobilization. In both the short-term and long-term, there was a greater reduction in pubic diastasis in the spica cast group ( P = 0.002 and P = 0.05, respectively). After adjustments, there were higher odds of having a greater reduction in pubic rami diastasis in both the short-term (odds ratio: 2.71, 95% CI: 1.52-4.86, P = 0.001) and long-term (odds ratio: 2.41, 95% CI: 1.00-5.80, P = 0.05). Length of stay was significantly higher in Bryant's traction group (26 vs 19 d, P < 0.001). Rates of pressure ulcers were higher in the Bryant traction group (26.7% vs 0%, P = 0.005). Rates of skin rash/abrasions, urethrocutaneous fistula, and bladder/fascial dehiscence did not differ. Spica cast immobilization is a safe and effective immobilization method. Compared with Bryant traction, spica cast immobilization was associated with a greater reduction in postoperative pubic diastasis both short and long-term, along with a shorter length of hospitalization and reduced rate of pressure ulcers. Level III-therapeutic study.

Robotic Assisted En-Bloc Removal of Kidney, Ureter and Bladder Wall for Endometriosis

To highlight a case where a nephroureterectomy and partial bladder cystectomy needed to be done due to endometriosis. A video article demonstrating a case study and the surgical management. Ureteral endometriosis is a complex form of endometriosis [1]. If left untreated, the ureter can become significantly compressed leading to hydroureter, hydronephrosis and complete loss of kidney function [2]. This is a case of a 29-year-old patient with pelvic pain and cyclical rectal bleeding. Further investigation showed significant left hydronephrosis and almost complete loss of left kidney function (8% on renogram). MRI revealed endometriosis involving the posterior bladder wall and distal left ureter, a large full-thickness sigmoid nodule and a large left endometrioma. The patient underwent a robotic-assisted left nephroureterectomy, partial cystectomy (bladder), excision of pelvic endometriosis and sigmoid resection. This procedure was performed jointly with the gynecologist, urologist, and colorectal surgeon and the SOSURE technique was employed [3]. The specimen (left kidney, whole length of ureter and bladder wall around ureteric orifice) was removed en-bloc through a small 3cm extension of the umbilical incision. As the distance between the sigmoid nodule and the anal verge was 35cm, which was above the limit of the transanal circular stapler, a limited resection was performed over a discoid excision. The patient made a good recovery postoperatively. Ureteral endometriosis is an indolent and aggressive condition which can lead to silent kidney loss. It is essential that hydronephrosis and hydroureter is ruled out in cases with deep endometriosis. Isolated hydronephrosis should also prompt a suspicion for endometriosis.

Robot-assisted radical cystectomy with neobladder diversion in females: Safety profile and functional outcomes

ObjectiveRadical cystectomy (RC) is a standard treatment for localized muscle invasive bladder cancer and high-risk or very high-risk non-muscle invasive bladder cancer not responding to adequate endovesical therapy. In women, traditionally RC is performed with hystero-adnexectomy and resection of the anterior vaginal wall, often resulting in sexual disorders. Vaginal-sparing techniques have been developed to improve functional outcomes. The present study explores the safety and the functional outcome of vaginal-sparing techniques. MethodsWe retrospectively analyzed all consecutive female patients undergoing robot-assisted RC (RARC) with neobladder diversion between October 2017 and February 2022. The indications for vaginal-sparing RC were absence of tumor on bladder neck or urethra and no sign of infiltration of posterior bladder wall at the preoperative MRI. Functional results were evaluated with the aid of five questions out of the Bladder Cancer Index questionnaire. Complications were reported according to Clavien–Dindo classification and cancer control was evaluated by recurrence-free and cancer specific survival. ResultsA total of 22 female patients underwent RARC with neobladder diversion. Neoadjuvant chemotherapy was given in 17 (77%) cases. Clavien–Dindo grades III–IV complications occurred in four (18%) cases. After a mean follow-up of 29 (interquartile range 16–44) months, six (27%) patients developed distant metastases, and one (5%) woman loco-regional relapse. Sexual-sparing surgery was performed in 19 (86%) patients, and in the others the anterior vaginal wall was resected, but neobladder was still performed. During daytime, no patients reported total incontinence and 73% (11/15) reported total continence or only occasional leaks. Sexual results showed that seven of 15 (47%) women regained sexual activity after surgery, with a quality reported as “good” or “very good” in 40% of all 19 cases. ConclusionRARC in female with anterior vaginal wall preservation is feasible. The approach showed a good safety profile, with satisfying results on continence and sexual activity. Sexual-sparing approaches should be carried out after correct patient selection.

INCIDENTAL BLADDER MELANOSIS WITH CHRONIC CYSTITIS

Abstract Introduction/Objective Melanosis is a black or brown discoloration due to melanin deposition in the skin or on the mucosa of body organs such as conjunctiva, lips, mouth, genitalia, colon, and rectum. For example, melanosis coli is associated with chronic laxative use. However, melanosis on the bladder mucosa is an extremely rare, incidental, and benign finding which is commonly associated with bladder cancer or melanoma. We report an unusual case of incidental bladder melanosis with chronic cystitis in a patient diagnosed with bladder cancer. Methods/Case Report A 77-year-old male current smoker presented for a follow-up of recurrent bladder cancer (high-grade T1 Transitional Cell Carcinoma, TCC) diagnosed in 2016 with currently no symptoms. His past medical history included high blood pressure, papillary thyroid carcinoma status post thyroid lobectomy, and Type 2 diabetes mellitus. He had completed two cycles of treatment of Bacillus Calmette-Guerin (BCG) and BCG/Interferon for 6 weeks each. He had multiple transurethral bladder resections and biopsies in the past which revealed invasive high- grade papillary urothelial carcinoma, not invading muscularis propria. A recent computerized tomography scan of the abdomen and pelvis revealed diffuse bladder wall thickening and trabeculation along the dome and posterior urinary bladder. His lab workup including urinalysis, complete blood count, and chemistry were within normal limits. This time, the patient underwent urinary bladder midline and back wall cystoscopic biopsies and transurethral resection of the right lateral wall. The biopsies showed mild chronic cystitis with melanosis, however, the resection showed non- invasive high-grade papillary urothelial carcinoma. Results (if a Case Study enter NA) NA Conclusion Bladder melanosis has been reported less than 25 times in the literature worldwide. The etiology of melanosis is still unknown. No specific symptoms or treatment guidelines have been established for bladder melanosis so far due to decreased number of cases reported and therefore, reduced follow-up surveillance. Nonetheless, the general behavior of bladder melanosis alone seems to be benign. To the best of our knowledge, this is the first report of bladder melanosis with chronic cystitis. Further studies are required to establish the association of bladder melanosis with chronic cystitis and to probe its clinicopathologic course, and implications.

High-Grade Urothelial Carcinoma with Divergent Prostatic Differentiation Mimicking a Collision Tumor

Abstract Introduction/Objective High-grade urothelial carcinoma (HGUC) shows marked morphologic plasticity with many recognized histologic subtypes that may coexist within the same tumor. These pose a diagnostic challenge and should be distinguished from collision tumors, defined by the coexistence of morphologically and genotypically distinct tumors at the same anatomic site. Herein, we present the first case of HGUC with malignant prostatic differentiation mimicking a collision tumor in a bladder diverticulum. Methods/Case Report 68 yo male presented with gross hematuria and was found to have a 2.2 cm tumor in a posterior bladder diverticulum. Initial transurethral resection (TUR) suggested HGUC, while re-TUR showed prostatic adenocarcinoma. Subsequent diverticulectomy specimen revealed two morphologically and immunohistochemically distinct tumor components: 1) a papillary component associated with urothelial carcinoma in situ, positive for CK903 and GATA3, and compatible with HGUC of the bladder, and 2) a distinct and intimately admixed malignant glandular component, which was GATA3 negative, but positive for markers of prostatic differentiation such as NKX3.1, PSA and PSAP and displayed prostatic duct adenocarcinoma features. Accurate diagnosis of this lesion is crucial, and a few possibilities exist: 1) a collision process between urothelial carcinoma of the bladder and a previously undiagnosed duct carcinoma of the prostate metastatic to the bladder diverticulum; 2) prostate cancer arising from an ectopic prostatic epithelium located in the bladder submucosa; 3) HGUC with malignant divergent prostatic differentiation. To this end, papillary and glandular tumor components were macrodissected and subjected to targeted massively parallel sequencing. Disease-associated variants in EGFR, DDR2, KMT2D, and RB1 were identified and were identical and shared among the two histologically distinct components. These findings suggest that the two components are part of the same neoplastic process and represent a urothelial carcinoma with divergent prostatic differentiation. Of note, the patient’s initial and subsequent PSA levels were within normal limits, and magnetic resonance imaging of the prostate was unremarkable. Results (if a Case Study enter NA) NA Conclusion Awareness of divergent differentiation in urothelial carcinomas has important diagnostic, prognostic and therapeutic implications and can be resolved with the use of ancillary and molecular studies.

Successful management of malignant colovesical fistula using covered colonic self-expanding metallic stent: a case report

BackgroundA colovesical fistula (CVF) is commonly treated by resection of the intestine containing the fistula or creation of a defunctioning stoma. We herein report a case of successful fistula closure and avoidance of colostomy after placement of a covered colonic self-expanding metallic stent (SEMS) as a palliative treatment for a malignant CVF.Case presentationA 75-year-old man undergoing infusional 5-fluorouracil and irinotecan chemotherapy plus bevacizumab for recurrent peritoneal dissemination of rectal cancer was admitted to our hospital because of fecaluria with a high-grade fever. Blood tests showed a moderate inflammatory reaction (white blood cell count, 9200/mm3; C-reactive protein, 11.03 mg/dL; procalcitonin, 1.33 ng/mL). Urinary sediment examination showed severe bacteriuria. Abdominal contrast-enhanced computed tomography showed intravesical gas, thickening of the posterior wall of the bladder, and irregular thickening of the sigmoid colon wall contiguous with the posterior bladder wall. Magnetic resonance imaging (MRI) clearly showed a fistula between the bladder and sigmoid colon. Colonoscopy revealed a circumferential malignant stricture 15 cm from the anal verge, and a fistula to the bladder was identified by water-soluble contrast medium. We diagnosed a complicated urinary tract infection (UTI) associated with a CVF due to peritoneal dissemination and started empirical treatment with sulbactam/ampicillin. Given the absence of active inflammatory findings around the fistula on MRI and the patient’s physical frailty, we decided to place a covered SEMS to close the fistula. Under fluoroscopic and endoscopic guidance, a covered colonic SEMS of 80-mm length and 20-mm diameter was successfully deployed, and the fistula was sealed immediately after placement. Urine culture on day 3 after stenting was negative for bacteria, and a contrast study on day 5 showed no fistula. The patient was discharged home on day 6 with no complications. The UTI did not recur for 4 months after discharge.ConclusionsA covered colonic SEMS was useful for sealing a malignant CVF in a patient unfit for surgery, and MRI was valuable to determine the status of the fistula. A covered colonic SEMS could be an alternative to surgical treatment for CVFs in patients who require palliative care.

Fluorescence guidance during robotic resection of bladder wall endometriosis: case report and technique.

The application of indocyanine green (ICG) has recently been reported to aid in the resection of endometriosis in the bladder wall and/or involving the ureters. A symptomatic 41-year-old patient with dysmenorrhea and pollakisuria was referred to our tertiary center. Imaging revealed a 1.5-2cm intramural endometriotic nodule in the posterior bladder wall. She was planned for robotic resection of the endometriotic nodule, under ICG guidance, together with a hysterectomy. After placement of double-J ureteral stents and clamping the bladder, perforation of the bladder mucosa could be avoided whilst performing a circumferential resection of the nodule. By clamping the bladder catheter after instillation of ICG, both the bladder wall thickness and ureters could be visualized with near-infrared imaging during robotic resection of the endometriotic nodule and hysterectomy. With the surgical approach described here, endometriotic nodules/tissue can be removed precisely with enlarged vision at the robot console, safely, and completely without damaging adjacent tissues.

Sonographic Prevalence of Lower Urinary Tract Infection among Out and in Patients in Biosensors Medical Diagnostics Wuse II Abuja Metropolis: A Case Study of Those Presented for Bladder Ultrasound

Introduction: Two hundred outpatients were recruited for the study only sixty-five (65) of them were used from those who presented for bladder ultrasound. Masmed F5 4D ultrasound machine with a curvilinear transducer at 3.5MHz of frequency was used for the study. Pre and post void urinary bladder volume, anterior and posterior bladder wall thickness measurements were made on 65 healthy asymptomatic outpatients. There was no statistically significant difference between anterior and posterior bladder wall thickness (P&gt;0.05) however there was a statistical significant difference between pre-void and post-void urine volume (P&lt;0.05). Females were more prevalent in the study population than males with higher bladder wall thickness (BWT) consistent with lower urinary tract infection, the sonographic prevalence of urinary bladder retention was 8(12.31%), consisting of a male (1.54%) and females 7(10.77%) In line with bladder outlet obstruction (BOO) assessed at 5% level of significance. The sonographic prevalence of lower urinary tract infection in Biosensors medical diagnostics Wuse ll Abuja was 32.5% when assessed at the 5% level of in-significance (P&gt;0.05), and it was most prevalent in individuals between the ages of 26 and 30. In Nigeria, it is advised that lower urinary tract infections should be diagnosed and treated early in both males and females.

Deiodinase inhibition impairs the formation of the three posterior swim bladder tissue layers during early embryonic development in zebrafish

Thyroid hormone system disruption (THSD) negatively affects multiple developmental processes and organs. In fish, inhibition of deiodinases, which are enzymes crucial for (in)activating thyroid hormones (THs), leads to impaired swim bladder inflation. Until now, the underlying mechanism has remained largely unknown. Therefore, the objective of this study was to identify the process during swim bladder development that is impacted by deiodinase inhibition. Zebrafish embryos were exposed to 6 mg/L iopanoic acid (IOP), a model deiodinase inhibitor, during 8 different exposure windows (0–60, 60–120, 24–48, 48–72, 72–96, 96–120, 72–120 and 0–120 h post fertilization (hpf)). Exposure windows were chosen based on the three stages of swim bladder development: budding (24–48 hpf), pre-inflation, i.e., the formation of the swim bladder tissue layers (48–72 hpf), and inflation phase (72–120 hpf). Exposures prior to 72 hpf, during either the budding or pre-inflation phase (or both), impaired swim bladder inflation, while exposure during the inflation phase did not. Based on our results, we hypothesize that DIO inhibition before 72 hpf leads to a local decrease in T3 levels in the developing swim bladder. Gene transcript analysis showed that these TH level alterations disturb both Wnt and hedgehog signaling, known to be essential for swim bladder formation, eventually resulting in impaired development of the swim bladder tissue layers. Improper development of the swim bladder impairs swim bladder inflation, leading to reduced swimming performance. This study demonstrates that deiodinase inhibition impacts processes underlying the formation of the swim bladder and not the inflation process, suggesting that these processes primarily rely on maternal rather than endogenously synthetized THs since TH measurements showed that THs were not endogenously synthetized during the sensitive period.

Prostate spindle cell neoplasm associated with early voiding difficulty after transurethral resection of the prostate

This report presents the case of 75-year-old men with spindle cell neoplasm. The patient underwent percutaneous nephrolithotomy and transurethral resection of the prostate (TURP) for renal stones and benign prostatic hyperplasia. One month postoperatively, the patient was able to void without any difficulty. Five months later, the patient experienced difficulty voiding and presented to the emergency room with severe pelvic pain. Computed tomography (CT) showed regrowth of the prostate mass into the posterior bladder and penile root. The prostate-specific antigen level remained constant at 1.14 ng/mL during the pre-and postoperative periods. Five months before the TURP operation, the patient’s CT scan showed a soft and mildly enlarged prostate with no protrusion into the bladder. Biopsy of the prostate, however, showed a protruding mass, indicative of a spindle cell neoplasm. The patient was subsequently treated with the chemotherapeutic drug adriamycin. Unfortunately, treatment was unsuccessful, and the patient died 18 months later.

Nitrate and Conductivity Effects in Fish Embryo-Larvae.

Nitrate concentrations have been rising in surface waters over the last century and now frequently exceed drinking water standards and environmental safety benchmarks globally. Health-wise, these trends are concerning because nitrate has been shown to disrupt endocrine function and developmental outcomes. This project investigated potential sublethal effects of nitrate on developing fathead minnows. Fish were exposed from fertilization through 21 days post fertilization (dpf) to environmentally relevant concentrations of nitrate (0, 2, 5, 10, 25, or 100 mg/L NO3 -N as NaNO3 ). Nitrate effects on hatch timing, heart rate and rhythm at 3 dpf, growth through 21 dpf, swim bladder inflation timing and size, scoliosis, pericardial edema, and mortality were assessed. Because adding NaNO3 increases water conductivity, two conductivity controls were included to match the ionic strength of the 10 and 100 mg/L NO3 -N treatments. Increasing nitrate delayed posterior swim bladder (PSB) inflation in a dose-dependent manner, with possible inhibition of anterior swim bladder (ASB) inflation at higher doses, although nitrate did not affect swim bladder size. Conversely, nitrate did not affect hatch timing or cardiac endpoints at 3 dpf or induce pericardial edema or scoliosis, although there was a noted brood effect on these latter defects. As was observed with increasing nitrate, higher ion concentrations in the conductivity controls caused dose-dependent increases in fish body size at 21 dpf. Increased ionic strength also hastened ASB inflation independent of nitrate. As in other published studies, the observed delay in PSB inflation suggests that nitrate disrupts the thyroid axis and warrants further investigation. Additionally, this work supports the need for conductivity controls in nitrate toxicity studies to distinguish nitrate-specific effects. This article is protected by copyright. All rights reserved. Environ Toxicol Chem 2023;00:0-0. © 2023 SETAC.