Transurethral Fulguration Research Articles

Intravesical instillation with glycosaminoglycan replacement treatment in patients suffering radiation-induced haemorrhagic cystitis: When and which patients can benefit most from it?

Radiation-induced haemorrhagic cystitis (RHC) is a frightening complication occurring after pelvic radiotherapy (PRT) which may significantly affect patients' quality of life. Bladder instillation with glycosaminoglycan replacement therapy (GRT) including hyaluronic acid +/- chondroitin sulphate has been proposed as an emerging alternative to prevent relapses of haematuria. Strong points in favour of using GRT for RHC are the ease of administration, cost, almost absence of side effects and possibility of administration to outpatients. We investigated the effectiveness of GRT in a cohort, single-centre, of patients with past-medical history of PRT attending the outpatient clinic and/or the accident & emergency department (A&E) for RHC. Patients with diagnosis of RHC, either with toxicity grade of 2 or 3, were deemed candidate for GRT as long as no active bleeding was occurring; in the case of non-self-limiting haematuria and/or anaemia for active bleeding, admission in the urology department was prompted for bleeding control prior to GRT instillation. An induction course of 6 weekly instillations was scheduled; if tolerated, patients were given a maintenance course with at least 6 monthly instillations. The primary end-point consisted in assessing the rate of haematuria remission (either partial or complete) defined as no need to readmission in the A&E and/or in the hospital. Secondary end-points included factors related to GRT failure. Univariate and multivariate analysis were undertaken to identify clinical independent variables associated to the events. Fifty-one patients with at least 1-year follow-up from the first GRT were included in the analysis. 88.2, 9.8 and 2% of patients had undergone PRT because affected by prostate, uterus and colorectal cancer, respectively. Median time-to-RHC was 31 months (IQR 21-90). Access to A&E and hospital admission were needed in 47 (92.1%) and 35 (68.6%) of the patients, respectively. Twenty-two (n = 22/35, 62.9%) patients required transurethral fulguration of the bladder, while the remainders could be managed with bladder wash-out. Median number of GRT instillations was 6 (IQR 3-7). Twenty-three (45.1%) patients needed to be readmitted to hospital a second time, receiving bladder wash-out (n = 7/23, 30.4%), transurethral fulguration of the bladder (n = 10/23, 43.5%) and/or cystectomy (n = 6/23, 26.1%). Ten (19.6%) patients received a second induction course of GRT. At the last follow-up, 36 (70.6%) patients did not required further hospital admission. Type of PRT and number of hospital admissions pre-GRT were the only variables statistically associated to the events at both univariate (P = 0.032 and P = 0.045) and multivariate analysis (P = 0.048 and P = 0.049). GRT should be prompted as soon as possible after diagnosis of the haematuria and settling of active bleeding. Patients who had undergone adjuvant PRT after radical prostatectomy are those at higher risk of GRT failure.

Prospective randomized controlled trial comparing fulguration versus fulguration and hydrodistension for Hunner-type interstitial cystitis/bladder pain syndrome.

In Hunner-type interstitial cystitis/bladder pain syndrome (IC/BPS), it is unclear whether suburothelial afferents underlying normal-appearing background areas contribute to symptom development. We examined whether adding hydrodistension (HD) to transurethral fulguration (TUF) of Hunner lesions, for the purpose of treating the background areas, is superior to TUF alone. This randomized controlled trial included 52 patients with Hunner-type IC/BPS allocated at a 1:1 (TUF:TUF+HD) ratio. HD was performed at 80 cmH2O for 8min before TUF in the TUF+HD group. Thirty-three patients remained until the end of the 6-month observational period. The primary endpoint was the visual analogue scale (VAS) pain score at 1month. Major secondary endpoints were the treatment-failure rate, VAS pain scores at ≥ 2months, and frequency-volume chart parameters. Both TUF and TUF+HD showed significant improvement in VAS pain score at 1month (95% confidence interval [CI]: - 1.62 to 0.16, P = 0.106). VAS pain scores were significantly lower in TUF+HD than TUF at 2 (95% CI: - 1.97 to - 0.28, P = 0.011), 4 (95% CI: - 2.83 to - 0.72, P = 0.002), and 6 (95% CI: - 3.11 to - 0.07, P = 0.040) months. Treatment-failure rate was higher in TUF (36.4%) than TUF+HD (17.4%), without significance (odds ratio: 2.714, 95% CI: 0.68 to 10.84, P = 0.189). Functional capacity and urgency were not significantly different between groups. The addition of HD to TUF tended to be superior to TUF monotherapy for controlling pain in Hunner-type IC/BPS. This indicates that not only Hunner lesions but also normal-appearing background areas may have a role in the pain of IC/BPS. ClinicalTrials.gov Identifier: NCT03987594, date of registration: 2019-06-17 (retrospectively registered).

Radiation-induced hemorrhagic cystitis-possible treatment options!

Radiation-induced hemorrhagic cystitis is alate-onset complication of radiation therapy of the pelvis with an incidence rate of approximately 5-10%. The severity of hematuria can vary from mild hematuria to more severe bleeding with clot formation and urinary retention to intractable life-threatening bleeding when blood transfusions fail to keep pace with blood loss. Management of radiation-induced hemorrhagic cystitis is based on the presenting symptoms after ruling out urinary tract infection or atumor. In cases with mild or moderate gross hematuria, hydration can be sufficient to prevent clot formation. In emergency cases, evacuation of clots and continuous bladder irrigation with isotonic saline is required, and in cases with persistent bleeding, transurethral fulguration is also required. Unfortunately, radiation-induced hemorrhagic cystitis can lead to persistent or intermittent hematuria. In these cases, intravesical instillation of astringent agents or hyperbaric oxygen therapy can alleviate symptoms. In emergency cases, transarterial embolization or surgical ligation of vesical arteries may be necessary. In rare refractory cases, urinary diversion with or without cystectomy should be performed.

Reduction of Bladder Capacity Under Anesthesia Following Multiple Recurrences and Repeated Surgeries of Hunner Lesions in Patients With Interstitial Cystitis

PurposeTo investigate the influence of multiple recurrences and repeated surgeries of Hunner lesions on bladder capacity under general anesthesia in patients with interstitial cystitis (IC).MethodsWe retrospectively reviewed the clinical records of Hunner-type IC (HIC) patients who underwent transurethral fulguration or resection of Hunner lesions combined with hydrodistension by a single surgeon between 2011 and 2020. Recurrence was defined as reappearance of uncontrolled urinary symptoms in association with new Hunner lesions identified by cystoscopy. Recurrent Hunner lesions were then treated by transurethral surgeries. The recurrence-free rate, potential predictive factors of recurrence, and changes in bladder capacity under anesthesia were examined at each surgical procedure.ResultsA total of 92 surgeries were performed in 47 HIC patients, 23 (49%) of whom required multiple procedures (range, 1–5 times). The mean recurrence-free time after the first surgery was 21.7 months. The recurrence-free rate was 53% at 24 months, and decreased to 32% at 48 months. There were no significant differences in age, sex, bladder capacity under anesthesia at the first surgery, duration from symptom onset to the first surgery, O’Leary-Sant questionnaire including symptom and problem indexes, visual analogue scale pain score, and the number of comorbidities between the cases with or without recurrence. Bladder capacity under anesthesia was gradually decreased as the number of surgeries was increased, and bladder capacity at the fourth procedure was significantly decreased to 80% of the capacity at the first surgery.ConclusionsThese results suggest that multiple recurrences and repeated surgeries of Hunner lesions result in a reduction of bladder capacity under anesthesia in HIC patients although no predictive factors for recurrence of Hunner lesions were detected.

Outcome of boys with posterior urethral valves from a single tertiary hospital in Singapore.

Posterior urethral valve (PUV) is the most common congenital cause of bladder outflow obstruction in male infants. Despite timely treatment, renal damage can still occur in the long-term leading to chronic kidney disease (CKD). A retrospective review of all PUV patients in a single tertiary institution between April 1998 and July 2019 was conducted to analyze their presentations, management and outcomes. Long-term renal function, radiologic scans and somatic growth were evaluated. A total of 16 patients were included in this study. Two patients who defaulted all follow-ups were excluded. Seven patients (43.7%) presented in the antenatal period; four patients (25%) presented in the neonatal period and five patients (31.3%) presented in the post-neonatal period. Primary transurethral fulguration of valves was done in 13 patients, while three had vesicostomies as the primary procedure. Three patients had associated anterior urethral valves (AUV), which were treated endoscopically. Nine boys had additional procedures for diversion and undiversion, VUR, non-functioning kidney and clean intermittent catheterization. Ten patients had urodynamic studies performed, of which eight patients received anticholinergic therapy. Eleven patients had DMSA scans, of which three patients had a normal study and eight patients showed unilateral reduced function. Four patients were diagnosed with CKD on long-term follow-up duration over 5 years. All patients were shown to have good somatic growth. Patients with PUV can suffer from complications despite primary treatment. In our small cohort, a quarter of our patients developed CKD on follow-up. Thus, patients need long-term follow-up to optimize bladder and renal function.

Therapeutic difficulties in vesicorectal fistula treatment using several techniques in one center

Introduction: Vesicorectal fistula (VRF) is a rare but devastating condition that may develop after surgery or radiotherapy. Many surgical methods to treat VRF have been described, but there is still no gold standard of VRF treatment. Aim: The aim of the study is to present our experience in the treatment of VRFs and analyze different surgical techniques applied in our center retrospectively. Material and methods: From June 2016 to June 2020, 7 patients (5 males and 2 females) aged 59–73 years (average 67.3 years) were treated for VRF in our center. The primary causes of VRFs were complications after laparoscopic radical prostatectomy (LRP), sigmoidectomy, laparotomy with removal of the tumour of the vaginal stump and anterior rectal resection and colostomy, Hartmann’s operation due to rectosigmoid carcinoma, radiotherapy, treatment of cervical cancer and transurethral resection of bladder tumor (TURBT). The patients were treated with one of the following methods: transvesical laparoscopic single-site surgery (T-LESS), transanal minimally invasive surgery (TAMIS), transurethral fulguration and radical cystectomy with the Bricker’s ileal conduit. Results and discussion: Five patients underwent T-LESS, 2 TAMIS, 1 transurethral fulguration and 1 radical cystectomy with the Bricker’s ileal conduit. The mean postoperative hospital stay was 4 days (range 2–8 days). The mean operative time was 139 minutes (range 100–285 minutes). Only 1 patient had a recurrence of a fistula. Conclusions: Surgical management of VRFs is obligatory to prevent possible complications. Currently, there is no gold standard for treatment of VRFs. Therefore, this condition requires further investigation.

Radiation-induced haemorrhagic cystitis after prostate cancer radiotherapy: factors associated to hospitalization and treatment strategies.

BackgroundLate onset of radiation-induced haemorrhagic cystitis (RHC) after radiation therapy (RT) for prostate cancer (PCa) may present or evolve severely, requiring hospitalization with invasive interventions. In the present study, we have analysed the prevalence and risk factors associated with the onset of RHC.MethodsFrom January 2002 to May 2017, 1421 patients undertook RT for PCa as a primary, adjuvant, or salvage treatment option. RHC presented in 5.6% (n = 80) of the patients; the diagnosis was based on clinical and endoscopic characteristics. Variables in observation included patients, tumours, and RT-dosimetry characteristics. Patients with a previous history of bladder cancer were excluded. Univariate (Student t/Chi square) and uni-/multivariate Cox regression analysis were performed; the events and time-points were hospitalization and time-to-event, respectively.ResultsThere were 80 patients with a mean age at RT of 70.1 years (SD 6.4), mean time lag to RHC of 43.9 months (SD 37.5). Median Emergency attendance was two and three times for patients without/with hospitalization, respectively. There were in total 64 admissions with invasive treatment required in 26/36 (72.2%) of the patients hospitalised, including transurethral fulguration in 22 and radical cystectomy in 5. Patients at higher risk of hospitalization were those undertaking antiplatelet/anticoagulant treatment (HR:3.30; CI 95%:1.53–3.30; p = 0.002) and those treated with salvage RT with higher bladder volume receiving >70 Gy (bladder V70) (HR:1.03; CI 95%:1.01–1.05; p = 0.027). At receiving operating characteristic analysis, the cutoff for bladder V70 was 29%.ConclusionNearly half of patients presenting RHC may require invasive treatment including cystectomy. Risk factors associated with hospitalization are patients undertaking antiplatelet/coagulant treatment and bladder V70 > 29% in salvage RT patients.

Editorial Comment to Clinical guidelines for interstitial cystitis/bladder pain syndrome.

The former Japanese Clinical Guidelines for interstitial cystitis (IC) and related conditions was published in 2009 and 2016.1 Homma et al. revised the previous guidelines, completing articles identified by the PubMed database published from 2016 to 2019.2 In the current clinical guidelines, one of the characteristics is the categorization. IC/bladder pain syndrome (BPS) is utilized as a comprehensive term, and divided into Hunner-type IC (HIC) and BPS. Only HIC represents Hunner lesions, thus endoscopic findings are indispensable for the diagnosis. Hunner lesion is introduced as a reddish lesion associated with converging vessels, covering fibrin clots or scars, and in this guideline, multiple characteristic endoscopic pictures are shown for reference. The authors have first provided a histopathology section in this guideline, because a recent study showed the histological difference between HIC and BPS.3 It has been reported that HIC shows an immunological inflammatory reaction accompanied by B-cell clonal expansion and epithelial denudation, whereas BPS shows few changes. Treatments for IC/BPS were listed in the order of conservative, medical, intravesical instillation, endoscopy surgery, cystectomy and other treatments. Conservative treatment includes patient education, meditation and a strict dietary therapy. Medical treatments, including new evidence of pentosane polysulfate, cyclosporine A and antibacterial agents, have been added, and certolizumab and tacrolimus have been newly added. Dimethyl sulfoxide instillation therapy still requires information; however, a randomized study showed that efficacy favored HIC.4 Chondroitin sulfate, botulinum toxin and steroids instillation were also introduced. Endoscopic hydrodilation and transurethral fulguration are still effective. Cystectomy would be the last resort. The clinical algorithm shows how to care for IC/BPS patients. Electrostimulation, such as sacral nerve neuromodulation and acupuncture, are introduced in the other treatments section. The algorithm provides a useful approach in the treatment of patients. To validate the therapeutic effectiveness of the treatments, the patients should be specified to IC/BPS, HIC alone or BPS alone. Future clinical studies are still necessary; however, this clinical guideline would help open a new window in understanding the pathophysiology and provide better management for urologists in this field. None declared.

Does repeated hydrodistension with transurethral fulguration for interstitial cystitis with Hunner’s lesion cause bladder contraction?

ABSTRACTObjective: To evaluate the effect of repeated bladder hydrodistension with transurethral resection or fulguration (TUF) of Hunner’s lesions on bladder capacity and interstitial cystitis (IC) symptoms. TUF for Hunner’s lesion is recommended in several IC/BPS guidelines, although recurrence is highly probable.Patients and methods: The study cohort comprised 44 IC patients with Hunner’s lesions who underwent multiple bladder hydrodistensions with TUF and electrocautery (EC) at our institution between July 2005 and June 2018. We analysed their frequency–volume chart, O’Leary Sant Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), and visual analogue scale (VAS) for pain, before and at 2, 6, and 12 months after surgery.Results: The 44 Hunner-type IC patients underwent a total of 117 surgeries. Patients were divided into three groups based upon the number of hydrodistensions with TUF they underwent. Group 1 (n = 44), Group 2 (n = 44) and Group 3 (n = 21) underwent one, two, and three surgeries, respectively. At 6 months after surgery, the mean average voided volume (AVV) and maximum voided volume (MVV) were 157 mL and 228 mL in Group 1; 203 mL, 283 mL in Group 2; and 193 mL, 264 mL in Group 3. The AVV in Group 2 (P < 0.01) and Group 3 (P < 0.03), and the MVV in Group 2 (P < 0.02) increased significantly compared to Group 1. ICSI, ICPI and VAS pain score in groups 2 (P < 0.003, P < 0.01, P < 0.05) and 3 (P < 0.001, P < 0.001, P < 0.001) decreased significantly compared to Group 1.Conclusion: Repeated hydrodistension and TUF with EC of Hunner’s lesions for recurrent Hunner-type IC patients improved their symptoms. There was a tendency toward an increase in bladder capacity and repeated hydrodistension with TUF did not appear to be a direct cause of bladder contraction.Abbreviations: AVV: average voided volume; BPS: bladder pain syndrome; EC: electrical cautery; IC: interstitial cystitis; ICPI: Interstitial Cystitis Problem Index; ICSI: Interstitial Cystitis Symptom Index; MVV: maximum voided volume; TUF: transurethral fulguration; TUR: transurethral resection; VAS: visual analogue scale

An Unusual Etiology for Hematospermia and Treatments That Were Successful

To describe the unusual etiology and effective treatments of intractable hematospermia from posterior urethral hemangioma. The ages, disease duration, syndromes, urinary routine, pathologic findings, immunohistochemical staining results, and postoperative complications of 5 patients were recorded. Four patients had a transurethral resection for total removal of lesions, and 1 patient was treated with transurethral fulguration. The 5 patients involved were middle aged with an average age of 46.2 years and average disease duration of 8.8 years. The clinical features of their hematospermia were as follows: break outs repeatedly after ejaculation in large quantities, no obvious mixing with the seminal plasma, urine after the first ejaculation or second in the morning is hematuria and is even accompanied by blood clots, and urethrorrhagia after sexual excitation, and there is no significant effect of various positive anti-inflammatory treatments. Cystourethroscopy found that the solitary varicosities were located between the distal end of the verumontanum and the external urethral sphincter. The varicose lesion was removed by transurethral resection for posterior urethral lesions, and the surrounding tissue was removed with fulguration. Vessel formation was confirmed by CD31 and CD34 immunohistochemical staining. Finally, the presence of posterior urethral hemangioma was verified in 4 patients by pathologic examination combined with immunohistochemistry, but 1 patient did not have any specimens available. The possibility of posterior urethral hemangioma should be considered for patients with repeated intractable hematospermia. Cystourethroscopy is recommended for examination throughout patient services, and transurethral resection, fulguration, or laser cutting methods can also be performed.

MP20-18 GRADE 4 HEMORRHAGE RADIATION CYSTITIS TREATED BY EARLY TRANSURETHRAL FULGURATION VERSUS CONSERVATIVE OBSERVATION STRATEGY: OUTCOME COMPARISON FROM 283 CASES

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder II1 Apr 2015MP20-18 GRADE 4 HEMORRHAGE RADIATION CYSTITIS TREATED BY EARLY TRANSURETHRAL FULGURATION VERSUS CONSERVATIVE OBSERVATION STRATEGY: OUTCOME COMPARISON FROM 283 CASES Toru Sugiahra, Hideo Yasunaga, Jun Kamei, Hiroki Matsui, Tohru Nakagawa, Tetsuya Fujimura, Hiroshi Fukuhara, Haruki Kume, Kiyohide Fushimi, Masaaki Tachibana, and Yukio Homma Toru SugiahraToru Sugiahra More articles by this author , Hideo YasunagaHideo Yasunaga More articles by this author , Jun KameiJun Kamei More articles by this author , Hiroki MatsuiHiroki Matsui More articles by this author , Tohru NakagawaTohru Nakagawa More articles by this author , Tetsuya FujimuraTetsuya Fujimura More articles by this author , Hiroshi FukuharaHiroshi Fukuhara More articles by this author , Haruki KumeHaruki Kume More articles by this author , Kiyohide FushimiKiyohide Fushimi More articles by this author , Masaaki TachibanaMasaaki Tachibana More articles by this author , and Yukio HommaYukio Homma More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.990AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite a severity of hemorrhage radiation cystitis (HRC), evidence for its treatment strategy has been limited, especially in intervention timing of transurethral fulguration (TUF). In the present study, length of hospital stay (LOS) among grade 4 HRC patients was compared between early TUF group and observation groups. METHODS Patients who were hospitalized because of radiation cystitis (ICD-10 code: N304) and received transfusion by 3rd day from admission were identified from the Japanese national clinical database named the Diagnosis Procedure Combination (DPC) database 2007 – 2012. Patients were classified into three strategy groups: 1) early TUF group (performed within 4 day from admission), 2) late TUF group (5 to 21 day), and 3) observation group (no TUF within 21 day). The three strategy groups were compared by Kaplan-Meier curve for discharge event and multivariate analysis using a Cox proportional hazard model for discharge event. Multivariate model included sex, age, comorbidity, and use of hyperbaric oxygen therapy. RESULTS Two hundred and eighty-three patients were extracted from the database. Median LOSs were 11 days in early TUF group (n=65), 20 days in late TUF group (n=32), and 20 days in observation group (n=186). Figure 1 showed Kaplan-Meier curves of three groups. (Log-rank test, p < 0.01) Multivariate analysis resulted that hazard ratios of discharge event based on early TUF group were 0.65 (p = 0.048) in late TUF group and 0.69 (p = 0.014) in observation groups. CONCLUSIONS The result of the present study suggested early TUF was associated with early discharge and would support that early TUF strategy could be a reasonable option for severe HRC. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e230 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Toru Sugiahra More articles by this author Hideo Yasunaga More articles by this author Jun Kamei More articles by this author Hiroki Matsui More articles by this author Tohru Nakagawa More articles by this author Tetsuya Fujimura More articles by this author Hiroshi Fukuhara More articles by this author Haruki Kume More articles by this author Kiyohide Fushimi More articles by this author Masaaki Tachibana More articles by this author Yukio Homma More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD20-10 PROSPECTIVE, MULTICENTER, RANDOMIZED CLINICAL TRIAL COMPARING THE EFFECT OF HYDRODISTENTION AND TRANSURTHRAL FULGURATION OF BLADDER IN INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME PATIENTS

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Interstitial Cystitis1 Apr 2015PD20-10 PROSPECTIVE, MULTICENTER, RANDOMIZED CLINICAL TRIAL COMPARING THE EFFECT OF HYDRODISTENTION AND TRANSURTHRAL FULGURATION OF BLADDER IN INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME PATIENTS Jang Hwan Kim, Sang Woon Kim, Sang Hyun Jee, Kyu Sung Lee, Myung Soo Choo, Joon Chul Kim, Sung Yong Cho, Ju Tae Seo, Jong Bo Choi, and Seung June Oh Jang Hwan KimJang Hwan Kim More articles by this author , Sang Woon KimSang Woon Kim More articles by this author , Sang Hyun JeeSang Hyun Jee More articles by this author , Kyu Sung LeeKyu Sung Lee More articles by this author , Myung Soo ChooMyung Soo Choo More articles by this author , Joon Chul KimJoon Chul Kim More articles by this author , Sung Yong ChoSung Yong Cho More articles by this author , Ju Tae SeoJu Tae Seo More articles by this author , Jong Bo ChoiJong Bo Choi More articles by this author , and Seung June OhSeung June Oh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.681AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hydrodistention (HD) and fulguration are recommended third-line treatment options for patients with IC/BPS. Fulguration and/or injection of triamcinolone to the bladder is specifically recommended in patients with Hunner's lesions. However, to our knowledge, there is no randomized clinical trial supporting the superiority of fulguration to HD. We performed a prospective, multicetner, randomized trial comparing the efficacy of HD and fulguration in IC/BPS patients with Hunner's lesions. METHODS Patients who have had symptoms of IC/BPS for at least 6 months and had Hunner's lesion were enrolled and randomly divided into either HD (group1) or transurethral fulguration of the bladder (group2) groups. Bladder pain was assessed using the visual analogue scale (VAS) and symptoms measured with ICIQ and PUF questionnaires before, 1, 2, 4 and 6 months after treatment. The primary end point of the study was VAS score at 1 month. RESULTS A total of 38 patients who have IC/BPS with Hunner's lesion were enrolled from Sep 2012 to Jun 2014 and randomized to receive HD (17 patients) or fulguration (21 patients). No medication was given after the procedure and the patients were allowed to dropout when pain or other symptoms warranted further treatment by the patient. During the progression of the study, the authors felt a clear superiority of one procedure over the other and enrollment after the 38th patient was stopped for ethical reasons. There was no statistically significant difference in age, symptom period, and VAS before treatment between the two groups. However, the postop VAS at 1 month was lower in the fulguration group (2.56¡¾1.72 vs. 4.47¡¾3.12, p=0.03). In addition, the dropout rate of the HD group was higher from 1 month on and at 6 months was nearly twice as high as the fulguration group. However, when the remaining patients at 6 months were compared there was no significant difference in symptom score. CONCLUSIONS Transurethral fulguration is superior than HD in relieving pain and low urinary tract symptoms in the short and long term in patients with IC/BPS with Hunner's lesions. Transurethral fulguration should remain the choice of treatment compared to HD for those IC/BPS patients with Hunner's lesions. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e401 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jang Hwan Kim More articles by this author Sang Woon Kim More articles by this author Sang Hyun Jee More articles by this author Kyu Sung Lee More articles by this author Myung Soo Choo More articles by this author Joon Chul Kim More articles by this author Sung Yong Cho More articles by this author Ju Tae Seo More articles by this author Jong Bo Choi More articles by this author Seung June Oh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Cystitis glandularis: A controversial premalignant lesion.

Cystitis glandularis (CG) has been hypothesized as a potential precursor of adenocarcinoma, although this remains controversial. The present study reports data accumulated from 166 cases of cystitis glandularis with follow-up periods ranging between 0.5 and 17 years. The association between intestinal and typical CG and bladder carcinoma was retrospectively evaluated. The patients included in the present study had presented with typical (n=155) or intestinal (n=11) CG between 1994 and 2010. Of those patients, concurrent carcinoma of the bladder was identified in 15 (9.0%) patients, including two cases of squamous cell carcinoma and 1 case of sarcoma. The cases of carcinoma were identified either prior to or concurrently with the diagnosis of CG. Follow-up was available for 9/11 (81.8%) patients with intestinal CG. Nine months following transurethral fulguration, 8/11 (72.7%) patients were in complete remission and 1/11 (9.1%) complained of urgency and dysuria; two patients were lost to follow-up. The follow-up of the patients ranged from 0.7 to 4.5 years (median, 2.67 years; mean, 2.82 years). No evidence of subsequent carcinoma was identified in any of the patients during the follow-up of the intestinal and typical CG groups. In addition, there was no evidence of carcinoma subsequent to CG in either of the typical or intestinal CG groups. The results did not support that CG increases the future risk of malignancy in the short term and repeated cystoscopies over a short period of time are not recommended.

Anterior urethral valves- a case report

The case is presented to discuss clinical signs, diagnostic tools and therapeutics of anterior urethral valves, an obstructive anomaly of the urinary system in males. Signs of urinary tract obstruction were identified on pre-natal ultrasound in a male fetus and the diagnosis of anterior urethral valves was made through post-natal evaluation. As an initial treatment, vesicostomy was performed in the patient. Later, the valve was fulgurated using an endoscopic procedure. During the follow-up period the patient presented normal renal function. Anterior urethral valve is a rare form of urethral anomaly that must be ruled out in boys with pre-natal ultrasound indicating infravesical obstruction. Vesicostomy used as an initial treatment rather than transurethral fulguration may prevent potential complications that can occur due to the small size of the neonatal urethra. DOI: http://dx.doi.org/10.3329/cbmj.v2i2.16703 Community Based Medical Journal 2013 July: Vol.02 No 02: 71-74

Tips for Office-Based Transurethral Biopsy and Fulguration as a Treatment of Tiny Bladder Tumors

Among the patients who underwent outpatient cystoscopy as a follow up of bladder cancer, quite a few patients are observed tiny papillary lesions suspicious for tumor recurrence. Transurethral biopsy and/or resection under spinal or general anesthesia in a hospitalized setting are the usual procedures for this kind of patients, even though these procedures are simple and brief. We tried transurethral biopsy and fulguration as a treatment for very small bladder tumor in an outpatient setting and here describe tips for these procedures. Olympus CYF-VA flexible cystoscope, a 3 Fr. diathermy probe, monopolar electrosurgical unit were used. No additional anesthetics except for 10 ml of 2% Xylocaine gel applied to (male patient’s) urethra as an initial flexible cystoscopic procedure, was required for tumor treatment. Distilled water was used as an irrigation fluid. Experienced tips of the procedures to avoid tumor recurrence are as follows: tumor should be one location, size of the tumor should be less than 5 mm, bladder should be washed several times after the fulguration with hundreds ml of distilled water. We conclude that outpatient biopsy and fulguration for tiny bladder tumor is effective and less invasive procedure as a treatment of bladder cancer patients.

Association of angiotensin converting enzyme and angiotensin type 2 receptor gene polymorphisms with renal damage in posterior urethral valves

To examine the association with renal damage in patients with posterior urethral valves (PUV) of two renin-angiotensin system gene polymorphisms: angiotensin converting enzyme insertion/deletion (ACE I/D) and angiotensin type 2 receptor (AT2R A1332G), PATIENTS AND METHODS: In 120 patients with PUV, after stabilization, transurethral fulguration or a Blocksom vesicostomy was performed. Records were reviewed for age at diagnosis, biochemical renal function at diagnosis, results of urine cultures, voiding cystourethrograms, radiologic, sonographic and nuclear medicine scan findings, and follow-up data. ACE I/D genotypes were determined by the polymerase chain reaction using allele specific primers. The frequency of the ACE DD genotype was significantly higher in patients with chronic kidney disease (P=0.02) and renal scarring (P=0.05). These genotypes were also associated with a statistically higher incidence of vesicoureteral reflux, diurnal incontinence, proteinuria and hypertension. A significantly higher frequency of the AT2R GG genotype was found in PUV patients as compared to healthy unrelated control subjects (P=0.001), and in PUV patients with scarring (P=0.02). The ACE DD and AT2R GG genotypes are associated with chronic kidney disease and scarring in PUV patients. The GG genotype incidence is higher among PUV patients compared to the control population, and further studies in this area may help understanding of the genetic basis of PUV.

Urologic pelvic surgery following mesh hernia repair

Few and controversial reports have recently appeared on the role of previously performed surgery in the inguinal region using a prosthetic mesh and the ensuing difficulties encountered by urologists during radical retropubic prostatectomy. We analyzed our experience with various surgical urological procedures performed after prior low abdominal wall hernia repair with synthetic mesh. We reviewed our database for all patients who underwent mesh repair of lower abdominal hernias and subsequent urologic surgery in our department between 2002 and 2008. Their perioperative parameters, complications, and postoperative outcomes were analyzed. Twenty-three patients (one female) underwent pelvic urologic surgery for benign and malignant disease after having undergone previous prosthetic hernia repair. The mean patient age was 75.3 years (range 58-91). The mean interval between hernia repair and pelvic urologic surgery was 3.8 years (range 1-7). Twenty-two patients underwent previous mesh inguinal hernia repair and one had prosthetic postoperative ventral hernia repair after a transabdominal hysterectomy. The urologic procedures included 16 open suprapubic prostatectomies, two radical cystoprostatectomies, one bladder augmentation, and four laparoscopic radical prostatectomies. Severe postoperative complications were abortion of surgery (n = 1), inability to perform lymph node dissection (n = 2), bleeding (n = 1), bladder injury (n = 2), and additional surgery (n = 3: mesh removal, transurethral prostatectomy, and transurethral fulguration of the prostatic fossa). Prior application of synthetic mesh during abdominal wall surgery creates difficulties during subsequent urological procedures and may dictate change in operative planning. Nevertheless, the surgery is feasible and should not be ruled out.

Urodynamic changes in patients with anterior urethral valves: Before and after endoscopic valve ablation

Purpose To retrospectively review a series of children with anterior urethral valves (AUV), with emphasis on patterns of urodynamic change and long-term outcome of endoscopic treatment. Patients and methods We reviewed the medical records of eight patients who had undergone thorough radiological and urodynamic exams before and after treatment. The diagnosis of AUV was based on radiological imaging and confirmed by urethrocystoscopy. The valves were ablated through either transurethral fulguration or resection. The upper urinary tracts were studied by renal scan and ultrasonography before and after the procedure. Bladder function was assessed urodynamically 3 months after surgery. Uroflowmetry was performed as soon as the children were toilet trained. Results Endoscopic ablation of AUV was successful in all cases and no surgical complications occurred. The initial symptoms resolved in all boys. VUR disappeared in two out of three patients, and five children had bladder trabeculation that was resolved after surgery. The final outcome was successful in seven patients (88%). The major urodynamic dysfunction was bladder hypercontractility that resolved following valve ablation. The mean maximum voiding detrusor pressure ( P detmax) decreased from 213.2 ± 17.9 cmH 2O to 80.7 ± 9.9 cmH 2O, 6 months after treatment ( P < 0.001). None of the patients had low-compliant bladder, detrusor instability or myogenic failure. The voiding pattern in all toilet-trained patients was staccato and of an interrupted shape prior to surgery, but changed to a normal bell-shaped voiding pattern following valve ablation. Conclusion AUV should be considered in the differential diagnosis of patients presenting with infravesical obstruction. We recommend endoscopic valve ablation as the treatment of choice.

経尿道的前立腺切除術後の持続膀胱洗浄

We investigated whether continuous bladder irrigation after Transurethral Resection of the Prostate (TURP) would prevent catheter obstruction by the clot. We analyzed data from 761 patients registered in "a multi-institutional study of TURP clinical pathway" sponsored by the Ministry of Health, Labor and Welfare between 2001 and 2003. The difference of clinical backgrounds of the cases, resected weight, operating time, risk of being feverish, risk of catheter obstruction and chance of postoperative Transurethral Fulguration (TUF) between each institution were investigated. The risk factor of catheter obstruction is characterized and the significance of continuous bladder irrigation is discussed. The incidence of catheter obstruction in the four institutions, in which 90% or more of patients underwent continuous bladder irrigation, was significantly lower than that in the three institutions, in which continuous bladder irrigation was performed in selected patients whose hematuria was severe (4.4% VS 12.9%, p<0.001). There was no difference in the frequency of either pyrexia or postoperative TUF. Logistic regression analysis showed that significant factors for catheter obstruction are continuous bladder irrigation, resected tissue weight and preoperative urinary infection. Routine continuous bladder irrigation achieved a lower incidence of catheter obstruction. However, we recommend that urologists should decide whether to perform routine continuous irrigation, considering the frequency of catheter obstruction, safety, labor and cost.

Isolated posterior urethral injury: an unusual complication and presentation following male coital trauma

We describe an unusual complication of coital trauma in a 29-year-old man who presented with a 3-year history of hematospermia and post-coital gross hematuria. Using urethroscopy under a semi-tumescent penis, an isolated urethral injury with active bleeding was detected at the prostatic urethra. The patient was successfully treated with transurethral fulguration. We suggest that isolated posterior urethral injury is one of the causes of male coital trauma, which might be asymptomatic when the penis is flaccid but show symptomatic bleeding when the penis is erect.