Correlation of Bladder Wall Endometriosis Histological Location, To Infertility Patients’ Clinical Characteristics and Severity of Peritoneal Endometriosis

Study question: What is the correlation of bladder wall endometriosis histological location, to the severity of peritoneal endometriosis in infertility patients? Summary answer: Secondary infertility, back pain, micturition problems, history of ectopic pregnancy and number of abortions can probably be considered as high-risk factors for bladder wall endometriosis for infertility patients. What is known already: Bladder and/or ureter endometriosis occur in 70–85% among patients with deep infiltrating endometriosis. The knowledge regarding the bladder wall involvement with endometriosis in association to peritoneal endometriosis and infertility patients’ clinical characteristics is limited. Study design, size, duration: Retrospective, longitudinal cohort, Sixty-six, primary and secondary infertility patients, collection of surgical and clinical data between 2010 to 2018. Participants/materials, setting, and methods: An experienced histopathologist on endometriosis was asked to review all the patients’ histopathological results. The histopathological reported findings were reviewed prior to the study to reassure the bladder wall depth of endometriosis involvement. The operation and tissue macroscopic description reports before processing were also reviewed. Attention was paid for possible discrepancies or missed important data that could influence the histopathological results. In cases where results were equivocal, the paraffin blocks were available for additional sections for reassuring the diagnosis. An extra effort was made to meticulously observe and identify the involvement of the bladder serosa, muscularis and mucosa with endometriotic cells and glands. Main results and the role of chance: Primary infertility was the indication for the current laparoscopic surgeries in 32 out of 66 (48.5%) patients and secondary infertility for the rest of the group. The highest incidence of bladder endometriosis (BE) was detected on the serosa of 12 patients and in the detrusor muscle (DM) of 11 cases. Bladder serosa endometriosis (BSE) was significantly more prominent among patients with history of ectopic pregnancy (p=0.004) and among patients with secondary infertility (p=0.029). Destrusor muscle endometriosis (DME) was significantly more frequent (p=0.012) in patients with increasing number of abortions. DME highest rates of 37.7% were observed among the severe spread of abdominal endometriosis as compared to 19% of the cases with bladder serosa endometriosis. No statistically significant difference found between serosa and detrusor muscle endometriosis involvement, when compared to severity and spread of endometriosis within the abdominal cavity. Back pain was most prominent with statistical significant difference (p=0.007) in 8 patients with BSE + DME as compared with other groups of patients (4 BSE, 3 DME and 3 BME+DME patients). Among 30 cases with an ovarian endometrioma detected by TVU, DME was diagnosed in 13 patients, in serosa of 10, and in serosa and DM of 6 patients. Statistical analysis was performed using Pearson chi-square, Fisher’s exact tests and the Kruskal-Wallis test by STATA version 15 SE (StataCorp. 2017). Limitations, reasons for caution: This is a cohort retrospective study. There is a possibility that other areas with endometriosis were also involved in the BW other than those diagnosed and treated. The mixture of patients with primary and secondary infertility could also affect the results, although statistical analysis did not show any significance in BWE, clinical symptoms and surgical findings. BE is rarely an isolated condition, and other forms of endometriosis are frequently concomitant Wider implications of the findings: Detrusor muscle endometriosis involvement was in 68% and bladder serosa in 32% of all cases with bladder endometriosis and infertility investigated. The severity of the peritoneal endometriosis can probably direct to meticulous intraoperative investigation for bladder endometriosis.

Histopathological Spectrum of Non-neoplastic and Neoplastic Lesions of Urinary Bladder

Introduction: Urinary bladder is a site of various non-neoplastic and neoplastic lesions, both of which can present with hematuria. Cystoscopy allows for direct visualization of the bladder mucosa and also obtaining tissue for histopathologic evaluation. The most common non-neoplastic and neoplastic lesion of the urinary bladder is non-specific cystitis and urothelial carcinoma respectively. Materials and methods: This study is a 4-year retrospective study conducted in the Department of Pathology at Patan Hospital, Nepal. All cases from the urinary bladder i.e., both cystoscopic and cystectomy samples were included in the study. Hematoxylin and eosin-stained slides were re-evaluated whenever required. Results: A total of 145 cases were included which consisted of 17 cystectomy specimens and 128 cystoscopic biopsies. There was a male predominance. The non-neoplastic and neoplastic cases consisted of 32% and 68% respectively. Chronic non-specific cystitis and high-grade infiltrating urothelial carcinoma were the most common non-neoplastic and neoplastic lesions respectively. 56.1% of cystoscopic biopsies had the presence of detrusor muscle with 21.7% showing its invasion. Conclusions: Urinary bladder lesions have a wide spectrum ranging from non-neoplastic to neoplastic conditions. The presence of detrusor muscle in a cystoscopic biopsy, and its evaluation for invasion helps in diagnosis and further planning of patient management.

En bloc transurethral resection of bladder tumors: A review of current techniques

Introduction: Growing interest surrounds the concept of en bloc transurethral resection of bladder tumors (ERBT). Theoretical advantages include improved adherence to oncological principles and potential yield of superior pathological specimens. Multiple ERBT methods exist. This review summarizes the current evidence regarding application of differing techniques and technologies to ERBT. Methods: A systematic review of MEDLINE/EMBASE/Scopus databases was performed, using terms “en bloc,” “ERBT,” “bladder,” and “urinary bladder neoplasm.” Template-based data extraction included technique of ERBT, feasibility, tumor size, activation of obturator nerve reflex, operative complications, detrusor muscle sampling rate, and recurrence data. Results: Multiple approaches to ERBT have evolved, using a variety of energy sources. The feasibility of electrocautery, laser, combined waterjet/electrocautery, and polypectomy snare techniques have been confirmed in achieving ERBT. ERBT appears safe, with a low complication rate. The use of laser energy sources reduces the risk of activating the obturator nerve reflex during lateral wall resections. Otherwise, no energy source is unequivocally superior in achieving ERBT. The rate of detrusor muscle sampling is high with use of ERBT and appears superior to that achieved with conventional TURBT (cTURBT) in multiple comparative studies. A limited number of largely non-randomized trials assess bladder tumor recurrence; current evidence suggests this is similar between ERBT and cTURBT groups. Conclusions: En bloc resection of bladder tumors using a variety of technologies is feasible and safe, with a high detrusor muscle sampling rate. Further research is required to determine whether rates of residual disease or recurrence can be reduced with ERBT vs. cTURBT.

Closed-loop audit of muscle sampling in Trans-Urethral Resection of Bladder Tumour

Introduction: Our experience with the presence of detrusor muscle (DM) following Trans-Urethral Resection of Bladder Tumour (TURBT). Objectives: To evaluate the presence of DM in primary TURBT specimens as a quality improvement exercise in Frimley Park Hospital, UK. And to assess if the level of the surgeon has impact on outcomes. Methods: Retrospective and prospective analysis of the electronic records from a single urology centre, servicing a group of urologists. Data collected over three consecutive audit loops between January 2014 and May 2018. Results: A total of 301 cases were performed under the care of seven consultant urologists. Analysis revealed a significant improvement in the overall quality of resections from 39% to 66% (50–84% for intermediate and high grade) after the introduction of the following interventions: (1) analysis and improved awareness of current practice; (2) introduction of European Association of Urology (EAU) guidelines by separating samples and sending a second specimen pot marked as bladder tumour base to look for DM; (3) dedicated urologists with an interest in bladder cancer performing en-bloc resection technique in appropriate cases. Conclusion: Through our closed-loop audits, we have demonstrated a considerable improvement in the quality of resections, resulting in accurate staging from the initial resection. This could in turn lead to improved over all prognoses and negating the need for re-resection in all cases of high-risk non-muscle invasive bladder cancer (NMIBC). Level of evidence: 3

Efficacy of Holmium laser enucleation of the prostate in men with impaired bladder contractility: A review

Introduction: Since Holmium laser enucleation of the prostate (HoLEP) was introduced in the 1990s as an endoscopic deobstructing modality for benign prostatic hyperplasia (BPH), several reports have concluded that HoLEP has compared favourably to transurethral resection of prostate (TURP) in relieving Bladder Outlet Obstruction (BOO). However, there has been no consensus regarding the efficacy of surgical management of men with Detrusor Underactivity (DU) and BOO. Methods: We performed a literature search of PubMed, Google Scholar, Scopus, and Web of Science databases. All studies that provided data on the effectiveness of HoLEP in men with BOO and DU were assessed. Data collected included the number of patients, median follow-up, International Prostate Symptom Score (IPSS), Qmax, post-void residual (PVR) and catheter dependency pre- and post-intervention. Results: Nine studies were identified in the literature with a follow-up range between 6 and 60 months. Only one prospective study was identified where investigators performed urodynamic studies (UDSs) before and after the intervention. In addition to a significant improvement of voiding parameters, they reported partial recovery of detrusor muscle contractility in approximately 80% of patients. Furthermore, all other studies reported an improvement in all outcome parameters and proved the efficacy of HoLEP in patients with DU and BOO. Conclusion: The current literature underpins the efficacy of HoLEP in patients with impaired bladder contractility. However, current research is limited and the majority of the published data are retrospective in nature. Therefore, more well-conducted prospective randomised studies are needed to reinforce high-level evidence for this hypothesis. Level of evidence: Not applicable.

Urinary Incontinence in Women with Low Back Pain After Post Partum Period

Background: Urinary incontinence is a very common problem in postpartum women. In the literature, about 38 to 43% of postpartum females experience urinary incontinence (UI). Postpartum UI usually occurs due to bladder injury, nerve injury, pelvic floor muscle dysfunction or damage to urethra during delivery. In women having C-section, UI is most probably occurs due to instability of detrusor muscle resulting from vesical denervation. Others risks factors involve in development of UI are fetal factors, operative vaginal delivery and antenatal bladder neck mobility due to pelvic floor muscles (PFM) dysfunction and connective tissue weakness. Lower backache (LBP) is also very common in postpartum females due to joint laxity, weakness of connective tissue, loosening of ligaments and strained abdominal muscles due to enlargement of uterus. There’s a coexisting link between low back pain and UI in postpartum females. Objective: To find association between the severity of urinary incontinence and low back pain in women after postpartum period. Methodology: In this study Quota sampling technique was used. Participants divided into two groups, one group with females having low back pain after postpartum period while other group was having females without low back pain after postpartum period. Participants were provided with questionnaires for urinary incontinence to find out the association between severity of UI and LBP. The questionnaires were self-administered and were provided in English language. Some participants were illiterate, thus questionnaires were filled from them by asking questions verbally. Results: Statistics of ICIQ-UI score was checked by applying Fisher’s exact test, The null hypothesis was not rejected because the p-value was > 0.05, indicating that there was no significant association between UI and LBP in females after their postpartum period Conclusion: It is concluded from this study that there is no significant association found between UI and low back pain in women after postpartum period. Keywords: Postpartum period. Urinary incontinence (UI), Stress urinary incontinence (SUI), Urgency urinary incontinence (UUI), Low back pain (LBP), Pelvic girdle pain (PGP), Pelvic floor muscles (PFM), Pelvic floor dysfunction (PFD)

A Cellular Reference Resource for the Mouse Urinary Bladder

The urinary bladder functions as a reservoir to store and extrude liquid bodily waste. Significant debate exists as to this tissue's cellular composition and genes associated with their functions. We use a repertoire of cell profiling tools to comprehensively define and spatial resolve cell types. We characterize spatially validated, basal-to-luminal gene expression dynamics within the urothelium, the cellular source of most bladder cancers. We define three distinct populations of fibroblasts that spatially organize from the sub-urothelial layer through to the detrusor muscle, clarifying knowledge around these controversial interstitial cells, and associate increased fibroblasts with aging. We overcome challenges of profiling the detrusor muscle, absence from earlier single cell studies, to report on its transcriptome with many novel and neuronal-like features presumably associated with neuromuscular junctions. Our approach provides a blueprint for tissue atlas construction and the data provides the foundation for future studies of bladder function in health and disease.

The Result of Re-Transurethral Resection of Bladder Tumor in Eight Years

Objective: To analyses the residual tumor and staging after transurethral resection of bladder tumor (TURBT). Moreover, to analyze the recurrence and free survival patients who received treatment by re-transurethral resection of bladder tumor (RE-TURBT) and their complications. Materials and Methods: A retrospective study from 35 patients operated by RE-TURBT between January 2010 and December 2018 was done. The patients in the present study were qualified by 1) incomplete resection from the first TURBT, 2) the detrusor muscle did not appear in specimen for high grade transition cell carcinoma, 3) any T1 lesion, or 4) large or multifocal lesion. The analysis of the residual tumor included staging, recurrence-free survival, and complication after RE-TURBT from the pathology report and follow up method. Results: Thirty-five patients were included in this study. The average age of the patients operated by RE-TURBT was 69 years old, with a range of 44 to 87 years old. The presenting symptom was hematuria with gross hematuria in 28 patients (80%) and microhematuria in seven patients (20%). Twenty-five patients (71.4%) were male. The relative factor was smoking in 23 patients (65%) and coexisting with irritative voiding symptom in 11 patients (31.4%). The present study found that there was incomplete resection in 11 patients (31.4%), with under-staging in five patients and incomplete resection in six patients. There were 14 months recurrence-free survival and minor complication in RE-TURBT patients. Conclusion: One third of the patients operated by RE-TURBT had unreasonable staging, especially in Ta high grade staging. This could change the treatment in two patients (5.7%), which found minor complication from RE-TURBT, and improve recurrence-free survival. Keywords: Transurethral resection of bladder tumor (TURBT); Re Transurethral resection of bladder tumor (Re-TURBT)

Pemenuhan Kebutuhan Eliminasi Pada Inkontinensia Urine Dengan Kegel Exercise Di UPT Pelayanan Sosial Lanjut Usia Binjai

ABSTRACT: FULFILLMENT OF URINE INCONTINENCE NEEDS FOR ELIMINATION WITH KEGEL EXERCISE AT BINJAI ELDERLY SOCIAL SERVICE UPT Background: Urinary incontinence means the spontaneous expulsion of urine at any time against the will (involuntary). Elderly is the process of slowly losing the ability of tissues to repair themselves/replace and maintain their normal function.Purpose: Kegel exercises are exercises to strengthen the pelvic muscles or exercises that aim to strengthen the pelvic floor muscles, especially the pubococcygeal muscles so that a woman can strengthen the urinary tract muscles.Methods: This research method is descriptive with a nursing process approach. The subject of the study was conducted on 2 patients with the same case, namely in patients who experienced urinary incontinence.Results: The results of the urinary incontinence assessment were associated with decreased bladder and detrusor muscle tone. The nursing interventions and implementation are monitoring the pattern and ability to urinate, identifying the causes of urinary incontinence, explaining the definition, types, and causes of urinary incontinence, recommending limiting fluid consumption 2-3 hours before bedtime, encouraging clients to do Kegel exercises and collaborating with medical and physiotherapists to overcome urinary incontinence. Kegel exercises were carried out in stages to the patient 2 days a day, morning and evening.Conclusion: The evaluation was carried out for 3 days and the results were that the patient was able to urinate and was controlled. The research is expected that the elderly UPT Binjai will improve more skills and always coordinate with other health teams in providing nursing care in accordance with Standard Operating Procedures (SOP). Keywords: Elimination Needs, Urinary Incontinence, Kegel Exercises INTISARI: PEMENUHAN KEBUTUHAN ELIMINASI PADA INKONTINENSIA URINEDENGAN KEGEL EXERCISE DI UPT PELAYANAN SOSIAL LANJUT USIA BINJAI Latar Belakang: Inkontinensia urin berarti pengeluaran urin secara spontan pada sembarang waktu diluar kehendak (involunter). Lansia adalah proses hilangnya secara perlahan-lahan kemampuan jaringan untuk memperbaiki diri/mengganti dan mempertahankan fungsi normalnya.Tujuan: Senam kegel adalah senam untuk menguatkan otot panggul atau senam yang bertujuan untuk memperkuat otot-otot dasar panggul terutama otot pubococcygeal sehingga seorang wanita dapat memperkuat otot-otot saluran kemih.Metode: Metode penelitian ini adalah deskriptif dengan pendekatan proses Keperawatan. Subjek penelitian dilakukan pada 2 orang pasien dengan kasu yang sama yaitu pada pasien yang mengalami inkontinensia urin.Hasil: Hasil pengkajian inkontinensia urin berhubungan dengan penurunan tonus kandung kemih dan otot detrusor. Intervensi dan implementasi keperawatanya itu memonitor pola dan kemampuan berkemih, mengidentifikasi penyebab inkontinensia urine, menjelaskan definisi, jenis dan penyebab inkontinensia urine, menganjurkan membatasi konsumsi cairan 2-3 jam menjelang tidur, menganjurkan klien untuk senam kegel dan melakukan kolaborasi dengan medis dan fisioterapi untuk mengatasi inkontinensia urine. Senam kegel dilakukan secara bertahap kepada pasien 2 hari sehari pagi dan sore hari.Kesimpulan: Evaluasi dilakukan selama 3 hari dan didapatkan hasil yaitu pasien dapat berkemih dan dikontrol. Penelitian diharapkan UPT lanjut usia Binjai meningkatkan keterampilan yang lebih dan selalu berkoordinasi dengan tim kesehatan lainnya dalam memberikan asuhan keperawatan sesuai dengan Standart Operasional Prosedur (SOP). Kata Kunci: Kebutuhan Eliminasi, InkontinensiaUrin, Senam Kegel

Human Urine-derived Stem Cells Improve Partial Bladder Outlet Obstruction in Rats: Preliminary Data and microRNA-mRNA Expression Profile

Background: Partial bladder outlet obstruction (pBOO), a common urological disease, often results in bladder tissue inflammation and remodeling. Human urine-derived stem cells (USCs) have demonstrated therapeutic benefits in various organ injury models. We used a rat model of pBOO to investigate the effect of USCs on bladder function and to explore the miRNA and gene expression profiles in bladder tissue using RNA sequencing.Methods: In total, 18 rats were randomly and evenly assigned to the following three groups: a sham surgery group, a pBOO without USC therapy group, and a pBOO with USC therapy group (subjected to treatment with USCs six times every other week). All rats were subjected to routine urodynamic monitoring. Detrusor muscle strips were analyzed and pathophysiology was assessed. Finally, altered miRNA and mRNA expression profiles of bladder tissue were examined using RNA sequencing and bioinformatics analysis technology.Results: After USC treatment, urodynamic monitoring revealed elevated bladder compliance and maximal voiding pressure, declined end filling pressure and voided volume, and improved detrusor muscle contractility and carbachol sensitivity in pBOO rats. Histology and TUNEL assay revealed reduced collagen deposition and muscle cell apoptosis in bladder tissue. The differential expression of eight miRNAs in pBOO rats was reversed by USC treatment. Bioinformatics analysis helped identify miR-142 and miR-9a as the two largest nodes of differentially expressed miRNAs in the miRNA‑gene interaction network in the USC-treated group. The Kyoto Encyclopedia of Genes and Genomes analysis revealed enrichment of multiple significant pathways, including those involved in necroptosis and cytokine-cytokine receptor interactions.Conclusions: This is the first study to reveal the protective effect of USCs on bladder function and bladder remodeling in pBOO rats. The miRNA and mRNA expression levels differed in the bladder of pBOO rats with and without USC treatment. Although the mechanism underlying these effects has not been fully elucidated, necroptosis and cytokine-cytokine receptor interaction-related pathways may be involved.