Efficacy of Complete Laparoscopic Ileal Augmentation Cystoplasty for the Treatment of Low Bladder Capacity and Compliance: a Case Series

Objectives: To investigate the safety and efficacy of complete laparoscopic ileal augmentation cystoplasty for the treatment of low bladder capacity and compliance.Methods: The clinical data of 13 patients with low bladder capacity and compliance were retrospectively analyzed. Therapeutic efficacy was evaluated at follow-up. The Clavien system was used to evaluate the severity of postoperative complications.Results: All 13 operations were successfully completed laparoscopically. The operation duration was 140-248 min (average: 189.9 ± 29.6 min), the time to postoperative recovery of bowel function was 1-10 days (average: 2.9 ± 2.3 days). There were 4 cases of grade I complications and 1 case of grade II complications (i.e., paralytic ileus caused by urinary leakage from the anastomosis of the augmented bladder). Cystography showed that the morphology of the bladder was close to normal, and the maximum safe capacity and compliance of the bladder were significantly increased [103.8 ± 16.6 mL and 332.3 ± 20.5 mL, p < 0.01; 7.0 ± 1.3 mL/cm H2O and 32.4 ± 2.1 mL/cm H2O, p < 0.01]. All patients were able to urinate spontaneously after catheter removal.Conclusions: Complete laparoscopic ileal augmentation cystoplasty is a safe and feasible treatment for low bladder capacity and compliance, and has the advantages of less trauma, less bleeding, faster recovery of intestinal function, and fewer postoperative complications. This treatment effectively increases bladder capacity, protects upper urinary tract function, and improves patient quality of life, and thus warrants clinical application.

The Aged Lower Urinary Tract: Deficits in Neural Control Mechanisms

Bothersome urinary symptoms plague many older adults and disproportionally affect women. Underreporting of symptoms and general stigma/embarrassment associated with incontinence has negatively impacted the availability of treatments, as research cannot be championed if the severity of the problem is not apparent. Available therapeutics have limited efficacy and are often not recommended in aged patients. Lower urinary tract function has a long and rich history in animal studies; while much of the underlying anatomy has been described, including neural control mechanisms, the impact of aging has only just begun to be addressed. Recent work has provided strong evidence that neural control over micturition is significantly impacted by aging processes. This mini review discusses recent findings regarding how aging impacts the neural control mechanisms of micturition.

Neuroimaging Study Investigating the Supraspinal Control of Lower Urinary Tract Function in Man With Orthotopic Ileal Neobladder

Introduction: Recent studies employing functional imaging methodology have revealed reference brain regions of urinary tract function, namely, the midbrain periaqueductal gray matter, thalamus, and cingulate and prefrontal cortices. The orthotopic ileal neobladder is a desirable method for urinary diversion after radical cystectomy, but its supraspinal control remains unknown. We aimed to evaluate brain activity while maintaining urinary urgency and voluntary urinary control in male subjects with ileal orthotopic neobladders by performing functional MRI (fMRI) during a block design experiment.Materials and Methods: Patients were recruited at the Sun Yat-sen Memorial Hospital of the Sun Yat-sen University from October 2017 to May 2019. Two tasks were performed during fMRI scanning: (1) repeated infusion and withdrawal of sterile saline solution into and out of the neobladder to simulate urgency; and (2) repeated contraction of the pelvic floor muscle with a full neobladder to induce inhibition of micturition since the subjects were asked not to urinate. The obtained data were visualized and statistically analyzed.Results: Sixteen subjects were recruited in the study, and data were obtained from 10 subjects: mean age 60.1 years, average postoperative time 20.2 months, and daytime continence rate 100%. The parahippocampus, frontal lobe, vermis, and anterior cingulate cortex were activated with large bladder volumes, and the thalamus and caudate nucleus were deactivated during voluntary urinary control.Conclusion: A complex supraspinal program is involved during ileal orthotopic neobladder control, which is significantly different from that with normal bladders, in which the original intestine visceral volume sensation is preserved.

Case Report: Miles Surgery Ameliorates High Blood Pressure in a Rectal Carcinoma Patient With Essential Hypertension

Hypertension is one of the major causes of public health problems. Multiple factors affecting gastrointestinal tract function are involved in hypertension. Emerging studies have manifested that gut intervention may play significant roles in regulating blood pressure but the underlying mechanisms are complex and not fully clear. Here, we report a case of 66 years old male who had a long history of hypertension and received Miles surgery for rectal carcinoma. The blood pressure of this patient was returned to normal levels after the operation. The possible reasons could be the modulation of sympathetic tone and the gut microbiota-brain axis. This report provides evidence about the relevance between hypertension and gut intervention particularly in the colorectal sites and gives hints for investigating the possible mechanisms of hypertension and the novel strategy for blood pressure control.

Farmer’s Lung Disease

Occupational lung disease is a lung disease or disorder that occurs due to the inhalation of dangerous particles, mist, vapors, or gases while a person is working. The materials accumulate in the respiratory tract or lungs. The type of lung disease that occurs depends on the size and type of the inhaled material. Substances that cause occupational lung disease are toxic materials called noksa. Noksa is a substance that can cause damage to the anatomical structure of body organs and cause respiratory tract function disorders. The lung disease that many farmers experience is often called farmer's lung disease (FLD). FLD is part of hypersensitivity pneumonitis (HP). HP, also known as extrinsic allergic alveolitis, is a group of lung diseases caused by the inhalation of various antigenic organic materials. The most common cause is exposure to agricultural biological dust derived from straw, mold spores, or other dust. HP can be a secondary reaction due to repeated and prolonged inhalation of specific antigens in sensitive individuals. Diagnosis of FLD is often inaccurate. Many of these cases are diagnosed as idiopathic interstitial lung disease. A complete anamnesis should be performed, especially regarding the history of exposure to moldy hay, previous work, and domestic animals, to determine the existence of a history of exposure to the antigen and to confirm the diagnosis.

A rare cause of bladder outlet obstruction: Vesical diverticular calculus

Vesical diverticula are herniations of the bladder mucosa and submucosa through the muscular wall of the bladder. A calculus in diverticulum is an unusual finding. It is usually secondary to bladder outlet obstruction [1]. The patient typically presents with lower urinary tract symptoms, lower abdominal pain or abdominal distention. The present case is a 64-year-old male with a giant vesical diverticulum calculus. Cystolithotomy was done with primary closure of bladder, with repair of bladder diverticulum. Post-operatively, he recovered well with improved lower urinary tract function.