Development and validation of a prognostic nomogram for predicting overall survival in patients with primary bladder sarcoma: a SEER-based retrospective study

Background Primary bladder sarcoma (PBS) is a rare malignant tumor of the bladder with a poor prognosis, and its disease course is inadequately understood. Therefore, our study aimed to establish a prognostic model to determine individualized prognosis of patients with PBS. Patients and Methods Data of 866 patients with PBS, registered from 1973 to 2015, were extracted from the surveillance, epidemiology, and end result (SEER) database. The patients included were randomly split into a training (n = 608) and a validation set (n = 258). Univariate and multivariate Cox regression analyses were employed to identify the important independent prognostic factors. A nomogram was then established to predict overall survival (OS). Using calibration curves, receiver operating characteristic curves, concordance index (C-index), decision curve analysis (DCA), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), the performance of the nomogram was internally validated. We compared the nomogram with the TNM staging system. The application of the risk stratification system was tested using Kaplan–Meier survival analysis. Results Age at diagnosis, T-stage, N-stage, M-stage, and tumor size were identified as independent predictors of OS. C-index of the training cohort were 0.675, 0.670, 0.671 for 1-, 3- and 5-year OS, respectively. And that in the validation cohort were 0.701, 0.684, 0.679, respectively. Calibration curves also showed great prediction accuracy. In comparison with TNM staging system, improved net benefits in DCA, evaluated NRI and IDI were obtained. The risk stratification system can significantly distinguish the patients with different survival risk. Conclusion A prognostic nomogram was developed and validated in the present study to predict the prognosis of the PBS patients. It may assist clinicians in evaluating the risk factors of patients and formulating an optimal individualized treatment strategy.

Spheroids of Bladder Smooth Muscle Cells for Bladder Tissue Engineering

Cell-based tissue engineering (TE) has been proposed to improve treatment outcomes in end-stage bladder disease, but TE approaches with 2D smooth muscle cell (SMC) culture have so far been unsuccessful. Here, we report the development of primary bladder-derived 3D SMC spheroids that outperform 2D SMC cultures in differentiation, maturation, and extracellular matrix (ECM) production. Bladder SMC spheroids were compared with 2D cultures using live-dead staining, qRT-PCR, immunofluorescence, and immunoblotting to investigate culture conditions, contractile phenotype, and ECM deposition. The SMC spheroids were viable for up to 14 days and differentiated rather than proliferating. Spheroids predominantly expressed the late myogenic differentiation marker MyH11, whereas 2D SMC expressed more of the general SMC differentiation marker α-SMA and less MyH11. Furthermore, the expression of bladder wall-specific ECM proteins in SMC spheroids was markedly higher. This first establishment and analysis of primary bladder SMC spheroids are particularly promising for TE because differentiated SMCs and ECM deposition are a prerequisite to building a functional bladder wall substitute. We were able to confirm that SMC spheroids are promising building blocks for studying detrusor regeneration in detail and may provide improved function and regenerative potential, contributing to taking bladder TE a significant step forward.

Primary bladder neck obstruction is one of the rare causes for renal failure in young adult males

Background Primary bladder neck obstruction (PBNO) is one of the causes of bladder outlet obstruction (BOO) and rarely results in renal failure. We are presenting the clinical characteristics of young male patients with PBNO and renal failure. Methods Medical records of patients between 18 and 40 years old with PBNO and renal failure were retrospectively reviewed (2014–2020). Patients with anatomical cause of BOO, and any urological or systemic disease or previous history of any surgical procedure associated with renal failure and/or lower urinary tract dysfunction were excluded. Serum creatinine measurement, ultrasonography, uroflowmetry, cystoscopy, and videourodynamics were performed. Results Seven male patients were identified, and the mean age of the patients was 28.8 years. Symptom duration was > 5 years in all patients. Two patients presented with difficult voiding, and five patients presented with both storage and voiding lower urinary tract symptoms (LUTS). Three patients were previously misdiagnosed as overactive bladder. At presentation, serum creatinine levels were between 1.7 and 2.4 mg/dl. One patient was under hemodialysis treatment and waiting for renal transplantation. Mean detrusor pressure at maximum measured flow rate, mean maximum flow rate (Qmax), and mean average flow rate (Qave) was 67.6 cm H2O, 9.5 ml/s, and 5.5 ml/s, respectively. With α-blocker treatment, serum creatinine levels were stable or decreased after 12 months follow-up and mean Qmax and Qave were increased to 14.8 ml/s and 10.1 ml/s, respectively. Conclusions PBNO is a common disease in young men presenting with a long history of LUTS. Videourodynamics is mandatory for accurate diagnosis, but having a high clinical suspicion for PBNO is key to ensure the diagnosis. Clinicians should pay more attention to PBNO in young male patients with a long history of LUTS to prevent misdiagnosis, incorrect treatment, and possible decrease in renal function by years.

Assessment of the sexual function of women with primary bladder pain syndrome

Introduction. Primary bladder pain syndrome (PBPS) also known as interstitial cystitis/bladder pain syndrome is a disease with a significant deterioration in quality of life. The reason of that is not only the presence of constant pain in the bladder and urinary disorders, but also due to psychoemotional disorders and sexual dysfunctions. The aim of the study was to assess the prevalence, nature and severity of sexual dysfunctions in women with PBPS. Materials and methods. The study involved 75 women (mean age 42.4±3.1 years) with a confirmed diagnosis of PBPS, the control group consisted of 75 women (mean age 41.8 ± 2.9 years) without dysuria and pelvic pain. The severity of clinical manifestations of PBPS was assessed on the basis of a 10-point visual analogue scale of pain in the bladder (VAS-10), questionnaires «Pelvic Pain and Urgency/Frequency Patient Symptom Scale, PUF Scale» and O'Leary-Sant Interstitial Cystitis Symptoms Index (ICSI). Sexual function was assessed using a specialized questionnaire «Female Sexual Function Index» (FSFI). Results. The overall assessment of sexual function according to the FSFI questionnaire in patients with PBPS was significantly lower than in the control group. In the patients of the main group the mean score according to the FSFI questionnaire was 16.5 ± 4.4, while in the control group it was 30.5 ± 4.2 points (p <0.01). Sexual dysfunctions were detected in 69 (92%) of 75 patients with PBPS and in 24 (32%) women in the control group. The most common type of dysfunction was dyspareunia, which was reported by 72% of women with PBPS. For all components of the sexual function of women with PBPS, its deterioration was noted in older age groups. The degree of sexual dysfunction significantly correlated with the intensity of PBPS symptoms. Discussion. Our results confirm a significant deterioration in sexual function in women with PBPS, which coincides with the data of other authors. The most common disorder is pain during intercourse. The symptoms of PBPS leads to the development of various sexual dysfunctions. It is advisable at the diagnostic stage for all women with chronic pelvic pain to assess their sexual function to understand the presence and severity of sexual dysfunctions. Conclusions. The results of this study indicate a high prevalence of sexual dysfunction in women with PBPS. The presence of pain during intercourse is the most frequent clinical manifestation and causes the development of other sexual disorders: desire, arousal, lubrication, orgasm and satisfaction. The high frequency of sexual dysfunctions and a significant impact on the quality of life of women with PBPS indicates the need for additional therapeutic measures to restore sexual function.

Sexual Dysfunction in Patients With Urinary Bladder Stones but no Bladder Outlet Obstruction

Objective: To explore the correlates of sexual dysfunction and lower urinary tract symptoms (LUTS) in male patients with urinary bladder stones and to determine the effect of stone extraction on recovery of sexual function.Materials and Methods: A total of 87 male patients with primary bladder stones were studied from January 2015 to May 2016. All patients underwent pneumatic lithotripsy for bladder stones. Sexual dysfunction was assessed based on sexual function assessment scales. The relationship of bladder stones with sexual dysfunction or LUTS was assessed using a two-sample t-test. Postoperative improvement of sexual function was assessed by repeated measures Analysis of Variance (ANOVA).Results: Forty-one patients had primary bladder stones and 46 had secondary stones from the kidneys. Eighty-three of 87 patients (95%) had sexual dysfunction; 79 patients (91%) had both sexual dysfunction and LUTS. There was a significant association between bladder stones and sexual dysfunction, between sexual dysfunction and LUTS, and between bladder stone and LUTS (p &lt; 0.05). There was no significant association between the course of illness, size and number of bladder stones, or urinary tract infection with sexual function (p &gt; 0.05). In addition, among 83 patients with both bladder stone and sexual dysfunction, 61 patients (73%) had benign prostatic hyperplasia (BPH) and 22 patients (27%) had no BPH. On postoperative evaluation at 3 months, sexual dysfunction scores were significantly improved in 77 patients (88.5%)Conclusion: Patients with bladder stones have a high incidence of sexual dysfunction, particularly those with co-existing LUTS and BPH. About 1/3 patients without BPH had sexual dysfunction and surgical removal of bladder stones significantly improved sexual function and LUTS.