Using laparoscope to remove an ectopic intrauterine device in the anterior wall of urinary bladder:A case report

BACKGROUND An intrauterine device(IUD)is a contraceptive device placed in the uterine cavity and is a common contraceptive method for Chinese women.However,an IUD may cause complications due to placement time,intrauterine pressure and other factors.Ectopic IUDs are among the most serious complications.Ectopic IUDs are common in the myometrium and periuterine organs,and there are few reports of ectopic IUDs in the urinary bladder,especially in the anterior wall.CASE SUMMARY A 52-year-old woman was hospitalized due to a urinary bladder foreign body found via abdominal ultrasound and computed tomography(CT)examination.The patient had a 2-year history of recurrent abdominal distension and lower abdominal pain,accompanied by frequent urination,urgency,dysuria and other discomfort.Ultrasound examination revealed foreign bodies in the bladder cavity,with calculus on the surface of the foreign bodies.CT revealed a circular foreign body on the anterior wall of the urinary bladder,suggesting the possibility of an ectopic IUD.After laparoscopic exploration,an annular IUD was found in the anterior wall of urinary bladder,and an oval calculus with a diameter of approximately 2 cm was attached to the surface of the bladder cavity.The IUD and calculus were successfully and completely removed.The patient recovered well after surgery.CONCLUSION Abdominal ultrasound and CT are effective methods for detecting ectopic IUDs.The IUD is located in the urinary bladder and requires early surgical treatment.The choice of surgical method is determined by comprehensively considering the depth of the IUD in the bladder muscle layer,the situation of complicated calculus,the situation of intravesical inflammation and medical technology and equipment.

Morphological changes of cholinergic nerve fibers in the urinary bladder after establishment of artificial somatic-autonomic reflex arc in rats

Objective To establish an artificial somatic-autonomic reflex arc in rats and observe the following distributive changes of neural fibers in the bladder. Methods Adult Sprague-Dawley rats were randomly divided into three groups： control group, spinal cord injury （SCI） group, and reinnervation group. DiI retrograde tracing was used to verify establishment of the model and to investigate the transport function of the regenerated efferent axons in the new reflex arc. Choline acetyltransferase （CHAT） in the DiI-labeled neurons was detected by immunohistochemistry. Distribution of neural fibers in the bladder was observed by acetylcholine esterase staining. Results DR-labeled neurons distributed mainly in the left ventral horn from L3 to L5, and some of them were also CHAT-positive. The neural fibers in the bladder detrusor reduced remarkably in the SCI group compared with the control （P 〈 0.05）. After establishment of the somatic-autonomic reflex arc in the reinnervation group, the number of ipsilateral fibers in the bladder increased markedly compared with the SCI group （P 〈 0.05）, though still much less than that in the control （P 〈 0.05）. Conclusion The efferent branches of the somatic nerves may grow and replace the parasympathetic preganglionic axons through axonal regeneration. Acetylcholine is still the major neurotransmitter of the new reflex arc. The controllability of detrusor may be promoted when it is reinnervated by the pelvic ganglia efferent somatic motor fibers from the postganglionic axons.

An unexpected urinary bladder xanthoma:Case report

In spite of the fact that xanthomas of the skin,tendons and mucosae are relatively common conditions,urinary bladder xanthoma is a rare benign lesion,only occasionally reported in literature.It usually appears as an exophytic mass into the bladder cavity,which often worries the clinicians,because it is considered as a neoplasm that need both an excision and follow-up.We herein describe the 32nd case,accidentally identified in a 63-year-old man with a right urinary bladder mass on follow-up abdominal ultrasound scan for a previous open pyeloplasty.He also referred mild obstructive lower urinary tract symptoms.Consequently,a cystoscopy with biopsies was performed and the subsequent histopathological examination was consistent with the diagnosis of urinary bladder xanthoma.Therefore,no additional therapeutics interventions were needed,and the patient currently presents nor symptoms,recurrences,or other pathologies.Although its rarity,it is important to correctly identify urinary bladder xanthoma,differentiating it from other pathological entities which present similar histopathological characteristics,but which sometimes could be associated with a patients’dismal prognosis.Moreover,an accurate diagnosis of urinary bladder xanthoma can avoid both additional treatments and follow up,but also allows to recognize some potential detrimental pathologies which could be associated with it,such as either an altered lipid metabolism or urothelial neoplasms.Proper and prompt recognition and treatment of these last can notably improve patient’s outcome.

Case Report:Diagnosis and treatment of pheochromocytoma in urinary bladder

Objective： To study the diagnosis and treatment ofpheochromocytoma in urinary bladder. Methods： Six cases of bladder pheochromocytoma were studied. Four cases showed hypertension, 3 of which were paroxysmal hypertension during urination. Catecholamine （CA） was increased in a case, and vanillymandelic acid （VMA） was increased in 2 cases. Bladder submucosal mass was detected by B-ultrasound in 5 cases （5/5）, computerized tomography （CT） in 3 cases （3/3）, cystoscopy in 5 cases （5/6）. Four cases took a-receptor blocker for 2 weeks, 1 case took β-receptor blocker to decrease heart rate. All patients were treated with surgical operation including 4 partial cystectomies, 2 excavations. Results： Three cases had manifestations including headache, excessive perspiration and hypertension during cystoscopy. Four cases were confirmed before operation. Two cases showed hypertension during operation. All patients were pathologically diagnosed as pheochromocytoma post- operatively. In five cases followed up, blood pressure returned to normal. No patient had relapse and malignancy. Conclusions： Typical hypertension during urination comprised the main symptoms. We should highly suspect bladder pheochromocytoma if a submucosal mass was discovered with B-ultrasound, CT, ^131I-M1BG （methyliodobenzylguanidine） and cystoscopy. The determination of CA in urine is valuable for qualitative diagnosis. The preoperative management of controlling blood pressure and expansion of the blood volume are very important. Surgical operation is a good method for effective treatment. Postoperative long-time followed up is necessary.

Experimental Study of the Effect of Capsaicin on the Urinary Bladder Function in Rats

In order to investigate the effect of capsaicin (CAP) on the urinary bladder function, an in vivo whole bladder study was undertaken in 25 adult healthy Wistar rats. CAP of various concentrations was instilled into the urinary bladder, and intravesical pressure, detrusor contraction and micturition status were recorded; then the trigone of the bladder was cut off and prepared for peroxidase -antiperoxidase (PAP) immunohistochemical investigation. The changes on the distribution of Sub- stance P (SP) in control and experimental groups were compared. The results showed that the intravesical application of CAP caused a significant change in the urinary bladder function. At a low concentration of CAP there was a slight increase of maximal detrusor pressure, but at a high concentration of CAP the maximal intravesical pressure was significantly decreased and associated with urinary retention and urinary incontinence. PAP sustaining had shown a depletion of SP in CAP-treated urinary bladder in rats, and this depletion was more significant at high concentrations of CAP. Because this depletion could block C-fiber transmission, detrusor function entered, from primary excitation phase, a late inhibitory phase. This suggests that a local application of CAP into urinary bladder could be used in the treatment of neurogenic bladder (detrusor hyperreflexia) to relieve frequency, urgency, incontinence and improve renal function.

Fish bone migration to the urinary bladder after rectosigmoid colon perforation

Fish bones are the most common foreign objects leading to bowel perforation.Most cases are confined to the extraluminal space without penetration of an adjacent organ.However,abscess formation due to the perforation of the rectosigmoid colon by a fish bone can lead to the penetration of the urinary bladder and may subsequently cause the fish bone to migrate into the urinary bladder.In the presented case,a 42-yearold female was admitted for lower abdominal pain.The computed tomography(CT)demonstrated a 5cm pelvic abscess containing a thin and curvilinear foreign body.After conservative management,the patient was discharged.After 1 mo,the subject developed a mechanical ileus.Surgery had to be delayed due to her hyperthyroidism.Migration of the foreign body to the urinary bladder was shown on additional CT.A Yellowish fish bone 3.5 cm in size was removed through intraoperative cystoscopy.The patient was discharged 8 d after the operation without any unexpected event.

A Combined Clinicopathologic Analysis of 658 Urothelial Carcinoma Cases of Urinary Bladder

Objective To study the clinicopathological features of patients with urothelial carcinoma of the urinary bladder (UCB), and analyze the association of clinicopathological characteristics with tumor recurrence and progression. Methods Altogether 658 UCB cases in Fudan University Shanghai Cancer Center were collected from January 2006 to December 2010. The histopathologic materials and the clinical records were reviewed. Univariate and multivariate analyses were preformed to detect the association. Results The mean age of the patients was 61.97±12.97 years (range, 20-90 years). Male to female ratio was about 5:1. A total of 517 cases (78.6%) were superficial at the time of diagnosis (stage Ta/T1). The mean follow-up period was 22.36±24.92 months. Twenty-five patients lacking follow-up information were excluded in calculating recurrence and progression rates, the recurrence rate was about 37.0% (234/633), and progression rate about 6.2% (39/633). Three variables (grade, tumor growth pattern, and pathological stage) were found to be significant risk factors for tumor progression in univariate and multivariate analyses (P<0.05). Conclusions Most of the newly diagnosed UCB cases may be superficial diseases. Grade, tumor growth pattern, and pathological stage are associated with tumor progression of UCB.

Haemangiomas in the urinary bladder:Two case reports

BACKGROUND Urinary bladder haemangioma is a benign nonurothelial tumour that rarely occurs in paediatric and adolescent patients.Clinical and radiological examinations are not adequate for an accurate diagnosis.The purpose of this serial case report is to raise awareness of urinary bladder haemangioma and appropriate management.CASE SUMMARY We described two rare cases of urinary bladder haemangioma that were confirmed by histopathology followed by immunohistochemistry and reviewed the literature on the diagnosis and treatment of patients with this disease.The radical cystectomy was performed with open method surgery associated with an abdominal wall ostomy of the ileal outlet tract for case 1.Case 2 underwent a laparoscopic partial cystectomy.Postoperative pathology confirmed the diagnosis of urinary bladder haemangioma.Haematuria resolved postoperatively,and there was no evidence of tumour recurrence in 3 years follow-up for case 1.Postoperative urinary and pelvic ultrasonography showed no signs of recurrence in 3 mo follow-up for case 2.CONCLUSION Careful histopathological and immunohistochemical studies are required to establish the correct diagnosis.There is no“gold standard”treatment for urinary bladder haemangioma,and treatment options are varied for individuals with favourable follow-ups.

Granular cell tumor of the urinary bladder: A case report

We reported a case of a GCT of the urinary bladder and review the literature.A 23-year-old female presented with dysuria that had lasted for the previous 6 months.MRI revealed a 3×2.5 cm global mass in the anterior wall of urinary bladder.Cystoscopy showed a semispherical tumor approximately 3 cm in diameter that was covered with normal bladder mucosa and extended from the bladder neck to the anterior wall of the bladder.The patient underwent transurethral resection of the tumor.Histological examination and immunohistochemical staining showed a granular cell tumor(GCT).There were no features suggesting a malignant phenotype.On 6 months follow-up,the patient has remained free of bladder recurrence.We recommend careful pathologic assessment for establishing the appropriate diagnosis and either a conservative or aggressive surgical treatment for benign or localized malignant GCT of the urinary bladder,respectively.

Glass ampoule in urinary bladder as a foreign body

A wide range of objects have been inserted into the urinary bladder and urethra.Most foreign bodies in the lower genitourinary tract are self-inserted via the urethra as the result of erotic impulses,psychometric problems,sexual curiosity,or sexual practice while intoxicated.Here we report the case of a 32-year-old female with alleged history of insertion of glass ampoule in the urethra by the husband in eroticism which was removed with open surgery.This is the first case of its kind as per the literature available.

Rare case of hepatocellular carcinoma metastasis to urinary bladder:A case report

BACKGROUND Hepatocellular carcinoma(HCC)is a primary liver cancer with high prevalence and mortality.There are many cases of advanced HCC at the time of diagnosis.Treatment methods and prognosis are different depends on whether metastasis is present.Thus,it is necessary to make an accurate evaluation at the time of diagnosis.Extrahepatic metastases of HCC usually occur through hematogenous spread or through adjacent organs such as the peritoneum.Metastasis to the urinary bladder alone is rare.Here,we report a rare case of biopsy-proven solitary metastasis of HCC to the bladder in a 60-year-old woman.CASE SUMMARY A 60-year-old female patient was found to be positive for hepatitis B surface antigen by chance after abdominal ultrasonography showed abnormal findings.Thus,liver dynamic computed tomography(CT)was performed.The patient visited the hospital for further examination.Ultrasound and CT showed 3.6 cm sized arterial enhancing mass in segment 5 and an infiltrative mass in segment 8.The patient was diagnosed with HCC through liver dynamic magnetic resonance imaging and liver biopsy.Afterwards,she underwent two transcatheter arterial chemoembolizations within five months for HCC.During follow-up,a newly appeared bladder tumor was found on liver dynamic CT.She underwent transurethral resection of the bladder tumor for diagnosis and treatment.The tissue was confirmed as metastatic HCC.CONCLUSION Although rare,metastasis to urinary bladder from HCC can occur without evidence of other distant metastases.Thus,regular follow-up imaging examination and clinical attention are required.

Study of wavy laminar growth of human urinary bladder cancer cell line in vitro

Objective: To observe the ordered growth behavior of human urinary bladder cancer cell line (BIU) under culture in vitro. Methods: The suspension of BIU cells was spread locally in a culture container. When the cells grew a-long the wall to form a cellular colony, macroscopic and microscopic observations complemented with measurements of the parameters including expanding diameter, expanding rate, cell shape. average cell density, average cell size. dehydrogenase activity and sensitivity to pH were conducted dynamically. Results: During cell culture, obvious laminar characteristics appeared in localized growing BIU cell colonies and there was difference between the cells of different zones in shape, size, density, dehydrogenase activity and sensitivity to pH. Conclusion: Space closing and bio-dissipation result in self-organization of BIU cells with ordered growth behavior. The present experiment offers a simple, controllable model for the study of wavy growth of human cells.

Diagnosis and treatment of primary small cell carcinoma of urinary bladder

Objective To investigate clinical and pathological features of small cell carcinoma of urinary bladder. Methods The pathological and clinical data of 9 cases of small cell carcinoma were analyzed retrospectively.

DEFENSE MECHANISMS OF URINARY BLADDER:STUDIES ON ANTIMICROBIAL POLYPEPTIDES FROM BLADDER MUCOSA

The acid soluble extract of the bladder mucosal surface was obtained by washing out the bladder with dilute acetic acid in the presence of protease inhibitors. The wash out materials from rats, rabbits, pigs, and humans manifested strong bactericidal activity against E.coli in vitro. The ultrafiltrate of the human material, which contained two major peptides with apparent molecular masses of 6 7 kD and 8 5 kD, respectively, showed potent bactericidal activity against E. coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus sanguis.Three antibacterial polypeptides (PiBPs) were purified from the porcine material. The molecular masses of PiBP 5, PiBP 11 and PiBP 25 were 5773.3 Da, 11127.8 Da and 25073 Da, respectively. PiBP 5 was unusually rich in glycine, serine and threonine residues(20 0, 16 3 and 10 4 mo1%, respectively), and N terminal amino acid sequencing revealed that PiBP 5 was homologous (83 3% identity in an 18 residue overlay) to the “tail” of human cytokeratin 7. Although the amino acid compositions of PiBP 11 and PiBP 25 were established, both had blocked N termini and primary sequence data were not obtained. These results provided evidence indicating that the presence of peptides in the bladder mucosa could enable it to kill adherent bacteria.

Understanding the role of transmembrane 9 superfamily member 1 in bladder cancer pathogenesis

In this editorial we comment on the article by Wei et al,published in the recent issue of the World Journal of Clinical Oncology.The authors investigated the role of Transmembrane 9 superfamily member 1(TM9SF1)protein in bladder cancer(BC)carcinogenesis.Lentiviral vectors were used to achieve silencing or overexpression of TM9SF1 gene in three BC cell lines.These cell lines were then subject to cell counting kit 8,wound-healing assay,transwell assay,and flow cytometry.Proliferation,migration,and invasion of BC cells were increased in cell lines subjected to TM9SF1 overexpression.TM9SF1 silencing inhibited proliferation,migration and invasion of BC cells.The authors conclude that TM9SF1 may be an oncogene in bladder cancer pathogenesis.

Effects of acupuncture stimulation of the sacral region on EEG and urinary bladder activity in rats

Objective To observe the effect of acupuncture stimulation of the sacral segment on the excitability of the cerebral cortex and the activity of the urinary bladder and the involvement of the cholinergic neurons in the laterodorsal tegmental （LDT） nucleus of the brainstem in acupuncture-induced electroencephalogram （EEG） changes. Methods A total of 109 SD rats were used in the present study. Under anesthesia （urethane）, a pair of stainless steel electrodes was separately implanted into the frontal and parietal bony sutures to record EEG. Glass microelectrodes were used to record extracellular discharges of single neuron of the LDT nucleus in the brainstem. Urinary bladder pressure was recorded through a catheter inserted in the bladder and the contraction was induced by infusion of normal saline. A filiform acupuncture needle was inserted into the sacral segment Ecorresponding to Zhongliao （中髎BL 33）] and rotated manually for 1 min. Results In 27 rats whose bladder was full of normal saline, acupuncture stimulation of the sacral region suppressed the contraction activity of the bladder, the fast EEG with lower amplitude and higher frequency tuned into slow EEG with higher amplitude and lower frequency in 6 cases （22.2%）. The inhibitory effect occurred from 45 s to 12 min after acupuncture manipulation. In 82 rats whose bladder was empty, acupuncture stimulation caused the fast EEG to turn into slow EEG in 71 cases （86.6%）. Simultaneously, LDT cholinergic neurons reduced their firing rates from （2.9±1.5） Hz to （1.2±0.6） Hz （n = 12, P〈0.05）, and the reduction of LDT neuronal discharge was earlier in time than the change of EEG. Conclusion Acupuncture stimulation of the sacral region can lower the excitability of the cerebral cortex and suppress bladder activity, which is closely associated with its resultant inhibitory effect on the electrical activity of LDT cholinergic neurons.

A novel bioreactor to simulate urinary bladder mechanical properties and compliance for bladder functional tissue engineering

Background Bioreactors are pivotal tools for generating mechanical stimulation in functional tissue engineering study.This study aimed to create a bioreactor that can simulate urinary bladder mechanical properties, and to investigate the effects of a mechanically stimulated culture on urothelial cells and bladder smooth muscle cells.Methods We designed a bioreactor to simulate the mechanical properties of bladder. A pressure-record system was used to evaluate the mechanical properties of the bioreactor by measuring the pressure in culture chambers. To test the biocompatibility of the bioreactor, viabilities of urothelial cells and smooth muscle cells cultured in the bioreactor under static and mechanically changed conditions were measured after 7-day culture. To evaluate the effect of mechanical stimulations on the vital cells, urethral cells and smooth muscle cells were cultured in the simulated mechanical conditions. After that, the viability and the distribution pattern of the cells were observed and compared with cells cultured in non-mechanical stimulated condition.Results The bioreactor system successfully generated waveforms similar to the intended programmed model while maintaining a cell-seeded elastic membrane between the chambers. There were no differences between viabilities of urothelial cells （（91.90±1.22）% vs. （93.14±1.78）%, P 〉0.05） and bladder smooth muscle cells （（93.41±1.49）% vs.（92.61±1.34）%, P 〉0.05）. The viability of cells and tissue structure observation after cultured in simulated condition showed that mechanical stimulation was the only factor affected cells in the bioreactor and improved the arrangement of cells on silastic membrane.Conclusions This bioreactor can effectively simulate the physiological and mechanical properties of the bladder.Mechanical stimulation is the only factor that affected the viability of cells cultured in the bioreactor. The bioreactor can change the growth behavior of urothelial cells and bladder smooth muscle cells, resulting in the cells undergoing adaptive changes in mechanically-stimulated environment.

Diagnosis and treatment of penetrating wounds through the anorectum and urinary bladder or posterior urethra

Penetrating wound of the anal canal is relatively rare, which is often complicated with injuries of the rectum, urinary bladder or posterior urethra. Misdiagnosis and improper treatments of the disease may lead to pelvic abscess, anal stenosis, fecal incontinence, or rectovesical fistula. From 1985 to 2004, 16 patients with penetrating wounds through the anorectum and urinary bladder or posterior urethra were treated in our hospital.

Small cell carcinoma of the urinary bladder without gross hematuria： a case report

Small cell carcinoma of the urinary bladder （SCCB） is a rare and aggressive form of bladder cancer with poor prognosis. Hematuria is the main symptom of this malignancy, and most patients have a history of smoking. The disease incidence of malignant bladder tumors in China is approximately 0.74%. Early and accurate diagnosis of SCCB can ensure timely and appropriate treatment of this malignant disease. Oncologic surgery is the standard treatment; however, it may not be a curative approach. Chemotherapy and/or radiotherapy should be performed following surgical removal. This case report describes a patient with a single neoplasm diagnosed as SCCB that arose because of recurrence of bladder cancer after bladder tumor resection. In contrast to previously reported cases, this patient had no gross hematuria and no history of smoking.

DIAGNOSIS AND TREATMENT OF PHEOCHROMOCYTOMAS IN URINARY BLADDER

Objective To investigate the diagnosis and treatment of pheochromocytomas in urinary bladder and review relative literatures. Methods The clinical data of 6 cases of bladder pheochromocytoma were retrospectively analyzed. Bladder submucosal mass was detected by B-ultrasound in 6 cases, computerized tomography （CT） in 4, and cystoscopy in 3. All patients were treated with surgical operation. Results Two patients showed obvious fluctuation of blood pressure during operation. All patients were pathologically diagnosed as pheochromocytoma postoperatively. Five patients were followed up （from 3 months to 7 years） , and their blood pressure returned to normal. No patient had relapse and malignancy. Conclusion Typical hypertension during urination and hematuria constitute the chief symptoms of bladder pheochromocytoma. B-ultrasound, CT, and cystoscopy are the main methods for the localization of the lesions. Partial cystectomy or excision of the tumor is the preferred management and postoperative long-term follow-up is necessary.