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.

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.

Stem cell applications for pathologies of the urinary bladder

New stem cell based therapies are undergoing intense research and are widely investigated in clinical fields including the urinary system. The urinary bladder performs critical complex functions that rely on its highly coordinated anatomical composition and multiplex of regulatory mechanisms. Bladder pathologies resulting in severe dysfunction are common clinical encounter and often cause significant impairment of patient's quality of life. Current surgical and medical interventions to correct urinary dysfunction or to replace an absent or defective bladder are sub-optimal and are associated with notable complications. As a result, stem cell based therapies for the urinary bladder are hoped to offer new venues that could make up for limitations of existing therapies. In this article, we review research efforts that describe the use of different types of stem cells in bladder reconstruction, urinary incontinence and retention disorders. In particular, stress urinary incontinence has been a popular target for stem cell based therapies in reported clinical trials. Furthermore, we discuss the relevance of the cancer stem cell hypothesis to the development of bladder cancer. A key subject that should not be overlooked is the safety and quality of stem cell based therapies introduced to human subjects either in a research or a clinical context.

Totally intracorporeal robot-assisted urinary diversion for bladder cancer(part 2).Review and detailed characterization of the existing intracorporeal orthotopic ileal neobladder

Objective:To review the most used intracorporeal orthotopic ileal neobladder(ICONB)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images.Methods:We performed a non-systematic review of the literature with the keywords“bladder cancer”,“urinary diversion”,“radical cystectomy”,and“neobladder”.Results:Forty studies were included in the analysis.The most frequent type of ICONB was the modified Studer“U”neobladder(70%)followed by the Hautmann“W”modified neobladder(7.5%),the“Y”neobladder(5%),and the Padua neobladder(5%).The operative time to perform a urinary diversion ranged from 124 to 553 min.The total estimated blood loss ranged from 200 to 900 mL.The rate of positive surgical margins ranged from 0%to 8.1%.Early minor and major complication rates ranged from 0%to 100%and from 0%to 33%,respectively.Late minor and major complication rates ranged from 0%to 70%and from 0%to 25%,respectively.Conclusion:The most frequent types of ICONB are Studer“U”neobladder,Hautmann“W”neobladder,“Y”neobladder,and the Padua neobladder.Randomized studies comparing the performance of the different types of ICONB,the performance in an intra or extracorporeal manner,or the performance of an ICONB versus ICIC are lacking in the literature.To this day,there are not sufficient quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used ICONB with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images of each technique.

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.

Urethral pressure profilometry in artificial urinary sphincter implantation: A case report

BACKGROUND Artificial urethral sphincter(AUS)implantation is currently the gold standard for treating moderate and severe urinary incontinence.Currently,cuffs are chosen based on the surgeon’s experience,and adjusting cuff tightness is crucial.The TDOC air-charged catheter has not been proven to be inferior to traditional catheters.We report how intraoperative urethral pressure profilometry is performed using a T-DOC air-charged catheter with ambulatory urodynamic equipment,to guide cuff selection and adjustment.CASE SUMMARY A 67-year-old man presented to our hospital with complete urinary incontinence following transurethral prostatectomy,using five pads/d to maintain local dryness.Preoperatively,the maximum urethral pressure(MUP)and maximum urethral closure pressure(MUCP)were 52 cmH2O and 17 cmH2O,respectively.An AUS was implanted.Intraoperatively,in the inactivated state,the MUP and MUCP were 53 cmH2O and 50 cmH2O,respectively;in the activated state,they were 112 cmH2O and 109 cmH2O,respectively.The pump was activated 6 wk postoperatively.Re-measurement of the urethral pressure on the same day showed that in the inactivated state,MUP and MUCP were 89 cmH2O and 51 cmH2O,respectively,and in the activated state,120 cmH2O and 92 cmH2O,respectively.One month after device activation,telephonic follow-up revealed that pad use had decreased from five pads/d to one pad/d,which met the standard for social continence(0-1 pad per day).There were no complications.CONCLUSION The relationship between intraoperative urethral pressure and urinary continence post-surgery can provide data for standardizing AUS implantation and evaluating efficacy.

Totally intracorporeal robot-assisted urinary diversion for bladder cancer(Part 1).Review and detailed characterization of ileal conduit and modified Indiana pouch

Objective:To review the most used robot-assisted cutaneous urinary diversion(CUD)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images Methods:A non-systematic review of the literature with the keywords“bladder cancer”,“cutaneous urinary diversion”,and“radical cystectomy”was performed.Results:Twenty-four studies of intracorporeal ileal conduit(ICIC)and two of intracorporeal Indiana pouch(ICIP)were included in the analysis.Regarding ICIC,the patients’age ranged from 60 to 76 years.The operative time to perform a urinary diversion ranged from 60 to 133 min.The total estimated blood loss ranged from 200 to 1117 mL.The rate of positive surgical margins ranged from 0%to 14.3%.Early minor and major complication rates ranged from 0%to 71.4%and from 0%to 53.4%,respectively.Late minor and major complication rates ranged from 0%to 66%and from 0%to 32%,respectively.Totally ICIP data are limited to one case report and one clinical series.Conclusion:The most frequent type of CUD is ICIC.Randomized studies comparing the performance of the different types of CUD,the performance in an intra-or extracorporeal manner,or the performance of a CUD versus orthotopic ileal neobladder are lacking in the literature.To this day,there are not enough quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used CUD with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images for each technique.

Phaeochromocytoma of the urinary bladder presenting with malignant hypertension and hypertensive retinopathy

Dear Editor,Phaeochromocytoma of thelurinary bladder is a rare tumour that originates from chromaffin tissue of the sympathetic nervous system situated within the urinary bladder wall[1].These are tumours of the sympathetic nervous tissue and the symptom profile will depend on the secretory function[1].These account for less than 0.05%of all bladder tu-mours and less than 1%of all phaeochromocytoma[1].As phaeochromocytoma of the urinary bladder is such a rare condition,only limited literature is available to direct clinical decision making.

ACUPUNCTURE FOR TREATMENT OF DIABETIC URINARY BLADDER NEURAL DYSFUNCTION - A Report of 36 Cases

Urinary bladder neural dysfunction (UBND) is a common complication of diabetes mellitus. When urinary bladder paralysis develops, urinary system infection readily occurs. If the infection is not treated properly, serious sequelae will happen. Western doctors primarily use

Inflammatory Myofibroblastic Tumor of the Urinary Bladder—A Case Report with Review of Literature

Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm with unknown malignant potential that has been described in most organ systems. We herein present a case of a young female who presented with macroscopic hematuria. An IMT of the urinary bladder which was not suspected after clinical, radiological and surgical work-up was diagnosed microscopically and confirmed by immunohistochemistry. A close clinical follow-up is recommended because of the unknown biological behavior of this tumor. A brief review of literature is also presented here.

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.

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.

Pressure assessment in intercavernous embedding of bulboperineal urethra for treatment of urinary incontinence after prostatic operation

Aim: To put forward criteria for the pressure assessment in the operation of intercavernous embedding of bulboper-ineal urethra for the treatment of urinary incontinence after prostatic operation. Methods: A F14 urethral catheter isinserted during the operation and upon suturing the corpora cavernosa centrally, the catheter is slowly pushed in andpulled out in order that the operator feels a certain degree of close-fit resistance. The degree of tightness of the stitches,which regulate the compression pressure, is adjusted in accordance with this close-fit sensation. To further ascertain theadequacy of the force of compression, the bladder is filled with 300 ml physiological saline and observe the appropriate-ness (size and continuity) of the outflow stream when the lower abdomen is depressed with a pressure of 80 - 90 cmH_2O. The operation was given to six patients suffered from urinary incontinence for 20 or more months after prostaticoperation. Results: Five cases achieved complete recovery, while the therapeutic effect of the 6th one was not sat-isfactory . A second stage operation was carried out 3 months later with the addition of one more stitch both proximallyand distally to reinforce the compression force. The condition was improved dramatically. The follow-up period aver-aged 3.5 years. Conclusion; The adequacy of the compression pressure exerted by the juxtaposed corpora cavernosais the key point determining the outcome of the operation. The measures for assessing the compression pressure suggest-ed by the authors are helpful in obtaining the good results of the present paper (6/6 success) as compared with 25/34success in the previous report. (Asian J Androl 2001 Sep; 3: 235 — 237)

Investigation of Patients with Spontaneous Rupture of the Urinary Bladder

Non-traumatic rupture of the urinary bladder is termed “spontaneous rupture of the urinary bladder”. Although this disorder is relatively rare, when the bladder ruptures into the abdominal cavity, urine leaking into the abdominal cavity leads to the development of urinary peritonitis. We encountered seven patients with spontaneous rupture of the urinary bladder at our institution between 1987 and 2012. Six of these patients were women, all of whom had undergone surgery and radiotherapy to treat malignant uterine tumor. All seven patients suddenly developed abdominal pain and ascites. Urea nitrogen (UN) and creatinine (Cre) levels were greater in ascites than in the blood in all patients. Although all patients were treated conservatively, recurrence was identified in three patients. Recurrence was observed in only one of the four patients who received hyperbaric oxygen therapy. Conclusion: Hyperbaric oxygen therapy may be effective for recurrence of spontaneous rupture of the urinary bladder.

Very Low, Real-Time Rate of Urinary Retention after Intradetrusor Botox^&regfor Non-Neurogenic Overactive Bladder

Introduction: According to the most recent AUA/SUFU guidelines, intradetrusor onabotulinumtoxinA (BTN/A) is a standard, evidence strength grade B, third line treatment option for refractory non-neurogenic overactive bladder (OAB). Urinary retention is the most common clinically significant reported side effect ranging from 5.4% to 43% in previous studies. The aim of this study was to investigate the real-time rate of urinary retention in patients treated with BTN/A for refractory non-neurogenic OAB in a multi-institutional study. Methods: Retrospective chart review identified 71 patients who were treated with 100U BTN/A for refractory non-neurogenic OAB from August 2011 to July 2015 at two institutions. Using a flexible cystoscope, 100U Botox&reg reconstituted with 10 ml normal saline was administered. Injections of 1 ml (10 units/ mL) were administered in 10 evenly distributed sites sparing the trigone. Pre and post BTN/A post-void residuals (PVR) were reviewed. Urinary retention was defined as PVR > 200 mL requiring clean intermittent catheterization (CIC). Results: After exclusion, the study group consisted of 66 patients with a mean age of 67 years and 30% were men. Mean pre and post-procedural PVR were 14.06 mL and 69.21 mL. Eight patients (12.12%) were noted to have elevated PVR > 200 mL post injection however only one patient (female) required initiation of CIC. The rate of urinary retention was 1.5% (N = 1). There was no correlation with age, history of previous radiation, diabetes or prior use of a neuromodulator device. Conclusions: To the best of our knowledge, this is the first study to demonstrate a very low risk of real-time urinary retention rates in appropriately selected patients treated with BTN/A for refractory non-neurogenic OAB outside of a clinical trial setting.

Detecting Urinary Bladder Contractions: Methods and Devices

In patients suffering from neurogenic detrusor overactivity, continence can be regained by conditional stimulation of the dorsal genital nerve (DGN);that is applying electrical stimulation to the DGN at the onset of an involuntary contraction. For this scheme to work, a sensor capable of reliably detecting the onset of bladder contractions is needed. This article reviews the methods proposed for or associated with detection of bladder contractions, and their applicability to onset detection is assessed. Fourteen methods are described in this review;bladder pressure, urethral sphincter EMG and anal sphincter EMG are the most promising options for onset detection. For all three modalities, however, further research is needed before clinical application becomes viable.

Could Bladder Inflation Prior to Cesarean Section Prevent Urinary Tract Injury in High Risk Group? A Randomized Controlled Trial

Background: Accidental urinary tract particularly bladder injury during cesarean delivery has a significant maternal morbidity, as it may lead to extended operative time, infection of urinary tract and sometimes development of urinary tract fistulae. Objective: To find out the efficacy of urinary bladder inflation immediately prior to cesarean section (CS) procedure in minimizing incidence of accidently urinary tract injury in high risk patients. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Qena, Egypt. Duration: From August 2017 to November 2018. Study Design: A prospective randomized controlled trial. Methods: Seventy six pregnant women recruited from attendants of outpatient antenatal care unit of obstetrics and gynecology department who planned for cesarean delivery and carried one or more risk factors for urinary tract injury. Patients randomly were classified into 2 groups (group I included 38 cases, underwent bladder inflation using triple way Foley’s catheter immediately before CS and group II included 38 cases, and underwent bladder deflation with 2 ways Foley’s catheter immediately before CS. Results: The overall incidence of urinary tract injury was significantly higher in group II (7 cases = 18.4%) than in group I (2 cases = 5.2%) with p value < 0.001. The incidence of urinary bladder injury was moderately significantly higher in group II (5 cases = 13.1%) than group I (2 cases = 5.2%) with p value 0.01;ureteric or combined vesico-ureteric injuries had been reported only in group II (1 case = 2.6% and 1 case = 2.6%) respectively with no case reported in group I (p There was a highly statistically significant difference between group I and group II as regard to hospital stay (p < 0.001) but mildly significant differences in operative time and remote urinary tract fistulae (p Conclusions: There was significant reduction in urinary bladder injury, ureteric injury, operative time and hospital stay. Urinary bladder inflation immediately before cesarean section should be applied in patients who have any risk factor of dense bladder adhesion as a protective procedure against urinary tract injuries.

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.

Urinary Bladder Cancer: The Current and Potential Role of MR Imaging in Non-Distant Metastatic Lesions

Urinary bladder cancer is the second most common genitourinary malignancy in Westernized countries. A number of emerging imaging techniques have recently been reported in the literature for use in imaging bladder cancer. While the explicit application of MR imaging in bladder cancer especially in non-distant bladder cancer or bladder cancer localized in pelvic remains uncertain and awaits a thorough evaluation. Therefore, this article aims to make a systematic review of previous literature and provide a complete assessment of the value of MR as an evolving imaging tool in localized urinary bladder cancer application. Studies were conducted by searching the MEDLINE and PubMed databases up to 2012 using both medical subject heading (Mesh) and a free text method like “urinary bladder cancer”, “magnetic resonance imaging” or “MRI”, “diffusion weighted imaging” or “DWI”. About 53 articles were selected and analyzed which were considered to be associated with the objective of this systematic review (Table 1). Results showed that MRI especially the newer functional imaging technique like DWI may has a great potential role in localized bladder cancer like early detection, staging, evaluation of tumor aggressiveness and therapeutic responsiveness of patients in the assessment of urinary bladder cancer and so forth. Newer MRI has already proceeded promising results in bladder cancer application;and the explicit role of newer MRI in bladder cancer patients still needs further research and awaits to be thoroughly evaluated.