Características clínico-patológicas de las lesiones malignas del tracto urinario inferior / Clinicopathological features of malignant lesions of the lower urinary tract / Características clínico-patológicas de lesões malignas do trato urinário inferior

RESUMEN Introducción: El cáncer de vejiga es un tumor mucho más frecuente de lo que a veces nos transmiten las estadísticas o los medios de comunicación. Ocupa el noveno lugar en cuanto al número de diagnósticos de cáncer a nivel mundial y se reporta aproximadamente cinco veces más frecuente en varones que en mujeres. Objetivo: Describir las características clínico-patológicas de los tumores malignos del tracto urinario inferior. Método: Se realizó un estudio descriptivo y transversal de 186 pacientes con tumores malignas del tracto urinario inferior diagnosticados anatomo-patológicamente en el Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres", de Santiago de Cuba, entre los años 2017 al 2020. Una vez recopilados los datos se procesaron mediante el sistema estadístico SPSS, en su versión 21.0. Resultados: En la serie la mayoría de los afectados fueron hombres entre los 60 y 79 años de edad, siendo más frecuente en el sexo masculino. Predominaron los carcinomas uroteliales con el 96,4 % del total en su variedad papilar y de alto grado de malignidad. Conclusiones: Los tumores malignos del tracto urinario inferior son un problema de salud de baja frecuencia cuya trascendencia es la afectación individual a quien lo padece, y su comportamiento clínico patológico, en sentido general, fue similar a lo reportado por la literatura nacional e internacional, salvo pequeñas y puntuales diferencias relativo a los síntomas, el diagnóstico histológico, en parte, y el grado de malignidad de las lesiones.

ABSTRACT Introduction: Bladder cancer is a more common tumor that sometimes the statistics database or media conveyed to us. It ranks ninth concerning cancer diagnoses worldwide and it is reported to be approximately five times more frequent in males than in females. Objective: To describe the clinicopathologic features of malignant lower urinary tract tumors. Method: A descriptive and cross-sectional study involving a total of 186 patients was conducted. Anatomical and pathological diagnoses were carried out to all patients with malignant lower urinary tract tumor at the Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" in Santiago de Cuba, from 2017 throughout 2020. Once the data were collected, they were processed using the SPSS statistical system, version 21.0. Results: Most affected patients with lower urinary tract tumor had an average age of 60 to 70, arising most frequently in males. The 96.4 % of the total of the patients were diagnosed with urothelial carcinomas (predominant), described in its papillary variety and the high degree of malignant transformation. Conclusions: Malignant lower urinary tract tumors are health problems labeled as the low frequency which differ in their transformation according to the patient. The clinical pathological behavior of the tumor, in a general sense, was similar to that reported in the national and international literature, except for small and pointed differences regarding symptoms, histological diagnosis, and the degree of the lesions´ malignant transformation.

RESUMO Introdução: O câncer de bexiga é um tumor mais comum do que às vezes o banco de dados de estatísticas ou a mídia veiculada por nós. Ele ocupa o nono lugar em diagnósticos de câncer em todo o mundo e é relatado ser aproximadamente cinco vezes mais frequente em homens do que em mulheres. Objetivo: Descrever as características clínico-patológicas dos tumores malignos do trato urinário inferior. Método: Foi realizado um estudo descritivo e transversal envolvendo um total de 186 pacientes. Os diagnósticos anatômicos e patológicos foram realizados a todos os pacientes com tumor maligno do trato urinário inferior no Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" em Santiago de Cuba, de 2017 a 2020. Uma vez coletados os dados, eles foram processados ​​no SPSS sistema estatístico, versão 21.0. Resultados: A maioria dos pacientes afetados com tumor do trato urinário inferior tinha uma idade média de 60 a 70 anos, surgindo mais frequentemente no sexo masculino. 96,4% do total dos pacientes foram diagnosticados com carcinomas uroteliais (predominantes), descritos em sua variedade papilar e alto grau de transformação maligna. Conclusões: Os tumores malignos do trato urinário inferior são problemas de saúde rotulados como de baixa frequência e que diferem em sua transformação de acordo com o paciente. O comportamento clínico-patológico do tumor, de um modo geral, foi semelhante ao relatado na literatura nacional e internacional, exceto por pequenas e pontuadas diferenças quanto à sintomatologia, ao diagnóstico histológico e ao grau de transformação maligna das lesões.

Operation mode to prevent obturator nerve reflex in plasmakinetic resection of bladder tumor / 中华泌尿外科杂志

Objective To observe the results and reality of transurethral resection of bladder tumor with preexcitation of electric cutting loop in the prevention of obturator nerve reflex.Methods The clinical data of 186 patients with bladder tumors admitted from January 2015 to August 2018 were retrospectively analyzed.There were 112 males and 74 females aged 35 to 83 years,average (59 ± 11)years.76 patients were admitted because of intermittent gross hematuria and 110 patients were admitted because of physical check-up.All patients underwent ultrasound,CT (plain scan/enhancement) and cystoscopy before operation.The pathological diagnosis of cystoscopy biopsy was bladder urothelial cell carcinoma.There were 105 cases clinical stage Ta stage,81 cases of T1 stage.There were 103 single cases and 39 multiple cases of non-muscular invasive bladder.According to the different surgical techniques,the patients were divided into two groups:the pre-excitation group and lateral incision group.There were 142 cases in pre-excitation group.In the pre-excitation group,the tumors were removed routinely by the resection ring.When the resection ring was far away from the tumors,the pedal switch was pressed to excite the resection ring.The resection ring was moved to the location of the tumors,and the tumors were cut to the muscular layer.The operation was completed after 2 cm electric cauterization around the wound and hemostasis.In the lateral incision group,the tumors were removed routinely by the electric resection ring.The operation time,incidence of obturator nerve reflex,incidence of bladder perforation,amount of bleeding,retention time of catheter,pathological grading,risk grading,hospitalization time and recurrence rate of tumors at 6 months after operation were compared between the two groups.Results The operation was successfully completed in both groups,and there was no transition to open operation.In the pre-excitation group,the operation time was 10 minutes to 56 minutes,with an average of (28 ± 12) minutes,and the intraoperative blood loss ranged from 5 ml to 70 ml,with an average of (35 ± 15) ml.In the lateral incision group,the operation time was 15 minutes to 65 minutes,with an average of (28 ± 11) minutes,and the blood loss was 10 ml to 80 ml,with an average of (40 ± 15) ml.There was no significant difference in operation time and blood loss between the two groups (P ＞ 0.05).There were only 3 cases of obturator nerve reflex in preexcitation group,the incidence was 2.1％.There were 13 cases of obturator nerve reflex in lateral resection group,the incidence was 29.5％.There was significant difference of nerve reflex incidence between the two groups (P ＜ 0.05).Conclusions In transurethral resection of bladder tumors,the method of pre-excitation of plasma resection ring can effectively decrease obturator nerve reflex and make the operation safer.

The diagnostic value of narrow-band imaging for fiat bladder lesions / 中华泌尿外科杂志

Objective To investigate the diagnostic value of narrow-band imaging for flat bladder lesions.Methods Forty-nine patients with flat bladder lesions diagnosed by white light cystoscopy + narrow-band imaging followed by transurethral resection were included.The diagnostic value of narrow-band imaging was evaluated based on postoperative pathological results.Results A total of 59 flat lesions were identified,in which 8 were normal urothelium,3 were chronic inflammation,1 was papillary urothelial neoplasm of low malignant potential,1 were mild dysplasia,1 was moderate dysplasia,1 were severe dysplasia,3 were carcinoma in situ,16 were low-grade papillary urothelial carcinoma,16 were high-grade papillary urothelial carcinoma,and 8 were invasive papillary urothelial carcinoma.For narrow-band imaging,the sensitivity was 86.7 ％ (39/45),specificity was 57.1％ (8/14),diagnostic accuracy was 79.7 ％ (47/ 59),false-positive rate was 42.9％ (6/14),positive predictive value was 86.7％ (39/45),negative predictive value was 57.1％ (8/14),area under ROC curve was 0.719.Among these lesions,the sensitivity and specificity for postoperative recurrent lesions were 100％ (3/3) and 40％ (2/5),respectively,and those for erythematous patch-like lesions were 90％ (9/10) and 100％ (4/4),respectively.Conclusion Narrow-band imaging can improve the detection rate for flat bladder tumor lesions,and reduce the risk for missed diagnosis under white light cystoscopy,especially for otherwise indistinguishable erythematous patch-like lesions.

Effect of ultrasound-guided obturator nerve block in prevention of obturator nerve reflex in transurethral resection of bladder tumor / 临床麻醉学杂志

Objective Comparing obturator nerve reflex in different anesthesia,to investigate the incidence of obturator nerve reflex in transurethral resection of bladder tumor.Methods A total of 160 patients with lateral wall of bladder tumors were included,who required a TURBT,were randomly divided into four groups:general anesthesia group (group G),combined spinal-epidural anesthesia group (group C),combined spinal-epidural anesthesia compounding intravenous anesthesia group (group V),combined spinal-epidural anesthesia compounding obturator nerve block group (group O),n =40 in each group.The incidence of obturator nerve reflex was recorded.Results Incidence of obturator nerve reflex in group O (7.5％) was lower than in group C (32.5％,P=0.005) and group V (40.0％,P=0.001).There was no significant difference between group G (5.0％) and group O (P =0.644).Conclusion Both combined spinal-epidural anesthesia with obturator nerve block and general anesthesia can effectively prevent obturator nerve reflex.

Effect of Silencing LRIG3 Gene on the Proliferation and Apoptosis of Bladder Cancer T24 Cells / 华中科技大学学报（医学）（英德文版）

This study examined the effect of silencing LRIG3 expression on the proliferation and apoptosis of bladder cancer T24 cells and explored the role of LRIG3 in the tumorigenesis of bladder cancer.Bladder cancer T24 cells were routinely cultured and pSilencer plasmids were employed to construct LRIG3 eukaryotic expression vector of LRIG3-siRNA,i.e.,pSilencer-LRIG3-siRNA.After confirmation,the vector was transfected into HEK293 cells to make a replication-deficient adenovirus,pAd-LRIG3-siRNA,which was then introduced into bladder cancer T24 cells.RT-PCR,Western-blotting were performed to detect the levels of LRIG3 mRNA and proteins.Cells number was determined by using MTT test.Hoechst33258 staining,transmission microscopy,flow cytometery were conducted to examine the cell apoptosis.Three groups included a blank control group,a negative control group (containing non-interfering plasmids) and a pAd-LRIG3-siRNA group.Our results showed that the recombinant pAd-LRIG3-siRNA was successfully transfected into the bladder cancer T24 cells.The siRNA formed by the transcription of the recombinant plasmids resulted in significantly reduced expressions of LRIG3 gene and protein and significantly decreased cell proliferation and growth in the pAd-LRIG3-siRNA group as compared with the control group (P＜0.01).The siRNA also caused apoptotic changes of some cells,with the apoptosis rate being (17.69±0.75)％,which was significantly different from that of the control group (P＜0.01).It was concluded that recombinant pAd-LRIG3-siRNA plasmids could effectively decrease the expression of LRIG3 mRNA and proteins and,to some extent,inhibit the proliferation and promote the apoptosis of bladder cancer T24 cells.Silencing LRIG3 gene might be a novel alternative for the treatment of bladder cancer.

The treatment of bladder tumors by the intravesical instillation of thio-TEPA or of actinomycin D

Thio-TEPA weekly instillations of 30-60 mg. in 30-60 ml. of sterile water or saline were employed in 20 patients with bladder papilloma or various stages of bladder carcinoma. Two of 6 patients with papilloma showed complete disappearance of the tumor after an average of 8 instillations and two of six (2/6) patients with papilloma showed partial destruction of the tumor. In 10 patients with deeply infiltrating cancers practically no response was observedActinomycin D was employed in 7 patients using a weekly topical dose of 1.0 mg. in 30 ml. of sterile water or saline. In the four patients with papilloma, one showed necrotic changes without apparent decrease in size of the tumor. In no instance was disappearance of a papilloma observedAs employed in this series, topical actinomycin D instillation for bladder tumor was of no value. Topical thio-TEPA may be useful for patients who are poor surgical risks and for patients whose lesions are diffuse and not amendable to surgical attack less than a cystectomy. For solitary or few papillary tumors conventional methods of transurethral treatment are preferable. (Summary)

Ho:YAG laser treatment of superficial bladder tumors / 临床外科杂志

Objectives To review our initial experience with the Ho:YAG laser in treating superficial bladder tumors.Methods Ho:YAG laser was applied for treating 52 cases of bladder tumors which were confirmed by cystoscopy and pathology with totally 87 tumors.All tumors were in stage Ta～T 2 and tumors grade G1～G2.The optical fiber was put into bladder through cystoscopy.Ho:YAG laser was used endoscpically to cut and vaporize bladder tumor and normal bladder mucosa near the tumor.Results Nine of 52 patients were performed under local anesthesia in outpatient.Operation time was apparently short (mean 25 minutes) Histopathology of biopsies showed no cancer cells left.There were no intraoperative complication such as bleeding,perforation and delay complication.Catheter time is very short,about 1～3 days or without catheter at all.None of the ureteral orifice were damaged in seven cases of bladder tumors near the ureteral orifice.Six patients were recrred during our follow-up in 50 patients (12%).Conclusions It has been demonstrated that Ho:YAG laser therapy is provided with advantages of simple procedure,the absence of complication,high patient satisfaction,and ability to be used in the outpatient.It is more convenience than TUR-Bt in tumors in the neck of bladder or apex of bladder.

Study on Correlation between the Expression of P-Glycoprotein and the Effect of Chemotherapy in Transitional Cell Carcinoma / 대한비뇨기과학회지

The resistance of neoplastic cells to chemotherapeutic agents may develops by a variety mechanisms. One of these mechanisms seems to be the amplification or overexpression of the multidrug resistance(MDR) gene. The MDR phenotype is conferred by a 170kD membrane protein, P-glycoprotein. This protein acts as a drug efflux pump for a variety of structurally unrelated antineoplastic agents, especially hydrophobic natural products such as adriamycin and vincristine. In the present study, immunohistochemical stain for P-glycoprotein was performed in paraffin section of 41 specimens of transitional cell carcinoma of the bladder obtained prior to chemotherapy to investigate the usefulness of P-glycoprotein as a predictor of response to M-VAC ( methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy. The overall clinical response rate to chemotherapy was 65.9%. The overall 3- year survival rate was 63%, with 80% in responder group( clinical complete and partial remission) and 36.3% non-responder group(minor response, stabilization and progression ) (P<0.05). In the responder group, 7.4% expressed strongly positive P-glycoprotein, 63% weakly positive and 29.6% negative. In the non-responder group, 28.6% expressed strongly positive P-glycoprotein, 64.3% weakly positive and 7.1% negative. The negative expression rate was high in responder group than non-responder, but this difference was not statistically significant. There was no correlation of expression of P-glycoprotein with either tumor stages or grades. In conclusion, these results suggest that tumors with negative expression of P-glycoprotein seem to have a better clinical response to chemotherapy, and further investigation of other mechanisms of cellular drug resistance should be required.

Effect of operative methods on the prognosis of bladder-preserving patients with bladder transitional cell carcinoma / 重庆医科大学学报

Objective:To investigate the correlation between overall recurrence rate,survival rate,and the first recurrence duration and operative methods,and to discuss the strategy of bladder-preserving for patients with bladder transitional cell carcinoma(TCC).Methods:A total of 249 cases of bladder tumor with complete follow-up data,treated from 1991 to 2005 in our hospital,were studied re trospectively.The correlation between overall recurrence rate,survival rate and the first recurrence duration and operative methods were analyzed by the life table method,and statistical methods,like Newman-Keuls and chi-square test.Result:The first recurrence duration was not influenced by operative methods. There was no significant difference of overall recurrence rate and short-term survival rate(3-year and 5-year)among different operative methods,the highest 10-year survival rate(77.3%)occurred in the group of transurethral resection of bladder tumor(TURB)and the lowest one(65.2%)in the group of partial cystectomy,and the difference was statistically significant.Conclusions:TURB could achieve the same short-term therapeutic effect as opening operations(partial resection of bladder or resection of bladder tumors)and the higher long-term survival rate can be obtained by TURB.

Prophylactic Treatment of Bladder Tumors by Bleomycin Instillations / 대한비뇨기과학회지

52 patients with superficial transitional cell carcinoma of the bladder during the period from January 1977 to July 982 were reviewed. Among them, 27 patients were treated with bleomycin instillation after TUR of open resection and coagulation (A group) Another 25 patients were not treat with bleomycin instillations as control group (B group) And the following results were obtained. 1. The age distribution histological grade, operation methods and follow up period of the above two group were almost same. 2. The recurrence rate in 3 month was 15 % in A group and 24 % in B group and in 6 month 34 % in A group and 48% in B group. But in 18 months, the recurrence rate was same in two groups as 56%.