The efficacy and safety of transurethral partial cystectomy combined with intravesical suturation in the treatment of bladder cancer / 中华泌尿外科杂志

Objective:To summarize the efficacy and safety of transurethral partial cystectomy combined with intravesical suturation in the treatment of bladder cancer.Methods:The clinical data of 28 patients with bladder cancer who were admitted in Zhengzhou People's Hospital from July 2020 to October 2021 were analyzed retrospectively. There were 22 males and 6 females, with the average age of (68.8±8.9) years old. Twenty cases were with single bladder tumor, and 8 cases were with multiple bladder tumors. The diameter of single bladder tumor measured by CT was less than 4 cm, with a median tumor diameter of 2.3(0.9, 2.8)cm. All 28 patients underwent transurethral partial cystectomy combined with intravesical suturation for the first time. Intraoperative intravesical instillation was conducted with 1 g gemcitabine. Bladder hot reperfusion treatment was performed with gemcitabine 2 g at 45℃ immediately after operation. The patients underwent reexamination with cystoscopy every 3 months after operation.Results:All the 28 patients successfully completed the operation. The average operation time was (128.3±16.3)min. No obturator nerve reflection was induced during operation. Muscularis tissue was found in all tumor pathological specimens after operation, among which 4 cases showed muscularis infiltration. Pathology of tumor basal and peripheral tissues showed tumor cell infiltration in 3 cases (1 case full-thickness infiltration, namely the incision margin was positive). The median continuous irrigation time of bladder after operation was 24.0(20.9, 25.0)h. The median time of indwelling catheter after operation was 6.5(6.0, 7.0)days, and one case developed severe bladder spasm. All patients were followed up, with a median follow-up of 7.5(4.0, 10.8) months.Postoperative recurrence occurred in 3 cases, all of which were ectopic recurrence in bladder.The 1-year recurrence rate was 10.7% (3/28).Conclusions:In the first surgical treatment of bladder cancer, transurethral partial cystectomy combined with intravesical suturation can provide accurate pathological staging, and low positive surgical margin rate. Immediate suturation of bladder wound during operation and immediate bladder perfusion chemotherapy can provide short bladder irrigation time, with few adverse reactions and low incidence of complications.

Status and progress of partial cystectomy in the treatment of myometric invasive bladder cancer / 中国综合临床

Bladder cancer is one of the most common malignant tumors in the urinary system, and the current standard treatment for muscle-invasive bladder cancer(MIBC) is radical cystectomy combined with pelvic lymphadenectomy.However, radical cystectomy is a surgical method with serious damege and high incidence of perioperative complications, leading to a low postoperative quality of life for patients.In recent years, with the improvement of chemotherapy regimens and the development of radiotherapy techniques, bladder preservation comprehensive therapy based on partial cystectomy(PC) has attracted the attention of domestic and foreign scholars again.This article reviews the current application and treatment progress of PC.

A rare case of asymptomatic leiomyoma of the urinary bladder

@#Leiomyoma of the urinary bladder is not often encountered, occurring in only 0.43% of all bladder tumors. Among the known cases, patients usually present with obstructive symptoms, irritative symptoms or hematuria. This is a rare case of a 50-year-old male who was incidentally diagnosed to have a bladder mass. After cystoscopy, an open partial cystectomy was done with complete resection of the bladder mass. Final histopathology and immunochemical stains confirmed the diagnosis of leiomyoma of the urinary bladder.

Preliminary application experience of resectoscope combined with laparoscopy in the treatment of paraganglioma of urinary bladder / 中华泌尿外科杂志

Objective To analyze the feasibility and safety in application of resectoscope combined with laparoscopy in the operation treatment of paraganglioma of urinary bladder.Methods 7 cases patients with paraganglioma of urinary bladder treated in our hospital from November 2014 to August 2018 were analyzed retrospectively.There were 5 males and 2 females,average age of 31.1 years (22-37 years),average body mass index was 22.3 kg/m2 (18.3-22.5 kg/m2).All the 7 cases patients complained of dizziness and palpitation after urination,average basal systolic blood pressure was 111.8 mmHg (97-124 mmHg),the average fluctuation of systolic blood pressure before and after urination was 64.9 mmHg(28-91 mmHg),the CT and cystoscopy prompt bladder tumor,the average diameter was 2.7 cm(2.1-3.5 cm).The average of plasma norepinephrine was 706.3 pg/ml(330-997 pg/ml);the average of plasma dopamine was 101.1 pg/ml(44-145 pg/ml);the average of 24h urinary vanilmandelic acid was 13.4 mg/24h (10.3-16.1 mg/24h).All the patients has controlled the blood pressure and dilate the blood vessels with phenoxybenzamine hydrochloride,accepted the operation of resectoscope combined with laparoscopy partial cystectomy and bladder sutura per abdomen after ample dilatancy.The patients had lithotomy position with trendelenburg,preparation of gas peritoneal cavity by transabdominal,inside the resectoscope by transurethral at the same time,mutilated bladder mucosa beside 1cm at the edge of the tumor,and cut full thickness bladder wall,take the extraperitional fat as the standard procedure;we could see the cutting edge clear at this time by laparoscopy,cut off the pelvic peritoneum,extraperitional fat and the tumor.The sample placed in bladder,close the bladder with absorbable or barbed wires,take out the sample by resectoscope.Results All the 7 cases patients operation was successfully completed,no cases has been transfered to open.The average time of operation is 85.3 min(65-100 min),the average amount of bleeding is 27.9 ml(10-50 ml).The average fluctuation of systolic blood pressure is 8.7 mmHg(6-15 mmHg).Bladder washout was stopped 24h after operation,catheter was removed 1 weeks after operation.There is no obvious complications occurred.The average hospital stay is 3.7 days (3-5 days).The average pain score of 4 cases 4h after operation is 3.8 (2-5),reevaluation 24h after operation is 2.3 (1-4).The average follow-up time is 7.9 months(2-15 months).All the 7 cases patients clinical symptoms disappeared,there is no fluctuation of systolic blood pressure before and after urination,there is no recurrence of the tumor.Conclusions To the paraganglioma of urinary bladder in fundus of bladder or anterior wall of bladder,we can accurate resection tumor by resectoscope combined with laparoscopy,reduce blood pressure fluctuations,reduce the surgical trauma and the distress of patients.It is a safety and effective minimally invasive surgery.

Avaliação morfofuncional do enxerto de túnica albugínea suína na cistoplastia em ratos / Morpho-fuctional evaluation of porcine tunica albuginea as a graft for cystoplasty in rats

O objetivo deste trabalho é avaliar o uso da túnica albugínea suína na cistoplastia em ratos, avaliando funcionalidade, capacidade de reparação do órgão e possibilidades de complicações. Foram selecionados 30 ratos Wistar, machos, de seis meses de idade, divididos em: um grupo teste (TA), em que os animais receberam o enxerto de túnica albugínea suína após a cistectomia parcial e um grupo controle (C), em que os animais sofreram somente a cistectomia parcial. Os animais pertencentes a ambos os grupos foram divididos igualmente em subgrupos de cinco animais cada, que sofreram eutanásia em sete, 28 e 42 dias de pós-operatório. Foi realizada uma análise macroscópica e, posteriormente, uma análise histopatológica da região da ferida cirúrgica. Aos sete e 28 dias, os animais pertencentes ao grupo C e ao grupo TA apresentaram urotelização, regeneração da lâmina própria e da musculatura, porém o grupo TA apresentou menores sinais inflamatórios e maior organização tecidual, principalmente com relação à formação das fibras musculares. Aos 42 dias de pós-operatório, ambos os grupos já apresentavam características histológicas normais. Concluiu-se que o enxerto de túnica albugínea suína obteve sucesso na regeneração da bexiga de ratos, mantendo a funcionalidade do órgão, sem rejeição, e favorecendo a migração celular.(AU)

The aim of this study is to evaluate porcine tunica albuginea as a graft for cystoplasty in rats, regarding bladder function, capacity and possible complications. 30 male Wistar rats with six monthes of age have been selected and separated into two different groups: A test group (TA) in which the animals received a tunica albuginea graft after partial cystectomy and a control group (C) in which partial cystectomy was performed, followed by bladder suture. In each group the animals were euthanized at seven, 28 and 42 days after surgery. Macroscopic and Histological analysis have been performed. At seven and 28 days after surgery the samples from both groups had urothelial lining upon a lamina propria and smooth muscle fibers in regeneration process. However, the TA group showed less inflammatory signs and more organized structure, mainly regarding the smooth muscle formation. At 42 days after surgery all groups showed a bladder wall structure qualitatively identical to the normal tissue. We could conclude that tunica albuginea graft is able to maintain bladder function and support cellular migration without any kind of rejection.(AU)

Isolated Bladder Endometriosis: A Rare Case Report.

Endometriosis is defined as presence of functional endometrial glands and stroma beyond the normal confines of the uterus.1,2 Overall incidence is 10 to 20% of women in reproductive age, with peak incidence between 30 and 45 years.2 About 40% of women with infertility and 60% of those presenting with chronic pelvic pain have endometriosis.1 About 1% of women with endometriosis have urinary tract involvement, of which 84% involve the bladder. Urinary bladder endometriosis as a part of deep infiltrating pelvic endometriosis is known, but isolated bladder involvement is extremely rare. Patients present with vague and distressing urinary symptoms mimicking recurrent cystitis, hence strong clinical suspicion with prompt recognition of this entity is important to avoid prolonged morbidity.2 We report a case of isolated bladder endometriosis in a 28-year-old female with previous two cesarean sections. Open partial cystectomy was performed. Histopathology of the excised mass was diagnostic.

Laparoscopic partial cystectomy for the treatment of hepatic hydatid cysts.

Background: The laparoscopic approach for the treatment of hepatic hydatid cysts is increasingly gaining importance. The aim of this study was to report a series of 27 patients with hepatic hydatid cyst managed with laparoscopic partial cystectomy. Methods: A retrospective review of patients treated at a university clinic for hepatic hydatid cysts from March 2010 to May 2014 was performed. Operative time, blood loss, length of hospital stay, post-operative complications, and early follow-up outcomes were evaluated. Results: Laparoscopic surgical intervention was performed on 27 patients (17 females and 10 males)who were diagnosed with hydatid cysts by ultrasonography and computed tomography (CT). Except 3 of the cysts, were located in the right lobe of the liver. No mortality was noted during the study. Two surgical site infections were observed and no abscesses developed in the cystic cavity. Recurrence was not noted during the mean follow-up Period of 22 months. Conclusion: Laparoscopic partial cystectomy is a safe and effective method for the treatment of hepatic hydatid cyst.

Pheochromocytoma of the Urinary Bladder—A Rare Case

Pheochromocytomas of urinary bladder are rare tumours. They present with non-specific clinical signs and symptoms. We present a case of bladder pheochromocytoma who presented with recurrent attacks of headache and hypertension during micturition in otherwise normotensive female. On evaluation she was found to have paroxysmal hypertension and raised urinary metanephrines with well-defined mass at the base of the bladder. The patient was treated surgically by partial cystectomy and lesion was confirmed postoperatively.

Value of partial cystectomy combined with chemotherapy and radiotherapy in the treatment of muscle-invasive bladder cancer / 中华泌尿外科杂志

Objective To review the experience with partial cystectomy combined with chemo-and radiation therapies in the treatment of muscle-invasive bladder cancer (MIBC) to assess the local control and survival rates,and to identify predictive factors for recurrence and survival.Methods From 2002 through 2007,a total of 100 patients with MIBC underwent partial cystectomy combined with adjuvant chemotherapy and radiation therapy (PC group).Meanwhile,36 patients with MIBC underwent radical cystectomy (RC group).The clinical and pathological data of these patients were retrospectively reviewed.Primary endpoints were cancer-specific survival (CSS),bladder-intact cancer-specific survival and bladder cancer recurrence.Results The 5-year CSS rate of the entire cohort was 65％,which was higher in PC group than in RC group (68％ vs 55％,P =0.033).In PC group,only 2 patients (2％) were confirmed to have residual tumor at the time of re-evaluation TUR 3 months after partial cystectomy.After a mean of 33.1 months,46 patients (46％) experienced superficial recurrence and 14 patients (14％) developed muscle-invasive recurrence.75％ of recurrence occurred within 16 months.8 patients underwent salvage cystectomy.The 5-year bladder-intact survival rate was 63％ in PC group.In multivariate analysis,the presence of tumor numbers more than 3 and tumors with infiltrating growth pattern were 2 predictive factors for cancer recurrence in PC group.In terms of survival,the presence of tumor numbers more than 3,lymphovascular invasion and partial cystectomy plus ureteral reimplantation (PC plus UR) were significantly associated with 5-y CSS in PC group and PC plus UR was indeed a protective factor for survival.By looking at the entire MIBC cohort,lymphovascular invasion,tumor numbers more than 3,history of superficial bladder cancer and age greater than 70 years old were identified as independent predictive factors for 5-y CSS.Conclusions Combined with adjuvant chemo-and radiation therapies,partial cystectomy might be a alternative to radical cystectomy for the treatment of MIBC,which provides adequate local control in selected patients,as well as acceptable survival rate.

Cistectomía parcial laparoscópica en cáncer de uraco / Partial cystectomy for urachus carcinoma

Introducción: Las opciones quirúrgicas para tratar el adenocarcinoma de uraco incluyen la cistectomía radical y la cistectomía parcial en bloque con escisión del uraco y el ombligo. Actualmente la laparoscopía es utilizada para resolver patología vesical y de uraco. El objetivo es presentar la cistectomía parcial laparoscópica con resección en bloque de uraco y ombligo como una alternativa terapéutica oncológicamente segura y mínimamente invasiva en el tratamiento del carcinoma de uraco. Material y método: presentamos una serie de casos de tres pacientes portadoras de adenocarcinomas del uraco sometidas a cistectomía parcial laparoscopia con escisión en bloque de uraco y ombligo. Las variables analizadas fueron el tiempo quirúrgico, el sangrado estimado del intraoperatorio, las complicaciones perioperatorias, la histología del tumor y la presencia de compromiso muscular de éste, el status oncológico de los linfonodos, los días de hospitalización, el tiempo de seguimiento y el estado oncológico actual. Resultados: El tiempo quirúrgico promedio fue de 210 minutos. El sangrado estimado promedio fue de 133 ml. No hubo complicaciones quirúrgicas. Los tres tumores correspondieron a adenocarcinomas pobremente diferenciados y el tercero a adenocarcinoma moderadamente diferenciado. Todos se catalogaron como invasores. Los márgenes quirúrgicos fueron negativos. Actualmente las tres pacientes se encuentran sin evidencias de enfermedad con períodos de seguimiento de 12, 18 y 38 meses.Conclusiones: La cistectomía parcial con resección en bloque del uraco y el ombligo con linfadenectomía pélvica extendida por vía laparoscópica representa una alternativa mínimamente invasiva y segura en la resolución de los tumores de uraco.

Introduction: Surgical options for urachal adenocarcinoma treatment include radical cystectomy and partial cystectomy with en bloc resection of the umbilicus, urachus, and bladder dome. Laparoscopy is used in resolving bladder and urachal pathologies. The objective of this case series report is to present laparoscopic partial cystectomy with en bloc resection of the urachus and umbilicus as a safe and minimally invasive option in treatment of urachal adenocarcinoma. Materials and methods: we present a case series of tree patients diagnosed of urachal adenocarcinoma, treated with laparoscopic partial cystectomy with en bloc resection of urachus and the umbilicus. Analyzed variables were surgical time, estimated bleeding during surgery, surgical complications, tumor histology and muscular involvement, oncological status of lymph nodes resected, hospitalization days, follow up time, and current oncological status. Results: Surgical average time was 210 minutes. Mean estimated bleeding was 133 ml. There was no surgical complications. Two tumors were poorly differentiated adenocarcinomas and the third one a moderately differentiated adenocarcinoma. All were cataloged as muscle invasive ones. Surgical margins were negative. Currently, all patients are without evidence of disease with follow up periods of 12, 18 and 38 months. Conclusions: Laparoscopic partial cystectomy with en bloc resection of the urachus and umbilicus and extended pelvic lymphadenectomy represents a safe and minimally invasive option in treatment of urachus tumors.

Laparoscopic partial cystectomy for urachal and bladder cancer

PURPOSE: To report our initial experiences with laparoscopic partial cystectomy for urachal and bladder malignancy. MATERIALS AND METHODS: Between March 2002 and October 2004, laparoscopic partial cystectomy was performed in 6 cases at 3 institutions; 3 cases were urachal adenocarcinomas and the remaining 3 cases were bladder transitional cell carcinomas. All patients were male, with a median age of 55 years (45-72 years). Gross hematuria was the presenting symptom in all patients, and diagnosis was established with trans-urethral resection bladder tumor in 2 patients and by means of cystoscopic biopsy in the remaining 4 patients. Laparoscopic partial cystectomy was performed using the transperitoneal approach under cystoscopic guidance. In each case, the surgical specimen was removed intact entrapped in an impermeable bag. One patient with para-ureteral diverticulum transitional cell carcinoma required concomitant ureteral reimplantation. RESULTS: All six procedures were completed laparoscopically without open conversion. The median operating time was 110 minutes (90-220) with a median estimated blood loss of 70 mL (50-100). Frozen section evaluations of bladder margins were routinely obtained and were negative for cancer in all cases. The median hospital stay was 2.5 days (2-4) and the duration of catheterization was 7 days. There were no intraoperative or postoperative complications. Final histopathology confirmed urachal adenocarcinoma in 3 cases and bladder transitional cell carcinoma in 3 cases. At a median follow-up of 28.5 months (range: 26 to 44 months), there was no evidence of recurrent disease as evidenced by radiologic or cystoscopic evaluation. CONCLUSIONS: Laparoscopic partial cystectomy in carefully selected patients with urachal and bladder cancer is feasible and safe, offering a promising and minimally invasive alternative for these patients.

Implantation metastasis to abdominal incision after open operation for bladder carcinoma / 中华泌尿外科杂志

Objective To study the diagnosis, treatment, and prognosis of implantation metastasis to abdominal incision after open operation for bladder carcinoma. Methods 10 cases of implantation metastasis to abdominal incision after open operation for bladder carcinoma encountered from 1985 to 1999 were retrospectively studied,nine being male and 1 female.The average age was 52.7 years. Results These were 6 transitional cell carcinoma (all were grade G 3),2 transitional cell carcinoma with squamous carcinoma or adenocarcinoma,1 squamous carcinoma,and 1 adenocarcinoma.The diameter of the metastasis lesion was 1.4～11.5 cm?1.0～6.9 cm.The treatments included total cystectomy with resection of metastasis,TURBt with resection of metastasis,urinary diversion with chemotherapy and/or radiotherapy, resection of metastasis with chemotherapy and/or radiotherapy, and chemotherapy and/or radiotherapy alone.7 of the 10 died of the carcinoma,the survival times being 4～41 months (average 13 months).Only 1 patient survived for 41 months.Whereas the others died within 14 months.3 patients are still alive for 5～9 months with no recurrence. Conclusions The differentiation of the cancer cells of implantation metastasis is usually bad and often accompanied by squamous followed by carcinoma or adenocarcinoma.Total cystectomy with resection of the metastasis followed by chemotherapy and/or radiotherapy might prolong the survival time, but the prognosis is usually poor.

A Case of Urachal Adenocarcinoma of the Urinary Bladder / 대한비뇨기과학회지

Urachal cancer was described first in 1863 by Hue and Jacquin. Since then no more than 160 cases have been reported in the literature. In Korea only 3 cases have been reported Like this, urachal carcinoma is an uncommon neoplasm associated with a poor prognosis, partly because the location of the tumor favors a long silent course before detection that belies its aggressive nature. Recently we experienced a case of urachal adenocarcinoma which was treated successfully with partial cystectomy and en block excision of urachus including umbilicus and reviewed literature briefly.

A Technique of Partial Cystectomy for Carcinoma / 대한비뇨기과학회지

A technique of partial cystectomy employing for hemostasis and traction was presented in conjunction with clinic study.