Implantable Devices for Sustained, Intravesical Drug Delivery / 대한배뇨장애요실금학회지

In clinical settings, intravesical instillation of a drug bolus is often performed for the treatment of bladder diseases. However, it requires repeated instillations to extend drug efficacy, which may result in poor patient compliance. To alleviate this challenge, implantable devices have been developed for the purpose of sustained, intravesical drug delivery. In this review, we briefly summarize the current trend in the development of intravesical drug-delivery devices. We also introduce the most recently developed devices with strong potential for intravesical drug-delivery applications.

Effects of Moderate Alcohol Intake in the Bladder of the Otsuka Long Evans Tokushima Fatty Diabetic Rats

Diabetes is related with a number of cystopathic complications. However, there have been no studies about the influence of alcohol consumption in the bladder of type 2 diabetes. Thus, we investigated the effect of moderate alcohol intake in the bladder of the Otsuka Long Evans Tokushima Fatty (OLETF) diabetic rat. The non-diabetic Long-Evans Tokushima Otsuka (LETO, n=14) and the OLETF control group (n=14) were fed an isocaloric diet; the LETO (n=14) and the OLETF ethanol group (n=14) were fed 36% ethanol 7 g/kg/day. After ten weeks, muscarinic receptors, RhoGEFs, myogenic change, and the level of oxidative stress were evaluated. Moderate alcohol intake significantly decreased excessive muscarinic receptor and Rho kinase expressions in the OLETF rats compared with the LETO rats. In addition, iNOS and collagen expression were not changed in the OLETF rats in spite of alcohol consumption. Superoxide dismutase levels, which is involved in antioxidant defense, in the LETO rats were significantly decreased after alcohol consumption, however those in the OLETF rats were similar. Moderate alcohol consumption reduces the oxidative stress, and may prevent molecular and pathologic changes of the bladder of rats with type 2 diabetes.

Chronic Lower Urinary Tract Symptoms in Young Men Without Symptoms of Chronic Prostatitis: Urodynamic Analyses in 308 Men Aged 50 Years or Younger

PURPOSE: We investigated the etiologies of lower urinary tract symptoms (LUTS) and compared urodynamic characteristics between different diagnostic groups in young men with chronic LUTS. MATERIALS AND METHODS: We reviewed the medical records of 308 men aged 18 to 50 years who had undergone a urodynamic study for chronic LUTS (> or =6 months) without symptoms suggestive of chronic prostatitis. RESULTS: The men's mean age was 40.4 (+/-10.1) years and their mean duration of symptoms was 38.8 (+/-49.2) months. Urodynamic evaluation demonstrated voiding phase dysfunction in 62.1% of cases (primary bladder neck dysfunction [PBND] in 26.0%, dysfunctional voiding [DV] in 23.4%, and detrusor underactivity [DU]/acontractile detrusor [AD] in 12.7%) and a single storage phase dysfunction in 36.4% of cases (detrusor overactivity [DO] in 13.3%, small cystometric capacity in 17.9%, and reduced bladder sensation in 5.2%). Most of the demographic characteristics and clinical symptoms did not differ between these diagnostic groups. Whereas 53.9% of patients with voiding dysfunction had concomitant storage dysfunction, 69.6% of those with storage dysfunction had concomitant voiding dysfunction. Men with DV or DU/AD exhibited lower maximum cystometric capacity than did those with normal urodynamics. Low bladder compliance was most frequent among patients with PBND (10.0%, p=0.025). In storage dysfunctions, men with DO exhibited higher detrusor pressure during voiding than did those with other storage dysfunctions (p<0.01). CONCLUSIONS: Because clinical symptoms are not useful for predicting the specific urodynamic etiology of LUTS in this population, urodynamic investigation can help to make an accurate diagnosis and, potentially, to guide appropriate treatment.

Efficacy and Safety of Cystocele Repair Reinforced with a Monofilament Polypropylene Mesh / 대한비뇨기과학회지

PURPOSE: Although surgical options for a cystocele repair have changed diversely over the past twenty years, a 29% recurrence rate after an operation has been reported. We assessed the efficacy and safety of a cystocele repair using monofilament polypropylene mesh (MPM) to reinforce the weakened muscular pelvic floor. MATERIALS AND METHODS: 28 women underwent a cystocele repair using MPM. According to the International Continence Society (ICS) stage classification, 5, 20 and 3 women had stages II, III and IV cystocele, respectively. The operations were performed through the vaginal approach. An anterior colporrhaphy was performed, and mesh (15x5cm), with the lateral extensions, was then positioned into the retropubic space, without fixation, for tension free support of the bladder. The cure of cystocele was defined as stage 0, improvement as stage I, and failed treatment as stage II or greater. RESULTS: The mean follow-up, catheterization time and hospital stay were 20.4+/-3.2 months, 2.4+/-1.2 days and 6.6+/-3.4 days, respectively. The anatomical cure rate of cystocele was 89.3% (25/28). The cystocele repair improved 2 patients, but failed in 1. No significant intraoperative complications occurred. The postoperative complications included voiding difficulty (2 cases), vaginal bleeding around the suture site (1 case) and de novo urgency (2 cases). There were no mesh related complications. CONCLUSIONS: Cystocele repair using MPM showed a success rate of 89.3%, with no complications associated with the use of mesh. This procedure seems to be safe and efficient, but a prospective randomized trial and longer follow-up will be required to confirm these results.

Experimental Study of Excitability and Autorhthmicity in Urinary Bladder Detrusor of Diabetes Rats / 华中科技大学学报（医学）（英德文版）

The changes in excitability and autorhthmicity of bladder detrusor in experimental noninsulin dependent diabetes mellitus (NIDDM) rats were observed. Sixty-nine NIDDM rats as NIDDM group and 69 normal rats as control group were enrolled into this experimental study. At 6th,10th, 14th, 18th, 22nd and 26th week after the rats were injected last time, the changes in the excitability and autorhthmicity of detrusor strips in vitro were observed. The results showed that the threshold of the tension which made the detrusor strips contract was significantly higher in NIDDM group (0.716±0.325 g) than in control group (0.323±0.177 g)(F=59.63, P＜0.001). At different stages, the threshold of the tension resulting the contract of the detrusor strips in NIDDM group was also higher than in control group. At 18th week after STZ injection, the frequency of spontaneous contract of the detrusor strips in NIDDM was significantly higher than in control group (P＜0.05), whereas at 22nd week, that in NIDDM group was significantly lower than in control group (P＜0.05). It was concluded that the decreased excitability of the bladder detrusor was the earliest and most obvious changes in bladder function in diabetes rats and the autorhthmicity had also changed at the early stage of diabetic bladder.

Role of free radicle in bladder detrusor impairment to T2DM rats / 第三军医大学学报

Objective To explore the role and significance of free radicle in the pathophsiological mechanisms of diabetic cystopathy(DCP).Methods The detrusor strip contraction experiments were performed and observed in the group of type 2 diabetes mellitus(T2DM) rats at different time stages and the control group.The bladder tissue samples was made into homogenate,and the activities of superoxide dismutase(SOD) and the contents of malondialdehyde(MDA) were determined.Results The minimum stretch forces to induce the detrusor contractions in T2DM group were larger than the control group.Compared with the control group,the detrusor contractive frequency was higher in the period of 0 to 16 weeks,but was lower after the 20th week.The maximum detrusor contractive forces in the T2DM group showed a descended tendency with the elapse of the experiment time.In the bladder homogenate of the control group,the activities of SOD was declined after reaching the peak at the stage of 8th week,and then escalated at the stage of 24th week.As for the T2DM group,the activities of SOD became higher in the 4th week,than descended at the stage of 8th and 24th weeks.The contents of MDA in both groups showed descended tendency.In T2DM group,MDA became even lower than the control group in the 4th week and became higher than the control group in the 8th week.The ratio of SOD/ MDA in T2DM group was lower than the control group.In details,the ratio of SOD/MDA in T2DM group rose significantly in the 4th week,while declined in the 8th week.There was a negative correlation between the maximum detrusor contractive force and detrusor contractive frequency,and a positive correlation between the maximum detrusor contractive force and the contents of MDA.Conclusion The destrusor functions are impaired by Diabetes Mellitus.In the initial stage of DCP,the bladder functions are normal,because the detrusor had a high ability to remove the free radicle.In the progression stage of DCP,the bladder functions become decompensation,because the organism is seriously injured by the free radicle.So the impairment by free radicle is one of important mechanisms of destrusor impairment of diabetic cystopathy.

Effect of Acupuncture Different Points on Unstable Bladder / 针灸推拿医学（英文版）

Purpose To observe the effect of acupuncturing different points on unstable bladder. Method Fifty-one patients of unstable bladder were divided randomly into Shu-point group, Mu-point group, He-point group,observe the change of symptom score and urodynamics.Results Puncturing these points can improve the symptom score and urodynamics, but the different points can get different effect, and the effect of Sbu-point and Hepoint is superior to that of Mu-point, Conclusion The different points of bladder have different adjusting function and that function relates with nerves locating in points.

Clinical application and long-term follow-up of the substitution of a segmental sinus-body of stomach for urinary bladder / 中华泌尿外科杂志

Objective To evaluate the reconstruction of bladder using a segmental sinus-body of stomach on the basis of a clinical study.Methods We retrospectively reviewed the medical records,laboratory evaluations,imaging examinations,cystoscopy,urodynamic studies of 30 patients(17 men and 13 women;mean age,55 years;age range,21-69 years) who underwent the reconstruction of bladder using a segmental sinus-body of stomach.Of the 30 patients,24 had primary bladder cancer and 6 had tuberculous contracture of the bladder.Results After operation,the new gastric bladder worked well in keeping and emptying urine.All patients micturated through the urethra.The bladder capacity was 280-580 ml(mean,385 ml).The maximum urethral pressure was 20-60 cm H_2O(mean,49 cm H_2O).The filling bladder pressure was 5-15 cm H_2O(mean,12 cm H_2O).The maximum bladder pressure was 35-65 cm H_2O(mean,55 cm H_2O),and it was 28-60 cm H_2O(mean,46 cm H_2O) during urination.Qmax and post-void residual urine were 10-28 ml/s(mean,18 ml/s) and 5-85 ml(mean,20 ml),respectively.Follow-up ranged from 9 months to 24 years(mean,8.2 years).There were no disturbance of water and electrolyte metabolism,no vesicoureteral reflux,no uracratia,and no damage to renal function.Complications included perineal and vesical pain in 4 cases,enuresis in 5 cases,which gradually remitted 3-6 months after surgery,and bladder stone formation in 1 case,who underwent surgery again.At 3.5 years after surgery bladder tumor relapsed in 1 case,who then underwent transurethral resection of bladder tumor. Conclusions Our data show that the substitution of a segmental sinus-body of stomach for urinary bladder worth popularizing because of low complication rate and approximately normal urologic indexes.

A Clinical Review of Laparoscopic Cholecystectomy / 한국간담췌외과학회지

BACKGROUND/AIMS: Laparoscopic cholecystectomy (LC) was performed by Mouret in 1987 and has rapidly and radically changed the surgical treatment of gallbladder (GB) disease. The purpose of this study is to clinical and historical review of LC in the Chonbuk National University Hospital. METHODS: We reviewed 1048 patients of LC between September of 1990 to April of 2000, retrospectively by clinical record. RESULTS: The age range of the patients was from 17 to 84 years(mean: 50.3). The associated diseases were hypertension and diabetes mellitus with each 56 cases, hepatitis with 22 cases, and bronchial asthma with 10 cases in order of frequency. 98 of 1048 patients had undergone previous abdominal operation. The most frequent previous abdominal opeartions were appendectomy with 56 cases, transabdominal hysterectomy with 14 cases and Cesarean section with 13 cases in order of frequency. Urinary catheters and Nasogastric tubes have not been used as a preoperative routine preparation since May 1995. Upto 1997, we preferred 4-trocar procedure to 3-trocar procedure(628/35 cases), thereafter the proportion was reversed(48/296 cases). The mean operative time was 51.6 minutes which varied between 15 minutes to 290 minutes. Up to 1996, we preferred to use a silastic drain in the Morison's pouch (465 cases of 580 cases), thereafter postoperative drains were used in selected cases(133 cases among 468 cases). The length of hospital stay ranged from 1 day to 54 days with an average of 5.2 days. The mean time gap to first oral intake was 1.1 days. Postoperative complications were occurred in 32 patients(3.1%). 12 patients among those were explored - bile leakage: 11 cases, bleeding: 1 case, the remainders were recovered by conservative treatment. A conversion to open cholecystectomy was done in 19 patiens(1.8%) during the operation and the causes of conversion were severe fibrotic adhesion due to inflammation with 8 patients, bleeding with 4 cases and previous operation with 13 cases. Pathological findings of the specimen revealed chronic cholecystitis(786 cases), cholesterolosis(52 cases), acute cholecystitis(27 cases), GB polyp(39 cases), GB cancer(26 cases), xanthogranulomatous cholecystitis(25 cases). CONCLUSION: Operative laparoscopy has advanced surprisingly in the last 10 years. LC is increasingly used in clinical surgery because of significantly faster convalescence than occurs with open surgery. These advances have been facilitated not only by optimal use of laparoscopic instruments but also by discarding unnecessary conventional procedures such as nasogastric and urinary indwelling catheterization. One of the important task in surgical education is to teach the optimal application of instruments to facilitate the conduct of an operation. In the era of minimally invasive surgery, minimal application of instruments such as less use of trocars in appropriate sites and developing more convenient instruments and measuring the technical proficiency during laparoscopic surgery are equally important issues.

Application of 3-D ultrasound in bladder diseases / 中华泌尿外科杂志

Objective To evaluate the clinical application of 3 D ultrasound in the diagnosis of bladder diseases. Methods In 21 patients with bladder disease,3 D images were studied with a Voluson 530D diagnostic system.At first,the two dimensional images of lesions were collected,then defined 3 D volumes of interest were stored,reconstructed and analyzed. Results 3 D ultrasound provided a clear stereoscopic view and depicted the appearance of the 21 bladder diseases,displayed the internal structures,and showed invasive depth within and outside the bladder wall and also metastasis of the adjacent organs. Conclusions 3 D ultrasound can clearly demonstrate the morphologic characteristics and internal structures of the bladder disease and provide much more reliable information for the diagnosis of diseases.