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Objective To investigate the effect of transurethral resection of bladder tumor (TURBT) with or without intravesical instillation therapy on cancer-specific-survival rate (CSS) of T1 stage non-muscle-invasive bladder transitional cell carcinoma (BTCC) patients. Methods The data of patients diagnosed with T1 stage non-muscle-invasive BTCC from 2010 to 2015 were obtained from the SEER database. The different dividing groups were based on TURBT with or without intravesical instillation therapy. A 1:1 PSM method was used to balance the differences in baseline data between each group. Herein, Kaplan-Meier methods were used to draw survival curves, and the difference between OS and CSS were compared by Log rank test. In addition, univariate and multivariate Cox regressionanalyses were used to explore the independent risk factors of CSS. Results The OS and CSS of patients in the TURBT combined with intravesical instillation therapy group were higher than those of the TURBT alone group (P < 0.05). TURBT combined with intravesical instillation therapy was a protective factor in prognosis with T1 stage non-muscle-invasive BTCC patients (HR=0.783, 95%CI: 0.650-0.942, P < 0.01). Conclusion TURBT combined with intravesical instillation therapy improves the CSS of patients with T1 stage non-muscle-invasive BTCC.
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Objective To investigate the efficacy and safety of Nocardiarubra cell wall skeleton (N-CWS) bladder irrigation in prevention of recurrence after transurethral resection for the treatment of non-muscle invasive bladder cancer (NMIBC).Methods The clinical data of patients with NMIBC treated by N-CWS and epirubicin collected between October 2013 and November 2018 at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.All patients underwent TURBT.Among the 118 NMIBC patients,the average age was (65.1 ± 1 1.9) years,and the sex ratio (male/female) was 1.9∶1 (77/41).Patients were divided into two group:N-CWS group (n =55) and epirubicin group (n =63) according to different instillation regimens.N-CWS was given as an instillation of 800 μg in 50 ml of saline and maintained in the bladder for 2 h in the N-CWS group.Epirubicin was given as an instillation of 50 mg in 50 ml of saline and maintained in the bladder for 1 h in the epirubicin group.In the N-CWS group,mean agewas (64.9 ± 12.1) years and 37 (67.3％) were male.Multiple tumors were present in 17 (69.1％) patients.Tumor size was ≤3 cm in 49(89.1％) and 7(12.7％) had a history of NMIBC.Stage was Ta and T1 in 36(65.5％) and 19(34.5％),respectively.Grade 1,Grade 2 and Grade 3 were the primary grades in 38(69.1％),13(23.6％) and 4(7.3％),respectively.Low risk,intermediate risk and high risk were present in 14 patients(25.5％),16 (29.1％) and 25 (45.5％),respectively.In the epirubicin group,mean age was (65.3 ± 11.2) years and 40(63.5％)were male.Multiple tumors were present in 19(30.2％) patients.Tumor size was ≤3 cm in 56(88.9％) and 11 (17.5％) had a history of NMIBC.Stage was Ta and T1 in 37(58.7％) and 26 (41.3％),respectively.Grade 1,Grade 2 and Grade 3 were the primary grades in 44(69.8％),12(19.0％)and 7(11.1％),respectively.Low risk,intermediate risk and high risk were present in 13 (20.6％),19 (30.2％) and 31 (49.2％),respectively.The tumor recurrence,progression and adverse reactions after Intravesical Instillation in both groups were followed up and recorded.No significant differences were found between the two groups.Results A total of 118 patients were followed up.Mean follow-up time was (33.7 ± 5.4) months.25.5％ (14/55) in the N-CWS group vs.42.8％ (27/63) in the epirubicin group had recurrence after 5 years (x2 =3.922,P =0.048).The five-year RFS was higher in the N-CWS group than in the epirubicin group (74.2％ vs.56.5％,P =0.044).No significant difference was found in the progression rate between the two groups(5.5％ vs.7.9％,P =0.867).The incidences of adverse events in the two groups were 16.4％ (9/55) and 19.0％ (12/63),respectively.The N-CWS group had significantly fewer cases with urinary frequency and dysuria than the epirubicin group.No significant differences were found in other side effects.Conclusions Intravesical instillation of N-CWS after NMIBC TURBT was found to be a promising procedure to prevent recurrence and prolong the recurrence-free survival with less side effects.
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Objective To evaluate transurethral fulguration with intravesical instillation of heparin and alkalinized lidocaine for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS).Methods Data from the chnical records of 31 patients (30 female and 1 male) with IC/BPS were analyzed retrospectively.Transurethral fulguration and biopsy were performed.Intravesical instillation of heparin and alkalinized lidocaine (25 000 units of hepmin,10 mL of 2％ lidocaine,and 5 mL of 5％ sodium bicarbonate) was administered weekly for 8 weeks.Thereafter,intmvesical instillation treatment was administered twice a month.The interstitial cystitis symptom index and problem index (O'Leary-Sant index),visual analog scale score for pain,quality-of-life index,voiding frequency,bladder capacity,and side effects of intravesical instillation were recorded preoperatively and at the first and sixth month follow-ups postoperatively.Results The follow-up period was 6 to 24 months.The interstitial cystitis symptom index and problem index,visual analog scale score for pain,quality-of-life index,daily voiding time,and maximal bladder volume improved significantly in 28 cases (90.32％;P ＜ 0.01),and no significant adverse effects were observed.Two patients underwent cystectomy,and the symptoms disappeared after the operation.Carcinoma in situ was detected on histopathological examination in one patient.Conclusion Transurethral fulguration with intravesical instillation of heparin and alkalinized lidocaine is a safe and effective therapy for IC/BPS.
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Objective To investigate the efficacy and safety of HCPT combined with 5-fluorouracil(5-Fu) in treatment of bladder cancer .Methods Selected 92 patients with advanced bladder cancer in our hospi-tal from February 2011 to August 2015 , equally divided into observation group and control group of 46 patients based on the random number table ,the control group were received 5-Fu intravesical chemotherapy ,The obser-vation group were given the HCPT combined with 5-Fu chemotherapy ,the chemotherapy infusion were once a week,continuous perfusion were observed for 3 months.Results The response rates in the observation group was 95.7%and the control group was 76.1%,the observation group were significantly higher than the control group (P0.05),all adverse reactions after symptomatic treatment were improved .All patients were followed up for 1 year,The mortality and recurrence rates in the observation group were 8.7%and 4.3%re-spectively,while the control group were 30.4%and 17.4%,the mortality and recurrence rates of the observation group were significantly lower than the control group (P<0.05).Conclusion HCPT combined with 5 -Fu chemotherapy for bladder cancer has strong anti -cancer effect and without increase the incidence of adverse re-actions,it can promote the improvement of the long -term prognosis,so it is a safe and effective topical bladder chemotherapy drugs .
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Objective To compare the advantages and disadvantages of two methods for rat overactive bladder(OAB)model construction in?duced by intraperitoneal injection and intravesical instillation cyclophosphamide. Methods A total of 30 female SD rats weighting 200?250 g were randomly categorized into three groups:intraperitoneal injection?induced OAB(Ip?OAB),intravesical instillation?induced group(Iv?OAB)and con?trol group. Ip?OAB rats was i.p. administrated cycbophosphe mide three times in dose of 75 mg/kg body weight,while Iv?OAB rats received intravesi?cal instillation three times in drug dose of 75 mg/kg body weight. Control group rats received no treatment. Maximum bladder capacity(MBC),maxi?mum voiding pressure(MVP),frequency of spontaneous contraction of each group were recorded. The incidence,the mortality and the pathology of the three groups were compared. Results MBC,MVP and frequency of spontaneous contraction between Ip?OAB group and Iv?OAB group had no statistically significant difference(P>0.05). Compared with the control group,MBC significantly increased(P<0.05),MVP significantly decreased (P<0.05),and frequency of spontaneous contraction significantly increased(P<0.05)in Ip?OAB and Iv?OAB rats. The modeling success rate and mortality were 100%and 80%in Ip?OAB group,and were 50%and 0%in Iv?OAB group,and pathological changes were found in the two groups. Conclusion The construction of experimental animal model of OAB in rat induced by intraperitoneal injection and intravesical instillation cyclo?phosphamide are both reliable methods. Ip?OAB rats exhibit high incidence and mortality rate,while Iv?OAB rats show low incidence and mortality rate.
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Objective To compare the outcomes between interstitial cystitis/painful bladder syndrome (IC/PBS) patients treated with four-drug combination (heparin,lidocaine,sodium bicarbonate,gentamicin) and sodium hyaluronate intravesical instillation.Methods There were 23 IC/PBS patients from Jan.1,2011 to Mar.1,2013.Ten patients (group A) received four-drug combination (heparin 40 000 U,'gentamicin 160 000 U,sodium bicarbonate 1％,lidocaine 0.4％) instillation treatment.Thirteen patients received instillation of sodium hyaluronate (40 mg/50 ml) therapy (group B).In group B,intravesical instillations were performed weekly in the first 6-8 weeks,and monthly until one year.Patients in group A received intravesical instillation twice a week in the first 6-8 weeks and twice a month for 10 months.All the patients were instructed to retain the instillation volume for at least one hour.Clinical symptoms (24 h frequency of urination,maximal micturition volume),O'Leary-Sant symptom and problem index were assessed at baseline and 1,6 and 12 months after treatment.The 2 therapies were compared within curative effects and side effects.Results Twenty-two of the 23 patients were followed up to 12 months.Patients in group A had no adverse events reported.One case of group B dropped out from treatment for recurrent urinary tract infection,and the other two cases felt painful in bladder area during instillation.There was no significant difference in initial scores between the 2 groups (P＞0.05).At 1,6,12 months after intravesical instillation,interstitial cystitis symptom index,interstitial cystitis problem index,24 h frequency of urination,the maximum bladder capacity were improved in both groups.All indicators in group A and B were improved significantly after treatment compared with pretreatment (P ＜ 0.05).≥ 25％ decrease of interstitial cystitis symptom index or ≥25％ decrease of 24 h frequency of urination were defined as remission.Remission rates of the 2 groups at each time point were:1 month after treatment (100％ versus 100％,P=1.000),6 months after treatment (80％ versus 83％,P=1.000),1 year after treatment (70％ versus 75％,P=1.000).There were no significant differences between the 2 groups in all time points for the outcomes (P ＞ 0.05).Conclusion The four-drug combination intravesical instillation could achieve a similar effect with hyaluronic acid therapy in patients with IC/PBS.
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Objective To investigate the therapeutic effect of ciprofloxacin (Cipro) conjugated with 11 poly-arginine peptide (R11) on rabbit model with bacterial cystitis (BC). Methods 50 New Zealand rabbits of 4-month old were chosen to establish the models and evenly divided into 5 groups randomly : Group A: normal control; Group B: intravesical instillation (II) of R11; Group C: II of Cipro; Group D: II of R11-Cipro; Group E: intravenous injection of Cipro. Several parameters were observed which included: urinary frequency, positive rate of urine culture, histopathological analysis of cystitis stained with hematoxylin and eosin. Results Severe inflammatory responses and massive infiltration of inflammatory cells were observed after the models were established. R11-Cipro group was better than intravenous injection of Cipro group in treating cystitis (P < 0.05). R11-Cipro group was better than the other four groups in urinary frequency and urine culture. Conclusions Intravesical instillation of R11-Cipro demonstrated significant therapeutic effect on bacterial cystitis. R11 , as an efficient vector, could deliver specific antibiotics to bladder mucosa precisely and function well locally.
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PURPOSE: Urinary tract infection (UTI) is an ascending infection of fecal uropathogens, urogenital lactobacilli are suggested to play a role in the prevention of UTI. This study was to investigate whether lactobacillus mixture (LM) could prevent the experimental infantile UTI. MATERIALS AND METHODS: The LM were composed of three lactobacillus strains (L. gasseri, L. rhamnosus, and L. reuteri). Mother rats were grouped as lactobacillus (LB) group I (LB I, n=22), II (LB II, n=24) and control (n=20). LB I and LB II were fed with LM (1 mL/day) and control with phosphate-buffered saline (PBS) from late pregnancy through lactation. All newborn rats were breast-fed and their urine and stool were collected at the end of the 3rd week to compare lactobacillus colony. Then, infant rats from LB II were treated with intravesical instillation of LM. Infant rats from LB I and control were instilled with PBS. Twenty-four hours later, experimental UTI was introduced by intravesical instillation of standard E. coli strain. After 72 hours later, the infant rats were sacrificed for histologic examination. RESULTS: Lactobacilli colonies in urine and stool were not statistically different among the three groups. The incidence of pyelonephritis in the LB II was 16.7% (4/24), LB I 72.7% (16.22) and control 75.0% (15/20) (p=0.015). The incidence of cystitis was not significantly different among the three groups. CONCLUSION: The intravesically instilled LM significantly prevented experimental pyelonephritis in infant rats, however, LM administered orally to the pregnant and lactating mother rats did not.
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Animals , Rats , Escherichia coli Infections/prevention & control , Lactobacillus , Probiotics/therapeutic use , Rats, Sprague-Dawley , Urinary Tract Infections/prevention & controlABSTRACT
Objective To discuss the efficacy of intravesical instillation of sodium hyaluronate for the treatment of cystitis glandularis after transurethral resection.Methods 85 patients (9 male and 76 female,age range 37-70 years,mean age 51) who were diagnosed as CG in China-Japan Union Hospital of Jilin University underwent transurethral resection.After the operation they were divided into three groups randomly according to different intravescal instillation:sodium hyaluronate for group A,epirubicin for group B and no medicine for group C.The group A started to instill with sodium hyaluronate 40mg once a week for four weeks,and then once a month for four months.The group B did the same way of intravesical instillation of epirubicin.All the patients were followed-up for 12 months.The cystoscopy was done every three months to detect recurrence and the clinical symptom score was evaluated at 1,3,6 and 12 months.Results No patients in group A treated by sodium hyaluronate relapsed but 6 cases and 9 cases in group B and group C respectively.Recurrence rate of group A is significant low compared with group B and C (P ＜ 0.05).The scores of clinical symptom score appendix after 1,3,6 and 12 months for group A were (3.18 ± 1.44),(1.29 ±0.66),(1.25 ±0.65) and (1.21 ±0.63),respectively.It was (3.37 ±1.62),(3.33 ±1.59),(1.37±0.74) and (1.30±0.61) for group B,and (3.47±1.81),(3.40±1.52),(3.27±1.41) and (3.23 ± 1.19) for group C.Compare the score of clinical symptom in the same group,there were significant differences for the score after 3 months compare with the score after 1 month in group A (P ＜ 0.05).But in group B,the significant differences showed after 6 months (P ＜ 0.05).There was no significant difference in group C (P ＞ 0.05) in the whole year.Conclusions Intravesical sodium hyaluronate therapy can effectively decline the recurrence rate of cystitis glandularis after transurethral resection.It could also significantly improve the urinary tract symptoms.
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PURPOSE: We analyzed the impact of immediate intravesical mitomycin C instillation after transurethral resection of the bladder (TURB) on tumor recurrence and progression in patients with periodic mitomycin C instillation. MATERIALS AND METHODS: Between June 2000 and June 2006, a retrospective study was performed in a total of 115 patients with primary bladder tumors receiving a 6-week course of mitomycin C instillation after TURB. The patients were assigned to two groups: 53 patients in the immediate mitomycin C (I-MMC) group were treated by immediate instillation of mitomycin C after TURB and periodic instillation (6 times, 1 time per week), and 62 patients in the MMC group received only periodic instillation. Tumor recurrence and progression were compared in the two groups. RESULTS: During the mean follow-up period of 46.5 months in the I-MMC group and 47.2 months in the MMC group, early recurrence (within 1 year) occurred in 6 of 53 patients (11.3%) in the I-MMC group and in 18 of 62 patients (29.0%) in the MMC group (p<0.02). Although a significantly lower early recurrence rate was observed in the I-MMC group, this difference was not significant for recurrence within 2 or 3 years or for total recurrence. Progression was not significantly different between the two groups regarding the early and total period. CONCLUSIONS: Our study confirmed the positive effect of a single, immediate mitomycin C instillation in patients with non-muscle-invasive bladder tumors who received periodic mitomycin C instillation. This benefit was limited to early recurrence and was not maintained with long-term follow-up. This approach can be an alternative to periodic mitomycin C instillation without immediate instillation.
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Humans , Administration, Intravesical , Follow-Up Studies , Mitomycin , Recurrence , Retrospective Studies , Urinary Bladder , Urinary Bladder NeoplasmsABSTRACT
Intravesical instillation after transurethral resection of bladder tumor (TURBT) has been considered as the most important and effective method for the prevention and treatment of non-muscle invasive bladder cancer (NMIBC).Nowadays, the main choices of intravesical instillation are chemical drugs and Bacillus Calmette-Guerin (BCG).For all pa-tients with NMIBC, intravesical instillation should be admistered as soon as possible after TURBT.For patients of G_(1-2)T, an immediate single postoperative instillation of chemotherapy as standard therapy for low-risk disease is enough.For interme-diate-risk patients, it is recommended to use an immediate single postoperative instillation of chemotherapy plus an induc-tion course or maintenance treatment, but the scheme of intravesical instillation should be based on the specific circum-stances of the patients.For high-risk patients, maintenance therapy with BCG should be the first chioce.The combination of intravesical BCG and chemotherapy has certain advantages in treating NMIBC, but its efficacy needs further verifica-tion.Although there is a long history of intravesical instillation after TURBT, the choice of drugs, the time of instillation, and the corresponding dosages are still inconclusive.This article summarizes the strategies of the treatment for NMIBC after TURBT.
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PURPOSE: We developed and characterized by histopathology and immunohistochemistry a syngeneic murine bladder tumor model derived from the MB49 tumor cell line. MATERIALS AND METHODS: Bladder tumor implantation was achieved by intravesical instillation of 5 x 10(5) MB49 tumor cells in C57BL/6 mice. A chemical lesion of the bladder was performed in order to promote intravesical tumor implantation. The bladder wall lesion was accomplished by transurethral instillation of silver nitrate (AgNO3). After 15 days, the animals were sacrificed, examined macroscopically for intravesical tumor and bladder weight. Histology and immunohistochemistry were performed using cytokeratin 7 (CK7), carcinoembrionic antigen (Dako-CEA), p53 and c-erbB2 oncoprotein (Her2/neu). RESULTS: Twenty-nine out of 30 animals (96.7 percent) developed intravesical tumors in a 15-day period. Macroscopically, the mean bladder weight was 0.196g (0.069-0.538g), 10 to 15 times the normal bladder weight. The immunohistochemical analysis showed significant membrane expression of CEA and CK7: a similar finding for human urothelial cancer. We also characterized absence of expression of p53 and anti-Her2/neu in the murine model. CONCLUSIONS: High tumor take rates were achieved by using the chemical induction of the bladder tumor. Although electric cauterization is widely described in the literature for syngeneic orthotopic animal models, the technique described in this study represents an alternative for intravesical bladder tumor implantation. Moreover, the histopathology and immunohistochemical analysis of the murine bladder tumor model derived from the MB49 cell line showed a resemblance to human infiltrating urothelial carcinoma, allowing clinical inference from experimental immunotherapy testing.
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Animals , Female , Mice , Carcinoma, Transitional Cell/pathology , Disease Models, Animal , Urinary Bladder Neoplasms/pathology , Administration, Intravesical , Cell Line, Tumor , Carcinoembryonic Antigen/analysis , Feasibility Studies , /analysis , /analysis , Biomarkers, Tumor/analysis , /analysisABSTRACT
PURPOSE: To investigate the safety and the efficacy of intravesical gemcitabine therapy, we prospectively studied intravesical gemcitabine instillation followed by Bacillus Calmette-Guerin(BCG) instillation for treating the patients who suffer from superficial bladder cancer, and the above method was then compared with conventional BCG instillation. MATERIALS AND METHODS: Between May 2005 and April 2007, a total of 84 patients were divided into Group I: the patients were treated with a 2-week course of gemcitabine(1,000mg/50ml, 2,000mg/50ml) followed by a conventional 6-week course of BCG, and Group II: the patients were treated by BCG instillation only. Gemcitabine was instilled immediately within 6 hours after complete trans-urethral resection of the bladder tumor (TURBT) and then this was repeated one week later. BCG instillation was started 2 weeks after TURBT. The complications, recurrence rates, progression rates and recurrence-free period(RFP) were analyzed in both groups. RESULTS: The treatment was well tolerated in all the patients. Most of the complications were self-limiting, and there was no significant difference between the two groups(p=0.379). The recurrence rates of the two groups were 25.6% and 26.7%, respectively(p=0.899). Yet the recurrence-free period(RFP) was significantly longer in Group I(p=0.021). The progression rates of the two groups were 2.6% and 6.7%, respectively(p=0.620). CONCLUSIONS: Intravesical gemcitabine instillation showed the effect to prolong the recurrence-free period for patients with superficial bladder cancer. Further long-term study will be needed.
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Humans , Administration, Intravesical , Bacillus , Deoxycytidine , Mycobacterium bovis , Prospective Studies , Recurrence , Urinary Bladder , Urinary Bladder NeoplasmsABSTRACT
In order to study bladder intravesical instillation methods in pure line LEW rats and nude mice, female LEW rats and nude mice aged 2 to 4 weeks were sacrificed. Their urethra and bladder were observed under anatomical microscopy. A trochar was prepared according to the outline and angle of the urethra. Ink was poured into female rats and nude mice bladder though urethra. Filling and staining of bladder were observed and evaluated under anatomical microscopy. Status and urethral injury of rats and mice were observed. The results showed that urethra anatomic structure of rats and nude mice was different from that of human urethra. When bladder was filled with ink and became blue, liquid was not seen to leak out. The success rate of intubation was high (100%). Living activities of animals weren't influenced by intravesical instillation. It was concluded that bladder irrigation might be a kind of valid and utilizable method in pure line rat and nude mouse empirical study. The model may be a more effective tool for study of bladder tumor.
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Objective To evaluate the clinical value of interventional chemotherapy and intravesical instillation for preventing postoperative recurrence and metastasis of cancer in urinary bladder.Methods One hundred and eight patients with urinary bladder cancer were divided into group A and group B.Intravesical instillations after surgical operation were performed in group A (n=52) and combined interventional chemotherapy and intravesical instillations after operation were performed in group B (n=56).The patients were followed up for 1 - 3 years.Results In group A,recurrence occurred in 5 cases (9.62%) within one year,and in 23 cases (44.23%) within 3 years after the operations metastasis developed in 21 cases (40.38%),and 18 cases (34.62%) died.In group B,recurrence occurred in 2 cases (3.57%) within one year,and in 11 cases (19.64%) within 3 years after the operation;metastasis developed in 7 cases (12.50%), and 5 cases (8.93%) died.There were statistical significant differences in recurrence,metastasis and mortality between these two groups (P
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PURPOSE: The goal of this study was to constructing a nonviral vector, expressing the chimeric gene of the SV40 T antigen and mouse uroplakin II promoter (UPII promotor), which was uniquely expressed in the urothelium, to aid in the treatment of bladder cancer by the creation of a tumor that will express itself in the bladder only, but that will have no effect on the other urothelium. MATERIALS AND METHODS: 36 female C3H/He mice, weighing 20-25grams, were used in this study. A UPII-GFP-liposome complex was installed into the bladder, with Enhanced Green Fluorescent Protein (EGFP), expressing the bladder mucosa, and analyzed via fluorescent microscopy. A UPII- SV40T-liposome complex was then administered into the bladders of the mice, and the bladder and ureter examined, grossly and microscopically, at 1, 2, 3 and 4 weeks, to find transitional cell carcinomas specific to the bladder, the degree of bladder cancer development, and whether the development was from superficial to deep tumors, as well as tumor metastasis. RESULTS: The expression of EGFP was found in all four mice after 2 days. No development of tumors was evident in any mice. However, of the 6 mice sacrificed 28 days after bladder instillation, urothelial dysplasia was evident in 4. There was no evidence of transient cell carcinomas in the ureter or renal pelvis in any of the mice, or of distant metastasis during the term of the study. CONCLUSIONS: This model of bladder cancer seems to take longer than other models for cancer formation as the carcinogen affects the DNA of urothelial cell for the formation of bladder cancer. However, our bladder cancer model was better than others due to its similarity for the processes of normal bladder cancer formation.
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Animals , Female , Humans , Mice , Administration, Intravesical , Antigens, Viral, Tumor , Carcinoma, Transitional Cell , DNA , Kidney Pelvis , Liposomes , Microscopy , Models, Theoretical , Mucous Membrane , Neoplasm Metastasis , Ureter , Urinary Bladder Neoplasms , Urinary Bladder , Uroplakin II , Uroplakins , UrotheliumABSTRACT
@# ObjectiveTo observe the effect of intravesical instillation of Brucea Javanica oil emulsion on recurrence of bladder cancer after transurethral resection of bladder tumor (TUR-Bt) operation.Methods187 patients with superficial bladder carcinoma after TUR-Bt operation were randomly divided into the group A (85 cases) and group B (102 cases). Patients of the group A were treated with instillation of Brucea Javanica oil emulsion; those of the group B were treated with mitomycin. A three-years following up was performed to observe the recurrence and side effects.ResultsAfter a 3-years following up, the recurrence rate of group A was 12.94%, lower than that of group B (34.31%). The side effects were seldom seen in the group A.ConclusionThe effect of intravesical instillation of Brucea Javanica oil emulsion to prevent the recurrence of bladder cancer after TUR-Bt operation is favorable.
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OBJECTIVE: To evaluate the effect of stretching therapy of neurogenic bladder in spinal cord injured patients. METHOD: Twelve spinal cord injured patients who had neurogeic bladder manifested with urinary incontinence resistant to oral and intravesical anticholinergic instillation treatment were selected. Oxybutynin solution was instillated via foley catheter and the catheter was clamped until incontinence occur. This was performed twice a day for 7 days. The urodynamic studies were compared before and after therapy. Total volume of daily incontinence and total volume of daily fluid intake were also monitored. RESULTS: After stretching therapy, median maximal bladder capacity increased from 190.08 to 457.17 ml (p<0.01), mean bladder compliance increased from 8.46 to 18.85 ml/cmH2O (p<0.01), mean reflex volume increased from 148.75 to 252.17 ml (p<0.05), mean maximal detrusor pressure decreased from 52.17 to 28.29 cmH2O (p<0.01), mean clinical maximal capacity increased from 277.50 to 537.50 ml (p<0.01), and mean daily incontinent volume decreased from 508.33 ml to 20.83 ml (p<0.01). No significant correlation was found between the duration since onset of injury and the urodynamic finding. CONCLUSION: This study proved that stretching therapy of bladder was an effective method in spinal cord injured patients who had neurogenic bladder with uncontrolled incontinence with conventional therapy.
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Humans , Administration, Intravesical , Catheters , Compliance , Reflex , Spinal Cord Injuries , Spinal Cord , Urinary Bladder , Urinary Bladder, Neurogenic , Urinary Incontinence , UrodynamicsABSTRACT
OBJECTIVE: The aim of this study was to investigate the efficacy of capsaicin, a neurotoxin for C-fiber afferents, applied intravesically in the treatment of neurogenic bladder with detrusor hyperreflexia (DH). METHOD: Six subjects, three women and three men with traumatic spinal cord injury who had neurogenic bladder manifested with DH and urinary incontinence resistant to oral and intravesical anticholinergic instillation treatment were tried with intravesical administration of capsaicin (1 mmol/l 100 ml) for 30 minutes. Single instillation was given in five subjects and two instillations in one. Maximal detrusor pressure and maximal bladder volume were monitored by the portable cystometer. Follow-up monitor of pressure and volume was recorded after 1 week and every 3 weeks afterwards for 21 weeks, with one exception (31 weeks). RESULTS: Average maximal detrusor pressure decreased by 50.8% and average bladder capacity at maximal detrusor pressure increased by 68% in five subjects after single instillation of capsaicin. Clinical benefit from single instillation lasted over 21 weeks and same as the subject with two instillations. Maximal effect on detrusor pressure appears during 6~9 weeks period and bladder capacity during 9~15 weeks period. Although autonomic dysreflexia in 5 of 6 subjects during instillation and macroscopic hematuria in 2 subjects during the 1st two days were noted, they were resolved spontaneously. CONCLUSION: Single and repeated intravesical instillation of capsaicin were safe and effective in the management of neurogenic bladder with DH in traumatic spinal cord injured patients.
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Female , Humans , Male , Administration, Intravesical , Autonomic Dysreflexia , Capsaicin , Follow-Up Studies , Hematuria , Reflex, Abnormal , Spinal Cord , Spinal Cord Injuries , Urinary Bladder , Urinary Bladder, Neurogenic , Urinary IncontinenceABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the clinical effectiveness of intravesical oxybutynin chloride instillation in the management of neurogenic bladder dysfunction in spinal cord injured patients. METHOD: Fifty-two spinal cord injured patients with hyperreflexic or hypertonic neurogenic bladder were treated with intravesical oxybutynin instillation therapy. The purified oxybutynin chloride was dissolved in sterile water and mixed with normal saline. This oxybutynin solution was instilled twice a day for 7 days. The urodynamic studies were compared before and after the instillation. Total volume of daily incontinence was also monitored. RESULTS: After the intravesical oxybutynin instillations, mean maximal bladder capacity increased from 212.13 to 323.81 ml (p<0.01), mean bladder compliance increased from 11.73 to 18.56 ml/cmH2O (p<0.01), mean maximal detrusor pressure decreased from 67.19 to 50.90 cmH2O (p<0.01) and mean daily amount of incontinence decreased from 735.58 to 201.73 ml (p<0.01). No significant differences were found between the groups according to the level of injury, completeness of injury, duration since onset of injury and the presence of asymptomatic bacteriuria. CONCLUSION: This study proved that intravesical instillation of oxybutynin solution is an effective method in spinal cord injured patients with hyperreflexic or hypertonic neurogenic bladder dysfunction regardless the level and completeness of injury, as well as duration since the onset of injury or the presence of asymptomatic bacteriuria.