Robot-assisted, laparoscopic and open radical cystectomy for bladder cancer: A systematic review and network meta-analysis

ABSTRACT Objectives: To evaluate the safety and effectiveness of robot-assisted radical cystectomy (RARC), laparoscopic radical cystectomy (LRC), and open radical cystectomy (ORC) in bladder cancer. Methods: A literature search for network meta-analysis was conducted using international databases up to February 29, 2024. Outcomes of interest included baseline characteristics, perioperative outcomes and oncological outcomes. Results: Forty articles were finally selected for inclusion in the network meta-analysis. Both LRC and RARC were associated with longer operative time, smaller amount of estimated blood loss, lower transfusion rate, shorter time to regular diet, fewer incidences of complications, and fewer positive surgical margin compared to ORC. LRC had a shorter time to flatus than ORC, while no difference between RARC and ORC was observed. Considering lymph node yield, there were no differences among LRC, RARC and ORC. In addition, there were statistically significant lower transfusion rates (OR=-0.15, 95% CI=-0.47 to 0.17), fewer overall complication rates (OR=-0.39, 95% CI=-0.79 to 0.00), fewer minor complication rates (OR=-0.23, 95% CI=-0.48 to 0.02), fewer major complication rates (OR=-0.23, 95% CI=-0.68 to 0.21), fewer positive surgical margin rates (OR=0.22, 95% CI=-0.27 to 0.68) in RARC group compared with LRC group. Conclusion: LRC and RARC could be considered as a feasible and safe alternative to ORC for bladder cancer. Notably, compared with LRC, RARC may benefit from significantly lower transfusion rates, fewer complications and lower positive surgical margin rates. These data thus showed that RARC might improve the management of patients with muscle invasive or high-risk non-muscle invasive bladder cancer.

Relationship between video game addiction and bladder/bowel dysfunction in children / Relación entre la adicción a los videojuegos y la disfunción vesical o intestinal en niños

Abstract Introduction. Video games have a strong influence on children and adolescents. Video game addiction has negative effects on children's health. Objective. To determine the relationship between video game addiction and bladder/bowel dysfunction in children. Materials and methods. Three hundred sixty-three children and their mothers who met the inclusion criteria constituted the sample of this correlational study. The data were collected using a descriptive information form, the Video Game Addiction Scale for Children, and the Childhood Bladder and Bowel Dysfunction Questionnaire. Results. We found that 72.5% of the children were nine years old and 27.5% were ten years old; 50.4% were males and 49.6% were female. While 4.7% of the children who participated in the study were underweight, 19.6% were overweight, and 17.9% were obese. The mean Video Game Addiction Scale for Children score was 50.77 ± 16.17, whereas the mean Childhood Bladder and Bowel Dysfunction Questionnaire score was 29.98 ± 8.90. The ratio of children with a mean Video Game Addiction Scale for Children scores equal to or greater than 90 was 0.8% (n = 3). We found that 3.6% (n = 13) of the children had urinary/fecal incontinence while playing video games. There was a weak positive relationship between the dimensions of the Video Game Addiction Scale for Children scores, the Childhood Bladder and Bowel Dysfunction Questionnaire scores, and children's bladder and bowel function (r = 0.220; p < 0.05). Conclusions. There is a correlation between children's video game addiction level and their bladder and bowel dysfunction grade. Higher video game addiction levels correspond to higher bladder and bowel dysfunction.

Resumen Introducción. Los videojuegos tienen una fuerte influencia en los niños y adolescentes. La adicción a ellos tiene efectos perjudiciales para la salud de los niños. Objetivo. Determinar la relación entre la adicción a los videojuegos y la disfunción vesical o intestinal en niños. Materiales y métodos. Los 373 niños y sus madres que cumplieron con los criterios de inclusión constituyeron la muestra de este estudio descriptivo y correlacional. Los datos se recopilaron mediante un formulario de información descriptiva, la Video Game Addiction Scale for Children y el Childhood Bladder and Bowel Dysfunction Questionnaire. Resultados. El 72,5 % de los niños tenía nueve años y, el 27,5 %, diez; el 50,4 % eran hombres y el 49,6 %, mujeres. El 4,7 % de los estudiantes que participaron en el estudio tenían bajo peso, el 19,6 % presentaba sobrepeso y el 17,9 % tenía obesidad. Se constató que las puntuaciones medias de las escalas fueron 50,77 ± 16,17 para la Video Game Addiction Scale for Children y 29,98 ± 8,90 para el Childhood Bladder and Bowel Dysfunction Questionnaire. La proporción de niños con una puntuación de 90 o superior en la dicha escala fue del 0,8 % (n = 3). Se encontró que el 3,6 % (n = 13) de los niños tenía incontinencia urinario-fecal mientras jugaba videojuegos. Se reveló que había una correlación positiva débil entre las dimensiones de las dos escalas evaluadas, y la función de la vejiga y el intestino (p < 0,05). Conclusiones. El grado de adicción a los videojuegos de los niños está correlacionado con su grado de disfunción vesical o intestinal: entre mayor sea la adicción, mayor es la disfunción.

Mesentery-Sparing Technique: a New Intracorporeal Approach for Urinary Diversion in Robot-Assisted Radical Cystectomy

ABSTRACT Background Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is associated with significant morbidity and mortality. We present an alternative technique that preserves the complete mesenteric vascularization during the isolation of the intestinal segment used in ICUD, including distal vessels. This approach aims to minimize the risk of ischemia in both the ileal anastomosis and the isolated loop at the diversion site. Methods This cohort study included 31 patients, both male and female, who underwent RARC with ICUD from February 2018 to November 2023, performed by a single surgeon. Intraoperative and postoperative complications data were retrieved for analysis, employing our proposed mesentery-sparing technique in all cases. The primary endpoint was the incidence of intraoperative and postoperative complications directly attributable to the mesentery-sparing approach in ICUD. Secondary endpoints included other postoperative variables not directly related to mesentery preservation, such as the incidence of postoperative ileus requiring parenteral nutrition and the duration of hospitalization. Results None of the patients experienced intraoperative or postoperative complications directly related to mesentery-sparing, such as intestinal fistulae or internal hernias. The median duration of hospitalization was 6 days, and postoperative ileus necessitating total parenteral nutrition occurred in 19% of the patients. Minor complications (Clavien-Dindo grades I-II) accounted for 27.6% of the cases and major complications (grades III-V) accounted for 20.6%. Conclusion The mesentery-sparing technique outlined herein offers an alternative method for preserving the vascularization of intestinal segments and reducing the risk of intestinal complications in ICUD during RARC.

Lower Urinary Tract Symptoms in a prospective cohort of COVID-19 survivors

ABSTRACT Purpose: To analyze the prevalence of lower urinary tract symptoms (LUTS) in patients who survived moderate and severe forms of COVID-19 and the risk factors for LUTS six months after hospitalization. Materials and Methods: In this prospective cohort study, patients were evaluated six months after hospitalization due to COVID-19. LUTS were assessed using the International Prostate Symptom Score. General health was assessed through the Hospital Anxiety and Depression Scale and the EQ5D-L5 scale, which evaluates mobility, ability to perform daily activities, pain and discomfort and completed a self-perception health evaluation. Results: Of 255 participants, 54.1% were men and the median age was 57.3 [44.3 - 66.6] years. Pre-existing comorbidities included diabetes (35.7%), hypertension (54.5%), obesity (30.2%) and physical inactivity (65.5%). One hundred and twenty-four patients (48.6%) had a hospital stay >15 days, 181 (71.0%) were admitted to an ICU and 124 (48.6%) needed mechanical ventilation. Median IPSS was 6 [3-11] and did not differ between genders. Moderate to severe LUTS affected 108 (42.4%) patients (40.6% men and 44.4% women; p=0.610). Nocturia (58.4%) and frequency (45.9%) were the most prevalent symptoms and urgency was the only symptom that affected men (29.0%) and women (44.4%) differently (p=0.013). LUTS impacted the quality of life of 60 (23.5%) patients with women more severely affected (p=0.004). Diabetes, hypertension, and self-perception of worse general health were associated with LUTS. Conclusions: LUTS are highly prevalent and bothersome six months after hospitalization due to COVID-19. Assessment of LUTS may help ensure appropriate diagnosis and treatment in these patients.

Identify risk factors for perioperative outcomes in Intracorporeal Urinary Diversion and Extracorporeal Urinary Diversion with Robotic Cystectomy

ABSTRACT Introduction: The increasing adoption of robotic-assisted cystectomy with intracorporeal urinary diversion (ICUD), despite its complexity, prompts a detailed comparison with extracorporeal urinary diversion (ECUD). Our study at a single institution investigates perioperative outcomes and identifies risk factors impacting the success of these surgical approaches. Methods: In this retrospective analysis, 174 patients who underwent robotic-assisted cystectomy at the University of Louisville from June 2016 to August 2021 were reviewed. The cohort was divided into two groups based on the urinary diversion method: 30 patients underwent ECUD and 144 underwent ICUD. Data on demographics, complication rates, length of hospital stay, and readmission rates were meticulously collected and analyzed. Results: Operative times were comparable between the ICUD and ECUD groups. However, the ICUD group had a significantly lower intraoperative transfusion rate (0.5 vs. 1.0, p=0.02) and shorter hospital stay (7.8 vs. 12.3 days, p<0.001). Factors such as male sex, smoking history, diabetes mellitus, intravesical therapy, higher ASA, and ACCI scores were associated with increased Clavien-Dindo Grade 3 or higher complications. Age over 70 was the sole factor linked to a higher 90-day readmission rate, with no specific characteristics influencing the 30-day rate. Conclusion: Robotic cystectomy with ICUD results in shorter hospitalizations and lower intraoperative transfusion rates compared to ECUD, without differences in operative time, high-grade postoperative complications, or readmission rates. These findings can inform clinical decision-making, highlighting ICUD as a potentially more favorable option in appropriate settings.

Smoking characteristics and years since quitting smoking of US adults diagnosed with lung and bladder cancer: A national health and nutrition examination survey analysis

ABSTRACT Purpose: Smoking is a recognized risk factor for bladder BC and lung cancer LC. We investigated the enduring risk of BC after smoking cessation using U.S. national survey data. Our analysis focused on comparing characteristics of LC and BC patients, emphasizing smoking status and the latency period from smoking cessation to cancer diagnosis in former smokers. Materials and Methods: We analyzed data from the National Health and Examination Survey (2003-2016), identifying adults with LC or BC history. Smoking status (never, active, former) and the interval between quitting smoking and cancer diagnosis for former smokers were assessed. We reported descriptive statistics using frequencies and percentages for categorical variables and median with interquartile ranges (IQR) for continuous variables. Results: Among LC patients, 8.9% never smoked, 18.9% active smokers, and 72.2% former smokers. Former smokers had a median interval of 8 years (IQR 2-12) between quitting and LC diagnosis, with 88.3% quitting within 0-19 years before diagnosis. For BC patients, 26.8% never smoked, 22.4% were active smokers, and 50.8% former smokers. Former smokers had a median interval of 21 years (IQR 14-33) between quitting and BC diagnosis, with 49.3% quitting within 0-19 years before diagnosis. Conclusions: BC patients exhibit a prolonged latency period between smoking cessation and cancer diagnosis compared to LC patients. Despite smoking status evaluation in microhematuria, current risk stratification models for urothelial cancer do not incorporate it. Our findings emphasize the significance of long-term post-smoking cessation surveillance and advocate for integrating smoking history into future risk stratification guidelines.

Caracterización del cáncer vesical en adultos según variables clínicas y epidemiológicas / Characterization of bladder cancer in adults according to clinical and epidemiological variables

Introducción: El cáncer de la vejiga es uno de los más frecuentes del tracto urinario y se manifiesta de dos formas: como tumor superficial de bajo grado o como neoplasia invasora de alto grado. Objetivo: Caracterizar el cáncer vesical en adultos, según variables clínicas, epidemiológicas y de servicio. Métodos: Se realizó un estudio observacional descriptivo y retrospectivo, para caracterizar el cáncer vesical en adultos, según variables clínicas, epidemiológicas y de servicio de los pacientes atendidos en el servicio de Urología del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro» en el periodo comprendido de octubre 2019 y 2022. Población del estudio: 242 pacientes diagnosticados con cáncer vesical. Resultados: La mayoría de los pacientes diagnosticados con cáncer vesical corresponden al año 2019 (45,86 %): masculinos (75,20 %); blancos (89,25 %); mayores de 70 o más años (64,46 %) y fumadores (95,45 %). La hematuria fue el síntoma principal (91,73 %), como expresión del carcinoma urotelial papilar de bajo grado (36,77 %). Tratamiento: la resección transuretral (88,01 %), sin metástasis a distancia (88,42 %). Conclusiones: La mayoría de los pacientes diagnosticados con cáncer vesical corresponden al año 2019, masculinos, blancos, mayores de 70 o más años, fumadores y con hematuria. Más frecuente: el carcinoma urotelial papilar de bajo grado. El tiempo trascurrido antes del diagnóstico de la enfermedad fue de 36-40 días, y un mes, el tiempo trascurrido antes del tratamiento de la enfermedad.

Introduction: bladder cancer is one of the most frequent cancers of the urinary tract and manifests itself in two ways: as a superficial low-grade tumor or as a high-grade invasive neoplasm. Objective: to characterize bladder cancer in adults according to clinical, epidemiological and service variables. Methods: a descriptive and retrospective observational study was carried out to characterize bladder cancer in adults according to clinical, epidemiological and service variables of patients treated in the Urology service at "Arnaldo Milián Castro" Clinical and Surgical University Hospital from October 2019 and 2022. The study population was 242 patients diagnosed with bladder cancer. Results: most of the patients diagnosed with bladder cancer correspond to the year 2019 (45.86%): male (75.20%); whites (89.25%); older than 70 or more years (64.46%) and smokers (95.45%). Hematuria was the main symptom (91.73%), as an expression of low-grade papillary urothelial carcinoma (36.77%). The treatment was transurethral resection (88.01%), without distant metastasis (88.42%). Conclusions: most of the patients diagnosed with bladder cancer correspond to the year 2019, male, whites, older than 70 years or older, smokers and with hematuria. Low-grade papillary urothelial carcinoma was the most frequent cancer. The time elapsed before the diagnosis of the disease was 36-40 days, and the time elapsed before the treatment of the disease was 1 month.

lncRNA ZFP36-AS1 regulates proliferation and immune escape of bladder cancer cell through miR-221 / 国际外科学杂志

Objective:To investigate the expression of long non-coding RNA(lncRNA) ZFP36-AS1 in bladder cancer and the effect of ZFP36-AS1/miR-221 axis on the proliferation and immune escape of bladder cancer cells.Methods:The expression difference of ZFP36-AS1 in bladder cancer tissues was analyzed by cBioPortal database. Real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) was used to analyze the expression difference of ZFP36-AS1 in bladder cancer cell lines (J82, RT-4, MGH-U3, 5637). MGH-U3 cells were randomly divided into negative control (NC) group and ZFP36-AS1 group, which were transfected with pcDNA3.1-NC plasmid and pcDNA3.1-ZFP36-AS1 plasmid, respectively. Colony formation assay and flow cytometry were used to analyze the proliferation activity and cell cycle of MGH-U3 cells, respectively. T lymphocytes were co-cultured with MGH-U3 cells in each group, and the levels of interleukin-10 (IL-10), γ-interferon (IFN-γ), and interleukin-4 (IL-4) in the supernatants of each group were detected by enzyme-linked immunosorbent assay (ELISA). The dual-luciferase reporter gene assay verified the targeting relationship between ZFP36-AS1 and miR-221. The effect of ZFP36-AS1 on the expression of miR-221 in MGH-U3 cells was detected by RT-qPCR. Western blotting was used to detect the effect of ZFP36-AS1/miR-221 axis on the protein expression of CDK3, Cyclin C, CDK5, Cyclin D1 and Cyclin D3 in MGH-U3 cells.Results:Compared with normal bladder tissue, ZFP36-AS1 was abnormally low-expressed in bladder cancer tissue ( P<0.01). Compared with SV-HUC-1 cells, ZFP36-AS1 was abnormally low-expressed in bladder cancer cell lines (J82, RT-4, MGH-U3, 5637) ( P<0.01), and the expression was lowest in MGH-U3 cells ( P<0.01). The number of MGH-U3 cell colonies formed in the NC group and the ZFP36-AS1 group were (220.80±34.65) and (77.84±19.11), respectively, and the number of MGH-U3 cell colonies formed in the ZFP36-AS1 group was significantly down-regulated, the difference was statistically significant ( P<0.01). The proportions of G 0/G 1 phase cells in NC group and ZFP36-AS1 group were (48.04±2.89)% and (72.89±3.46)%, respectively, and the proportion of S phase cells were (35.38±2.98)% and (20.62±2.56)%, respectively. The proportion of G 2/M stage cells was (16.59±1.46)% and (6.48±1.50)%, respectively. The proportion of cells in G 0/G 1 phase were up-regulated in ZFP36-AS1 group ( P<0.01), and the proportion of cells in S phase and G 2/M phase were both down-regulated ( P<0.01). Compared with the NC group, the levels of IL-4 and IFN-γ in the ZFP36-AS1 group were significantly up-regulated ( P<0.01), and the level of IL-10 was significantly down-regulated ( P<0.01). ZFP36-AS1 can target miR-221 ( P<0.01). The relative expression of miR-221 in the NC group and the ZFP36-AS1 group was 6.84±1.35 and 1.00±0.21, respectively. Compared with the NC group, overexpression of ZFP36-AS1 could significantly inhibit the expression of miR-221 ( P<0.01). Compared with the NC group, the expressions of CDK3, Cyclin C, CDK5, Cyclin D1, and Cyclin D3 in the ZFP36-AS1 group were significantly decreased. Conclusion:ZFP36-AS1 is abnormally low-expressed in bladder cancer, and it reduces the proliferation activity of bladder cancer cells and inhibits their immune escape by inhibiting the expression of miR-221.

Integrating the continuous-time random-walk diffusion model and the vesical imaging-reporting and data system to predict muscle invasion of bladder cancer / 中华放射学杂志

Objective:To investigate the diagnostic performance of continuous-time random-walk (CTRW) diffusion model combined with vesical imaging-reporting and data system (VI-RADS) in the diagnosis of muscle invasion of bladder cancer.Methods:In this case-control study, 64 patients with pathologically confirmed bladder urothelial carcinoma in Peking University First Hospital were retrospectively enrolled from August 2022 to March 2023. The patients were divided into the muscle invasive bladder cancer (MIBC) group and the nonmuscle invasive bladder cancer (NMIBC) group (29 cases and 35 cases, respectively) according to the pathological results. All patients underwent bladder MRI within 4 weeks before surgery, including T 2WI, conventional diffusion weighted imaging (DWI), and multi-b-value DWI. The CTRW model was used to obtain three quantitative diffusion parameters, including D m (an anomalous diffusion coefficient), α (related to temporal diffusion heterogeneity), and β (related to spatial diffusion heterogeneity). The apparent diffusion coefficient (ADC) was calculated using a mono-exponential model. The VI-RADS scores were evaluated based on T 2WI and conventional DWI. The Mann-Whitney U test was used to compare the diffusion parameters between the MIBC group and the NMIBC group. The combination of the parameters was investigated with logistic regression analysis. The diagnostic performance for muscle invasion of bladder cancer was evaluated by receiver operating characteristic analysis and the area under the curve (AUC). The difference between AUC was compared using the DeLong test. Results:There were statistically significant differences in ADC, D m, and α between the MIBC group and the NMIBC group ( Z=-2.31, -2.91, -3.97, P=0.021, 0.004,<0.001). No significant difference was found in β between the two groups ( Z=1.69, P=0.091). The AUC (95% CI) of D m and α for diagnosing MIBC were 0.712 (0.587-0.838) and 0.790 (0.676-0.904) respectively, both of which were higher than that of ADC (AUC 0.669, 95% CI 0.537-0.801) with statistically significant differences ( Z=2.86, 2.27, P=0.004, 0.023). The AUC (95% CI) of CTRW (D m+α) was 0.782 (0.661-0.876), which was significantly higher than that of ADC ( Z=2.35, P=0.019). The AUC (95% CI) of VI-RADS score and VI-RADS combined with CTRW parameter (VI-RADS+D m+α) were 0.823 (0.716-0.930) and 0.900 (0.799-0.961) respectively, with a statistically significant difference between them ( Z=2.16, P=0.031). Conclusion:The D m and α parameters in the CTRW diffusion model show better performance than the ADC in the mono-exponential model for muscle-invasive evaluation of bladder cancer, and the CTRW diffusion model can enhance the diagnostic performance of VI-RADS.

Influencing factors for over active bladder syndrome in patients with cerebral small vessel disease / 中华老年心脑血管病杂志

Objective To explore the influencing factors of over active bladder(OAB)in patients with cerebral small vessel disease(CSVD)and its correlation with CSVD imaging markers.Meth-ods A total of 163 elderly CSVD patients admitted in our hospital from January 2021 to Decem-ber 2022 were enrolled and divided into OAB group(37 cases)and non-OAB group(126 cases)based on the results of OAB rating scale.Mini-mental State Examination(MMSE)score,Fazekas scale score,and total CSVD burden score were recorded and compared between the two groups.Results The OAB group had older age,higher urinary frequency,larger proportions of nocturia,urgency,and urge incontinence ratio,increased Fazekas score,periventricular white matter hyper-intensity(PWMH)score and deep white matter hyperintensity(DWMH)score,and elevated total CSVD burden score and lower MMSE score than the non-OAB group(P＜0.05,P＜0.01).PWMH score and DWMH score were risk factors for the occurrence of OAB(P＜0.01).The OAB score was positively correlated with Fazekas score,PWMH score,and DWMH score in the CSVD patients(r=0.533,P=0.001;r=0.462,P=0.004;r=0.398,P=0.015).The occurrence of urgency urinary incontinence was positively correlated with Fazekas score and PWMH score in the CSVD patients(r=0.352,P=0.033;r=0.346,P=0.036).Conclusion PWMH and DWMH are risk factors for OAB occurrence in CSVD patients.

Primary large cell neuroendocrine carcinoma of bladder with urothelial carcinoma: a case report / 中华泌尿外科杂志

Large cell neuroendocrine carcinoma of bladder is a rare malignant tumor with high degree of malignancy, strong invasiveness and poor prognosis. We reported a case of a 56-year-old man who underwent transurethral resection of bladder tumor because of bladder mass. Postoperative pathology revealed large cell neuroendocrine carcinoma of the bladder with urothelial carcinoma. Radical cystectomy was performed after postoperative chemotherapy, and there was no recurrence after 3 months of follow-up.

Non-reducible inguinoscrotal hernia of the urinary bladder as a direct component of a pantaloon hernia: A case report and review of literature

@#Pantaloon hernias are a subset of abdominal hernias wherein both indirect and direct components of inguinal hernias are present on one side. Inguinoscrotal hernia of the urinary bladder is a rare condition involved in less than 4% of inguinal hernias and more so if they are part of a direct component of a pantaloon hernia. This is a case of a 65-year-old male who presented a non-reducible right inguinoscrotal mass. Inguinoscrotal herniation of the urinary bladder was preoperatively diagnosed through imaging. Intra-operatively a pantaloon hernia was noted with the herniated urinary bladder as the direct component and omentum as the indirect component. The patient underwent cystourethroscopy, inguinal exploration right, and mesh hernioplasty. The patient had an unremarkable post-operative course and was discharged with improved conditions. Awareness of this clinical condition will aid in the diagnosis, and proper management and prevent post-operative complications.

Cateterismo urinário e as técnicas para prevenção de hematúria: revisão integrativa / Cateterismo urinario y las técnicas para prevención de hematuria: revisión integradora / Urinary catheterization and techniques for preventing hematuria: integrative review

Resumo Objetivo Analisar e sintetizar as evidências científicas disponíveis sobre o cateterismo urinário e as técnicas utilizadas para prevenir a hematúria no esvaziamento da bexiga, na retenção urinária aguda e crônica, em adultos e idosos. Métodos Revisão integrativa realizada nas bases de dados Pubmed, LILACS, Embase, Cochrane, Web of Science e Scopus; e busca manual nas listas de referências dos estudos incluídos. Um período ilimitado foi usado para revisar estudos em português, inglês, francês, alemão e espanhol. Aplicado estratégia PICOS na elaboração da pergunta de pesquisa e instrumento Joanna Briggs Institute (JBI) para avaliar qualidade metodológica dos estudos. Resultados Foram incluídos 11 estudos, com um total de 659 pacientes. A retenção urinária ocorreu principalmente em homens, tendo como principal causa a hiperplasia prostática benigna. As técnicas utilizadas para descompressão vesical, por cateterismo urinário, foram a descompressão rápida e a gradual, sendo as principais complicações, independente da técnica, hematúria e hipotensão. Os resultados mostraram que não houve diferença significativa entre as duas técnicas quanto ao desfecho prevenção da hematúria. Conclusão O esvaziamento gradual da bexiga não previne a hematúria em comparação com o esvaziamento rápido e completo. Mas os estudos, principalmente os relatos de casos, descrevem quadros clínicos que merecem atenção diante da ocorrência de hematúria após cateterismo urinário e as implicações no tratamento dos pacientes. Destaca a importância da enfermagem na identificação e prevenção do diagnóstico de Retenção Urinária, a fim de evitar intervenções posteriores e complicações clínicas, inclusive hematúria pós-cateterismo.

Resumen Objetivo Analizar y sintetizar las evidencias científicas disponibles sobre el cateterismo urinario y las técnicas utilizadas para prevenir la hematuria en el vaciado de la vejiga, en la retención urinaria aguda y crónica en adultos y personas mayores. Métodos Revisión integradora realizada en las bases de datos Pubmed, LILACS, Embase, Cochrane, Web of Science y Scopus y búsqueda manual en las listas de referencias de los estudios incluidos. Se utilizó un período ilimitado para revisar estudios en portugués, inglés, francés, alemán y español. Se aplicó la estrategia PICOS en la elaboración de la pregunta de investigación y el instrumento Joanna Briggs Institute (JIB) para evaluar la calidad metodológica de los estudios. Resultados Se incluyeron 11 estudios con un total de 659 pacientes. La retención urinaria ocurrió principalmente en hombres, principalmente a causa de la hiperplasia prostática benigna. Las técnicas utilizadas para la descompresión vesical por cateterismo urinario fueron la descompresión rápida y la gradual, y las principales complicaciones, independientemente de la técnica, fueron hematuria e hipotensión. Los resultados mostraron que no hubo diferencia significativa entre las dos técnicas respecto al resultado de prevención de la hematuria. Conclusión El vaciado gradual de la vejiga no previene la hematuria en comparación con el vaciado rápido y completo. Sin embargo, los estudios, principalmente los relatos de casos, describen cuadros clínicos que necesitan atención ante los episodios de hematuria después del cateterismo urinario y las consecuencias en el tratamiento de los pacientes. Se destaca la importancia de la enfermería en la identificación y prevención del diagnóstico de retención urinaria, a fin de evitar intervenciones posteriores y complicaciones clínicas, inclusive hematuria poscateterismo.

Abstract Objective Analyze and synthesize the available scientific evidence on urinary catheterization and techniques used to prevent hematuria in bladder emptying and acute and chronic urinary retention in adults and the elderly. Methods This integrative review was carried out in the PubMed, LILACS, Embase, Cochrane, Web of Science, and Scopus databases. Hand searching was used in the reference lists of included studies. An unlimited period was used to review the studies published in Portuguese, English, French, German, and Spanish. The PICOS strategy was applied to develop the research question and the Joanna Briggs Institute (JBI) instrument was used to assess the methodological quality of studies. Results Eleven studies were included, with a total of 659 patients. Urinary retention occurred mainly in men and the main cause was benign prostatic hyperplasia. Rapid and gradual decompressions were the techniques used for bladder decompression by urinary catheterization, and hematuria and hypotension were the main complications regardless of the technique. The results showed that there was no significant difference between the two techniques in terms of the outcome of hematuria prevention. Conclusion Gradual bladder emptying does not prevent hematuria compared to rapid and complete emptying. Case reports describe clinical conditions that deserve attention when hematuria occurs after urinary catheterization and the respective implications in the treatment of patients. We highlight the importance of nursing in identifying and preventing the diagnosis of Urinary Retention to avoid subsequent interventions and clinical complications, including post-catheterization hematuria.

Desenvolvimento da Intervenção de Enfermagem "Ultrassonografia: bexiga" segundo a Nursing Interventions Classification / Desarrollo de la intervención de enfermería "ecografía de vejiga" de acuerdo con la Nursing Interventions Classification / Development of the "Ultrasound: bladder" nursing intervention according to the Nursing Interventions Classification

Resumo Objetivo Desenvolver uma intervenção de enfermagem com o uso de ultrassonografia de bexiga segundo a Nursing Interventions Classification. Métodos Estudo metodológico em duas etapas: revisão integrativa de literatura e desenvolvimento da intervenção. Para etapa da revisão integrativa de literatura foram investigadas quatro bases de dados (PubMed, CINAHL, LILACS e SCOPUS), incluindo estudos de acesso gratuito e disponíveis na íntegra, nos idiomas inglês, português e espanhol, sem delimitação temporal. Na etapa de desenvolvimento da intervenção, foram seguidas as Diretrizes para Submissão de uma Intervenção à Nursing Interventions Classification Nova ou Revisada. Resultados Na revisão integrativa de literatura foram encontrados 328 estudos primários nas bases de dados, sendo incluídos 17 na análise final. Destacaram-se estudos com delineamento descritivo, sendo prevalente o nível de evidência VI. Os achados possibilitaram desenvolver cada um dos componentes da intervenção de enfermagem (Título, Definição, 17 atividades, Nível de Formação e o Tempo Estimado para realização). Conclusão A Intervenção de Enfermagem intitulada "Ultrassonografia: bexiga" foi desenvolvida, submetida ao Comitê Editorial da Nursing Interventions Classification e aceita para publicação na oitava edição da Classificação.

Resumen Objetivo Desarrollar una intervención de enfermería con el uso de ecografía de vejiga de acuerdo con la Nursing Interventions Classification. Métodos Estudio metodológico en dos etapas: revisión integradora de la literatura y desarrollo de la intervención. Para la etapa de revisión integradora de la literatura se investigó en cuatro bases de datos (PubMed, CINAHL, LILACS y SCOPUS), con la inclusión de estudios de acceso gratuito y disponibles con texto completo, en idioma inglés, portugués y español, sin límite temporal. En la etapa de desarrollo de la intervención, se siguieron las directrices para el envío de una intervención a Nursing Interventions Classification Nueva o Revisada. Resultados En la revisión integradora de la literatura, se encontraron 328 estudios primarios en las bases de datos, de los cuales se incluyeron 17 en el análisis final. Se destacaron los estudios con diseño descriptivo, con prevalencia de nivel de evidencia VI. Los resultados permitieron desarrollar cada uno de los componentes de la intervención de enfermería (título, definición, 17 actividades, nivel de formación y tiempo estimado para la realización). Conclusión La intervención de enfermería titulada "Ecografía: vejiga" fue desarrollada, enviada al Comité Editorial de la Nursing Interventions Classification y aprobada para publicar en la octava edición de la Clasificación.

Abstract Objective To develop a nursing intervention using bladder ultrasound according to the Nursing Interventions Classification. Methods This is a methodological study in two steps: integrative literature review and intervention development. For the integrative literature review step, four databases were investigated (PubMed, CINAHL, LILACS and Scopus), including free access studies available in full, in English, Portuguese and Spanish, without time limits. In the intervention development step, the Guidelines for Submission of a New or Revised Nursing Interventions Classification Intervention were followed. Results In the integrative literature review, 328 primary studies were found in the databases, 17 of which were included in the final analysis. Studies with a descriptive design stood out, with level of evidence VI being prevalent. The findings made it possible to develop each component of the nursing intervention (title, definition, 17 activities, level of training and estimated time for completion). Conclusion The nursing intervention entitled "Ultrasound: bladder" was developed, submitted the Nursing Interventions Classification Editorial Committee and accepted for publication in the 8th edition of the Classification.

Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital

Abstract Objective: To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Results: Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.

Outcomes of urethral meatal preservation ventral urethroplasty for female urethral stricture: a series of cases

Abstract Objective: To present a series of cases with our initial experience and short-term outcomes of a modified vaginal mucosal flap urethroplasty. Methods: Patients diagnosed with urethral stricture and operated by the same operative technique between January 2012 and January 2018 were followed for at least 6 months. Uroflowmetry and clinical outcomes were evaluated. Results: Nineteen patients were included with an average age of 56.4 years, mean preoperative Qmax of 5.3 ml/s, and PVR of 101.4 mL. After 6 months of the procedure, the mean Qmax improved to 14.7 mL/s (p<0.05), PVR decreased to 47.3 mL (p<0.05), and 84.2% of all patients reported improvement in clinical self-reported symptoms. There was an improvement in symptoms such as voiding effort in 84.2% of patients, weak stream (89.5%), and recurrent urinary tract infection (85.7%). The success rate (absence of symptoms and normal Qmax with no significant PVR) of the procedure was 84.2%. Conclusion: The described technique was considered effective for the treatment of female urethra stricture, with a high clinical success rate and an objective improvement of Qmax and decrease in PVR after 6 months of the procedure.

Bladder transplantation: the new frontier in abdominal organ transplantation / Transplante de bexiga: a nova fronteira no transplante de órgãos abdominais

ABSTRACT Lower urinary tract abnormalities are directly implicated in the etiology of renal dysfunction in 6 to 24% of dialytic patients. These patients require bladder capacity and compliance readjustment before being considered viable candidates for renal transplantation. Vesical augmentation surgeries often involve the use of intestinal segments. Although these procedures can effectively restore bladder capacity and compliance, they present various issues related to maintaining mucous absorption and secretion capacity. Acidosis, recurrent urinary tract infections, and stone formation are extremely common, leading to frequent hospitalizations and graft function loss. Urinary tissue is certainly ideal for these reconstructions; however, bladder augmentation using ureter and renal pelvis are feasible only in a minority of cases. Experimental studies have been conducted to establish the groundwork for vascularized bladder transplantation. Last year, for the first time, this procedure was performed on a brain-dead patient. During this intervention, cystectomy was performed with preservation the vascular pedicle, followed by organ reimplantation. The graft remained viable for a period of 12 hours post-transplant. However, this intervention utilized a robotic platform, making it less reproducible in a multi-organ procurement setting as well as for most transplant centers. Moreover, it is debatable whether the benefits of exclusive bladder transplantation outweigh the risks associated with immunosuppression. For patients needing renal transplantation and requiring lower urinary tract reconstruction, however, utilizing the donor's bladder may offer an attractive alternative, avoiding the inherent complications of enterocystoplasty without increasing immunological risk. Combined kidney and bladder transplantation has the potential to emerge as the next frontier in abdominal organ transplants.

RESUMO As alterações do trato urinário inferior estão diretamente implicadas na etiologia da disfunção renal em 6 a 24% dos pacientes em diálise. Esses pacientes necessitam readequação da capacidade e complacência vesical antes de serem considerados candidatos viáveis para o transplante renal. As cirurgias de ampliação vesical frequentemente envolvem a utilização de segmentos intestinais. Embora estes procedimentos possam reestabelecer de forma eficaz a capacidade e complacência vesical, apresentam diversos problemas relacionados à manutenção da capacidade de absorção e secreção de muco. Acidose, infecções urinárias de repetição e formação de cálculos são extremamente comuns levando a internações frequentes e perda de função do enxerto. O tecido urinário é certamente ideal para estas reconstruções, contudo, ampliações vesicais utilizando ureter e pelve renal são viáveis somente em uma minoria dos casos. Estudos experimentais têm sido conduzidos na busca de se estabelecer os fundamentos para um transplante vascularizado de bexiga. No ano passado, pela primeira vez, este procedimento foi realizado em um paciente em morte encefálica. Nessa intervenção, foi realizada a cistectomia, preservando-se o pedículo vascular, seguida pelo reimplante do órgão. Esse enxerto mostrou-se viável pelo período de 12 horas após o transplante. Entretanto, nesta intervenção, foi utilizada plataforma robótica tornando-o pouco reprodutível em um contexto de captação de múltiplos órgãos bem como para a maioria dos centros transplantadores. Além disso, é discutível se os benefícios do transplante vesical exclusivo compensam os riscos associados à imunossupressão. Para pacientes que precisam ser submetidos a transplante renal e requerem reconstrução do trato urinário inferior, entretanto, a utilização da bexiga do mesmo doador pode representar uma alternativa atraente, evitando as complicações inerentes às enterocistoplastias sem aumento do risco imunológico. O transplante combinado de rim e bexiga tem o potencial de se destacar como a próxima fronteira nos transplantes de órgãos abdominais.

Validation of a mobile application for adults with neurological lower urinary tract dysfunction / Validação de aplicativo móvel para adultos com disfunção neurológica do trato urinário inferior / Validación de una aplicación móvil para adultos con disfunción neurológica del tracto urinario inferior

Abstract Objective: to validate with experts the content of a mobile application to guide patients with neurological dysfunction of the lower urinary tract. Method: methodological study. For content validation, 81 specialist nurses took part. The data collection instrument was designed in the form of an electronic form, and included assessments of the application's objectives, content, language, relevance, functionality and usability. The data was submitted to descriptive and inferential statistical analysis, based on the measurement of the Content Validity Index. Results: the overall content validity index of the prototype application was 0.98. The lowest item (0.93) was related to the adequacy of the font size, and the highest module (1) was associated with usability, showing ease in handling the application. The experts recommended correcting spelling and grammar, as well as adding and minimizing information, standardizing language, among others. Conclusion: the content of the MeduLar sem Medo ® mobile app was validated with excellence by specialists, and presented important resources for teaching urinary dysfunction control and adherence to rehabilitation. With these results, it is possible to envision the next stages of validation, with application in the populations for which it is intended and incorporation of this care technology into the Unified Health System.

Resumo Objetivo: validar com especialistas o conteúdo de aplicativo móvel para orientação de pacientes com disfunção neurológica do trato urinário inferior. Método: estudo metodológico. Para validação do conteúdo, participaram 81 enfermeiros especialistas. O instrumento de coleta de dados foi elaborado no formato de formulário eletrônico e conteve avaliações sobre objetivos, conteúdo, linguagem, relevância, funcionalidade e usabilidade do aplicativo. Os dados foram submetidos à análise estatística descritiva e inferencial, com base na mensuração do Índice de Validade de Conteúdo. Resultados: o índice de validade de conteúdo global do protótipo de aplicativo foi de 0,98. O item mais baixo (0,93) foi referente à adequação do tamanho da fonte, e o módulo mais alto (1) foi associado à usabilidade, que mostrou facilidade no manuseio do aplicativo. Os especialistas recomendaram correção ortográfica e gramatical, além de acréscimos e minimização de informações, padronização da linguagem, dentre outros. Conclusão: o conteúdo do aplicativo móvel MeduLar sem Medo® foi validado com excelência por especialistas, pois apresentou recursos importantes para o ensino do controle da disfunção urinária e a adesão à reabilitação. Com tais resultados, é possível vislumbrar as próximas etapas de validação, com aplicação nas populações a que se destina e incorporação desta tecnologia de cuidado no âmbito do Sistema Único de Saúde.

Resumen Objetivo: validar con especialistas el contenido de una aplicación móvil para orientación de pacientes con disfunción neurológica del tracto urinario inferior. Método: estudio metodológico. Para la validación del contenido, participaron 81 enfermeros especialistas. El instrumento de recolección de datos se elaboró en formato de formulario electrónico y contuvo evaluaciones sobre objetivos, contenido, lenguaje, relevancia, funcionalidad y usabilidad de la aplicación. Los datos se sometieron a análisis estadístico descriptivo e inferencial, basado en la medición del Índice de Validez de Contenido. Resultados: el índice de validez de contenido global del prototipo de la aplicación fue de 0,98. El ítem más bajo (0,93) se refirió a la adecuación del tamaño de la fuente, y el módulo más alto (1) se asoció a la usabilidad, que mostró facilidad en el manejo de la aplicación. Los especialistas recomendaron corrección ortográfica y gramatical, además de adiciones y minimización de información, estandarización del lenguaje, entre otros. Conclusión: el contenido de la aplicación móvil MeduLar sin Miedo® fue validado con excelencia por especialistas, pues presentó recursos importantes para la enseñanza del control de la disfunción urinaria y la adhesión a la rehabilitación. Con tales resultados, es posible vislumbrar las próximas etapas de validación, con aplicación en las poblaciones a las que se destina e incorporación de esta tecnología de cuidado en el ámbito del Sistema Único de Salud.

Conflito decisional de pacientes com lesão medular que realizam cateterismo uretral intermitente / Conflicto decisional de pacientes con lesión medular que realizan cateterismo uretral intermitente / Decisional conflict in patients with spinal cord injury who perform intermittent urethral catheterization

Resumo Objetivo Identificar o conflito de decisão de pacientes com lesão medular frente ao cateterismo intermitente limpo. Métodos Estudo observacional, transversal, e quantitativo, que utilizou duas ferramentas de pesquisa, um questionário sociodemográfico e clínico e a versão brasileira da Decisional Conflict Scale. A investigação foi empreendida com uma amostra não probabilística em um hospital público especializado em reabilitação no Distrito Federal. Os dados coletados foram analisados por meio de estatística inferencial e descritiva de tendência central e de dispersão utilizando-se frequências absoluta e relativa, média e desvio padrão. O protocolo de pesquisa foi avaliado e aprovado pelo Comitê de Ética em Pesquisa da Secretaria de Saúde do Distrito Federal e todos os participantes aderiram ao termo de consentimento livre e esclarecido. Resultados A pesquisa envolveu 30 pacientes, sendo a maioria homens, com idade média de 32,43 anos. Destes 16 realizavam o auto cateterismo e 14 eram submetidos ao cateterismo assistido. O conflito de decisão foi identificado em metade dos pacientes, predominantemente entre os com menor tempo de lesão medular e período de realização do cateterismo. A lacuna de informações e a falta de suporte para a realização do procedimento foram os fatores preponderantes para a ocorrência do conflito de decisão. Conclusão O tempo de lesão e de realização do cateterismo parecem influenciar na aquisição de habilidades e conhecimentos na realização do cateterismo, manifestando-se com acentuado conflito decisório logo após a lesão. Suporte decisional e autocuidado apoiado podem contribuir para melhor engajamento do paciente.

Resumen Objetivo Identificar los conflictos de decisión de pacientes con lesión medular respecto al cateterismo intermitente limpio. Métodos Estudio observacional, transversal y cuantitativo, en el que se utilizaron dos herramientas de investigación, un cuestionario sociodemográfico y clínico y la versión brasileña de la Decisional Conflict Scale. La investigación se llevó a cabo con una muestra no probabilística en un hospital público especializado en rehabilitación en el Distrito Federal. Los datos recopilados se analizaron mediante estadística inferencial y descriptiva de tendencia central y de dispersión, con el uso de frecuencia absoluta y relativa, promedio y desviación típica. El protocolo de investigación fue evaluado por el Comité de Ética en Investigación de la Secretaría de Salud del Distrito Federal y todos los participantes adhirieron al consentimiento informado. Resultados Participaron 30 pacientes en el estudio, la mayoría hombres, de 32,43 años de edad promedio. Del total, 16 realizaban el autocateterismo y 14 el cateterismo asistido. Se identificaron conflictos de decisión en la mitad de los pacientes, de forma predominante en aquellos con menor tiempo de lesión medular y período de realización del cateterismo. El vacío de información y la falta de apoyo para la realización del procedimiento fueron los factores preponderantes para los casos de conflicto de decisión. Conclusión El tiempo de lesión y de realización del cateterismo parecen influir en la adquisición de habilidades y conocimientos para la realización del cateterismo, y se manifiesta con un elevado conflicto decisorio poco después de la lesión. El apoyo en la decisión y el autocuidado con apoyo pueden contribuir para que el paciente se comprometa más.

Abstract Objective To identify the decisional conflict of patients with spinal cord injury who perform clean intermittent catheterization. Methods An observational, cross-sectional, quantitative study was conducted using two research tools: a sociodemographic/clinical questionnaire and the Brazilian version of the Decisional Conflict Scale. The research was carried out with a non-probabilistic sample in a public hospital specializing in rehabilitation in the Federal District. The data collected was analyzed using inferential and descriptive statistics of central tendency and dispersion using absolute and relative frequencies, mean, and standard deviation. The research protocol was evaluated and approved by the Research Ethics Committee of the Federal District Health Secretariat and all participants signed an informed consent form. Results The study involved 30 patients, most of whom were men, with a mean age of 32.43 years. Of these, 16 performed self-catheterization and 14 underwent assisted catheterization. Conflict of decision was identified in half of the patients, predominantly among those with a shorter period of spinal cord injury and period of catheterization. The information gap and the lack of support for the procedure were the main factors in decisional conflicts. Conclusion The time since the injury and the period during which the catheterization was performed seem to influence the acquisition of skills and knowledge in performing the procedure, showing a marked decisional conflict soon after the injury. Decisional support and supported self-care can contribute to better patient engagement.

Factores de riesgo asociados al cáncer vesical en pacientes adultos / Risk factors associated with bladder cancer in adult patients

Introducción: El cáncer vesical es una enfermedad que afecta, generalmente, a pacientes masculinos de la tercera edad. Este tumor tiene dos formas principales de manifestarse: como tumor superficial y de bajo grado, o como neoplasia invasora de alto grado. La mayoría de los pacientes afectados con esta enfermedad presentan como factor de riesgo, el consumo de tabaco. Objetivo: Contribuir al conocimiento de la comunidad científica en lo relativo a los factores de riesgo y al síntoma principal asociados al cáncer vesical en pacientes adultos de la tercera edad. Métodos: Se realizó una revisión sistemática sobre el tema en las bases de datos: SciELO, EBSCO, Scopus, PubMed, y en revistas de Urología. Los artículos fueron publicados en idioma español o inglés. Se realizó un análisis del contenido para lograr la actualización teórica del tema. Conclusiones: El cáncer vesical es una enfermedad multifocal que provoca la aparición de varias neoformaciones dentro del epitelio transicional, en toda su extensión. La presencia de hematuria asintomática en los pacientes adultos fue la causa más común de consulta con el urólogo. Dentro de los factores de riesgo, el principal fue el consumo de tabaco.

Introduction: bladder cancer is a disease that generally affects elderly male patients. This tumour has two main forms of manifestation: as a low-grade superficial tumor or as a high-grade invasive neoplasm. Most of the patients affected with this disease have tobacco consumption as a risk factor. Objective: to contribute to the knowledge of the scientific community in relation to the risk factors associated with bladder cancer in elderly patients. Methods: a systematic review on the subject was carried out in SciELO, EBSCO, Scopus and PubMed databases as well as in Urology journals. Articles published in Spanish or English languages were taken into account. A content analysis was conducted to achieve a theoretical update on this topic. Conclusions: bladder cancer is a multifocal disease that causes the appearance of several neoformations within the transitional epithelium and throughout its entire length. The presence of asymptomatic hematuria in adult patients was the most common reason for consultation with the urologist. The main risk factor was tobacco consumption.