Transcriptome sequencing identifies ANLN as a promising prognostic biomarker in bladder urothelial carcinoma.

The prognosis of bladder urothelial carcinoma (BLCA) varies greatly even for patients with similar pathological characteristics. We conducted transcriptome sequencing on ten pairs of BLCA samples and adjacent normal tissues to identify differentially expressed genes. Anillin (ANLN) was identified as a transcript that was significantly up-regulated in BLCA samples compared with normal tissues. Prognostic power of candidate gene was studied using qRT-PCR and immunohistochemistry on 40 and 209 patients, respectively. Patients with elevated ANLN expression level was correlated with poorer cancer-specific (median, 22.4 vs. 37.3 months, p = 0.001), progression-free (median, 19.7 vs. 27.9 months, p = 0.001) and recurrence-free survival (median, 17.1 vs. 25.2 months, p = 0.011) compared with low ANLN expression. Public datasets TCGA and NCBI-GEO were analyzed for external validation. Knockdown of ANLN in J82 and 5637 cells using small interfering RNA significantly inhibited cell proliferation, migration, and invasion ability. Moreover, knockdown of ANLN resulted in G2/M phase arrest and decreased expression of cyclin B1 and D1. Microarray analysis suggested that ANLN played a major role in cell migration and was closely associated with several cancer-related signaling pathways. In conclusion, ANLN was identified as a promising prognostic biomarker which could be used to stratify different risks of BLCA.

Laparoscopic ureteral reimplantation underneath broad ligament tunnel for female vesicoureteral stenosis: a technical innovation.

INTRODUCTION: In order to anatomically reconstruct ureteral stenosis, we present a novel technique for laparoscopic ureteral reimplantation. PATIENTS AND METHODS: Three young females, who were diagnosed with hydroureteronephrosis caused by congenital vesicoureteral junction obstruction, were treated by laparoscopic ureteral reimplantation with a tunnel underneath the broad ligament. RESULTS: Surgery was performed successfully without conversion to open surgery. No major intra- or postoperative complications occurred. Postoperative follow-up was 38, 33 and 26 months, respectively. The operative time was between 220 and 260 min. The mean estimated blood loss was less than 20 ml. Subsequent imaging performed 3 months after surgery revealed relief of hydroureteronephrosis for all patients. The patients all gave birth to healthy neonates and showed normal urinary tract sonogram and urine analysis during the gestation period. CONCLUSION: Laparoscopic ureteral reimplantation with broad ligament tunnel is safe and effective, allowing for anatomical reconstruction of ureter defects. However, a larger clinical sample and longer follow-up period will be needed.

Laparoscopic versus open radical cystectomy for elderly patients over 75-year-old: a single center comparative analysis.

PURPOSE: To explore the morbidity, mortality and oncological results of laparoscopic radical cystectomy (LRC) in the elderly patients over 75-year-old in contrast with open radical cystectomy (ORC). MATERIALS AND METHODS: We analyzed 46 radical cystectomies from January 2009 to December 2013 in patients over 75-year-old in our institute, 21 patients in the LRC group and 25 in the ORC group. Demographic parameters, operative variables and perioperative outcome were retrospectively collected and analyzed between the two groups. Perioperative morbidity and mortality were categorized as early (within 90 days after surgery) or late (more than 90 days) according to the time of occurrence. RESULTS: Patients in both groups had comparable preoperative characteristics. A significant longer operative time (418 vs. 337 min, p = 0.018) and less estimated blood loss (400 vs. 500 ml p = 0.038) were observed in LRC group compared with ORC group. Infection and ileus were the most common early complications after surgery. Patients underwent ORC suffered from significantly more postoperative ileus (28.0% vs. 4.8%, P = 0.038) and infection (40% vs. 9.5%, P = 0.019) than LRC group within 90 days after surgery. The mortality rate was 4.7% (1/21) and 4% (1/25) for LRC group and ORC group respectively. At a median follow-up of 21 months (range 2-61 months), the Kaplan-Meier survival curves and log-rank analysis demonstrate that there were no significant differences between the LRC and ORC groups in the 3-year overall, cancer-specific, or recurrence-free survival rates. CONCLUSIONS: It is suggested that LRC should be recommended as the primary intervention to treat muscle invasive or high risk non-muscle invasive bladder cancer in elderly patients with a relative long life expectancy.

Solifenacin is able to improve the irritative symptoms after transurethral resection of bladder tumors.

OBJECTIVE: To evaluate the efficacy and safety of solifenacin in the management of irritative symptoms after transurethral resection of bladder tumors (TURBTs) with subsequent intravesical chemotherapy. METHODS: A total of 116 patients undergoing TURBT were randomly allocated into 2 groups, 58 patients in each group. Group 1 patients received solifenacin 5 mg, 6 hours before surgery and 5 mg per day, after surgery for 2 weeks, whereas group 2 patients received a placebo. Patients with low-risk non-muscle-invasive bladder cancer received immediate postoperative instillation of epirubicin. Patients with medium- or high-risk non-muscle-invasive bladder cancer received postoperative instillation twice within 2 weeks, once immediately following the operation and once on the eighth postoperative day. All patients completed bladder diaries before surgery, on the 1st, 7th, and 14th days after removal of the catheter with overactive bladder symptom scores completed preoperatively, and on the 7th and 14th days. Additionally, the incidence and severity of catheter-related bladder discomfort were recorded at 6, 12, 24, 48, and 72 hours after the surgery. RESULTS: The incidence and the severity of catheter-related bladder discomfort in group 1, compared with group 2, were significantly reduced (P<.05). There was a significant difference in overactive bladder symptom scores between the 2 groups (5.67 vs 7.86; P<.001). Episodes of daytime, frequency, nocturia, urgency, and urge urinary incontinence in group 1 were also significantly lower than in group 2 (P<.05). CONCLUSION: This study demonstrates that solifenacin can be beneficial for the management of irritative symptoms after TURBT with subsequent intravesical chemotherapy.

A new tool for distinguishing muscle invasive and non-muscle invasive bladder cancer: the initial application of flexible ultrasound bronchoscope in bladder tumor staging.

OBJECTIVES: To validate the flexible ultrasound bronchoscope (FUB) as a tool in distinguishing muscle invasive and non-muscle invasive bladder tumors. MATERIALS AND METHODS: From June 2010 to April 2012, 62 patients (11 female and 51 male) with 92 bladder urothelial carcinoma were treated in our study. The mean (±SD) patient age was 64.0±12.5 years old (ranged from 22 to 87). Clinical T stage was assessed by FUB at first in operating room, then immediately initial diagnostic transurethral resection (TUR) was performed. A second TUR would be done 2-4 weeks after initial TUR when the latter was incomplete (in large and multiple tumours, no muscle in the specimen) or when an exophytic high-grade and/or T1 tumour was detected. And radical cystectomy would be performed for the patients who were diagnosed with muscle-invasive tumors. FUB staging and initial TUR staging, final pathological results were compared. RESULTS: In ultrasonic images, the normal muscle layer of bladder wall could be clearly distinguished into three layers, which were hyperechogenic mucosa, hypoechogenic muscle and hyperechogenic serosal. For non-muscle invasive tumors, the muscle layers were continuous. And distorted or discontinuous muscle layers could be seen in muscle-invasive case. The overall accuracy (95.7%) and the specificity of muscle invasion detection of FUB (98.8%) were comparable to TUR (overall accuracy 90.2% and specificity 100%), but sensitivity of muscle invasion detection of FUB was significantly higher than initial TUR (72.7%VS18.2%). Moreover, the tumor's diameter could not affect the FUB's accuracy of muscle invasion detection. For tumors near the bladder neck, FUB also showed the similar validity as those far from bladder neck. CONCLUSIONS: To conclude, the flexible ultrasound bronchoscope is an effective tool for muscle invasion detection of bladder tumor with ideal ultrasonic images. It is an alternative option for bladder tumor staging besides TUR. It might have the potentiality to change the bladder diagnostic strategy.

Music reduces panic: an initial study of listening to preferred music improves male patient discomfort and anxiety during flexible cystoscopy.

PURPOSE: To assess the impact of listening to preferred music on relieving male patients' pain and anxiety during flexible cystoscopy. PATIENTS AND METHODS: A total of 124 male patients were admitted to our hospital for flexile cystoscopy by a single urologist between January 2013 and September 2013 and randomized to two equal groups. Group 2 included 62 patients who could select and listen to their preferred music during flexible cystoscopy. Group 1 included 62 patients who were unable to listen to the music. All patients were administered the same amount of lidocaine (10 mL) for 3 minutes for local anesthesia before flexible cystoscopy. A visual analog scale (VAS) ranging from 0 to 10 was used to assess patients' pain feeling after the cystoscopy procedure. Anxiety levels were calculated according to the State Instrument of State-Trait Anxiety Inventory (STAI-S), and the pulse rate were recorded 5 minutes before and immediately after the procedure. The duration of the procedure of each group were also analyzed. RESULTS: Statistically significant differences were detected between group 1 and group 2 in the mean pain score on VAS (2.53 ± 1.34 vs 1.63 ± 1.09, P=0.002, Mann-Whitney U test), mean postprocedural State Anxiety Inventory pain score (39.4 ± 6.5 vs 34.5 ± 5.8), and postprocedural pulse rate (79.8 ± 5.5 vs 76.0 ± 7.3) (P<0.001 for both, t test). Patients who listened to their preferred music experienced less discomfort and lower anxiety at cystoscopy. Patient age, duration of the procedure, preprocedural STAI-S, and preprocedural pulse rate of each group were comparable. CONCLUSION: Listening to preferred music during flexible cystoscopy is an easy way to improves male patients' comfort and reduce their anxiety. It could be recommended for male patients.

Imaging diagnosis and endoscopic treatment for ureteral fibroepithelial polyp prolapsing into the bladder.

OBJECTIVE: Fibroepithelial polyps of ureter prolapsing into the bladder are a rare urological condition. We report the imaging findings and our experience with endoscopic treatment for ureteral fibroepithelial polyps prolapsing into the bladder. PATIENTS AND RESULTS: Four patients with frank pain and hematuria were enrolled. Intravenous urography and computed tomography revealed a ureteral mass with filling defects in affected ureter and mild hydronephrosis. Endoscopic examination showed ureteral polyps prolapsing in the bladder. The histopathologic diagnosis on 4 cases was benign fibroepithelial polyps of ureter. The largest polyps (from 4-10 cm in length) were successfully resected and vaporized by Holmium: YAG laser. A double-pigtail ureteral stent at 7F was placed and left for 6 weeks after the procedure. Neither recurrence nor ureter stricture was observed after up to 12 years of follow-up. CONCLUSIONS: Ureteral malignancy must be excluded in cases where a ureteral mass is detected. Endoscopic management is recommended to minimize morbidity and complications in treatment of ureteral fibroepithelial polyps that prolapse into the bladder.

miRNA-100 inhibits human bladder urothelial carcinogenesis by directly targeting mTOR.

miRNAs are involved in cancer development and progression, acting as tumor suppressors or oncogenes. In this study, miRNA profiling was conducted on 10 paired bladder cancer tissues using 20 GeneChip miRNA Array, and 10 differentially expressed miRNAs were identified in bladder cancer and adjacent noncancerous tissues of any disease stage/grade. After being validated on expanded cohort of 67 paired bladder cancer tissues and 10 human bladder cancer cell lines by quantitative real-time PCR (qRT-PCR), it was found that miR-100 was downregulated most significantly in cancer tissues. Ectopic restoration of miR-100 expression in bladder cancer cells suppressed cell proliferation and motility, induced cell-cycle arrest in vitro, and inhibited tumorigenesis in vivo both in subcutaneous and in intravesical passage. Bioinformatic analysis showed that the mTOR gene was a direct target of miR-100. siRNA-mediated mTOR knockdown phenocopied the effect of miR-100 in bladder cancer cell lines. In addition, the cancerous metastatic nude mouse model established on the basis of primary bladder cancer cell lines suggested that miR-100/mTOR regulated cell motility and was associated with tumor metastasis. Both mTOR and p70S6K (downstream messenger) presented higher expression levels in distant metastatic foci such as in liver and kidney metastases than in primary tumor. Taken together, miR-100 may act as a tumor suppressor in bladder cancer, and reintroduction of this mature miRNA into tumor tissue may prove to be a therapeutic strategy by reducing the expression of target genes.