- [A primary intestinal-derived adenocarcinoma in intestine bladder substitutes: a case report]. [Journal Article]
- BDBeijing Da Xue Xue Bao Yi Xue Ban 2018 Aug 18; 50(4):737-739
- Intestinal primary intestine-derived adenocarcinoma of the bladder substituted by the intestine is a very rare long-term complication after complete urethral reconstruction of the bladder. The probab...
Intestinal primary intestine-derived adenocarcinoma of the bladder substituted by the intestine is a very rare long-term complication after complete urethral reconstruction of the bladder. The probability of its occurrence is low. However, in recent years, it has been proved to be objective, but there is rare literature about its diagnosis and treatment methods. This article describes a case of cystectomy and Studer ileal conduit in Peking University Third Hospital due to bladder cancer. After 9 years, he was discovered with a primary intestinal-derived adenocarcinoma in the bladder substitutes by the intestine. A male patient, 64 years old, with persistent abdominal pain in the lower abdomen for two weeks. There was carrion-like material in the urine, no gross hematuria, no urinary frequency, urgency, dysuria, and no abnormalities in the examination. Urinary CT showed intestinal metaplasia in the bladder. There was 5.7 cm×2.4 cm×4.8 cm irregular tissue shadow, and ureteroscopy found, on the right side, the bladder tumor whose diameter was 4-5 cm. We performed open lumpectomy and repaired the bladder, and postoperative pathology showed middle-high differentiated adenocarcinoma. The patient recovered well after the surgery. This article reviewed the similar intestinal primary intestine-derived adenocarcinoma of the bladder substituted by the intestine and found that it had the highest incidence in the elderly male population. The pathogenetic factor was most closely related to the smoking. If the patients developed hematuria, carrion-like substances in the urine, and bladder irritation, the possibility of tumor development should be suspected. Then the patients should promptly take the tests, such as urine exfoliation cytology, urine FISH, urinary system B-ultrasound, cystoscopy, etc. The microscope was the most direct observation of the lesion site examination. If the pathological tumor occurred ,and then the tumor should be immediately removed, and a new urinary diversion was needed to avoid further progress of the tumor. And postoperative smoking was strictly prohibited, also the patients should strictly control their eating habits and regularly adhere to the follow-up at least 4 years or more, but the lifelong follow-up and review was a must. The mechanism of intestinal primary intestinederived adenocarcinoma of the bladder substituted by the intestine is still unclear. Studies suggest that it may be related to N-nitroso compounds, smoking, and postoperative inflammatory reactions.
- Prevalence and phenotype of the c.1529C>T SPG7 variant in adult-onset cerebellar ataxia in Italy. [Journal Article]
- EJEur J Neurol 2018 Aug 11
- CONCLUSIONS: SPG7 c.1529C>T (p.Ala510Val) mutants account for 2.3% of cerebellar ataxia cases in Italy, suggesting that this variant should be considered as priority test in the presence of late onset pure ataxia. Moreover, the heterozygous/homozygous genotype appears to predict the onset of clinical manifestation and disease progression. This article is protected by copyright. All rights reserved.
- Choosing oral drug therapy for overactive bladder in older people. [Journal Article]
- EOExpert Opin Pharmacother 2018 Aug 09; :1-6
- Overactive bladder (OAB) and urgency incontinence are common in older people. Nevertheless, there remains a paucity of prospectively collected data on the efficacy of commonly used drug treatments fo...
Overactive bladder (OAB) and urgency incontinence are common in older people. Nevertheless, there remains a paucity of prospectively collected data on the efficacy of commonly used drug treatments for the condition. Many trials have included older people, but have seldom reported results stratified by age or reported adverse events of particular relevance to older people in clinical practice. This has partially been rectified with the introduction of more recently introduced antimuscarinic agents, particularly fesoterodine, and the beta-3-agonist, mirabegron. Areas covered: This article discusses evidence from recent trials relevant to robust and medically complex older people including synthesis of evidence on the association of anticholinergic medications and impaired cognition with relevance to OAB medications Expert opinion: There are increasing data concerning pharmacological therapy in both robust and medically complex older adults. There is a need to explore the efficacy and tolerability of pharmacological treatment of OAB and UUI (urgency urinary incontinence) in specific subgroups and to produce confirmatory real-world data on efficacy and tolerability. Guidelines which address treatment of older people is currently sparse but, as time progresses and data improve, more specific guidance should become available.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Nocturia is often described as the most bothersome of all urinary symptoms and is also one of the most common symptoms. It affects 40 million people in the United States alone. One in 3 adults older ...
Nocturia is often described as the most bothersome of all urinary symptoms and is also one of the most common symptoms. It affects 40 million people in the United States alone. One in 3 adults older than age 30 make at least 2 trips to the bathroom every night, and about 70% of these individuals are bothered by this. Nocturia can be associated with long-term sleep deprivation in addition to the inconvenience that it causes. Nocturia is defined as the need for a patient to get up at night on a regular basis to urinate. The urinary episode must be preceded and followed by a period of sleep to count as a nocturnal void. This means the first-morning void is not considered when determining nocturia episodes. Nocturnal enuresis is a completely different disorder as patients are generally not aware of a full bladder and typically experience an involuntary void while in bed. Additionally, nocturnal frequency is very similar to nocturia except that in nocturia the voiding episodes are each preceded and followed by sleep periods. Nocturia frequently accompanies an overactive bladder not explainable by urinary tract infections or other identifiable disorders. About half of the patients with daytime urinary urgency will also have nocturia. Those with nocturia of 3 or more nocturnal voids per night have a significantly higher overall mortality rate than the general population. Nocturia affects overall health and daytime functioning from loss of sleep, risks falls and injuries at night, reduces the quality of life, lowers productivity, and may even affect the health of the partner whose sleep is often disrupted as well. In particular, older adults with nocturia who make multiple nocturnal trips to the bathroom are at substantially increased risk of potentially serious falls. A quarter of all the falls that occur in older individuals happen overnight. Of these, 25% are directly related to nocturia. Patients who make at least 2 or more nocturnal bathroom visits a night, have more than double the risk of fractures and fall-related traumas. Nocturia leads to sleep deprivation, which can cause exhaustion, mood changes, somnolence, impaired productivity, increased risk of falls and accidents, fatigue, lethargy, inattentiveness, and cognitive dysfunction. It is also associated with decreased physical health, obesity, diabetes, depression, and heart disease. There is a significant financial aspect associated with nocturia. The disorder costs an estimated $62.5 billion dollars to Americans each year due to lost productivity and sick leave associated with nocturia; primarily as a result of preventable falls, fractures, and associated injuries. Despite its relative frequency, nocturia is often underreported, poorly managed, and inadequately treated. Many patients are reluctant or too embarrassed to mention this problem to their physicians, or they mistakenly believe it just a normal part of aging. Compounding the problem, initial treatment of nocturia by physicians is often superficial and somewhat routine regardless of the actual underlying etiology; with men typically receiving alpha blockers and women prescribed overactive bladder medications without any diagnostic investigation. Further evaluation and management of nocturia are often lacking even when these initial measures fail. For these reasons, it may take 1 or even 2 years between the onset of significant symptoms and the beginning of physician-directed, effective nocturia treatment. This creates an obligation of physicians to ask patients about their nocturia, explain that it is an abnormal but treatable condition and offer appropriate help. Treatment should be based on the underlying cause, which requires further evaluation. The purpose of this review is to facilitate improved diagnosis and treatment of this common and bothersome urinary disorder that often requires additional diagnostic and therapeutic measures beyond simple drug treatment of benign prostatic hyperplasia (BPH) in men or bladder overactivity (OAB) in women. A simple evaluation, based on a good medical history, diabetes screening, voiding diary, urinalysis and post-void residual determination, can identify the underlying etiology (such as diabetes or nocturnal polyuria) leading to better treatment outcomes, improved quality of life scores, and substantial symptom resolution.
- Long-term outcomes of anti-incontinence surgery and subsequent transvaginal sling incision for urethral obstruction. [Journal Article]
- IUInt Urogynecol J 2018 Aug 06
- CONCLUSIONS: Transvaginal sling incision is effective for urethral obstruction after PVS procedure. Voiding dysfunction after PVS could be resolved via sling incision. Most patients could maintain urinary continence and reported good satisfaction.
- Three-year safety, efficacy and persistence data following the daily use of mirabegron for overactive bladder in the clinical setting: A Japanese post-marketing surveillance study. [Journal Article]
- LULow Urin Tract Symptoms 2018 Aug 05
- CONCLUSIONS: Over 3 years, mirabegron was well tolerated and no cumulative events or delayed ADRs were observed. Mirabegron was an effective treatment with early improvements in OABSS being maintained throughout the treatment period. High persistence was observed after the use of mirabegron.
- Higher Neural Correlates in Multiple Sclerosis Patients with Neurogenic Overactive Bladder Following Treatment with Intradetrusor Injection of OnabotulinumtoxinA. [Journal Article]
- JUJ Urol 2018 Aug 01
- CONCLUSIONS: Intradetrusor injection of OnabotA appears to increase the activity most of the brain regions known to be involved in the sensation and process of urinary urgency in female MS patients with NOAB. This is the first study of its kind to evaluate the possible effects of OnabotA at the human brain level where sensory awareness is located. This pattern of activation may be used to phenotype patients further to optimize therapy or to uncover sensory effects of OnabotA beyond the bladder.
- Statewide Success of Staged Sacral Neuromodulation for the Treatment of Urinary Complaints in California (2005-2011). [Journal Article]
- FPFemale Pelvic Med Reconstr Surg 2018 Jul 27
- CONCLUSIONS: The "real world" success rates for staged SNS implantation in California are less than those observed by some academic centers of excellence but better than previously reported for Medicare beneficiaries. Successful trial rates for interstitial cystitis and neurogenic voiding dysfunction are similar to refractory overactive bladder.
- Long-term Pelvic Floor Symptoms, Recurrence, Satisfaction, and Regret Following Colpocleisis. [Journal Article]
- FPFemale Pelvic Med Reconstr Surg 2018 Jul 27
- CONCLUSIONS: Colpocleisis remains an excellent surgical option for elderly patients. However, regret and dissatisfaction may increase over time as bowel and bladder symptoms may be perceived to be the result of surgery. Our findings highlight the continued need for detailed consent and expectation setting for women considering colpocleisis.
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- Functional connectivity of the brain in older women with urgency urinary incontinence. [Journal Article]
- NUNeurourol Urodyn 2018 Jul 27
- CONCLUSIONS: These data support the postulate that responders and non-responders to therapy may represent different subsets of UUI, one with more of a central etiology, and one without.