Showing 11 results for Bladder
Shamimi K, Aminian A, Moazami F, Jalali M,
Volume 64, Issue 12 (11-2006)
Abstract
Background: Abdominal compartment syndrome (ACS) is a clinical entity that develops from progressive, acute increases in intra-abdominal pressure (IAP) and adversely affects all vital organ systems In this study, the development of intra-abdominal hypertension (IAH) and ACS in a surgical ICU population is described and examined.
Methods: Over a one-year period (2004), urinary bladder pressure (UBP) was measured prospectively in all surgical patients with abdominal problems admitted to the ICU of the Imam Hospital complex. UBP of >20 cm H2O indicated IAH. ACS was defined as the development of multiple organ dysfunction including peak airway pressure (PAP) >50 cm H2O, Horowitz quotient <150 torr or urine output <0.5 ml/kg/hr in the setting of IAH. Data were gathered on all patients with IAH and ACS.
Results: We evaluated some 353 patients, consisting of 165 elective laparatomies and 188 emergency cases, including 28 trauma patients. The incidence of IAH and ACS was 2 and 1 per cent (7 and 3 patients, respectively). The mean IAP of these seven patients was 29.8 cm H2O. No elevated IAP was observed after elective laparotomy (165 patients), nor in emergency cases with temporary abdominal wall closure (29 patients). APACHE II score, PAP and worst base deficit were significantly higher in patients with elevated IAP. None of the three patients with ACS underwent decompressive laparotomy. The mortality rate for patients with elevated IAP was 85%, significantly higher than the total study population.
Conclusion: IAH is a rare disease of the rarity of IAH, routine measurement of IAP is necessary only in high-risk patients. Prophylactic temporary abdominal wall closure may prevent IAH and ACS in high-risk patients. Patients with elevated IAP have dismal outcomes. Critical care practitioners should become familiar with different aspects of IAH and ACS, including decompressive laparotomy.
Mohseni M.gh, Aghamir S.m.k, Meysame A, Gooran Sh, Mohtaram S.n,
Volume 65, Issue 10 (1-2008)
Abstract
Background: We evaluated the efficacy of botulinum-A toxin (BTX-A) injection into detrusor muscle in patients with incontinence resistant to anticholinergic drugs due to detrusor overactivity.
Methods: Our prospective study included 12 male patients with detrusor overactivity and incontinence due to spinal cord injury, which had been unsuccessfully treated with anticholinergic medication. Under visual control through the cystoscope 300 units of BTX-A were injected into detrusor muscle at 30 sites, sparing the trigone. After the treatment patients continued to perform clean intermittent self-catheterization (CIC) and clinical follow-up was planned for 6 weeks, 6 months and 9 months after treatment and urodynamic study was repeated after 6 weeks.
Results: At the 6-week follow-up complete continence was restored in 9 of the 12 patients and after 6 months of 9 continent patients 1 patient lost his follow-up from the study and 7 were still continent. After 9 months 3 patients remained continent. Mean cystometric bladder capacity (p<0.001), compliance (p<0.001), and mean post-void residual urine volume significantly increased (p<0.001), whereas maximal detrusor contraction pressure significantly decreased (p<0.001).
Conclusions: BTX-A injections appears to be an effective and safe therapeutic option for overactive bladder in adult patients with spinal cord injury failing anticholinergic therapy even if these patients present with very low bladder compliance. Patients may require repeated injections after 6 months to remain continent.
Ghafouri A, Nasiri Sh, Karam Nejad M, Farshidfar F,
Volume 66, Issue 7 (10-2008)
Abstract
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Background: Port-site metastasis following laparoscopic
cholecystectomy with unsuspected gallbladder carcinoma is a serious problem.
Gallbladder carcinoma is found in 1% of all biliary tract operations, in most being diagnosed only after
histological examination of the gallbladder. The spread of cancer following
laparoscopy appears aggressive and widespread, as noticed from re-operation for
radical treatment. The pathologic findings of gallbladder were consisting of
tumoral and necrotic tissue, indicating of well differentiated adenocarcinoma.
Mucosa and submucosa were involved, but no evidence of invasion to muscular
layer and gall bladder serosa was found (T1). In this article we present the first of an unusual case of four port
site adenocarcinoma metastasis from gallbladder cancer.
Case report: A 63 year old woman
underwent laparoscopic cholecystectomy for acute cholecystitis. Thirty months
later, she was admitted to the hospital with a complaint of masses at the four
trocar sites. A biopsy from the port sites was undertaken
and led to the diagnosis of adenocarcinoma metastasis. There is no published
report of all four port site metastasis of
gallbladder cancer after laparoscopic cholecystectomy.
Yahyazadeh Sr, Mehraban D, Ghaffari Sh, Alimoghadam K, Ghavamzadeh A, Naderi Gh, Kazemeyni Sm, Rasteh M,
Volume 67, Issue 1 (4-2009)
Abstract
Background: Transitional Cell Carcinoma (TCC) of bladder is the second most common urogenital malignancy and because of its high rate of recurrence (two third of tumors recur) vigilant surveillance is necessary. There have been a lot of efforts to find a proper biomarker for detecting urothelial cancers because available methods are expensive and invasive (like cystoscopy) or have a low degree of sensitivity (like urine cytology). Urothelial malignancies, like other cancers tend to express a large amount of telomerase. The aim of this study was to evaluate the possible application of voided urine human telomerase reverse transcriptase (hTERT) mRNA assay in detecting low-grade bladder carcinoma in comparison with urine cytology.
Methods: Voided urine samples were collected from 49 patients who were supposed to go under operation. Samples were examined by both Quantitative Real-time RT-PCR (for measuring hTERT mRNA level) and cytology the results were then compared to the final pathologic studies.
Results: Regardless of clinical stage and or pathological grade of tumor, sensitivity of telomerase test and urine cytology was 74% and 16% respectively. There was a strong correlation between results of urine cytology and stage and/or grade of tumor however, sensitivity of telomerase test was acceptable regardless of stage and or grade of tumor. There was a statistically significant difference between sensitivity of urine cytology and telomerase test (p<0.001).
Conclusion: Detection of hTERT-mRNA can potentially be used as a non-invasive method for diagnosis and follow up of bladder carcinoma instead of urine cytology.
Ghanbari Z, Esmaeili M, Eftekhar T, Esmaeili M, Miri E,
Volume 69, Issue 5 (8-2011)
Abstract
Background: Overactive bladder (OAB) is one of the most prevalent diseases of lower urinary system. OAB disease is defined by the Standardization Subcommittee of the International Continence Society as urinary urgency, with or without urge incontinence, usually with frequency and nocturia with no proven infection or other obvious pathology. Treatment with the antimuscarinic agents tolterodine and oxybutynin is the mainstay of therapy for overactive bladder. The study was undertaken to compare the efficacy and side-effects of tolterodine and oxybutynin in a number of Iranian women.
Methods: This study consisted of two trials and done in Imam Khomeini Hospital in 2009 in one trial, 50 patients with overactive bladder were randomized to 4 weeks of treatment with 2 mg of twice-daily tolterodine, and in the other to 5 mg of three times a day oxybutynin. Urodynamic investigations, Episodes of urge urinary incontinence and adverse events were also evaluated.
Results: The results showed a good association between the questionnaire and cystometry data but urodynamic studies showed significant differences in efficacy. Tow groups showed significant improvements in all Symptoms, but The results showed that the two drugs had no significant differences in efficacy.
Conclusion: The data obtained by questionnaire indicated that both drugs increased quality of life but there were no significant differences between the two in symptom cure. Dry mouth was the most common side-effect in the two groups but unlike other studies it was higher in the tolterodine group. Therefore, our study did not show any preference between oxybutynin and tolterodine.
Ayati S, Vahidroodsari F, Talebian M,
Volume 69, Issue 6 (9-2011)
Abstract
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Background: Placenta accreta is a life-threatening complication after previous cesarean
delivery. The aim of this case report is to present a case of placenta percreta
with bladder involvement and subsequent maternal death.
Case
presentation: The patient was a 37-year
old who had an unwanted pregnancy due to tubectomy failure two years afterwards.
She was hospitalized at 26th and 30th week of gestation
because of gross hematuria. Sonography reported placenta previa. Cesarean section
was performed at 34th gestational week. Due to severe hemorrhage, hysterectomy with resection of some
part of the bladder was done. Died at the operating room after four hours of
severe uncontrollable hemorrhage.
Conclusion: The increasing prevalence of different forms of placenta accreta is the result
of the ever-increasing rate of cesarean deliveries. One of the strategies to
prevent this catastrophic obstetric complication is decreasing the number of cesarean
deliveries without appropriate indications.
Moradi Tabriz H, Olfati G, Ahmadi A, Niki F,
Volume 70, Issue 4 (7-2012)
Abstract
Background: Transitional Cell Carcinoma (TCC) is the most common type of urinary bladder cancer. Cyclooxygenase-2 (COX-2), a key enzyme in prostaglandins biosynthesis, has been introduced as a new candidate for targeted therapy in this cancer. In this study, we investigated the expression of COX-2 in urinary bladder TCCs and its relationship with clinicopathological parameters such as tumor grade and stage.
Methods: This cross-sectional study was performed in the Pathology department of Sina Hospital in Tehran, Iran during 2006-2011. Pathology reports of patients with definite diagnosis of urinary bladder TCCs who had undergone Transurethral Resection (TUR) were reviewed and 40 cases were selected. Subsequently, COX-2 expression was assessed immunohistochemically by the examination of paraffin embedded tissue blocks. Staining in more than 5% of tumor cells was considered as positive expression.
Results: COX-2 was expressed in 52.5% of the patients. High-grade tumors revealed a higher (87.5%) COX-2 expression versus other grades of the lesions and there was a statistically significant difference in COX-2 expression between them (P<0.001). Patients' age was also related to the expression of this marker (P=0.03). In contrast, this marker did not correlate with other characteristics including gender, lymphatic invasion or tumor stage. In addition, perineurial or vascular invasions were not detected in any of the patients.
Conclusion: COX-2 expression was seen in more than half of our patients and it had a marked relation to tumor differentiation. Accordingly, this molecule may be a useful tumor marker in the assessment of urinary bladder cancers.
Roghayeh Teimourpour , Zahra Meshkat , Mohsen Arzanlou , Hadi Peeridogaheh , Aida Gholoobi ,
Volume 74, Issue 10 (1-2017)
Abstract
Background: Despite advances in the vaccinology and chemotherapy in the past century, tuberculosis is still responsible for two million deaths every year. Emergence of multi-drug resistant strain and coinfection of TB-HIV make it a serious concern. Treatment and control of tuberculosis is a great health burden in every community. Active tuberculosis in children has very severe consequences especially those who are under 5-years-old, therefore vaccine indication should be taken. Bacille Calmette-Guérin (BCG) is a live attenuated strain of Mycobacterium bovis that has been used for providing immunity or protection against tuberculosis (TB). In addition, BCG provides relative protection against leprosy and Buruli ulcer, it also can be used for treatment of bladder cancer. BCG is the most widely administered vaccine around the world. It has been given to over three billion individuals over the past decades. At first it was developed in 1908 at the Pasteur Institute in Lille by Albert Calmette and Camille Guérin. In fact BCG is a strain of Mycobacterium bovis that bear deletion in its genome following too long subculture in special media. Deletion in region of deletion 1 (RD1), a specific region of Mycobacterium bovis genome, has decreased pathogenicity of BCG strain. Following culture of BCG on different media since 1921 make genetic variation in the BCG strains that have specific characteristics. BCG should begin given to only immune-competent individuals and should not be administered to immunocompromised people. This vaccine is not effective in people formerly infected or sensitized with environmental mycobacteria. Previous meta-analysis studies indicate that BCG has variable range of protection from 0 to 80 percent against pulmonary TB, but is very effective against severe disseminated forms such as meningitis and miliary form of TB. Despite many research and develop new generation vaccine against TB, BCG vaccine still remains as the only effective vaccine because many efforts to replace it with better ones were unsuccessful.
Hamid Mazdak , Zahra Tolou-Ghamari , Mehdi Gholumpour ,
Volume 77, Issue 4 (7-2019)
Abstract
Background: Due to the incidence and recurrence of bladder cancer (BC), it could be categorized as a clinical and social problem that often occurs at an advanced age. This study was designed to determine the incidence of BC in Isfahan, Iran.
Methods: A retrospective descriptive survey of information based on bladder cancer (ICD-O, third edition; C67) was obtained from the Isfahan Deputy of Health. The study was in conducted to the department of Urology and Kidney Transplantation Research Center and approved by the University Ethics Committee. The Isfahan Cancer Program is intended to record all cancer cases in the Isfahan. From 20 March 2016 to 19 March 2017, records with linkage to using of pathology, demographic and clinical information were recorded in Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA) and analyzed by SPSS statistical software, version 22 (IBM, Armonk, NY, USA). The incidence rates (Irs) were calculated by dividing new cases of BC during the year of study to the population at risk during the same time period×100000.
Results: A total of 417 patients that corresponded to Irs of 8 per 100000 persons were studied. The overall recorded number was comprised of 361 males (IRs of 13.9 per 100000) and 56 females (Irs of 2.2 per 100000). The mean±SD age of patients was 64.7±13 years. The minimum age in males versus females was 12 versus 25 years old respectively. Age in the most patients (80% of cases) was more than 50 years old. The invasion of the muscle was recorded in 44% of cases. Geographical distribution in 65% of cases was related to Isfahan City as a place of birth-residence and in the next categories were Khomeinishahr (7.6%), Najafabad (6.8%), Lenjan (4.5%), Mobarekeh (3.7%) and Felavarjan (2.8%) respectively.
Conclusion: Comparison of BC incidence rate between the year 2014 and 2016 showed that incidence rates decreased by 18.2%. In the 44%, invasive neoplasm of BC was recorded for the population studied. The highest frequency of BC was associated with Isfahan City and then Khomeinshahr, Najaf abad, Lenjan, Mobarakeh and Falavarjan.
Hamid Arshadi, Pooya Hekmati, Hojatollah Raji, Mohammad Vasei , Mehrzad Mehdizadeh,
Volume 80, Issue 1 (4-2022)
Abstract
Background: Appendicovesical fistula in patients suffering from cystic fibrosis is a rare condition. Although this situation is so rare it should be considered in the differential diagnosis, dealing with a patient with cystic fibrosis and chronic abdominal pain with no response to primary management. To the best of our knowledge, this is the third case of appendicovesical fistula in a patient with cystic fibrosis.
Case presentation: In this paper, we are reporting a bladder lesion of a nine-year-old Iranian girl, a known case of cystic fibrosis, who was referred to pediatric urology clinic, Children’s Medical Center, Tehran University of Medical Sciences. The girl is a known case of cystic fibrosis on regular follow-up who had chronic abdominal pain for about one year. While primary management had been failed for her, further workups were done by her pediatric pulmonologist. In her pelvic sonography, the radiologist reported a bladder lesion so she was referred to our clinic. Cystoscopy was done for her, but transurethral biopsy/resection was impossible according to the lesion location. The non-papillary nature of the lesion raised our concern about the possibility of genital rhabdomyosarcoma with bladder invasion. So, an Abdominopelvic CT scan and a pelvic MRI were also done for her. Intact uterus and vagina with an enhancing lesion at the dome of the bladder with some degree of inflammation/attachment around the adjacent GI tract were detected on her images. The urachal inflammatory/tumoral process could not be ruled out. So open surgical exploration was planned. During the attempt for surgical exploration and partial cystectomy, at the Children’s Medical Center in December 2021, we found that the mass, is actually her appendix which has invaded the urinary bladder, and presented as a bladder lesion.
Conclusion: Abdominal pain is a relatively common complaint of patients with cystic fibrosis. Every caregiver or physician should consider rare conditions, dealing with a cystic fibrosis patient whose abdominal pain does not respond to common management.
Solmaz Ohadian Moghadam , , Mohsen Ayati, Erfan Amini , Faeze Salahshour, Mohsen Shiraghaei ,
Volume 82, Issue 5 (8-2024)
Abstract
Background: Sarcopenia is the degenerative loss of skeletal muscle mass, which is known as a poor postoperative outcome in various cancer types. Radical cystectomy (RC) is often associated with high mortality rates, and sarcopenia is hypothesized to aid in risk stratification. Hence, this study assessed the role of Sarcopenia as an indicator of postoperative outcomes and survival rates in patients undergoing RC for bladder cancer.
Methods: This cross-sectional research was carried out between January 2022 and January 2023 on 30 patients with bladder cancer who were candidates for RC and referred to the urology clinic of Imam Khomeini Hospital in Tehran. One week before surgery, the cross-sectional area of the psoas muscle was measured using MRI to estimate muscle volume, and the sarcopenia index was calculated. Muscle area evaluation was performed by calculating the cross-sectional area of the left and right psoas muscles on MRI. The psoas muscle area was calculated by excluding blood vessels, bony structures, and intermuscular fat regions based on fat signals. The calculated psoas muscle area was then normalized to the patient's height in square meters. To improve the quality of reporting on surgical complications, the patients were re-examined and the duration of patients' hospital stays was measured.
Results: The mean sarcopenic index for the patients was 1264.6 ± 591.5 mm²/m². Seven patients (24.1%) were smokers, while 22 patients (75.9%) were non-smokers. During the 10-month follow-up period, 25 patients (83.3%) remained alive, and 5 patients (16.7%) passed away. The mean value of sarcopenic index in patients with localized cancer was higher than those with advanced cancer, but this difference was not statistically significant. Data analysis revealed a significant association between higher mortality rates and the presence of locally advanced bladder tumors (P = 0.046). Additionally, a reduced sarcopenic index in this study was significantly correlated with lymphovascular invasion. In this study, no correlation was found between perioperative complications and sarcopenic index.
Conclusion: To conclude, a significant association was observed between a reduction in the sarcopenic index and lymphovascular invasion; however, no connection was identified between mortality rates and postoperative complications following RC.
