Honghai Lu

Clinical character of cystitis glandularis accompanied with upper urinary tract obstruction

OBJECTIVE We explore the clinical character of cystitis glandularis accompanied with upper urinary tract obstruction. METHODS We compared 70 cases of cystitis glandularis accompanied with upper urinary tract obstruction with 60 cases of cystitis glandularis without upper urinary tract obstruction. The difference of clinical manifestation and surgical efficacy was observed between the 2 groups. RESULTS The incidence of cystitis glandularis in women was higher than in men and the age of patients with cystitis glandularis and upper urinary tract obstruction was younger than the age of patients without upper urinary tract obstruction. The main symptom of cystitis glandularis accompanied with upper urinary tract obstruction were renal colic and abdominal pain; a few patients with a shorter course of the disease also had nausea, vomiting, frequency, urgency, dysuria, hematuria and fever. The distribution and morphological characteristics of lesions on the bladder and in the urine culture were not different between the 2 groups. There was no second operation on patients with upper urinary tract obstruction, but at least a second operation was performed on 9.3% patients without upper urinary tract obstruction. CONCLUSIONS In patients with upper urinary tract obstruction, we found that it was the main clinical symptom of their cystitis glandularis. Identifying and removing the causes of upper urinary tract obstruction is the most important management method. For the cystitis glandularis, active treatment or close follow-up should be made.

Clinical Investigation on the Relationship between Upper Urinary Tract Obstruction and the Accompanied Chronic Cystitis

Objective: To explore the relationship between upper urinary tract obstruction and the accompanied chronic cystitis. Patients and Methods: The prospective study was carried out in 350 patients with upper urinary tract obstruction. They were inspected by urinary bacterial culture, cystoscopy and ureteroscopcy. Results: In 350 cases of upper urinary tract obstruction, 75 (21.45%) cases were accompanied with visible chronic cystitis. Fifty-one (20.08%) cases were accompanied with chronic cystitis in 254 cases of upper urinary tract obstruction induced by renal and ureteral stone, and 24 (25.00%) cases were accompanied with chronic cystitis in 96 cases by other factors (p > 0.05). Fifty-eight of 350 (16.57%) cases were chronic nonbacterial cystitis in 75 cases of chronic cystitis. Among them, 38 (10.86%) cases were cystitis glandularis, 11 (3.14%) cases were vesical leukoplakia and 9 (2.57%) cases were chronic hyperplastic cystitis. Six (10.34%) cases were positive urine culture in 58 cases of accompanied chronic nonbacterial cystitis in upper urinary tract obstruction, and 27 (9.82%) cases were positive urine culture in 275 cases without cystitis, as compared between 2 groups (p > 0.05). Following up to 16 cases of accompanied chronic non-bacterial cystitis in upper urinary tract obstruction, the clinic symptom and suspicious inflammation foci on the bladder in 10 cases was disappeared, but that in 6 cases remained visible and needed further management. Conclusion: It is suggested that there would be an association of upper urinary tract obstruction with the accompanied chronic cystitis, and long-term upper urinary tract obstruction could induce chronic nonbacterial cystitis. The pathogenesis should be further studied.

Living status in patients over 85 years of age after TUVRP

Abstract Introduction: To evaluate surgical risk and post-operative quality of living status in patients over 85 years of age after transurethral vaporization resection of the prostate (TUVRP). Methods: Sixty patients over 85 years of age underwent TUVRP were compared with 228 patients less than the age of 80 years. Group A was 60 patients greater than 85 years of age, Group B was 137 patients from 71 to 79 years of age, and Group C was 91 patients from 60 to 70 years of age. Results: In Group A, pre-operative ASA grade was higher than the other two groups, compared with Group C, p < 0.01. Operating time was 40.03 ± 18.90 min, compared in the three groups, p > 0.05. Follow-up was obtained in 49 (81.67%) patients; of them 10 patients were deaths with a survival time of 22.90 ± 11.14 months. In the 39 survivors, post-operative IPSS score was 11.17 ± 6.9, compared with Group B, p > 0.05 and Group C, p < 0.01. Quality of Life (QOL) index was 1.11 ± 0.80, compared with Group B, p < 0.001 and Group C, p < 0.01. Barthel Index score in 16 patients was >60 and the score was 82.81 ± 8.56 pre-operatively. The patients with >60 were increased to 19 cases and the score was improved to 90.93 ± 7.58 (p < 0.001) in follow-up. Conclusion: Surgical risk in patients over 85 years of age was higher than patients less than the age of 80 years. A safety TUVRP could improve their voiding function and activities of daily living.

Effect of ageing on the efficacy efficiency of TUVRP

Introduction: To evaluate the effect of ageing on the efficacy of transurethral vaporization resection of the prostate (TUVRP). Methods: The clinical outcomes of 285 patients treated by TUVRP were retrospectively analyzed. Patients were divided into three groups by age, Group A with 91 patients less than ≤70 years of age, Group B with 127 patients from 71 to 79 years of age, and Group C with 67 patients greater than ≥80 years of age. Results: Prostate volume was 53.1 ± 24.1 ml in Group A, 67.8 ± 39.7 ml in Group B and 60.0 ± 43.9 ml in Group C (p < 0.001). More co-existent systemic diseases were identified in Group C than in the other two groups (p < 0.001). American Society of Anesthesiologists (ASA) grade increased with age (p < 0.001). Urological comorbidities associated with BPH, operating time, IPSS score, and QOL index were not different among the three groups. A significant difference was observed in before and after surgery IPSS score, QOL index, and maximum urinary flow rate (Qmax), in all three groups (p < 0.05). Post-operative Qmax decreased with age (p < 0.05). Conclusion: TUVRP was safe and effective for the patients greater than 80 years of age, similarly to younger patients. Advanced aged was not a contraindication for surgery, and did not increase the difficulty of the procedure.

Transurethral holmium laser vaporization to the urethral tumour through a ureteroscope

We present 2 cases of urethral cancers: one is recurrent bladder transitional cell carcinoma accompanied by urethral metastatic carcinoma located on the right side of verumontanum, and the other is primary bladder and metastatic urethral adenocarcinoma. The urethral tumour was treated by transurethral holmium laser vaporization to the urethral tumour through a ureteroscope and the bladder tumour was treated with transurethral resection and degeneration of the bladder tumour (TURD-Bt). After the second or third therapy, patients were free of urethral or bladder tumour recurrence; they also did not experience urethral stricture or urinary incontinence during the 24- to 36-month follow-up. Transurethral holmium laser vaporization and TURD-Bt could be performed to treat non-invasive urethral cancer accompanied with bladder cancer and preserve the urethra and bladder.

Pathological feature and immunoprofile of cystitis glandularis accompanied with upper urinary tract obstruction.

Objective. To explore the pathological feature and immunoprofile of immunoprofile accompanied with upper urinary tract obstruction and the immunoprofile in various types of glandular cystitis. Methods. Pathological sections from 31 cases of cystitis glandularis with upper urinary tract obstruction and 34 cases of cystitis glandularis without upper urinary tract obstruction were observed as pathological feature on microscopy. Meanwhile, an immunohistochemical analysis was employed to determine the expression of p53, Ki67, p21, MMP-9, MUC1, MUC2, and COX-2. Results. In the two groups, main pathological type was transitional epithelial, followed by intestinal epithelial; other types were a few, and the difference between the two groups was not significant. All immunohistochemical expressions of p53, Ki67, p21, MMP-9, MUC1, MUC2, and COX-2 were positive in varying degrees, and there was no significant difference between the groups. Transitional epithelial type was compared with mixed type; the difference of COX-2 was significant, P < 0.05. The differences of immunohistochemical expression among other different pathologic types were not significant. Conclusions. It is suggested that glandular cystitis accompanied with upper urinary tract obstruction shares the same pathological feature and immunoprofile as that without upper urinary tract obstruction. No significant differences of immunohistochemical expression in tissue are in cystitis glandularis with different pathological types.

Transurethral resection and degeneration of bladder tumour

INTRODUCTION We evaluate the efficacy and safety of transurethral resection and degeneration of bladder tumour (TURD-Bt). METHODS In total, 56 patients with bladder tumour were treated by TURD-Bt. The results in these patients were compared with 32 patients treated by current transurethral resection of bladder tumour (TUR-Bt). Patients with or without disease progressive factors were respectively compared between the 2 groups. The factors included recurrent tumour, multiple tumours, tumour ≥3 cm in diameter, clinical stage T2, histological grade 3, adenocarcinoma, and ureteral obstruction or hydronephrosis. RESULTS Follow-up time was 48.55 ± 23.74 months in TURD-Bt group and 56.28 ± 17.61 months in the TUR-Bt group (p > 0.05). In patients without progressive factors, no tumour recurrence was found and overall survival was 14 (100%) in the TURD-Bt group; 3 (37.50%) patients had recurrence and overall survival was 5 (62.5%) in the TUR-Bt group. In patients with progressive factors, 8 (19.05%) patients had tumour recurrence, overall survival was 32 (76.19%) and cancer death was 3 (7.14%) in TURD-Bt group; 18 (75.00%) patients had tumour recurrence (p < 0.05), overall survival was 12 (50.00%) (p < 0.01) and cancer death was 8 (33.33%) (p < 0.05) in TUR-Bt group. No significant complication was found in TURD-Bt group. CONCLUSION This study suggests that complete resection and degeneration of bladder tumour can be expected by TURD-Bt. The surgical procedure is safe and efficacious, and could be predictable and controllable before and during surgery. We would conclude that for bladder cancers without lymph node metastasis and distal metastasis, TURD-Bt could be performed to replace radical TUR-Bt and preserve the bladder.

UP-1.011: Clinical Investigation on the Relationship Between Upper Urinary Tract Obstruction and the Accompanied Chronic Cystitis

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