Lynn W. Blunt

Tumor Necrosis Factor Promotes Differential Trafficking of Bladder Mast Cells in Neurogenic Cystitis

PURPOSE IC is often considered neurogenic cystitis, in which mast cells are involved in a positive feedback loop that results in sustained urothelial inflammation. To characterize these processes we developed a murine model of neurogenic cystitis using Barthas strain of PRV based on a similar model in the rat. MATERIALS AND METHODS Female C57BL/6 mice (National Cancer Institute, Bethesda, Maryland) were used in the study. Neurogenic cystitis was induced by the injection of Barthas strain of PRV (2.2 x 10 pfu) into the abductor caudalis dorsalis tail base muscle. Bladder inflammation was assessed by leukocyte influx and Evans blue dye extravasation. Mast cells were visualized in bladder tissue by staining with 0.1% toluidine blue. RESULTS Inoculation with PRV in the abductor caudalis dorsalis resulted in cystitis within 3 days. Coincident with the induction of cystitis mast cells accumulated in the lamina propria due to mast cell trafficking from the proximal detrusor (relative to the lumen), whereas mast cells from the distal detrusor were unchanged and total mast cell counts were not increased. Degranulated mast cells increased approximately 20-fold in the lamina propria of infected mice relative to controls. In TNF receptor 1/2 deficient mice (Jackson Laboratory, Bar Harbor, Maine) mast cell trafficking was not observed in response to PRV and mast cells were not degranulated. CONCLUSIONS These data indicate that neurogenic cystitis is associated with the differential trafficking and activation of distinct mast cell pools in the bladder. Since TNF mediates these events, anti-TNF therapy may mitigate the pathogenesis of neurogenic cystitis.

Safety and efficacy of 12-mm radial dilating ports for laparoscopic access

obturator is removed and its depth adjusted under laparoscopic vision. The dilated fascia and crossed-hatch mesh sheath provide a gas-tight fascial seal, and enable stability and minimize slipping in the fascia. We have found stay sutures to be unnecessary. Additional ports may be placed using the same technique under direct laparoscopic vision. At the end of the procedure, the ports are simply removed and the skin closed, as no fascial sutures are used.

Prone positioning for bulbar urethral reconstruction

Exaggerated lithotomy is a surgical position associated with significant morbidity. We describe the use of the prone position for bulbar urethral reconstruction in a selected patient. We propose modified prone positioning as an alternative to exaggerated lithotomy for select patients undergoing reconstruction of the bulbar urethra.