Siobhan Woolsey

Morphological expression of KIT positive interstitial cells of Cajal in human bladder.

Purpose We investigated the 3-dimensional morphological arrangement of KIT positive interstitial cells of Cajal in the human bladder and explored their structural interactions with neighboring cells. Materials and Methods Human bladder biopsy samples were prepared for immunohistochemistry/confocal or transmission electron microscopy. Results Whole mount, flat sheet preparations labeled with anti-KIT (Merck, Darmstadt, Germany) contained several immunopositive interstitial cell of Cajal populations. A network of stellate interstitial cells of Cajal in the lamina propria made structural connections with a cholinergic nerve plexus. Vimentin positive cells of several morphologies were present in the lamina propria, presumably including fibroblasts, interstitial cells of Cajal and other cells of mesenchymal origin. Microvessels were abundant in this region and branched, elongated KIT positive interstitial cells of Cajal were found discretely along the vessel axis with each perivascular interstitial cell of Cajal associated with at least 6 vascular smooth muscle cells. Detrusor interstitial cells of Cajal were spindle-shaped, branched cells tracking the smooth muscle bundles, closely associated with smooth muscle cells and vesicular acetylcholine transferase nerves. Rounded, nonbranched KIT positive cells were more numerous in the lamina propria than in the detrusor and were immunopositive for anti-mast cell tryptase. Transmission electron microscopy revealed cells with the ultrastructural characteristics of interstitial cells of Cajal throughout the human bladder wall. Conclusions The human bladder contains a network of KIT positive interstitial cells of Cajal in the lamina propria, which make frequent connections with a cholinergic nerve plexus. Novel perivascular interstitial cells of Cajal were discovered close to vascular smooth muscle cells, suggesting interstitial cells of Cajal-vascular coupling in the bladder. KIT positive detrusor interstitial cells of Cajal tracked smooth muscle bundles and were associated with nerves, perhaps showing a functional tri-unit controlling bladder contractility.

Urethral stents for detrusor sphincter dyssynergia

failure to fully eliminate residual urine, the potential for significant haemorrhage and the need to repeat the procedure in up to 25% of patients [2]. Patients are also reliant upon condom-catheter drainage and less than half of patients continue with this drainage method in the long term. An alternative, less-invasive method is sphincter ablation by direct injection of Botulinum toxin. This provides only temporary relief, and repeat injections are necessary every couple of months. Balloon dilatation is another alternative, but this is restricted by recurrent obstruction and excessive bleeding [3].

Intra‐testicular varicocele presenting as acute scrotum

The term varicocele describes a dilated, tortuous and elongated pampiniform plexus of veins, which is well known in relation to the spermatic cord. Recently varicocele has also been observed inside the testis, and this new entity is known as intra‐testicular varicocele. We present a case of intra‐testicular varicocele presenting as acute scrotum and discuss the management issues.

Squamous cell carcinoma and transitional cell carcinoma arising in bladder augmentations.

Tumours arising in bowel-augmented bladders are rare. Usually these tumours are adenocarcinomas that occur along the anastomotic line. We present two unusual tumours, squamous cell carcinoma and transitional cell carcinoma, that occurred in bladder augmentations. We also emphasize the need for regular cystoscopic surveillance.

The incidence and outcome of abnormal prostatic specific antigen in patients referred to a LUTS clinic

ConclusionsApproximately one in three patients being referred to a LUTS clinic have a raised PSA level. The incidence of prostate cancer in asymptomatic males under 70 years has been reported at 3.3%. Our data suggest that the incidence of prostate cancer in such patients is higher if they have LUTS. This may have significant implications for screening programmes and further studies are needed to clarify this issue.

Prospective, randomised, placebo-controlled trial of peri-prostatic local anaesthetic in transrectal prostate biopsy

ConclusionPeri-prostatic local anaesthetic with 1% lignocaine reduces discomfort significantly during TRUS biopsy and we recommend it should be used routinely.