A glance at imaging bladder cancer.

Purpose: Early and accurate diagnosis of Bladder cancer (BCa) will contribute extensively to the management of the disease. The purpose of this review was to briefly describe the conventional imaging methods and other novel imaging modalities used for early detection of BCa and outline their pros and cons. Methods: Literature search was performed on Pubmed, PMC, and Google scholar for the period of January 2014 to February 2018 and using such words as bladder cancer, bladder tumor, bladder cancer detection, diagnosis and imaging . Results: A total of 81 published papers were retrieved and are included in the review. For patients with hematuria and suspected of BCa, cystoscopy and CT are most commonly recommended. Ultrasonography, MRI, PET/CT using 18F-FDG or 11C-choline and recently PET/MRI using 18F-FDG also play a prominent role in detection of BCa. Conclusion: For initial diagnosis of BCa, cystoscopy is generally performed. However, cystoscopy can not accurately detect carcinoma insitu (CIS) and can not distinguish benign masses from malignant lesions. CT is used in two modes, CT and computed tomographic urography (CTU), both for dignosis and staging of BCa. However, they cannot differentiate T1 and T2 BCa. MRI is performed to diagnose invasive BCa and can differentiate muscle invasive bladder carcinoma (MIBC) from non-muscle invasive bladder carcinoma (NMIBC). However, CT and MRI have low sensitivity for nodal staging. For nodal staging PET/CT is preferred. PET/MRI provides better differentiation of normal and pathologic structures as compared with PET/CT. Nonetheless none of the approaches can address all issues related for the management of BCa. Novel imaging methods that target specific biomarkers, image BCa early and accurately, and stage the disease are warranted

Acute Colonic Diverticulitis: CT Findings, Classifications, and a Proposal of a Structured Reporting Template

Acute colonic diverticulitis (ACD) is the most common complication of diverticular disease and represents an abdominal emergency. It includes a variety of conditions, extending from localized diverticular inflammation to fecal peritonitis, hence the importance of an accurate diagnosis. Contrast-enhanced computed tomography (CE-CT) plays a pivotal role in the diagnosis due to its high sensitivity, specificity, accuracy, and interobserver agreement. In fact, CE-CT allows alternative diagnoses to be excluded, the inflamed diverticulum to be localized, and complications to be identified. Imaging findings have been reviewed, dividing them into bowel and extra-intestinal wall findings. Moreover, CE-CT allows staging of the disease; the most used classifications of ACD severity are Hinchey’s modified and WSES classifications. Differential diagnoses include colon carcinoma, epiploic appendagitis, ischemic colitis, appendicitis, infectious enterocolitis, and inflammatory bowel disease. We propose a structured reporting template to standardize the terminology and improve communication between specialists involved in patient care

Lower Urinary Tract Dysfunction

Lower urinary tract dysfunction (LUTD) is an umbrella diagnosis that covers the abnormalities of anatomy and function in the bladder, urethra, and, in men, the prostate. People with LUTD face a number of social, mental, and physical health effects due to the symptoms. Despite the increasing evidence in the assessment and management of lower urinary tract symptoms, it remains a challenge to bridge the gap between research evidence and clinical practice. In this book, each and every one of the authors presents a remarkable work for how to apply the evidence to clinical practice from different aspects. I hope this book is a key for every reader to open the door to LUTD

Investigating Polymer based Scaffolds for Urinary Bladder Tissue Engineering

Current surgical treatments for urinary bladder disorders rely on the use of autologous intestinal segments and xenografts such as small intestinal submucosa, which suffer from various complications including mechanical mismatch and graft shrinkage. Despite early promises of bladder tissue engineering, a recent report of unsuccessful clinical trials suggests that the technology needs further improvement and evaluation through animal models of bladder dysfunction. Therefore, the objective of this doctoral dissertation was to characterize a viable bladder tissue scaffold (patch) which mimics the mechanical properties of the bladder, maintains the phenotype of the BSMC seeded in it and finally, tested in vivo in a dysfunctional bladder model to evaluate its true efficacy. In pursuit of this goal, firstly we explored the use of composite hydrogel blends composed of Tetronic (BASF) 1107-acrylate in combination with extracellular matrix (ECM) moieties collagen and hyaluronic acid seeded with bladder smooth muscle cells (BSMC). The results of in vitro experiments demonstrated that the composite hydrogel system provided an environment for bladder smooth muscle cells to adhere, migrate and secrete ECM, thereby increasing the construct\u27s overall strength and stiffness. However, the mechanical properties of our cell-seeded composite hydrogels were limited after two weeks of culture and hence, we characterized various biodegradable elastomers as scaffolds for bladder tissue engineering. Our studies indicated that poly (carbonate urethane) urea (PCUU) scaffolds exhibit relatively high compliance under low forces and are able to withstand stress corresponding to super physiological peak stress experienced by urinary bladders in vivo and thus, possess the strength and stiffness necessary to be used as a urinary bladder tissue engineering scaffold. Finally, we attempted at implanting the PCUU scaffolds onto a bladder outlet obstruction (BOO) rat model to create a clinically informative study. The PCUU augmentation led to the enhanced survival of the rats and increased bladder capacity and voiding volume with time, indicating that the high-pressure bladder symptom was alleviated. The histological analysis of the explanted scaffold indicated smooth muscle cell and connective tissue infiltration. The knowledge gained in the present study will work towards future improvement of bladder tissue engineering technology to ultimately aide in the treatment of bladder disorders

Development of a pad test to assess stress urinary incontinence in young healthy women: a pilot study

Purpose: Current literature reports that between 7 and 14% of young, healthy women have stress urinary incontinence (SUI). No gold standard exists for quantifying urine leakage, although pad tests have been used in older, parous populations. The aim of this study was to determine the reliability and accuracy of a new pad test for young, healthy women with SUI. Methods: The pad test consisted of measuring quantity of leakage after the following activities: stair running, standing up from sitting, curl-ups, running on the spot, jumping jacks, jumping on a mini-trampoline and coughing vigorously. Bladder volume was standardised by having the volunteers drink one litre of water one hour prior to the testing. The volunteers performed the pad test on two consecutive days. Results: Sixteen nulliparous women between the ages of 18 and 30 years (7 controls and 9 with SUI) participated in this study. The mean increase in pad weight was 0.64 g (± 0.50) in the continent group and 11.89 g (± 20.32) in the group with SUI. There was no significant difference in pad weight between the testing sessions (p=0.228), however the test was not able to elicit measureable urine loss in 3 participants with SUI. Pad weights between the two groups of women were significantly different (p=0.023). The test re-test ICC for the continent group was 0.845 (95% CI: 0.139–0.973) and 0.782 (95% CI: -0.040–0.952) for the group with SUI. Significance: The results of this study support the use of this pad test in healthy young women with SUI; it appears to be reliable and challenging enough to cause measureable urine loss in the majority, and it may be useful for diagnosing and quantifying SUI without urodynamic studies