Botulinum Toxin A for Bladder Pain Syndrome/Interstitial Cystitis

Botulinum neurotoxin A (BoNT-A), derived from Clostridium botulinum, has been used clinically for several diseases or syndrome including chronic migraine, spasticity, focal dystonia and other neuropathic pain. Chronic pelvic or bladder pain is the one of the core symptoms of bladder pain syndrome/interstitial cystitis (BPS/IC). However, in the field of urology, chronic bladder or pelvic pain is often difficult to eradicate by oral medications or bladder instillation therapy. We are looking for new treatment modality to improve bladder pain or associated urinary symptoms such as frequency and urgency for patients with BPS/IC. Recent studies investigating the mechanism of the antinociceptive effects of BoNT A suggest that it can inhibit the release of peripheral neurotransmitters and inflammatory mediators from sensory nerves. In this review, we will examine the evidence supporting the use of BoNTs in bladder pain from basic science models and review the clinical studies on therapeutic applications of BoNT for BPS/IC

Clinical Study Oncologic Outcomes of Asian Men with Clinically Localized Prostate Cancer after Extraperitoneal Laparoscopic Radical Prostatectomy: A Single-Institution Experience

properly cited. Purpose. To evaluate the midterm oncologic results of extraperitoneal laparoscopic radical prostatectomy (EPLRP) for Asian men with localized prostate cancer. Methods. Between 2004 and 2009, 218 men underwent EPLRP at an Asian tertiary hospital. The mean preoperative prostate-specific antigen (PSA) was 15.5 ng/ml and mean Gleason score was 6.6. Stage distributions were cT1a-b in 21 cases, cT1c in 139, cT2 in 48 and cT3 in 10. Disease recurrence was defined as PSA ≥ 0.2 ng/mL in 2 consecutive measurements or initiation of secondary therapy. Results. Postoperative pathological stage was pT2a-b in 33 patients, pT2cN0 in 10, pT3a in 27, pT3b in 36, pT4 in 9 and pN1 in 10. Positive surgical margins occurred in 14.6% and 48.6% for pT2 and pT3 diseases, respectively (P < .001). The overall PSA recurrence-free survival at 3 and 5 years was 82.1% and 74.5%. By the pathological stages, 3-year recurrence-free survival was 92.4% (pT2), 81.1% (pT3a), 62.6% (pT3b-4) and 55.6% (pN1), respectively (P < .001). Conclusions. EPLRP is curative even for some locally advanced prostate cancers in a midterm follow-up. Even at an Asian center of low volume of radical prostatectomy EPLRP still provides oncologic outcomes similar to that of high volume centers

針對各種膀胱病變之腹腔鏡部份膀胱切除術

To present our initial experience with laparoscopic partial cystectomy ( LPC) in selected patients with various bladder pathologies. Between December 2004 and April 2006, four patients had LPC at our centre (mean age 52 years, range 35- 70); the transperitoneal approach was used for three and a pre-peritoneal approach for one. The surgical procedures used sequentially included transurethral incision around the lesion, laparoscopic excision of the lesion (partial cystectomy) and intracorporeal suturing. Laparoscopic pelvic lymphadenectomy was also used for the two patients with malignancy. All operations proceeded smoothly; the bladder pathologies included one bladder endometriosis, one bladder leiomyoma, one urothelial carcinoma within the bladder diverticulum and one urachal adenocarcinoma. The mean (range ) operative duration was 197.5 (120-300) min, the estimated blood loss 70 (50-100) mL, the hospital stay 6.75 (5-9) days , and duration of Foley catheterization 7.25 (6-9) days. No open conversion was required and no patient had peri- operative complications. The surgical margins were free of cancer and the dissected lymph nodes were negative in those two patients with bladder malignancy. LPC is safe and feasible in selected patients with various bladder pathologies

Osteoblast-derived WISP-1 increases VCAM-1 expression and enhances prostate cancer metastasis by down-regulating miR-126

Bone metastases of prostate cancer (PCa) may cause intractable pain. Wnt-induced secreted protein-1 (WISP-1) belongs to the CCN family (CTGF/CYR61/NOV) that plays a key role in bone formation. We found that osteoblast-conditioned medium (OBCM) stimulates migration and vascular cell adhesion molecule-1 (VCAM-1) expression in human PCa (PC3 and DU145) cells. Osteoblast transfection with WISP-1 shRNA reduced OBCM-mediated PCa migration and VCAM-1 expression. Stimulation of PCa with OBCM or WISP-1 elevated focal adhesion kinase (FAK) and p38 phosphorylation. Either FAK and p38 inhibitors or siRNA abolished osteoblast-derived WISP-1-induced migration and VCAM-1 expression. Osteoblast-derived WISP-1 inhibited miR-126 expression. Moreover, miR-216 mimic reversed the WISP-1-enhanced migration and VCAM-1 expression. This study suggests that osteoblast-derived WISP-1 promotes migration and VCAM-1 expression in human PCa cells by down-regulating miR-126 expression via av beta 1 integrin, FAK, and p38 signaling pathways. Thus, WISP-1 may be a new molecular therapeutic target in PCa bone metastasis

Intermediate-Term Oncological Outcomes of Hand-Assisted Laparoscopic Versus Open Bilateral Nephroureterectomy for Dialysis and Kidney Transplant Patients with Upper Urinary Tract Urothelial Carcinoma

Purpose: To compare the outcomes of hand-assisted laparoscopic bilateral nephroureterectomy (HALBNU) for dialysis and kidney transplant patients with clinically localized upper urinary tract urothelial carcinoma (UUT-UC ) with those achieved by open bilateral nephroureterectomy ( OBNU). Materials and Methods: Between 1995 and 2006, 49 patients under dialysis or after kidney transplantation underwent simultaneous bilateral nephroureterectomy for clinically presumed localized UUT-UC at our institute. Of those, 33 underwent HALBNU and 16 received conventional open surgery. Perioperative and pathological data and oncological outcomes were collected by chart review. Bladder recurrence, metastasis, and cancer -specific and overall survival were analyzed and compared between both groups. Results: The median follow-up for HALBNU and OBNU group was 35 and 46 months, respectively. Totally, 40 patients were identified to have pathologically confirmed urothelial carcinoma of upper urinary tract. HALBNU group was associated with less blood loss, earlier bowel recovery, less narcotic use, shorter hospital stay, and earlier convalescence. The operative time and complication rate were comparable between the two groups. There was no open conversion in the HALBNU group. The two groups were similar in regard to bladder recurrence rate. The overall, cancer- specific, and bladder-recurrence-free survival were also equivalent between the HALBNU and OBNU group (all p>0.05). Conclusion: In dialysis and kidney transplant patients with localized UUT-UC, simultaneous bilateral nephroureterectomy with hand-assisted laparoscopic approach offered less perioperative morbidity and, most importantly, comparable intermediate-term oncological and survival results when compared with its open counterpart. A longer follow-up is required to demonstrate the oncological efficacy of this minimally invasive procedure

An Alternative Access Technique under Direct Vision for Preperitoneoscopic Pelvic Surgery: Easier for the Beginners

Background: We present an alternative access technique to facilitate preperitoneoscopic (extraperitoneal laparoscopic) approach for radical prostatectomy, herniorrhaphy, and other pelvic procedures. Methods: A 0 degrees telescope was mounted into a Visiport Optical Trocar (Visiport), and via a periumbilical incision it was advanced under direct vision at first vertically through different layers of the anterior abdominal wall. Immediately before the posterior rectus sheath, it was redirected caudally and horizontally toward the symphysis pubis. The Visiport was withdrawn and replaced by a dissection balloon that was inflated for developing the working space, then it was substituted with a 12-mm trocar to begin the pneumo-extraperitoneum. The surgical procedures are detailed in the attached video. Results: This technique was used in 168 of 179 patients undergoing preperitoneoscopic surgery (97 radical prostatectomies, 80 totally extraperitoneal herniorrhaphies, and 2 urinary bladder diverticulectomies). Operative parameters were compared with 11 preceding patients approached with the open Hasson technique. All of the procedures to create the preperitoneoscopic space were successfully with no complications. For radical prostatectomy, there was a significantly faster access to the preperitoneal space (38 + /- 12 vs 540 +/- 69 seconds) and a faster setup of the whole operative space (15 +/- 5 vs 29 +/- 9 minutes, both P < .05 ) with the new technique. Less pericannular CO2 leakage was experienced during the preperitoneoscopy with our technique. Conclusion: This alternative technique offers a simple, safe, quick, and effective access for creating a preperitonescopic working space

High Incidence of Urinary Tract Malignancy among Patients with Haematuria Following Kidney Transplantation in Taiwan

Haematuria is a common complication following kidney transplantation, but few studies describing post-transplant haematuria have been published. Herein, we investigated the incidence and etiologies of persistent hematuria with kidney transplant patients in Taiwan. The medical records of 189 kidney transplant recipients with functioning grafts were retrospectively reviewed. Any episode of haematuria during routine follow- up was recorded and evaluated. The patient characteristics, possible causes of haematuria and consequent managements were reviewed. Among the 189 patients , 44 patients (23.3%) experienced 45 episodes of persistent haematuria during routine monthly follow-up at our transplant clinic. Thirty-two episodes (71%) were microscopic haematuria and 13 (29%) were gross haematuria. The most prevalent etiology explained for the persistent haematuria in our series was urologic malignancy (19 patients, 42.2%), followed by urinary tract infections (24.5 %) and unexplained reasons (17. 8%). Furthermore, those patients with persistent haematuria caused by urologic malignancy were also associated with significantly longer duration following transplantation and worse graft function. Haematuria is frequently seen in kidney transplant recipients and the most prevalent cause in our series is urologic malignancy. Those patients were also associated with significantly poorer graft function; however, the mechanism is still unclear