Effect of Chinese Medicine on the Biological Behavior and Magnetic Resonance Imaging of Bladder Cancer

Objective. This study aimed to investigate the effects of traditional Chinese medicine (TCM) on biological behavior and magnetic resonance imaging and recurrence rate of patients with bladder cancer. Method. Forty-seven postoperative bladder cancer patients treated in our hospital who met the criteria were selected and randomly divided into the TCM treatment group (observation group) and the group without TCM treatment (control group). In the TCM treatment group, the prescription was slightly adjusted according to the different symptoms, and the main prescription remained unchanged. According to the treatment plan, patients continued to undergo bladder irrigation chemotherapy plus TCM treatment, while the control group was only treated with bladder irrigation chemotherapy. The number of patients with recurrence at 3 and 6 months and 1 year, the effects on patients’ clinical symptoms, and quality of life were observed, respectively. The changes in MRI images, blood routine, immune function, and leukocyte level and other related indexes before and after treatment were compared between the two groups. Results. After the patients in the observation group were treated with traditional Chinese medicine, the patients’ quality of life significantly improved. The patients’ CD3+, CD4+, and CD4+/CD8+ indexes were significantly higher than those of the control group. The levels of Hb and PLT of the patients in the observation group were significantly lower than those of the patients in the control group. Patients in the observation group had higher leukocyte levels and a lower recurrence rate than patients in the control group. Conclusion. TCM with chemotherapy drugs can effectively improve patients’ immune function, increase the level of T-lymphocyte subpopulation, and improve bone marrow hematopoietic function, which has a significant effect on the prevention and treatment of bladder cancer recurrence after surgery.

Therapeutic Effect Analysis of Plasma Bipolar Intelligent Electrotonic for Cystostomy in the Treatment of Senile Prostatic Hyperplasia

To solve prostatic hyperplasia in the elderly, a method of cystostomy with plasma bipolar resection was proposed. From January 2019 to March 2020, 42 patients with BPH who needed surgical treatment in the urological department were selected. Cystostomy was performed in bipolar TURP. The cystostomy group and robot group were divided into two groups. The surgical safety, surgical efficiency, complications, and nursing time between the two groups were compared. The results showed that the experimental and control groups’ RUV values were significantly lower than those before surgery. In comparison, the Qmax value was considerably higher than that before surgery. The difference was statistically significant ( P < 0.05 ), suggesting that the cystostomy group in bipolar TURP had more substantial improvement of dysuria, better recovery of detrusor function, and better prognosis. It was proved that, for BPH below 80 g, cystostomy could reduce the operation time, bladder irrigation time, catheter indwelling time, and postoperative hospital stay, improve the operation efficiency, and have the same effect on patients’ symptoms improvement, more excellent psychological support, and higher quality of life score. It is proved that plasma bipolar resection combined with cystostomy can effectively improve annual BPH surgery.

1498 A Ten-Year Observational Study of The Use of Two-Way Catheters Post-Transurethral Resection of The Prostate Without the Use of Post-Op Irrigation

Over 15,000 transurethral resections of the prostate (TURP) are performed yearly in the UK. It is therefore vital that peri-operative care is optimised. Our centre favours the use of two-way catheters post-operatively without continuous bladder irrigation (CBI). Aim To evaluate our practice of using two-way catheters without irrigation post-TURP and to determine impact on patient care compared to standard three-way catheterization. Our primary outcome was duration of admission, but multiple secondary outcomes were also analysed. Method This was a prospective observational study. Every patient undergoing TURP at our centre from 2009 to 2019 was included. Prospective patient data were collected pertaining to peri-operative factors. This data was then compared with data published in the NICE guidance pertaining to TURP. Results 687 patients underwent TURP at our centre between 2009-2019. The average age of patients was 71.42 (±7.89). 87.17% (n = 598) had two-way catheters placed post-operatively. Average duration of admission was 1.61 (±1.35) days. TWOC was successful in 93.74% (n = 644). Complication rate was 8.73% (n = 60), reduced in comparison to other units. Furthermore, when compared to other centres, our method reduced lengths of admission and transfusion rates (1.6 days vs. 3.1 days and 0.87% vs. 2.83% respectively). Conclusions Our method preserves patient safety and is associated with reduced length of admission. It also has cost-saving benefits and a reduced post-operative period of catheterisation. We recommend this practice to the wider urological community.

Safe Hb Concentration Measurement during Bladder Irrigation Using Artificial Intelligence

We have developed a sensor for monitoring the hemoglobin (Hb) concentration in the effluent of a continuous bladder irrigation. The Hb concentration measurement is based on light absorption within a fixed measuring distance. The light frequency used is selected so that both arterial and venous Hb are equally detected. The sensor allows the measurement of the Hb concentration up to a maximum value of 3.2 g/dL (equivalent to ≈20% blood concentration). Since bubble formation in the outflow tract cannot be avoided with current irrigation systems, a neural network is implemented that can robustly detect air bubbles within the measurement section. The network considers both optical and temporal features and is able to effectively safeguard the measurement process. The sensor supports the use of different irrigants (salt and electrolyte-free solutions) as well as measurement through glass shielding. The sensor can be used in a non-invasive way with current irrigation systems. The sensor is positively tested in a clinical study.

A Complex Case of Emphysematous Cystitis in a Peritoneal Dialysis Patient

Emphysematous cystitis (EC) is a relatively rare condition characterized by gas formation in the bladder wall and/or lumen. We report a case of emphysematous cystitis with a bladder perforation in an 84-year-old male on peritoneal dialysis who presented with fever, dysuria, hematuria, and hypotension. Gas in the bladder wall, as well as a small perforation in the roof of the urinary bladder, was seen on the abdominal CT scan. The causative organism identified was Escherichia coli. The patient recovered with broad-spectrum antibiotics along with bladder irrigation and drainage. After initial bladder washouts, peritoneal dialysis was continued with close monitoring. Early antibiotic therapy and a conservative approach to the management of small intraperitoneal bladder perforations were effective in this patient. Peritoneal dialysis was uninterrupted for the duration of the admission and after discharge.

Efficacy and safety of intravesical fibrin glue instillation for management of patients with refractory hemorrhagic cystitis: 12-months results. A promising therapy for hemorrhagic cystitis

Objectives: Fibrin glue (FG) endo-vesical application seems to be a promising therapy for hemorrhagic cystitis (HC). We aimed to evaluate efficacy and safety of FG instillation in patients with HC. Methods: Patients with HC not responsive to conventional treatments (bladder irrigation, catheterization, blood transfusions, hyperhydration and endoscopic coagulation) were treated with FG endo-vesical instillation (April 2017- December 2018). FG was prepared from 120 mL of patient blood with the Vivostat® system. After standard cystoscopy, bladder was insufflated with carbon dioxide (CO2) according to bladder compliance and autologous FG was applied to bladder wall and bleeding sites. Results: Ten patients included with grade 2 or higher HC secondary to bone marrow graft for hematological diseases (30%) or to actinic cystitis caused by prostate cancer radiotherapy (RT) (70%). The median HC onset time after RT was 4.8 (IQR 3.9- 6.3) years and 35 (IQR 27.5-62.5) days after hematopoietic stem cell transplantation (HSCT). Five patients had a complete response after one treatment, three patients had clinical response (grade < 2 hematuria, amelioration of symptoms), one of them required catheterization and bladder irrigation. One patient required a second instillation of FG achieving a clinical response. No adverse events related to the procedure were recorded, however one patient died for causes not related to the procedure. Median Interstitial Cystitis Symptoms Index was 13.0 (IQR 11.0-15.0) pre-operatively and 4.0 (IQR 2.0-5.0) post-operatively. Conclusions: Our study showed that, even in hematological patients, autologous FG instillation maybe a safe, repeatable and effective treatment modality in patients with refractory HC.

The Use of BT-ESD Technology under General Intravenous Anesthesia in the Treatment of Nonmuscle Invasive Bladder Cancer and the Effect of PI3K/Akt Signaling Pathway on Tumor Recurrence

Objective. The objective is to investigate the effect of minimally invasive treatment of nonmuscle invasive bladder cancer (NMIBC) by transurethral endoscopic submucosal dissection of bladder tumor (BT-ESD) under general intravenous anesthesia and the expression of Akt in NMIBC and to study the effect of upregulation of intracellular phosphatidylinositol kinase (PI3K)/protein kinase B (Akt) on tumor recurrence. Method. 130 patients with NMIBC were selected as the research subjects, including 101 males and 29 females. The patients were divided into transurethral resection of bladder tumor (TURBT) group, BT-ESD learning group A (early 20 cases of chief surgeon), and BT-ESD learning group B (follow-up cases of the chief surgeon). The general information (male and female prevalence ratio and average age), operation duration, postoperative bladder irrigation duration, postoperative indwelling catheter time, postoperative hospitalization time, and postoperative complications were compared among the patients in all groups. The normal bladder tissues and pathological tissues of NMIBC patients were stained by immunohistochemistry. Results. No significant difference is identified in age among the three groups ( P > 0.05 ), but there are significant differences in the operation duration, postoperative bladder irrigation time, postoperative indwelling catheter time, and postoperative hospital stay ( P > 0.05 ). At the same time, compared with BT-ESD group A and BT-ESD group B, the number of postoperative complications in TURBT group is statistically different ( P < 0.05 ). Akt has a strong positive expression in the nucleus of patients, which indicates that Akt activated by cellular PI3K will form the PI3K/Akt signaling pathway and reduce the recurrence rate of bladder tumor.