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Key Clinical Message: A self-insertion of the styrofoam in urinary bladder is relatively rare. The diagnosis might be missed due to concealing the history of self-insertion of the foreign body and the presence of gas in the bladder on CT and MRI. Younger patients with lower urinary tract symptoms should raise the index of suspicion. Abstract: Transurethral self-insertion of a foreign body into the bladder is the most common type of bladder foreign body, which is unlikely to be misdiagnosed. we report a case of self-insertion bladder foreign body and present the symptoms, imaging, diagnosis and treatment in a 14-year-old Chinese boy of Han nationality. Younger patients with lower urinary tract symptoms should raise the index of suspicion. Endoscopic removal of foreign bodies can be a challenge. Patients with self-insertion of foreign objects should undergo psychiatric evaluation to avoid repeated transurethral insertion of foreign bodies.

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The prevalence and severity of overactive bladder increase with age, and mirabegron is an approved treatment for this condition. This meta-analysis systematically evaluated the efficacy and safety of mirabegron compared with placebo for overactive bladder treatment. We searched PubMed and the Cochrane Library (30 October 2023) for relevant articles (source: MEDLINE, EMBASE, ClinicalTrials.gov, ICTRP, CINAHL). We included randomized controlled trials involving adults with overactive bladder syndrome that compared mirabegron with placebo treatment. Data were analyzed according to the Cochrane Handbook for Systematic Reviews of Interventions [Review Manager (computer program) Version 5.4]. Nine parallel-group trials (10 articles) were included. The evaluation included a total of 8,527 adults, including 6,445 women and 2,082 men, of whom 5,726 were White, 2,462 were Asian, and 161 were Black. The mean age of the participants ranged from 53.4 to 60.3 years. This evaluation involved three specifications of mirabegron: 25 mg, 50 mg, and 100 mg. In all trials, patients were enrolled in a 12-week double-blind treatment period, and the dose was once daily. The review of trials found that on average, people taking mirabegron had about 13 ml more volume voided per micturition, five fewer micturitions, and four fewer incontinence episodes every week, with moderate improvements in quality of life. About one in five people taking the drug reported TRAEs. Mirabegron treatment is well tolerated, with the risk of adverse events similar to that of a placebo. For best results, a dose of 50 mg once daily is recommended for long-term use. It is unclear whether any benefits are sustained after treatment discontinuation. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42023430737).

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BACKGROUND: Although surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool. OBJECTIVE: The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women's decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when "thinking about my bladder" and shortly before "I just peed," (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere. METHODS: The development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ≥74, was 40 women completing the study. RESULTS: Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57%), college-educated (n=25, 57%), and with incomes below US $75,000 (n=27, 62%). The SUS score was 78.0 (SE 1.7), which was higher than 75% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022. CONCLUSIONS: WhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/54046.

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OBJECTIVE: Comparative effectiveness studies comparing trimodal therapy (TMT) to radical cystectomy (RC) are typically hindered by selection bias where TMT is usually reserved to patients with poor overall health status. We developed a novel approach by matching patients based on their calculated other-cause mortality (OCM) risk. Using this homogeneous cohort, we tested the impact of TMT vs RC on cancer-specific mortality (CSM). MATERIALS AND METHODS: The Surveillance, Epidemiology and End Results (SEER) 2004-2018 database was queried to identify patients diagnosed with cT2-4N0M0 muscle-invasive bladder cancer (MIBC). A Fine-Gray competing-risk regression model calculating the 5-year OCM risk was used to create a 1:1 propensity-score matched-cohort of patients treated with RC or TMT. Cumulative incidence and competing-risk regression analyses tested the impact of treatment type (RC vs TMT) on CSM. Patients were further stratified according to clinical T stage (cT2 vs cT3-4) in sensitivity analyses. RESULTS: We identified 6,587 patients (76%) treated with RC and 2,057 (24%) with TMT. The median follow-up was 3.0 years. In the unmatched-cohort, 5-year OCM and CSM rates were 14% and 40% for RC vs 23% and 47% in TMT group, respectively (all P < 0.001). Our matched-cohort included 4,074 patients, equally distributed for treatment type, with no difference in 5-year OCM (HR: 0.98, 95% CI: 0.86-1.11, P = 0.714). In clinical-stage specific sensitivity analyses, 5-year CSM rate was significantly worse for cT2N0M0 patients treated with TMT (HR: 1.52, 95% CI: 1.21-1.91, P < 0.001) than those treated with RC. For cT3-4N0M0 patients, there was no difference in CSM among the 2 approaches (HR: 0.98, 95% CI: 0.63-1.52, P = 0.900). CONCLUSIONS: Our findings demonstrate an oncologic advantage of RC over TMT for cT2 MIBC patients. Conversely, we did not find a cancer-specific survival difference for cT3-T4 MIBC patients, regardless of treatment.

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Introduction: Although uterine perforation is a rare but serious complication, intrauterine devices are globally popular and effective contraceptive methods. Case presentation: A 76-year-old female patient manifesting symptoms of vaginal leakage and lower abdominal discomfort was admitted to our hospital. Diagnostic imaging identified a vesicovaginal fistula and bladder calculi attributable to perforation of the bladder by an intrauterine device that had been inserted over four decades ago. The patient underwent open surgery for cystolith removal and vesicovaginal fistula repair. Conclusions: If a patient with an intrauterine device complains of bladder stones or ongoing lower urinary tract symptoms, bladder perforation caused by the device should be considered in the differential diagnosis.

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Since its first discovery as a bioactive phospholipid inducing potent platelet aggregation, platelet-activating factor (PAF) has been shown to be involved in a wide variety of inflammatory and allergic disease states. Many pharmacological studies in the 1980s and 1990s also showed that PAF induces endothelium-dependent vascular relaxation and contraction of various smooth muscles (SMs), including those in the airway, gastrointestinal organs, and uterus. However, since the late 1990s, there have been few reports on the SM contractions induced by PAF. The lower urinary tract (LUT), particularly the urinary bladder (UB) has attracted recent attention in SM pharmacology research because patients with LUT dysfunctions including overactive bladder are increasing as the population ages. In addition, recent clinical studies have implicated the substantial role of PAF in the inflammatory state in LUT because its production increases with smoking and with cancer. However, the effects of PAF on mechanical activities of LUT SMs including UBSM have not been investigated to date. Recently, we found that PAF very strongly increased mechanical activities of UBSM in guinea pigs and mice, and partly elucidated the possible mechanisms underlying these actions of PAF. In this review, we describe the effects of PAF on LUT SMs by introducing our recent findings obtained in isolated UBSMs and discuss the physiological and pathophysiological significance. We also introduce our data showing the effects of PAF on the SM mechanical activities of genital tissues (prostate and vas deferens).

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BACKGROUND AND OBJECTIVE: Neoadjuvant therapy followed by radical cystectomy with lymphadenectomy remains the gold standard of treatment in patients with muscle-invasive bladder cancer. Pathologically positive lymph node (pN+) disease is known to convey a poor prognosis. Tumor-informed circulating tumor DNA (ctDNA) has emerged as a possible novel prognostic biomarker in the field. We seek to assess recurrence-free survival (RFS) for patients undergoing robotic-assisted radical cystectomy (RARC) with extended pelvic lymphadenectomy (ePLND) and to assess whether ctDNA status can be a prognostic marker for RFS outcomes in patients with pN+ disease. METHODS: Patients who underwent RARC + ePLND during 2015 to 2023 were included. A sub-group analysis (n = 109) of patients who had prospectively collected serial-longitudinal tumor-informed ctDNA analyses during 2021-2023 was performed. Survival analysis and Cox-regression models were conducted. RESULTS: Included were 458 patients with a median age of 69 (IQR 63-76), and a median follow-up time of 20 months (IQR 10-37). RFS for pN0 (n = 353) and pN+ (n = 105) at 12, 24 and 36 months were 87% vs. 54%, 80% vs. 39%, and 74% vs. 35%, respectively (log-rank, P < 0.0001). On Cox multivariate analysis ≥pT3 disease (Hazzard ratio [HR] = 3.36 [2.18-5.18], P < 0.001), pN+ disease (HR = 2.39 [1.55-3.7], P < 0.001), and recipients of neoadjuvant treatment (HR = 1.61 [1.11-2.34], P = 0.013) were predictive of disease relapse. Patients with pN+ disease and undetectable precystectomy or postcystectomy ctDNA status had similar RFS to patients with pN0 with undetectable ctDNA. On Cox-regression multivariate sub-group analysis, detectable precystectomy ctDNA status (HR = 3.89 [1.32-11.4], P = 0.014), detectable ctDNA status in the minimal residual disease window ([MRD], HR = 2.89 [1.12-7.47], P = 0.028), and having ≥pT3 with pN+ disease (HR = 4.2 [1.43-12.3], P = 0.009) were predictive of disease relapse. CONCLUSIONS: Patients with pN+ .after RARC had worse oncological outcomes than patients with pN0 disease. Undetectable ctDNA status was informative of RFS regardless of nodal status at both the precystectomy and the MRD window. Patients with undetectable ctDNA status and pN+ disease may benefit from treatment de-escalation.

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OBJECTIVE: To evaluate the prediction value of Dual-energy CT (DECT)-based quantitative parameters and radiomics model in preoperatively predicting muscle invasion in bladder cancer (BCa). MATERIALS AND METHODS: A retrospective study was performed on 126 patients with BCa who underwent DECT urography (DECTU) in our hospital. Patients were randomly divided into training and test cohorts with a ratio of 7:3. Quantitative parameters derived from DECTU were identified through univariate and multivariate logistic regression analysis to construct a DECT model. Radiomics features were extracted from the 40, 70, 100 keV and iodine-based material-decomposition (IMD) images in the venous phase to construct radiomics models from individual and combined images using a support vector machine classifier, and the optimal performing model was chosen as the final radiomics model. Subsequently, a fusion model combining the DECT parameters and the radiomics model was established. The diagnostic performances of all three models were evaluated through receiver operating characteristic (ROC) curves and the clinical usefulness was estimated using decision curve analysis (DCA). RESULTS: The normalized iodine concentration (NIC) in DECT was an independent factor in diagnosing muscle invasion of BCa. The optimal multi-image radiomics model had predictive performance with an area-under-the-curve (AUC) of 0.867 in the test cohort, better than the AUC = 0.704 with NIC. The fusion model showed an increased level of performance, although the difference in AUC (0.893) was not statistically significant. Additionally, it demonstrated superior performance in DCA. For lesions smaller than 3 cm, the fusion model showed a high predictive capability, achieving an AUC value of 0.911. There was a slight improvement in model performance, although the difference was not statistically significant. This improvement was observed when comparing the AUC values of the DECT and radiomics models, which were 0.726 and 0.884, respectively. CONCLUSION: The proposed fusion model combing NIC and the optimal multi-image radiomics model in DECT showed good diagnostic capability in predicting muscle invasiveness of BCa.

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Bladder cancer is one of the most economically costly types of cancer, but few studies have evaluated its mortality considering the factors that impact this outcome. This study aimed to investigate the impact of sociodemographic factors, period, cohort, and health services on bladder cancer mortality. This ecological study analyzed bladder cancer mortality data in Brazil from 2000 to 2022 and evaluated sociodemographic variables (race, region of residence), socioeconomic variables (gross domestic product per capita, Gini index of household income per capita, number of health professionals per inhabitant, expenditure on public health services, and consultations per inhabitant), and bladder cancer diagnosis and treatment procedures. These data were subjected to statistical analysis, which revealed that after the age of 50, there was a progressive increase in the risk of bladder cancer. Indigenous people had the lowest mortality rate, while white people had a significantly greater mortality rate than black and brown people. The North Region and Northeast Region presented the lowest mortality rates, whereas the South Region presented the highest mortality rates. In the South and Southeast Regions, a higher GDP was related to lower mortality. In the South, higher mortality was associated with a lower number of consultations per inhabitant per region. Fewer bladder punctures/aspirations and bladder biopsies were associated with higher mortality rates. In oncology, more procedures, such as total cystectomy, cystoenteroplasty, and total cystectomy with a single shunt, do not reduce the mortality rate. These results can serve as guidelines for adjusting public health policies.

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Tumor cells produce excessive reactive oxygen species (ROS) but cannot detoxify ROS if they are due to an external agent. An agent that produces toxic levels of ROS, specifically in tumor cells, could be an effective anticancer drug. CMC-2 is a molecular hybrid of the bioactive polyphenol curcumin conjugated to dichloroacetate (DCA) via a glycine bridge. The CMC-2 was tested for its cytotoxic antitumor activities and killed both naïve and multidrug-resistant (MDR) bladder cancer (BCa) cells with equal potency (<1.0 µM); CMC-2 was about 10-15 folds more potent than curcumin or DCA. Growth of human BCa xenograft in mice was reduced by >50% by oral gavage of 50 mg/kg of CMC-2 without recognizable systemic toxicity. Doses that used curcumin or DCA showed minimum antitumor effects. In vitro, the toxicity of CMC-2 in both naïve and MDR cells depended on increased intracellular ROS in tumor cells but not in normal cells at comparable doses. Increased ROS caused the permeabilization of mitochondria and induced apoptosis. Further, adding N-Acetyl cysteine (NAC), a hydroxyl radical scavenger, abolished excessive ROS production and CMC-2's cytotoxicity. The lack of systemic toxicity, equal potency against chemotherapy -naïve and resistant tumors, and oral bioavailability establish the potential of CMC-2 as a potent drug against bladder cancers.

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Key Clinical Message: Consideration of spontaneous urinary bladder rupture in the differential diagnosis of acute abdominal pain for alcohol-abusing patients is crucial for ensuring timely surgical intervention and preventing life-threatening complications due to its high associated morbidity and mortality. Abstract: Spontaneous rupture of the urinary bladder (SRUB) is a rare but critical urological emergency, typically associated with malignancy, neurogenic dysfunction, or previous radiation therapy. Here, we present a unique case of SRUB in a 65-year-old chronic alcoholic male who presented with acute lower abdominal pain following heavy alcohol consumption. Initial evaluations revealed leukocytosis, elevated serum creatinine levels, and ultrasound findings suggestive of bladder rupture. Computed tomography confirmed the diagnosis, indicating an intraperitoneal rupture with associated hematoma. Immediate surgical repair was performed, leading to a successful outcome. This case underscores the importance of considering SRUB in patients with acute abdominal pain, especially in the context of alcohol intoxication, and highlights the diagnostic and therapeutic challenges associated with this condition. Early recognition and intervention are crucial to prevent life-threatening complications associated with urinary bladder rupture.

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BACKGROUND: Urinary bladder neoplasms constitute a heterogeneous group of tumors with diverse clinical behaviors and outcomes. Understanding the correlation between clinicopathological characteristics and the prognostic significance of molecular biomarkers in bladder cancer is vital for personalized treatment strategies and improved patient outcomes. OBJECTIVE: This prospective observational study aimed to comprehensively investigate the clinicopathological correlations and prognostic significance of molecular biomarkers in urinary bladder neoplasms. METHODS: A cohort of 174 patients diagnosed with urinary bladder neoplasm participated in this study. Clinicopathological data, including demographic information, medical history, imaging findings, and histopathological reports, were collected from the patient records. Tissue samples obtained from transurethral resection or biopsy were subjected to molecular biomarker analysis using immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and molecular profiling techniques. Longitudinal follow-up assessments were conducted to monitor disease progression, recurrence, and overall survival. RESULT: Out of 174 patients diagnosed with bladder neoplasms, the mean age of the patients was 62.4 years (±8.7), indicating that the study cohort primarily comprised elderly individuals. The majority of patients were male (126, 72.4%), reflecting the higher prevalence of bladder cancer among men compared to women. Preliminary analysis revealed significant associations between clinicopathological parameters, molecular biomarker expression profiles, and clinical outcomes in patients with urinary bladder neoplasms. Elevated expression levels of specific biomarkers such as tumor protein p53 (p53), Ki-67, and estimated glomerular filtration rate (EGFR) were observed in advanced tumor stages (p < 0.001) and higher histological grades (p < 0.05), indicating their potential prognostic significance. Furthermore, genetic alterations detected using molecular profiling techniques, including chromosomal gains and losses, were significantly correlated with aggressive disease phenotypes and increased recurrence risk (p < 0.01). Longitudinal follow-up data demonstrated that patients with elevated biomarker expression levels or genetic alterations had poorer treatment responses and shorter overall survival durations than those with lower biomarker expression levels. CONCLUSION: This study highlights the importance of integrating clinicopathological parameters and molecular biomarker data for the risk stratification, treatment selection, and prognostic assessment of urinary bladder neoplasms.

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BACKGROUND: This retrospective study aims to provide a comprehensive analysis of the demographics, survival rates, and therapeutic approaches of small-cell neuroendocrine carcinoma (SCNEC) and large-cell neuroendocrine carcinoma (LCNEC) while highlighting key differences compared to common urinary bladder cancers. METHODS: Our analysis utilized the Surveillance, Epidemiology, and End Results database (SEER), and data was collected from 2000-2020. RESULTS: A total of 1040 cases of urinary bladder SCNEC and LCNEC were identified. Most patients were over the age of 80 years (33.2%), male (78.9%), and Caucasian (83.6%). Most tumors were over 4.1cm (47.4%) and in the lateral wall of the bladder (37.8%). The overall 5-year survival was 22.1% (95% confidence interval (95% CI):20.7-23.5). The 5-year survival by sex was greatest for the female population (28.0%; (95% CI: 24.5-35.0). For treatment modality, the 5-year survival for each was as follows: surgery, 12.5% (95% CI: 10.5-14.5) multimodality therapy (surgery and chemotherapy), 31.1% (95% CI: 28.5-33.7) and combination (surgery, chemotherapy, and radiation) 32.8% (95% CI: 29.1-36.5). On multivariable analysis, positive nodal status hazar ratio (HR)(HR3.65 [95% CI: 2.34-5.71], P < .001) was identified as a negative predictor for survival, and increasing age was nearly significant for a worse prognosis (P = .052). The prognostic nomogram that was created to predict patient survivability mirrored the findings from the statistical analysis, with a statistically significant difference found in race, treatment modality, and tumor stage. CONCLUSIONS: SCNEC and LCNEC are rare yet highly intrusive subtypes of bladder cancer that usually affect Caucasian males over the age of 80 years old. The study identifies older age and positive nodal status as adverse prognostic indicators. Our findings offer crucial insights that can inform future clinical guidelines and serve as a basis for more tailored treatment strategies for these aggressive subtypes of bladder cancer.

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Of all primary bladder cancers, primary adenocarcinoma is an uncommon tumor. When considering all tumor origin areas, secondary bladder involvement from carcinoma, whether by direct extension or metastasis, is actually more prevalent than primary adenocarcinoma, despite its rarity. The most common source of subsequent bladder tumors is endometrial, lung, colon, prostate, breast, or other organ adenocarcinomas. Primary bladder adenocarcinoma is thought to result from urothelial metaplasia, which is frequently linked to persistent irritation or inflammation. Bladder exstrophy, recurrent urinary tract infections, long-term irritation from calculi or foreign bodies, and history of schistosomiasis are risk factors. A portion of these malignancies are associated with urachal remnants, where the tumor originates at the dome of bladder. Here we present a case of primary adenocarcinoma in a 44-year-old female patient that originated from the dome of urinary bladder.

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INTRODUCTION: Video games have a strong influence on children and adolescents. Video game addiction has negative effects on children's health. OBJECTIVE: To determine the relationship between video game addiction and bladder/bowel dysfunction in children. MATERIALS AND METHODS: Three hundred sixty-three children and their mothers who met the inclusion criteria constituted the sample of this correlational study. The data were collected using a descriptive information form, the Video Game Addiction Scale for Children, and the Childhood Bladder and Bowel Dysfunction Questionnaire. RESULTS: We found that 72.5% of the children were nine years old and 27.5% were ten years old; 50.4% were males and 49.6% were female. While 4.7% of the children who participated in the study were underweight, 19.6% were overweight, and 17.9% were obese. The mean Video Game Addiction Scale for Children score was 50.77 ± 16.17, whereas the mean Childhood Bladder and Bowel Dysfunction Questionnaire score was 29.98 ± 8.90. The ratio of children with a mean Video Game Addiction Scale for Children scores equal to or greater than 90 was 0.8% (n = 3). We found that 3.6% (n = 13) of the children had urinary/fecal incontinence while playing video games. There was a weak positive relationship between the dimensions of the Video Game Addiction Scale for Children scores, the Childhood Bladder and Bowel Dysfunction Questionnaire scores, and children's bladder and bowel function (r = 0.220; p ˂ 0.05). CONCLUSIONS: There is a correlation between children's video game addiction level and their bladder and bowel dysfunction grade. Higher video game addiction levels correspond to higher bladder and bowel dysfunction.

Introducción: Los videojuegos tienen una fuerte influencia en los niños y adolescentes. La adicción a ellos tiene efectos perjudiciales para la salud de los niños. Objetivo: Determinar la relación entre la adicción a los videojuegos y la disfunción vesical o intestinal en niños. Materiales y métodos: Los 373 niños y sus madres que cumplieron con los criterios de inclusión constituyeron la muestra de este estudio descriptivo y correlacional. Los datos se recopilaron mediante un formulario de información descriptiva, la Video Game Addiction Scale for Children y el Childhood Bladder and Bowel Dysfunction Questionnaire. Resultados: El 72,5 % de los niños tenía nueve años y, el 27,5 %, diez; el 50,4 % eran hombres y el 49,6 %, mujeres. El 4,7 % de los estudiantes que participaron en el estudio tenían bajo peso, el 19,6 % presentaba sobrepeso y el 17,9 % tenía obesidad. Se constató que las puntuaciones medias de las escalas fueron 50,77 ± 16,17 para la Video Game Addiction Scale for Children y 29,98 ± 8,90 para el Childhood Bladder and Bowel Dysfunction Questionnaire. La proporción de niños con una puntuación de 90 o superior en la dicha escala fue del 0,8 % (n = 3). Se encontró que el 3,6 % (n = 13) de los niños tenía incontinencia urinario-fecal mientras jugaba videojuegos. Se reveló que había una correlación positiva débil entre las dimensiones de las dos escalas evaluadas, y la función de la vejiga y el intestino (p ˂ 0,05). Conclusiones: El grado de adicción a los videojuegos de los niños está correlacionado con su grado de disfunción vesical o intestinal: entre mayor sea la adicción, mayor es la disfunción.

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Context and Aims: Despite its rarity, iatrogenic urinary tract injury can cause severe morbidity and mortality. The purpose of this study was to determine the frequency of urinary tract injuries caused by medical treatment in a hospital in Medan, Indonesia. Settings and Design: This retrospective descriptive study was conducted at H. Adam Malik General Hospital and Universitas Sumatera Utara Hospital in Medan from March to August 2022. Subjects and Methods: Medical data of individuals who had iatrogenic urinary tract injuries in a Medan teaching hospital from 2018 to 2022 were obtained using total sampling. SPSS version 25 was utilized to analyze patient characteristics, the type of surgery, urinary tract injuries, and urologic procedures. Results: There were 11 ureteral injuries and 23 bladder injuries in 32 iatrogenic urinary tract injuries. The average age of the patients was 40.5 ± 13.3. Patients who received obstetrical care had the highest rate of iatrogenic urinary tract injury (56.3%), followed by patients who received gynecological care (21.9%) and surgical care (21.9%). The procedure most likely to cause iatrogenic urinary tract injury was hysterectomy (40.6%). Bladder rupture (65.5%) and ureteral transection (28.1%) were common types of iatrogenic bladder and ureteral injuries. Majority of iatrogenic urinary tract injuries were treated with bladder repair (68.8%). Conclusions: Obstetrical and gynecologic procedures, especially hysterectomy, were the most common causes of iatrogenic urinary tract injury; bladder repair was the most common treatment. Iatrogenic urinary tract injury is best managed by knowing the anatomical position of the urinary tract inside the operative field.

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Objectives: To examine the relationship between clinical patient characteristics and the severity of the disease course in patients hospitalized due to urinary bladder tamponade. The severity was assessed based on hemoglobin (Hgb) levels upon admission, the requirement for red blood cell transfusion (RBCT), and length of hospital stay. Materials and Methods: A retrospective analysis was conducted at a single center, involving 75 patients who were hospitalized due to urinary bladder tamponade. Results: Bladder cancer (33.3%) and postoperative bleeding (28%) were the most common causes of bladder tamponade. Patient age exhibited a negative correlation with Hgb levels upon admission (r = -0.539, P < 0.001) and a positive correlation with the quantity of administered RBCT units (r = 0.425, P < 0.001) and the length of hospitalization (r = 0.541, P < 0.001). The number of comorbidities exhibited a negative correlation with Hgb levels upon admission (r = -0.555, P < 0.001) and a positive correlation with the quantity of administered RBCT units (r = 0.522, P < 0.001) and the length of hospitalization (r = 0.543, P < 0.001). Patients taking antithrombotic therapy (AT) had lower mean Hgb levels on admission (87.8 ± 13.5 g/L vs. 107.6 ± 18.7 g/L, P < 0.001), a higher mean number of administered RBCT units (2.8 ± 2.1 vs. 1.1 ± 1.3, P < 0.001) and longer hospitalizations (4.6 ± 1.6 days vs. 3.1 ± 1.1 days, P < 0.001) compared to those not taking AT. Conclusion: Older patients with multiple comorbidities, particularly those taking AT, should be expected to have a more severe clinical course of bladder tamponade. Therefore, special clinical attention is necessary for this vulnerable patient group.

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PURPOSE: This study aimed to compare health-related quality of life (HRQoL) between children with bladder and bowel dysfunction (BBD) and lower urinary tract dysfunction (LUTD) alone and healthy controls based on self-report forms and parent-proxy report forms. MATERIALS AND METHODS: In this retrospective study, clinical records were reviewed. Children with LUTD, with or without bowel dysfunction, and healthy children were included in this study. The dysfunctional voiding scoring system and Rome IV Diagnostic Criteria were used to assess lower urinary tract symptoms. The Rome IV Diagnostic Criteria was also used to evaluate bowel symptoms. The Pediatric Quality of Life Inventory 4.0 (PedsQL) questionnaire was administered to investigate pediatric HRQoL. RESULTS: Of the total 252 children (mean age, 7.3±2.1 years) who participated in this study, 78 were classified into the BBD group and 174 into the LUTD group. Compared with the control group, the BBD group had significantly lower total PedsQL scores (p<0.001) and psychosocial healthy summary scores (p<0.001). The BBD group had significantly lower emotional functioning scores than the LUTD group (p=0.023). Children with BBD who presented with fecal incontinence (FI) had a significantly lower social functioning score than those without FI (p=0.023). CONCLUSIONS: Children with BBD who present with FI are at higher risk of decreased psychosocial HRQoL, and they require special emotional support. These findings underscore the need for effective treatment and follow-up to improve the HRQoL of children with BBD who presented with FI.

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PURPOSE: Urothelial carcinoma has various molecular subtypes, each with different tumor characteristics. Although it is known that molecular changes occur during tumor progression, little is known about the specifics of these changes. In this study, we performed transcriptional analysis to understand the molecular changes during tumor progression. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded tumor tissues were obtained from 12 patients with muscle-invasive bladder cancer (MIBC). The invasive and non-invasive papillary areas were identified in papillary urothelial carcinoma specimens. Immunohistochemistry (IHC) and mRNA sequencing were performed for each tumor area. RESULTS: Patients with CK5/6-negative and CK20-positive non-invasive papillary areas were selected and classified into the IHC switch subgroup (CK5/6-positive and CK20-negative in the invasive area) and the IHC unchanged subgroup (CK5/6-negative and CK20-positive in the invasive area) according to the IHC results of the invasive area. We identified differences in the mRNA expression between the non-invasive papillary and invasive areas of the papillary MIBC tissue samples. In both the non-invasive papillary and invasive areas, the IHC switch subgroup showed basal subtype gene expression, while the IHC unchanged subgroup demonstrated luminal subtype gene expression. CONCLUSIONS: The non-invasive papillary area showed a gene expression pattern similar to that of the invasive area. Therefore, even if the non-invasive papillary area exhibits a luminal phenotype on IHC, it can have a basal subtype gene expression depending on the invasive area.

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