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Rhabdomyosarcoma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Gideon Sandler, Andrea Hayes-Jordan
Bladder and prostate RMS is usually unresectable at diagnosis. Biopsy can be cystoscopic, via a transabdominal open or laparoscopic approach, or via a core transrectal USS or transabdominal CT-guided approach. Preservation of bladder function is paramount. Uncommonly, small tumors of the bladder dome are primarily resectable. More commonly, management is with neoadjuvant chemotherapy +/- RT followed by DPE. More extensive, particularly distal bladder resections may require ureteric reimplantation and/or bladder augmentation. Bladder outlet obstruction should be managed with urethral catheterization. If suprapubic catheterization is required, the track will need excision due to the risk of seeding.
Pathophysiology of the Low Compliant Bladder
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
W. Blair Townsend, Michael J. Kennelly
Impaired bladder compliance is seen in neurologic conditions that affect lower urinary tract function such as spinal cord injuries (SCIs) or lesions, spina bifida, and Parkinson's disease. Many of these patients can have increased outlet resistance secondary to detrusor external sphincter dyssynergia (DESD). In men, neurogenic causes of bladder outlet obstruction can be compounded with nonneurogenic phenomena such as benign prostatic obstruction that further exacerbate secondary bladder fibrosis and hypertrophy.36
EMQ Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
C Bladder outlet obstructionThe symptoms of bladder outlet obstruction may vary, but can include abdominal pain, continuous feeling of a full bladder, frequent of micturition, pain during urination (dysuria), problems initiating voiding, a feeling of incompletely emptying the bladder, urinary hesitancy, slow, uneven urine flow and in some cases inability to void. Straining to urinate and urinary tract infections may be associated to complications. (Urinary Incontinence and Pelvic Organ Prolapse in Women: Management Prolapse in Women: Management. NICE Guideline, Published: 2 April 2019)
Gender discrepancies in bladder cancer: potential explanations
Published in Expert Review of Anticancer Therapy, 2020
Pravin Viswambaram, Dickon Hayne
Anatomic differences between men and women may account for some gender-related differences in UCB. Men have a thicker detrusor than women, which may thicken even further as men age, due to bladder outlet obstruction from benign prostatic hypertrophy. This could protect against rapid extravesical progression or metastases [2,15]. The prostate and prostatic urethra in men may act as a barrier in limiting the lymphovascular spread of UCB [68]. During embryonic development, the trigone and posterior bladder neck share a common origin with the proximal vagina [69]. This could explain more invasive UCB in women [20]. The absence of Denonvilliers’ fascia and a barrier between the anterior vagina wall and the posterior bladder may be responsible for increased localized invasion of UCB and lymphatic spread [16]. In women, lymphatic vessels travel through the lateral vagina walls, draining lymph from the bladder neck to the internal iliac lymph nodes, facilitating UCB spread to the urethra [68,70,71]. This justifies the excision of the anterior vaginal wall and entire urethra in female RC [16].
Long-term urodynamic findings following radical prostatectomy and salvage radiotherapy
Published in Scandinavian Journal of Urology, 2018
Maria Ervandian, Jens Christian Djurhuus, Morten Høyer, Charlotte Graugaard-Jensen, Michael Borre
The non-invasive uroflowmetry showed a prolonged flow in six patients that indicated the presence of infravescial obstruction, as a result of either bladder outlet obstruction or a poorly contractile detrusor muscle. With regard to the simultaneous measurement of bladder pressure and bladder function, 10 patients had a non-compliant bladder and detrusor overactivity, and involuntary contractions were present in seven patients. In the voiding phase, bladder outlet obstruction was present in seven patients with increased detrusor pressure and reduced flow rates; only three of the seven patients had signs of urethral stricture on their UPP. Based on the UPP, these results demonstrate a strong relationship between low MUP and daily urinary incontinence.
Defining and discriminating responders from non-responders following transurethral resection of the prostate
Published in Scandinavian Journal of Urology, 2018
Erik Sagen, Hans Hedelin, Olle Nelzén, Ralph Peeker
Lower urinary tract symptoms (LUTS), due to benign prostatic enlargement (BPE), are increasingly common, as men get older [1]. It has been reported that one-third of the Swedish male population over 50 years of age suffers from LUTS to a varying degree [2]. Men with bothersome LUTS are as a rule initially offered medical therapy, with the aim of relieving symptoms and, in case of medication with 5-ARI, reducing the volume of adenomatous tissue. However, a significant proportion of men will eventually progress with worsening symptoms or with the development of some form of complication secondary to bladder outlet obstruction, e.g. urinary retention [3]. These men require surgical intervention.