The capabilities of cross-polarization optical coherence tomography (CP OCT) for early bladder-cancer detection are assessed in statistical study and compared with the traditional OCT. Unlike the traditional OCT that demonstrates images only in copolarization, CP OCT acquires images in cross-polarization and copolarization simultaneously. 116 patients with localized flat suspicious lesions in the bladder were enrolled, 360 CP OCT images were obtained and analyzed. CP OCT demonstrated sensitivity 93.7% (vs. 81.2%, <0.0001), specificity 84% (vs. 70.0%, <0.001) and accuracy 85.3% (vs. 71.5%, <0.001) in detecting flat malignant bladder lesions, which is significantly better than with the traditional OCT. Higher diagnostic efficacy of CP OCT in detecting early bladder cancer is associated with the ability to detect changes in epithelium and connective tissues.
The aim of the investigation was to study the possibilities of the quantitative assessment of the bladder collagen and elastin state using nonlinear microscopy for determining the degree of side effect severity after the radiotherapy of female reproductive system tumors. Materials and Methods. The object of investigation was a biopsy material from nine patients undergone radiotherapy for malignant neoplasms of the small pelvis organs in their past history, and from three patients treated for chronic cystitis of bacterial etiology. The extracellular matrix of the bladder connective tissue was examined by nonlinear microscopy in the modes of the second harmonic generation (SHG) and two-photon excited autofluorescence (TPEF) on 10 μm unstained dewaxed histological sections. 133 urinary bladder images of the patients divided into 4 groups according to their clinical picture (104 images with the radiation damage grade II (n=24), III (n=40), and IV (n=40)) were quantitatively and qualitatively analyzed and compared with 29 bladder images of the patients with chronic cystitis. Mean value of intensity and a non-uniformity parameter of SHG and TPEF signals were chosen as indices of the quantitative assessment (collagen and elastin state in terms of their form and packing density, integrity/disorganization, and orientation). Results. In the given bladder pathology, the state of the collagen and elastin fibers grows from radiation cystitis grade II to grade IV while in chronic cystitis the picture may be similar with radiation cystitis grade II or III alike. Alterations in the collagen and elastin fibers with the loss of the native structure and spatial arrangement are seen on part of the images as a fuzzy fiber contour (blurring), disorganization/ fragmentation, areas with a dense random fiber arrangement or anhistic areas with a high signal. Mean value of collagen SHG and elastin TPEF signal intensity in severity grade II was statistically significantly higher than in grades III and IV (р≤0.05). Such decrease of the values reflects a marked disorganization (fragmentation) of the fibers in comparison with their native structure which results in the lower ability of the fibers to generate SHG or TPEF signal. Increase of the SHG signal non-uniformity values in grade III and IV radiation damage of the urinary bladder compared to grade II and chronic cystitis reflects the same tendency. Conclusion. A nonlinear microscopy method makes it possible to assess both qualitatively and quantitatively spatial and structural organization of the extracellular bladder matrix in radiation damage and chronic cystitis, to determine the severity degree of complications in radiation damage, and to predict their course.
The study aimed to assess the characteristics of the urinary bladder extracellular matrix after radiotherapy for cervical cancer and hysterocarcinoma using nonlinear microscopy.Materials and Methods. Two groups of patients were studied. The first group (n=75) involved female patients with severe complications after combined radiotherapy for cervix cancer or endometrial cancer. Adverse events of urinary bladder developed within the period from a year to eleven years. The second group (n=80) consisted of female patients suffering from chronic cystitis of bacterial etiology, their past history being over 3 years. We carried out a comparative analysis of the cystoscopic pattern of mucosa and the morphological analysis findings of urinary bladder bioptates.For the first time there was studied the extracellular matrix state of the bladder connective tissue after radiotherapy by nonlinear microscopy carried out in the modes: second harmonic generation and two-photon excited autofluorescence to examine the state of collagen and elastin, respectively. To verify the obtained images we studied parallel histological sections stained by hematoxylin and eosin and picrosirius red.Results. Nonlinear microscopy in radiation and chronic cystitis revealed similar inflammatory changes and tissue fibrosis. The intensity of radiation changes of the urinary bladder tissues depended directly on time after radiation, they being more intense and gross compared to those in chronic cystitis. Nonlinear microscopy enabled to reveal the difference in collagen and elastin structures after urinary bladder radiation damage of various severity. The structure of collagen fibers in II severity degree of radiation was preserved, the fibers being more packed, while III degree was characterized by marked disarrangement of collagen fibers.Conclusion. The combination of optical methods (nonlinear microscopy combined with specific staining of histological preparations) enables to assess objectively structural changes of the urinary bladder extracellular matrix and determine the intensity of alterations after ionizing radiation.The findings can serve as the basis to develop the approaches to visual and quantitative evaluation of the results of noninvasive optical techniques (e.g., polarization modifications of optical coherence tomography) to monitor radiation-induced damage in the urinary bladder.
One of the triggers of infectious processes developing in the kidney after contact laser lithotripsy is calculus disintegration followed by the release of bacteria and toxins from the biofilm. Prevention urgency determines the search for new mechanisms and methods of laser calculus fragmentation without scattering of fragments and microbial dissemination into the pelvicalyceal system of the kidney. The aim of the study was to evaluate the possibilities of applying the technology of urinary calculus fragmentation with continuouswave diode lasers of different wavelengths using fiber light guides with strongly heated distal tips for controlled fragmentation and minimization of traumatic effects on the adjacent tissues. Materials and Methods. To fragment postoperative samples of porous urinary stones (n=58), we applied standard certified continuouswave diode 10 W lasers with fiber output to quartz light guides, their distal tips being coated with a layer of graphite microparticles in silicone varnish. The quality of stone fragmentation using lasers with wavelengths of 0.81 (n=17), 0.97 (n=22), and 1.47 µm (n=19) and identical quartz light guides were evaluated. Control of laser-induced heating of the urinary tract tissues adjacent to the stone was carried out on the model medium with a thermocouple. Simulation of intraoperative errors (short contact with the ureteral wall as the result of the fiber slipping off the stone surface) was performed on the ureteral wall took post mortem. Tissue condition was assessed using histological sections stained with hematoxylin and eosin. Results. The average fragmentation time depended on calculus density and cross-sectional dimension and was 12-15 s. All selected stones, including those potentially infected, with X-ray density 119 to 1735 HU were fragmented effectively both in liquid and air. Assessment of temperature regimes provided by lasers with 0.81 and 0.97 µm wavelengths showed that the stone surface temperature during fragmentation in the air reached 40 and 57°C, respectively, and it was 25 and 33°C in liquid. The obtained morphological and thermometric data suggest safety of lasers used for controlled fragmentation of potentially infected urinary calculi. Conclusion. The use of continuous-wave diode lasers with strongly heated distal fiber tips at 0.81 and 0.97 µm wavelengths makes it possible to successfully fragment potentially infected urinary stones into size-controlled fragments, which may become a significant factor in prevention of systemic inflammatory response in the postoperative period.
Radiation therapy is one of the cardinal approaches in the treatment of malignant tumors of the pelvis. It leads to the development of radiation-induced complications in the normal tissues. Thus, the evaluation of radiation-induced changes in the extracellular matrix of the normal tissue is deemed urgent, since connective tissue stroma degradation plays a crucial role in the development of Grade 3–4 adverse effects (hemorrhage, necrosis, and fistula). Such adverse effects not only drastically reduce the patients’ quality of life but can also become life-threatening. The aim of this study is to quantitatively analyze the bladder collagen state in patients who underwent radiation therapy for cervical and endometrial cancer and in patients with chronic bacterial cystitis and compare them to the normal bladder extracellular matrix. Materials and methods: One hundred and five patients with Grade 2–4 of radiation cystitis, 67 patients with bacterial chronic cystitis, and 20 volunteers without bladder pathology were enrolled. Collagen changes were evaluated depending on its hierarchical level: fibrils and fibers level by atomic force microscopy; fibers and bundles level by two-photon microscopy in the second harmonic generation (SHG) mode; general collagen architectonics by cross-polarization optical coherence tomography (CP OCT). Results: The main sign of the radiation-induced damage of collagen fibrils and fibers was the loss of the ordered “basket-weave” packing and a significant increase in the total area of ruptures deeper than 1 µm compared to the intact sample. The numerical analysis of SHG images detected that a decrease in the SHG signal intensity of collagen is correlated with the increase in the grade of radiation cystitis. The OCT signal brightness in cross-polarization images demonstrated a gradual decrease compared to the intact bladder depending on the grade of the adverse event. Conclusions: The observed correspondence between the extracellular matrix changes at the microscopic level and at the level of the general organ architectonics allows for the consideration of CP OCT as a method of “optical biopsy” in the grading of radiation-induced collagen damage.
The article provides a clinical case of urethral cancer in women. Primary urethral carcinomas are rare, less than 1% of all malignant tumors. According to the Rarecare Cancer Surveillance Agency for Europe (RARECARE), urethral cancer in women is 0.6 and 1.6 in men per 1 million people per year. A 56-year-old patient with histologically verified clear cell adenocarcinoma of the proximal urethra was monitored for 18 months. An aggressive course of the tumor process has been shown, which led to the need to perform anterior exenteration of the pelvic organs. The histogenesis of primary clear cell urethral adenocarcinoma has not been definitively determined. The atypical external localization in the described case suggests the periurethral origin of this cancerous tumor from the Skenes glands. The demonstration of a rare form of urethral cancer, clear cell adenocarcinoma, contributes to the accumulation of knowledge about its histopathology and clinical course, as well as increasing cancer alertness in the treatment of urethral diseases in doctors of any specialty.
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