Since the time the first case of interstitial cystitis/bladder pain syndrome (IC/BPS) was reported, there have been complaints of a decreased quality of life secondary to bladder pain; thus, effective treatment(s) are required. Several treatments have been developed, among which the intravesical instillation of lidocaine is considered one of the most favorable treatments due to the rapid local anesthetic action with minimal systemic side-effects, and even serves as a potential diagnostic tool for IC/BPS. In addition, the anti-inflammatory effects of lidocaine are associated with a longer duration of pain relief as compared to the effects of local anesthetic by breaking the vicious cycle of neurogenic inflammation. However, the main difficulty encountered with this treatment is the low absorption rate and the lack of maintaining a monthly effect. To overcome this difficulty, several approaches, including alkalization or the use of drug cocktails have been attempted. Recently, several indwelling lidocaine-releasing devices have been developed; however, the majority of these devices have not yet entered clinical trials, at least to the best of our knowledge. The only device evaluated in phase II clinical trials to date has failed to demonstrate a statistically significant efficacy compared to the placebo group. If the efficacy is improved and further clinical evidence is collected, the use of IC/BPS as a treatment strategy may become feasible. Contents 1. Introduction 2. Literature selection 3. Overview of IC/BPS 4. Pharmacological effects of lidocaine 5. Diagnostic significance of lidocaine in IC/BPS 6. Therapeutic significance of lidocaine in IC/BPS 7. Intravesical indwelling lidocaine-releasing devices 8. Conclusions and future perspectives
An ectopic kidney is a rare congenital defect in which the kidney does not migrate to its normal anatomical position. In the present study, a robot-assisted radical cystectomy and intracorporeal urinary diversion were performed for a patient with an ectopic kidney. The present study describes the case of a 72-year-old male patient who was diagnosed with a bladder tumor by magnetic resonance imaging and cystoscopy. A transurethral resection of the bladder tumor was performed. The pathological examination revealed an invasive urothelial carcinoma. Contrast-enhanced computed tomography revealed an ectopic left kidney in the upper pelvis. A robot-assisted radical cystectomy, extended lymph node dissection and intracorporeal urinary diversion were performed. On the whole, as demonstrated herein, a robot-assisted radical cystectomy with intracorporeal urinary diversion is a feasible approach for muscle-invasive bladder cancer complicated by an ectopic kidney.
Intravesical immunotherapy using bacillus Calmette-Guérin (BCG) is recommended for patients with intermediate-to high-risk non-muscle invasive bladder cancer. Bladder tuberculosis (TB) is a rare complication of BCG therapy. The present study describes the case of a 73-year-old man who underwent intravesical BCG therapy for urothelial carcinoma in situ of the bladder. Red patches around the resection scar were first detected 1 year and 5 months after BCG treatment; these findings gradually spread to encompass more of the bladder wall. Transurethral biopsy revealed a benign lesion, but the patient developed bilateral hydronephrosis and mild voiding dysfunction. The patient was eventually diagnosed with bladder TB by mycobacterial urine culture and TB-specific polymerase chain reaction (PCR). The patient was given multidrug therapy (isoniazid, rifampicin and ethambutol) and their bladder TB was completely cured; however, their voiding dysfunction and bilateral hydronephrosis did not fully improve. Bladder TB can occur long after intravesical BCG administration and cystoscopy findings consistent with inflammation can be the key to suspecting this condition. Acid-fast examination and PCR testing of a urine sample are necessary for early diagnosis.
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