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Bladder Mucosal Pathological Changes Accompany High Grade and Squamous Cell Bladder Tumors

Author: Jassim Mohammad Alkhazraji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 4 Pages: 536-541
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Carcinoma of the bladder is the second most common cancer in Iraq. The status of the bladderurothelium other than the principal lesions can provide distinct diagnostic information with regard totreatment response and outcome. Positive mucosal biopsy results are a significant indicator ofintravesical recurrence. Currently, in our urological practice, the importance of performing this step incystoscopy is relatively underestimated.OBJECTIVE:The objective of this study is to carry out a histological assessment of 'extra-tumor' bladder mucosa fordysplasia, and correlate the resulting findings of dysplasia with the grade, the type, and the macroscopicappearance of the tumor.MATERIALS AND METHODS:A total of 350 biopsies were taken by cystoscopy from 68 patients admitted with bladder tumors, eitherby cold-cupped biopsy forceps or resectoscope as part of TUR of the tumor. Normal-looking mucosa ofthe bladder was included in each patient's biopsy in a four quadrant way. All biopsies were examinedby the same histopathologist. All patients were managed according to their presentation, cystoscopicand histopathological findings.RESULTS:Statistical analysis showed that the highest significant difference was obtained in patients with tumorgrade, low against high grade (p<0.005). However, a noticeable difference was found in the other twocomparison groups, namely, the type, transitional against squamous and the macroscopic appearance,papillary against solid (p<0.05).CONCLUSION:The high grade, solid tumors and squamous cell carcinoma are associated with general bladder mucosaldysplastic changes which may exclude the bladder preserving procedures as an option of surgicaltreatment. In Iraq, more extensive studies are necessary to come out with appropriate guidelines for abetter treatment and outcome of bladder carcinoma which is a major health problem


Article
Bladder Mucosal Pathological Changes Accompany High Grade and Squamous Cell Bladder Tumors

Author: Jassim Mohammad Alkhazraji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 4 Pages: 536-541
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Carcinoma of the bladder is the second most common cancer in Iraq. The status of the bladderurothelium other than the principal lesions can provide distinct diagnostic information with regard totreatment response and outcome. Positive mucosal biopsy results are a significant indicator ofintravesical recurrence. Currently, in our urological practice, the importance of performing this step incystoscopy is relatively underestimated.OBJECTIVE:The objective of this study is to carry out a histological assessment of 'extra-tumor' bladder mucosa fordysplasia, and correlate the resulting findings of dysplasia with the grade, the type, and the macroscopicappearance of the tumor.MATERIALS AND METHODS:A total of 350 biopsies were taken by cystoscopy from 68 patients admitted with bladder tumors, eitherby cold-cupped biopsy forceps or resectoscope as part of TUR of the tumor. Normal-looking mucosa ofthe bladder was included in each patient's biopsy in a four quadrant way. All biopsies were examinedby the same histopathologist. All patients were managed according to their presentation, cystoscopicand histopathological findings.RESULTS:Statistical analysis showed that the highest significant difference was obtained in patients with tumorgrade, low against high grade (p<0.005). However, a noticeable difference was found in the other twocomparison groups, namely, the type, transitional against squamous and the macroscopic appearance,papillary against solid (p<0.05).CONCLUSION:The high grade, solid tumors and squamous cell carcinoma are associated with general bladder mucosaldysplastic changes which may exclude the bladder preserving procedures as an option of surgicaltreatment. In Iraq, more extensive studies are necessary to come out with appropriate guidelines for abetter treatment and outcome of bladder carcinoma which is a major health problem.


Article
The Efficacy of the Antimuscarinic Drug Oxybutynin in the Treatment Women with Overactive Bladder (OAB) Symptoms

Authors: Jassim Mohammad Alkhazraji --- Ban Dawood Mahmood
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 282-287
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: INTRODUCTION:Overactive bladder is a symptom basedsyndrome and defined by the InternationalContinence Society (ICS) as urgency, with orwithout urgency incontinence, usually withfrequency and nocturia, if there is no proveninfection or other obvious pathology (1). * Department of Urology, Al-Karama TeachingHospital; Baghdad. ** Department of Gynecology and Obstetrics,Ibn Al-Baladi Hospital; Baghdad. BACKGROUND: Overactive bladder (OAB) is a symptom based syndrome. These symptoms include: urgency, withor without urgency incontinence, usually with frequency and nocturia with no proven infection orother pathology. It is encountered in women visiting urodynamic units as part of mixed urinaryincontinence (MUI). It greatly affects physical and social activities. Incontinence is often the keysymptom for the assessment of OAB symptoms and the decision to treat patients. Antimuscarinicdrugs are the main agents used to treat this condition. Oxybutynin (immediate-release) 5 mg orallyis the main available form in our clinical practice. OBJECTIVE: The objective of this study is to assess the efficacy of Oxybutynin immediate-release (OXY-IR) 5mg oral tablets, in the treatment of women with overactive bladder, i.e. reduction in episodes ofurge incontinence, total incontinence, and micturition frequency. MATERIALS AND METHODS: Twenty-five patients, age range from 18-75 years, diagnosed as having overactive bladdersymptoms were treated with Oxybutynin immediate-release (IR) 5 mg tablets 2-3 times daily for 8weeks period. Homma OAB symptom score system was used for assessment of treatment efficacy.Cystometry was done in all patients to look for detrusor overactivity. RESULTS:After Oxybutynin treatments, all the parameters in micturition patterns improved significantly:frequency, nocturia, urgency (p value < 0.005). Homma overactive bladder symptoms scores alsoimproved following the treatment (p value <0.001). Cystometric examination revealed the presenceof detrusor overactivity in 20 of the 25 (80%) patients at presentation. This was reduced to 4/25(16%) following treatment. About two-thirds (64%) of the patients reported good to great benefitfrom the treatment and had a positive effect on their life concerning physical and social activity,sleep and feeling of well-being. CONCLUSION: The selective antimuscarinic agent Oxybutynin (OXY-IR) 5 mg 2-3 times orally is effective intreating overactive bladder symptoms in these women by reducing incontinence attacks, urgency,micturition times and nocturia; consequently, it improves their life quality. We recommenddevising a score system for OAB suiting Iraqi patients

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