| BackgroundCystitis glandularis,CG is a kind of chronic hyperplastic disease characterized by urothelial adenoid metaplasia.Although it has been more than 120 years since the first report,the relationship between glandular cystitis and bladder cancer is still unclear.At present,most scholars believe that glandular cystitis has the possibility of malignant change.Clinically,transurethral electric resection combined with bladder infusion chemotherapy drugs or immune agents are commonly used.But patients often have trouble tolerating bladder irritation caused by these drugs.Some patients even develop chemical cystitis,which aggravates their symptoms.With the development of glandular cystitis research,glycosaminoglycan(GAG)layer damaged by various chronic stimuli has attracted more attention,it is located on the surface of the urinary tract skin and inhibits the progression of inflammation of the bladder lining by blocking toxins in the urine and preventing bacteria from sticking to it.Hyaluronic acid is one of the key components of GAG.The repair effect of exogenous supplementation of sodiumhyaluronate(SH)on GAG has been verified in the treatment of various non-bacterial cystitis.While hyperthermia can produce anti-tumor effects through a variety of mechanisms.As a way of hyperthermia,bladder heat perfusion can act on the entire bladder mucosa,which can not only kill the tiny lesions that cannot be removed by electric resection,but also promote the discharge of various metabolic wastes.Based on the respective advantages of intravesical hot irrigation and intravesical instillation of sodium hyaluronate solution,this study evaluated intravesical hot perfusion,intravesical SH and the combination of both as adjuvant treatments for postoperative cystitis glandularis.It is desirable to inquire new strategies for the treatment of cystitis glandularis by analyzing the effects of simple electrodecretion and three different treatment modalities.To investigate the efficacy of plasma electroresection alone and electroresection combined with bladder thermal perfusion,bladder perfusion of sodium hyaluronate and their combination in the treatment of glandular cystitis.MethodsA total of 390 patients who were pathologically diagnosed with cystitis glandularis at People’s Hospital of Henan Province between March 2016 and October 2020 were selected.After randomly coding,the first 372 cases were selected as observed cases,and patients were randomly assigned to group A,B,C and D,93 patients in each group were given: Group A: Transurethral plasma resection of bladder abnormal mucosa;Group B: Bladder thermal perfusion therapy was performed regularly after transurethral resection of abnormal mucosa of bladder with isoelectricity;Group C: Bladder perfusion SH was performed regularly after transurethral plasma resection of abnormal bladder mucosa;Group D: bladder thermal perfusion combined with SH treatment was performed regularly after electroresection.Frequency of instillation: once a week for the first two months for 8 sessions and once a month thereafter for 4 sessions,with a total course of 6 months.All patients completed the core lower urinary tract symptom score scale(CLSS)before operation and 1,3,6,12 months after operation,and reexamined cystoscopy every 3 months to compare the efficacy and safety of four different modalities for the treatment of cystitis glandularis.Statistical analysis was performed by using SPSS 26.0(IBM Company,USA)for the collected data.The measurement data that conformed to normal distribution were expressed as mean ± standard deviation((?)x±s),and the comparison was performed by F-test,while LSD method was used for pairwise comparison,and P<0.05 was considered statistically significant.Measurements that did not follow a normal distribution are presented as median(quartile)[M(Q1,Q3)].Wilcoxon signed rank test was used when comparing within groups.Kruskal-wallis H test was used for comparison between groups.The software automatically corrects the inspection level during pairwise comparison.P<0.05 was considered as statistically significant difference.The comparison of count data between multiple groups was performed using chi square test with correction of test level when pairwise comparisons were made,and P<0.05/m(“m” was the number of pairwise comparisons)was considered statistically significant.ResultA total of 48 patients had dropped out of the trial halfway among 372 patients in the study,giving a dropout rate of 15.6%,and finally total of 324 patients had completed the study.There were no statistically significant differences in baseline data,clinical manifestations,and comorbidities among the patients in each group in this study(P>0.05).In terms of adverse effects: the incidence of adverse reactions was 0%,3.2%,2.2%,5.4% in patients of four groups A,B,C and D respectively.There was no statistically significant difference in the incidence of adverse effects among the groups(P>0.05).In terms of recurrence rate,patients in groups A,B,C and D experienced recurrence rates of 36.3%,16.0%,14.5% and 2.5%respectively,one year after surgery.Among them,group D showed a significantly lower recurrence rate than A,B and C groups(P<0.0083),and groups B,C showed a significantly lower recurrence rate than group A(P<0.0083),but there was no significant difference in recurrence rates between group B and group C(P>0.0083).In terms of CLSS,there was no significant difference in preoperative symptom score among groups A,B,C and D(P>0.05),and the scores of each group were significantly improved at 1,3 and 6months after electroresection(P<0.05),At 12 months after operation,there was no significant difference in group A compared with 6 months after operation(P>0.05),but the scores of other groups were lower than those at 6 months after operation(P<0.05).There was no significant difference in the score among the four groups at 1 month after operation(P>0.05).The scores of the four groups were significantly different at 3months after surgery(P<0.05),among them the scores of the AB,AC,AD,BC and BD groups were significantly different by pairwise comparison(P<0.05),and the scores of CD groups were not significantly different(P>0.05).There were significant differences among four groups at 6 months after surgery(P<0.05).There were statistically significant differences(P<0.05)between AB,AC,AD,BD and CD at 12 months after surgery,but not between BC groups(P>0.05).Conclusions1.Bladder thermal infusion therapy,sodium hyaluronate infusion therapy and the combination of both can improve the lower urinary tract symptoms of patients with cystitis glandularis after electroresection,and reduce the recurrence rate of cystitis glandularis after resection.2.Sodium hyaluronate infusion therapy can relieve lower urinary tract symptoms more quickly than hot bladder perfusion therapy,but there was no significant difference in recurrence rate and symptom improvement one year after operation.3.Bladder thermal instillation therapy,sodium hyaluronate infusion therapy and the combination of both have high safety. |
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