Mesane İçi Kematerapötik İlaçların Mesane Fonksiyonu Üzerine Olan Etkileri

AMAÇ: Yüzeyel mesane üroepitelyal tümörleri tedavisinde transüretral rezeksiyon altın standarttır. Transüretral rezeksiyon sonrası gelişebilecek nüks ve ilerlemenin önlenmesi amacıyla yüzeyel mesane tümörlerinin evresine, derecesine, tek veya çok odaklı olmasına, boyutuna ve ilk ya da ikincil tedavi edilmesi gibi ölçütlere bağlı olarak intravezikal kemo/immunoterapi uygulanmaktadır. İntravezikal kemo/immunoterapi alan hastalarda alt üriner sistem semptomları sık olarak görülmektedir. Bu semptomların ortaya çıkmasının sebebi ve mekanizması bilinmemektedir. Bu çalışmadaki amacımız Mitomycin C ve Epirubicin gibi intravezikal kemoterapötik ilaçların sıçan mesane kası şeritlerinin kolinerjik ve pürinerjik ajanlara verdiği in vitro yanıtları nasıl etkilediğini araştırmaktır.YÖNTEMLER: Bu çalışmada 30 adet Wistar Albino dişi sıçan; Mitomycin C grubu, Epirubicin ve kontrol grubu olmak üzere üçe ayrıldı. Mitomycin C grubuna 8 hafta 1 mg/mL 0.1 mL intravezikal haftada 1 kez, Epirubicin grubuna 8 hafta 1 mg/mL 0.1 mL intravezikal haftada 1 kez, kontrol grubuna 8 hafta 0.1 cc % 0.9 NaCl intravezikal haftada 1 kez uygulandı. Tedavinin bitiminden 1 hafta sonra tüm gruplardan alınan mesane şeritleri in vitro olarak değerlendirildi. Karbakol, KCL, ATP, ADP ve elektriksel alan uyarısı ile oluşan kasılma yanıtlarına bakıldı. BULGULAR: Çalışma sonucunda mesane şeritlerinde in vitro olarak yapılan değerlendirmelerde kontrol grubu ile Mitomycin C ve Epirubicin grubunda KCL kasılma yanıtlarında anlamlı fark bulunmazken; Karbakol, ATP ve ADP kasılma yanıtlarında kontrole göre Mitomycin C ve Epirubicin grubunda anlamlı olarak azalmış bulundu. Elektriksel alan uyarısı ile elde edilen kasılma yanıtlarında kontrol ve Epirubicin grupları arasında anlamlı fark saptanmadı. Mitomycin C grubunda ise kontrole göre elektriksel alan uyarısı ile elde edilen kasılma yanıtlarında anlamlı artış saptandı. SONUÇ: Kolinerjik ve pürinerjik ajanlara yanıt azalmış iken elektriksel alan uyarısı ile elde edilen kasılma yanıtlarında beklenebilecek azalmanın olmaması, Mitomycin C grubunda artış olması ve Epirubicin grubunda ise değişiklik olmaması, farklı mekanizmaların bu olayda rol oynayabileceğini düşündürmektedir. Bu konu ile ilgili ileri araştırmalara gerek vardır.

Anahtar Kelimeler:

Mesane Tümörü, Kolinerjik, Pürinerjik, Mitomycin C, Epirubicin.

Investigation of effects of intravesical Chemotherapeutics on Bladder Functions

OBJECTIVE: Transuretral resection is the gold standart method in superﬁcial bladder uroepithelial tumor treatment. Intravesical chemo/immunotherapy is performed in order to prevent recurrence after transurethral resection regarding tumor level and grade, multiplicity, size and first or second time treatment. Lower urinary tract symptoms are seen in patients received intravesical chemo/immunotherapy. Mechanism and causes of these symptoms are unknown. The aim of this study is to investigate if Mitomycin C and Epirubicin, two intravesical chemotherapeutic agents, change in vitro cholinergic and purinergic responses of rat bladder smooth muscle.METHODS: In this study 30 wistar albino rats were separated in three groups each consisting of Mitomycin C group, Epirubicin group and control group. Mitomycin C group received 1 mg/ml 0.1ml intravesical Mitomycin C once a week for 8 weeks, Epirubicin group received 1 mg/ml 0.1ml intravesical Epirubicin once a week for 8 weeks, control group received 0.1 cc % 0.9 NaCl intravesical once a week for 8 weeks. One week after therapy bladder shreds was examined in vitro. Carbachole, KCL, ATP, ADP and electrical field stimulation responses were evaluated. RESULTS: There was no significant difference between Mitomycin C and Epirubicin groups with KCL, whereas Carbachole, ATP and ADP contraction responses were significantly decreased in Mitomycin C and Epirubicin groups as compred to control group. Electrical field stimulation contraction responses were not significantly different between Epirubicin and control groups. Contraction responses showed significant increase in Mitomycin C group with respect to control groups. CONCLUSION: While the decreased response to cholinergic agent and purinnergic, expected from the lack of decrease to response at contractıon alert that is obtained by the electric field warning.Increase the Mitomycin C group and the lack of change in the epirubicin group suggests that different mechanisms may play a role in this case. Further research is required on this object.

Keywords:

Bladder Tumor, Cholinergic, Purinergic, Mitomycin C, Epirubicin.,

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