Biomedical subjects

Philippe Sebe

Publications and source records attributed to Philippe Sebe.

At least 19 recordsLinked to original sources

PubMed2005

Fetal development of striated and smooth muscle sphincters of the male urethra from a common primordium and modifications due to the development of the prostate: an anatomic and histologic study.

BACKGROUND: The aim of the study was to investigate the development of the human urethral sphincter complex during fetal development. METHODS: 23 human male fetal specimens were investigated. The histological sections were processed according to the epoxy resin-based plastination technology. RESULTS: At 9th week of gestation, a combined sphincteric primordium of the rhabdosphincter and the lissosphincter is situated at the anterior and lateral aspects of the membranous and prostatic urethra. Both muscular components assume an omega-shaped configuration due to the presence of a constant connective tissue raphe posterior to the urethra that anchors the rhabdosphincter in the perineal body. Development of the prostate laterally and posteriorly does not modify the growth of the urethral sphincter complex anteriorly but inhibits its development laterally and posteriorly. CONCLUSIONS: The important morphological characteristics of the male adult rhabdosphincter and lissosphincter can be seen very early in fetal development.

Fetal Development↗

PubMed2005

An embryological study of fetal development of the rectourethralis muscle--does it really exist?

PURPOSE: The so-called rectourethralis muscle is widely described in the urological literature. However, its description is subject to variations concerning extent and morphology. Moreover, little is known about its fetal development, which would allow a better understanding of the adult anatomy. The aim of this study was to investigate the morphology, extent and development of the rectourethralis muscle in fetal specimens. MATERIALS AND METHODS: A total of 15 normal human male fetuses were included in the study. Age ranged from 13th week of gestation to term. The histological study used plastination and standard and immunohistochemical techniques to identify the developing muscular structures in serial sections of the rectourethral space. Investigations in all 3 planes (coronal, sagittal and transverse) were performed. RESULTS: In all sections of the proximal aspect of the rectourethral space no developing muscle fibers could be identified leaving the anterior wall of the rectum to join the rhabdosphincter or the apical prostate. In the distal aspect of the rectourethral space an independent muscular structure located between the external muscular layer of the anorectal canal and the dorsal bundles of the rhabdosphincter could be clearly demonstrated. This structure consisted of connective, smooth and striated muscle tissue, and was deeply anchored to the apical perineal body. CONCLUSIONS: This study suggests that the so-called rectourethralis muscle is a misnomer in the urological literature. In the fetal period a developing muscular structure could be clearly identified as a part of the apical perineal body, which would correspond to the rectoperinealis muscle in the adult.

Humans↗

PubMed2005

Fetal development of the female external urinary sphincter complex: an anatomical and histological study.

PURPOSE: We investigated the fetal development of the smooth (lissosphincter) and striated (rhabdosphincter) female external urinary sphincter. Growth and organization of the muscle fibers around the urethra and morphological modifications due to the development of the vagina were analyzed in detail. MATERIALS AND METHODS: A total of 28 human female fetal specimens were investigated in an anatomical and histological study. The sections were processed according to plastination technology. This technique allows examination of structures and organs of the small pelvis with minimal artifacts in all 3 planes. RESULTS: At gestational week 9 the primordium of the external urethral sphincter complex was observed extending along the anterior aspect of the urogenital sinus, before the development of the primitive urethra and the vaginal primordium. From 15 weeks of gestation the lissosphincter and rhabdosphincter could be identified and clearly distinguished. After 20 weeks of gestation both elements acquired an omega-shaped configuration with a narrow posterior connective tissue raphe that was constantly present, fixing both components to the ventral vaginal wall. Both muscles were mainly located in the middle third of the urethra. In the proximal third of the urethra growth of the vagina led to disappearance of the striated muscle fibers of the rhabdosphincter, whereas the lissosphincter seemed to intermingle with the internal layer of the detrusor musculature of the bladder. CONCLUSIONS: The important morphological characteristics of the female adult rhabdosphincter and lissosphincter (omega-shaped configuration, presence of a narrow connective tissue raphe posteriorly and maximum thickness in the middle third of the urethra) are already evident early in fetal development and do not evolve during postnatal growth or by the influence of sex hormones.

Female↗

PubMed2005

[Value of infrared spectrophotometry morpho-constitutional analysis of double J stent encrustations for indirect determination of urinary stone composition].

INTRODUCTION: A single stone analysis is necessary during the patient's clinical history in order to institute specific drug treatment and health and dietary measures to prevent stone recurrence. In practice, only one in every two stones is recovered for morpho-constitutional analysis. The objective of this study was to determine the place of double J stent encrustation analysis for indirect determination of stone composition. MATERIAL AND METHODS: Double J stents and stones from all patients treated in the same centre over 24 months were consecutively analysed by infrared spectrophotometry. The correlation coefficient 1, evaluating the concordance between the composition of stones and double J stent encrustation was estimated statistically by SPSS 12.0 software (0<1<1; 1=0: no concordance; 1=1: perfect concordance). RESULTS: 45 males and 27 females with a mean age of 45.3 years (range: 29-70) were included Double J stents were placed for: febrile obstruction (N=52; 72%), acute renal colic (N=15; 21%) and impaired renal function (N=5; 7%). Calculated values for 1 were: 0.78 for the concordance between the predominant constituent of the stone and the encrustation (N=72; p < 0.0005); 0.91 for the concordance between the nature of the encrustation of the upper loop and that of the lower loop of the stent (N=30, p < 0.0005). CONCLUSION: The composition of mineral encrustation of double J stents is a good marker of stone formation. This constitutes an alternative method that can be used by urologists when no stone is available for spectrophotometric analysis.

Adult↗

PubMed2005

[Comparative study of two latest generation flexible ureterorenoscopes].

INTRODUCTION AND OBJECTIVES: Miniaturization and development of flexible instruments have led to the development of flexible ureterorenoscopy. The objective of this study was to compare the capacities of active deflection of two latest generation flexible ureterorenoscopes and to evaluate alteration of deflection and flow of irrigating fluid in the presence of instruments in the operating channel. MATERIAL AND METHODS: Two ureterorenoscopes were evaluated in this study. The Karl STORZ Flex-X and the ACMI DUR-8 Elite. Comparison of deflection movements was performed ex situ by super-imposing all active movements of the two ureterorenoscopes. Alteration of deflection was performed by alternately placing an extraction or fragmentation instrument of variable dimensions in the operating channel. Alteration of flow was also assessed in the presence of the same instruments. RESULTS: The ex situ deflection capacities of the DUR-8 Elite flexible ureterorenoscope were more extensive than those of the Flex-X, but it was more complicated to manipulate. Alterations of deflection and flow of irrigation fluid were comparable for the two ureterorenoscopes. CONCLUSION: On the basis of these data, we can confirm that the two latest generation ureterorenoscopes present comparable capacities, but different functioning modalities. We therefore recommend that each operator test the two ureterorenoscopes to become familiar with their manipulation. Other studies are necessary to evaluate the optical properties, ease of use in clinical practice and fragility of these new ureterorenoscopes.

Equipment Design↗

PubMed2004

Radical retropubic prostatectomy in men younger than 45 years diagnosed during early prostate cancer detection program.

OBJECTIVES: To evaluate the incidence and outcome of prostate cancer in men younger than 45 years of age treated with radical retropubic prostatectomy after screening in an early prostate cancer detection program. METHODS: Our study group comprised 19,302 men younger than 45 years old who participated in this program. The indications for prostate biopsy were a prostate-specific antigen (PSA) level of 1.25 ng/mL or greater and a percent-free PSA value of 18% or less. Patients with prostate cancer underwent nerve-sparing radical retropubic prostatectomy. Intraoperative and early postoperative complications, clinical and pathologic stage, Gleason score, and surgical margins were reviewed retrospectively. In addition, potency, continence, and biochemical recurrence were assessed at the last follow-up visit. RESULTS: Of the study population eligible for prostate biopsy (1027 patients), only 175 (17%) consented to undergo the procedure (mean PSA 3.8 ng/mL). Twenty-eight men were diagnosed with prostate cancer, corresponding to 0.14% of the screened population and 16% of the biopsied patients. Twenty-six patients agreed to undergo radical retropubic prostatectomy. Pathologic examination revealed organ-confined disease in 22 (84.6%) and extraprostatic extension in 4 (15.4%). Positive surgical margins were seen in 2 patients (7.7%). The Gleason score was 7 or greater in 11 (42.3%) and 6 or less in 15 patients (57.7%). During a mean follow-up period of 15.8 months (range 3 to 36), all patients were continent, and 13 of the 16 patients with a follow-up of 12 months or longer were potent. CONCLUSIONS: In a large screening population younger than 45 years old, 16% of biopsied patients were positive for prostate cancer. These tumors were clinically significant but of a low stage and therefore potentially curable by surgery.

Adenocarcinoma↗

PubMed2004

Three-dimensional ultrasound guidance for percutaneous drainage of prostatic abscesses.

OBJECTIVES: To evaluate the feasibility and effectiveness of three-dimensional ultrasound-guided transperineal puncture and drainage of prostatic abscesses. METHODS: Between 1985 and 2003, a prostatic abscess was diagnosed in 22 patients. One of the therapeutic modalities used to drain the abscesses was transperineal puncture under three-dimensional ultrasound guidance. The postoperative results were compared with the outcomes of other modalities. RESULTS: The average patient age was 52 years. Predisposing factors were present in 12 patients. Transperineal puncture was performed in 7 patients under general anesthesia. In addition to antibiotic therapy, a nephrostomy tube was left in place in all cases for a mean period of 3 days to drain the abscess. All patients were treated effectively without additional therapy or complications. CONCLUSIONS: Three-dimensional ultrasound-guided transperineal puncture is a minimally invasive and effective technique for the treatment of prostatic abscesses.

Abscess↗

PubMed2004

Fate of implanted syngenic muscle precursor cells in striated urethral sphincter of female rats: perspectives for treatment of urinary incontinence.

OBJECTIVES: To analyze the outcome of syngenic skeletal muscle precursor cells (MPCs) after implantation in the striated urethral sphincter of the female rat. METHODS: MPCs were isolated from the striated muscles of the lower limbs and infected with a retrovirus carrying the gene for green fluorescent protein. Approximatively 10(5) cells were injected longitudinally in the striated urethral sphincter of 24 animals using a 10-muL Hamilton syringe. The whole urethra was excised at 0, 1, 7, 10, 14, 30, and 90 days after implantation for histologic study and fluorescence analysis of the transections. RESULTS: At days 0 and 1, some small, round, fluorescent MPCs were observed at the injection site. At day 7, significant MPC persistence was noted, with infiltration of inflammatory cells in the whole urethral wall (striated muscle layer, smooth muscle layer, and connective tissue). At day 10, some fusiform cells appeared in the striated muscle layer, suggesting the incorporation of MPCs into the striated myofibers. Inflammatory cells were no longer visible. At day 14, the fusiform cells tended to be larger. The small, round cells were no longer seen. At days 30 and 90, all myofibers of the striated muscle layer were strongly fluorescent, and no fluorescence was detectable in the smooth muscle layer. CONCLUSIONS: Implantation of skeletal MPCs in the urethral sphincter resulted in selective incorporation into striated myofibers. Muscle-derived cell autografting could represent a new approach for the treatment of urinary incontinence in humans.

Animals↗

PubMed2004

Prostatic capsule- and seminal-sparing cystectomy for bladder carcinoma: initial results for selected patients.

OBJECTIVE: To evaluate the oncological outcome and functional results of prostate-sparing cystectomy (PSC), proposed for treating bladder cancer, used since 1999 in our institution in an attempt to preserve male sexuality and to increase continence after cystectomy. PATIENTS AND METHODS: Between January 1999 and December 2001, 111 men were candidates for cystectomy; 42 were selected for a prostatic capsule- and seminal-sparing cystectomy with orthotopic urinary diversion. All patients had clinically organ-confined tumours (clinical stage </= T2, N0M0). The first stage of the procedure was a transurethral resection of the prostate to exclude the involvement of transitional cell carcinoma (TCC) in the prostate. RESULTS: Eight patients were excluded from PSC because they had TCC (seven) or prostate adenocarcinoma (one). The mean age of the remaining 34 patients was 61 years and all underwent PSC. After a mean follow-up of 26 months, seven patients (21%) had a recurrence; one developed a local recurrence, there were widespread metastases in six (18%), and five had histologically confirmed organ-confined tumour (T1-2N0M0). Rates for daytime and night-time continence were 90% and 85%, and in 29 patients potency was unchanged. CONCLUSION: These early results suggest that PSC is not equivalent to radical cystoprostatectomy for bladder cancer control, despite marked improvements in the functional results. Moreover, in carefully selected patients this approach appears to dramatically increase an unusually high metastasis rate. Therefore, the indications for PSC should be either clearly well defined or abandoned in these patients.

Adenocarcinoma↗

PubMed2004

[Laparoscopic nephrectomy for benign kidney disease. Review of a 12-year experience and review of the literature].

Based on 12 years of experience, laparoscopic nephrectomy has become the reference approach to benign kidney disease. This technique is effective, safe and reproducible. The complication rate is comparable or even lower than that of open nephrectomy and the postoperative course is more favourable. Based on a review of the literature, this paper reviews the technique, indications and results of laparoscopic nephrectomy for benign kidney disease.

Adult↗

PubMed2003

The striated urethral sphincter in female rats.

The aim of this study was to give a microscopic description of the organization, the innervation and the slow or fast type of the striated fibers of the external urethral sphincter in the female rat. Conventional methods for photonic microscopy and immunochemistry were applied to cross and longitudinal sections of snap-frozen urethra. With hematoxylin-eosin stained cross sections, striated fibers are of small diameter and attached directly to the surrounding connective tissue. They are innervated by cholinergic endplates as shown by acetylcholinesterase techniques and alpha-bungarotoxin binding. The histological aspects of the cross sections as well as the distribution of endplates along the length of the sphincter suggest an organization of the fibers in four bundles, possibly acting as a photographic diaphragm does. Like striated skeletal muscle fibers, the fibers bind monoclonal antibodies against dystrophin with subsarcolemmal distribution and against desmin which visualizes striations. All the fibers express fast myosin heavy chains and very few co-express slow myosin heavy chains as determined by immunocytochemistry. We are taking advantage of the diaphragmatic organization of the striated sphincter to develop a longitudinal section as a model of chronic incontinence to test the efficiency of grafted myoblasts provided by fast striated skeletal muscle.

Acetylcholinesterase↗

PubMed2003

Combined reporting of cancer control and functional results of radical prostatectomy.

INTRODUCTION: The results of radical prostatectomy (cancer control, continence and sexual potency) are currently presented separately, while the success of this surgery depends on a combination of good cancer control with maintenance of continence and erections. We propose a score to jointly evaluate and report cancer control and functional results. METHODS: The results of 205 radical prostatectomies were studied at one year. Cancer control was evaluated by PSA. Continence and sexual potency were evaluated by a self-administered questionnaire. Each patient was attributed 0 or 4 points according to the presence of absence of biochemical progression (PSA>0.2 ng/ml), 0 or 2 points according to the presence or absence of urinary incontinence (use of pads) and 0 or 1 point according to the presence or absence of impotence (no erections). The sum of these points provided a score classifying the patient into 8 distinct categories, from 0 to 7, each corresponding to a specific status (from 0 (0+0+0): no cancer control-incontinence-impotence to 7 (4+2+1): cancer control-continence-sexual potency). RESULTS: One year after the operation, 175 (85%) of patients had a PSA less than 0.2 ng/ml, 135 (65.8%) were continent and 64 (32.7%) reported erections. All patients with a score > or =4 had good cancer control, with no functional disorders for a score of 7 (4+2+1) (20%), no disorders of continence for a score of 6 (4+2+0) (31.5%), no disorders of erection for a score of 5 (4+0+1) (8.3%), or with incontinence and impotence for a score of 4 (4+0+0) (21.9%). All patients with a score <4 had a PSA>0.2 ng/ml, but with no functional disorders for a score of 3 (0+2+1) (2.4%), no incontinence for a score of 2 (0+2+0) (8.3%), and no impotence for a score of 1 (0+0+1) (1.9%). 1.9% of patients were incontinent, impotent and showed signs of biochemical progression (score 0=0+0+0). CONCLUSION: This score allows analysis of the global (cancer control and functional) results of radical prostatectomy and would facilitate comparisons between various surgical techniques (type of approach, nerve-sparing techniques) and various centres.

Aged↗

PubMed2003

[Prognostic value of the localization of positive resection margins after radical prostatectomy for intraprostatic tumors].

OBJECTIVE: To evaluate the risk of biochemical recurrence of organ-confined prostate cancer (pT2+) after radical prostatectomy, according to the site of positive resection margins. MATERIAL AND METHODS: 649 radical prostatectomies were performed between 1988 and 2002 for organ-confined tumours in 436 cases (stage pT2). Preoperative (clinical stage, PSA assay and Gleason score on biopsies) and post-operative data (weight of the resection specimen, Gleason score and tumour volume) were recorded as a function of the site of positive resection margins. Biochemical recurrence was defined by a PSA level greater than 0.2 ng/ml. Biochemical progression-free survival was studied according to the Kaplan-Meier method, as a function of the site of positive resection margins. RESULTS: Sixty-six patients (15.1%) had a single positive margin. With a mean follow-up of 52.9 months (range: 1.1 to 160.4 months), eleven patients (16.6%) developed biochemical recurrence. The mean progression-free survival was 7.8 months. An apical positive resection margin was associated with the most unfavourable prognosis compared to other sites. CONCLUSION: Apical positive resection margins appear to be associated with a poorer prognosis than other sites. This study confirms that dissection of the apex is essential to ensure optimal tumour control and prognosis in organ-confined prostate cancer.

Humans↗

PubMed2003

[Simple nephrectomy with retroperitoneal laparoscopy].

OBJECTIVE: Nephrectomy was one of the very first urological procedures to be performed by laparoscopy. The objective of this study was to evaluate the results of retroperitoneal laparoscopic simple nephrectomy. METHODS: From 1995 to 2002, 88 retroperitoneal laparoscopic simple nephrectomies were performed in 87 patients with a mean age of 45.3 years (range: 18 to 77 years). The intraoperative and postoperative complications, conversion rate, blood loss, operating time and length of hospital stay were studied for each patient. RESULTS: The mean operating time was 114 min (range: 35 to 280 min), mean blood loss was 97.6 ml (range: 0 to 300 ml), there were 3 conversions (3.4%) and the mean length of hospital stay was 4.7 days (range: 2 to 13 days). The main postoperative complications were 2 cases of haematoma and one abscess of the nephrectomy site requiring surgical revision and 3 intraoperative thromboses of arteriovenous fistulas in 3 patients with polycystic kidney disease. CONCLUSION: Due to its low morbidity, laparoscopic simple nephrectomy has probably become the, reference technique for all indications for nephrectomy for benign disease.

Adolescent↗

PubMed2003

[Superficial grade G2 tumors of the bladder: recurrence, progression, prognosis].

OBJECTIVE: The primary objective of this study was to describe the course of a series of grade 2 noninvasive urothelial carcinomas and to determine their prognosis by establishing recurrence, progression and mortality rates The initial histological and endoscopic characteristics were analysed in order to identify risk factors for recurrence and progression towards detrusor invasion. MATERIAL AND METHODS: This retrospective study was conducted on 75 patients with initially grade 2 superficial bladder tumours. Tumours were initially multifocal in 47% of cases and were classified as follows: 52 pTa tumours (69%) and 23 pT1 tumours (31%). The mean follow-up was 58 months. RESULTS: After the initial endoscopic resection, 26 patients (3.9%) received adjuvant therapy by intravesical instillations. The overall recurrence and progression rates in this series were 67% and 7%, respectively. Twelve patients (16%) underwent cystectomy. The specific mortality rate was 2.6%. Among the initial prognostic criteria, only the multifocal nature was identified as a risk factor for recurrence and progression towards detrusor invasion. CONCLUSION: This study confirmed the uncertain prognosis of grade 2 superficial bladder tumours. These tumours have a high recurrence risk with a cystectomy rate of 16%. These tumours require surveillance identical to that of high-grade tumours, at least half-yearly for the first 3 years then annually thereafter.

Adult↗

PubMed2003

[How to present in a unique fashion the oncologic and functional results after radical prostatectomy].

INTRODUCTION: The results of radical prostatectomy (cancer control, continence and sexual potency) are currently presented separately, while the success of this surgery depends on a combination of good cancer control with maintenance of continence and erections. We propose a score to jointly evaluate and report cancer control and functional results. METHODS: The results of 205 radical prostatectomies were studied at one year. Cancer control was evaluated by PSA and continence and sexual potency were evaluated by a self-administered questionnaire. Each patient was attributed 0 or 4 points according to the presence or absence of biochemical progression (PSA > 0.2 ng/ml), 0 or 2 points according to the presence or absence of urinary incontinence (use of pads) and 0 or 1 point according to the presence or absence of impotence (no erections). The sum of these points provided a socre classifying the patient into 8 distinct categories, from 0 to 7, each corresponding to a specific status (from 0 (0 + 0 + 0): no cancer control-incontinence-impotence to 7 (4 + 2 + 1): cancer control-continence-sexual potency). RESULTS: One year after the operation, 175 (85%) of patients had a PSA less than 0.2 ng/ml, 135 (65.8%) were continent and 64 (32.7%) reported erections. All patients with a score > or = 4 had good cancer control, wit no functional disorders for a score of 7 (4 + 2 + 1) (92%), no disorders of continence for a score of 6 (4 + 2 + 1) (31.5%), no disorders of erection for a score of 5 (4 + 0 + 1) (8.3%), or with incontinence and impotence for a score of 4 (4 + 0 + 0) (21.9%). All patients with a score < 4 had a PSA > 0.2 ng/ml, but with no functional disorders for a score for 3 (0 + 2 + 1) (2.4%), no incontinence for a score of 2 (0 + 2 + 0) (8.3%), and no impotence for a score of 1 (0 + 0 + 1) (1.9%). 1.9% of patients were incontinent, impotent and showed signs of biochemical progression (socre 0 = 0 + 0 + 0). CONCLUSION: This score allows analysis of the global (cancer control and functional) results of radical prostatectomy and would facilitate comparisons between various surgical techniques (type of approach, nerve-sparing techniques) and various centres.

Aged↗

PubMed2003

[Organization and innervation of striated muscle fibers of the striated sphincter in the rat].

OBJECTIVES: To determine the organization of striated muscle fibre (FMS) of the rat striated sphincter (SS) and to characterize the motor endplates (MEP). MATERIAL AND METHODS: The urethras of 30 male and female rats were studied. Two thousand hematein-eosin stained serial sections and 800 sections simultaneously stained for MEPs and nerve endings were studied. RESULTS: The SMFs of the SS are organized in the urethral wall in four symmetrical bands. MEPs are predominantly found in the cranial third of the SS (22 MEPs per section). Sixty sixteen per cent of MEPs were situated in the lateral regions. Motor units were composed of a maximum of five SMFs. CONCLUSION: The SMFs of the SS are organized in four symmetrical bands. Myoconnective insertions of SMFs emphasize the importance of the connective tissue in their contractile action. They are innervated by a single MEP, in the same way as skeletal striated muscle fibres. In the SS, MEPs are predominantly located laterally to the right and to the left. The specific organization of motor units suggests an original mechanism of reinforcement of muscle contraction of the SS.

Animals↗

PubMed2002

Prognostic value of p53 overexpression in T1G3 bladder tumors treated with bacillus Calmette-Guérin therapy.

OBJECTIVES: To evaluate the correlation between the overexpression of mutant protein p53 and disease recurrence and progression in patients treated with bacillus Calmette-Guérin (BCG) intravesical therapy for T1G3 bladder cancer. METHODS: We analyzed the outcome of 29 consecutive patients treated for T1G3 bladder tumor with transurethral resection. Patients previously treated for a bladder tumor, those who underwent incomplete resection, and those in whom no assessment of the muscle cell layer was possible were excluded from the study. p53 overexpression was determined using monoclonal p53-DO7 antibody, with a 20% cutoff for definition of positivity. After the initial transurethral resection, all patients were treated with Pasteur BCG (75 mg in 50 mL saline), weekly for 6 weeks. The correlation between p53 overexpression and disease recurrence and progression was assessed by the Fisher exact test. RESULTS: The median follow-up was 36.7 months (range 1 to 108). Of the 29 patients, 18 (62.1%) were p53 positive and 11 (37.9%) were p53 negative. Both groups were similar according to age, tumoral substage (T1a/T1b), association with carcinoma in situ, multifocality, and length of follow-up. The recurrence rate was 54.4% in the p53-negative group versus 38.9% in the p53-positive group (P = 0.47). The progression rate was 18.2% in the p53-negative group versus 33.3% in the p53-positive group (P = 0.67). CONCLUSIONS: These findings suggest that overexpression of p53, as determined immunohistochemically, has no predictive value for recurrence and progression in T1G3 bladder cancers treated with intravesical BCG.

Administration, Intravesical↗