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PubMed2004

Bladder neck stenosis after transurethral resection of prostate: does size matter?

AIM: To understand the risk factors associated with the incidence of bladder neck stenosis (BNS) after transurethral prostate surgery. PATIENTS AND METHODS: We retrospectively reviewed 900 patients who underwent transurethral prostate surgery over a 4-year period. The mean age of the men was 72.3 (47-94) years. The specific outcome data assessed related to BNS, including type of operation performed, resected tissue weight and history of previous surgery in the lower urinary tract. RESULTS: 29 (3.4%) patients developed BNS at a mean of 10.3 (3-33) months, with a mean resected prostatic tissue weight of 11+/-3.7 g. Four of the 29 patients with BNS were treated with bladder neck resection and re-stenosed. Fifty-four men underwent bladder neck incision for small prostates with a high bladder neck, measured by digital rectal examination and assessed cystoscopically, with no BNS. All the remaining patients from our series did not have a BNS, with a mean resected weight of 28+/-8.9 g, which is statistically greater than in the BNS group (p<0.05, unpaired t test). CONCLUSIONS: BNS after transurethral prostate surgery is a significant problem. It is clear from our study that resection in small prostates with no sign of a high bladder neck will increase the development of BNS. Thus, small prostates should be managed by an initial bladder neck incision, even if the bladder neck is not high.

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PubMed2004

Second transurethral resection of superficial transitional cell carcinoma of the bladder: a must even for experienced urologists.

INTRODUCTION: As even experienced urologists have a high percentage of persisting carcinoma after transurethral bladder tumour resection (TUR-B) the importance of a routine second resection in the management of transitional cell carcinoma (TCC) of the bladder is defined. PATIENTS AND METHODS: The medical records of all patients treated with TUR-B at our institution between January 1989 and September 2000 were reviewed. 214 patients with pTa and pT1 carcinoma undergoing a second resection 4-6 weeks later were included in the analysis. The rate of persisting carcinoma in the second resection was compared to the actual tumour stage and grade, the patient's age, sex and the experience of the urologist performing the resection. RESULTS: Of the 214 patients 99 had pTa and 115 pT1 carcinoma. The rate of persisting tumour in the second resection was 27% in pTa and 37% in pT1 carcinoma. This rate was independent of the patient's age and sex. Urologists in training had an equally low rate of persisting carcinoma in the second resection compared to senior urologists (p = 0.08). CONCLUSIONS: Routine second resection of superficial transitional cell carcinoma of the bladder should be part of the treatment even in larger operative experience.

Adult↗
PubMedDate not supplied

Postoperative bladder washing cytology after transurethral resection. Can it predict the recurrence of urothelial carcinoma?

OBJECTIVE: To assess the ability of postoperative bladder washing cytology, performed immediately after transurethral resection of mostly stage Ta or T1 papillary urothelial carcinoma, to predict early recurrence. STUDY DESIGN: In a 1-year period, preoperative and postoperative bladder washing cytology specimens were sampled from patients undergoing transurethral resections in which all visible tumor was removed. There were 38 resections in 32 patients. RESULTS: Postoperative cytology was satisfactory in 35 of 38 cases and positive in 17 (49%) after a mean of 6.9 months. Follow-up of these 35 transurethral resections disclosed a 15/17 (88%) recurrence rate after positive cytology and a 4/18 (22%) recurrence rate after negative cytology (P < .001). Postoperative cytology demonstrated a sensitivity for recurrence of 79%, specificity of 88%, positive predictive value of 88% and negative predictive value of 77%. In contrast, tumor in the transurethral resection specimen had a positive predictive value of 54% for recurrence, and its grade and stage were inferior to cytology in predicting recurrence. CONCLUSION: Postoperative bladder washing cytology is a useful adjunct to the management of papillary urothelial carcinoma. A positive result, signifying residual tumor, should encourage prompt follow-up and possibly repeat transurethral resection.

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PubMed1985

[Significance of local tumor associated infiltration of mononuclear leukocytes for persistent tumor formations following transurethral resection (TUR) of bladder cancers].

In 140 patients with primarily curatively resected tumour of the urinary bladder the inclination to persistence was investigated in relation to the local peritumoural infiltration of leucocytes. 19% of the tumours with cellular infiltration and 33% of the tumours without cellular infiltration showed persistent tumour formations. Altogether 30 (21%) of the 140 tumours were persisting. The following parameters were found in persistent tumour formations: Multifocal tumours have a higher persistence rate than isolated primary tumours. With increasing degree of malignancy (G) the rate of persistence is elevating. It seems that in differentiated transurethral resection (separate resection of the exophyte, the tumour basis, resection of the marginal wall, if necessary, with second look operation) the local depth spreading of the tumour has no influence on the rate of persistence. Tumours without peritumoural infiltration with mononuclear leucocytes show a higher persistence rate than tumours with cellular infiltration, in which case this difference becomes even more significant with advanced tumour formation (T) and degree of malignancy (G).

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PubMed2003

[Ureteral and bladder metastases of renal cell carcinoma following synchronous renal cell carcinoma and bladder cancer; a case report].

A 73-year-old man presented with gross hematuria. Ultrasonography and computerized tomography showed small bladder tumors and a left renal mass protruding to renal pelvis. Transurethral resection of bladder tumor and ureteroscopic tumor biopsy were performed, and pathological examinations revealed transitional cell carcinoma in the bladder and renal cell carcinoma in the kidney. He underwent left radical nephrectomy. A 4-month postoperative cystoscopy revealed a solitaly non-papillary tumor in the bladder. Transurethral resection was performed and pathological diagnosis was metastasis from renal cell carcinoma. At that time, multiple metastases to ureteral stump and lung were found. He had undergone palliative treatment because of his poor general condition until he died 26 months postoperatively. Care should be taken for management of ureteral stump when diagnostic ureteroscopy was done for renal cell carcinoma invading the renal pelvis.

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PubMed2005

Comprehensive study of bladder neck contracture after transurethral resection of prostate.

OBJECTIVES: To test the validity of transurethral resection of the prostate (TURP) plus transurethral incision (TUI) of bladder neck as an alternative to TUI of the prostate, a nonrandomized and retrospective study was done to review comprehensively the incidence of, severity of, and risk factors for bladder neck contracture (BNC) in patients with benign prostatic hyperplasia who underwent transurethral surgery. METHODS: The evaluation parameters included age, prostate-specific antigen level, urinalysis and uroflowmetry findings, voided volume, presence of vesical stones and urinary retention, surgical type, adenoma weight, and perioperative morbidities. RESULTS: Of the 1470 patients studied, 1135 (77.2%) were eligible for analysis. At a mean follow-up of 37.9 months, 110 patients (9.7%) had developed BNC. The adenoma weight, blood transfusion, and postoperative maximal and mean flow rate in patients with BNC were significantly less than in patients without BNC. The incidence of BNC in the TURP group was greater than that in the TURP plus TUI group (12.3% versus 6%, P = 0.000). BNC was completely prevented using TURP plus TUI if the adenoma weight was greater than 30 g. However, in the TURP group, 4% of patients developed BNC even with an adenoma weight greater than 50 g. Multivariate analyses showed that adenoma weight and surgical type were significant risk factors for BNC. Patients with associated vesical stones were less prone to develop BNC. CONCLUSIONS: TURP plus TUI provides a pathologic diagnosis, and with minimal morbidity, it can be an alternative to TUI of the prostate in selected patients. Personal diathesis may play a role in the pathogenesis of BNC.

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PubMedDate not supplied

Cost analysis of neodymium-YAG laser versus transurethral resection treatment of superficial bladder carcinoma.

We have analyzed a group of patients treated by various urologists with both neodymium-YAG laser photoirradiation and transurethral resection in the treatment of superficial bladder carcinoma. The average hospitalization for the group of patients treated by the laser was significantly shorter than the group of patients treated by transurethral resection of the bladder tumor. The complications were similar. The cost savings to patients treated by laser photoirradiation appears to be significantly greater in laser groups of patients as opposed to conventional transurethral resection techniques.

Adult↗
PubMed1991

Oral or intravesical bacillus Calmette-Guerin immunoprophylaxis in bladder carcinoma.

A total of 71 patients with superficial transitional cell carcinoma underwent transurethral resection of bladder tumor. All patients had stage pTa or pT1 transitional cell carcinoma or carcinoma in situ without other concurrent malignancies. The patients were assigned to 3 treatment groups: control group--transurethral resection discontinued within the study, oral bacillus Calmette-Guerin (BCG) group--transurethral resection of bladder tumor plus BCG (Moreau) and intravesical BCG group--transurethral resection of bladder tumor plus BCG. Of 9 patients in the control group 8 (89%) experienced tumor recurrence during a mean followup of 20 months. Of the 28 patients in the oral BCG group 11 (39.3%) had recurrence during a mean followup of 36 months. Of the 34 patients in the intravesical group 6 (18%) had recurrence in a 24-month mean followup. The incidence of complications was higher in the intravesical (41.2%) than in the oral BCG group (28.5%). These results show that intravesical BCG is a more effective immunotherapy; however, oral BCG can be used in patients who do not accept intravesical BCG administration.

Administration, Intravesical↗
PubMed1986

Mitomycin C plasma levels after intravesical instillation with and without hyaluronidase.

In 20 patients undergoing transurethral resection for bladder tumor or multiple transurethral biopsies for monitoring after transurethral resection, mitomycin C, 20 mg., was instilled into the bladder immediately after the procedure. Mitomycin C was associated with hyaluronidase, 200.000 U, in 10 patients. Serum levels of mitomycin were determined by column chromatography 30 and 60 minutes after instillation. Hyaluronidase was not found to make any difference in mitomycin absorption. Potential expansions of the therapeutic modalities for preventing recurrent bladder tumor by hyaluronidase are discussed.

Combined Modality Therapy↗
PubMed1992

Feasibility of transurethral resection for muscle-infiltrating carcinoma of the bladder: prospective study.

A prospective study was done to evaluate treatment of patients with muscle-infiltrating bladder cancer by transurethral resection exclusively. Inclusion criteria for this study were histological confirmation of muscular bladder infiltration, endoscopic radical transurethral resection, disappearance of hardened areas after transurethral resection, and negative biopsies of the depth and periphery of the tumor bed. The study began in April 1981. The average followup in series 1 (April 1981 to December 1986, 59 patients) was 55.4 months. Actually, of the patients 31 (52.5%) are without evidence of recurrence and 28 (47.5%) have recurrent disease. Of the latter patients 11 (18.6%) had invasive bladder recurrence, including 7 (11.9%) who had recurrence at 3 months, which indicated clinical understaging. Three patients (5%) had metastases without bladder tumor. The remaining 14 patients (23.7%) had superficial bladder recurrence. The overall survival rate was 83% (49 of 59 patients) and 43 patients (72.8%) still retain the bladder. The present data are confirmed by the results of series 2 (December 1986 to August 1989). Therefore, the data would justify conservative management in a selected group of patients with muscle-infiltrating bladder cancer.

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PubMed1998

Absorption of epirubicin instilled intravesically immediately after transurethral resection of superficial bladder cancer.

As postoperative adjuvant therapy for superficial bladder cancer, intravesical instillation therapy is commonly conducted. In this case, from the view point of prevention of intraoperative dissemination, commencement of instillation therapy at an early postoperative period is preferred. However, increased drug permeability is suspected because of damage to the bladder mucosa during operation. Therefore, this study was conducted to investigate the plasma level of epirubicin (EPI) instilled immediately after transurethral operation. EPI (20 mg/40 ml or 50 mg/100 ml) was instilled immediately after a transurethral operation, and retained in the bladder for 1 h. Blood samples were obtained before instillation, as well as 30, 60, 120 and 240 min after instillation, and EPI levels were assayed. The mean EPI concentrations (ng/ml) among the 20-mg/40 ml group (n = 5) were < 2.5 and < 2.0 at 30 and 60 min, respectively, after which they were undetectable. The 50-mg/100 ml group (n = 5) recorded 5.0, 4.4 and < 3.0 after 30, 60 and 120 min, respectively, and after 240 min it was undetectable. Intravesical instillation of EPI immediately after a transurethral operation causes a small increase in the plasma level and it is thought to cause small systemic side effects.

Absorption↗
PubMed1995

Adjuvant treatment with a vitamin A analogue (etretinate) after transurethral resection of superficial bladder tumors. Final analysis of a prospective, randomized multicenter trial in Switzerland.

Vitamin A and its derivatives, the retinoids, have antiproliferative effects and may induce cellular differentiation. Etretinate, a synthetic retinoid, has a more favorable therapeutic index experimentally than all-trans-retinoic acid or 13-cis-retinoic acid. Ninety patients with superficial papillary bladder tumors stages Ta and T1 entered a prospective randomized double-blind multicenter trial in Switzerland. Seventy-nine of the patients were eligible and received either 25 mg of etretinate or a placebo orally each day. The early withdrawal of a significantly greater number of patients in the placebo group for treatment failure during the first year of the study resulted in a secondary positive selection in this group. High-risk patients were removed and low-risk patients remained. In those patients who had tumor recurrences after randomization, the time to first recurrence was similar in both groups with 13.5 and 13.6 months in the placebo and etretinate groups, respectively. However, the mean interval to subsequent tumor recurrence was significantly longer in the etretinate group. The mean interval between recurrences in these subgroups was 12.7 months in the placebo arm and 20.3 months in the etretinate arm (p = 0.006). Consequently, the number of transurethral resections per patient-year was also reduced significantly in the etretinate group (p < 0.001). In patients with more than one transurethral resection of papillary tumors before randomization, the annual transurethral resection rate in the two treatment groups dropped from 1.7 to 1.3 in the 30 patients in the placebo group (NS, p = 0.1) and from 2.1 to 0.95 in the 25 patients in the etretinate group (p < 0.001). The side effects of etretinate (cheilitis, dryness of mucous membranes and skin) were acceptable to most patients. The relationship of the 3 myocardial infarcts observed in the etretinate group to the retinoid is not clear. Despite their significant effect on the recurrence rate of superficial papillary bladder tumors, retinoids should only be used in well-controlled prospective trials until more is known about their dosage-toxicity profiles.

Adult↗
PubMed2005

Outcomes of hand-assisted laparoscopic nephroureterectomy for managing upper urinary tract transitional cell carcinoma--China Medical University Hospital experience.

OBJECTIVES: To report our experience with hand-assisted laparoscopic nephroureterectomy (HALNU) to treat upper urinary tract transitional cell carcinoma (TCC). In addition, we report the treatment of 4 patients with upper urinary tract TCC and synchronous superficial urinary bladder TCC by HALNU and simultaneous transurethral resection of bladder tumor (TURBT). METHODS: We retrospectively reviewed 33 patients who had undergone HALNU. Recovery was evaluated according to the Eastern Cooperative Oncology Group performance status. Four patients had concomitant superficial urinary bladder cancer and underwent simultaneous TURBT at the beginning of surgery. We compared our data with those of our open surgery group and previously published data. RESULTS: Partial recovery had occurred by 1 week and complete recovery by 4 weeks postoperatively. Conversion to open surgery was required in 2 (6%) of the 33 patients. The complication rate was 24% (8 of 33) without any mortality. The recurrence rate of urinary bladder TCC was 6% (2 of 33). Both patients with recurrent tumor were treated successfully by TURBT and bacille Calmette-Guérin instillation. All 4 patients with synchronous superficial urinary bladder TCC had undergone simultaneous transurethral resection of bladder tumor, and all 4 were disease free at the last follow-up visit. CONCLUSIONS: Hand-assisted procedures are appropriate for surgeons with limited experience with laparoscopic surgery. In our study, the convalescence of patients was excellent, and the postoperative results were compatible with those of previous studies. To treat upper urinary tract TCC with synchronous urinary bladder TCC, HALNU and TURBT together seems to be a safe and efficient technique.

Adult↗
PubMed1995

[The presence of muscularis mucosae in the urinary bladder of samples from transurethral resection].

OBJECTIVES: The role of the muscularis mucosae (MM) of the bladder as a distinct histologic structure has been recently recognized. The prognostic implications of its distinction in patients with T1 bladder cancer is a matter of discussion with possible future implications in the classification of bladder cancer. However, the prevalence of this structure in transurethral resection (TUR) biopsies is unknown. METHODS: A retrospective review of 60 bladder biopsies performed by TUR, all deep enough to include smooth muscle, is presented. In 48 cases (80%) superficial urothelial carcinoma (Tis, Ta, Tl) was present, in 9 (15%) biopsy evidenced inflammatory changes, and in 3 (5%) there was no remarkable histologic finding. RESULTS: In 25 cases (42%) MM was identified either total or partially and in 14 cases (23%), although absent, its level was suggested by the presence of large vessels in the subepithelial connective tissue. CONCLUSIONS: The MM of human urinary bladder can be identified in a high proportion of cases after TUR. The prognostic implications of such distinction are discussed.

Adult↗
PubMed1997

[Outpatient treatment of bladder cancer--lower cost and satisfied patients].

Transurethral resection of bladder tumours and recurrences accounts for a substantial part of the workload at a urology unit. With the aim of reducing costs, since 1992 we have performed transurethral resection as an out-patient procedure if possible. Transurethral resection as day surgery in selected patients has been enabled by the use of extirpation and fulguration under cover of intravesical lignocaine (lidocaine) anaesthesia or submucosal lignocaine injection. Before the introduction of the out-patient treatment policy, around 270 transurethral resections of bladder tumours were performed annually at a cost of SEK 5.7 million. During 1994 and 1995, almost half of the procedures could be performed in an out-patient setting, with minimal complications and a very high level of patient acceptance, the respective reductions in costs being SEK 2.4 million and SEK 3.2 million.

Ambulatory Surgical Procedures↗
PubMed1993

Transurethral resection for muscle-invasive bladder cancer.

The perioperative morbidity of local radical transurethral resection performed in 103 patients with muscle-invasive bladder cancer (T2-T3a) was 20%, their mortality 1%. The three- and five-year survivals were 54% and 36%, respectively. Within 5 years after transurethral resection of primary tumours relapses were encountered in 46%, progression in 33% of the cases. The cause of death was tumour in 29% of the patients, and some other disease in 35%. The full thickness transurethral resection combined with adjuvant treatment may be an alternative to cystectomy in selected cases of T2-T3a bladder cancer.

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