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PubMed2003

Paraganglioma of the urinary bladder: a case report.

Paragangliomas of the urinary bladder are very rare. To date, there are no reliable methods for predicting their clinical behavior, so long-term follow-up is required. We describe a paraganglioma of the urinary bladder in a 32-year-old male who presented with painless gross hematuria. Abdominal ultrasonography revealed a protruding mass with hematoma over the right lateral wall of the urinary bladder. The tumor was not completely resected by transurethral resection of bladder tumor (TURBT) due to intermingling with the bladder wall. Follow-up I131-metaiodobenzylguanidine was performed 3 weeks after surgery and suspected incomplete resection lesions were noted. Histologic examination of the tumor indicated paraganglioma of the urinary bladder. We also provide a brief review of the literature for comparison.

3-Iodobenzylguanidine↗
PubMed2001

Treated natural history of superficial bladder cancer.

BACKGROUND: The present study was conducted to examine the natural history of superficial bladder cancer. METHODS: One hundred and forty-four patients with superficial bladder cancer who had been treated with transurethral resection of bladder tumor (TURBt) alone were analyzed. RESULTS: The non-recurrence rate was 64.8% at 36 months and 61.2% at 60 months after TURBt. When the non-recurrence rate after TURBt was analyzed by background variables, the rate differed significantly between the solitary tumor group and the multiple tumor group. The tumor recurrence hazard curves for the entire population had one high peak before 500 days and another slight peak around 1500 days after TURBt. CONCLUSIONS: These results will provide basic information useful when evaluating new regimens of intravesical instillation therapy for prophylaxis of superficial bladder cancer after our complete TURBt in the Nara Uro-Oncology Research Group.

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PubMed2001

[A case of human chorionic gonadotropin-producing bladder cancer].

An 86-year-old man consulted our hospital complaining of gross hematuria. Cystoscopy revealed a nodular broad-based cancer at the dome of the bladder. The patient was initially treated by transurethral resection of bladder tumor. Since histological examination showed grade 3 transitional cell carcinoma containing giant cells that were positive for beta-human chorionic gonadotropin (beta-HCG), we made a diagnosis of beta-HCG-producing bladder cancer. Because of his advanced age and poor general condition, the patient underwent partial cystectomy alone without adjuvant chemotherapy. One month later, a chest X-ray film revealed multiple lung metastases, and he developed paraplegia of the lower extremities suggesting spinal metastases. One month later, he was brought to our hospital with cardiopulmonary arrest. This is, to our best knowledge, the 22nd case report of beta-HCG-producing bladder cancer in Japan.

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PubMed2003

[Cyclophosphamide-induced bladder cancer: three case reports].

Three cases of cyclophosphamide (CPM)-induced transitional cell carcinoma (TCC) of the bladder are reported. A 36-year-old female (case 1) and a 63-year-old male (case 2) received CPM at total doses of 104 g and 100 g, respectively, for the therapy of Wegener's granulomatosis. A 50-year-old female (case 3) received CPM at a dose of 57 g for the therapy of recurrent breast cancer. They visited our institute with the chief complaint of macrohematuria. In all cases, cystoscopy revealed bladder tumor with hemorrhagic cystitis. They underwent transurethral resection of bladder tumor. Histological examination revealed grade 2 TCC in cases 1 and 2 and grade 3 TCC in case 3. All patients underwent intravesical instillation of Mitomycin C with or without hyperthermia. Including our 3 cases, 17 cases of CPM-induced bladder tumor have been reported in the Japanese literature.

Administration, Intravesical↗
PubMed1991

[Immunohistochemical localization of proteoglycans in interstitial elements of human bladder cancer].

The immunohistochemical localization of glycosaminoglycan side chains and core protein of proteoglycan was observed, using monoclonal antibodies, on 8 specimens of non-tumor bladder tissues and 26 specimens of bladder tumors obtained from total cystectomy or transurethral resection of bladder tumor (TUR-Bt). In non-tumor tissues of human bladder examined, the surface of urothelial epithelium consisted of heparan sulfate as revealed with antibody HepSS-1, and submucosal interstitial elements consisted mainly of small proteoglycan having chondroitin 4-sulfate side chains as revealed with antibodies 6B6 and 9A2, respectively. On the other hand, in bladder tumors examined, the interstitial fibrous elements, the so-called "specific stroma" in cancer cell nests, consisted mainly of large proteoglycans having chondroitin 4-sulfate or 6-sulfate side chains as revealed with antibodies 2B1, 9A2 and 3B3, respectively. Antibodies 2B1 and 3B3 are considered to be useful to demonstrate the involvement by invasive growth of bladder tumor cells.

Antibodies, Monoclonal↗
PubMed2006

Detrusor quantitative morphometry in obstructed males and controls.

PURPOSE: We studied the usefulness of computer assisted morphometry for measuring detrusor muscle cell diameter and the connective tissue-to-smooth muscle ratio in patients with bladder outlet obstruction, acute urinary retention and a nonobstructed control group. MATERIALS AND METHODS: A prospective study was done in patients with bladder outlet obstruction undergoing transurethral prostate resection. Patients were divided into 33 with obstruction and 14 in acute urinary retention. A total of 15 males without obstruction undergoing transurethral prostate resection for bladder tumor formed the control group. Detrusor specimens were obtained during transurethral prostate resection. Detrusor muscle cell diameter was measured using light microscopy and a semiautomatic image analysis system. The connective tissue-to-smooth muscle ratio was automatically determined with computer assisted image analysis. Symptoms and urodynamic assessment were performed preoperatively and 6 months postoperatively. RESULTS: A total of 62 patients were included. The obstruction and acute urinary retention groups had a statistically higher detrusor muscle cell diameter and more fibrosis than the control group. Patients in acute urinary retention had more intrafascicular fibrosis (higher connective tissue-to-smooth muscle ratio at 40x magnification) than patients with obstruction. There were no differences in detrusor muscle cell diameter or interfascicular fibrosis (connective tissue-to-smooth muscle ratio at 10x magnification) between the obstruction and acute urinary retention groups. Detrusor muscle cell diameter correlated with symptom duration and functional recovery after transurethral prostate resection. Detrusor fibrosis correlated with preoperative detrusor pressure at maximum flow and postoperative compliance. Patients in acute urinary retention had fewer symptoms and higher residual volume. Other urodynamic parameters and their improvement after surgery were similar in the acute urinary retention and obstruction groups. CONCLUSIONS: Morphometric differences in detrusor muscle cell diameter and the connective tissue-to-smooth muscle ratio were observed between controls and patients with obstruction. There is an increase in detrusor muscle cell diameter and fibrosis in bladder outlet obstruction and more intense intrafascicular collagen deposition in patients in acute urinary retention.

Acute Disease↗
PubMed1998

Feasibility of transurethral resection for muscle infiltrating carcinoma of the bladder: long-term followup of a prospective study.

PURPOSE: We analyzed the long-term results of radical transurethral resection for the treatment of a large series of patients with muscle infiltrating bladder cancer entered into a prospective study to determine progression predictive factors. MATERIALS AND METHODS: The study included 133 patients with invasive bladder cancer treated by radical transurethral resection who had negative biopsies of the muscle layer of the tumor bed. Followup was more than 5 years for all subjects and more than 10 years in 59 (44.4%). A comparative nonrandomized study was performed of a control group of 76 patients with invasive pathological stage pT2-3a, N0-3 bladder cancer treated by cystectomy. In those patients treated by radical transurethral resection univariate and multivariate analyses were performed to establish clinical progression predictive factors. RESULTS: At 5 and 10 years of followup cause specific survival rates were 80.5 and 74.5%, and bladder preservation rates were 82.7 and 79.6%, respectively. No significant difference was noted in terms of cause specific survival, with respect to the control group. The initial presence of associated bladder carcinoma in situ was the only independent progression predictive factor. CONCLUSIONS: For patients with invasive bladder cancer radical transurethral resection is justified when the tumor is clinically limited to the muscular layer and when all biopsies of the periphery and depth of the tumor bed show muscular tissue negative for tumor cells. Patients with initial associated bladder carcinoma in situ should not be excluded from this treatment but endovesical bacillus Calmette-Guerin immunotherapy should be administered and a closer followup is recommended.

Adult↗
PubMed1984

[Bladder neck strictures following transurethral resection--limits of transurethral therapy].

Primary strictures of the vesical cervix probably do not occur more frequently following TUR than after transvesical adenomectomy, but, unlike the latter, they are in greater danger of recidivation under continued transurethral therapy. There is clearly a striking disposition with small primary adenomas. Our own patients are taken as the basis for some thoughts on a few aetiologically effective TUR-specific risk factors and therapeutic conclusions.

Aged↗
PubMed1996

[Intestinal obstruction caused by transitional carcinoma].

OBJECTIVES: To draw attention to the possibility that distant intestinal metastasis can arise from transitional urothelial carcinoma located in the bladder. METHODS: Two female patients developed distant metastasis during treatment of the tumor by transurethral resection of the bladder. RESULTS: Following complicated transurethral resection with perforation of the peritoneal cavity, the patients developed intestinal obstruction from metastatic transitional cell carcinoma. CONCLUSIONS: Direct or distant seeding of tumor cells on previously undamaged peritoneal serosa produced with the resectoscope may not be exceedingly unlikely.

Aged↗
PubMed2001

Repeated transurethral resection and intravesical BCG for extensive superficial bladder tumors.

PURPOSE: We report our experience with repeat transurethral resection (TUR) in a group of patients with superficial bladder tumors in whom complete resection in one session was impossible because of the extensive tumor burden. PATIENTS AND METHODS: Only the patients with such extensive (>10 g of resected tissue) tumors that we were unable to perform complete TUR initially were included in the present study. The patients underwent repeat TUR(s) 4 weeks after the previous one until complete resection of the tumor was achieved. After complete TUR, if the pathology examination confirmed superficial disease, the patients received intracavitery immunotherapy and were followed up thereafter. If pathology examination documented muscle-invasive disease, cystectomy was suggested. RESULTS: Of the 43 patients undergoing repeat TUR, 15 needed a second and 5 needed a third session to achieve complete resection. Of the patients, 28 (65%) had stage T1 and 15 (35%) has stage Ta tumor. Eight patients (19%) otherwise regarded as having superficial tumor were found to have muscle-invasive disease following repeat TURs. The mean follow-up of the remaining 35 patients with superficial disease was 34 months (range 1-126 months). Four of the patients with superficial disease progressed to T2 tumor. However, 16 patients achieved a state of complete response with no tumor recurrences during a mean of 38 months (range 4-126 month). The present protocol achieved bladder sparing in a total of 22 (63%) of the 35 patients with superficial disease. CONCLUSIONS: From the presented series, we suggest that one can use the combination of repeat TUR and intravesical immunotherapy in the management of bulky superficial bladder tumors in an effort to preserve the bladder.

Adult↗
PubMedDate not supplied

[The incidence of bladder tumor recurrences after transurethral resection during combined treatment].

A total of 231 patients undergoing transurethral resection combined with intravesical chemotherapy were examined for incidence of vesical tumor relapses. Some patients were subjected only to transurethral resection (Group I), those had the resection followed by intravesical adriamycin (Group II), those underwent the resection followed by thiophosphamide chemical prevention (Group III), and those had surgeries after intravesical chemotherapy (Group IV). The incidence of the relapses was 44, 43.1, 29.6, and 52.9%, respectively. The incidence of relapses was examined in relation to the type, malignancy, and multiple foci of the tumor.

Administration, Intravesical↗
PubMed1993

The management of clinically unconfirmed positive urinary cytology.

An aggressive evaluation of extravesical sites of disease in patients with clinically unconfirmed positive urinary cytology findings is indicated only in previously untreated asymptomatic or symptomatic patients (group 1) and in those with a complete response to intravesical therapy who are without evidence of disease for 1 year (group 4). Patients who have positive urinary cytology findings immediately after complete transurethral resection of bladder tumors or intravesical therapy will almost always have recurrent bladder transitional cell carcinoma and do not require aggressive extravesical evaluation initially. Transurethral resection prostate biopsy between the 5 and 7 o'clock positions along the entire length of the prostatic urethra is the technique of choice for detecting transitional cell carcinoma of the prostate, since other less invasive techniques frequently underestimate the extent of disease. In the absence of radiographic disease, bilateral ureteral lavage cytology is the technique of choice to identify the upper tract as the source of a positive urinary cytology result. Rigid and flexible ureteropyeloscopy should be performed only in the presence of radiographic or cytological evidence of upper tract transitional cell carcinoma, or in patients with a history of upper tract disease who have suspected relapse on the basis of a positive urinary cytology result.

Carcinoma, Transitional Cell↗
PubMed2000

Predicting extravesical extension of bladder carcinoma: a novel method based on micrometer measurement of the depth of invasion in transurethral resection specimens.

OBJECTIVES: Patients with bladder cancer and extravesical extension (Stage T3 or greater) have worse survival than those with organ-confined cancer. We sought to determine whether the depth of invasion in transurethral resection of the bladder (TURB) specimens will predict extravesical extension in patients treated by radical cystectomy. METHODS: We studied 90 patients diagnosed with invasive bladder carcinoma between 1979 and 1984. The 1997 TNM (tumor, lymph node, metastasis) system was used for pathologic staging. The mean patient age was 65 years (range 44 to 78). The male/female ratio was 5:1. All patients had invasive bladder cancer at TURB. Muscle invasion was identified in 35 patients (39%) and lamina propria invasion was present in 55 patients (61%) in the TURB specimens. The depth of invasion in the TURB specimens was measured by an ocular micrometer. All patients were treated by radical cystectomy. The median interval from TURB to cystectomy was 44 days (range 2 to 159). Extravesical extension (Stage T3 or greater) at cystectomy was present in 39 patients (43%). RESULTS: The depth of invasion was associated with final pathologic stage (Spearman correlation r = 0. 58, P <0.001). The overall accuracy of the depth of invasion for the prediction of extravesical extension, measured by the area under the receiver operating characteristic curve, was 0.81 (standard error 0. 045). The mean depth of invasion among patients with extravesical extension at cystectomy was 4.0 mm compared with 2.2 mm for those without extravesical extension. On the basis of a 4.0-mm cutoff point, the sensitivity, specificity, positive predictive value, and negative predictive value for extravesical extension were 54%, 90%, 81%, and 72%, respectively. CONCLUSIONS: Patients with a bladder cancer depth of invasion greater than 4 mm in the TURB specimens, as measured by micrometer, are likely to have extravesical extension, and more aggressive treatment should be considered.

Adult↗
PubMed2002

Clinically relevant improvement of recurrence-free survival with 5-aminolevulinic acid induced fluorescence diagnosis in patients with superficial bladder tumors.

PURPOSES: Fluorescence diagnosis induced by 5-aminolevulinic acid enables more thorough transurethral resection of superficial bladder carcinoma compared with conventional white light. We performed a prospective, single institution, randomized trial to investigate whether the residual tumor rate and long-term tumor recurrence can be decreased by fluorescence diagnosis. MATERIALS AND METHODS: A total of 301 patients underwent transurethral resection of bladder tumors with white light or fluorescence diagnosis. Transurethral resection was repeated 5 to 6 weeks later to evaluate the residual tumor rate. To determine recurrence-free survival patient followup was performed every 3 months by white light cystoscopy and urine cytology. Recurrence-free survival was analyzed via Kaplan-Meier methods and multivariable Cox regression analysis. RESULTS: A total of 191 patients with superficial bladder carcinoma were available for efficacy analysis. The residual tumor rate was 25.2% in the white light arm versus 4.5% in the fluorescence diagnosis arm (p <0.0001). Median followup in the white light arm in 103 cases was 21.2 months (range 4 to 40) compared with 20.5 (range 3 to 40) in the 88 in the fluorescence diagnosis arm. Recurrence-free survival in the fluorescence diagnosis group was 89.6% after 12 and 24 months compared with 73.8% and 65.9%, respectively, in the white light group (p = 0.004). This superiority proved to be independent of risk group. The adjusted hazard ratio of fluorescence diagnosis versus white light transurethral resection was 0.33 (95% confidence interval 0.16 to 0.67). CONCLUSIONS: Fluorescence diagnosis is significantly superior to conventional white light transurethral resection with respect to the residual tumor rate and recurrence-free survival. The differences in recurrence-free survival imply that fluorescence diagnosis is a clinically relevant procedure for decreasing the number of tumor recurrences.

Administration, Intravesical↗
PubMed1995

Detection of muscle layer invasion with submillimeter pixel MR images: staging of bladder carcinoma.

Conventional magnetic resonance (MR) images used for the pelvic organs generally have a pixel size of 1.3 mm x 1.3 mm. We obtained images with a higher resolution than conventional images, and evaluated the usefulness of this type of image in staging urinary bladder carcinoma. Twenty-six patients having either transurethral resection of bladder tumor (TUR-BT) or cystectomy were retrospectively studied. T2-weighted images of the bladder were acquired with a 20 cm field-of-view, a matrix size of 224 x 224 (pixel size: 0.9 mm x 0.9 mm), and a slice thickness of 7 mm using a 0.5 T system. MR appearances of the carcinoma were divided into the following five categories: no abnormality found on the inner surface of the bladder wall (0), high signal layer or protrusion without breakage of the wall (I), partial disruption of the wall (II), transmural disruption of the wall (III), and complete disruption with mass formations in the perivesicular region (IV). These findings were correlated with the TNM pathologic staging determined from each tissue specimen. A prediction for muscle layer invasion was calculated by selecting pathologic stage pT2 and MR category III as a boundary measure. The accuracy was 96.2%, the sensitivity 100.0%, and the specificity 91.7%. The results obtained indicate that submillimeter pixel MR imaging shows promise as a noninvasive method for the preoperative staging of bladder cancers.

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