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Mitochondrial DNA mutations in chemical carcinogen-induced rat bladder and human bladder cancer.

Mitochondrial (mt) DNA mutations have been described recently in different tumors, whereas similar studies focusing on bladder cancer are scarce. In an effort to understand the significance of mtDNA mutations in bladder cancer, we investigated the mtDNA alterations in both clinical human bladder cancer and in a carcinogen-induced rat bladder cancer model. Human bladder cancer tissues were obtained by radical cystectomy and transurethral resection of bladder tumors. Rat bladder tumors were induced in SD rats by treatment with N-butyl-N-(4-hydroxybutyl) nitrosamine in drinking water for 24-28 weeks. Genomic DNA was extracted from tumor specimens and microdissected normal bladder mucosae. Mitochondrial genes and D-loop region were amplified by PCR. The amplified PCR fragments were either cloned into plasmid vector or used for direct DNA sequencing. The results of DNA sequence revealed numerous point mutations in the non-coding D-loop region and different mtDNA genes in both human and rat bladder cancers. In addition, we also detected deletions of variable lengths in mononucleotide repeats in the D-loop region, ND2, ATPase 8 and COIII genes in human bladder cancer samples. Our results show that mtDNA exhibits a high rate of mutations in both human and rat bladder cancers. We also demonstrate that the repetitive sequences of mononucleotides within the mt genome are unstable and subjected to deletions. The high incidence of mtDNA mutations in bladder cancer suggests that mtDNA and mitochondria could play an important role in the process of carcinogenesis and also mtDNA could be valuable as a marker for early bladder cancer diagnosis.

Animals↗

The role of adjunctive immunotherapy in superficial bladder cancer.

Seventy-eight patients with superficial bladder cancer were entered into a randomized study. A streptococcal preparation, OK-432, was injected into bladder cancers before transurethral resection and instilled into the bladder for 6 months after resection to reduce the recurrence. The control group were only transurethrally resected, as usual. The recurrence rate for patients with primary disease was 3.6 in 100 months for the OK-432 group and 9.1 in 100 months for the control group (P less than 0.05). In the control group, multiple, large, sessile, and high-grade tumors had high recurrence rates. But in the OK-432 group, overall recurrence rates were low in both high-risk and low-risk patients. Supplementary immunotherapy is especially effective and is recommended in high-risk patients.

Adjuvants, Immunologic↗

Is repeated transurethral resection justified in patients with newly diagnosed superficial bladder cancer?

OBJECTIVES: To assess the value of repeated transurethral resection (TUR) in patients with newly diagnosed superficial bladder cancer. METHODS: A second TUR was performed in 110 consecutive patients (24 women and 86 men) with newly diagnosed superficial bladder cancer. The mean age was 66 years (range 30 to 85). A second TUR was performed within 4 to 6 weeks after the initial TUR. After the first TUR, the pathologic stage was pTa in 31 patients (28%), pT1 in 76 (70%), and carcinoma in situ in 3 (2%). The pathologic records of the second TUR were reviewed and compared with the findings of the first operation. RESULTS: Cystoscopy before the second TUR was negative in 79 patients. Of these cases, 14 (17.7%) had cancer histologically. The second TUR was negative in 70 patients (63.6%). Twenty-two (20%) had residual cancer of the same stage, 9 (8.2%) had a lower stage, and 9 (8.2%) had a higher stage. Of 31 patients with Stage pTa and 76 patients with Stage pT1 at the first TUR, 19 (61.3%) and 51 (67.1%) had a negative second TUR, respectively. CONCLUSIONS: We recommend a second TUR for patients with superficial bladder cancer for several reasons. A negative second TUR provides important prognostic information. In addition, removal of residual cancer is achieved early. Finally, patients with pT1 G3 tumors are at high risk of residual, or even invasive, cancer and should be offered definitive therapy as early as possible.

Adult↗

A randomized trial comparing bladder infusion with standard catheter removal after transurethral resection of the prostate.

OBJECTIVE: To examine the effect of bladder infusion before catheter removal on patients' readiness for discharge and the day of discharge after transurethral resection of the prostate (TURP). PATIENTS AND METHODS: The study comprised 75 consecutive patients undergoing TURP who were randomized to either have their catheter removed in the standard manner (38 patients), or to undergo bladder infusion before a trial of voiding (ToV) on the second day after TURP (37 patients). RESULTS: In those undergoing bladder infusion, seven (19%) patients were discharged on the same day as their ToV, compared with five (13%) in the standard group. Of the 75 patients, 15 (68%) were discharged by the third day after TURP whether or not the bladder had been filled. In the infusion group, 23 (62%) were ready for discharge on the same day as their TOV, compared with only 14 (37%) in the standard group (P < 0.05). CONCLUSION: Bladder infusion before a ToV after TURP significantly increases the rate of readiness for discharge, allowing an early decision to discharge on the second day in a large proportion of patients.

Humans↗

[Intravesical instillation of adriamycin in the aftertreatment of transurethrally resected carcinoma of the urinary bladder (author's transl)].

32 patients whose condition was diagnosed as carcinoma of the urinary bladder were subjected to weekly intravesical instillation treatment with adriamycin for a period of 6 weeks after transurethral resection of the tumours. The oncolytic and thus recurrence-preventive value of treatment was determined by endoscopic controls with exploratory excisions. All in all a persistent tumour was found in 31% of the cases and a recurrence-free course in 69% over a minimum observation period of 1 year. These results are definitely better than those for comparable instillation treatments with surface-active or immunologically active substances.

Aged↗

Clinical evaluation of soluble cytokeratin 19 fragments (CYFRA 21-1) in serum and urine of patients with bladder cancer.

OBJECTIVES: CYFRA 21-1 is a new tumor marker that measures cytokeratin 19 (CK-19) fragments by a sandwich enzyme-linked immunosorbent assay (ELISA). In this study, we evaluated the usefulness of serum and urine CYFRA 21-1 as a tumor marker for bladder cancers. METHODS: We measured serum and urine CYFRA 21-1 levels in a group of patients with bladder cancer (n = 58) and a group without bladder cancer (n = 220). The latter group was divided into five subgroups of patients (those with cystitis, benign prostatic hyperplasia (BPH), urolithiasis, or renal dysfunction, and a group of healthy, controls). In the bladder cancer group, we measured CYFRA 21-1 levels after transurethral resection of bladder tumor (TUR-Bt), and we also analyzed the relationship between serum and urine CYFRA 21-1 levels and tumor-related factors. RESULTS: Serum and urine CYFRA 21-1 levels were significantly higher in the bladder cancer group than in each of the non-bladder cancer subgroups. However, urine CYFRA 21-1 levels did not differ significantly between the bladder cancer group and the cystitis subgroup. In the bladder cancer group, serum CYFRA 21-1 levels were significantly higher in patients with local advanced-stage tumors and in those who had metastases. Urine CYFRA 21-1 levels decreased as a function of time after TUR-Bt. These levels were strongly correlated with tumor volume and were significantly better than urine cytology for the detection of bladder cancers of grades 1 and 2. CONCLUSIONS: These results suggest that urine CYFRA 21-1 is a useful tumor marker in screening for bladder cancer, and that serum CYFRA 21-1 may be a tumor marker for advanced bladder cancers.

Antibodies, Monoclonal↗

Diagnosis of urothelial carcinoma of the bladder using fluorescence endoscopy.

Bladder cancer is a frequent disease and represents the second most common genitourinary neoplasm. Although many aspects of the management of superficial bladder cancer are now well established, significant challenges remain, which influences patient outcome. Early detection and treatment of recurrent disease is required to optimize bladder preservation, reduce patient morbidity, and increase quality of life and survival. Fluorescence endoscopy, often referred to as 'photodynamic diagnosis' (PDD), with intravesical application of photosensitizing agents, has been developed to enhance the early detection of bladder cancer. There is growing evidence that PDD using 5-aminolaevulinic acid (ALA), hexyl-ALA ester or hypericin enhances the detection of bladder cancer, particularly of high-grade flat lesions. Furthermore, transurethral resection of bladder tumour under fluorescence guidance reduces the risk of recurrent tumours. However, the impact on the progression of disease remains unclear and must be investigated in prospective randomized trials.

Aminolevulinic Acid↗

The clinical value of urinary cytology: 12 years of experience with 615 patients.

AIMS: To analyse the diagnostic value of cytological examination compared with histological findings in a large series of patients (n = 615) with tumours of the urinary tract epithelium. METHODS: Cytological examinations (n = 785) after bladder washing and exfoliative cytology were retrospectively compared and correlated with histological findings. In addition, 1527 bladder washings were obtained during follow up of patients after transurethral resection of bladder tumours. RESULTS: Cytology in bladder washings (overall diagnostic accuracy 66%) provides considerably more information that exfoliative cytology (overall accuracy 49%). Cytological examinations (n = 1125) in patients with bladder tumours receiving intravesical cytostatic drugs (for example, mitomycin C) yielded suspicious or positive results in 28% of patients, without being confirmed by endoscopy during follow up. CONCLUSION: Our results illustrate two major drawbacks of urinary cytology. First, a high rate of false positive results in patients on intravesical chemotherapy. Second, a high rate of false negative results in highly differentiated carcinomas, stressing the need for additional diagnostic tests such as staining with monoclonal antibodies directed against tumour antigens or assessment of ploidy.

Carcinoma, Transitional Cell↗

[Choriocarcinoma of the renal pelvis: a case report].

A 68-year-old male presented to our hospital complaining of gross hematuria. Intravenous pyelography subsequently demonstrated a left non-visualized kidney, and he was admitted for further evaluation. Cystoscopy revealed a bladder tumor around the left ureteral orifice and retrograde pyelography showed a filling defect in the left renal pelvis. The urinary cytology from the left renal pelvis indicated class IV, and the microscopic findings of a bladder biopsy demonstrated grade 1 transitional cell carcinoma. We performed transurethral resection of bladder tumor (TUR-BT) followed by left nephroureterectomy with bladder cuff. The pathological diagnosis was high grade transitional cell carcinoma with choriocarcinomatous component. After the operation, the serum human chorionic gonadotropin-beta (hCG-beta) level was slightly elevated, and the combination chemotherapy with methotrexate, vinblastine and cisplatin (MVC) was administered. Although the serum hCG-beta level fell to 0.1 ng/ml, after two courses of MVC chemotherapy, bilateral pulmonary metastases appeared in the chest X-ray with increasing hCG-beta levels. Salvage chemotherapy with cisplatin, etoposide and bleomycin (PEB) was performed. After two courses of PEB chemotherapy, the serum hCG-beta level fell to within the normal range and all pulmonary metastases disappeared.

Aged↗

[Leiomyoma of the bladder].

OBJECTIVE: To report a case of leiomyoma of the bladder, a benign tumor that accounts for 0.43% of bladder tumors. The literature is briefly reviewed. METHODS/RESULTS: A 64-year-old male with prostatic syndrome is described. The preoperative evaluation showed bladder lithiasis and signs compatible with prostatic hypertrophy, but no evidence of a bladder tumor. Endoscopic evaluation, however, revealed a tumor in the bladder neck. Transurethral resection of the tumor, prostate and endoscopic lithotripsy of the bladder were performed. The anatomopathological findings showed leiomyoma of the bladder. The postoperative course was unremarkable. CONCLUSION: Leiomyoma of the bladder does not present specific symptoms and is frequently an incidental finding. The diagnosis is based on the results of the anatomopathological analysis of the specimen.

Humans↗

The role of nuclear matrix protein 22 combined with bladder tumor antigen stat test in surveillance of recurring bladder cancer.

OBJECTIVE: To investigate a non-invasive, effective and rapid mode of detecting the recurrence of bladder cancer during follow-up. METHODS: Ninety patients following transurethral resection of bladder tumor (TURBt) surgery were recruited from January 1998 to March 2000. Standard ELISA was used to determine the quantity of nuclear matrix protein (NMP-22) in urine of all bladder cancer patients during their follow-up periods. Urine bladder tumor antigen (BTA) stat test was simultaneously performed and followed by cystoscopy. RESULTS: The total positive rates of urinary NMP-22 and BTA stat test were 76.7% (33/43) and 67.4% (29/43), respectively. Comparatively, this positive rate would increase to 93.0% (40/43) when the combination of both urine NMP-22 and BTA test were adopted. CONCLUSION: Examination of NMP-22 in urine is a rapid and effective way to detect the recurrence of bladder cancer. If combined with BTA test, NMP-22 may be used as a non-invasive method in surveillance of recurring of bladder cancer, which may reduce the frequency of patients needing to undergo conventional invasive cystoscopy.

Antigens, Neoplasm↗

[Tumors of the urethra].

For a period of 6 years 416 men with bladder tumors have been treated by transurethral resections and hemotherapy. The bladder disease was associated with tumors of the urethra: 15.6 per located in its prostate portion and 3.1 per cent in the cavernous part. The urethral tumors were also treated by transurethral resections, ureterotomy and total cystectomy. It was shown that the numerous transurethral resections of bladder tumors contribute to the appearance of urethral tumors: 79 per cent of these developed after the 5. transurethral resection. The results of this study led to a number of inferences: Tumors in the cavernous portion of the male urethra appeared at a relatively younger age (mean 57.8 years); the membranous portion of the urethra is a particular borderline in the histologic structure and the prognosis; appearance of tumors in the cavernous part of the urethra is a poor prognostic sign--tumors in this zone may run a fulminant course with rapid lethal outcome. Inferences were drawn on the methods of choice of treatment of combined bladder tumors and tumors in the cavernous portion of the urethra.

Aged↗

Results of transurethral resection and intravesical doxorubicin prophylaxis in patients with T1G3 bladder cancer.

OBJECTIVES: This retrospective study evaluates the outcome of patients with T1G3 bladder cancer treated by transurethral resection (TUR) and intravesical doxorubicin prophylaxis and identifies clinically useful prognostic factors. METHODS: One hundred twenty-eight consecutive patients with primary T1G3 bladder cancer were treated by TUR followed by 1-year intravesical prophylaxis with doxorubicin. Sex, age, number, size, and morphology of the tumors, exfoliative cytology, presence of dysplasia at first observation, pathologic findings of the first recurrence, and number of recurrences were the parameters considered in a multivariate analysis whose object was to identify specific risk factors for recurrence and progression. RESULTS: The recurrence rate was 56.3% and progression of disease was seen in 23.4% of cases with a disease-specific mortality rate of 7.8%. The disease-free survival in patients who had cystectomy was 37.7 months and the disease-specific mortality rate for this group was 35.7%. The recurrence rate was found to be significantly higher for multiple tumors, solid morphology, size greater than 3 cm, positive exfoliative cytology, and concurrent dysplasia. The reappearance of Stage 1, grade 3 tumor on first recurrence was the only factor found to be correlated with progression. CONCLUSIONS: Up front therapy consisting of TUR and intravesical doxorubicin prophylaxis is appropriate for T1G3 bladder cancer. Patients with unfavorable prognostic factors should be kept under strict control; and if a T1G3 tumor is identified on first recurrence, immediate cystectomy should be considered.

Administration, Intravesical↗

[A case of metastatic urinary bladder tumor from colon carcinoma].

A 62-year-old female patient underwent an operation for a brain tumor. The pathological diagnosis of the resected specimen was metastatic adenocarcinoma with signet-ring cells. The primary lesion was found in the ascending colon. In addition, a non-papillary and pedunculated tumor was found on the right wall of the bladder on cystoscopy. Biopsy of the bladder tumor showed adenocarcinoma with signet-ring cells, which was the same as the histologies of the colon and the brain tumors. Under the diagnosis of metastatic bladder tumor, transurethral resection of the tumor was performed. This is the first case of metastatic bladder carcinoma from the colon reported in Japan.

Brain Neoplasms↗

[Primary localized amyloidosis of the urinary bladder: a case report].

A case of primary localized amyloidosis of the bladder during a twelve-year period is described. The initial symptom was miction pain when she was 43 years old. Cystoscopic examination revealed yellowish elevated lesion with hemorrhage at the right side of the bladder neck. Transurethral resection was performed, but two years later recurrence was found at the trigonum as well as the original site. The two lesions were apart. She remained asymptomatic for the following ten years until she returned to us with bladder symptoms. Cystoscopy showed the lesion was more diffuse and the posterior wall was involved in continuity with the trigonum. Complete transurethral resection was not possible because of generalized bladder involvement. Our case illustrates the clinically benign but slowly progressive nature of amyloidosis of the bladder. Multifocal recurrence is also to be noted. Our current treatment policy is conservative treatment with careful follow-up. She is asymptomatic three months postoperatively.

Amyloidosis↗

Immunohistochemical evaluation of p53, proliferating cell nuclear antigen (PCNA) and bcl-2 expression during bacillus Calmette-Guerin (BCG) intravesical instillation therapy for superficial bladder cancers.

Bacillus Calmette-Guerin (BCG) immunotherapy for superficial bladder cancer is now widespread, but non-effective cases are not uncommon and it has yet to be clarified why this is the case. In an attempt to cast light on this problem, we evaluated differences between effective and non-effective cases immunohistochemically using p53, proliferating cell nuclear antigen (PCNA), and bcl-2 antibodies. Between March 1988 and March 1996 a total of 79 superficial bladder cancer patients were treated with BCG intravesical instillation therapy after transurethral resection of bladder tumor (TUR-Bt). Of these, 19 demonstrated recurrence after the initial treatment. From the 60 remaining patients without recurrence, we randomly chose 19 additional cases and evaluated both series for p53, PCNA and bcl-2 immunohistochemical staining using formalin-fixed, paraffin-embedded tissues. For the recurrent cases, material taken prior and subsequent to BCG therapy was available for 17 of the 19 patients. Positive staining for p53 was noted for 42.1% (8/19) of both recurrent and non-recurrent cases, without any difference between the two. The rates for PCNA and bcl-2 were 52.6% (10/19) and 47.4% (9/19) in recurrent, and 36.8% (7/19) and 78.9% (15/19) in non-recurrent cases, respectively. Thus, there was a significant difference for lower incidences of bcl-2 in recurrent cases (P = 0.044). Values for p53 and bcl-2 were respectively 47.1% (8/17) and 41.2% (7/17) pre-treatment, and 52.9% (9/17) and 35.3% (6/17) post-treatment in the recurrence group. In contrast to the similarity in these results, PCNA positive cases were 52.9% (9/17) pre-treatment and 17.6% (3/17) post-treatment. These data suggest that there are differences between BCG-sensitive and BCG-resistant bladder cancers in terms of bcl-2 expression.

Adult↗

[Study of preventive effect of 1-hexylcarbamoyl-5-fluorouracil (HCFU) or combination of HCFU and 2.5-di-O-acetyl-D-glucaro (1-4) (6-3) dilactone (SLA) after preservative operation against bladder cancer].

To treat superficial bladder cancer or invasive bladder cancer presenting as a solitary tumor, conservative therapy such as transurethral resection of bladder tumor or partial cystectomy has long been carried out. We studied the effect of 1-hexylcarbamoyl-5-fluorouracil (HCFU), and the effects of the combination of HCFU and 2.5-di-O-acetyl-D-glucaro-(1-4)(6-3) dilactone (SLA) which is an anti-beta-glucuronidase agent, for preventive therapy. In the patients treated with HCFU, the recurrence rate was 3.6% and 26.6% one year and two years, respectively, after conservative operation. In the patients treated with both SLA and HCFU, the recurrence rate was lower than in those treated with HCFU one year or more after conservative operation, and a long-term preventive effect was expected for nondrinkers.

Adult↗

[Clinical statistics of the patients admitted to the Department of Urology, Kobe University Hospital, 1985-1987].

Between 1985 and 1987, a total number of 791 inpatients were treated at our department and 683 operations were performed. Urogenital malignant tumors (42.0%) were most frequently treated. Male infertility (14.8%) and urolithiasis (8.5%) followed. Bladder tumor was the most frequent disease in our hospital and transurethral resection of bladder tumor was the most frequent operation. Clearly endourological procedures have replaced so-called open surgeries.

Adolescent↗