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PubMedDate not supplied

CT-virtual endoscopy of the urinary tract.

OBJECTIVE: To demonstrate the various applications of CT-virtual endoscopy, for the assessment of urinary tract abnormalities. MATERIALS AND METHODS: Sixty-three patients were evaluated by CT-virtual endoscopy (49 CT-cystoscopy; 14 CT-pyeloureteroscopy). CT-cystoscopy was obtained for follow-up of bladder tumor (n=21), radiologic suspicion (n=12) or radiologic evidence of urinary tract lesion (n=16). CT-pyeloureteroscopy was done due to neoplasm (n=5), calculi (n=3) and extrinsic compressions (n=3). RESULTS: In 49 patients submitted to CT-cystoscopy, 27 tumors were detected intraoperatively (ranging 0.5-4.8cm). CT-cystoscopy revealed 21 tumors (78%); all tumors larger than 0.6 cm were detected. Tumor within a bladder diverticulum was seen by CT-cystoscopy but not by endoscopy, in two patients. Useful additional information such as extension of tumors into the anterior portion of the bladder neck (n=2) and adequate characterization of bladder diverticulum in a child (n=1) was also obtained. CT-pyeloureteroscopy detected 6 of 9 tumors (67%), and was useful in the differential diagnosis of pelvic/ureteral tumor versus calculi (n=8) and intrinsic versus extrinsic ureteral lesion (n=3). CONCLUSION: CT-virtual endoscopy is a useful procedure, particularly in the following situations: a)- Follow-up of bladder tumors; b)- Complimentary evaluation of areas of difficult approach by endoscopy; c)- Differential diagnosis of intrinsic versus extrinsic lesion of the renal pelvis and ureter.

Journal Article↗

PubMed2005

[Clinical study of CT virtual endoscopy in staging diagnosis of bladder tumors].

OBJECTIVE: To evaluate CT virtual endoscopy (CTVE) based on spiral CT in the staging diagnosis of bladder neoplasms and its clinical application. METHODS: Forty patients with bladder neoplasms and 10 normal patients underwent volume scanning using spiral CT. All images with thin collimation and overlapping reconstruction were transferred to computer workstation to obtain the images of CTVE. The results of all CTVE findings were compared with those of conventional CT, cystoscopy, operation and pathological data. RESULTS: CTVE showed the normal anatomical structure of bladder as actual cystoscopy. The size, configuration, location and extension of bladder neoplasms was detected by CTVE scans agreed with that of actual cystoscopy. CTVE revealed the structure of trigone of urinary bladder that were not available in actual cystoscopy, and they were confirmed operatively and compared with the pathological results according to the TNM classification of malignant neoplasms. The sensitivity of CTVE for bladder tumors and accuracy in preoperative neoplasms staging was 98% (39/40) and 85% (33/39), respectively. The sensitivity of mass detection of diameter > or = 0.5 cm was 100%. The results were studied in a blind way. CONCLUSIONS: CTVE is a noninvasive, safe and reliable procedure in the staging diagnosis of bladder neoplasms. CTVE can well show bladder neck anatomy and serve as an important complementary method to conventional cystoscopy. The limitation of CTVE is that it can not observe change of mucosal appearances and perform biopsy.

Adolescent↗

PubMed2005

Concomitant anomalies in 100 children with unilateral multicystic kidney.

OBJECTIVES: To determine the incidence and type of associated urogenital anomalies in children with a unilateral multicystic kidney and to assess in children with nephrectomy the additional diagnostic value of cystoscopy and, in girls, of colposcopy. METHODS: This was a follow-up study of 100 fetuses with antenatally detected unilateral multicystic kidneys. After ultrasound confirmation of the diagnosis within a few days after birth voiding cystourethrography and isotope scan were performed in 83 of the surviving children to exclude vesicoureteral reflux and to establish renal function. Eighty-one children underwent nephrectomy and, prior to surgery, all underwent cystoscopy and girls also underwent colposcopy. RESULTS: Seventy-five children had one or more additional urogenital anomalies: 39 had anomalies of the contralateral kidney, 40 had anomalies of the ipsilateral kidney and 30 had one or more anomalies of the lower urogenital tract. With cystoscopy 54 anomalies of the genitourinary tract were detected in 48 children and with colposcopy three anomalies were detected in 35 girls. Eighty-one children had a nephrectomy or heminephrectomy and 33 of them needed other urological intervention. Thirteen fetuses died (mostly from agenesis of the contralateral kidney) and six infants had no surgery at all. CONCLUSION: Children with a unilateral multicystic kidney are at considerable risk of having other urogenital anomalies. When cystoscopy and colposcopy are added to routine investigations the rate of detection of anomalies is 75%, twice that reported in the literature.

Abnormalities, Multiple↗

PubMed2003

[Non-invasive urinary diagnosis of bladder cancer. What do we know?].

Although the current system of classifying bladder cancer by stage and histological grade is very useful, it is still difficult to predict the natural progression of the disease either with or without therapy. Cystoscopy and urine cytology are currently the gold standards in the monitoring and diagnosis of bladder cancer. Classical urine cytology is, however, at least in the diagnosis of G1-tumors, characterized by a relatively low sensitivity. In the last few years, the molecular biological investigation of the basic mechanisms involved in carcinogenesis has provided a host of markers which are of potential diagnostic value for bladder cancer. We provide a current, comprehensive review of the literature on bladder tumor markers and summarize their diagnostic and prognostic potential. At present, no diagnostic marker with a comparable sensitivity and specificity to cystoscopy exists, given that cystoscopy has never been evaluated. The combined analysis of several tumor markers seems to be the most promising approach as an adjunct to cystoscopy. Moreover, the increasing simplification of test systems will increase their acceptance by clinicians.

Biomarkers, Tumor↗

PubMed2004

True occult bladder perforation during placement of tension-free vaginal tape.

Bladder perforation is one of the most common complications of the trans-vaginal tape (TVT) procedure, and is generally identified on routine intra-operative cystoscopy. We present a case of occult bladder perforation occurring during the TVT procedure that could not be identified by cystoscopy. A 57-year-old woman underwent TVT placement for treatment of stress urinary incontinence. A bladder perforation, suspected because of clear fluid at one of the abdominal incision sites, could not be identified with cystoscopy, but was confirmed with bladder installation of sterile infant formula. The tape was removed and the bladder was drained for 48 h. The patient's recovery was uneventful and she subsequently underwent TVT placement without complication. Cystoscopy alone may be inadequate for identification of some bladder perforations during the TVT procedure. Awareness of alternative methods of identification is essential.

Cystoscopy↗

PubMed2005

Urine markers for bladder cancer surveillance: a systematic review.

INTRODUCTION: The follow-up of patients with urothelial cell carcinoma (UCC) of the bladder is done by cystoscopy and, in most cases, cytology. The last decade, many urine-based tests for UCC have been developed and tested in different populations. For the urological practice, considering the amount of follow-up cystoscopies, especially urine markers for recurrent disease would be useful. Therefore, we reviewed the literature on these markers for recurrent UCC and compared our findings with recent review-articles. METHODS: We performed a PubMed search. In case of primary and recurrent disease, the study was included if the patients under surveillance were reported separately. Patients with no evidence of disease at surveillance cystoscopy were considered to determine specificity. A marker was included if at least 2 studies from 2 different institutions/authors were available. RESULTS: The literature review yielded 64 articles. We found 18 markers (BTAstat, BTAtrak, NMP22, FDP, ImmunoCyt, Cytometry, Quanticyt, Hb-dipstick, LewisX, FISH, Telomerase, Microsatellite, CYFRA21-1, UBC, Cytokeratin20, BTA, TPS, Cytology) that met our criteria. BTAstat, NMP22, ImmunoCyt and cytology were evaluated in more than 750 patients. Telomerase, Cytokeratin20 and Hb-dipstick were tested in less than 250 patients. The highest median sensitivities were reported for CYFRA21-1 (85%), Cytokeratin20 (85%) and Microsatellite analysis (82%). The highest specificities were reported for Cytology (94%), BTA (92%) and Microsatellite analysis (89%). In comparison with recent reviews, median sensitivity was>or=5% lower for the surveillance group in 13/18 urine-based tests while specificity remained relatively constant between different patient groups. CONCLUSIONS: To our knowledge, this is the first review that assesses sensitivity and specificity of urine markers solely for UCC surveillance. In our view, Microsatellite analysis, ImmunoCyt, NMP22, CYFRA21-1, LewisX and FISH are the most promising markers for surveillance at this time. Nevertheless, clinical evidence is insufficient to warrant the substitution of the cystoscopic follow-up scheme by any of the currently available urine marker tests. Future studies may test some of the most sensitive and specific assays to reduce the cystoscopy frequency. However, our results show that initiators of these studies should anticipate a lower sensitivity than reported in the current literature.

Biomarkers, Tumor↗

PubMed1994

Unsuspected bladder carcinoma in patients undergoing radical prostatectomy.

Unsuspected synchronous transitional cell carcinoma of the bladder was discovered between January 1991 and June 1993 in 4 patients who were candidates for radical prostatectomy. Each of these patients had multiple urinalyses that did not demonstrate hematuria. During the 2 1/2-year period these patients represented 1.2% of all radical prostatectomies with cystoscopy performed preoperatively. Using the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) data the expected number of bladder neoplasms was estimated. The occurrence of synchronous bladder carcinoma observed in our prostatectomy group compared with age-matched population-based SEER data demonstrates a statistically significant difference as analyzed by the chi-square test (p < 0.001). Management of these superficial bladder tumors included transurethral resection before radical prostatectomy. All patients were free of prostatic and urothelial malignancy at 6 to 24 months. The finding of an unsuspected bladder malignancy in a radical prostatectomy candidate should be addressed first and further therapy should be guided by the stage of the bladder neoplasm. Cystoscopy provides information regarding bladder pathological findings, the status and location of the ureteral orifices, preexisting urethral pathological conditions and tumor encroachment on the urethra. The ideal time to perform cystoscopy is in the office before the scheduled date of surgery. Given the low morbidity and cost, cystoscopy should be performed before radical prostatectomy.

Aged↗

PubMed1981

Flow cytometry for followup examinations of conservatively treated low stage bladder tumors.

A series of 26 conservatively treated patients with low stage bladder tumors was examined later by outpatient cystoscopy, conventional cytology and flow cytometry. Based on those findings the patients were separated into 5 groups. In the 4 patients in group 1 all findings persistently were negative. The 4 patients in group 2 had initially normal cystoscopy with progressively more abnormal flow cytometry and intermittently positive cytology; they subsequently suffered tumors. The 10 patients in group 3 had positive cystoscopy and flow cytometry, and intermittently positive cytology. The 6 patients in group 4 had negative cystoscopy with intermittently positive cytology and persistently positive flow cytometry. In all 6 cases flow cytometry was more sensitive than conventional cytology in detecting early and, sometimes, cystoscopically occult neoplasms. In the 2 patients in group 5 cystoscopically visible papillomas and low grade papillary carcinomas were found with negative flow cytometry and negative or suspicious cytology. The papillary tumors in these 2 patients were believed to be composed principally of benign or atypical epithelium, with too few malignant cells to be detected by present flow cytometry techniques. Our preliminary results suggest that flow cytometry may be a valuable tool for followup of patients who have had conservatively treated low stage bladder tumors and are at risk for development of carcinoma. In addition, the techniques may be used to monitor changes in the proportion of benign and malignant cells and, thus, can be of help in following the course of newly forming papillomas, papillary carcinomas or carcinoma in situ in papillomas or flat epithelium.

Aged↗

PubMed2001

Analysis of false-positive BTA STAT test results in patients followed up for bladder cancer.

OBJECTIVES: To evaluate the role of a positive BTA stat Test result in patients with negative cystoscopic findings. METHODS: Five hundred one consecutive patients in follow-up for bladder cancer were studied. A voided urine sample was obtained before cystoscopy and split for culture, cytology, and BTA stat testing. In the case of a positive BTA stat Test, but negative cystoscopic findings, patients underwent additional investigations. RESULTS: Of 501 patients, 133 (26.5%) had bladder cancer recurrence at cystoscopy, of which the BTA stat Test detected 71 (53.4%); only 21 of the cases (17.9%) were detected by cytologic examination. Of the remaining 368 patients with no visible tumor at cystoscopy, 96 (26.1%) had a positive BTA stat Test result. Fifty-five of those (57.3%) underwent intravenous urography or renal ultrasound and random biopsies, and an additional 9 recurrences (16.4%) were detected. Of those 46 patients who had a true false-positive BTA stat Test, 3 (3 of 43, 7.0%) had recurrence at the next follow-up cystoscopy, 4 (8.7%) had a urine infection, and 8 (17.4%) had ongoing intravesical instillations; the latter two percentages were significantly higher than among those with true-negative BTA stat Test results (0% and 6.8%, respectively). CONCLUSIONS: Patients with a positive BTA stat Test result but negative cystoscopic findings have about a 16% risk of an undetected recurrence. False-positive results may be due to present instillation treatment and urine infection, and the predictive value of a BTA stat Test for subsequent recurrence seems relatively low.

Adult↗

PubMed2000

Urinary tissue polypeptide-specific antigen for the diagnosis of bladder cancer.

OBJECTIVES: To evaluate the diagnostic characteristics of the urinary measurement of cytokeratin tissue polypeptide-specific antigen (TPS) for the detection of bladder cancer. METHODS: Three hundred thirty-five individuals in five groups were studied: group 1, subjects with microhematuria under suspicion for primary bladder cancer; group 2, patients being followed up with scheduled cystoscopic examinations; group 3, patients in follow-up receiving chemotherapy instillations; group 4, patients with other urologic diseases; and group 5, healthy subjects. Urine samples belonging to subjects from groups 1, 2, and 3 were collected immediately before cystoscopy. Additionally, patients from groups 2 and 3 were monitored with urinary TPS for a minimum period between two cystoscopies. TPS was measured by an enzyme immunosorbent assay. RESULTS: Receiver operating characteristic analysis gave a sensitivity of 64% and a specificity of 84% at a threshold value of 279 U/L. The positive and negative predictive value was 66% and 82%, respectively; accuracy was 77%. TPS could discriminate the presence of bladder tumor sooner than the scheduled cystoscopies in 9 of 19 follow-up patients with recurrence. False-positive results during follow-up were found in 112 urine samples, one third of which were associated with urinary tract infections. TPS did not appear to be specific for bladder cancer, with elevated results in 45% of patients from group 4, which might lead to clinical misinterpretation of urinary TPS results. CONCLUSIONS: Urinary TPS might provide additional information for the detection of bladder cancer as an adjunct to cystoscopy. Considering the false-positive rates, different urologic diseases should be ruled out before making clinical decisions on the basis of elevated urinary TPS results.

Administration, Intravesical↗

PubMed2002

Differences between local and review urinary cytology in diagnosis of bladder cancer. An interobserver multicenter analysis.

OBJECTIVES: The objective of the study is to evaluate the agreement of local and review urinary cytology in patients with newly diagnosed bladder cancer and in those being followed for their disease. In addition, the effect of the type of institution on agreement was determined. METHODS: A total of 652 consecutive patients with bladder cancer from 19 institutions were evaluated; 575 (88.2%) of the patients had cytopathological sample available for central review and were eligible for analysis. One hundred and twenty nine (22.4%) of the patients had newly diagnosed bladder cancer, whereas the remaining 446 (77.6%) patients were under follow-up. A voided urine sample was obtained prior to transurethral resection of the bladder (TURB) or routine follow-up cystoscopy and split for culture and cytology. The cytopathological samples were first analysed by a local pathologist, and then re-analysed by a central reviewer. The agreement of cytological readings was determined by Kappa coefficient. RESULTS: The sensitivities of local and review cytology in detection of primary bladder cancer were 38.8 and 31.0%, respectively. Recurrence was observed in 119 of the 446 (26.7%) patients under follow-up, of which both local and review cytology detected 21 (17.6%) cases. Specificities of local and review cytology were 97.6 and 96.6%, respectively. Overall agreement of urine cytology was good in patients with primary bladder cancer and moderate in those being followed for their disease as Kappa coefficients were 0.70 and 0.60, respectively. However, some disagreement was found when results were analysed according to type of institution, to type of primary tumour, and to result of follow-up cystoscopy. In patients with primary bladder cancer the Kappa coefficient was 0.86 (very good) in university hospitals and 0.36 (fair) in city hospitals. Accordingly, in patients under follow-up the Kappa coefficient was 0.65 (good) in university hospitals and 0.39 (fair) in district hospitals. Although the stage of primary tumour had no effect on agreement, agreement was moderate (Kappa coefficient 0.45) in those with low grade tumour and good (Kappa coefficient 0.67) in those with high grade tumour. In addition, Kappa coefficients were 0.65 (good) and 0.40 (fair) in those with and without recurrence at follow-up cystoscopy. CONCLUSIONS: Although overall agreement of routine cytology was from moderate to good in both diagnosis and monitoring of bladder cancer, there is some variation in agreement according to the type of institution. Accordingly, grade of primary tumour and the result of follow-up cystoscopy had effect on agreement reflecting subjectiveness and weak reproducibility of this test. This not only emphasises the need for continuing education and quality control for urine cytologic analysis, but also inspires the development of more objective tests.

Carcinoma, Transitional Cell↗

PubMed2003

Surveillance with microsatellite analysis of urine in bladder cancer patients treated by radiotherapy.

OBJECTIVES: The interpretation of cystoscopy and cytology may be troublesome in bladder cancer patients previously treated by radiotherapy. We evaluated polymerase chain reaction (PCR)-based molecular cytology by microsatellite analysis (MA) and routine urine cytology (RUC) and expert urine cytology (EUC) as modes of surveillance for patients previously treated by radiotherapy with curative intent. METHODS: Eighty-one voided urine samples were obtained from 49 patients prior to cystoscopy and subjected to MA, RUC and EUC. RESULTS: During the follow-up period, six patients developed a recurrence. Sensitivity of MA, RUC and EUC was 83%, 50% and 33%, respectively. The specificity of MA, RUC and EUC was 93%, 85% and 97%, respectively. Cystoscopy was positive in 15 cases. Therefore, the positive predictive value of cystoscopy remained limited to 40%. CONCLUSIONS: Next to recent studies demonstrating a high accuracy for MA in non-irradiated patients, our results indicate that molecular cytology by MA may also be a useful tool to improve the surveillance of bladder cancer patients previously treated by radiotherapy.

Adult↗

PubMed1987

[Propofol in urological endoscopy in elderly patients. Comparison with methohexital].

Twenty patients undergoing cystoscopy (group A) and forty patients undergoing transurethral resection (group B), aged more than 65 years, were anaesthetized. Duration of anaesthesia was less than 15 min for cystoscopy, and more than 30 min for transurethral resection. No premedication was given. The patients were ASA I or ASA II. Group A patients were allocated randomly to receive either 1.5 mg . kg-1 propofol (n = 10) or 2 mg . kg-1 methohexitone (n = 10) for induction of anaesthesia. Anaesthesia was maintained using incremental doses of propofol or methohexitone and 60% N2O with a face-mask. Forty group B patients undergoing transurethral resection were randomly assigned to four equal groups (PB: propofol 1.5 mg . kg-1; MB: methohexitone 2 mg . kg-1; PF: propofol and 1.5 micrograms . kg-1 fentanyl; PFV: propofol, 2 micrograms . kg-1 fentanyl and 0.1 mg . kg-1 vecuronium). Suxamethonium (1 mg . kg-1; groups PB, MB and PF) and vecuronium (0.1 mg . kg-1; group PFV) were given to facilitate endotracheal intubation. Anaesthesia was maintained by infusion of propofol or methohexitone, using a calibrated pump started immediately after intubation. Ventilation was controlled only in group PFV. Induction with 1.5 mg . kg-1 propofol resulted in stopping counting after 62 s and loss of the eye-lash reflex after 84 s versus 47 and 67 s respectively with methohexitone. The anaesthesist's assessment was favourable for cystoscopy with propofol and methohexitone; recovery times were similar for the two drugs in cystoscopy lasting less than 30 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1999

Ureteral compromise after laparoscopic Burch colpopexy.

Ureteral obstruction occurred in two patients after laparoscopic Burch cystourethropexy. Both women experienced right flank pain and right hydronephrosis. Cystoscopy revealed transmural passage of suture anterior and lateral to the ureteral orifice on the right side. One patient was managed by suprapubic cystoscopy to release the suture; the other was managed by preperitoneal laparoscopy to release suture at the bladder neck. In both patients efflux of urine was seen immediately from the ureteral orifice after suture release. Ultrasound confirmed prompt resolution of hydronephrosis. Cystoscopy with confirmation of patent ureters should be performed after every case of retropubic cystourethropexy. Retrograde rigid cystoscopy may not afford adequate access to remove transmural sutures. Placement of sutures at the bladder neck from medial to lateral may avoid entrapment of the intramural portion of ureter. (J Am Assoc Gynecol Laparosc 6(2):217-219, 1999)

Adult↗

PubMedDate not supplied

The UroVysion fluorescence in situ hybridization assay is an effective tool for monitoring recurrence of bladder cancer.

The newly developed UroVysion fluorescence in situ hybridization (FISH) probe was applied to urine specimens from 19 patients being monitored for recurrence of bladder cancer. The results for the multi-target DNA FISH assay were compared with independent analyses of urine cytology and flexible cystoscopy. Patients with tumors identified through the cystoscopy exam were biopsied and/or underwent surgery. In 12 patients with normal cytoscopy, cytology and FISH were also normal. Therefore, the specificity of these two tests was 100%. In 7 patients, a tumor was diagnosed by cystoscopy, and 3 of them had abnormal urine cytology while 6 of them had an abnormal result in the FISH assay. Accordingly, the sensitivity was 43% for the cytology and 87% for the FISH test. Interestingly, a pT1G3 tumor in a bladder diverticulum was not detected by cytology or the FISH test. These results agreed with a large series previously published using similar FISH probes and support the proposal for a multicenter trial to confirm the usefulness of the UroVysion probe as a screening tool to select patients for cystoscopy.

Aged↗

PubMed2000

The nurse cystoscopist: a feasible option?

OBJECTIVES: To compare the accuracy achieved by a trained urology nurse practitioner (UNP) and consultant urologist in detecting bladder tumours during flexible cystoscopy. PATIENTS AND METHODS: Eighty-three patients underwent flexible cystoscopy by both the UNP and consultant urologist, each unaware of the other's findings. Before comparing the findings, each declared whether there was tumour or any suspicious lesion requiring biopsy. RESULTS: Of 83 patients examined by flexible cystoscopy, 26 were found to have a tumour or a suspicious lesion. One tumour was missed by the UNP and one by the urologist; each tumour was minute. Analysis using the chance-corrected proportional agreement (Kappa) was 0.94, indicating very close agreement. CONCLUSION: A UNP can be trained to perform cystoscopy and detect suspicious lesions as accurately as can a consultant urologist. Legal and training issues in implementation are important.

Cystoscopy↗

PubMed2004

[The impact of ALA (5-aminolevulinic acid)-fluorescence detection on the prognosis of superficial bladder cancer].

PURPOSE: Throughout the past years, several studies have shown that fluorescence cystoscopy with ALA (5-aminolevulinic acid) improves the detection rate of superficial bladder tumors by approximately 20 % compared to standard white light cystoscopy. These results suggest a reduced rate of residual/recurrent tumors with the routine use of ALA fluorescence technique prior to bladder tumor resection. The present prospectively randomized study was performed to verify this hypothesis. MATERIALS AND METHODS: A total of 115 bladder tumor patients were randomized for initial resection under white light or ALA fluorescence. After 6 to 8 weeks, a second-look resection was performed in all patients guided by ALA fluorescence. Additional white light cystoscopies were performed after 3, 6 and 12 months. RESULTS: The second-look resection did not find a tumor in 31 of 51 (59 %) patients initially resected under white light guidance compared to 43 of 51 (84 %) patients in the fluorescence group. This difference was statistically significant (p = 0.005). At 12 months, a tumor was not found in 17 of 48 patients from the white light group vs. 25 of 47 patients from the fluorescence group (p = 0.03). Seven patients were lost to follow-up. CONCLUSIONS: By reducing otherwise inevitable re-operations, fluorescence cystoscopy decreases morbidity and lowers treatment costs.

Adult↗

PubMed2004

Prognostic factors in patients with carcinoma in situ treated with intravesical bacille Calmette-Guérin.

OBJECTIVE: To report prognostic factors and follow-up data for an unselected group of patients with carcinoma in situ (CIS) of the urinary bladder treated with bacille Calmette-Guérin (BCG). MATERIAL AND METHODS: The clinical records of patients with CIS treated with BCG were reviewed. All 173 patients treated between 1986 and 1997 in four hospitals in two Swedish cities were included. The median follow-up period was 72 months (range 6-154 months). The impact of 18 variables on the times to recurrence and progression was studied using multivariate Cox proportional hazard regression and Kaplan-Meier analyses. RESULTS: No pre-treatment variables, including type of CIS and T1G3 tumour, had prognostic value in terms of time to progression. The result of the first cystoscopy had a very strong prognostic importance: 44% of patients with a positive first cystoscopy progressed in stage, 59% were BCG failures and 35% died from urothelial cancer. The corresponding values for patients with a negative first cystoscopy were 11%, 18% and 8%. Fourteen patients (8%) were diagnosed with an upper urinary tract tumour but no variable had prognostic significance. The diagnoses of the upper urinary tract tumours were evenly distributed during follow-up. CONCLUSIONS: We were not able to predict which patients would respond favourably to BCG. Cystectomy should be strongly considered even after a positive first cystoscopy. The accumulated incidence of patients with bladder CIS and a subsequent upper urinary tract tumour is rather high but it is questionable whether the prognosis will improve if routine follow-up urographies are performed.

Administration, Intravesical↗