PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Transurethral Resection of Bladder”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 595 records · Page 33Linked to original sources
PubMed2000

pT1 urothelial carcinoma of the bladder: criteria for diagnosis, pitfalls, and clinical implications.

One of the challenging areas in genitourinary pathology is the recognition of early invasion in urothelial neoplasia. Not uncommon, the patterns of invasion into lamina propria are subtle because a desmoplastic response is absent. Tangential sectioning due to inability to orient transurethral resection of bladder tumor specimens, crush and cautery artifacts further compound this problem. This review is presented to familiarize surgical pathologists with the criteria and different patterns of lamina propria invasion by urothelial carcinoma. Problems and pitfalls associated with the recognition of invasion and the clinicopathologic significance of lamina propria invasive urothelial cancer are also discussed.

Carcinoma, Transitional Cell↗
PubMed2002

Psoas abscess-like metastasis from transitional cell carcinoma of urinary bladder.

We report a 70-year-old male who presented with gross painless total haematuria associated with persistent left hip pain of one month duration. Computerised tomography of abdomen revealed a mass on the right lateral wall of urinary and abscess like lesion in the left psoas. He underwent transurethral resection of bladder tumour and ultrasonographical guided tru-cut biopsy of psoas lesion. Histopathology confirmed transitional cell carcinoma with metastasis to left psoas muscle. The presentation highlights the clinical and radiological features along with review of literature of rare metastatic site from transitional cell carcinoma of urinary bladder.

Aged↗
PubMed1989

[A case of localized amyloidosis of the bladder manifesting post-renal failure].

We report a case of primary localized amyloidosis of the bladder which manifested post-renal failure. A 79-year-old woman with diabetes mellitus complained of anorexia and oliguria. Computed tomographic (CT) scan showed bilateral hydronephrosis. Cystoscopic examination revealed a broad-based nonpapillary tumor in the trigonum of the bladder and CT scan demonstrated thickening of the posterior wall of the bladder. Pathological examination of the transurethral biopsy specimen revealed amyloid deposits in the submucosa, but no malignant changes were found. Cytodiagnosis of washing fluid of the bladder revealed amyloid deposits around the exfoliative cells. Serum electrophoresis showed a normal pattern. Urinary Bence-Jones protein was not detected. Amyloid deposits were not found in rectal mucosa. Systemic or secondary amyloidosis was ruled out from these findings, and primary localized amyloidosis of the bladder was diagnosed. The mass of the bladder was transurethrally resected and pig-tail stents were indwelt. These procedures gave a satisfactory result.

Acute Kidney Injury↗
PubMed2002

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

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

Administration, Intravesical↗
PubMed2003

Comparison of the nuclear matrix protein 22 with voided urine cytology in the diagnosis of transitional cell carcinoma of the bladder.

Several urinary markers for transitional cell carcinoma have been investigated, including urine cytology, bladder tumor antigen, autocrine motility factor receptor and fibrin degradation products. Unfortunately, they have poor overall sensitivity. The United States Food and Drug Administration have recently approved nuclear matrix protein (NMP 22) for the detection of occult or rapidly recurring disease after transurethral resection of bladder tumor. The objective of the current study was to assess the sensitivity of NMP 22 for the detection of bladder carcinoma, as well as to correlate the NMP 22 values with multiplicity of tumor, tumor size, configuration, stage and grade respectively. A total of 78 patients (38 with bladder cancer) provided a urine sample which was divided into appropriate aliquots for each of urine cytology and NMP 22. Comparative results demonstrate a clear superiority of NMP 22 in bladder cancer detection (52.6% vs 31.6% sensitivity), while specificity was in favor of urine cytology (100% vs 82.5%). For superficial tumors, sensitivity was 78.5% for NMP 22 and 41.6% for cytology and for invasive cancers, sensitivity was 90% for NMP 22 and 60% for cytology. Urinary NMP 22 levels were significantly correlated with tumor grade and were significantly higher in large tumors than small tumors. NMP 22 test results showed sufficient sensitivity in comparison with urine cytology for the detection of transitional cell carcinoma. However, we do not think that it is a useful tool as a substitute for endoscopic examination for the detection and surveillance in bladder cancer.

Biomarkers, Tumor↗
PubMed2003

Significance of protein p53 overexpression in the clinical course of high-risk superficial bladder cancer.

OBJECTIVES: This is a retrospective study in which the long-term biological behavior of 67 "high-risk" superficial bladder tumors and the prognostic relevance (prediction of disease recurrence and progression) of the determination of the p53 phenotype in these cases were studied. MATERIAL AND METHODS: 67 tumors with a "high-risk" of progression were selected from the 1,103 transurethral resections for bladder cancer carried out in 640 patients in this center between 1987 and 1992. These included 39 T1G3, 14 Tis (isolated or associated with Ta-T1, non-G3 tumors), and 14 Ta-T1, non-G3 tumors with submucosal lymphatic affection (L+). The median follow-up of these cases was 69.7 months. An immunohistochemical technique with monoclonal antibodies (DO-7) was used to detect the p53 phenotype in paraffin-fixed material. RESULTS: Tumor recurrence occurred in 31 patients (46.3%) and local or distant progression in 14 (20.9%). Radical cystectomy was carried out in 16 (23.9%) cases. p53 overexpression of > or =20% ("p53+") was detected in 40 tumors (59.7%). The rate of recurrence and progression, the disease and progression-free intervals, cancer-specific survival, disease-free survival and progression-free survival were similar in the 3 tumor groups (in all cases, p > 0.05). There were no significant differences in the overexpression of protein p53, using the standard cutoff point of 20% stained nuclei, on comparing the same variables in the whole group of 67 patients (in all cases, p > 0.05). CONCLUSION: The detection of protein p53 was not found to be of use in the retrospective prediction of disease progression or survival in "high-risk" superficial bladder cancer.

Aged↗
PubMed2003

Correlation study showing no concordance between EPAS-1/HIF-2alpha mRNA and protein expression in transitional cellcancer of the bladder.

OBJECTIVES: Endothelial Per-ARNT-Sim (PAS) domain protein-1 (EPAS-1)/hypoxia-inducible factor (HIF)-2alpha is a recently identified, endothelial-specific, hypoxia-induced transcription factor and is reputed to have an important role in tumor angiogenesis and tumor progression. Only a few studies have reported on the clinical correlation with grade, stage, necrosis, and microvessel density in transitional cell carcinoma of the bladder. In vitro studies have reported no concordance of EPAS-1/HIF-2alpha mRNA and protein expression. We sought to elucidate these two issues. METHODS: Surgical specimens from 110 patients with transitional cell carcinoma comprised the study, including 51 from radical cystectomy and 59 from transurethral resection of bladder tumor. Immunohistochemistry and in situ hybridization were performed with antibodies against EPAS-1/HIF-2alpha, CD31, and a human EPAS-1/HIF-2alpha cDNA subclone probe. RESULTS: EPAS-1/HIF-2alpha protein expression was found almost exclusively in high-grade and high-stage tumors (P <0.0001). EPAS-1/HIF-2alpha mRNA expression was detectable only in high-grade (grade 3) and high-stage (pT3a or greater) cases with positive EPAS-1/HIF-2alpha protein expression (P = 0.0017). The presence of necrosis correlated with EPAS-1/HIF-2alpha expression, tumor grade, and tumor stage (P <0.0001). Microvessel density was much lower in invasive, larger tumor nodules in EPAS-1/HIF-2alpha-positive cases than in the negative cases (P <0.0001). CONCLUSIONS: EPAS-1/HIF-2alpha protein and mRNA levels correlate with higher grade and advanced bladder transitional cell carcinoma. In lower stage cases, no concordance was found between transcription and translation of EPAS-1/HIF-2alpha gene expression. Because EPAS-1/HIF-2alpha mRNA is only detectable in highly invasive cancer cases, it may serve as a therapeutic target (eg, by an antisense mRNA approach) for bladder cancer.

Adult↗
PubMed1996

Effect of surgical stress on immune function in patients with urologic cancer.

BACKGROUND: To determine the immunosuppressive effect of surgery for urologic cancers, multiple variables of immune function were measured serially before and after operation in patients with urologic cancer. METHODS: Peripheral blood was obtained before operation and at postoperative day 7 and 14 from 20 patients with bladder cancer, renal pelvic, or ureteral cancer, or renal cell carcinoma. RESULTS: In patients with bladder cancer who were undergoing radical cystectomy with use of intestine for urinary diversion, the serum level of immunosuppressive acidic protein (IAP) increased, and serum levels of immunoglobulin (Ig)A, IgG, and IgM decreased after operation. In contrast, the number of CD25+ lymphocytes significantly increased. Transurethral resection of bladder cancer also resulted in an increase in serum IAP level, however, the number of CD4+ and human leukocyte-associated HLA-DR+ lymphocytes increased. In patients with renal pelvic or ureteral cancer undergoing nephroureterectomy with cuff, the level of serum IAP increased and serum IgG level decreased after operation. By contrast, the number of CD3+ lymphocytes increased. In patients with renal cell carcinoma, radical nephrectomy led to a significant increase in the number of CD8+ lymphocytes. CONCLUSIONS: These findings suggest that surgical stress in patients with urologic cancer may result in both suppression and stimulation of host immunity.

Adult↗
PubMedDate not supplied

Bladder preservation in muscle-invasive bladder cancer by conservative surgery and radiochemotherapy.

Organ preservation has been investigated in muscle-invasive bladder cancer over the past decades as an alternative to standard radical cystectomy. The results of large prospective protocols and population-based studies suggest that an organ-preserving approach is possible without deferring the survival probability. Organ preservation requires a trimodal schedule, including transurethral surgery (transurethral resection of bladder tumor (TURBT)), radiation, and chemotherapy. A complete TURBT is the most important single prognostic factor, and should be attempted. Radiotherapy, in conjunction with concurrent platinum-based chemotherapy, can control the vast majority of urothelial bladder tumors. The histologically-proven complete remission rates of macroscopic tumors (unresectable by TURBT) lie in the range of about 70%. After radiochemotherapy, a histological response evaluation with repeated TURBT is recommended. Patients with residual tumor require salvage cystectomy. In cases of complete remission, patients can maintain their bladders but they should be closely followed over years. The risk of severe late-radiation sequelae is low, in the range of less than 5%. About 75% of long-term survivors maintain a normally functioning bladder.

Humans↗
PubMed1988

[Operations during a 5-year period (1982-1986) at our department].

The statistics of urological operations performed at our department between Jan., 1, 1982 and Dec., 31, 1986 were reviewed. During the 5 year period, 2331 patients were admitted to our hospital and 2192 urological operations were performed on 1834 patients. These statistics were compared with earlier statistics for two periods (1972-1976 and 1977-1981) and the recent trend of urological operations was investigated. With regard to operated organ, operations on the kidney were the most frequent followed by those on the urinary bladder. Operations on the ureter decreased during the recent 5 year period and they were the fourth most frequent following those on the scrotum, scrotal contents and penis. Operations on the adrenal gland, retroperitoneal space and parathyroid gland have gradually increased. As in the former report, transurethral resection of bladder tumor (TUR-Bt) was the most frequent and nephrectomy, TUR of prostate (TUR-P) and renal allotransplantation have followed. TUR-Bt and TUR-P have increased more and more and due to the introduction of percutaneous nephrolithotripsy and transureteral lithotripsy, open surgery for urolithiasis has greatly decreased. Endourological operations will still be on the increase.

Female↗
PubMed1996

[A case of primary localized amyloidosis of the urinary bladder].

A case of primary localized amyloidosis of the urinary bladder is reported. The patient was a 46-year-old female who suffered from macrohematuria and consulted our department. A yellowish non-papillary tumor at the retrotrigone of the bladder was observed on cystoscopy. Histological diagnosis was amyloidosis of the bladder. Since there was no evidence of disease in other organs, this patient was diagnosed with primary localized amyloidosis of the bladder and transurethral resection was performed. The clinical course was uneventful and she has been well without recurrence for 6 months postoperatively. This case was cured by transurethral resection, but close follow-up of the patients is necessary because of the recurrence.

Amyloidosis↗
PubMed2006

Urinary CYFRA 21.1 is not a useful marker for the detection of recurrences in the follow-up of superficial bladder cancer.

OBJECTIVES: The objective of this prospective study is to establish an appropriate cutoff value of urinary CYFRA 21.1 assay and to assess its utility combined with voided cytology and/or haemoglobin dipstick in the follow-up of patients with superficial bladder cancer. METHODS: From December 2000 to November 2003, 446 patients in follow-up for superficial bladder cancer (Ta-T1) after transurethral resection of the bladder (TURB) were included in a prospective study. Voided urine specimens were collected 7-14 d before cystoscopy and/or TURB for CYFRA 21.1 (one sample), haemoglobin dipstick (one sample), and cytology (three samples). All samples were processed for CYFRA 21.1 and haemoglobin dipstick according to manufacturer instructions. A control group (n=185) was obtained from patients in follow-up after transurethral resection of superficial disease (without recurrences within the following 6 mo). There were 125 recurrent transitional tumours detected by cystoscopy (34 TaG1; 53 TaG2/T1G1-2; 23 Ta-1G3/Tis, and 15 T2-4). Receiver operator characteristic (ROC) curves were constructed and cutoff values were chosen. Sensitivity, specificity, PPV (positive predictive value), NPV (negative predictive value), and their 95% confidence intervals were calculated. RESULTS: ROC curve analysis based on the previously reported cutoff value of 4ng/ml for CYFRA 21.1 demonstrated a sensitivity and specificity of 43% and 68%, respectively. At a cutoff value of 1.5ng/ml, sensitivity was 73.8% with a low specificity (41%). Further lowering of the cutoff point below 1.5ng/ml did not demonstrate a significant increase in sensitivity. Therefore, this value was chosen as the most sensitive CYFRA 21.1 cutoff point during the rest of the study. Specificity increased when all the patients treated with pelvic radiotherapy or with UTI, urethral catheterisation, and intravesical instillations within 3 previous months were not included in our analysis. CYFRA 21.1 plus cytology and the combination of CYFRA 21.1, cytology, and haemoglobin dipstick demonstrated the highest overall sensitivities, and detected 91.3% of Ta-1G3 tumours and 93.3% of T2-4 tumours. However, there were one muscle-invasive tumour, two T1G3/Tis, three T1G2, and nine T1G1 neoplasms with negative combination of cytology and CYFRA 21.1 (1,5ng/ml). All these tumours were smaller than 2cm in size; most were single tumours. Nevertheless, there were 16 tumours larger than 0.5cm (0.5-2cm), and multiple neoplasms were endoscopically detected in 14 patients. Similar results were obtained through the combination of CYFRA 21.1 (cutoff: 1.5ng/ml), cytology, and haemoglobin dipstick. CONCLUSIONS: In our experience the low sensitivity of urinary CYFRA 21.1, even using lower cutoff values and/or a combination with cytology and/or haemoglobin dipstick, makes its application not very useful as a surveillance tool for superficial bladder carcinoma.

Antigens, Neoplasm↗
PubMed2004

Combined chemotherapy and external beam radiotherapy for transitional cell carcinoma of the bladder.

A growing body of evidence supports the treatment of invasive transitional cell carcinoma of the bladder with transurethral resection, chemotherapy, and external beam radiotherapy. Randomized trials have demonstrated the superiority of chemotherapy plus radiotherapy to radiotherapy alone. Several series with 10 years of follow-up demonstrate that the success of this approach can be maintained. Preservation of the urothelium, however, results in continued risk of de novo bladder cancer development in addition to the possibility of recurrence. Thus, continued close surveillance and treatment of subsequent superficial or invasive bladder cancer is an essential component of this bladder preservation approach. Concomitant cisplatin chemotherapy and radiotherapy or initial (neoadjuvant) combination cisplatin-based chemotherapy followed by radiotherapy are the two options best supported by the literature. How these regimens compare with each other and with cystectomy-based treatment remains to be defined.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Abdomino-perineal repair of recurrent and complex bladder neck-prostatic urethra contractures.

OBJECTIVE: To evaluate the effectiveness of abdomino-perineal repair in treating complex and recurrent bladder neck-prostatic urethra contractures. METHODS: The study included 6 patients retrospectively. Their ages ranged from 66 to 75 years (67.83+/-8.13, mean + SD). All presented with a long history of voiding difficulty and urinary incontinence. Prior to definitive treatment all the patients had been subjected to multiple unsuccessful transurethral resections of bladder neck-prostatic urethra contractures. They were all subjected to diagnostic work-up including retrograde and voiding urethrogram, urethroscopy and urodynamics. Finally all the patients underwent abdomino-perineal excision of the stenotic area and end to end anastomosis. All of them received simultaneously an artificial urinary sphincter insertion for concurrent sphincteric deficiency and three were subjected simultaneously to clam type ileocystoplasty for intractable detrusor instability. The follow-up ranged from 8 to 56 months (24.42+/-19.64, mean + SD). RESULTS: The actual surgical time ranged from 3.5 to 5.5 h (4.1+0.4, mean + SD). Five patients void satisfactorily remaining unobstructed through the entire follow-up period, while one has to empty his augmented bladder by means of clean intermittent self catheterization. Five patients are continent and one significantly improved. Major complications due to infection-erosion of the prosthetic material were encountered in one patient. CONCLUSIONS: Abdomino-perineal repair is an effective surgical procedure for the management of recurrent and complex bladder neck-prostatic urethra contractures, although it is time consuming and requires in the majority of cases combined techniques in order to achieve optimal results.

Aged↗
PubMed1987

[Radical transurethral resection of prostate for spinal cord bladder: its therapeutic effects and urodynamic evaluations].

89 spinal cord injury patients who had voiding disturbance and were refractory to conservative therapy, were treated by radical transurethral resection of prostate (radical TUR-P). We evaluated the therapeutic effects of this procedure using clinical, urographic and urodynamic studies. 80 of 89 cases attained satisfactory voiding parameters after radical TUR-P. Postoperative incontinence was not seen and in some cases incontinence was improved. The vesicoureteral reflux was abolished in 15 of 23 refluxing ureters and ameliorated in 3 ureters. Hydronephroureters were normalized in 9 of 10 cases. Urodynamically, vesical compliance was increased after radical TUR-P. Detrusor hyperreflexia was suppressed in 6 of 15 cases. Detrusor sphincter dyssynergia was abolished or suppressed in 25 of 31 dyssynergic patients. By referring to the neuroanatomy and physiology of the denervated urethra, why radical TUR-P works was ascribed to its possible "sympathectomy" effect.

Adult↗
PubMed2001

Lessons to be learned: a case study approach. Paraganglioma of the urinary bladder.

Primary paraganglioma arises infrequently in the urinary bladder. We present here the clinicopathological, immunohistochemical and ultrastructural findings in a 23-year-old Saudi female. She was hospitalised because of gross haematuria over the previous seven days. The intravenous urogram revealed a filling defect in the urinary bladder. Cystoscopy disclosed a non-papillary tumour arising from the roof of the bladder neck. Transurethral resection was, accordingly, performed--but marked fluctuation in blood pressure was observed during the procedure. The histopathological findings of trabeculae and small nests of plump oval to spindle cells with a clear to acidophilic cytoplasm, forming an organoid pattern and demonstrating inconspicuous mitotic activity, were diagnostic of paraganglioma of the urinary bladder, the diagnosis was confirmed by means of immunohistochemical and ultrastructural studies. The endocrine markers chromogranin A and neuron-specific enolase were positive in chief cells; sustentacular cells at the periphery of neoplastic cell clusters were positive for S-100 protein. Neurosecretory granules were identified by electron microscopic examination. It is emphasised that, currently, there are no anatomico-pathological criteria to distinguish benign and malignant forms of the disease. Post-surgical recovery was uneventful in this case. Recurrence and metastases, though infrequent, have been reported in the literature; therefore, radiation therapy may be an important adjunct--and long-term follow-up is mandatory.

Adult↗
PubMed1998

Evaluation of clinical staging before cystectomy in transitional cell bladder carcinoma: a long-term follow-up of 276 consecutive patients.

OBJECTIVE: To evaluate retrospectively the clinical staging in a consecutive series of patients selected for cystectomy and to define its limitations with a view to possible improvements. PATIENTS AND METHODS: From 1979 to 1988, 276 patients with newly detected or recurring transitional cell carcinoma (TCC) of the bladder, were offered pre-operative irradiation (20 Gy) and cystectomy. The patients were assessed during 1995 and the outcome related to both clinical and surgical data. Survival was analysed on the basis of 'intention to treat'. Estimates of survival probabilities were calculated by the method of Kaplan and Meier. Differences in survival among subgroups were assessed using the log rank test and Cox stepwise regression analysis. RESULTS: Cancer-specific actuarial survival for the whole series was 68% at 5 years and 63% at 10 years. Survival was closely related to the depth of invasion found at surgery, clearly discriminating those with tumours confined to the bladder wall (< or = P3A) from those with extravesical extension (> or = P3B). The cancer-specific survival at 5 years for patients with < or = P3A tumours was 85% and for those with > or = P3B tumours was 50%. This important distinction was anticipated accurately using bimanual palpation before surgery, those patients with no palpable mass after transurethral resection of bladder tumour (TURBT) having an actuarial survival of 83%, and those with a residual mass a survival of 50% at 5 years. In the multivariate analysis, increasing clinical stage was the only pretreatment variable with significant prognostic value for survival. However, this variable was highly dependent on the palpatory findings after TURBT, the presence of a residual mass being a prerequisite for the clinical stage T3 in case of muscle-invasive tumour. CONCLUSION: Bimanual palpation remains crucially important in clinical staging, and there is a need for further standardization and refinement of this procedure.

Adult↗