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PubMed1992

[Primary carcinoma in situ of the ureter: a case report].

A 47-year-old man presented with gross hematuria and left lower abdominal dull pain of 6-weeks duration. Cystoscopic examination revealed bloody efflux from the left ureteral orifice but no tumor in the bladder. Retrograde pyelogram showed irregular stricture of middle portion of the left ureter. Cytologic studies of the voided urine and left ureteral urine were positive for cancer, and nephro-ureterectomy with excision of a bladder cuff was carried out. The surgical specimen showed no intraluminal mass but histologically, transitional cell carcinoma in situ with G3 anaplasia and squamous metaplasia was found in the narrowed portion of the ureter. Followup examinations, including exfoliative urinary cytology, cystoscopy and IVP revealed no abnormalities until intravesical recurrence was confirmed 34 months later. Transurethral resection of bladder tumor was performed and superficial papillary transitional cell carcinoma with G2 anaplasia was found in the trigone of the bladder. Followup examinations for the last one year have revealed no abnormalities.

Carcinoma in Situ↗

PubMed1988

Tumor recurrence in prostatic urethra following simultaneous resection of bladder tumor and prostate.

A comparative retrospective study was performed on 100 patients who had undergone transurethral resection of a superficial bladder tumor (Ta-Tl) with no associated carcinoma in situ (group 1) and 100 patients who had undergone simultaneous transurethral resection of a superficial bladder tumor (Ta-Tl), with no associated carcinoma in situ, and benign prostatic hyperplasia (group II). Evaluation of the recurrences of prostatic urethral tumors in both groups showed that they appeared in 10 patients (12 recurrences) in group I and 10 patients (14 recurrences) in group II (p = not significant). These data enabled us to rule out the influence of simultaneous transurethral resection in cases of recurrences of prostatic urethral tumors.

Adult↗

PubMed2006

Intravesical adjuvant therapy using mitomycin C.

Bladder cancer is mostly superficial at first diagnosis. High incidence of recurrence is the major problem after initial management with transurethral resection (TUR) of bladder tumor. Adjuvant chemotherapy has been advocated to reduce the incidence of recurrence. A study was carried out to observe the efficacy of intravesical adjuvant therapy with single immediate versus delayed multi-dose regimen of Mitomycin C (MMC) in preventing recurrence of superficial bladder cancer. One hundred Patients having intermediate risk superficial bladder cancer were randomized into two equal groups. All patients were followed carefully. Total duration of follow-up was minimum 12 months, maximum 36 months, mean 29 months. No recurrence was seen on 3(rd), 6(th) and 9(th) month of intravesical therapy. As much as 94% and 96% of recurrence free rate was observed in immediate single and delayed multi-dose group respectively on 12(th) month; 86% and 84% on 18(th) month; 74% and 72% on 24(th) month; 70% and 68% on 36(th) month of follow-up cystoscopy respectively. Efficacy of post transurethral resection of bladder tumour (TURBT) MMC single immediate dose was found similar to that of MMC delayed multi-dose regimen in preventing the recurrence of intermediate risk superficial bladder transitional cell carcinoma (TCC) in the study. The difference between the two groups insignificant (p>0.05).

Administration, Intravesical↗

PubMed1987

[A case of multiple urothelial tumors with chronic renal failure].

We report a case of multiple urothelial tumors (left renal pelvis, ureter and bladder) with chronic renal failure in a 72-year-old man. The patient was admitted because of gross hematuria with increasing volume and intervals on September 14, 1985. Admission evaluation including excretory urography, retrograde pyelography, computed tomography and cystoscopy revealed multiple urothelial tumors in the left renal pelvis, ureter and bladder. Radical surgery, however, was postponed because of pneumothorax induced by an inadvertent insertion of the CVP catheter at operation. Subsequent respiratory disturbance persisted so that he was observed at the outpatient clinic following right ureterocutaneostomy. Gradual increase in anemia and decrease in renal function, however, prompted another admission. Gross hematuria necessitating frequent blood replacement could not be controlled by transurethral resection of bladder tumors. Therefore left nephroureterectomy with resection of bladder cuff was performed after internal arteriovenous shunt had been established, because favorable results regarding tumor resection were obtained from preoperative evaluations. He showed satisfactory recovery and was spared hemodialysis despite eventful postoperative course with transient decrease in renal function. The patient was discharged on 130th postoperative day and is now being followed up at the outpatient clinic. The relevant literature is also reviewed briefly.

Aged↗

PubMed1991

[Study of the combined M-VAC therapy in invasive bladder cancer].

We carried out combined M-VAC therapy in 12 patients with invasive bladder cancer without metastatic foci, and studied mainly the pathohistological findings and side effects before and after chemotherapy. There were 9 male cases and 3 female cases who were between 53 and 76 years old, and 66 years old on the average. After admission, 1 or 2 courses of M-VAC therapy were performed after confirmation of the pathological tissues by transurethral resection of bladder tumor (TUR-BT), and then total cystectomy (in 6 cases) or TUR-BT (in 6 cases) was conducted after 15 days on the average. According to the combined M-VAC therapy, down-stage was noted in 6 cases (50%) and down-grade in 6 cases (50%). Side effects such as anorexia, nausea and leukopenia were noted in all cases, and depilation, vomiting and thrombopenia were frequently noted. However, all these cases were transient without any serious trouble. The usefulness of the combined M-VAC therapy in invasive bladder cancer was proven, and the possibility of elevating the therapeutic response by surgery with lesser invasion was suggested.

Aged↗

PubMed2004

A randomized controlled trial of short-term versus long-term prophylactic intravesical instillation chemotherapy for recurrence after transurethral resection of Ta/T1 transitional cell carcinoma of the bladder.

PURPOSE: In a prospective randomized controlled study, we investigated the optimal schedule for intravesical instillation of epirubicin for maximizing its effect on prophylaxis and disease progression after transurethral resection of newly diagnosed Ta/T1 bladder cancer. MATERIALS AND METHODS: The patients were instilled with epirubicin (30 mg/30 ml in normal saline) within 24 hours after transurethral resection and then randomized into 2 groups after a definite histopathological diagnosis of Ta/T1 bladder cancer. One group of 77 patients received 19 intravesical instillations of epirubicin in the year after transurethral resection (group 1). The second group of 73 patients received 9 intravesical instillations of epirubicin during the 3 months after transurethral resection (group 2). Nonrecurrence rates and toxicity were compared. RESULTS: In the followup period, 10 group 1 patients (13.0%) and 23 group 2 patients (31.5%) had recurrent disease. The 3-year nonrecurrence rate was 85.2% in group 1, whereas it was 63.9% in group 2. The nonrecurrence rate of group 1 was significantly higher than that of group 2 throughout the observation period (p = 0.005). The incidence and severity of toxicity were not significantly different between the 2 groups. CONCLUSIONS: Our study indicates that long-term instillation of epirubicin is more effective than short-term instillation in preventing recurrence after transurethral resection of Ta/T1 bladder cancer.

Administration, Intravesical↗

PubMed1996

Clinicopathological evaluation of repeated courses of intravesical bacillus Calmette-Guerin instillation for preventing recurrence of initially resistant superficial bladder cancer.

PURPOSE: The efficacy of repeated courses of intravesical bacillus Calmette-Guerin (BCG) for superficial bladder cancer was assessed with particular attention to initially resistant cases. MATERIALS AND METHODS: A total of 75 patients with stages Ta to T1b superficial transitional cell bladder carcinoma received 6 weekly instillations of 80 mg. Tokyo strain BCG in 40 ml. saline followed by 6 instillations at monthly intervals. If tumors recurred, another course of treatment was given with surgery. RESULTS: Of 17 patients (22.7%) with recurrent tumor at followup periods of up to 84 months 12 received an additional course of BCG instillations according to the same protocol after transurethral resection of bladder tumors, and 10 (83.3%) showed no further recurrence with or without additional surgery and BCG therapy after a median followup of 42.9 months. Thus, the overall success rate with this approach was 90.7% (68 of 75 patients). Comparison of patients with and without recurrence revealed a significant difference in number of tumors before therapy (p < 0.05), and a pronounced tendency (p = 0.00507) for recurrence after prior systemic chemotherapy or intravesical instillation. CONCLUSIONS: The results suggest that up to 3 courses of repeated intravesical instillation of BCG are effective even for cases that initially did not respond, and that best results may be achieved if no other prior chemotherapy has been attempted.

Administration, Intravesical↗

PubMed1987

Intravesical irrigation with distilled water during and immediately after transurethral resection and later for superficial bladder cancer.

In a retrospective study, the influence of distilled water, used as the irrigation fluid during and immediately after the complete removal of superficial bladder cancer, on the recurrences of bladder cancer was evaluated. Thirty-two percent recurrence developed in the first year (25 patients) and 50% in the second year (39 patients). The 3-month and 1-year recurrence-free rates were 87.2 and 68% respectively. The results support the concept that recurrences may arise from tumor cell implantation at the time of transurethral management of bladder tumors and may be reduced effectively by using distilled water.

Aged↗

PubMed2003

[Leiomyoma of the urinary bladder: report of three cases].

We report 3 cases of leiomyoma of the urinary bladder. One patient was a 57-year-old female. Magnetic resonance imaging (MRI) revealed a small tumor, and cystoscopy revealed a submucosal tumor on the left wall. Partial cystectomy was performed, and she has had no recurrence for 10 months. Two females who were aged 68 years and 52 years, were referred to our hospital with the complaint of pain of meatus of urethra, and pollakisuria, respectively. Transurethral resection of bladder tumor (TURBT) was performed, and they have had no recurrence for more than 3 and 4 years, respectively. Histological examination in the three cases showed a leiomyoma of the urinary bladder. To our knowledge, there are 151 cases of leiomyoma of the urinary bladder reported in the literature in Japan.

Aged↗

PubMed2005

Staging bladder carcinoma by three-dimensional ultrasound rendering.

Organ-confined staging for bladder cancer has major impact on further treatment. Most imaging techniques for this purpose are insufficient. We, therefore, assessed the value and the limitations of a new diagnostic tool, the 3-D ultrasound (US) rendering, to distinguish invasive from noninvasive bladder cancers. A total of 63 patients underwent 3-D US of the bladder before transurethral resection or radical cystectomy. The US findings were compared with the pathologic stages of the transurethral resection material or the cystectomy specimens. Superficial (pTa) carcinomas were correctly staged in 66% by 3-D US. Lamina propria infiltrating (pT1) were correctly staged in 83% and the quota of correct staging of infiltrating carcinomas (>pT1) by 3-D rendering was 100%. The overall accuracy was 79%. Three-dimensional US rendering is most valuable to discriminate between superficial stages pT1. This new technique might improve staging of bladder cancer.

Cystectomy↗

PubMed1997

Single-dose versus multiple instillations of epirubicin as prophylaxis for recurrence after transurethral resection of pTa and pT1 transitional-cell bladder tumours: a prospective, randomized controlled study.

OBJECTIVE: To compare single-dose and multiple instillations of epirubicin in the chemoprophylaxis of superficial bladder tumours. PATIENTS AND METHODS: In a prospective randomized and controlled study, 168 evaluable patients were assigned to three groups after transurethral resection of bladder tumour (TURBT) and histological confirmation of its superficial nature (pTa and pT1). The groups were comparable for tumour stage, grade and other tumour characteristics. In group 1, patients received a single dose of 50 mg epirubicin in 50 mL normal saline immediately after TURBT; group 2 received 50 mg epirubicin in 50 mL normal saline 1-2 weeks after TURBT and the instillations were repeated for 8 weeks and thereafter monthly to complete one year of treatment: group 3 (control group) received no adjuvant therapy after TURBT. The patients were assessed by cysto-urethroscopy, urine cytology and DNA flow cytometry 8 weeks after resection and then every 3 months during the first 2 years and 6 monthly thereafter during the next 2 years. Intravenous urography was performed annually and when otherwise indicated. RESULTS: The recurrence rate was significantly lower in the patients treated with epirubicin than in the control group (24, 25 and 52%, respectively; P < 0.001). In those receiving epirubicin, the rates of recurrence were statistically comparable (P = 0.9). Patients who had a large tumour burden showed slightly lower recurrence rates with single-dose epirubicin than with delayed maintenance therapy but the difference was statistically insignificant. Patients with a history of bladder tumours before treatment had lower recurrence rates with maintenance treatment than with a single dose (34.6 and 22.6% in groups 1 and 2, respectively); again this difference was statistically insignificant. Patients with grade 3 tumours showed a marginal difference in favour of maintenance therapy. The rates of progression amongst the three groups were 5.5, 3.4 and 9.3%, respectively, with no significant differences. The overall toxicity rates were comparable in the two treated groups (22 and 25%). CONCLUSION: With the possible exception of grade 3 tumours, single-dose immediate epirubicin is as effective as delayed maintenance therapy, with the advantage of being more cost-effective.

Adult↗

PubMed1987

[Study on effectiveness of carmofur (Mifurol) in urogenital carcinoma, especially bladder cancer, as a post-operative adjuvant chemotherapeutic agent].

This study was carried out to evaluate the effects of carmofur (Mifurol), a masked compound of 5-fluorouracil (5-FU), in preventing postoperative recurrence of urogenital carcinoma (especially in bladder cancer). Carmofur was given orally at the dose of 300 approximately 600 mg/day to 134 patients (90 males and 44 females) after the resection. Out of 134 patients, 121 patients were evaluable and the rate of their recurrence was 10.7%. The rate of cumulative nonrecurrence for 65 patients it was 96.0, 73.0 and 60.8% in 1, 2 and 3 years, respectively. The group of curative resection demonstrated a higher cumulative nonrecurrence rate than that of noncurative or palliative resection group. In considering the resection methods, transurethral resection of bladder tumor group demonstrated a higher rate than partial or total cystectomy. The average concentration of 5-FU in serum was 0.65 microgram/ml at 120 minutes after oral administration of 200 mg of carmofur. Moreover, the concentration of 5-FU (15 approximately 35 micrograms/ml) in urine was higher than that of carmofur. The rate of side effects that appeared was 19.6%. The side effects were hot feeling (12.2%), pollakisuria (4.3%), anorexia (4.3%), an antabuse-like reaction by drinking (3.8%) and so on. These results were similar to those already reported.

Administration, Oral↗

PubMed2005

[A case of sigmoid colon cancer that spread to the urinary bladder via the ureter].

A 69-year-old male was admitted to the hospital with the chief complaint of left hydronephrosis and diagnosed. A year ago, he underwent sidmoidectomy to cure sigmoid colon cancer diagnosed as stage IV. Ultrasonography (US) and computed tomography (CT) detected the compression of the ureter at its middle left due to the enlargement of the left iliac lymph node and hydronephrosis and hydroureter at the proximal to the compressed part. Then, a ureteral tumor was suspected and urinary cytology was class V. Cystoscopy detected a papillary tumor projecting from the left ureteral orifice. Because the histopathological manifestation by transurethral resection of bladder tumor and that by the sidmoidectomy were consistent, it was considered that sigmoid colon cancer spread to the urinary bladder via the left ureter. There have been only 4 reported cases of adenocarcinoma that multiplied in the ureter, and this is the fifth case report.

Adenocarcinoma↗

PubMed2001

[Radiotherapy of urothelial carcinomas of the urinary bladder].

Radiotherapy of bladder cancer is a locally effective therapeutic approach. It is increasingly becoming part of the multimodal protocols aimed at the preservation of both organ and organ function. In this context, it is an alternative to cystectomy. The addition of chemotherapy to radiotherapy enhances the curative potential of this non-surgical approach and may be useful especially in older, multimorbid patients. If chemotherapy can not be applied, the use of radiotherapy alone is reasonable, although in advanced tumors the results are disappointing. After the transurethral resection of bladder cancer, postoperative radiotherapy should be considered in muscle-invasive cancer as well as when other negative prognostic factors occur. The prerequisites for an effective, minimally toxic, state of the art radiotherapy are a subtle treatment-planning procedure and an accurate delivery of the radiation.

Carcinoma, Transitional Cell↗

PubMed1999

[Preoperative balloon occluded arterial infusion chemotherapy for locally invasive bladder cancer--accurate staging for bladder preservation].

The possibility of bladder preservation by preoperative balloon occluded arterial infusion (BOAI) chemotherapy was studied in 111 patients with locally invasive bladder cancer. BOAI was performed by blocking the blood flow of the internal iliac artery and by performing intra-arterial infusion of adriamycin (50 mg/body) and cisplatin (100 mg/body). Before BOAI the clinical diagnosis was T2 in 36, T3a in 29, T3b in 27, T4 in 11 and after BOAI it was T0 in 1, T1 in 27, T2 in 25, T3a in 20, T3b in 20, and T4 in 10. Down staging was observed on diagnostic images in 46.6%. Thirty patients (27.0%) received transurethral resection of bladder tumor (TUR-Bt) and their bladder could be preserved. The 5-year cancer-specific survival rate was 100% in pT0 (n = 9), 97.5% in pT1 (n = 47), 79.9% in pT2 (n = 21), 80.0% in pT3a (n = 6), 39.9% in pT3b (n = 18) and 51.9% in pT4 cases (n = 9). For the bladder preservation, accurate staging diagnosis is required. Since 1992, endorectal magnetic resonance imaging (MRI) has been used in addition to imaging diagnosis for improving the accuracy of staging diagnosis. The accuracies of staging diagnosis with and without endorectal MRI were 62.5% and 44.0%, respectively. BOAI as a neoadjuvant chemotherapy has the possibility of bladder-preserving therapy in locally invasive bladder cancer. Also, the endorectal MRI can improve the accuracy of staging diagnosis, which is important for the bladder preservation.

Aged↗

PubMed2006

Should we screen for bladder cancer in a high-risk population?: A cost per life-year saved analysis.

BACKGROUND: The U.S. Food and Drug Administration recently approved screening high-risk patients for bladder cancer using urine-based markers. The cost and life-years saved associated with bladder cancer screening were evaluated. METHODS: A Markov model was created to estimate cumulative cancer-related costs and efficacy of screening (vs. no screening) of a high-risk population for bladder cancer using a urine-based tumor marker over a 5-year period. Assumptions were based on literature review of survival and progression rates for patients with bladder cancer and costs associated with different bladder cancer disease states. RESULTS: Screening for bladder cancer in a population with a 4% incidence of bladder cancer resulted in a gain of 3.0 life years per 1000 subjects at a cost savings of $101,000 for the population, assuming a 50% downstaging in the screened population from muscle-invasive to nonmuscle-invasive disease. One-way sensitivity analyses found that screening is the most cost-effective strategy if cancer incidence is >1.6%, tumor marker costs <$126, marker sensitivity is >26%, marker specificity is >54%, downstaging with screening is >20%, and office cystoscopy costs <$694. Varying costs of cystectomy, transurethral resection of bladder tumor (TURBT), chemotherapy, end-of-life care, costs of metastatic disease, and a computed tomography scan over a wide range did not affect the superiority of screening. CONCLUSIONS: The model found that urine-based markers are cost-effective in a high-risk population. Prospective randomized trials in a completely asymptomatic high-risk cohort are indicated before bladder cancer screening can be recommended.

Biomarkers, Tumor↗

PubMed2003

[Transurethral resection in saline (TURis): a newly developed TUR system preventing obturator nerve reflex].

PURPOSE: We developed an innovative transurethral resection system (TURis) consisting of a uniquely-designed generator and a resectoscope. The obturator nerve is protected from troublesome reflexes during TURis because the high frequency current delivery route is via the resection loop to the sheath of the resectscope and not via a patient plate. After extensive preclinical evaluation and verification of the system using an animal model to ensure efficacy as well as operational safety, TURis was conducted for treatment of superficial bladder cancer and benign prostatic hyperplasia. MATERIALS AND METHODS: In preclinical experiments swine bladder wall was transurethrally resected using the system in a saline environment. The results were compared with data obtained from an identical resection using the conventional system using sorbitol solution irrigation. Electrolytic contents were measured after TUR for comparative evaluation vis-a-vis corresponding pre-TUR data. Also, the depth of heat degeneration was measured in the resected tissue. From December, 2000 to June, 2002, TURis was performed in 25 cases of superficial bladder cancer and 30 cases of benign prostatic hyperplasia (BPH), using saline irrigation. All 55 cases were performed under spinal anesthesia without an obturator nerve block. The output power was set at 280 W for cut and 120 W for coagulation. A smaller electrode than those used in conventional TUR was used to improve the cutting efficacy. Occurrence of obturator nerve reflexes, difference of hematocrit and electrolytic contents before and after TURis, operation time and total volume of irrigated saline were evaluated. RESULTS: TURis in animal model: No adductor contraction of a lower limb was observable except for minimal creeping during the resection of a site close to the urethra. There were no apparent anomalies relative to the blood electrolyte content after TURis. No difference was observed in the mean depth of heat-degeneration tissue change compared with the conventional system. TURis for bladder cancer and BPH: No additional skills were required for TURis compared to conventional TUR. No obturator nerve reflex was observed except for a clinically insignificant thigh movement in one case of bladder cancer. The post-TURis blood tests manifested no significant anomalies in blood electrolyte content. Mean operation time for bladder cancer and BPH were 32 and 42 minutes respectively. Mean volumes of saline consumed during TURis were 6,083 ml for bladder cancer and 16,100 ml for BPH. CONCLUSIONS: TURis worked effectively in a saline-irrigated environment. It does not need a patient plate and obturator nerve block even in cases of bladder cancer on the lateral wall. In addition, saline was both safe and cost-effective compared to non-electrolytic solution as irrigant for TUR of BPH. This suggests that TURis may have more applications than conventional TUR.

Animals↗

PubMed1999

Transitional-cell carcinoma of the bladder in an adolescent.

We report a rare case of transitional-cell carcinoma of the bladder in an 18-year-old girl with intermittent hematuria. The tumor was diagnosed through the cystogram phase of the excretory urogram and bladder ultrasound. Transurethral resection (TUR) of the tumor was performed. As most tumors are low-grade and low-stage and are associated with an excellent prognosis, endoscopic TUR is the preferred therapeutic measure. However, recurrence as well as death have been reported in this age group. These patients should be followed carefully, similar to adult patients.

Adolescent↗