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PubMed1998

Bladder cancer recurrence by implantation of exfoliated cells: is gamma-linolenic acid an effective tumoricidal agent?

OBJECTIVE: To compare the tumoricidal efficacy of meglumine gamma-linolenic acid (MeGLA), mitomycin C, epirubicin and water on two urothelial cell lines, and to establish the effect of serum protein levels derived from bladder cancer resection craters on the action of these agents. MATERIALS AND METHODS: The human urothelial cell lines MGHU-1 and RT112 and their drug-resistant variants were exposed to short pulses of aqueous MeGLA, mitomycin, epirubicin and water. Both adherent and suspended cells were exposed to these agents. The MTT viable biomass assay and a clonogenic assay were used to establish tumoricidal efficacy. These experiments were then repeated to assess the effect of added serum proteins on the test results. Estimates of protein in the waste irrigation fluid from 10 patients undergoing transurethral resection of bladder tumour (TURBT) were used to select the quantity of protein used in the study, to establish the clinical relevance. RESULTS: MeGLA caused > 95% reduction in the residual viable biomass of adherent cells, compared with < 50% reduction with any other agent. Both epirubicin and mitomycin were as effective as MeGLA in preventing colony formation from suspended drug-sensitive (parental) cells. However, using multidrug-resistant (MDR) cell lines, only MeGLA prevented any colony formation, although counts were greatly reduced by mitomycin and epirubicin. Water was least effective as a tumoricidal agent on both adherent and suspended cells. On the latter, water was markedly inactivated by adding 5% serum. TURBT waste irrigation fluid was found frequently to contain such quantities of serous fluid contamination, as shown by albumin estimates in waste fluid from 10 consecutive patients undergoing this procedure. CONCLUSION: MeGLA is an effective tumoricidal agent against both parental and MDR cell lines. Its efficacy is maintained in the presence of clinically relevant serum contamination.

Antibiotics, Antineoplastic↗

PubMed1995

Combined intraarterial cisplatin infusion and radiation therapy for invasive bladder cancer.

Combined intraarterial cisplatin infusion and radiation therapy were performed as the initial treatment for 23 patients (mean age: 70 years) with invasive bladder cancers (T2 in 17, T3 in 6) who were suitable for total cystectomy. Of these patients, five who had multiple invasive cancers without laterality had their intrapelvic hemodynamics altered by embolizing a contralateral internal iliac artery. Cisplatin (50 mg) was infused into the internal iliac artery through a subcutaneous reservoir twice a week over three weeks while concurrent radiation therapy with 30 Gy, delivered in 15 fractions, was performed. Additional cisplatin infusions were given in six patients. After this combined therapy, total cystectomy and ileal conduit was performed in six patients and transurethral resection of bladder tumor (TURBT) in 17. Two of the patients who underwent total cystectomy were found to exhibit a complete response. Therefore, the overall response rate was 87%, including 13 complete responses and seven partial responses. The complete response rates in patients with clinical stage T2 and T3 disease were 53 and 67%, respectively. The complete response rate was slightly higher in patients with a non-papillary cancer than in those with a papillary one. Toxic reactions included a decrease in bladder capacity in two patients and severe diarrhea due to methicillin-resistant Staphylococcus aureus colitis in one. Other forms of toxicity, including nausea, vomiting, neurotoxicity in the gluteal region, nephrotoxicity and myelosuppression, were tolerable. All but one of the patients are alive.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1995

Combined intraarterial cisplatin infusion and radiation therapy for invasive bladder cancer.

Aged↗

PubMed2000

Inverted papilloma arising in a juvenile.

A 15-year-old man presented with painless, gross hematuria. Excretory pyelography showed a filling defect in the bladder and ultrasonography revealed a solitary bladder tumor. Cystoscopy showed a solitary, papillary tumor on the bladder neck. Transurethral resection was then performed and histological examination showed an inverted papilloma. In addition, the expression of proliferative cellular nuclear antigen and p53 in the surgical specimen were 37.1 and 0%, respectively. Since an inverted papilloma arising during the first two decades of life is quite rare, we herein report the above case and review previous reports.

Adolescent↗

PubMed2003

[Acute and immediate urination syndrome after transurethral resection: a case of incrustating cystopathy].

The authors present a case of acute and prompt symptomatic irritative urinary cystitis after transurethral resection (TR) of bladder cancer. The clinical presentation, like a irritative syndrome, was with a positive urine cultive to Enterococci and Staphylococcus. The physical examination, under general anesthesia (EBA), eliminated the urethral injury or the meatus trauma, so the urethral stenosis. The bladder view, in scaring processing yet, was congestive, bledding and edematous; an extensive white calcification was covering all the mucose surface bladder. The presumptive diagnosis was incrusted cystophatie (cystitis) and a transurethral resection (TR), along total bladder mucosa, was made so the result of pathological examination was sure. Intravenous and oral antimicrobial agent (Amoxicillin-Clavunan), in different ways, was instaured like a treatment, to achieve a negative urinary cultive, to eradicate the bacterial agents. We made a revision of the most important aspects in the clinical presentation, laboratory diagnosis and therapy, in this cystophatie that is not frequent, where the ureolitic bacterial agents have the responsibility, main Corynebacterium urealiticum, and where the recent urologic surgery or instrumentation, is narrowly related with the development of this cystophatie.

Acute Disease↗

PubMed2004

Holmium:YAG laser vaporization of recurrent papillary tumours of the bladder under local anaesthesia.

OBJECTIVES: To evaluate holmium:YAG laser vaporization of papillary tumours of the bladder, focusing on surgical technique, patients' satisfaction, complications and cost-effectiveness when using the technique under local anaesthesia as an outpatient procedure. PATIENTS AND METHODS: In all, 52 consecutive patients with recurrent papillary tumours of the bladder were scheduled for holmium:YAG laser vaporization under local anaesthesia using a flexible cystoscope. The number of papillomas and total operative duration was recorded. Patients and surgeons were asked to complete a questionnaire about the procedure. RESULTS: In all, 197 papillomas were successfully vaporized in 88 operations, with a median operative duration of 15 min (5 min per papilloma) and no patient needed treatment under general anaesthesia. Most patients (86%) had no pain (as reported during standard cystoscopy) and none of the procedures was stopped because of pain. All patients would undergo the treatment again, compared with a standard transurethral resection of bladder tumour. The five surgeons rated the procedure as easy in most patients (78%) and difficult in a few (6%). The total cost for the outpatient procedure was less than that for standard treatment. CONCLUSION: This study clearly indicates that holmium:YAG laser vaporization of superficial bladder tumours is feasible, easy and fast, with a high degree of patient satisfaction, and it seems to be an attractive alternative to standard treatment. The procedure has some clear positive socio-economic perspectives in both the short- and long-term.

Aged↗

PubMed2006

[Inverted papilloma of the bladder].

OBJECTIVES: To report a series of patients with bladder inverted papilloma, pointing out the clinical features, presentations, treatment options and outcomes. We also perform a bibliography review oriented to the diagnostic criteria, treatment options and prognosis of the inverted papilloma. METHODS: We reviewed the medical charts of all patients with the diagnosis of bladder inverted papilloma treated by our group between July 1996 and June 2003. RESULTS: 16 cases of inverted papilloma of the bladder were diagnosed in ten males and six females, with a mean age of 53.1 yr. (range 31-72). The most frequent reason for consultation was voiding urgency (43.7%), followed by hematuria (37.5%). In 14/16 patients the lesion was localized in the bladder trigone. Transurethral resection of the lesion was performed in all patients. Two cases (12.5%) presented associated transitional cell carcinoma. CONCLUSIONS: The inverted papilloma is a rare pathologic entity Despite the absence of agreement about its aggressiveness or innocuousness we consider its potential malignancy should be taken into consideration after the evidence of recurrences and its association with transitional cell carcinoma.

Adult↗

PubMed1995

BCG treatment of existing Ta, T1 tumours or carcinoma in situ of the bladder.

There are theoretical limits to the efficacy of intravesical instillation of anticancer agents as a method to prevent recurrence of superficial bladder cancer. Studies on the direct efficacy of intravesical instillation of bacillus Calmette-Guérin (BCG) to treat existing papillary tumours (Ta, T1) have shown a complete response rate of 66.4% and a partial response rate of 20.8%. These figures represent potent efficacy similar to that of BCG in the treatment of carcinoma in situ (CIS). Moreover, this efficacy was found to persist over a long period of time, and the subsequent recurrence rate was markedly reduced. In cases with multiple tumours, or in subjects where concurrent CIS is strongly suspected, these findings suggest that intravesical instillation of BCG might best be performed prior to transurethral resection of bladder tumours.

Administration, Intravesical↗

PubMed1995

Bacillus Calmette-Guerin in the treatment of stage T1 grade 3 transitional cell carcinoma of the bladder: long-term results.

PURPOSE: We performed a retrospective long-term study to evaluate the results of immunotherapy in the treatment of high grade superficial bladder tumors. MATERIALS AND METHODS: Between 1981 and 1993, 593 patients with superficial transitional cell carcinoma of the bladder underwent transurethral resection. Of 64 patients with stage T1 grade 3 disease 50 received intravesical bacillus Calmette-Guerin after transurethral resection of all visible tumor. RESULTS: At a median followup of 42 months (range 12 to 112) 36 patients (72%) are disease-free and have not required further treatment. Superficial recurrence was noted in 8 patients (16%). Disease progressed in 6 patients (12%), including 5 with locally invasive and 1 with metastatic disease. Cystectomy was performed for progression in 4 patients and for recurrent stage T1 grade 3 disease in 1. There was 1 disease related death (2%). The overall survival rate is 94%. CONCLUSIONS: Intravesical bacillus Calmette-Guerin appears to be the most effective conservative treatment for patients with stage T1 grade 3 bladder cancer.

Adjuvants, Immunologic↗

PubMed1984

[Primary hyperparathyroidism associated with bladder tumor: report of a case].

A 47-year-old man was admitted with chief complaints of macroscopic hematuria and bone pain. Hypercalcemia still remained after three small papillary tumors on the left retrotrigonal wall of the bladder were resected transurethrally. Some biochemical as well as X-ray examinations thereafter pointed out an association with primary hyperparathyroidism. An adenoma arising from right upper parathyroid gland was found and excised. Then his symptoms, both subjective and objective, were normalized. Six documented cases of primary hyperparathyroidism associated with urological malignancy including our own were found in the Japanese literature.

Calcium↗

PubMed2002

Delay and survival in bladder cancer.

OBJECTIVE: To assess in detail and evaluate the effect on survival of delays in the diagnosis and treatment of cancer (which might lead to a worse prognosis), dividing the delay from onset of symptoms to first treatment into several components, comprising patient delay, general practitioner (GP) delay, and two or more periods of hospital delay. PATIENTS AND METHODS: Data were prospectively collected on 1537 new cases of urothelial cancer in the West Midlands from 1 January 1991 to 30 June 1992. Death information was obtained from the West Midlands Cancer Intelligence Unit and censored at 31 July 2000. The influence of delay times on survival was explored. RESULTS: The median delay from onset of symptoms to GP referral was 14 days (Delay 1), from GP referral to first hospital attendance was 28 days (Delay 2), and from first hospital attendance to first transurethral resection of bladder tumour was 20 days (Delay 3). The median hospital delay (Delay 2 + 3) was 68 days and the median total delay (Delay 1 + 2 + 3) was 110 days. Patients with a shorter Delay 1 had a lower tumour stage and a 5% better 5-year survival. Patients with a shorter hospital delay had worse survival; total delay had no effect on survival. CONCLUSIONS: There was significantly better survival for patients referred to hospital within 14 days of the onset of symptoms. The relationship between delay and survival in bladder cancer is complex. Hospital delays may be influenced more by comorbidity than by the characteristics of the tumour. However, the adverse effects of delay seem to be most pronounced for patients with pT1 tumours.

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PubMed1995

Preventive effect of a Lactobacillus casei preparation on the recurrence of superficial bladder cancer in a double-blind trial. The BLP Study Group.

A double-blind trial was conducted in 138 patients with superficial transitional cell carcinoma of the bladder following transurethral resection to evaluate the prophylaxis of recurrence by an oral Lactobacillus casei preparation (BLP). Patients were stratified into the following 3 subgroups: (A) with primary multiple tumors; (B) with recurrent single tumors, and (C) with recurrent multiple tumors. In each group, patients were randomly allocated to receive BLP or placebo. BLP showed a better prophylactic effect in subgroups A and B than placebo, whereas no significant difference was observed in subgroup C. Cox multivariate analysis showed that the outcome with BLP was significantly better than with placebo (p = 0.01). Slight and tolerable adverse reactions occurred in 3 patients receiving BLP and in 3 of the placebo-treated patients. Oral administration of BLP was thus safe and effective for preventing recurrence of superficial bladder cancer.

Administration, Oral↗

PubMed1986

[Tumor-associated mononuclear cell infiltrate and recurrence rate in the superficial urothelial carcinoma of the urinary bladder].

Investigation on the absence or presence of malignancy-associated mononuclear cell infiltration in correlation to the recurrence rate after topic adriamycin chemotherapy was made in 53 patients with a superficial urothelial carcinoma of the urinary bladder after transurethral resection. The tumor recurrence rate, after an average observation period of 2.8 years, was 55%. Malignancy-associated mononuclear cell infiltration was found in 18 cases (34%) and of these, 6 (33%) showed recurrence. Absence of cell infiltration was found in 35 cases (66%) and of these, 23 (66%) showed recurrence. In those tumors which showed recurrence, cell infiltration was absent in 83%, whereas it was absent in only 46% of the tumors without recurrence.

Aged↗

PubMed2000

Radiation therapy and concomitant paclitaxel/carboplatin chemotherapy for muscle invasive transitional cell carcinoma of the bladder: a well-tolerated combination.

This review evaluates tolerance and disease control for eight patients with muscle invasive bladder cancer treated with pelvic radiotherapy and concomitant paclitaxel/carboplatin chemotherapy. From October 1996 through February 1998, eight patients were treated with pelvic radiotherapy and concomitant paclitaxel/carboplatin chemotherapy. All received from 39.60-41.40 Gy to the pelvis followed by a boost to the initial site of disease. Final tumor doses ranged from 64.80-68.40 Gy. Most patients received paclitaxel at 150 mg/m2 and carboplatin at an area under the curve (AUC) of 7 at 3-week cycles during the radiation therapy. No patient required treatment interruption. With a median follow-up of 27 months, three patients remain free of local and distant disease at follow-up intervals of 24, 25, and 31 months. No surviving locally controlled patient demonstrated late urinary or gastrointestinal morbidity. All patients with a visibly complete transurethral resection of bladder tumor (TURBT) prior to radiotherapy achieved local disease control. For this group of patients, the absolute 2-year pelvic tumor control rate is 57%. The 2-year disease-specific survival is 43%. Paclitaxel/carboplatin chemotherapy can be delivered with continuous course pelvic radiation therapy without severe acute or apparent late toxicity. This combination also appears to be effective in achieving disease control in the urinary bladder, particularly in those patients who have undergone a thorough TURBT. The authors believe that it would be reasonable to investigate this combination in future bladder conservation protocols. The combination of paclitaxel and carboplatin with radiotherapy may be of particular value in elderly patients or those with renal impairment.

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PubMed1994

A pilot study of chemotherapy alternating with twice-a-day accelerated radiation therapy as an alternative to cystectomy in muscle infiltrating (stages T2 and T3) cancer of the bladder: preliminary results.

Laboratory studies have suggested that rapidly alternating chemotherapy and accelerated radiation therapy might act synergistically. We evaluated the toxicity and effectiveness of this approach in muscle infiltrating transitional cell carcinoma of the bladder in patients who were poor risks for or who refused cystectomy. We treated 18 men and 3 women with stage T2 or T3 transitional cell carcinoma of the bladder by transurethral resection, followed by 3 cycles of chemotherapy (during weeks 1, 4 and 7) rapidly alternating with 3 cycles of twice-a-day radiation therapy (during weeks 2, 5 and 8). Chemotherapy consisted of methotrexate, vinblastine, doxorubicin and cisplatin. The total dose of radiation therapy was 5,400 to 6,000 cGy, during 6 1/2 weeks and the total duration of chemotherapy and radiation therapy was 7 1/2 weeks. One patient died of hematological toxicity during treatment. With a median followup of 2 years (range 0.5 to 5.5 years) the observed survival rate was 72% at 2 years and 60% at 3 years. To date, only 1 patient (5%) had recurrence of invasive cancer in the pelvis. Only 3 others (15%) had carcinoma in situ but to date none has required cystectomy. Bladder function was normal in 15 of 18 evaluable patients (83.5%). This pilot study suggests that chemotherapy alternating with radiation therapy produced an encouraging survival rate without cystectomy and deserves further study. These patients require continued surveillance for carcinoma in situ.

Actuarial Analysis↗

PubMed1993

[Clinical observations on bladder cancer--difference in clinical features with age].

Three hundred and ninety-four patients with transitional cell carcinoma of the bladder who initially visited Yokohama City University Hospital were reviewed according to age group. The patients were divided into four groups, group A (less than 49 years old), group B (from 50 to 64 years old), group C (from 65 to 79 years old) and group D (more than 80 years old). The clinical characteristics as follows were obtained by statistical analysis compared with these four groups. No statistical significance was obtained about frequency of macroscopic hematuria as chief complaint. However, the younger age groups (A and B) tended to visit hospital later after the first symptom of hematuria. The older age groups (C and D) had multiple and large tumor at the first cystoscopic examination. The older age groups (C and D) had high stage and high grade tumor at the first roentgenological examination and transurethral biopsy or resection. The 5-year recurrence free rate after transurethral resection of bladder tumor (TUR-BT) of the older age group (D group) was lower than that of the other groups. The 5-year survival rate of older age group was lower than that of the younger age group. However, no statistical significance between the age groups existed concerning high grade or high stage tumor and survival after total cystectomy. We clarified here that the clinical features of elderly patients who have bladder cancer were significantly different from those of younger patients. Otherwise the prognosis of patients who have high grade and/or high stage bladder cancer were demonstrated to be poor regardless of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2004

Endourologic procedures combined with other surgical and urologic interventions--early experience.

OBJECTIVES: To assess the feasibility of performing endourologic interventions combined with other operations during the same operative session. METHODS: Eighteen patients underwent simultaneous operations endourologically for upper urinary tract pathologic findings and other surgical and urologic indications. The operating time, technical feasibility, operative success, complications, hospital stay, and patient satisfaction were analyzed. RESULTS: The average patient age was 63 years (range 40 to 83). Five patients underwent percutaneous nephrolithotomy combined with either contralateral laparoscopic nephrectomy, contralateral open nephrectomy, radical retropubic prostatectomy, inguinal/umbilical hernia repair, transurethral resection of prostate, or cystolithotripsy. Thirteen patients underwent 15 retrograde endoscopic procedures (13 for stone disease and 2 for diagnostic purposes) that were combined with open contralateral nephrectomy, inguinal hernia repair, circumcision, closure of ileostomy, transurethral resection of bladder tumor, excision of lymphoma of thigh, drainage and sclerozation of hydrocele, or percutaneous gastrostomy. All procedures were successfully completed without complications. The average hospital stay was 5 days (range 3 to 6) in the percutaneous nephrolithotomy group and 2 days (range 1 to 5) in the retrograde endoscopic procedure group. The duration of hospitalization was related to the more complex operation; combining the procedures did not prolong it. The average follow-up was 11 months (range 3 to 24). All patients were highly satisfied because they were spared the need for more than one surgical session. CONCLUSIONS: Our results support the concept of performing simultaneous endourologic procedures and other operations during one surgical session. This approach obviates the need for repeated anesthesia, patient inconvenience, the psychological stress related to multiple operations, and reduces the total hospital stay.

Adult↗

PubMed1997

Long-term followup of all patients with muscle invasive (stages T2, T3 and T4) bladder carcinoma in a geographical region.

PURPOSE: We studied the relationship between long-term survival and treatment of stages T2, T3 and T4 bladder carcinoma in an unselected patient population. MATERIALS AND METHODS: A total of 680 patients with the initial diagnosis of bladder carcinoma in 1987 to 1988 in Western Sweden was prospectively registered and followed until 1994. Of these patients 107 had stage T2 to T3 and 41 had stage T4 disease. RESULTS: Of the patients with stage T2 to T3 disease 30 (mean age 66) underwent radical cystectomy, 33 (mean age 75) full dose radiotherapy and 44 (mean age 81) nonradical therapy (mainly transurethral resection of the bladder). The 5-year crude survival rates were 33, 15 and 14%, respectively. Of the patients with stage T4 disease 6 (mean age 61) underwent radical cystectomy, 9 (mean age 73) full dose radiotherapy and 26 (mean age 81) nonradical therapy (mainly transurethral resection of the bladder). All except 1 patient died of disease within 4 years. CONCLUSIONS: More than 60% of the patients in the cohort were considered unsuitable for radical cystectomy and their survival was poor, whether treated with full dose radiotherapy or transurethral resection of the bladder alone.

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