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Results for “Transurethral Resection of Bladder”

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PubMed1997

Adjuvant chemotherapy for superficial transitional cell bladder carcinoma: long-term results of a European Organization for Research and Treatment of Cancer randomized trial comparing doxorubicin, ethoglucid and transurethral resection alone.

PURPOSE: We compared the efficacy of transurethral resection alone or transurethral resection followed by bladder instillations of doxorubicin or ethoglucid for 1 year in patients with superficial bladder carcinoma, and followed them long term for the incidence of progression to muscle invasion. MATERIALS AND METHODS: A total of 443 patients with superficial transitional cell carcinoma of the bladder was randomized. After randomization of 206 patients the control arm was closed to patient entry based on the results of an interim analysis showing a significant difference in favor of those receiving adjuvant chemotherapy. RESULTS: Final analysis of treatment results for recurrence included 432 patients at a median followup of 3.4 years for time to first recurrence, 5 years for analysis of time to invasion (Category T2 disease or worse) and 10.7 years for duration of survival. Time to first recurrence was significantly prolonged by both drugs compared to transurethral resection alone (doxorubicin versus transurethral resection alone p < 0.001 and ethoglucid versus control p < 0.001). Recurrence rate per year was 0.30 for both adjuvant treatment arms and 0.68 for the resection only group. Progression to muscle invasion was rare (15.1% of cases) and not apparently different in the 3 treatment arms. Of the 423 patients death from any cause in 199 and from malignant disease in 59 was not correlated with treatment. However, there was a strong correlation between death from malignant disease, and T category and tumor grade. CONCLUSIONS: In regard to time to first recurrence and recurrence rate per year this study indicates that adjuvant chemotherapy with doxorubicin and ethoglucid using the indicated schedule is superior to transurethral resection alone. However, progression in stage or survival was not influenced by the treatment regimen.

Aged↗

PubMed2000

An overview of the treatment of superficial bladder cancer. Intravesical chemotherapy.

Superficial bladder cancer accounts for approximately 70% to 80% of all newly diagnosed bladder cancers. The vast majority of these cancers are transitional bladder tumors of various histologic grades (I to III). Superficial tumors include carcinoma in situ (CIS), tumors confined to the epithelium (Ta), and superficial tumors that invade the lamina propria (T1) but do not involve superficial muscle layers. The primary treatment for eradication of stage Ta and T1 bladder cancers is transurethral resection of the tumor. Many patients with superficial bladder tumors treated with endoscopic surgery alone have recurrence or tumor progression at some point in their follow-up, and, in these patients, the need for adjuvant treatment becomes a major concern.

Administration, Intravesical↗

PubMed1984

Complications of TUR of the bladder neck in the female. A study of 238 procedures.

Transurethral resection of the bladder neck in the female is unpopular because of complications and indifferent results. This retrospective study of 238 procedures (carried out over the period 1940-72) documents the various complications and shows that the fears generally held are exaggerated. Most complications are of moderate incidence and can be easily and satisfactorily managed. The incontinence rate (4.7% in this study) can be further reduced by selection of cases after careful urodynamic evaluation and avoiding certain types of cases. It is related more to the type of patient than to the procedure itself.

Adolescent↗

PubMed2001

[A case of urothelial tumors which occurred simultaneously in bilateral upper urinary tracts and bladder presenting with anuria].

A 72-year-old male was admitted with a chief complaint of anuria. Clinical examinations showed that he was in uremic state and had bilateral hydronephroses. An endoscopic examination revealed a left ureteral tumor and a bladder tumor. Left nephroureterectomy with partial cystectomy and transurethral resection of the bladder tumor were performed. Pathological examinations showed an invasive left renal pelvic tumor (pT3, G3), an invasive left ureteral tumor (pT4, G3), and a bladder tumor (pTis, G3). Following the operation, roentgenological and urinary cytological findings showed a right ureteral carcinoma. He died of multiple liver and bone metastases and local recurrence at 5 months postoperatively.

Aged↗

PubMed2001

[Transitional cell carcinoma of the bladder in a young patient: a case report].

A 14-year-old male patient was admitted with the chief complaint of macroscopic hematuria. Abdominal ultrasonography demonstrated a tumor of the anterior wall of the bladder. Further, cystoscopic examination confirmed a papillary tumor. Transurethral resection of the bladder tumor was performed. Histopathology of the excised tumor showed transitional cell carcinoma (G1, pTa). Recurrence has not been observed for 9 months postoperatively.

Adolescent↗

PubMed1988

Neoadjuvant M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) effect on the primary bladder lesion.

Of 50 patients with bladder cancer given 1 to 5 cycles of neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin in a pilot phase I and II study 63 per cent of 41 with pure transitional cell stage T2-4 lesions responded. While significant downstaging occurred by transurethral resection of the bladder in 70 per cent and by cytology in 60 per cent of the patients, the final T response rate by all noninvasive clinical staging procedures, including sonography and computerized tomography, revealed complete remission in 24 per cent and partial remission in 39 per cent. Of 30 patients who underwent pathological staging 33 per cent achieved stage P0 and 17 per cent stage Tis disease or P less than T. Despite extensive re-evaluation by transurethral resection of the bladder and other noninvasive staging procedures, a clinical staging error (T versus P) of 38 per cent was observed. Of the other 9 patients 4 with mixed nontransitional cell histological findings at presentation never achieved complete remission, although 3 had resolution of all transitional cell elements and 5 (10 per cent) were inevaluable. The toxicity of the regimen was generally acceptable but 6 per cent of the patients required hospitalization for neutropenic fever. While this active regimen can clinically (T) and pathologically (P) induce downstaging in a significant number of patients with primary bladder tumors, this pilot study has raised serious questions concerning the design of future nonrandomized and randomized neoadjuvant studies.

Adult↗

PubMed1988

[Instillation chemotherapy with peplomycin in superficial bladder cancer: clinical study on the effects of the direct antitumor activity and of the prophylaxis of recurrence].

Two kinds of clinical studies for intravesical instillation chemotherapy of peplomycin (PEP) were carried out, one to evaluate the direct antitumor activity in superficial bladder cancer (study I), and the other to evaluate the prophylactic effect on recurrence of bladder cancer after transurethral resection (study II). In study I, 22 patients with low stage bladder cancer were entered, and 16 of them were eligible for evaluation of efficacy. Twelve patients were treated twice a week with intravesical instillation of 20 mg of PEP/20 ml of saline for 4 weeks. Four patients were treated in the same way with 40 mg of PEP/20 ml of saline. Among the patients treated with 20 mg of PEP, two showed complete remission and one showed partial remission. Of the patients treated with 40 mg of PEP, one showed partial remission. Thus, the overall response rate was 25%. The tumors of the two complete responders were so tiny that they might have been damaged mechanically by the biopsy forceps. Therefore, we considered that the instillation chemotherapy of PEP at a dose of 20 or 40 mg/20 ml of saline had little effect on superficial bladder cancer. In study II, we performed a randomized trial designed to compare the recurrence rate after transurethral resection (TUR) alone with that after TUR followed by prophylactic instillation of PEP. Ninety-four patients newly diagnosed as having low stage bladder cancer were entered in the study. They were divided into three groups after TUR. Group A consisted of 38 patients who were treated with weekly instillation of 20 mg of PEP/20 ml of saline for 8 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravesical↗

PubMedDate not supplied

[Conservative treatment with transurethral resection of stage T2 cancer of the bladder: retrospective study].

We carry out a review of all the primary bladder T2 tumours in the service in order to evaluate the possibilities of conservative treatment in this category of tumour. Despite being tumours that infiltrated the muscularis, there were all treated initially by transurethral resection. Minimum criteria for classification were the case history, urographies, bimanual touch under anaesthetic and transurethral resection of all tumoural formations, including the whole bladder wall and pericystium. It is a group of 73 patients, 66 males and 7 females, having an average age of 65.6 (range 51-58 years old), with primary transitional bladder tumour, who were followed up over a period ranging from 3 months to 10 years, three years on average. 55 (75.3%) are single tumours and 18 (24.6%) multiple tumours. The degree of anaplasia is G2 in 23 (31.5%) and G3 in 50 (68.5%). Of the 73 patients, 43 (58.9%) 43 (58.9%) are free of disease, 33 (45.2%) of them after a single transurethral resection and 10 who required various transurethral resections due to fresh occurrences of lesser degree and stage. The probability of survival of T2 tumours at 5 years is 72% with a margin of reliability of 11% (p less than 0.05).

Aged↗

PubMed2006

Clinical aspects and surgical treatment of urinary tract endometriosis: our experience with 31 cases.

OBJECTIVES: To present and discuss clinical and surgical management of urologic endometriosis. METHODS: Retrospective review of a database on surgical patients with endometriosis. RESULTS: Thirty-one patients (incidence, 2.6%; mean age, 33.1 yr) were affected by urologic endometriosis (bladder, 12; ureter, 15; both, 4). Bladder endometriosis was revealed by symptoms related to menses and showed a typical endoscopic picture, whereas ureteral involvement had a nonspecific or silent symptomatology. All patients affected by bladder endometriosis and undergoing transurethral resection (2 cases) developed a bladder recurrence; a ureteral recurrence was observed in two of six patients submitted to laparoscopic ureterolysis and in one of two patients submitted to ureterectomy with ureteroureterostomy. Conversely, no relapses were observed among the 14 patients who had partial cystectomy or the 9 who had ureterectomy and ureterocystoneostomy. Finally, two patients underwent nephrectomy due to end-stage renal atrophy. CONCLUSIONS: Cystoscopy is advisable in women with pelvic endometriosis with lower urinary tract symptoms; the upper urinary tract should be evaluated in all patients with pelvic endometriosis to exclude asymptomatic ureteral involvement. Partial cystectomy gives the best results when used to treat bladder endometriosis. Ureterolysis can be successful only in case of limited ureteral involvement with no urinary obstruction, whereas terminal ureterectomy and ureterocystoneostomy should be preferred in case of obstructive ureteral endometriosis.

Adult↗

PubMed2003

Are false-positive urine markers for the detection of bladder carcinoma really wrong or do they predict tumor recurrence?

INTRODUCTION AND OBJECTIVES: A problem in the interpretation of noninvasive urine tests for detection of bladder carcinoma is the finding of false-positive results. Several authors have described that patients with false-positive results are at high risk for tumor recurrence or progression. Only few data are available for comparing the clinical course of patients with false-positive test results and patients with true-negative results. We studied whether patients with false-positive results of various urine test had a higher recurrence rate than patients with true-negative results. METHODS: Urine samples from 61 patients without evidence of active bladder carcinoma were included. Of the 61 patients, 51 had a history of bladder cancer, and 10 underwent transurethral resection for suspect of bladder carcinoma but had negative pathologic findings. Immunocytology (Lewis X and 486p3/12) was performed on bladder washings, and BTAstat and NMP22 were performed on urine samples. RESULTS: During the follow-up period, 22 patients had one or more false-positive BTAstat test results, 25 patients had one or more false-positive NMP22 tests, 42 patients had at least one false-positive Lewis X test, and 11 patients had one or more false-positive 486p3/12 test. During a follow-up period of 3-39 months (median, 17.6 months) four patients expected a tumor recurrence. Among patients with false-positive urine test results 2 of 22 (9.1%, BTAstat), 2 of 25 (8%, NMP22), 4 of 42 (9.5%, Lewis X), and 3 of 11 (27.2%, 486p3/12) suffered from tumor recurrence. In contrast, among patients with true-negative test results 2 of 39 (5.2%, BTAstat), 2 of 36 (5.6%, NMP22), 0 of 18 (0%, Lewis X), 1 of 50 (2.0%, 486p3/12) had a tumor recurrence. CONCLUSIONS: Patients with a false-positive urine test result do not generally have a greater risk of tumor recurrence or progression than patients with a true-negative result. In our series, only patients with false-positive 486p3/12 test result had a higher recurrence rate. Our findings do not justify a more aggressive adjuvant treatment or surveillance for patients with false-positive urine tests.

Antibodies, Monoclonal↗

PubMed1994

Long-term survival with malignant melanoma metastatic to the bladder.

Malignant melanoma metastatic to the bladder is a relatively common autopsy finding, but rarely manifests clinically as it is usually a late finding in the course of the disease. Herein is the report of a case of muscle invasive malignant melanoma at the dome of the urinary bladder treated by radical transurethral resection with no evidence of bladder recurrence four years later.

Journal Article↗

PubMed2000

Bladder pheochromocytoma: a 3-year follow-up after transurethral resection (TURB).

We report a case of a 75-year-old female with pheochromocytoma of the bladder. Clinical evaluation included ultrasonography, intravenous pyelography, CT scan, I-MIBG scintiscan. A transurethral resection was performed for a exophytic tumor of 2 cm diameter. The histological result indicated the diagnosis of bladder pheochromocytoma. Three years later the patient remains disease free. Preoperative diagnosis is established by determination of blood and urine levels of catecholamines and their metabolites is a nonspecific diagnostic tool. The sensitivity of CT scan is 82%. Iodine-methyliodobenzylguanidine (I-MIBG), used by scintiscanning, specifically accumulates in pheochromocytomas. Life-long follow-up is necessary to diagnose late recurrences.

Aged↗

PubMed2006

The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomized clinical trial.

PURPOSE: We compared the outcomes of repeat transurethral resection plus intravesical mitomycin C with initial transurethral resection of bladder plus intravesical MMC in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder in terms of recurrence, progression and overall survival. MATERIALS AND METHODS: Of 148 newly diagnosed patients with T1 bladder cancer 142 were prospectively randomized in 2 groups between January 2001 and January 2005. A total of 74 patients underwent second TURB and received adjuvant MMC intravesically (group 1) and 68 patients received adjuvant MMC following the initial TURB (group 2). All repeat TURB operations were performed 2 to 6 weeks following initial TURB. Patients with incomplete resection, Cis or muscle invasive disease were excluded from study. The first dose of mitomycin C (40 mg per week for a total of 8 weeks) was instilled intravesically in all patients during the first 24 hours after the last surgery. RESULTS: Mean followup was 31.5 months (range 6 to 48) with no difference between the 2 groups. The rate of recurrence-free survival was 86.35% (SE 0.4%), 77.67% and 68.72% in group 1, and 47.08%, 42.31% and 37.01% in group 2 for the first, second and third year, respectively (overall 74.32% vs 36.76%, log rank 0.0001). Recurrence was observed in 19 of the 74 (25.68%) patients in group 1 and in 43 of the 68 (63.24%) patients in group 2. Ten of the 19 (52.63%) patients in group 1 and 35 of the 43 (81.39%) patients in group 2 had recurrence within 12 months. Recurrence was observed in 17.6%, 25% and 60% of patients with G1, G2 and G3 tumors, respectively, in group 1. The same rates for group 2 were 25%, 64% and 90%. The RFS rate was significantly worse in the high grade group (G2 and G3) (p <0.001). Progression was observed at 4.05% for group 1 compared to 11.76% for group 2 (log rank 0.0974). OS was 91.89% and 89.71% in group 1 and 2, respectively (log rank 0.732). CONCLUSIONS: The high recurrence rate in patients who did not undergo ReTUR is due to a high residual tumor rate following initial TURB. The benefit of ReTUR is especially true for high grade tumors. Since intravesical MMC was present in both groups, this study has shown that intravesical chemotherapy does not compensate for inadequate resection. Progression does not seem to be affected by ReTUR although there was a trend favoring the ReTUR group. We recommend ReTUR for patients with primary high grade T1 disease to achieve better recurrence-free survival.

Administration, Intravesical↗

PubMed1992

Clinical information system that enhances the use of resources in endoscopic prostatic procedures.

In this study we evaluated, by means of an automated management system, the identification of subgroups of patients within certain operative categories whose predictable length of stay was compatible with treatment on a 5-day ward. This was achieved by using a computer directed analysis of urological workload on prospectively collected clinical data. Graphical presentation of the results was achieved by a technique known as the patient-bed dissociation curve. Patients with bladder outflow obstruction treated by transurethral prostatic resection (701) and bladder neck incision (113) were selected from a total of 7,162 hospital admissions. The main outcome measures were length of stay and complication rates for the 2 procedures. The results demonstrated that a group of patients about to undergo transurethral resection could be selected by age and source which would indicate an 18% greater probability of discharge within 5 days. These patients were easily identifiable in advance and would be suitable for treatment on a 5-day ward. It was concluded that computer-held clinical data were easily accessible to the surgeon. The process of detailed analysis need not take time. With properly directed studies the information retrieved could be used to effect change. The patient-bed dissociation curve may prove a valuable tool in examining and comparing discharge patterns in any groups of patients.

Adult↗

PubMed1999

Radical transurethral resection and chemotherapy in the treatment of muscle-invasive bladder cancer: a long-term follow-up.

OBJECTIVE: To evaluate the treatment of patients with muscle-invasive bladder cancer (T2-T4a) by radical transurethral resection (TUR) and cisplatin-methotrexate systemic chemotherapy. PATIENTS AND METHODS: Fifty patients with transitional cell carcinoma (TCC) of the bladder (nine T2, 36 T3 and five T4a) were treated by 'complete' TUR of the bladder tumour followed by 2-6 cycles of cisplatin (70 mg/m2) and methotrexate (40 mg/m2) chemotherapy. The median (range) tumour size was 3 (1-7 cm). In six patients, attempted TUR at the dome of the bladder led to intraperitoneal perforation; the tumour was excised by partial cystectomy in these patients. The latest follow-up results from 57 patients treated by radical TUR and methotrexate alone, reported previously, are included. RESULTS: At the first evaluation cystoscopy immediately after completing chemotherapy, 38 patients were tumour-free, eight had persistent muscle-invasive TCC and four had Ta, T1+CIS disease. With an overall median follow-up of 47 months, 10 additional patients relapsed with muscle-invasive carcinoma in the bladder after a median interval of 15.6 months; three patients developed Ta, T1 tumours, three Ta, T1 + CIS, and six CIS only. Six of the 10 recurrent invasive tumours were at the same site, but four were at a different site in the bladder. Although during follow-up 12 patients developed superficial recurrence that required endoscopic treatment, the bladder was preserved (free of muscle-invasive cancer) in 37 of 50 patients. In 30 of these 37, this was achieved with no need for salvage radiotherapy or cystectomy. Six patients died from metastatic TCC with no tumour in the bladder. CONCLUSION: In this selected group of patients, muscle-invasive bladder cancer was controlled by TUR and systemic chemotherapy, preserving normal bladder function in 60% of patients without apparently comprising overall survival.

Adult↗

PubMed2001

Second resection and prognosis of primary high risk superficial bladder cancer: is cystectomy often too early?

PURPOSE: We evaluated the prognostic significance of a second transurethral resection in patients with moderately and poorly differentiated T1 bladder cancer. MATERIALS AND METHODS: A total of 47 patients with primary T1 bladder cancer were evaluated. A second transurethral resection was performed in 42 patients in case of moderately or poorly differentiated T1 bladder tumor or concomitant carcinoma in situ in the first resection. Five patients underwent immediate cystectomy due to large, multifocal and moderately or poorly differentiated pT1 disease. RESULTS: Of the 42 patients who underwent repeat resection 15 (36%) had no tumors. Up staging and change of treatment strategy due to the result of the second resection occurred in 10 (24%) cases. Mean followup was 60 months. An R0 second resection correlated with a 33% recurrence rate at followup compared with 57%, 75% and 87.5% in patients with pTa, Tis and T1 residual tumor, respectively, in the second resection. The rate of organ preservation was also related to the result of the second resection with 100% organ preservation in patients with no tumor in the second procedure. After immediate radical cystectomy 3 of 5 patients died during followup due to disease progression. Of this group 2 patients survived without clinical or radiological signs of disease progression. CONCLUSIONS: To our knowledge residual tumor after the first transurethral resection is a fact in bladder cancer treatment. The second transurethral resection offers the possibility to preserve the bladder. Furthermore, residual disease can be detected and removed in due time. In case of up staging to muscle infiltrating tumor, cystectomy is the next therapeutic step.

Cystectomy↗

PubMed1987

[Controlled obturator nerve block using electrostimulation: prevention of the stimulation of the obturator nerve during resection of the lateral walls of the bladder].

An adductor contraction secondary to obturator nerve stimulation can occur during transurethral resection of a lateral bladder lesion and then can induce bladder perforation or hamper complete resection. Many technique have been advocated but they are ineffective or unreliable. Obturator nerve blockade in the obturator canal by local anesthesia with control by nerve stimulator can prevent these complications. The technique described, has been used in 12 patients it is reliable, fast and easy to perform.

Anesthesia, Local↗

PubMed2002

Evaluation of an unconventional treatment modality with mistletoe lectin to prevent recurrence of superficial bladder cancer: a randomized phase II trial.

PURPOSE: The indication for topic chemotherapy or immunotherapy for well differentiated, noninvasive superficial bladder cancer remains controversial. Side effects of these treatments promoted use of unconventional therapies with cytokines, immunomodulators and mistletoe extracts. However, there are no controlled clinical data available on the efficacy of these extracts for bladder cancer. We evaluate the influence of subcutaneously applicated mistletoe lectin on bladder tumor recurrence after transurethral resection. MATERIALS AND METHODS: The study consists of 45 patients with pTa G1-2 bladder cancer treated with transurethral resection during a 3-year period. Median patient age was 65 years and 33 patients were male. The study cohort was randomly divided into a treatment group receiving adjuvant therapy with mistletoe lectin and a control group receiving no additional treatment. Patients in the treatment group received mistletoe lectin according to schedule 2 weeks after transurethral resection. Clinical followup was assessed 3, 6, 9, 12 and 18 months after the initial resection, and included uretherocystoscopy. RESULTS: Both study arms comprised similar patients with regard to total number of previous tumors (mean 2.6 versus 2.9), number of primary lesions (14 versus 12) and number of recurrent tumors (8 versus 11). After followup of 18 months the recurrence-free interval in both study arms was similar (p = 0.76) and the total number of recurrences comparable (p = 0.48). CONCLUSIONS: Subcutaneous use of mistletoe lectin as adjuvant treatment after transurethral resection does not seem to affect the time to first recurrence, total number of recurrences or recurrence-free outcome.

Aged↗