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PubMed1987

Bladder tumors: when to do and what to expect from random mucosal biopsies with reference to blood group cell surface antigens.

Routine random biopsies of normal looking bladder mucosa in the evaluation of bladder tumors demonstrated a high occurrence of anomalies ranging from dysplasia to carcinoma in situ (CIS). 75 patients with a urothelial bladder tumor were submitted to 165 endoscopic procedures under anesthesia including transurethral resection of any bladder tumor and random mucosal biopsies in the 4 quadrants of the bladder. The frequency and severity of mucosal anomalies rise with the tumor grade and stage: in stage 0.Ta, the percentage of anomalies rises from 15% in grade-1 lesions to 53% in grade-3 tumors. 80% of the stage A (T1) B and C (T2, T3) tumors are associated with anomalies of the normal looking bladder mucosa characterized by CIS in 50% of the cases. These lesions which may persist in the absence of any visible tumor respond dramatically to endovesical bacillus Calmette-Guérin therapy. Simultaneous determinations of blood group antigens fail to demonstrate a clear correlation between the antigenic status of the tumor and that of random biopsies. These results may help to clarify the indications of random mucosal biopsies which should be reserved to the treatment and surveillance of grade 3-tumors, irrespective of their stage.

ABO Blood-Group System↗
PubMed1987

[Metastatic malignant melanoma of the urinary bladder: a case report].

A 77-year-old male was admitted to our department with the chief complaint of positive occult blood in urine on July 30, 1984. Endoscopically, we found a dark red tumor on the left posterior wall of the urinary bladder, which seemed to have coagula covering it. On August 31, transurethral resection of the bladder tumor (TUR-Bt) was performed, and the pathological interpretation was malignant melanoma. Dermatologically and ophthalmologically, we could not found the primary foci. A month later, cystoscopy demonstrated multiple blue black spots consistent with diffuse melanoma of the bladder. On May 7, 1985, he was admitted to our clinic with right hypochondralgia. On physical examination, the liver was palpable with an irregular surface, and the echogram showed multiple metastasis in the liver. TUR-Bt was carried out again, on May 17, 1985. Ultrastructually resected specimens demonstrated a lot of mature melanosomes in the tumor cells. The course of the patient progressively worsened, and he died on May 30, 1985. At autopsy, we found metastases in the central nervous system, bone, genitourinary tract, gastrointestinal tract and other organs. The left eye ball, which had been diagnosed as ophthalmomalacia by glaucoma six years earlier, was filled by a melanoma mass, and it seemed to be the primary foci.

Aged↗
PubMed1992

The use of a bladder pressure warning device during transurethral prostatic resection decreases absorption of irrigation fluid.

During a period of 4 weeks 102 patients underwent transurethral prostatic resection (TURP). Of these, 50 were randomly allocated to the use of an intravesical pressure device which warned the surgeon at a pressure elevation of 1.5 kPa. Ethanol (1%) was used as a marker in the irrigation fluid (glycine 2.2%), and absorption of ethanol-tagged irrigation fluid was detected by measurements in the expired air. In 28 patients absorption took place (in 8 of the 50 patients equipped with the warning device and in 20 of the 52 without the device). The greatest absorption was seen in the group without the device. No differences were found between the groups with regard to age, resected mass, resection time, resection speed, or haemorrhage. Patients who absorbed irrigation fluid were slightly older and bled more, and the resected mass was larger. The use of a pressure warning device reduces the amount of irrigation fluid absorbed and the number of patients who absorb irrigation fluid, and minimises the risk of the TUR syndrome.

Absorption↗
PubMed1986

Superficial bladder tumors (stage pTa, grades 1 and 2): the importance of recurrence pattern following initial resection.

We treated 414 new patients with stage pTa, grades 1 and 2 bladder tumors by transurethral resection between 1970 and 1982. All of the patients with grade 3 or previous upper tract tumors, or who had been treated at some stage with intravesical chemotherapy were excluded. Followup for 5 or more years was available in 188 of the patients. There was a low increase in T stage (6 per cent). Of the patients followed for 5 or more years 46 per cent remained free of tumor. Only 16 per cent of the patients had multiple tumors at presentation and 20 per cent had tumors of 10 gm. or more. These factors were associated with a worse prognosis. Patients free of tumor at 3 months had an 80 per cent chance of having no further recurrences and this rate remained the same up to 2 years from the start of the disease. Patients with a recurrence at 3 months were much less likely to remain free of tumor, and had a higher chance of recurrence at every future visit.

Follow-Up Studies↗
PubMed2002

[Pseudo-tumoral colic metaplasia of the urinary bladder].

Colic metaplasia of the urinary bladder is a rare disease, secondary to a chronic irritative factor. In its minor form, it has the same clinical features as simple cystitis, but its major pseudoneoplastic form may be mistaken for bladder tumor. The diagnosis is essentially histological. Treatment is based on eradication of the irritative factor and of the resection of pseudoneoplastic form. Surgery is performed in the case of complications of this disease. The clinical course is unclear, requiring long-term surveillance. We report one case of colic-type glandular metaplasia of the urinary bladder in a 50 years-old patient. The clinical symptomatology was dominated by hematuria and pollakuria. A bladder neoplasm was highly suspected in ultrasound and endoscopic findings. The patient underwent a transurethral resection of the bladder tumor. Histological examination of of resection shavings revealed a colic-type glandular metaplasia.

Granuloma, Plasma Cell↗
PubMed2003

A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams).

PURPOSE: Holmium laser enucleation of the prostate (HoLEP) is a surgical treatment for bladder outlet obstruction secondary to benign prostatic hyperplasia. HoLEP is a transurethral procedure that uses the holmium laser fiber (wavelength 2,140 nm) to dissect whole prostatic lobes off of the surgical capsule in retrograde fashion, while maintaining excellent hemostasis. The lobes are removed from the bladder by a purpose built transurethral morcellator, which means that large volume prostates can be enucleated endoscopically. We compared this procedure with transurethral prostate resection (TURP) in a randomized trial by evaluating outcomes in patients with a prostate volume of 40 to 200 ml on transrectal ultrasound. MATERIALS AND METHODS: A total of 61 patients with urodynamically proved bladder outlet obstruction secondary to benign prostatic hyperplasia were randomized to TURP or HoLEP. Perioperative parameters recorded included resectoscope, laser, electrocautery, morcellation and catheter time, hospital stay, bladder irrigation, volume blood transfusion the rate and resected tissue weight. Patients were followed 1, 3, 6 and 12 months postoperatively with peak urinary flow rate measurement and quality of life and American Urological Association symptom scores. Patients also underwent urodynamic assessment at 6 months with measurement of peak detrusor pressure at maximal flow, post-void residual volume and prostate volume by transrectal ultrasound. Continence, potency and all adverse events were recorded at each visit. RESULTS: HoLEP was superior to TURP in terms of mean catheter time (17.7 +/- 0.7 vs 44.9 +/- 10 hours) and hospital stay (27.6 +/- 2.7 vs 49.9 +/- 5.6 hours) but it required more time to perform (62.1 +/- 5.9 vs 33.1 +/- 3.7 minutes). More prostate tissue was removed in the HoLEP group (40.4 +/- 5.7 vs 24.7 +/- 3.4 gm). HoLEP was also superior to TURP in terms of relieving urodynamic obstruction at 6 months of followup (postoperative detrusor pressure at maximum flow 20.8 +/- 2.8 vs 40.7 +/- 2.7 cm H2O). HoLEP and TURP led to significant improvements in peak flow rates, symptom scores and quality of life scores compared with baseline and there was no significant difference between the 2 procedures with respect to these parameters at 12 months. Fewer adverse events were recorded in the HoLEP group. CONCLUSIONS: HoLEP is superior to TURP for relieving bladder outlet obstruction in men with benign prostatic hyperplasia. It allows more rapid catheter removal and hospital discharge. It requires more time to perform than TURP but more prostate tissue is removed, resulting in similar efficiency in tissue retrieval. HoLEP is equivalent to TURP in relieving men of lower urinary tract symptoms and in improving peak urinary flow rates at 12 months of followup.

Aged↗
PubMed1991

Histological evaluation of superficial bladder tumors treated by Nd-YAG laser and transurethral resection.

Based on 3 study groups we have tried to analyze some concepts concerning the treatment of superficial bladder tumors by the Nd-YAG laser. In the first group of 34 superficial bladder tumors, we evaluated the accuracy of cold-cup biopsy in staging the tumor before treatment with the laser (100% for grade and 90% for stage). The possibility of identifying the tumoral grade in the lasered mass is 73%. In the second group of 53 random superficial bladder tumors we compared the effects of laser and transurethral resection (TUR) with regard to recurrence and progression after a 3-year follow-up: no significant differences are found between the treatments. In the third group the histologic changes in the bladder wall after treatment with the laser or TUR were evaluated by cold-cup biopsy (31 lasered cases and 24 resected cases) and by resector loop biopsy (11 lasered cases and 11 resected cases) between 12 and 24 months after treatment, without significant differences in terms of fibrosis.

Aluminum↗
PubMed2004

Venous air embolism during transurethral resection of the prostate.

Venous air embolism during transurethral surgery is a rare event. There have been case reports in the anesthesia and urology literature of fatal air embolism during transurethral prostate resection and transurethral incision of the bladder neck. We present a case of nonfatal venous air embolism during transurethral prostate resection in which incorrect assembly of the bladder irrigation-resectoscope-drain system led to a rapid entrainment of air into the open venous channels of the prostate bed.

Aged↗
PubMed1995

New method to quantify the urodynamic improvement when treating bladder outlet obstruction: the efficacy of transurethral resection in benign prostatic hypertrophy.

A method to measure the urodynamic improvement when treating urethral obstruction is introduced and applied to patients with benign prostatic hypertrophy. The patients performed pressure-flow studies before and 3-6 months after TUR-p. The urethral resistance relation was estimated by curve fitting in the pressure flow plot. The new method quantifies the improvement in urethral resistance as the distance between the urethral resistance relation before and after treatment expressed in pressure units. The distance is measured at the flow rate equal to 75% of the maximum flow rate for the micturition with the lowest maximum flow rate and this distance is called delta-URA. The median improvement after TUR-p was 71 cm H2O (range 2-119). The improvement was strongly correlated to the resistance before treatment and the regression line indicates that the operation normalizes the resistance irrespective of its preoperative value. On the average a lowering of the urethral resistance relation with 8 cm H2O improved the maximum flow rate with 1 ml/s. The greatest advantage with the new method is that it has a high validity and is almost completely insensitive to changes in contractility.

Humans↗
PubMed2002

Long-term follow-up of G3T1 transitional cell carcinoma of the bladder treated with intravesical bacille Calmette-Guérin: 18-year experience.

OBJECTIVES: Immunotherapy with bacille Calmette-Guérin (BCG) has been proposed in the past decade as first-line treatment for high-grade superficial bladder cancer (G3T1). We report our 18-year experience in the treatment of patients with G3T1 bladder cancer. METHODS: From January 1989 to July 1997, 670 patients underwent transurethral resection for superficial bladder cancer. Eighty-one patients (12%) had G3T1 tumors. All of these patients were treated with an innovative schedule of Pasteur strain BCG followed by maintenance BCG therapy. Treatment consisted of four cycles of 6 instillations per cycle of BCG. The first cycle was administered weekly x 6, the second was given every 2 weeks x 6, the third cycle was given monthly x 6, and the fourth was given every 3 months x 6 instillations. RESULTS: Sixty-nine patients (84%) completed at least the first two cycles. At a median follow-up of 76 months (range 30 to 197), the overall recurrence rate was 33% (27 of 81). The median time to recurrence was 20 months (range 5 to 128). Of these patients, 12 (15%) had progression at a median follow-up of 16 months (range 8 to 58). Cystectomy was required in 7 patients (8%). Death from disease occurred in 5 (6%) of 81 patients. One patient died of adenocarcinoma at the ureterosigmoidostomy site. Sixty patients (74%) were alive at a median follow-up of 79+ months (range 15 to 182). Of these, 56 (69%) were alive with a functioning bladder. CONCLUSIONS: Conservative treatment with BCG is a reasonable approach for patients with primary G3T1 transitional cell carcinoma of the bladder. The long-term results of BCG therapy are good. Cystectomy may not be justified as the therapy of choice in first-line treatment of high-grade superficial carcinoma of the bladder.

Adjuvants, Immunologic↗
PubMed2001

Cystitis cystica glandularis masquerading as a bladder tumor.

A young man admitted with complaints of painless paroxysmal gross hematuria was found to have bilateral vesical masses involving the bladder base, trigone and ureteric orfices. Urine cytology and AFB were negative. Transurethral resection of the bladder mass was carried out and the histopathology suggested cystitis cystica glandularis. The literature regarding this entity has been reviewed and the differential diagnosis discussed.

Adult↗
PubMed2001

Prognostic significance of platelet-derived endothelial cell growth factor/thymidine phosphorylase expression in stage pT1 G3 bladder cancer.

BACKGROUND: The management of patients with pT1 G3 bladder cancer remains controversial because of the high incidence of recurrence with muscle invasion. Thymidine phosphorylase (dThdPase) is identical to platelet-derived endothelial cell growth factor (PD-ECGF) and has angiogenic activity. The aim of this study was to determine whether the expression of PD-ECGF/dThdPase in bladder cancer tissue was associated with tumor progression and recurrence in patients with pT1 G3 bladder cancer. METHODS: Fifteen patients who were pathologically diagnosed as having pT1 G3 transitional cell carcinoma of the bladder were treated with transurethral resection. Sections of paraffin-embedded bladder tissue were immunohistochemically stained with either mAb654-1, a monoclonal antibody against human PD-ECGF or anti-CD34 monoclonal antibody, respectively. When more than 10% of tumor cells were positively stained with mAb654-1, this section was defined as positive in this study. RESULTS: Eight of 15 sections from patients with pT1 G3 bladder cancer (53%) were positive with PD-ECGF/dThdPase. During follow up, patients in the negative group had no disease progression and only two patients had local recurrence. In contrast, seven of eight positives had recurrence (P < 0.05) and progression was also observed in four recurrent patients. However, there was no statistical relationship between PD-ECGF and CD34 expression in any of the patients. CONCLUSION: The expression of PD-ECGF/dThdPase appears to be an important prognostic factor of pT1 G3 bladder cancer and did not show any significant relationship between PD-ECGF/dThdPase expression and vascular density.

Aged↗
PubMed2003

Pheochromocytoma of the urinary bladder without typical symptoms.

Pheochromocytoma of the urinary bladder is an unusual tumor that typically presents with hypertensive crises related to micturition. We report, herein, the case of a 62-year-old woman with bladder pheochromocytoma. The patient presented with a bladder tumor that was incidentally found by computed tomography (CT) without the triad of sustained hypertension, hematuria and postmicturitional syncope. Cystoscopy revealed a yellowish submucosal tumor in the right lateral wall of the bladder. Treatment consisted of transurethral resection in the initial diagnosis of bladder tumor. A definitive diagnosis was made postoperatively upon pathological examination. The patient has been followed up for 12 months and has shown no recurrence.

Abdominal Pain↗
PubMedDate not supplied

Hepatocellular carcinoma and bladder cancer as complications following five years of chemotherapy for acute myeloblastic leukemia.

Acute myeloblastic leukemia (AML) was diagnosed in a 54-year-old male, a chronic hepatitis B surface antigen (HBsAg) carrier, in June, 1983. Prompt remission was achieved, and maintenance and intensification chemotherapy were given for five years. He was readmitted in March, 1988 because of a mass in the liver and was diagnosed as having hepatocellular carcinoma (HCC). Curative right segmentectomy was performed in May, 1988. In December, 1988, transitional cell carcinoma of the bladder was discovered, and resected transurethrally. These secondary neoplasms, HCC and bladder cancer, were thought to be associated with the long-term chemotherapy given for the AML.

Antineoplastic Combined Chemotherapy Protocols↗