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PubMed2002

Comparison of the bladder tumour antigen test with photodynamic diagnosis in patients with pathologically confirmed recurrent superficial urinary bladder tumours.

OBJECTIVE: To verify the sensitivity of the bladder tumour antigen (BTAstat, Bard Urological, Covington, GA) test against the sensitive procedure of photodynamic diagnosis (PDD), in which 5-aminolaevulinic acid (5-ALA, a precursor of fluorescent porphyrins) is absorbed by the tumour and detected by ultraviolet cystoscopy, in the early diagnosis of urinary bladder tumours. PATIENTS AND METHODS: Forty-three patients (31 men and 12 women, age range 21-87 years) were assessed after transurethral resection of their bladder tumour using the BTAstat test and PDD. Sixty-nine biopsies from suspect areas of bladder mucosa were taken during cystoscopy under ultraviolet light and all suspect lesions electrocoagulated. RESULTS: Thirty-five patients (81%) had a positive BTAstat test; in these patients PDD detected malignant lesions (17 Ta1G1-2, two T1G2, two T1G3 and 14 Tis). In eight patients (19%) the BTAstat was negative but PDD detected three malignant lesions (two Tis and one TaG1). CONCLUSIONS: PDD is valuable for detecting bladder malignancy and can identify small lesions not detected by the BTAstat test.

Adult↗
PubMed2003

[A case in which severely irritable bladder following intravesical instillation of Bacillus Calmette Guerin was successfully treated by steroid therapy].

We report a patient whose irritable bladder symptoms following Bacillus Calmette Guerin (BCG) instillation were satisfactorily treated by steroid administration. A 59-year-old male had undergone transurethral resection for the bladder carcinoma recurred three times. The histopathological examination revealed the tumor as transitional cell carcinoma, G1 to G2, and pTa. Subsequently an instillation of 80 mg BCG into the bladder was planned 8 times every 7 days. After the 5th instillation he presented with gross hematuria, painful micturition, pollakisuria, urgency and reduced bladder capacity of 15 ml. The dose was reduced to 40 mg and another 3 instillations were accomplished. Since conventional treatments of anti-cholinergics, analgesics and epidural anesthesia were of little help for the subjective symptoms, he was put on the steroid pulse therapy 2 weeks after completion of the BCG regimen. The treatment gradually improved the subjective symptoms and increased the bladder capacity up to 160 ml. In conclusion, we believe that the steroid pulse therapy deserves considering in the early stage of irritable bladder symptoms following BCG instillation.

Administration, Intravesical↗
PubMed2005

[Small cell carcinoma of the urinary bladder: a case report].

We report a case of primary small cell carcinoma of the urinary bladder. A 74-year-old woman was referred to our hospital because of pollakiuria. Cystoscopy showed a papillary tumor. We operated transurethral resection of the bladder tumor (TUR-Bt). Histopathological finding was transitional cell carcinoma (TCC), grade3, pT1 containing pTis. About six months later, tumor recurred to the bladder. Pathologic diagnosis was TCC in part and most was small cell carcinoma. Pelvic magnetic resonance imaging revealed a huge mass lesion with extravesical extension in the urinary bladder, and computed tomography scan showed external iliac lympho node metastasis. The rapid rise of a tumor maker NSE and pro-GRP were remarkable. It was diagnosed as a rapid advance of small cell carcinoma. We performed pelvic radiotherapy, and chemotherapy using carboplatin (CBDCA) and etoposide (VP-16). However 14 months after it had left hospital, computed tomography showed paraaortic lympho node metastasis. The patient died due to rapidly progressive disease.

Aged↗
PubMed2005

Expression of thymidine phosphorylase in human superficial bladder cancer.

BACKGROUND: The purpose of the present paper was to investigate the expression level of thymidine phosphorylase (TPase) in superficial bladder cancer tissues obtained by transurethral resection, and determine whether its expression correlates with tumor recurrence. METHODS: From March 1998 to December 2001, 99 patients with superficial bladder cancer were diagnosed and treated at eight affiliated hospitals. Tissue specimens obtained by transurethral resection of superficial bladder cancer (TURBT) were applied to immunohistochemical study using anti-TPase antibody as well as pathological diagnosis. The data were subjected to statistical analysis. RESULTS: Using MoAb 654-1 as the primary antibody, TPase was clearly stained in human bladder cancer tissues. The maximum TPase level measured by enzyme-linked immunosorbent assay (ELISA) method in normal bladder tissues was 18.7 U/mg protein. The TPase activity was 2.8-fold higher in tumors than in normal bladder samples (P = 0.037). The TPase positivity rates determined by immunohistochemical and ELISA methods were distinctly correlated (P = 0.046). For the recurrence-free rates in pT1 tumors treated by TURBT alone (n = 46), there were no statistically significant differences between Tpase-positive or -negative cases. CONCLUSIONS: The TPase expression determined by ELISA and immunohistochemistry is significantly up-regulated in superficial bladder tumors compared with normal bladder samples. However, TPase expression by immunohistochemistry is not a predictive index of recurrence-free rate for superficial bladder cancer treated with TURBT alone.

Aged↗
PubMed2001

[Clinical pathway for TUR of bladder neoplasms. Analysis of the first 2 years of its implementation].

OBJECTIVE: To analyze the results of the first two years of application of the clinical pathway for transurethral resection (TUR) of bladder tumors at La Paz University Hospital. METHODS: We developed a clinical pathway of 4 hospital stays (5 days) for TUR of the bladder that included the following: matrix-verification, treatments prescribed, verification of changes, patient information sheet and patient satisfaction questionnaire. The information for the evaluation of the results were obtained from the pathway records and data on the activities of the Urology services. To assess the results for efficiency in the use of resources, the mean duration of hospital stay of patients in the pathway were compared with that of a control group comprised of 50 randomly selected patients submitted to TUR of the bladder in 1997. RESULTS: From June 1998 to May 2000, 481 of the 494 (97.4%) treated patients entered the clinical pathway. CONCLUSIONS: In our experience, the clinical pathway for the urinary bladder is a useful instrument for developing the clinical management of this condition. It reduces the unwanted changes in patient care and hospital stay, carries a low incidence of complications and readmissions, and achieves a high degree of patient satisfaction.

Critical Pathways↗
PubMed1997

Absorption of irrigating fluid during transcervical resection of endometrium--a report of two cases.

It has been recognized for many years that the use of hypotonic solution for the irrigation of the bladder cavity during transurethral resection of the prostate (TURP) may result in hyponatremia and water intoxication due to rapid and excessive absorption of the solution from the exposed prostatic bed, the clinical manifestation of which is termed "TURP syndrome". A similar condition termed "female TURP syndrome" following hysteroscopic transcervical endometrial resection (TCR) has been reported. Since the frequency of TCR continues to increase the increased rate of "TCR syndrome" would come in its wake. Here, we present two cases who developed severe hyperglycemia and hyponatremia while underwent TCR with 10% dextrose in water as the irrigation fluid and the same time emphasize the potential risk of this complication.

Adult↗
PubMed1999

[Three cases of transitional cell carcinoma in bladder diverticulum treated by a bladder-preserving approach].

Three cases of transitional cell carcinoma (TCC) in the urinary bladder diverticulum were encountered during a period of 12 years and bladder preserving treatments were performed. Case 1: A 78-year-old man was admitted with a chief complaint of hematuria. Papillary tumors in the diverticulum of the right bladder wall were revealed (TCC, G3, T3N0M0). Intraarterial infusion chemotherapy was performed and complete remission was achieved. When a recurrent bladder tumor appeared 22 months later, transurethral resection was performed and there was no evidence of recurrence for 50 months. Case 2: A 60-year-old man was admitted with a chief complaint of gross hematuria. Cystoscopic examination revealed papillary tumors in a bladder diverticulum near the ureteral left orifice. Transurethral resection revealed TCC G2 and carcinoma in situ. Partial cystectomy, including the bladder diverticulum, and vesicoureteral neostomy was performed. The histological stage of the tumor was pTis and the wall of diverticulum possessed a thin muscle layer histopathologically. Twenty two months later, recurrence in the left bladder wall developed and transurethral resection and bladder instillation therapy were performed. For 21 months he had no evidence of recurrence. Case 3: A 59-year-old man was admitted with a chief complaint of hematuria. A solid tumor in the diverticulum of the bladder left wall was revealed. After 4 courses of intraarterial infusion chemotherapy, 41% remission was achieved and partial cystectomy was performed. Histopathological diagnosis was TCC G3, pT3b, INF-alpha, v (-), ly (-), and no muscle layer was found in the diverticulum. There was no evidence of recurrence 16 months after operation. By using the combination therapy, bladder preserving treatment is possible in the cases of bladder cancer arising in the diverticulum.

Aged↗
PubMed1994

Unsuspected bladder carcinoma in patients undergoing radical prostatectomy.

Unsuspected synchronous transitional cell carcinoma of the bladder was discovered between January 1991 and June 1993 in 4 patients who were candidates for radical prostatectomy. Each of these patients had multiple urinalyses that did not demonstrate hematuria. During the 2 1/2-year period these patients represented 1.2% of all radical prostatectomies with cystoscopy performed preoperatively. Using the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) data the expected number of bladder neoplasms was estimated. The occurrence of synchronous bladder carcinoma observed in our prostatectomy group compared with age-matched population-based SEER data demonstrates a statistically significant difference as analyzed by the chi-square test (p < 0.001). Management of these superficial bladder tumors included transurethral resection before radical prostatectomy. All patients were free of prostatic and urothelial malignancy at 6 to 24 months. The finding of an unsuspected bladder malignancy in a radical prostatectomy candidate should be addressed first and further therapy should be guided by the stage of the bladder neoplasm. Cystoscopy provides information regarding bladder pathological findings, the status and location of the ureteral orifices, preexisting urethral pathological conditions and tumor encroachment on the urethra. The ideal time to perform cystoscopy is in the office before the scheduled date of surgery. Given the low morbidity and cost, cystoscopy should be performed before radical prostatectomy.

Aged↗
PubMed1989

Neo-adjuvant chemotherapy for invasive bladder cancer. Experience with the M-VAC regimen.

A series of 71 patients with muscle invasive bladder cancer received a median of 3 cycles (range 1-6) of methotrexate, vinblastine, Adriamycin and cisplatin (M-VAC). Efficacy assessed by transurethral resection alone showed that 48% of patients were TO, 13% Tis and 54% had normalisation of initially positive urinary cytology after treatment. However, when considering transurethral resection of the bladder (TURB), cytology and non-invasive procedures (CT scan and/or ultrasound), only 21% had a clinical complete remission (cCR); 48 patients (68%) had pathological evaluation and 13 (27%) were PO after treatment. Non-responding patients had a poor prognosis: 14/30 (47%) developed metastatic disease and 13 died. In assessing the primary lesions, clinical understaging was significant. Of 15 patients who were TO cystoscopically prior to surgery, 6 (40%) had residual disease in the pathological specimen, including 4 with muscle infiltration; 23 patients (32%) remained clinically staged, only 8 of whom remain disease-free. With a median follow-up of 24 months (range 2-42+), 41 patients are alive and disease-free, including 20 with a functional bladder. The large staging error raises questions concerning studies using clinical rather than pathological endpoints as the sole criteria of efficacy.

Adult↗
PubMed1989

[Inverted papilloma of the bladder with mild atypia].

A case of inverted papilloma of the bladder with mild atypia in a 31-year-old male is reported. The patient was admitted complaining of macroscopic hematuria. An excretory urogram revealed a small filling defect in the center of the bladder. A 15 x 11 mm. exophytic lesion was noted at the center of the trigone by cystoscopy and ultrasonography. The patient underwent transurethral resection of the bladder tumor and selected-site mucosal biopsies. The result of a histopathological examination of the tumor was an inverted configuration with nuclear atypia, corresponding to transitional cell carcinoma, grade 1. No histopathological abnormalities in the normal-appearing bladder mucosa were observed. The patient has been subsequently followed up for 43 months and there was no evidence of recurrence.

Humans↗
PubMed1989

Recurrence of superficial bladder carcinoma after intravesical instillation of mitomycin-C. Comparison of exposure times.

A total of 70 patients were treated with intravesical instillations of Mitomycin-C (MMC) following transurethral resection for superficial bladder carcinoma. In this randomised prospective study the influence of 2 exposure times (0.5 and 1 h) was studied in relation to tumour recurrence, recurrence interval, tumour progression and toxicity. The number of patients with recurrent tumours was significantly lower in the 1-h group. Tumour progression was seen in only 2 patients in each group and all had primary or secondary carcinoma in situ of the bladder or prostatic urethra. Fourteen patients were excluded from further evaluation because of side effects. A longer instillation time over a longer period and a lower dose of MMC are recommended.

Administration, Intravesical↗
PubMed2003

Intravesical bacillus Calmette-Guerin versus mitomycin C for Ta and T1 bladder cancer.

BACKGROUND: Tumour recurrence following transurethral resection (TUR) for Ta and T1 bladder cancer is a major clinical problem. Intravesical administration of mitomycin C (MMC) or bacillus Calmette-Guerin (BCG) has proven prophylactic activity but both are associated with local and systemic side-effects. A systematic review was carried out to compare the efficacy of these two agents. OBJECTIVES: To undertake a systematic review and meta-analysis comparing intravesical mitomycin C and Bacillus Calmette-Guerin in terms of tumour recurrence, disease progression and overall survival in Ta and T1 bladder cancer. Treatment-related toxicities would also be evaluated. SEARCH STRATEGY: A comprehensive search of MEDLINE, EMBASE, Healthstar, Cochrane Controlled Trials Register, Cancerlit, and DARE was performed, and hand searching of relevant journals undertaken. SELECTION CRITERIA: Trials in any language were included in the meta-analysis if they were properly randomised, included medium to high risk patients with Ta or T1 bladder cancer and compared intravesical MMC versus BCG. DATA COLLECTION AND ANALYSIS: Trial eligibility, methodological quality and data extraction were assessed independently by two reviewers. Time to event analysis was evaluated using log hazard ratios, with a sensitivity analysis for subgroups according to patient's risk of recurrence. MAIN RESULTS: Twenty-five articles were identified but only seven were considered eligible. This represented 1901 evaluable patients in total, 820 randomised to MMC and 1081 to BCG. Six trials had sufficient data for meta-analysis and included 1527 patients, 693 in the mitomycin arm and 834 in the BCG arm. The weighted mean log hazard ratio (variance) for tumour recurrence for the six trials was - 0.022 (0.005). This indicated no significant difference between MMC and BCG (p = 0.76). However, the meta-analysis indicated evidence of significant heterogeneity between trials (p = 0.001). A subgroup analysis of three trials that included only high risk Ta and T1 patients indicated no heterogeneity (p = 0.25) and a log hazard ratio (variance) for recurrence of -0.371 ( 0.012). With MMC used as the control in the meta-analysis, a negative ratio is in favour of BCG and, in this case, is highly significant (p = 0.0008). The seventh trial, in abstract form only, used BCG in low doses for two arms of the trial (27 mg and 13.5mg) compared to a standard dose of mitomycin C (30mg), and reported a significantly reduced recurrent rate with BCG (27mg) compared to mitomycin C (p = 0.001). Only two trials included sufficient data to analyse disease progression and survival, representing a total of 681 patients; 338 randomised to BCG and 343 to MMC. There was no significant difference between MMC and BCG for disease progression (log hazard ratio + variance: 0.044 + 0.04, p = 0.16) or survival (-0.112 + 0.03, p = 0.50). Local toxicities (dysuria, cystitis, frequency, and haematuria) were associated with both MMC (30%) and BCG (44%). Systemic toxicities, such as chills, fever and malaise, were observed with both MMC and BCG (12% and 19%, respectively) although skin rash was more common with MMC. REVIEWER'S CONCLUSIONS: The data from the present meta-analysis indicate that tumour recurrence was significantly reduced with intravesical BCG compared to MMC only in the subgroup of patients at high risk of tumour recurrence. However, there was no difference in terms of disease progression or survival, and the decision to use either agent might be based on adverse events and cost.

Administration, Intravesical↗
PubMed2002

[Prospective study of effectiveness. Reoperation (re-TUR) in superficial bladder carcinoma].

To assess the rate of residual cancer after transurethral resection (TUR) of superficial bladder cancer, a prospective study was carried out. All patients with transitional cell cancer (TCC) stage pTa-pT1 underwent a repeat TUR (ReTUR) within 6-8 weeks. Sites and rates of tumors found during ReTUR were documented as well as the morbidity of the ReTUR. Of a total of 192 TUR, superficial TCC was found in 124 cases; 83 underwent ReTUR according to the study protocol. Residual tumor was detected in 27% of pTa and 53% of pT1 tumors. Worsening of grading or T stage was found in 8%. Of the tumors detected by ReTUR, 81% were localized at the site of the first TUR. In this prospective study, residual tumor formation was detected in a high percentage. Routine ReTUR is therefore recommended in superficial bladder cancer except solitary pTaGI lesions.

Carcinoma, Transitional Cell↗
PubMed1991

Tumor enzymes and prognosis in transitional cell carcinoma of the bladder: prediction of risk of progression in patients with superficial disease.

The activities of 6 enzymes of carbohydrate metabolism were estimated in superficial transitional cell carcinomas from 103 patients undergoing transurethral resection of the bladder for the first time. The patients were followed by quarterly endoscopic examinations for a maximum of 81 months (median 33 months). During followup 24 patients had progressive disease. The activities of phosphofructokinase and phosphohexose isomerase were significantly lower in tumors from patients whose disease had superficially invaded the lamina propria (stage pT1) than in others in whom it was confined to the bladder mucosa (stage pTa). Similarly the activities of the 2 enzymes were significantly higher in well differentiated (grade 1) than in moderately well differentiated (grade 2) carcinomas. Univariate analyses using the log rank test showed that neither pathological stage nor malignancy grade of the carcinoma was a significant factor in predicting the risk of progression. Of the 6 enzymes, below median activities of phosphofructokinase, lactate dehydrogenase and phosphohexose isomerase were associated with a significantly increased risk of progression in these patients. Multivariate analyses using Cox's proportional hazards model showed that the activity of lactic dehydrogenase in superficial transitional cell carcinoma is an independent prognostic factor in predicting the risk of progression. It is postulated that the measurements of the activities of the 3 enzymes in tumors from patients with superficial transitional cell carcinoma might help to select individual patients with a high risk of progression for adjuvant intravesical treatments.

Age Factors↗
PubMed1983

[Blood and tissue levels of mitomycin C after intravesical instillation].

Local mitomycin C (MMC) bladder instillation immediately after transurethral resection of superficial transitional cell carcinoma of the bladder caused an MMC serum concentration up to 24.5 ng/ml of an average. Neither bladder perforation by TUR nor vesicorenal reflux are contraindications for local instillations MMC. Systemic side effects are not to be expected. The highest MMC concentrations were found in the cancer tissue. There were measurable concentrations of MMC down to the adventitia. The indication for immediate postoperative local MMC-chemotherapy is discussed.

Antibiotics, Antineoplastic↗
PubMed1996

[Random biopsy and recurrence risk in patients with bladder cancer].

BACKGROUND: We studied the relationship between the recurrence rate of primary superficial bladder cancer and random biopsy. METHODS: We performed transurethral resection of primary superficial bladder cancer in 144 patients, and in 55 of those cases a random biopsy was also performed. The non-recurrence rate was examined in many recurrence facters. RESULTS: The non-recurrence rate in the group with random biopsy was not significantly different from that observed in the group (100 patients) without random biopsy (chi 2 test, Generalized Wilcoxon test and multivariate analysis). Because the intravesical instillation therapy is an important inhibition factor in the recurrence rate of the primary superficial bladder cancer, we further analysed the recurrence rate in two non treated groups with or without random biopsy (13 and 35 patients respectively). No significant difference in the rate of recurrence between the two groups was observed. However, we noted recurrence of bladder cancer at biopsy positions in 8/13 patients. CONCLUSION: It appears that random biopsy may have an effect on the recurrence or the implantation of tumor cells. Further studies are needed to clarify whether random biopsy is a risk factor in the recurrence rate of primary superficial bladder cancer.

Aged↗
PubMed2005

[Obturator nerve block for transurethral surgery. comparing ropivacaine 0.75 % vs. prilocaine 1 %].

OBJECTIVE: Obturator nerve block is used for transurethral resection of lateral bladder wall tumors to prevent adductor muscle spasm and associated complications. Therefore, the local anesthetic applied should provide an adequate motor blockade. Ropivacaine 0.75 % was compared to prilocaine 1 % and motor blockade assessment performed by the Medical Research Council (MRC)-scale. METHODS: 40 patients (20 per group) scheduled for transurethral resection were randomized to either receiving 10 ml ropivacaine 0.75 % or prilocaine 1 % for direct obturator nerve block in a controlled user-blinded study. Motor block was assessed with the MRC-scale 5 and 10 minutes after local anesthetic injection followed by an assessment 120 and 180 minutes after surgery. Surgery was performed in equally distributed spinal or general anesthesia, intraoperative adductor spasm intensity was evaluated by surgeon's ranking. RESULTS: Motor blockade intensity was significantly higher with ropivacaine 0.75 % at all time points of assessment. Intraoperatively, severe spasm only occurred in the prilocaine 1 %-group. CONCLUSION: Ropivacaine 0.75 % is a more appropriate agent for direct obturator nerve block than prilocaine 1 %, providing a faster onset and a more intense and longer-lasting motor blockade. This may reduce surgical complications and facilitate early surgical re-intervention. In this study, MRC-scale was appropriate for motor blockade assessment in a peripheral nerve block.

Aged↗