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At least 919 records · Page 51Linked to original sources
PubMed1992

Intravesical therapy with adriamycin plus verapamil in patients with superficial bladder cancer: a pilot study.

Nineteen patients with histologically proven superficial bladder cancer (Ta, T1) were treated with intravesical instillation of 30 mg of adriamycin (ADM) dissolved in 24 ml physiological saline plus 15 mg of verapamil (VR) (6 ml) every day for 10 days. In spite of the short period of treatment, 6 of the 18 evaluable patients (33.3%) showed complete response (CR) and a further 5 (27.8%) showed partial response (PR). Five of the 6 patients with CR were recurrent cases who had previously received prophylactic intravesical instillation chemotherapy including ADM. Irritative urinary symptoms were observed in 11 of the 19 patients (57.9%). However, these symptoms were mild in the majority of patients and the treatment was completed without interruption in all but 1 patient. There was no significant absorption of ADM and VR into the systemic circulation. No clinical evidence of systemic toxicity was observed. These results suggest that combination of ADM and VR has a possibility to be a useful prophylactic intravesical instillation chemotherapy after endoscopic resection of not only primary but also recurrent chemoresistant bladder cancers.

Administration, Intravesical↗
PubMed1990

[Prophylactic intravesical BCG for bladder tumor after surgery of upper tract urothelial carcinoma].

We report the result of prophylactic intravesical instillation of BCG after surgery of upper tract urothelial carcinoma. The BCG Tokyo 172 strain was given preoperatively and/or postoperatively, as a rule, in a dose of 80 mg in 30 ml saline instilled into the bladder. Only one (14.3%) of the 7 patients with intravesical BCG developed bladder tumor at 14 month after surgery, while (45.4%) of 11 patients who did not receive intravesical BCG suffered from bladder tumor within 2 years after surgery. Prophylactic intravesical instillation of BCG reduced significantly (p less than 0.005) the recurrence of bladder tumor after the surgery of renal pelvis and ureteral tumor.

Administration, Intravesical↗
PubMed1999

[Intravesical morphine analgesia in pediatric urology].

OBJECTIVE: Evaluation of the technique and value of intravesical morphine instillation after ureterovesical reimplantation in children. MATERIAL AND METHODS: From July 1997 to June 1998, the Duckett protocol (Philadelphia, USA), comprising slow intravesical infusion of morphine for the first three prosoperative days, was applied in 25 children aged five months to twelve years after ureterovesical reimplantation surgery, without bladder catheterization. Postoperative pain was evaluated by CHEOPS and VAS scales and by all nursing staff by an anonymous questionnaire. RESULTS: Analgesic assessment tests confirmed a significant improvement of postoperative comfort, despite the absence of a bladder catheter. No adverse effects or complications related to intravesical morphine instillation were observed. CONCLUSION: Intravesical morphine instillation is an easy, effective postoperative analgesia technique, allowing good tolerance of the absence of postoperative bladder catheterization.

Administration, Intravesical↗
PubMedDate not supplied

No inhibition of urinary bladder carcinogenesis in rats with intravesical instillation of alpha-galactosylceramide.

The immunostimulatory a-galactosylceramide, KRN 7000 ((2S,3S,4R)-1-O-(a-D-galactopyranosyl)-2-(N-hexacosnoylamino)-1,3,4-octadecatrienol), may be anticipated to have antitumor activity in vivo apart from any direct toxicity to cancer cells. In this experiment, inhibition of rat bladder carcinogenesis by intravesically instillated KRN7000 was investigated. Male Fischer 344 rats, 6-weeks-old at the start, were divided into 4 groups, all first receiving the carcinogen, 0.05% N-butyl-N-(4-hydroxybutyl)nitrosamine, in their drinking water for 12 weeks. Then groups 1 and 2 respectively were administered 500 and 50 mg/kg of KRN7000 intravesically once weekly for 17 weeks. Group 3 similarly received only 0.3 micro/l of saline (vehicle control). Group 4 did not undergo bladder catheterization. On macroscopic examination at 30 weeks, multiplicities and sizes of bladder tumors in the KRN 7000 high and low-dose groups were not significantly different from those of the vehicle control group. Histologic examination confirmed no significant variation in incidences of carcinomas or preneoplastic lesions in the bladder among groups 1 to 4. Thus the results indicate that intravesical instillation of KRN7000 does not inhibit bladder carcinogenesis in rats.

Adjuvants, Immunologic↗
PubMed1996

Photodynamic therapy on rat urinary bladder with intravesical instillation of 5-aminolevulinic acid: light diffusion and histological changes.

PURPOSE: Photodynamic therapy (PDT) has the potential to treat extensive premalignant lesions and microinvasive tumors in the bladder, but its use has been hampered by the risk of detrusor muscle damage and prolonged skin photosensitivity. We have shown that the rat urothelium can be sensitized by selectively using a 10% solution of 5-aminolevulinic acid (ALA) at pH 5.5 administered intravesically. This paper evaluates the photodynamic effects on sensitized bladders. MATERIALS AND METHODS: The bladders ofs Wistar rats were instilled with ALA solutions of different concentrations at pH 5.5 and subsequently treated with laser light at 630 nm. Bladders were harvested 1 to 7 days after PDT for histological assessment. RESULTS: Under optimum conditions (10% intralipid diffusion medium, light dose 50J) uniform urothelial necrosis was seen after 1 to 2 days; it healed in 7 days without damage to the underlying muscle layer although some increase in collagen was seen in the lamina propria. Overtreatment or poor light distribution resulted in muscle necrosis and scarring. CONCLUSIONS: Selective urothelial necrosis is possible with PDT using intravesical ALA. There is now sufficient data for pilot clinical trials to start photodynamic therapy for management of superficial bladder cancer or carcinoma in situ.

Administration, Intravesical↗
PubMed1997

High-risk superficial bladder cancer: intravesical therapy for T1 G3 transitional cell carcinoma of the urinary bladder.

The ideal treatment for T1 G3 transitional cell carcinoma (TCC) of the urinary bladder remains controversial. Therapeutic options after the initial transurethral (TUR) resection are observation, intravesical therapy, a repeat resection, radiation therapy, and cystectomy. Because more than half of patients with T1 G3 TCC of the urinary bladder do not progress, initial cystectomy can represent overtreatment. However, observation alone following TUR for T1 G3 TCC of the urinary bladder is associated with a progression rate of 48%. Intravesical immunotherapy has been shown to decrease recurrence and progression in high-grade Ta carcinoma in situ and T1 bladder cancer. When patients with T1 G3 tumors are well selected, intravesical therapy following the initial TUR can significantly improve survival and quality of life. Persistence or recurrence of high-grade tumor mandates consideration of cystectomy.

Adjuvants, Immunologic↗
PubMed2000

Intravesical Bacillus Calmette-Guerin in Ta and T1 Bladder Cancer.

BACKGROUND: Intravesical therapy with Bacillus Calmette-Guerin (BCG) aims to reduce the incidence of tumour recurrence following transurethral resection (TUR) for patients with superficial bladder cancer. OBJECTIVES: The objective of this review was to compare the incidence of tumour recurrence after the standard therapy of transurethral resection versus transurethral resection plus intravesical Bacillus Calmette-Guerin. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (March 2000), Medline (February, 2000), EMBASE (February, 2000), Cancerlit (February, 2000), Healthstar (February, 2000), Database of Abstracts of Reviews of Effectiveness (February, 2000) and the Bath Information Data Service. The Proceedings of the American Society Clinical Oncology was hand searched (1996 - 1999). SELECTION CRITERIA: Randomised or quasi-randomised trials of transurethral resection alone versus transurethral resection plus intravesical Bacillus Calmette-Guerin. Patients with Ta and T1 bladder cancer of medium or high risk of tumour recurrence, were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Four reviewers assessed trial quality and two abstracted the data independently. The Peto odds ratios and log hazard ratios were determined to compare the number of patients with disease recurrence at 12 months and the rate of recurrence, respectively. MAIN RESULTS: Six randomised trials were included involving 585 eligible patients. There were significantly fewer patients with disease recurrence at 12 months in the BCG plus TUR group compared to those that received TUR alone (odds ratio 0.30, CI 0.21, 0.43). The overall log hazard ratio for recurrence (-0.83, variance 0.02) indicated a significant benefit of BCG treatment in reducing tumour recurrence. Toxicities associated with BCG consisted mainly of cystitis (67%), haematuria (23%), fever (25%) and urinary frequency (71%). No BCG-induced deaths were reported. REVIEWER'S CONCLUSIONS: In patients with medium/high risk Ta or T1 bladder cancer, immunotherapy with intravesical BCG following TUR appears to provide a significant advantage over TUR alone in delaying tumour recurrence.

Adjuvants, Immunologic↗
PubMed1994

Phase II study of intravesical chemoprophylaxis of epirubicin after transurethral resection of bladder tumors. Tottori University Oncology Group.

We performed intravesical instillation of epirubicin in 53 patients with the aim of preventing recurrence of bladder tumors. The patients had undergone transurethral resection of superficial bladder tumors (only transitional-cell carcinoma) within the preceding week, between January of 1990 and July of 1991. Recurrence was found in 11.3% (6/53) of cases during follow-up periods lasting from 1 to 20 months. Side effects occurred in 5.7% (3/53) of the patients. The cumulative nonrecurrence rate was 96.0% for a follow-up period of 6 months and 78.4% for 12 months. The results of this study suggest that intravesical instillation of epirubicin is very useful as adjuvant therapy after transurethral resection of superficial bladder tumors.

Administration, Intravesical↗
PubMed1996

Intravesical epirubicin in the prophylaxis of superficial bladder cancer.

UNLABELLED: Forty-five patients who underwent transurethral resection (TUR) for Ta-T1 superficial bladder cancer were included in the study. Fourteen patients who had TUR alone were assigned to the control group. Epirubicin therapy was started two weeks after complete TUR of the tumour. Epirubicin in a dose of 50 mg diluted in 50 ml saline was installed weekly for 8 weeks in the epirubicin group. The mean follow-up was 24 months. Although recurrence rate was higher in the control group (64.2% versus 32.2%), it was not found to be statistically significant (p = 0.0914, chi-square test). Tumour-free intervals in patients with recurrent disease were significantly longer in the epirubicin group (p < 0.05, Mann-Whitney U-test). IN CONCLUSION: intravesical epirubicin therapy, which both reduces recurrence rate and prolongs time to recurrence, was found to be effective in the prophylaxis of superficial bladder cancer.

Administration, Intravesical↗
PubMed1986

Detection of interleukin 2 in the urine of patients with superficial bladder tumors after treatment with intravesical BCG.

Adjuvant intravesical BCG therapy is an effective means of treating superficial bladder tumors. The mechanism by which BCG mediates antitumor activity is not known; however, clinical and animal studies suggest that immunological responsiveness to BCG antigens correlates with antitumor activity. In this report the detection of interleukin 2 (IL-2, a lymphokine produced in response to BCG) in urine specimens of patients treated with intravesical BCG is reported. Patients with superficial transitional cell carcinoma of the bladder received intravesical BCG once each week for six weeks. No intradermal injections were administered. Urine specimens were obtained prior to BCG instillation and four, eight and 24 hours afterwards. The specimens were dialysed, concentrated five-fold and assayed for the presence of IL-2 in a biological assay using an IL-2 dependent cultured T-cell line. IL-2 was detected in urine but not serum after intravesical BCG instillation. IL-2 was characterized by absorption against an IL-2-dependent T cell line and neutralization by monoclonal anti-IL-2 antibodies. No IL-2 was detected in specimens obtained prior to BCG instillation or from donors with no detectable bladder pathology. One of 10 urine specimens from patients with urinary tract infections had detectable IL-2 levels. IL-2 production generally peaked during the fourth to sixth intravesical BCG treatment. Production was short-term in that IL-2 levels peaked four to eight hours after BCG instillation and were rarely (six of 54 specimens) observed 24 hours after instillation. Mean IL-2 levels were higher in patients who were rendered tumor free after BCG therapy but statistical significance was not achieved. Ten of 12 patients (83%) who responded to BCG therapy had urine IL-2 levels greater than or equal to 1.6 units/ml. at least once during the six week treatment period while two of six (33%) patients not responding to therapy had similar urine IL-2 levels. These results show that intravesical BCG therapy induces the production of lymphokines including IL-2. The presence of BCG-induced lymphokines may be associated with anti-tumor activity.

Administration, Intravesical↗
PubMed2003

T2a transitional cell carcinoma of the bladder: long-term experience with intravesical immunoprophylaxis with bacillus Calmette-Guerin.

PURPOSE: In this prospective study we evaluate the effect of combined transurethral resection of early muscle invasive bladder cancer and immunotherapy with bacillus Calmette-Guerin (BCG) in patients unfit for radical cystectomy or refusing more aggressive therapies. MATERIALS AND METHODS: A total of 22 patients with a mean age 73.6 years were included in the study. Inclusion criteria were histologically proven muscle invasive transitional cell carcinoma of the bladder with a tumor-free second resection and negative staging examinations in patients unfit for radical cystectomy or refusing more aggressive therapies. All patients received 6 weekly instillations of 120 mg. BCG starting 14 to 21 days after the last transurethral resection of the tumor. Followup at 3 months included cystoscopy, urinary cytology, ultrasound of the abdomen and chest x-ray. Every 6 months computerized tomography of the abdomen and bone scans were performed. RESULTS: The overall 5-year survival rate was 69.1%, while the disease specific 5-year survival rate was 94%. One muscle invasive recurrence was noted at 69 months, which was again treated with the same regimen but ultimately led to radical cystectomy 21 months later. One patient died of progressive recurrence in the upper urinary tract. The 5-year recurrence-free survival rate was 46.5%. The only severe complication was BCG pneumonitis. CONCLUSIONS: The data show encouraging results for transurethral resection of bladder tumor with intravesical BCG therapy in select patients with T2a bladder cancer who are not candidates for radical cystectomy.

Administration, Intravesical↗
PubMed1987

Prospective study of intravesical dimethyl sulphoxide in the treatment of chronic inflammatory bladder disease.

Thirty patients with biopsy-proven chronic inflammatory bladder disease were treated with intravesical dimethyl sulphoxide (DMSO). Satisfactory symptomatic relief was achieved in 80% of patients completing treatment and no significant side effects were encountered. Despite the improvement in symptoms there was no significant alteration in the endoscopic or morphological appearance of the bladder after treatment. Intravesical DMSO is safe and relatively easy to administer and seems to have a place in the management of patients with this difficult problem.

Administration, Intravesical↗
PubMed1994

Marker tumour response to Evans and Pasteur bacille Calmette-Guérin in multiple recurrent pTa/pT1 bladder tumours: report from the Medical Research Council Subgroup on Superficial Bladder Cancer (Urological Cancer Working Party).

OBJECTIVE: To compare the efficacy of Evans bacille Calmette-Guérin (BCG) and Pasteur BCG in eradicating marker bladder tumours and to compare the toxicity of the two strains. PATIENTS AND METHODS: Ninety-nine patients with multiple recurrent pTa or pT1 bladder tumours were allocated at random to six instillations at weekly intervals of either Evans BCG or Pasteur BCG. All tumours were resected except one marker tumour. At cystoscopy 3 months after randomization all tumours including the marker tumour, if still present, were resected. RESULTS: The incidence of adverse events was similar in the two groups but numbers were small and only large differences would have been detected. No statistically significant difference in efficacy regarding the response of the marker tumour or the appearance of other tumours at 3 months was noted in the two groups. There was no evidence of stage progression of the marker tumours. CONCLUSIONS: In multiple recurrent pTa or pT1 bladder tumours clearing the bladder of all except one marker tumour provides a safe and convenient way of measuring the response to intravesical therapy. No significant difference in efficacy or toxicity was detected between Evans BCG and Pasteur BCG.

Administration, Intravesical↗
PubMed1995

A controlled study of intravesical epirubicin with or without alpha 2b-interferon as prophylaxis for recurrent superficial transitional cell carcinoma of the bladder. Finnish Multicentre Study Group.

OBJECTIVES: To evaluate the efficacy of intravesical epirubicin with or without alpha 2b-interferon (alpha 2b-IFN) as a prophylactic treatment for recurrent superficial transitional cell carcinoma (TCC) of the urinary bladder. PATIENTS AND METHODS: A total of 81 patients with superficial (stage Ta and T1), well or moderately differentiated (grades 1 and 2) TCC were treated between June 1988 and December 1993. The patients were randomized into three groups: Group 1 was treated by transurethral resection (TUR) alone; Group 2 received 50 mg epirubicin and Group 3 received 50 mg epirubicin combined with 10 MU alpha 2b-IFN, intravesically in 50 mL sterile buffer solution. The instillations were started 1 week after TUR and were performed weekly during the first month and then once a month for one year. The patients were followed for a total of 2 years. Recurrence rate and tumour rate were calculated to assess the behaviour of the disease. RESULTS: The patients were followed for a mean of 20 months. Patients receiving intravesical chemoimmunotherapy (Group 3) had the most favourable outcome; they had comparatively lower recurrence and tumour rates, fewer patients with recurrences and, most importantly, the longest disease-free interval. Side-effects were mostly mild and transient, and no differences were found among the groups. CONCLUSIONS: In reducing the number of patients having recurrences and extending the recurrence-free interval, intravesical chemoimmunotherapy with epirubicin and alpha 2b-IFN had a promising effect on the natural course of superficial bladder cancer, particularly in patients with a history of prior recurrences.

Administration, Intravesical↗
PubMed1994

[Topical use of oxybutynin hydrochloride in women with urge incontinence].

In 36 women with cystometric evidence of bladder instability we investigated the efficacy of intravesical instillation of oxybutynin. The intravesical application of oxybutynin had a significant effect regarding the reduction of pollakiuria and nocturia and an improvement of bladder capacity. No local or systemic side effects were noted.

Administration, Intravesical↗
PubMedDate not supplied

Contemporary management of superficial bladder cancer.

BACKGROUND: Bladder cancer is the second most common urologic malignancy after prostate cancer. Superficial bladder cancer presents as a heterogeneous group of tumors with variable biological potential. A significant percentage of patients diagnosed with superficial cancer will have multiple recurrences, and some will progress to invasive disease. METHODS: Patients are stratified into low- or high-risk for recurrence and progression. We review the most recent literature regarding intravesical therapy for superficial bladder cancer, and we summarize indications for the use of intravesical agents as well as their efficacy, toxicity, and cost. RESULTS: Several intravesical agents are available for the treatment of superficial bladder cancer. Patients may be identified as low- or high-risk for recurrence and progression. High-risk patients benefit from intravesical therapy. CONCLUSIONS: Superficial bladder cancer is a heterogeneous group of diseases. Treatment is effective in preventing recurrences and progression in the high-risk group.

Adenocarcinoma↗
PubMed2006

Radiochemotherapy after transurethral resection for high-risk T1 bladder cancer: an alternative to intravesical therapy or early cystectomy?

PURPOSE: For high-risk T1 bladder cancer, the most important issue is how to restrict radical cystectomy to selective patients with a high likelihood of tumor progression and to choose an initial bladder-sparing approach in others without affecting survival. Radiotherapy or radiochemotherapy (RT/RCT) may help to strike a balance between intravesical treatment and early cystectomy. PATIENTS AND METHODS: Between 1982 and 2004, 141 patients with high-risk T1 bladder cancer (84 patients with T1 grade 3 [T1G3]; others with T1G1/2 and associated carcinoma-in-situ, multifocality, tumor diameter > 5 cm, or multiple recurrences) were treated with RT (n = 28) or platinum-based RCT (n = 113) after transurethral resection of bladder tumor (TURBT). Six weeks after RT/RCT, response was evaluated by restaging TURBT. Salvage cystectomy was recommended for patients with persistent disease and for tumor progression after initial complete response (CR). Median follow-up was 62 months; 65 patients have been observed for 5 years or more. RESULTS: CR was achieved in 121 of 137 patients (88%; four patients without restaging TURBT). Tumor progression for the entire group of 141 patients was 19% and 30% at 5 and 10 years, respectively (for 121 patients with CR, 15% and 29%; for 84 patients with T1G3, 13% and 29%, respectively). Disease-specific survival rates were 82% and 73% at 5 and 10 years (CR, 89% and 79%; T1G3, 80% and 71%, respectively). More than 80% of survivors preserved their bladder; 70.4% were "delighted" or "pleased" with their urinary function. CONCLUSION: RT/RCT after TURBT with selective bladder preservation is a reasonable alternative to intravesical treatment or early cystectomy for high-risk T1 bladder cancer.

Administration, Intravesical↗