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PubMed2002

Radical radiotherapy and salvage cystectomy as the primary management of transitional cell carcinoma of the bladder. Results following the introduction of a CT planning technique.

The objective of this study was to review the results of our policy of primary radiotherapy (RT) and salvage cystectomy for transitional carcinoma (TCC) of the bladder in the light of changes in our radiotherapy planning procedure, in particular the introduction of CT planning. The case notes of 163 patients treated with radical radiotherapy using a CT planning technique were examined. The main endpoint for assessment was response at the time of the check cystoscopy 6 months after the completion of treatment. In addition survival was estimated by stage of disease and by response at the time of first cystoscopy. Patterns of relapse and time to relapse were analysed. All percentages quoted in the text use the initial 163 patients as the denominator. One hundred patients (61%) achieved a complete response. The complete response rate was significantly related to T stage at presentation being 90% for T1, 75% for T2, and 53% for T3 disease respectively. Of these patients 78 remain disease free in the bladder (47%). Twenty-two have relapsed in the bladder, of whom 5 have also relapsed at metastatic sites. Fifteen patients have relapsed outside the bladder whilst remaining disease free within the bladder. At the time of last follow up or death from other causes 63 of the 100 patients who had a complete response remained disease free with an intact bladder. There were 18 (11%) partial responders. Seven of these patients went on to have a cystectomy. Ten remain alive, 7 disease free, 4 with intact bladders. In 24 patients (15%) there was no response and these patients have all died, the median survival being 10 months. In 21 patients (13%) a postradiotherapy cystoscopy was not performed. In all but one patient, who was lost to follow up, this was because of progressive disease. The median survival of these 20 patients was 6 months. Of the 163 patients 35% are alive and well with an intact bladder. If patients dying from other causes are included then 42% were rendered disease free. Cause specific survival was significantly related to stage of disease at presentation with 5 year actuarial survival being 87%, 48% and 26%, for T1, T2 and T3 disease respectively. Survival was also related to response to treatment at 6 months with 5 year survival being 64%, and 52% for complete and partial responders respectively. Survival was extremely poor for non-responders with only 37.5% surviving 1 year and none 5 years. There was a highly significant relationship between response and the development of, and the time to developing metastatic disease. Of those who exhibited a response 21% developed metastatic disease compared to 78% of non-responders. Salvage cystectomy offers the possibility of cure in those who achieve a complete or partial response with 42% of such patients being rendered disease free. Results however are poor in those who did not respond with all patients dying of their disease. Response rates for all stages, and survival for stages T1 and T2 are much improved from those previously reported from this centre and compare favourably with other published series. These results confirm the place of radiotherapy and salvage cystectomy in the management of TCC of the bladder in selected patients. In about one-third of patients the desired outcome of curing the patient of their cancer with organ preservation is achieved. The prognostic significance of cystoscopic response at 6 months and stage at presentation is confirmed. The outcome for patients with early stage disease is excellent. The relationship between response and the development of metastatic disease would suggest that even if these patients had had a primary cystectomy they may have fared badly, a conclusion supported by the fact that these results are comparable with surgical series. This series supports the role of radiotherapy in the management of this disease and suggests that modern RT techniques including CT planning have had a beneficial effect on the results of radical radiotherapy.

Aged↗

PubMed2000

Relationship of MRI and clinical staging to outcome in invasive bladder cancer treated by radiotherapy.

AIM: To compare MRI and clinical staging of invasive bladder cancer prospectively and identify additional prognostic features on MRI before radiotherapy. METHODS AND MATERIALS: 143 patients with a pathological diagnosis of transitional cell carcinoma underwent MRI (1.0 T) of the abdomen and pelvis before radical radiotherapy. Tumour size, site, degree of infiltration, presence of adenopathy and hydronephrosis were assessed and an appropriate radiological stage assigned. Following radiotherapy all patients received regular cystoscopic follow-up. Date of first relapse and date of death were recorded. RESULTS: The median follow-up was 2.8 years for survivors. Those patients upstaged from T2a clinically to T3b on MRI had a significantly worse outcome (P = 0.0078). In univariate analysis a number of MRI features were significantly associated with adverse outcome: tumour size, circumferential tumour extent, and presence of hydronephrosis (all P < 0.05). After adjustment for clinical T stage and histological grade, all these MRI features and the MRI T stage were found to confer additional prognostic information in predicting early disease relapse and death (P < 0.05). CONCLUSION: This study demonstrates that MRI before radiotherapy provides valuable additional prognostic information compared to clinical staging.

Aged↗

PubMed2001

The assessment of irradiated bladder carcinoma using dynamic contrast-enhanced MR imaging.

AIM: To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) in distinguishing residual or recurrent tumour from radiation change in patients with bladder carcinoma. MATERIALS AND METHODS: Forty patients with biopsy proven bladder carcinoma were imaged before and at 4 and 12 months after radiotherapy (XRT) using conventional and dynamic contrast-enhanced magnetic resonance imaging at 0.5 Tesla. An enhancement of >1.54 times above baseline at 80 s post-contrast injection proved a reliable indicator of tumour before radiotherapy and was therefore applied to the assessment of patients after XRT. Conventional MR images and dynamic enhancement profiles (DEPs) from the site of previous tumour were scored by three radiologists for the presence of tumour at 4 and 12 months after XRT. Findings were compared with cystoscopic biopsy. RESULTS: Dynamic contrast-enhanced magnetic resonance imaging had negative predictive values of 100% and 93% for tumour recurrence at 4 and 12 months, respectively. The positive predictive values, sensitivity and specificity were 48, 100 and 48% at 4 months and 50, 80 and +76% at 12 months post XRT, respectively. CONCLUSION: Dynamic contrast-enhanced magnetic resonance imaging may prove reliable in excluding the presence of persistent or recurrent tumour up to 12 months after XRT.

Contrast Media↗

PubMed2000

Diagnosis and surgical management of ectopic ureters.

Ureteral ectopia is a congenital abnormality of the terminal segment of one or both ureters in which the ureteral orifice is located distal to the trigone of the bladder. Continuous or intermittent urinary incontinence is the most frequently reported clinical symptom associated with ureteral ectopia. A variety of anatomic morphologies of ectopic ureters have been reported. Historically, surgical therapy focused on reestablishing drainage of the ureters into the bladder lumen. However, continued urinary incontinence after surgery is the most frequently reported complication. Specific classification and successful management of the various types of ectopic ureters remain diagnostic and therapeutic challenges to the veterinary clinician. Cystoscopic evaluation of the lower urinary tract and urodynamic evaluation of bladder and urethral function has improved the presurgical assessment of the patient. Surgical procedures, which are aimed at repositioning the ureteral orifice(s) within the bladder lumen and treating primary sphincter incompetence, are necessary to successfully manage small animal patients with ectopic ureters.

Animals↗

PubMed1975

[Cystitis emphysematosa (author's transl)].

Two cases of cystitis emphysematosa are described and the literature is reviewed. The aetiology, course and diagnosis are discussed, the radiological appearances being of particular importance. The cystoscopic and laboratory findings are mentioned. Cystitis emphysematosa is analogous to other conditions which cause gas to collect in abdominal organs and has similar aetiological factors.

Aged↗

PubMed2002

The sex hormone receptors in the bladder in childhood - I: preliminary report in male subjects.

The sex hormone receptors (oestrogen, androgen, progesterone) in the bladder were demonstrated in clinical studies by various authors in adult patients. But the presence of these receptors in childhood had not been investigated. The aim of this study was to assess the presence of sex hormone receptors in the bladder of male subjects in childhood. The study included 20 bladder biopsies from a total of 15 children. Biopsies were taken during open surgery and/or cystoscopic procedures for various indications from the bladder dome, trigonum and in the region of the bladder neck. All biopsies were routinely fixed and processed for histopathological assessment and investigated immunohistochemically to determine the sex hormone receptors in the bladder. The sex hormone receptors were demonstrated with different densities and locations. In particular, sex hormone receptors were found very frequently in biopsies taken from the bladder neck. Overall receptor positivity in the specimens was 90 % for progesterone, 65 % for androgen and 25 % for oestrogen. There was no receptor expression in the deeper tissues of the bladder wall. This preliminary study demonstrated: 1. Sex hormone receptors are present in children; 2. There was a female sex hormone (progesterone, oestrogen) receptor expression in male subjects; 3. The receptors are mainly localised at the bladder neck and in transitional epithelium of the bladder wall. We think that the sex hormone receptor map may be useful in the evaluation of lower urinary tract and specially bladder neck disorders in childhood in the future.

Biopsy↗

PubMed2005

[Subjective patient satisfaction after injection of botulinum-a toxin in detrusor overactivity].

PURPOSE: The established treatment for overactive detrusor function consists of anticholinergic drugs. But this treatment can fail or produce intolerable side effects. We therefore investigated the effect of botulinum-A toxin in treating overactive detrusor function in patients with neurogenic and nonneurogenic bladder dysfunction. We were particularly interested in patient satisfaction with this therapy. MATERIAL AND METHODS: The subjects were 38 patients who had overactive detrusor function of different origins and in whom therapy with anticholinergic drugs had failed. To measure results, we used urodynamic studies and a questionnaire that consisted of 27 validated questions ("Urogenital Distress Inventory UDI-6", "Symptom Severity Index" and "Symptom Impact Index") as well as a satisfaction questionnaire. We injected 200 - 300 U of botulinum-A toxin (Botox) cystoscopically. RESULTS: At least 4 weeks after injection, 90 % of the patients reported clear improvement of their voiding situation and 93 % stated that they would undergo this procedure again. The frequency of micturition decreased by 29 % in average, and the increased postvoid residual volume was clinically irrelevant. Patients reported side effects or complications in 6.7 % of cases. The satisfaction scale (0 - 10) averaged 6.9. Urodynamically, reflex volume increased by 85 %, maximal bladder capacity increased by 47 %, and bladder pressure decreased by 33 %. CONCLUSIONS: Botulinum-A toxin injection into the overactive detrusor muscle seems to be very effective. The effect is not only reflected in urodynamic studies but also in the subjective patient satisfaction.

Adult↗

PubMed2006

[Melanosis of the urinary bladder--a case report with 10 years of follow-up and review of literature].

INTRODUCTION: Extradermal melanotic lesions are found predominantly in the oral cavity, colon or conjunctiva, and by far less frequently in other organs. We report for the first time a case of solitary melanosis of the urinary bladder with a follow-up of more than 10 years. CASE REPORT: A 48-year old man presented with symptoms of frequency, urge incontinence, obstructive voiding symptoms and nocturia. On urethrocystoscopy under general anaesthesia, melanosis of the bladder with visibly reduced bladder capacity was diagnosed and confirmed on biopsy. The patient was treated for his micturation problems with alpha-blockers, intravesical electrostimulation and GAG-substitution therapy, without success. The chronic progression of bladder symptoms and shrinkage eventually led to cystoprostatectomy and bladder replacement by an orthotopic ileal neobladder, 10 years after primary diagnosis. CONCLUSION: The very low number of reported cases accounts for the lack of management guidelines for this disease. Symptomatic treatment as well as repeated cystoscopic monitoring are logical therapeutic recommendations. Since the development of malignant disease can only be ruled out microscopically, repeated biopsies or prophylactic cystectomy need to be considered.

Biopsy↗

PubMed1996

[Virtual cystoscopy based on spiral CT data].

Simulation of three-dimensional cystoscopy based on helical CT scan data in real-time in patients with tumours of the urinary bladder. In three patients with histologically confirmed carcinoma of the urinary bladder, a helical CT scan with double detector technology was carried out preoperatively. A native scan was first performed, followed by an examination in the early contrast medium enhanced phase. After adequate contrasting of the urinary bladder (30 minutes latency), further images were acquired. These data were transferred to a separate graphic computer workstation and reconstructed. The results were then compared with the cystoscopic and pathohistological findings. All tumours of the urinary bladder identified at fiberoptic cystoscopy were also visualised by virtual cystoscopy. The best reconstruction results were obtained from data acquired after the 30-minute latency period. Virtual cystoscopy represents an interesting option in helical CT scanning, which is able to visualise polypoid tumours of the urinary bladder. Its clinical relevance, however, must be demonstrated in studies with a larger number of patients examined.

Aged↗

PubMed1981

Orientation in endoscopy.

This paper is intended to help the beginner endoscopist learn to interpret the orientation of the object seen through the endoscope. This is applicable only to an endoscope with a reflecting (side view) prism at its distal end, such as a cystoscope. A proposed counterrotation device for turning the image upright is described.

Endoscopes↗

PubMed1996

[The VIVA urethral plug: a sensible expansion of the spectrum for conservative therapy of urinary stress incontinence?].

OBJECTIVE: To evaluate applicability, acceptance, side effects and complications and the possible curative effect on female stress urinary incontinence of the treatment with the urethral plug VIVA (Braun Melsungen, Germany). DESIGN: Part I: Prospective clinical study. Part II: Ongoing prospective-longitudinal study. Additionally two case reports. SUBJECTS: Part II: 156 consecutive patients of the urodynamic out patient clinic. Part II: 21 patients with urinary stress incontinence (SUI). MAIN OUTCOME MEASURES: Part I: Ability to hold the plug while walking and standing, acceptance rate of plug therapy. Part II: Subjective improvement of SUI, pad-weighing test, cough test, urinary tract infections, other complications during four months of plug treatment. RESULTS: Part I: 62% of 156 patients were able to hold the plug. 40% of 53 patients with SUI accepted the plug treatment. Part II: 14 patients completed the study. 4 pat. were subjectively and objectively cured, 3 were improved, 7 unchanged. The cured patients all had a low grade SUI with a urine loss of 3 g in the pad-weighing test before treatment. 12/21 pat, showed 1-2 urinary tract infections and 1 patient dropped out from the study because of recurrent urinary tract infections. In one patient a plug migrated into the bladder and was removed cystoscopically. In two case reports the possibility of symptomatic plug treatment for patients with severe stress incontinence after surgical and radiological treatment of cervical cancer is demonstrated. CONCLUSIONS: Plug treatment is a broadening of the spectrum of conservative treatment of SUI as a symptomatic treatment in pat. with contraindications to anti-incontinence surgery and as a curative treatment in low grade SUI.

Adult↗

PubMedDate not supplied

[Human fibrin glue as a new therapeutic concept in cyclophosphamide-induced cystitis and macrohematuria].

Successful treatment of hemorrhagic cystitis after systemic chemotherapy with cyclophosphamide yields up great problems up to now, because all therapeutic modalities that have been done were accompanied with severe side-effects. A 16 year old girl presented massive chemical cystitis and severe bleedings of the bladder mucosa after systemic long-term low-dose chemotherapy with cyclophosphamide. In this case bladder lesions could be cured completely by endoscopic application of fibrin adhesive through a cystoscope. Side-effects were not noted.

Administration, Oral↗

PubMed1985

[Functional disorders of the lower urinary tract following a radical abdominal operation in cervical cancer].

196 women underwent radical abdominal hysterectomy with pelvic lymphadenectomy for cervical cancer of the clinical stages Ib to IIb, at the University Department of Obstetrics and Gynaecology in Graz during 1977 to 1982. 51 patients without recurring cancer and without subsequent radiotherapy were followed up for functional disturbances of the efferent urinary tract. The time interval between surgery and follow-up being 6 to 60 months. Follow-up examination consisted of palpation and, in addition, specific anamnesis based on a specially designed questionnaire, determination of residual urine, control of urine culture, and urodynamic measurement. Furthermore, urethro-cystoscopy and excretion urography were performed in all patients. 21.6% of the patients were completely free from complaints. In contrast, 78.4% of the women reported more or less pronounced signs and symptoms: first of all, delayed spontaneous micturition (78.4% of the cases), and, secondly, stress incontinence (58.8%) and a reduced desire to urinate (47.1%). Enhanced amounts of residual urine were measured in 35.3% of the women, whereas significant bacteriuria occurred in 31.4% of the women. Urodynamic measurement resulted in normal intravesical pressure values in 23 women (45.1%). On the other hand, hypotonic intravesical pressure was seen in 20 patients (39.2%) and hypertonic pressure in 8 women (15.7%). In all patients micturition was disturbed both in respect of urine flow and micturition time. 41 (80.4%) urethro-cystoscopic findings and 41 intravenous pyelography were in the normal range. The complaints reported by the patients were mostly not of special significance for them, since 34 women (66.6%) were greatly satisfied with their condition. The results are described in detail and are discussed.

Adult↗

PubMed1990

[Errors and dangers of various valve resection technics].

Complications are frequently seen in patients with urethral valves, especially in the youngest age bracket. Some of the complications are due to valve obstruction and others due to the primary therapy. Valve resection can be transvesical, with or without symphysic incision, in direct view, via perineostomy or transurethral. These different methods represent a historical development. The mandatory prerequisite consists of the availability of update cystoscopic equipment for babies and infants. The main problems involved in "open" surgery concern incontinence. Transurethral approach can result in strictures; incontinence due to sphincter lesion can also occur. In recent years antegrade resection is being performed via percutaneous transvesical approach. It may be expected that this reduces the complications, but there is still insufficient experience to permit final assessment.

Cystoscopy↗

PubMed1981

[Results of antireflux-surgery in children according to Leadbetter-Politano].

The indications for operation and results of antireflux-operation according to Leadbetter-Politano method are discussed in a retrospective evaluation of 80 children. Age of child, grade of reflux, cystoscopic findings of ureteral orifices and therapeutic success in treatment of urinary tract infection are the main criteria for the indication to surgical intervention. The operation was successful in 79 out of 80 children. Three of them needed a corrective operation. The number of postoperative complications was in accordance with results in the literature. The incidence of postoperative recurrence of urinary tract infection in 7.5% was relatively low.

Child↗

PubMed1993

Solitary polyp of posterior urethra in children: report on seventeen cases.

Seventeen cases of a solitary polyp of posterior urethra in children (ages ranged between 4 months and 12 years) are presented. All patients were treated endoscopically using a 10 Fr. pediatric cystoscope, equipped with a straight ahead lens, and a Bugbee 3 Fr. electrode to fulgurate the stalk of the polyp through the urethra, without meatotomy. No complications or relapses are recorded, which proves the safety and the efficiency of the transurethral endoscopic resection in all pediatric ages. With the exception of one case, the smallest polyp of the series, lost because entirely burnt during the electrocution, all polyps were recuperated and examined histologically. The dimensions of the polyps ranged from 4 mm to 27 mm length. Their shape varied from a long "cordon-like" peduncle to a short stalk, "balloon-like" appendix. The histologic features were similar, the main component was an axis of connective tissue and vessels, surrounded by transitional epithelium, usually described as a fibroepithelial polyp.

Child↗

PubMed1982

[Grading and staging of urinary bladder carcinomas (author's transl)].

In a retrospective study, staging and grading of 2085 primary and recurrent urinary bladder carcinomas were determined according to WHO and UICC rules. Of the carcinomas 51% were papillary, 23% solid and 26% partly papillary and partly solid. 46.2% of carcinomas were correspondent to malignancy grade I, 37.7% to grade II and 16.1% to grade III. The depth of invasion was the greater the less the degree of differentiation. The uncorrected recurrence rate of carcinoma was 14.9%, 28% of the recurrences showed an increase in malignancy grade and (or) depth of invasion. The recurrence rate fell within the first three years from 76.8% to 8.2%. In addition, there was a high degree of coincidence between carcinoma grade III and severe urothelial dysplasia. The diagnosis of severe dysplasia is an indication for frequent cystoscopic and bioptic checks. Since the biological significance of urinary bladder carcinoma depends not only on the degree of malignancy but also on the depth of invasion and the readiness of carcinoma towards invasion, it is necessary for successful prospective studies, designed to evaluate the course of urinary bladder carcinoma and their therapeutic response, to incorporate exact staging and grading.

Adult↗

PubMed2000

Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi)

BACKGROUND: Chinese-herb nephropathy is a progressive form of renal fibrosis that develops in some patients who take weight-reducing pills containing Chinese herbs. Because of a manufacturing error, one of the herbs in these pills (Stephania tetrandra) was inadvertently replaced by Aristolochia fangchi, which is nephrotoxic and carcinogenic. METHODS: The diagnosis of a neoplastic lesion in the native urinary tract of a renal-transplant recipient who had Chinese-herb nephropathy prompted us to propose regular cystoscopic examinations and the prophylactic removal of the native kidneys and ureters in all our patients with end-stage Chinese-herb nephropathy who were being treated with either transplantation or dialysis. Surgical specimens were examined histologically and analyzed for the presence of DNA adducts formed by aristolochic acid. All prescriptions written for Chinese-herb weight-reducing compounds during the period of exposure (1990 to 1992) in these patients were obtained, and the cumulative doses were calculated. RESULTS: Among 39 patients who agreed to undergo prophylactic surgery, there were 18 cases of urothelial carcinoma (prevalence, 46 percent; 95 percent confidence interval, 29 to 62 percent): 17 cases of carcinoma of the ureter, renal pelvis, or both and 1 papillary bladder tumor. Nineteen of the remaining patients had mild-to-moderate urothelial dysplasia, and two had normal urothelium. All tissue samples analyzed contained aristolochic acid-related DNA adducts. The cumulative dose of aristolochia was a significant risk factor for urothelial carcinoma, with total doses of more than 200 g associated with a higher risk of urothelial carcinoma. CONCLUSIONS: The prevalence of urothelial carcinoma among patients with end-stage Chinese-herb nephropathy (caused by aristolochia species) is a high.

Anti-Obesity Agents↗