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PubMedDate not supplied

[Diagnosis and surgical treatment of tumors of the upper urinary tract].

The author believes that in diagnosis of tumors of the upper urinary tracts more information can be obtained at ureteropyeloscopy with retrograde contrasting of the urinary tracts and, if necessary, biopsy of abnormal urothelium regions. 19 patients with pelvic and 4 patients with ureteral tumor were operated on. 2(8.7%) patients with tumor in the lower third of the ureter underwent resection with Boari operation, classic nephroureterectomy with bladder resection was made in 15(65.2%) patients, transurethral resection of the wall of the bladder, ostium and distal ureter followed by nephroureterectomy was performed in 6(26.1%) patients. The latter operative procedure is radical but less traumatic. Five-year survival made up 73.9%.

Aged↗
PubMed2006

Recent improvements in the detection and treatment of nonmuscle-invasive bladder cancer.

In total, 70-80% of newly diagnosed bladder cancers are confined to the mucosa and staged as Ta, T1 or carcinoma in situ according to the 2002 tumor, lymph nodes and metastasis classification. The standard treatment for these nonmuscle-invasive bladder cancers is transurethral tumor resection with or without adjuvant intravesical chemotherapy or intravesical immunotherapy and subsequent follow-up. Diagnosis and follow-up of nonmuscle-invasive bladder cancer offers two main problems. First, approximately 10-20% of all tumors are not seen in standard cystoscopy. Additionally, frequently repeated follow-up cystoscopies are bothersome for the patient. As an adjunct to standard cystoscopy, fluorescence-guided cystoscopy has demonstrated significantly higher tumor detection rates and optimized patient treatment in recent Phase III studies. Second, routinely performed urine cytology is characterized by high specificity but low sensitivity. Today, several urine tests are available that may increase diagnostic accuracy and potentially prolong intervals of follow-up cystocopy. Owing to rather high recurrence rates after transurethral tumor resection in most tumors and high progression rates in poorly differentiated tumors, adjuvant intravesical chemotherapy or intravesical immunotherapy has gained widespread use in patients with nonmuscle-invasive bladder cancer. Only a few further immunomodulatory drugs, such as recombinant cytokines, have shown significant clinical effectiveness. Additional approaches, such as photodynamic therapy with different photosensitizers and thermotherapy in combination with intravesical chemotherapy, have been evaluated in Phase III studies.

Biomarkers, Tumor↗
PubMed2004

One immediate postoperative instillation of chemotherapy in low risk Ta, T1 bladder cancer patients. Is it always safe?

OBJECTIVE: The optimal treatment for solitary low grade, low stage papillary bladder tumours consists of transurethral resection (TUR) followed by one immediate postoperative instillation with a chemotherapeutic drug. However, when during TUR a bladder perforation or a near-perforation occurs, instillation of a chemotherapeutic drug may lead to leakage outside the bladder, possibly causing severe morbidity. So far, few case reports dealing with complications using mitomycin C have been published, but severe complications of leakage after an early adjuvant instillation with epirubicin have not been reported. METHODS: We describe 3 patients in whom we observed serious complications of one immediate postoperative instillation of epirubicin. RESULTS: Two of the patients recovered after conservative therapy, one patient died due to multi organ failure after explorative laparotomy. CONCLUSION: In order to prevent such complications, an immediate postoperative instillation has to be avoided when there is overt or even suspicion of bladder wall perforation.

Administration, Intravesical↗
PubMed1983

Adriamycin permeability of the rat bladder under different conditions.

Fifty female Sprague-Dawley rats were treated with 1.4 or 2.4 mg. adriamycin intravesically. Radioimmunological measurement of serum concentrations were performed up to 3 hours post-instillation in normal bladder mucosa, cystitis, and after electrocoagulation, under different filling conditions, as well as with the use of a detergent (Tween 80). The serum concentrations achieved were markedly higher after electrocoagulation or cystitis; altogether they reached only 1/6,000 of the instilled concentration. These studies on the rat bladder suggest that perioperative instillation of adriamycin to prevent recurrence is not contraindicated shortly before or after transurethral resection (TUR) of superficial bladder tumors.

Absorption↗
PubMed1982

[Clinical trials with localized mitomycin instillation therapy for superficial urothelial bladder carcinoma].

105 patients with transitional cell carcinoma of the bladder, stage Tis, TA, T1 were treated by a local cytostatica therapy with Mitomycin C (MMC) after transurethral resection (TUR) of the bladder with the following purposes: 1. curative therapy of the carcinoma in situ 2. avoidance of tumor cell implantation from the TUR. After a follow up of 22,3 months this therapeutic concept seems to be of great promise because of its clearly reduced recurrence rate of a total of 12,4%. Side effects are slight. Nevertheless it must be pointed out, that any definitive statement can only be made after a longterm observation, especially by multicentric, controlled, randomized studies. MMC serum resorption studies with 19 patients, partly with reflux and TUR caused perforation of the bladder, showed that MMC instillation therapy (20 mg MMC/40 ml NaCl) immediately after resection did not lead to a systemic toxic concentration.

Adult↗
PubMed1994

[A modified cervico-prostatic incision technic in hypertrophic adenoma in young subjects desiring to preserve ejaculation].

The treatment of bladder neck obstruction by transurethral resection of the prostate is responsible for retrograde ejaculation, which is poorly tolerated by our younger patients. Bladder neck incision, initially proposed as treatment for bladder neck sclerosis and for small prostates, was performed according to a modified technique in 36 patients with a mean age of 57.6 years (range: 41-72 years), with benign prostatic hypertrophy less than 30 grams and wishing to retain antegrade ejaculation. This technique consists of creating a deep groove with the resector hook extending from the ureteric orifice to 5 mm above the verumontanum, incising the full thickness of the detrusor and prostatic urethra as far as the retrocervical fat. This preserves a supramontanal ring of urethral muscle whose contraction during orgasm prevents retrograde ejaculation of semen. Resection of the median lobe was also performed in 8 patients, while sparing the cervical muscular ring. The mean follow-up was 2.4 years (range: 4-84 months). Dysuria was very considerably improved in 32 patients (91.5%), with a Madsen score of less than 2. Antegrade ejaculation was preserved in 32 patients (91.5%). Two patients had to undergo secondary prostatic resection because of persistent dysuria (these 2 patients retained antegrade ejaculation). Unilateral bladder neck incision, sparing a supramontanal muscular ring is an easy, rapid technique with low morbidity, effective in the treatment of prostatism due to a small prostate (less than 30 grams). It is the operation of choice in young patients with small prostates who wish to retain antegrade ejaculation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Photodynamic therapy with intravesical instillation of 5-aminolevulinic acid for patients with recurrent superficial bladder cancer: a single-center study.

OBJECTIVES: Photodynamic therapy (PDT) is an effective treatment option for patients with superficial bladder cancer uncontrolled by transurethral resection and/or intravesical bacille Calmette-Guérin (BCG) immunotherapy alone. We determined the efficacy and side effects of PDT in patients with recurrent superficial bladder cancer. METHODS: Between April 1994 and July 2001, PDT was performed in 31 patients (23 men and 8 women). 5-Aminolevulinic acid (50 mL) in a 3% concentration was instilled intravesically. Patients were instructed to hold the solution as long as possible and were irradiated transurethrally with a mean light dose of 3.9 W using laser light emitting a wavelength of 633 nm for a mean time of 1260 seconds. RESULTS: The mean patient age at the procedure was 70.2 years. At an average follow-up of 23.7 months (range 1 to 73), 16 patients were free of tumor recurrence; 15 patients had developed tumor recurrence after a mean of 8.3 months. Of 10 patients with prior BCG treatment, 4 were free of tumor recurrence. Treatment was well tolerated, with the only side effect being dysuria due to urinary tract infection in 4 patients and hematuria in 7 patients. No phototoxic skin reactions were observed. CONCLUSIONS: PDT represents a safe, effective, and less-invasive treatment for patients with recurrent superficial bladder cancer. Because of the favorable side-effect profile, PDT can also be applied to patients with comorbidity precluding surgical treatment. Furthermore, PDT represents a second-line treatment for patients with tumor recurrence after BCG failure.

Administration, Intravesical↗
PubMed2002

[Nephrogenic adenoma of the bladder in children].

We report an unusual case of a 3-year-old girl with multiple nephrogenic adenomas in the urinary bladder following previous surgical intervention. When she was 6-month-old, right vesicoureter-alreflux (VUR) and left marked hydronephrosis with ectopic urethral opening were found. The left renal pelvis and ureter were incompletely duplicated with a short common segment. Bilateral ureterocystoneostomy and closure of ectopic opening of the left ureter were performed. Left ureteral orifice resulted in double barreled pattern. Postoperative voiding-cystourethrography revealed VUR in the ureter belonging to the lower part of the left kidney. At the age of 3 year, cystoscopic examination revealed multiple papillary lesions in the urinary bladder. These lesions were resected transurethrally and the pathologic diagnosis was nephrogenic adenoma. The patient is the 27th case of nephrogenic adenoma of bladder reported in the Japanese literature.

Adenoma↗
PubMed2001

[Prophylactic effect of pirarubicin (THP) on postoperative recurrence of superficial bladder cancer in terms of intravesical retention time].

In order to determine the modality of prophylactic intravesical instillation of pirarubicin (THP = tetrahydropyranyladriamycin) following transurethral resection (TUR) of superficial bladder cancer, a prospective randomized study was performed. A total of 79 patients were randomized into "2-hour instillation" (A), "5-min instillation" (B) and "control" (C) groups. Prophylactic efficacy and side effects were analyzed in each group. In groups A and B, 20 mg of THP was first dissolved in 10 ml of distilled water, adjusted to 40 ml with saline and was administered intravesically once a week for 10 weeks, starting from 1 week after TUR. The recurrence-free rate was calculated in 65 evaluable patients. The one-year recurrence-free rate was 70.2% in group A, 62.8% in group B and 52.1% in group C. The one-year recurrence-free rate was significantly higher in group A than in group C. Adverse effects were observed in 21.4% of the patients in group A and 40.7% in group B. There was no significant difference in the occurrence rate of side effects between these two groups. Taking the prophylactic efficacy and side effects into consideration, "2-hour instillation" seemed to be better than "5-min instillation".

Administration, Intravesical↗
PubMed1991

[The place of interventional ultrasound in urology].

The search for new methods of diagnosis, treatment and prognosis and their introduction in practice is a stable process in world urologic practice. It was not until after the first echographic apparatuses were produced in the fifties that the introduction of interventional ultrasound in urology became feasible. The authors set themselves the task to study and summarize the possibilities of this method for treatment of diseases of the kidneys, upper urinary tract, bladder and prostate. Renal cysts were diagnosed by ultrasound in 312 patients; in 229 of them percutaneous puncture was performed under ultrasound control. To reduce relapses, different sclerosing substances were applied, peak success being obtained with tetraolean. For establishing the exact cause of obstruction of the upper urinary tract the authors used antegrade pyelography under ultrasound control in 92 patients. Percutaneous nephrostomy for drainage of the upper urinary tract, a new endourologic operation was performed in 67 patients. To raise the radical approach to transurethral resection of the prostate and of bladder tumors, intraoperative transurethral ultrasound control was adopted for all patients operated by this technique.

Adult↗
PubMed1996

In situ transitional cell carcinoma involvement of prostatic urethra: bacillus Calmette-Guérin therapy without previous transurethral resection of the prostate.

OBJECTIVES: Bacillus Calmette-Guérin (BCG) has demonstrated both the efficacy in patients with carcinoma in situ (CIS) of the bladder and the penetration in the prostate (granulomas) after endovesical treatment. We treated patients with CIS of the prostatic urethra with bladder instillations of BCG without previous transurethral resection to assess the local therapeutic effect. METHODS: Eighteen patients with CIS of the prostatic urethra (15 multifocal CIS and 15 associated to superficial bladder carcinoma) were treated with endovesical instillations of 81 mg of BCG Connaught weekly for 6 weeks. RESULTS: After a mean follow-up of 31 months, 14 of 18 patients had complete response, 3 had progression (2 in the prostate and 1 in the bladder); diffuse CIS of the bladder persisted in 1 patient. Three patients required cystectomy and 1 underwent palliative transurethral resection. Fifteen patients are alive with no evidence of disease, 2 patients died due to progression of the disease, and 1 is alive with tumor. CONCLUSIONS: The presence of CIS in the prostatic urethra can be managed with endovesical BCG as initial treatment with fairly good success. There is no need for transurethral resection, even though a loop biopsy may have to be obtained at the first control examination to make sure there is no stromal invasion.

Administration, Intravesical↗
PubMed1987

Prevention of post-prostatectomy vesical neck contracture by prophylactic vesical neck incision.

Most vesical neck contractures occur after resection of adenomas weighing less than 20 gm. This complication is believed to be secondary to excessive resection or fulguration of an undilated bladder neck. Prophylactic bladder neck incision was performed in conjunction with transurethral resection of the prostate on 114 patients with prostatic adenomas weighing less than 20 gm. Vesical neck contracture occurred in 1 patient (0.87 per cent), compared to 12 contractures in 161 patients who underwent transurethral resection of the prostate alone (7.5 per cent). Increasing bladder neck diameter by incision appears to be protective against formation of vesical neck contractures in patients with small obstructing prostatic adenomas.

Contracture↗
PubMed1996

[Bladder tumors].

Of possible tumours of the urogenital tract the carcinoma of the urinary bladder, which is to be seen above all in the elderly, comes as to its incidence after the carcinoma of the prostate. According to postulated theory of carcinogenesis tumours appear very often multifocally with a high relapse tendency in spite of resection. Early diagnosis at primary noninvasive stage is recommended there being a good chance of recovery by adequate means of therapy. The painless haematuria as cardinal symptom of c. bladder tumour remains tumour indicative until the contrary is being proved. To make the diagnosis we dispose of a cystoscopy and the intravenous urogram as part of the basic examination. The treatment of choice in case of a superficial carcinoma of the urinary bladder is the radical transurethral resection. In high-risk patients we initiate an adjuvant local immuno- or chemotherapy to prevent recurrence. In those with muscle invasive carcinoma of the urinary bladder the radical cystectomy together with simultaneous removal of the adnexa is indicated.

Adenocarcinoma↗
PubMed2001

[Bladder carcinoma producing granulocyte colony-stimulating factor (G-CSF): a case report].

An 84-year-old male was admitted to our hospital with complaints of leg edema and general fatigue. He had undergone transurethral resection of transitional cell bladder cancer, grade 3, pT1b, one year previously. The computed tomographic scan revealed a hypoattenuating bladder tumor, protruding extravesically. Laboratory examination showed remarkable leukocytosis of 46,900/mm3 in the peripheral blood and high value of granulocyte colony-stimulating factor (G-CSF) 226 pg/ml (normal: less than 30 pg/ml). The resection of the tumor (partial cystectomy) was performed. The histological diagnosis was transitional cell carcinoma, grade 3. The production of G-CSF was confirmed by immunohistochemical examination in the recurrent tumor and the surgical sample from the transurethral resection. The leukocyte count in the peripheral blood decreased to the normal range after surgery. But leukocytosis recurred one month postoperatively and the computed tomographic scan revealed intrapelvic tumor recurrence. He died due to drastic progression of recurrent tumor at three months postoperatively.

Aged↗
PubMed2005

Organ preservation in muscle-invasive bladder cancer.

While organ preservation with nonextirpative surgery, radiotherapy, and frequently, chemotherapy has become a favored strategy in the treatment of many cancers, bladder preservation for patients with invasive disease remains controversial. The standard treatment for muscle-invasive bladder cancer in the United States is still radical cystectomy with pelvic lymph node dissection. An alternative to cystectomy is multimodality bladder preservation with thorough transurethral resection, chemotherapy, and radiation therapy. This review will address issues raised by a multimodality approach for the treatment of invasive bladder cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[A case of spontaneous pneumothorax due to metastasis of urinary bladder carcinoma to the lung].

We reported a case of spontaneous pneumothorax associated with pulmonary metastasis of urinary bladder carcinoma. A 73-year-old male patient complaining of chest pain and dyspnea was admitted, who had undergone transurethral resection of the urinary bladder carcinoma and diagnosis of inactive pulmonary tuberculosis based on the chest X-ray film finding one year previously. On admission, chest X-ray film showed right pneumothorax, and the re-expanded chest X-ray film revealed a cystic lesion in the right upper lung field adjacent to the anterior chest wall, corresponding to the previous pulmonary lesion. Three months later, right thoracotomy was performed because of relapse accompanying by profuse air-leakage. There was a pleural fistula on the surface of the cystic lesion and necrotic tissue in it. Drainage bronchi were involved by surrounding tumorous tissue. Histological examination of the specimen from the cyst wall disclosed metastasis of transitional cell carcinoma of the bladder. The probable mechanism of the spontaneous pneumothorax probable consisted of stenosis of the right B3 bronchus caused by the metastatic tumor produced a check valve mechanism leading to cystic lesion, the rupture of which caused the spontaneous pneumothorax.

Aged↗
PubMed1997

New strategy of bio-chemoprevention on recurrence of superficial bladder cancer based on a hypothesis of the mechanism of recurrence.

There are theoretical limits to the efficacy of intravesical chemotherapy for prevention of tumor recurrence after transurethral resection of a superficial bladder cancer. Our multi-institutional studies revealed that the direct efficacy of BCG, intravesical instillation for treatment of an existing tumor is very promising. This efficacy persisted over a long period of time, and the subsequent recurrence rate was markedly reduced. Bladder cancer, sometimes earlier known as an occupational disease, might be related to unknown chemical carcinogens. Since enterobacterias are thought to produce carcinogens and mutagens, including nitroso-compounds in the intestinal tract, BLP (lactobacillus casei preparation), treatment may suppress the production of such compounds by altering the intestinal flora. Preclinical studies have demonstrated that BLP suppresses the development of bladder cancer induced by N-butyl-N-(4-hydroxy-butly)-nitrosamine in mice and rats. A double-blind clinical trial recently revealed that BLP was effective for preventing the recurrence of superficial bladder cancer. Bropirimine, a interferon inducer, is now an internationally developing agent for superficial bladder cancer, which is discussed on the basis of Japanese phase II trial data.

Administration, Intravesical↗