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PubMed1994

Triplicity of the malignant tumor of the urinary bladder.

Described report case of the patient after left nephrectomy, performed 18 years ago, for adenocarcinoma. Recently he has a simultaneous carcinoma of the bladder and the left ureter. Carcinoma of the bladder was treated with transurethral resection and electrocoagulation. Once checked, the hemorrhage was found from the left ureter, later, papilocarcinoma was diagnosed and the urethrectomy with the resection of the part of the wall of the bladder in the region of the estuary. Patient was in good condition 5 months after the operation. There is a review of others report cases.

Adenocarcinoma↗
PubMed1999

[Prophylaxis of recurrence in superficial bladder carcinoma by intravesical chemotherapy--comparative study between instillation of combined double anticancer agents and single anticancer agent].

We performed a study to compare the usefulness of double or single anticancer agents in the prophylactic treatment after the transurethral resection (TUR) of superficial bladder cancer. We experienced 127 superficial bladder cancer cases. Of these cases, 42 were treated with intravesical adriamycin (ADR) and peplomycin (PEP), 56 with ADR, PEP, epirubicin (epi-ADR) or pirarubicin (THP) only, and the remaining 29 with TUR only. Nonrecurrence rates were significantly higher in the intravesical treated cases than in the cases with TUR only, and also significantly higher in the cases treated with ADR and PEP than the other treated cases. We concluded that intravesical chemotherapy with combined agents was more effective than with a single agent.

Administration, Intravesical↗
PubMed1986

Bone marrow suppression after intravesical mitomycin C treatment.

Intravesical chemotherapy has been established as a modality for the treatment and prevention of superficial bladder tumors. However, the optimal time for instillation of chemotherapy following transurethral resection is still not clear. We report on a patient with a superficial bladder tumor treated immediately after transurethral resection with relatively high dose mitomycin C. Bone marrow failure developed within 2 weeks. A possible relationship is suggested.

Aged↗
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↗
PubMed2002

Telomerase is upregulated in irreversible preneoplastic lesions during bladder carcinogenesis in rats.

Multiple occurrence or recurrence after transurethral resection is an important characteristic of superficial bladder tumors. To study bladder carcinogenesis, we focused on detection of telomerase activation, which was investigated in several human cancers, including bladder tumors. We experimentally examined the telomerase activity during bladder carcinogenesis, especially in precancerous lesions, induced by N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) in rats. Male Wistar rats were given 0.05% BBN in water from the age of 8 weeks to 24 weeks. Subgroups were euthanized at 4, 8, 10, 12, 18, and 24 weeks after BBN administration. Using the stretch PCR method, telomerase activity was semiquantified in exfoliated bladder epithelial cells. In addition, telomere length in each subgroup was measured by southern hybridization for the terminal restriction fragment using a (TTAGGG)(4) probe. Statistical analyses were performed using analysis of variance and Fisher's PLSD test. Epithelial cells of normal bladder in the control groups and those of diffuse hyperplasia, which was a reversible change at 4 weeks, expressed no telomerase activity. In contrast, telomerase activity significantly increased in the stage after nodular hyperplasia, an irreversible change at 8 weeks, then elevated with carcinogenesis. However, telomere length was still preserved by the 12th week, and was shortened at 18 and 24 weeks. These results suggest that telomerase activation is probably induced independent of telomere shortening during bladder carcinogenesis in the rat, and might be a biological tumor marker of irreversible preneoplastic lesions, which evolve into bladder tumors in the rat.

Animals↗
PubMed1995

Gangrene of the bladder due to over distention.

Massive over distention of the bladder in a man caused necrosis of the mucosa and submucosa, which then separated from the muscularis of the bladder. Suprapubic removal of the necrotic tissue followed by prolonged drainage resulted in regeneration of the mucosa. Normal bladder function returned after transurethral resection of the obstructing prostate. Diagnosis of this rare condition is confirmed when necrotic tissue occludes the eyes of catheters so that fluid can be instilled into but not removed from the bladder.

Aged↗
PubMed2006

The expression of thymidine phosphorylase is a prognostic predictor for the intravesical recurrence of superficial bladder cancer.

BACKGROUND: Thymidine phosphorylase (TP), also known as platelet-derived endothelial cell growth factor, has been implicated in the angiogenesis of bladder cancer. The aim of this study is to investigate the association between TP expression and the clinicopathologic findings, and the prognostic value. METHODS: TP immunohistochemical staining was performed in specimens from 71 patients (50 men and 21 women) with superficial bladder cancer (pTa or pT1). Thirty-nine patients had received intravesical instillation of tetrahydropyranyladriamycin (THP) after transurethral resection (TUR) and the other 32 had not. For immunohistochemistry, paraffin-embedded specimens were stained with mouse monoclonal antibody against TP. When more than 10% of tumor cells were positively stained, staining was defined as positive. The correlations between TP immunostaining and clinicopathological features were analyzed. Multivariate analysis, using the Cox proportional hazard model, was performed to determine the risk factors for intravesical recurrence. RESULTS: Specimens from 29 of the 71 patients (19 men and 10 women) were positive for TP. The expression of TP was not correlated with age, sex, histological grade, multiplicity, or morphology. Also, TP expression was not associated with whether the cases were primary or recurrent. Multivariate analysis demonstrated that the decreased expression of TP and the use of THP instillation could be independent predictors of a higher rate of intravesical recurrence-free bladder cancer. CONCLUSION: The present study suggests that immunohistochemical TP staining is useful for predicting the intravesical recurrence of superficial bladder cancer after Transurethral resection of bladder tumor (TUR-Bt).

Administration, Intravesical↗
PubMed2002

Design and evaluation of a mucoadhesive therapeutic agent delivery system for postoperative chemotherapy in superficial bladder cancer.

The most common treatment method is known as the transurethral resection (TUR) for the therapy of bladder cancer. Unfortunately, because of the recurrency of the tumoral tissues after TUR the chemotherapy or immunotherapy should be performed. In these kind of therapies the pharmacotherapeutics are infused intravesically into the bladder after TUR periodically (i.e. upto 6--36 weeks, each week). But these therapies are having very big problems (i.e. disturbancy to patients, adjustment of the suitable dosage, loss of active agents without using etc.). An alternative approach can be proposed as to design a pharmacotherapeutic agent delivery system, which will supply the suitable dosage of the agent for a certain time period to solve those problems. In this study; the pharmacotherapeutic agent (i.e. Mytomycin-C) delivery system was prepared by using a mucoadhesive polymer (i.e. chitosan) in the form of cylindirical geometry to facilitate the insertion of the carrier for in vivo studies. The chitosan carriers were prepared by cross-linking during the solvent evaporation technique. In the preparation of the chitosan carriers the chitosan polymers with different molecular weights, different amounts of cross-linker (i.e. glutaraldehyde) and different amounts of pharmacotherapeutic agent were used to obtain desired attachment onto the bladder wall and optimum release rate of the agent. On the other hand because of the gelous structure of the chitosan, the swelling behaviour of the polymer was evaluated by gravimetric determinations in aqueous media periodically.

Adhesives↗
PubMed1994

The effects of intravesical chemoimmunotherapy with epirubicin and bacillus Calmette-Guérin for prophylaxis of recurrence of superficial bladder cancer: a preliminary report.

The effects of intravesical chemoimmunotherapy with epirubicin and bacillus Calmette-Guérin (BCG) for prophylaxis of recurrence of superficial bladder cancer (pTa, pT1) were investigated in 29 patients aged a median of 70 years between January of 1991 and May of 1993. The patients received intravesical instillation of 40 mg epirubicin immediately after transurethral resection (TUR) of the bladder cancer. At 1 week after TUR, 80 mg Tokyo-strain BCG was instilled into the bladder once a week for 6 weeks. Thereafter, the patients were followed by cystoscopy and urinary cytology at 3-month intervals until recurrence was detected. Of the 29 patients, 28 had no evidence of disease over a mean follow-up period of 20 months. The 1 case of recurrence occurred at 3 months after TUR and that patient died of cancer progression. The simple recurrence rate was 3.5% after therapy. According to the person-years method, the number of recurrent tumors per 100 patient-months was 0.17. The cumulative nonrecurrence rate determined for all cases was 96.5% at 30 months. Adverse reactions, including urinary frequency, urgency, and miction pain, among others, were observed in 27 patients (93%). Only 1 patient was withdrawn from the treatment because of severe bladder-irritation symptoms due to the BCG instillation. The intravesical chemoimmunotherapy with epirubicin and BCG seemed to be effective for prophylaxis of recurrence of superficial bladder cancer.

Administration, Intravesical↗
PubMed1991

Transurethral treatment of bladder diverticula.

We performed transurethral fulguration of the diverticular mucosa and incision of the diverticular neck in combination with transurethral prostatectomy or bladder neck resection to treat all aspects of diverticula in 9 patients. Eight cases with bladder outlet obstruction, involving 2 cases of large diverticula, have been successfully treated. A case with neurogenic bladder has failed. We found the transurethral procedure to be equally effective as open operation.

Aged↗
PubMed2003

Cyclooxygenase-2 promotes angiogenesis in pTa/T1 urothelial bladder carcinoma but does not predict recurrence.

OBJECTIVE: To investigate the effect of cyclooxygenase-2 (COX-2) on microvessel density (MVD) and on the clinical prognosis in patients with non-muscle invasive urothelial carcinoma of the bladder, as COX-2 expression is significantly greater in epithelial tumours and there is increasing evidence that COX-2 might contribute to tumour neovascularization. PATIENTS AND METHODS: We assessed tumour samples from 110 patients undergoing transurethral resection for primary pTa/pT1 bladder carcinoma (pTa, 84; pT1, 26; grade 1, 22; grade 2, 81; grade 3, seven). Paraffin sections were assessed immunohistochemically using antibodies against COX-2, CD34 (endothelial cells) and CD105 (proliferating vessels). COX-2 expression was quantified by the number of stained cells (negative, +, ++) and the MVD calculated as vessels per field. RESULTS: Of the 110 tumours, 45 (41%) had no immunostaining for COX-2, 40 had faint staining with at least isolated positive cells (+) and 25 stained ++. COX-2 positive tumours had significantly greater vascularization for proliferating vessels. In COX-2 negative tumours the MVD was 22.1, identified by CD34 immunostaining, and 3.4 for proliferating vessels (CD105), whereas COX-2 positive tumours had a MVD of 18.3 (CD34), and of 5.8, respectively (CD105). Complete follow-up data were available in 91 patients; after a mean follow-up of 25 months, 18 (20%) had tumour recurrences. There was no significant difference in the recurrence rates or disease-free survival between COX-2-positive (19%, 25.6 months) or -negative patients (21%, 25.2 months). CONCLUSION: These results confirm the involvement of COX-2 in angiogenesis in bladder cancer, as COX-2 promoted blood vessel proliferation in the tumour zone, and indicate the usefulness of COX-2-inhibiting drugs in preventing and treating superficial bladder cancer.

Adult↗
PubMed1985

Intravesical thiotepa and mitomycin C treatment immediately after transurethral resection and later for superficial (stages Ta and Tis) bladder cancer: a prospective, randomized, stratified study with crossover design.

In a prospective, randomized, stratified study with crossover design the effect of thiotepa was compared to that of mitomycin C when each was instilled intravesically immediately at the end of complete removal of superficial bladder cancer (stages Ta and Tis) and later on tumor recurrence. The 3-month and 1-year rates free of recurrence were 93 and 78 per cent, respectively, for thiotepa (41 patients), and 97.6 and 67.1 per cent, respectively, for mitomycin C (42 patients) (p equals 0.6). On crossover (5 patients to thiotepa and 9 to mitomycin C) at 1 year 60 per cent of the patients receiving thiotepa secondarily and 51.9 per cent of those receiving mitomycin C secondarily were free of recurrence (p equals 0.52). Therefore, both drugs are equally effective in reducing bladder tumor recurrence. Future comparative studies should continue to include thiotepa as a standard by which the efficacies of other agents are judged.

Adult↗
PubMed2000

Transurethral resection and sequential chemo-immunoprophylaxis in primary T1G3 bladder cancer.

OBJECTIVES: T1G3 superficial bladder cancer is considered to be at high risk for progression, and in some institutions early cystectomy is advocated. Other authors and personal experience suggest that conservative treatment, such as TURBT followed by intravesical prophylaxis, may be adequate in the majority of cases. The purpose of the present phase II study was to assess the tolerability and efficacy of sequential intravesical administration of a chemotherapeutic agent, epirubicin, followed by BCG, after TURBT. MATERIALS AND METHODS: 81 patients with primary T1G3 superficial bladder cancer, without evidence of Tis or upper tract tumor, underwent TURBT and intravesical prophylaxis with weekly epirubicin 50 mg for 8 weeks followed by weekly BCG Connaught 120 mg for 6 weeks. A control cystoscopy with bladder mapping and/or TUR of suspicious areas was performed at 15-17 weeks. Then patients were followed-up with 3-month urinary cytology and cystoscopy. RESULTS: The sequential chemo-immunoprophylaxis was generally well tolerated. After a mean follow-up of 48 months recurrent tumors were found in 19 patients (23.4%) and progressive disease in 6 cases (7.4%). Of 6 progressions, 4 patients died (5%) of the disease. CONCLUSION: Sequential chemo-immunoprophylaxis with epirubicin followed by BCG is well tolerated and seems to be efficacious in primary T1G3 bladder cancer. The recurrence progression and disease-specific mortality rates were acceptable so that this study seems to confirm previous data which show that TURBT and intravesical prophylaxis are appropriate treatment for the majority T1G3 tumors.

Administration, Intravesical↗
PubMed1991

[Clinico-anatomical studies of patients with sclerosis of the bladder neck].

Clinico-anatomical studies were carried out in patients with sclerosis of the bladder neck. Specimens for histologic examination were obtained by transurethral resection or transvesical excision of the bladder neck. Histologic changes indicative of chronic nonspecific inflammatory process were found in the majority of cases. The most seldom finding was hypertrophy of the bladder neck muscular tissue.

Cystectomy↗
PubMed1988

[Combination transurethral resection and systematic chemotherapy as primary treatment of infiltrating bladder tumors (pT2-pT4 NxM0)].

From Sept. 83 to Sept. 86, 20 patients (pts), mean age 65 yr, with a muscle-infiltrating bladder tumor would normally have been treated by total cystectomy. Pts were staged by intravenous urography, pelvic and abdominal CT, physical examination under general anesthesia, and deep TUR, then given neoadjuvant chemotherapy: cisplatinum and 5-FU. Courses were given every 28 days. Results were evaluated after the 3rd and 6th courses by CT, IVP and TUR. 9 pts had a histologically confirmed complete clinical response (pCR: 6 pT2, 2 pT3, 1 pT4). Median follow-up in Jan. 1988 was 30 mo. (17-52). This protocol was objectively active and well tolerated, even by elderly pts. Problems remain concerning pCR pts: (1) the respective roles of chemotherapy and TUR on the outcome; (2) prevention of recurrence (5/9 pCR).

Adult↗
PubMed2001

Tumor progression and survival in patients with T1G3 bladder tumors: multicentric retrospective study comparing 94 patients treated during 17 years.

OBJECTIVES: To compare tumor recurrence, progression, and patient survival in T1G3 bladder tumors treated with transurethral resection (TUR) alone, early cystectomy, or TUR with an adjuvant 6-week course of bacille Calmette-Guérin (BCG) and followed up for a minimum of 5 years. METHODS: Between 1979 and 1996, 94 patients with T1G3 bladder tumors (lamina propria invasion) were treated at nine different centers. The time to tumor recurrence, tumor stage and grade progression, number of delayed cystectomies, and patient survival were analyzed retrospectively in relation to the initial treatment. RESULTS: The mean follow-up was 62 months. Thirty patients were treated by TUR alone (32%), 50 patients by TUR plus BCG (53%), and 14 patients by primary cystectomy (15%). The recurrence, progression, and cystectomy rates were significantly different between patients treated by TUR alone and TUR plus BCG (Fisher's exact test, P = 0.0005, P = 0.02, and P = 0.005, respectively). The disease-free survival was also significantly different when comparing TUR plus BCG with TUR alone or primary cystectomy (Kaplan-Meier analysis, log-rank test, P = 0.02). CONCLUSIONS: Endoscopic resection plus BCG treatment of pT1G3 tumors allows an 80% rate of disease-free 5-year survival with bladder preservation. This conservative option has been widely accepted as first-line treatment, offering good cancer control with excellent quality of life. Very accurate surgical and pathologic evaluations before treatment and lifelong follow-up are obviously required.

Aged↗