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PubMed1996

[Hematuria].

Hematuria is an important symptom to be taken seriously and to be investigated quickly and thoroughly. One can distinguish between gross and microscopic hematuria as well as between initial, total and terminal hematuria. The most common cause of hematuria is bladder infection. However, because of the grave consequences bladder cancer has to be excluded. Family doctors have many tools to investigate the urine, i.e. urinary sticks, microscopic urine analysis, urine culture as well as sonography of the urinary bladder. If suspicion of bladder cancer arises further investigations by an urologist using cystoscopy, intravenous or retrograde pyelogram and sonography must be considered. Treatment of bladder cancer consists in transurethral resection of the tumor, local or systemic chemotherapy or radical cystectomy.

Algorithms↗

PubMed2004

Chemoradiotherapy as a bladder-preservation approach for muscle-invasive bladder cancer: current status and perspectives.

Radical cystectomy has been considered the gold standard for the treatment of muscle-invasive bladder cancer. However, because of disappointing results with radical surgery in terms of survival and decreased quality of life (QOL), bladder-preservation treatment has been introduced as an alternative to radical cystectomy. The primary purpose of the bladder-preservation approach has been to maximize overall cure rates, with the secondary purpose being to preserve the patient's bladder. The modalities used to ensure successful bladder preservation include radical transurethral resection (TUR), concurrent cisplatin (CDDP)-based chemotherapy, and radiotherapy. In patients who achieve a complete response (CR) after trimodality therapy, 5-year survival rates of more than 50%, the same as those of radical cystectomy, can be achieved and 70% of this group will retain an intact functional bladder. In this article, bladder-preservation studies using chemoradiotherapy are reviewed.

Antineoplastic Agents↗

PubMed2005

[Cell cycle and apoptosis mechanisms implicated in intravesical chemotherapy resistances in superficial bladder cancer].

It is well documented the effectiveness of intravesical chemotherapy following transurethral resection to prevent recurrences of superficial bladder cancer. But it is also known that efficacy may be limited by tumour cell resistance to one or several of the drugs available for instillation. In addition to the genetically determined unicellular mechanisms classically described in the literature such as glycoprotein P-170 expression (mdr-1), overexpression of Bcl-2 or glutation S-transferase activity, it has been recently shown that multicellular mechanisms may also be involved in drug resistance. Multicellular resistance can only be demonstrated in three-dimensional cultures and fails to be shown in monolayers or cell suspensions. This is explained by the fact that cell-to-cell and cell-to-stroma adhesion limits drug penetration and by the variable susceptibility to cytotoxicity determined by oxygen and tissue proliferation gradients. A better understanding of the molecular mechanisms involved in drug resistance is necessary to increase intravesical chemotherapy effectiveness. Current research includes improving drug penetration, searching resistance reversing agents and developing in vitro chemosensitivity tests to identify drug resistance.

Apoptosis↗

PubMed2003

[Inflammatory pseudotumor of the urinary bladder diagnosed using 3D-CT cystoscopy].

Inflammatory pseudotumor of the urinary bladder is a rare benign entity of the submucosal stroma that can easily be mistaken for a malignant neoplasm both clinically and histologically. We report a case of an inflammatory pseudotumor of the urinary bladder in which 3D-CT cystoscopy aided in the diagnosis. A 38-year-old man presented with persistent miction pain, penile pain, and dysuria despite symptomatic treatment at another hospital. Cystoscopic examination, MRI and 3D-CT cystoscopy revealed a 3.0 X 3.0 cm wide-based nonpapillary tumor located at the anterior dome of the urinary bladder. Transabdominal biopsy and transurethral resection were performed and the tumor was suspected to be transitional cell carcinoma. A partial cystectomy and urachus excision were then performed for suspected urachal tumor based upon the radiological examinations. Careful examination of the specimen revealed an inflammatory pseudotumor. We discuss 20 cases of inflammatory pseudotumor of the urinary bladder including ours.

Adult↗

PubMed2006

Association of PAX5 expression with clinical outcome in patients with TaT1 transitional cell carcinoma of the bladder.

OBJECTIVES: To assess the frequency and intensity of PAX5 gene messenger ribonucleic acid (mRNA) expression in TaT1 bladder cancer tissue, as well as its correlation with clinicopathologic variables and patient outcome. METHODS: The RNA expression of PAX5 was evaluated with reverse transcriptase polymerase chain reaction in the tumor tissue of 75 patients with stage TaT1 bladder cancer treated with transurethral resection. Patients were observed with cystoscopy and urinary cytologic evaluation. The association between PAX5 expression and clinicopathologic variables and patient outcome was evaluated. Benign urothelium from 8 patients with benign prostatic hyperplasia was obtained. These patients were used as a control group. RESULTS: PAX5 expression was found in 62 patients with bladder cancer (82.7%) but in no patient from the control group. High PAX5 expression (greater than 0.2) was confirmed in 19 patients (25.3%). No significant relationship was observed between quantity of PAX5 expression and clinicopathologic variables. The 3-year recurrence-free and progression-free survival rates in highly positive patients were 13.2% and 71.6%, compared with 40.6% and 92.8%, respectively, in patients with weak or negative expression (log-rank test, P = 0.0075, P = 0.022). Multivariate Cox proportional hazard model analysis identified PAX5 expression as an independent predictor of tumor recurrence. CONCLUSIONS: PAX5 gene expression is a frequent finding in superficial transitional cell carcinoma of the bladder. High levels of PAX5 are associated with poorer recurrence-free and progression-free survival rates. Moreover, PAX5 expression was found to be an independent prognostic factor for recurrence-free survival by a multivariate analysis.

Adult↗

PubMed1983

[A long-term survival after partial nephrectomy in a case of pelvic tumor arising in a solitary kidney].

A 44-year-old man was admitted on January 21, 1975 because of asymptomatic hematuria. The patient had nephrectomy of his left kidney due to nephritis at the age of three. Cystoscopy revealed no abnormalities, and excretory urography showed an irregular filling defect and slight ectasia in right upper calyx. A clinical diagnosis of pelvic tumor of the right kidney was made and partial nephrectomy was performed on April 18, 1975. The resected kidney was 4.5 X 5.0 X 6.5 cm in greatest dimension and the tumor was well localized in the upper calyx. Pathological diagnosis was transitional cell carcinoma, papillary, grade 11, stage 1. About 2 years after the operation, the patient developed a rice-sized tumor in the bladder neck followed by transurethral resection. Otherwise he is in good condition to date, 7 years and 4 months after the partial nephrectomy.

Adult↗

PubMed1990

Quantitative immunocytology in the management of patients with superficial bladder carcinoma. I. A marker to identify patients who do not require prophylaxis.

We used monoclonal antibody 486P 3/12 to monitor 55 patients after transurethral resection of stages Ta and T1 transitional cell bladder carcinoma. The method has a high sensitivity (89%) in detecting grades 1 to 3 lesions. We examined voided urinary specimens taken every 4 weeks after transurethral resection for a mean of approximately 2 years. Of the 55 patients 22 remained negative for marker without prophylaxis and only 2 of them had another tumor. Only 6 of 33 patients who were positive for marker after transurethral resection were negative for marker at least once immediately after transurethral resection. Of the 33 patients 14 had a recurrent tumor. In all 14 patients a marker-positive urine specimen preceded visible tumor recurrence by several months. Monoclonal antibody 486P 3/12 is a safe marker to identify patients with superficial bladder carcinoma after transurethral resection who do not require prophylaxis. The 22 patients who remained negative for marker after transurethral resection had an almost equal distribution of stages Ta to T1 lesions (9 versus 13) and equal distribution of grades 1 and 2 lesions (11 versus 11).

Antibodies, Monoclonal↗

PubMed2002

Ultraviolet-excited (308 nm) autofluorescence for bladder cancer detection.

OBJECTIVES: To assess the ability of ultraviolet laser-induced autofluorescence for the diagnosis of transitional cell carcinoma of the bladder. METHODS: We studied 43 patients undergoing transurethral resection with recurrent transitional cell carcinoma of the bladder. Guided through 5-aminolevulinic acid-induced fluorescence endoscopy, the autofluorescence of the red fluorescing areas and the adjacent tissue and inconspicuous-appearing mucosa were measured spectroscopically. The autofluorescence excitation was carried out with a xenon chloride excimer laser operating at 308 nm (AF308). For the evaluation of the autofluorescence spectra, an intensity ratio (335/430 nm) was calculated and correlated with the histologic results of the biopsies taken. RESULTS: We analyzed the AF308 spectra of 114 biopsies (21 malignant, 93 benign). The autofluorescence intensity ratios for the benign lesions were a factor of 2 to 7 higher than carcinoma in situ and neoplastic tissue. Therefore, 20 of 21 neoplastic lesions were detected as true positive by AF308. A sensitivity and specificity for AF308 of 95% and 77%, respectively, could be calculated. The sensitivity and specificity for 5-aminolevulinic acid-induced fluorescence endoscopy was 90% and 61%, respectively. By combining the two methods, we calculated a sensitivity of 90% and a specificity of 84%. CONCLUSIONS: The combination of a sensitive imaging technique such as 5-aminolevulinic acid-induced fluorescence endoscopy and a more specific spectral fluorescence probe technique with autofluorescence at 308 nm is a very efficient procedure in the detection of transitional cell carcinoma of the bladder.

Aged↗

PubMed1999

[Pheochromocytoma of the urinary bladder: a case report].

A 49-year-old man was hospitalized with the chief complaint of coagulation in urine. The patient was not hypertensive. Cystoscopic examination showed a submucosal tumor in the left lateral wall of the bladder. A transurethral sonogram revealed a low echoic nodule. Transurethral resection of the tumor in the urinary bladder was performed. The histopathological diagnosis indicated pheochromocytoma. Blood pressure was stable. After operation, the patient's course was uneventful, and there has been no recurrence for one year after surgery. This patient is the 52nd patient with pheochromocytoma of the urinary bladder reported in the Japanese literature.

Follow-Up Studies↗

PubMed2002

[Urinary endometrioma].

OBJECTIVES: To analyze the series of cases of endometriosis with urologic involvement reported in our country. METHODS/RESULTS: We found a total of 26 cases of endometriosis including our case, 15 affected bladder and 11 ureter. Independently of ureteral or bladder location, the treatment performed varied, from transurethral resection and laser to cystectomy in cases involving bladder, from segmental ureterectomy with ureteral reimplantation to nephrectomy in ureteral cases. CONCLUSIONS: Surgery is the definitive solution for urinary tract endometriomas. The definitive treatment of endometriosis must be done by gynecologists, by means of hormonal and surgical treatment depending on age, severity and location of the lesions, patient's wishes for future pregnancies, and tolerance to hormone therapy.

Adult↗

PubMed1992

Plasma concentrations of lignocaine after obturator nerve block combined with spinal anaesthesia in patients undergoing transurethral resection procedures.

Bilateral obturator nerve block has become a widely accepted technique to avoid adductor contraction during transurethral resection of prostate or bladder tumours. However, little is known about plasma lignocaine concentrations after the block. We conducted this study to assess a safe dose of lignocaine for injection in obturator nerve block. Bilateral obturator nerve block was performed with the aid of a peripheral nerve stimulator in 12 patients after spinal anaesthesia. In group I (n = 6), patients received 2% lignocaine 10 ml (200 mg) for the block; those in group II (n = 6) received 2% lignocaine 15 ml (300 mg). The block was satisfactory and no single adductor contraction was observed in either group during surgery. The peak plasma concentrations of lignocaine were 2.28 (SD 0.29) micrograms ml-1 and 3.75 (0.79) micrograms ml-1 in groups I and II, respectively. The greatest plasma concentration was 5.07 micrograms ml-1 in a patient of group II. There were no symptoms suggesting systemic toxicity. We conclude that bilateral obturator nerve block may be performed safely and effectively with 2% lignocaine 10 ml with the aid of a peripheral nerve stimulator in patients undergoing transurethral resection procedures with spinal anaesthesia.

Aged↗

PubMed2005

Concomitant chemoradiotherapy for muscle-invasive bladder cancer: the way forward for bladder preservation?

Muscle-invasive bladder cancer is a common malignancy with a high mortality rate. Despite ongoing debates about the optimal primary intervention, radical cystectomy remains the cornerstone of first-line therapy in many institutions. Over the past decade, bladder-preserving strategies involving transurethral resection (TUR), chemotherapy and radiotherapy have evolved. However, the advantage of these approaches over radiation treatment as monotherapy has yet to be fully evaluated. In other tumour models, most notably cervical and anal cancer, radiation and chemotherapy delivered concomitantly have resulted in significant survival advantages. Here, we consider the potential value of this approach in the treatment of invasive bladder cancer. Concomitant chemoradiotherapy is currently the mainstay of several bladder-preserving programmes reported in the medical literature. Overall, local control and survival rates compare favourably with contemporary cystectomy series; however, difficulties in drawing valid conclusions are highlighted. Concomitant chemoradiotherapy may have a role in the management of certain patient subgroups, and the debate should remain open. Further large-scale randomised trials are needed, and information regarding bladder function and quality of life after treatment is lacking at present. The importance of close follow-up and prompt salvage cystectomy is emphasised.

Antineoplastic Agents↗

PubMed1975

Haematuria following radiotherapy for bladder tumours. An approach to therapy.

Unrestrainable haematurias after supervoltage therapy of bladder tumours are a serious complication for the treatment. Excellent results were obtained by radical transurethral resection of the pathologically modified bladder mucosa. There is no bleeding and new mucosa with a particular appearance replaces the resected tissue. The histological findings and the results of the treatment confirm that the only cause of these haematurias is the presence of large newly formed vascular "lakes".

Hematuria↗

PubMed1989

Nd: YAG laser treatment of vesical leiomyosarcoma.

The first in the literature of bladder leiomyosarcoma, treated by transurethral resection followed by laser irradiation, in a 75-year-old woman is reported. At 22 months follow-up the patient is well and has no evidence of metastasis.

Aged↗

PubMed1982

[Transurethral and transrectal examination of the bladder and prostate by ultrasound (author's transl)].

This article describes a non-invasive technique of intravesical examination used for the purpose of staging a bladder tumour and to assess the state of the prostatic bed during and after electrical transurethral resection. The apparatus visualises the bladder tumour and its infiltration using a type B image produced by rotation of an ultrasonic head. In addition it is easy to estimate the dimensions, size and weight of a benign tumour of the prostate using a transrectal ultrasonic probe.

Humans↗

PubMed1995

Hutch paraureteral diverticulum complicating radical hysterectomy.

BACKGROUND: Paraureteral diverticula are abnormalities of the urinary bladder which are more common in males, and thus are infrequently encountered in the patient population of the gynecologic oncologist. CASE REPORT: A 59 year old white female, with a history of recurrent bladder cancer treated by transurethral resection, presented with an abnormal cervical cone biopsy revealing invasive squamous cell carcinoma of the uterine cervix". The patient had a known Hutch paraureteral diverticulum for which she was receiving prophylactic cyprofloxacin. Computed tomography revealed an 8.5 x 8 x 7 cm paraureteral diverticulum on the right. There was no hydronephrosis of either renal pelvis. Laparotomy revealed a mass, resembling a second urinary bladder, which was very closely associated with the bladder and lateral proximal vagina on the right. Since a urological consultant advised that the diverticulum should not be resected, dissection around the bladder and vagina for the radical hysterectomy was made much more difficult. CONCLUSION: The presence of a paraureteral diverticulum increases the difficulty of performing a radical hysterectomy.

Carcinoma, Squamous Cell↗

PubMed2006

[Clinical study of bladder tamponade resulting from clots of blood].

PURPOSE: There were many case reports about bladder tamponade resulting from clots of blood. However, there were few reports about the clinical study that result from collecting cases of bladder tamponade. Thus, we performed a retrospective study about bladder tamponade resulting from clots of blood that we had managed. MATERIAL AND METHODS: We investigated 20 patients who had bladder tamponade and were consulted at our facility between October 2002 and September 2005. We researched causes of the bleeding, characteristics of the patients, the laboratory data of coagulation system and treatments of our experience in managing patients. There were 17 males and 3 females. The average age of the patients was 74.0 years old. RESULTS: 8 cases took anticoagulant drugs, 6 cases had medical history of cerebral infarction or cardiac infarction, 4 cases took anticholinergic drugs and 9 cases had benign prostate hypertrophy or urethral stricture. Bleeding was due to bladder tumor in 9, prostate cancer in 1, radiation cystitis in 3, chronic cystitis in 1, malignant lymphoma in 1, idiopathic causes in 3 and unknown causes in 2 cases. Except 1 case, in all cases, evacuation of the clots was the first procedure followed by saline irrigation. This initial line of treatment was able to control the hemorrhage in 40% of the patients. For the remaining cases, transurethral coagulation and resection of bladder tumor were used as the second line treatment, and furthermore, radical cystectomy was performed in 1 case. Surgical treatments were required in 12 cases. Blood transfusion was required in 4 cases. CONCLUSION: According to progress aging society, the amounts of taken anticoagulant drugs and the patients who had lower urinary tract dysfunction may increase. It may be suggested that the cases of bladder tamponade resulting from clots of blood without bladder tumor or radiation cystitis tend to increase.

Aged↗

PubMed1979

Fibrous contracture of bladder neck: cause, prevention, and treatment.

Through a retrospective study of bladder neck contracture it was found that bladder neck resection and incision were equally effective for treatment of postoperative bladder neck contractures. It was also found that incising the bladder neck at the end of transurethral resection of the prostate (TURP) did not cause vesicoureteral reflux and did not improve the incidence of postoperative bladder neck contracture.

Contracture↗