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Results for “Transurethral Resection of Bladder”

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PubMed1989

[A case of cystitis glandularis. Its relationship to bladder carcinoma].

A 41-year-old male was admitted to the hospital for frequent urination and severe retardation before voiding. Roentgenography revealed exophytic lesions which were located mainly in the trigone of the bladder, and he underwent transurethral resection. The pathological diagnosis was cystitis glandularis. There was no literature which reported cystitis glandularis causing urinary disturbance. This case, moreover, had been diagnosed as cystitis glandularis 13 years before by endoscopical biopsy. The origin of cystitis glandularis and its potentiality as a pre-malignant lesion were discussed from the clinical course for over 10 years.

Adult↗

PubMedDate not supplied

[Bladder villous adenoma: report of a new case].

OBJECTIVES: Villous adenoma is a benign neoplasia, the appearance of which in the urinary tract is extraordinarily unfrequent. We report a new case recently experienced in our department. METHODS: We report the case with its past urologic history, clinical picture, diagnostic tests, and treatment. RESULTS: Pathologic report confirmed the diagnosis of bladder villous adenoma, being transurethral resection the only treatment applied to leave the patient disease-free. CONCLUSIONS: Prognosis of this kind of neoplasia, which is unfrequent, is excellent; being endoscopic resection curative, with no local or distant progression, except in cases associated with adenocarcinoma foci, in which local recurrence or distant metastasis are possible, and a more aggressive treatment might be indicated.

Adenoma, Villous↗

PubMed1988

[Which intravesical chemotherapy for what tumor of the bladder?].

The rationale for adjuvant chemoprophylaxis in superficial bladder cancer treated by transurethral resection is discussed. Many questions remain unsolved as far as chemoprophylaxis in concerned. The authors try to answer them through an analysis of the results of prospective and randomized studies undertaken by the EORTC genito-urinary group for 12 years. Advantages and disadvantages of the most common agents (Adriamycin, Epodyl, Mitomycin, Thiotepa, BCG) are analyzed; an attempt is done to define instillations regimens; indications and results of these adjuvant treatments are studied.

Administration, Intravesical↗

PubMed1993

Intravesical mitoxantrone in superficial bladder tumours (Ta-T1).

36 patients with histologically proven grade G1-G2, Ta-T1 transitional cell carcinoma of the bladder were introduced, after transurethral resection (TUR), into a study of intravesical chemoprophylaxis with mitoxantrone (20 mg diluted in 50 ml). After a mean follow-up of 23 months, 16 (50%) patients showed a superficial recurrence with a mean recurrence rate of 0.56 per year. In 19 patients with recurring tumours the mean recurrence rate decreased from 1.65 to 0.58 per year. 9 patients (25.7%) suffered from a chemical cystitis that in 2 cases (5.7%) required treatment interruption.

Administration, Intravesical↗

PubMed1993

[Natural history and prognostic factors of superficial tumors of the bladder].

Forty-five patients with superficial bladder cancer managed by transurethral resection alone were studied longitudinally to identify factors associated with progression. Tumor grade, multiple tumor foci, and time to first recurrence were closely correlated with progression. Findings from this study are compared with previous reports. These data are useful to identify patients requiring more aggressive therapy, including intravesical anticancer drugs and BCG, and monitoring with closer-spaced cystoscopies.

Female↗

PubMed1990

[Treatment of priapism with intracavernous injection of etilefrine hydrochloride].

A case of priapism following epidural anesthesia was reported. A 67 year old man received epidural anesthesia for the transurethral resection of a malignant bladder tumor. Epidural anesthesia which he had wanted to receive was given through the L3 to L4 intervertebral space with 18 ml of 2% lidocaine. The penile erection occurred while he was prepared and draped. Additional 8 ml of 1% lidocaine failed to overcome it and the operation cancelled. After this episode, he had anesthesia on 5 occasions in 2 years. General anesthesia was given 3 times without penile erection, but epidural block was tried on 2 occasions, which was followed by penile erection. For the penile erection, intracavernous injection of etilefrine hydrochloride was effective and surgical procedure could be done smoothly. The mechanism of priapism remained unclear but imbalance of the autonomic nervous system may be a involved. This case suggests that intracavernous injection of etilefrine hydrochloride is effective for treatment of penile erection during transurethral surgery.

Aged↗

PubMed1990

Neodymium-YAG laser irradiation of stage T2 muscle-invasive bladder cancer. Long-term results.

The study group consisted of 15 patients with solitary stage T2 bladder tumours treated with transurethral resection (TUR) and subsequent neodymium-YAG laser irradiation. Ten patients are alive without evidence of cancer 56 to 78 months (mean 67) after treatment; 1 died of cardiovascular disease 2 years after treatment and autopsy revealed no cancer. In 4 patients the treatment failed and cystectomy or external beam radiation was carried out. The long-term results indicate the combination of TUR and laser irradiation to be beneficial in the management of T2 tumours in selected cases.

Aged↗

PubMed1985

Improved continuous flow transurethral prostatectomy.

We compared 2 continuous flow resectoscopes for transurethral resection of the prostate--a new intrinsic bladder pressure-controlled drainage system and the suction drainage system. In 31 patients undergoing transurethral prostatic resection who were assigned randomly to a pressure-controlled (17) or suction drainage (14) resectoscope group the required irrigant volume and operative blood loss (milliliter per gram resected tissue) were appreciably less with pressure-controlled drainage, while the resection rate (gram per minute) was significantly greater. Irrigant absorption, as evidenced by weight gain and changes in hematocrit, serum osmolality and serum sodium, was minimal in either group, with no significant difference between the 2 methods. In addition, there was no significant difference in intraoperative intravesical pressure between the 2 groups. The suction drainage system led to pump drainage failure in certain rotational positions, resulting in diminished visibility and increased resection time. The pressure-controlled drainage system required no suction devices or adjustments, thus, allowing constant improved visibility and uninterrupted resection. These results suggest that the efficiency and ease of transurethral prostatic resection are superior with the pressure-controlled continuous flow drainage system than with the suction drainage system.

Drainage↗

PubMed2006

[Bladder endometriosis. Case report and review of the literature].

OBJECTIVE: To report a new case of bladder endometriosis and to perform a bibliographic review. METHODS: We report the case of a 34-year-old female with the diagnosis of bladder endometriosis treated by transurethral resection and subsequent hormonal therapy with good outcome one year after diagnosis. RESULTS: Treatment with analogs was started after TUR, in conjunction with the Gynecology Department, and maintained six months. The patient remained asymptomatic one year after diagnosis, with a negative cystoscopic study. CONCLUSIONS: We emphasize the need of early diagnosis due to the increased morbidity and health-care expenses; also the need of surgical treatment of all urological lesions before any hormonal therapy, mainly ureteral lesions. We finally emphasize that definitive treatment should be performed by the gynecologist.

Adult↗

PubMed1997

High-energy transurethral microwave thermotherapy in men with lower urinary tract symptoms.

Since 1993, we have treated patients having lower urinary tract symptoms and benign prostatic obstruction using the high-energy transurethral microwave thermotherapy (HE-TUMT) protocol (Prostasoft; software version 2.5). This study was conducted to investigate the outcome and durability of this treatment. A series of 301 patients with a mean prostate size of 56.4 cc were treated by HE-TUMT if they had a Madsen Symptom Score > or = 8, a maximum flow rate < 15 mL/sec, a voided volume > or = 100 mL, and a postvoiding residual volume < 350 mL. The prostate volume measured by transrectal ultrasonography was > or = 25 cc. Follow-up visits were scheduled at 12, 52, 78, and 104 weeks. Patients were stratified according to the response evaluation criteria set at the 3rd International Consultation on Benign Prostatic Hyperplasia. These response criteria were measured at 12 weeks. At 2 years, there appeared to be a better response in the bigger prostates. Irrespective of relief of outflow obstruction, a good symptomatic response was seen in both good and poor responders. Twenty-two patients were re-treated during the 2-year follow-up period: three underwent bladder neck incision, nine transurethral resection, two laser prostatectomy, one open prostatectomy, and seven additional medical therapy. At 2-year follow-up, HE-TUMT resulted in a durable good outcome in 93% of patients with an objective improvement rate of 42% and a subjective improvement rate of 65%. The best predictor of durability appeared to be the extent of relief of obstruction. Of the 96 bad responders in this group, 14 underwent retreatment, compared with 6 of the 100 good responders.

Aged↗

PubMed2002

Intravesical Bacillus Calmette-Guerin treatment improves patient survival in T1G3 bladder tumours.

OBJECTIVE: To study the clinical and pathological factors that affect recurrence, progression and survival in pT1G3 bladder tumours treated conservatively. MATERIAL AND METHODS: From January 1979 to December 1996, 80 patients were conservatively treated for pT1G3 bladder tumours. All patients were studied for potential prognostic factors such as: age, sex, previous tumour recurrence, tumour size, multiple tumours, carcinoma in situ, and intravesical instillations. A longitudinal, retrospective, observational and analytical study was conducted to evaluate four different types of events: recurrence, progression, overall survival, and disease-specific survival. The chi(2) (Fischer exact test) and student t tests were used to assess the prognostic value of the qualitative and quantitative variables. Estimations of the survival distributions were calculated according to the Kaplan-Meier method and compared with the Log rank test. Multivariate analysis of the data was performed with Cox proportional hazard models. RESULTS: Among the 80 patients, 67 (84%) were men and 13 (16%) were women, with median age of 65.5 years. The median tumour size was 20 mm, most had single tumour (58.8%) and carcinoma in situ was found in six patients (7.5%). Thirty patients were treated with transurethral resection (TUR) of the bladder tumour and 50 patients were treated with TUR followed by BCG. The two groups of patients were comparable and followed up during a median time of 61 and 65 months, respectively (p=0.454). Kaplan-Meier estimators and Log rank tests demonstrated that patients with TUR alone recurred (p<0.0001), progressed (p<0.040) and died (overall survival: p<0.009; disease-specific p<0.040) earlier than patients who received intravesical instillations of BCG. The results were confirmed with Cox models and odds-ratios are presented. CONCLUSION: In this study, BCG adjuvant immunotherapy was the only factor affecting recurrence, progression and survival. Conservative treatment using TUR followed by BCG may improve disease-specific survival.

Adjuvants, Immunologic↗

PubMed1982

Soft agar culture of human transitional cell carcinoma colonies from urine.

Soft-agar culture of transitional cell carcinoma colonies from urine, bladder irrigation fluid, and transurethral resection solid tumor specimens demonstrate generally better growth of tumor cell colonies from urine than from irrigation fluid. Growth of tumor colonies from urine was adequate to evaluate presence of tumor and to study growth parameters of the tumor colonies in vitro, although the number of colonies produced from urine was inadequate to evaluate sensitivity or resistance to chemotherapeutic agents. Growth in soft agar of transitional cell carcinoma colonies from urine may offer a simple, noninvasive method of evaluating the effectiveness of therapy and the prognosis for tumor progression.

Adult↗

PubMed2000

Intravesical mitoxantrone in superficial bladder cancer.

Twenty-five patients with Ta-T1 transitional cell carcinoma of the bladder were treated by transurethral resection (TUR) followed by intravesical chemoprophylaxis with mitoxantrone (10 mg diluted in 50 ml normal saline) administered weekly for 6 weeks. After a mean follow-up of 12 months, 76% of patients in the whole group, 69% in the newly diagnosed patients and 89% in the group of previously relapsed patients remained relapse free. These rates compare favorably with the other prophylactic agents available. Therapy was well tolerated in most patients, with only two patients reporting grade 3 local toxicity. We conclude that mitoxantrone is an effective and safe agent for intravesical chemotherapy.

Administration, Intravesical↗

PubMed1994

Prophylaxis of superficial bladder cancer with mitomycin or interferon alfa-2b: results of a multicentric Italian study.

PURPOSE: Interferons have shown a definite activity in the intravesical treatment of residual papillary bladder cancer or carcinoma in situ (CIS). The purpose of the present study was to investigate the efficacy of interferon alfa-2b (IFN) as prophylactic treatment of superficial bladder cancer. PATIENTS AND METHODS: Two hundred eighty-seven patients with primary pTa G2, pT1 G1 to G2 superficial bladder cancer, following complete transurethral resection (TUR), were randomly allocated to receive intravesical treatment, either with IFN (50 x 10(6) IU) or mitomycin (MIT-C; 40 mg). Drugs were instilled on a weekly basis for a total of 8 weeks. RESULTS: MIT-C was superior to IFN treatment with respect to time to recurrence, relative recurrence rate, recurrence rate per 100 patients per month, and recurrence tumor rate per 100 patients per month. This difference was particularly evident in patients with pTa G2 tumors. After multivariate analysis, the number of primary tumors and tumor grade were the best predictors of recurrence, while allocated treatment had only a moderate effect. Intravesical treatment was well tolerated in both arms. However, more local toxicity was experienced by patients treated with MIT-C. On the other hand, fever occurred significantly more frequently in patients treated with IFN. CONCLUSION: IFN was less effective, although locally better tolerated, than MIT-C as prophylactic treatment of primary superficial bladder cancer.

Administration, Intravesical↗

PubMed2006

[Use of novel radiation fractionation regimens in organ-sparing therapy of bladder cancer].

The findings of evaluation of complex organ-sparing therapy of 153 patients with invasive bladder cancer are discussed. Transurethral resection of the exophytic end of tumor was followed by two courses of polychemotherapy plus combined treatment. Radiotherapy was carried out by conventional fractionation (group I), hyperfractionation (group II) and accelerated hyperfractionation (group III) (total focal dose--up to 60-66 Gy). Overall and corrected 5-year survival rates were: 47.3 +/- 7.5% and 51.7 +/- 7.5% (group I), 65.6 +/- 1% and 70.4 +/- 8.4% (group II), 53.9% +/- 6.8% and 61.9% +/- 6.8% (group III), respectively. Our tentative results suggest that further efforts be made to improve the efficiency of radiotherapy by introduction of novel techniques.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1997

Natural killer (NK) cell assay within bladder mucosa of patients bearing transitional cell carcinoma (TCC) after interferon (IFN) therapy: an immunohistochemical and ultrastructural study.

The authors studied the number and the ultrastructural evidence of NK cell activation in the non-involved urothelium in patients with transitional cell carcinoma (TCC) of the urinary bladder, before and after transurethral resection (TUR) and interferon (IFN) therapy. Eight male patients, free of recurrence 1 year after TUR and IFN-a2b therapy, were studied. Each patient received 22 instillations of 50MU of IFN-a2b over a period of 1 year. Two specimens from the non-involved urothelium, one adjacent to and another away from the tumour, were obtained before and after therapy, for immunohistochemical and ultrastructural studies. The number of NK cells was evaluated immunohistochemically in paraffin sections with the CD57 monoclonal antibody, and their activation was detected by routine electron microscopy processing. Before treatment, few NK cells were randomly found in the lamina propria. At the end of therapy, however, their number increased and NK cells were found to infiltrate the urothelium, a finding that was not observed before treatment. The number of NK cells did not correlate with the degree of the inflammatory infiltrate of the mucosa. Moreover, the ultrastructural study revealed activation of NK cells with enhanced cytolytic activity. IFN therapy increases the number and promotes the activation of NK cells within the bladder mucosa. This finding could be of clinical significance in the prevention of tumour recurrence, given that NK cells enhance the immunological defense mechanisms of the bladder.

Carcinoma, Transitional Cell↗

PubMed2006

Polymorphisms of the human NRAMP1 gene are associated with response to bacillus Calmette-Guerin immunotherapy for superficial bladder cancer.

PURPOSE: Superficial bladder tumors have a high recurrence rate and 10% to 20% of recurrences progress to invasive cancer. Recurrence and progression can best be prevented by nonspecific immunotherapy using intravesical BCG instillations. The NRAMP1 gene has been implicated in susceptibility to infectious and autoimmune diseases, and in response to BCG in murine models. We evaluated the association of 5 NRAMP1 gene polymorphisms with the risk of superficial bladder cancer recurrence and response to immunotherapy. MATERIALS AND METHODS: The (GT)n, 274 C/T, 469 + 14 G/C, 1465-85 G/A and D534N polymorphisms were tested on peripheral blood DNA of individuals from three cohorts: 37 bladder tumor patients treated by transurethral resection and without recurrence after up to eight years, 67 patients at high risk of recurrence of their bladder tumors and treated with BCG and 109 controls, using restriction fragment length polymorphisms or microsatellite analysis following PCR amplification. RESULTS: The D543N G:A genotype was found more frequently in patients at high risk of recurrence (8 of 67 or 12%) than in controls (2 of 109 or 2%) (p = 0.007). Patients with nonrecurrent tumors showed no difference with controls (1 of 37 or 3%) (p = 1.0). Moreover, in multivariate and survival analyses, both D543N and (GT)n polymorphisms showed association with recurrence-free survival in the cohort of patients at high risk of recurrence, following BCG treatment. CONCLUSIONS: These data suggest the implication of the NRAMP1 gene in bladder cancer recurrence and response to BCG immunotherapy.

Adjuvants, Immunologic↗

PubMed1999

Quantitative assessment of bladder cancer by nuclear texture analysis using automated high resolution image cytometry.

The aim of this study was to investigate the possibility of identifying urothelial neoplasia by nuclear chromatin texture feature analysis using high resolution image cytometry to improve the diagnostic accuracy of cytologic examination in the detection and monitoring of bladder cancer. Touch imprints of transurethral resection material of 56 control group (CG) cases of nonmalignant urothelium and 94 tumor group (TG) cases of bladder cancer were analyzed. The specimen collection was divided randomly into a training set and a test set. Cells were stained specifically for DNA by the Feulgen method. Only diploid cell nuclei were analyzed from both groups. A discriminator comprised of three nuclear texture features was derived from the training set of cases to separate CG from TG cases. This discriminator was then applied to the independent test set. CG cases were separated from TG cases with a sensitivity of 97% and a specificity of 95% on the independent test set of cases. When dividing TG cases into high-risk and low-risk groups, sensitivity in the low-risk group was 93%. None of the high-risk cases was misclassified (sensitivity, 100%). This retrospective investigation demonstrates that by high-resolution image cytometry it is possible to distinguish between urothelial neoplasia and normal urothelium with high reliability when examining diploid cell nuclei only. This method is superior to DNA ploidy analysis using image or flow cytometry and may become clinically relevant as a supplement to conventional cytologic examination. These promising results should be confirmed on cytologic preparations derived from bladder washings or voided urine.

Adult↗