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[Cytology by lavage in the follow-up of bladder neoplasms].

We evaluated the results of urinary cytology, obtained from bladder washing, in the follow-up of patients with superficial bladder tumors. For the study, we used 545 samples. These were compared with the cystoscopic findings when cytology was negative, and with the biopsy findings when positive. We observed that the sensitivity of cytology increased with tumor grade, stage and number. The highest sensitivity rate was observed for carcinoma "in situ". However, a low specificity rate was observed for single, low grade/stage lesions. False-positives diminished inversely with cytologic grading, which was only 8% for cytology grade 3. There were more false-positives in patients that were on prophylactic therapy with thiotepa. The foregoing increased with the duration of treatment. Bladder lithiasis, abacterial cystitis, urinary infection, adenoma and prostatic cancer found to yield falsely positive results. False-negatives appeared principally in single, low grade/stage tumors. We underscore the low number of false-negatives observed in patients on thiotepa or those with bladder diverticulum. Follow-up of patients with true-negative or false-positive cytology showed a higher incidence and earlier tumor recurrence in the latter patient group. We discuss all the foregoing findings and present a protocol for patient follow-up.

Adenocarcinoma↗
PubMed1999

[Virtual cystoscopy of bladder neoplasms. Preliminary experience].

PURPOSE: We investigated the comparative sensitivity of virtual and conventional cystoscopy in patients with urinary bladder cancer. MATERIAL AND METHODS: Twelve patients (8 men and 4 women; mean age: 61 years, range: 49-73) with findings of bladder cancer at conventional cystoscopy were submitted to volumetric spiral CT of the urinary bladder. Before the examination, the urinary bladder was distended with 180-200 mL of air. CT findings were then sent to an independent workstation to generate interactive intraluminal views of the bladder. The findings of virtual cystoscopy were compared with those of conventional cystoscopy in 11 patients and with the findings of transurethral resection after urethrotomy in one patient. All lesions had pathologic confirmation. RESULTS: Eighteen (90%) of 20 masses detected on conventional cystoscopy were visualized with virtual cystoscopy. The latter allowed readers to identify 13 of 13 masses (100%) > 1 cm and only 5 of 7 (71%) < 1 cm; three 4-mm masses were missed. Although only a subjective evaluation of lesion size was possible on conventional cystoscopy, there seemed to be good agreement on mass size and site with both techniques. DISCUSSION: Cystoscopy plays a key role in the diagnosis of urinary bladder carcinoma. However cystoscopy is invasive, has a limited field of view and lacks an objective scale; moreover, it is not indicated in patients with severe urethral strictures or active vesical bleeding. In our study, virtual cystoscopy depicted all the masses > 1 cm, and a lesion in a diverticulum with a small opening. Virtual cystoscopy was also very useful in a patient with urethral stricture (who could no be submitted to conventional cystoscopy) where it showed the lesion before transurethral resection after urethrotomy. The virtual technique could also be complementary to conventional cystoscopy in evaluation of bladder base and anterior bladder neck, as well as for postchemotherapy follow-up. Unfortunately virtual cystoscopy does not allow biopsy of suspicious lesions.

Aged↗
PubMed1996

[Bladder neoplasms and cyclophosphamide. Apropos pf 3 cases amd review of the literature].

We report three new cases of bladder cancer occurring in patients treated by cyclophosphamide (Endoxan): two patients had Waldenström disease and were treated during 7.5 and 7 years respectively (total received dose of 220 and 190 g respectively). The third patient was treated for autoimmune erythroblastopenia and the bladder cancer occurred 5 years after treatment by cyclophosphamide (39 g during 3.3 years). Bladder cancers after cyclophosphamide treatment are generally transitional cell carcinomas. They are observed after an oral treatment, generally given for more than one year. A cumulative dose of more than 20 g is the principal risk factor, with a median interval from treatment to tumor of 7 years. No other risk factor has been identified (tobacco, age, sex, hemorrhagic cystitis). The relative risk of bladder cancer is estimated between 7 and 9, and seems proportional to the cumulative dose of cyclophosphamide. The first hypothesis to explain bladder cancer occurrence is a carcinogenic effect of one of the cyclophosphamide metabolites, acrolein, but the immunosuppressive effect of cyclophosphamide may play a role. The risk of secondary bladder cancer implies to limit the use of cyclophosphamide, particularly in non malignant disease, and to closely watch the patient especially by way of annual cystoscopy.

Aged↗
PubMed1982

The role of urine in a patient with a bladder neoplasm.

A review was done on reported cases of spontaneous regression of superficial bladder tumors in which cystectomy was preceded by bilateral ureterosigmoidostomy (the interval ranging from 21 days to 6 months). In every case in which the tumors were superficial complete disappearance of the papillary masses was observed by the naked eye and by microscopic examination. Tumor cells persisted in those cases in which the bladder wall was involved. I propose that the urine of the patient acts as a promoter to hyperplasia and neoplasia on foci of defective urothelial cells whose special coding apparatuses had been injured or destroyed by a carcinogen. The latter need no longer be present nor need there be exposure to co-carcinogen(s), such as is associated with excess alcohol intake or cigarette smoke inhalation. Tumor cells that were found in the excised bladder wall were cells that had become invasive (cancerous) and were no longer dependent.

Aged↗