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PubMed1998

[Endoscopic surveillance of superficial papillary tumors of the bladder].

All cases of superficial bladder tumor treated in 1991 at the urology department of La Pitié hospital were reviewed to study the course of superficial bladder tumors with regard to the risk of muscle infiltration and the value of endoscopic follow-up. In 1991, 73 patients (63 men and 10 women) with a mean age of 64 years had TUR for superficial bladder tumor. Patients had repeated cystoscopy at 3 and 6 months and then on a yearly basis for 5 years. Fourty-eight patients had TIS tumors, and 19 patients had T1 tumors. Five patients were lost to follow-up. Sixty-eight patients were followed for 5 years. Of 48 patients with stage TIS tumors, 39 (81.5%) did not show any deterioration at histological examination, eight patients (16.5%) had infiltration of the lamina propria by tumor (pT1) and the tumor invaded muscle in one patient (2%). Of the 19 patients with stage T1 tumors at the first TUR eight (47%) had no pathologic deterioration, but nine (53%) developed muscle invasion (pT2). Two patients were lost to follow-up. Invasion of the lamina propria present at diagnosis or during the subsequent course is considered to be an indicator of high risk of progression to muscle invasive disease (over 50% of cases). The prognostic accuracy of both the grade and stage needs to be enhanced using molecular markers.

Carcinoma in Situ↗

PubMed1998

Bilateral ureteral inverted papilloma with synchronous transitional cell tumor of the bladder.

Inverted papillomas are benign urothelial tumors. The majority of cases occur in the bladder, while inverted papillomas of the upper urinary tract are very rare. The association of inverted papillomas of the bladder and urothelial malignancy is documented, but the incidence is low. Inverted papillomas of the upper urothelial tract coexist frequently with urothelial malignancy. Close follow-up with urography and cystoscopy is mandatory in such patients. We describe a case with synchronous bilateral ureteral inverted papilloma and a transitional cell tumor of the bladder, illustrating the strong association of upper urothelial tract inverted papilloma and urothelial malignancy.

Aged↗

PubMed1998

[Recurrent febrile infections of the urinary tract and diverticulum of the urachus].

The urachus can present a partial or complete obliteration defect. If the defect is situated in its vesical extremity, it then forms a diverticulum. The authors report a case of diverticulum of the urachus in a young adult, responsible for recurrent febrile urinary tract infections since the beginning of adolescence. The diagnosis was suggested by ultrasonography and magnetic resonance imaging and confirmed by cystoscopy and histological examination. Treatment consisted of complete surgical resection via a suprapubic incision.

Adolescent↗

PubMed2007

Management of vesicovaginal fistulae in urological context.

OBJECTIVE: To find out the commonest cause of vesicovaginal fistula (VVF) and describe the surgical management. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: The Department of Urology and Transplantation, Pakistan Institute of Medical Sciences (P.I.M.S.) Islamabad, from January 1995 to April 2002. PATIENTS AND METHODS: The subjects were presenting with vesicovaginal fistulae. Symptomatology and demographic causes were noted. Investigation included IVU, cystoscopy, vaginoscopy and examination under anesthesia. Repair and outcome was noted. Patients presented with genitourinary fistulae other than VVF were excluded from the study. RESULTS: Most of the patients were young women of childbearing age. The causative factor of VVF in 27 (84.3%) out of 32(100%) patients was obstetrical trauma. Surgical repair proved to be successful through transabdominal route in all 24 (100%) cases of VVF and in 4 (80%) out of 5 (100%) cases through transvaginal route. Repair failed in the 2(100%) attempted through abdominovaginal route and 1(100%) through endoscopic fulguration. To describe an overall result, 28 (87.5%) vesicovaginal fistulae were successfully repaired at first attempt. CONCLUSION: Obstetrical trauma was the commonest cause of VVF in this series. Transabdominal repair was the most successful method of repair in this series. Despite the good results of surgical repair, attempt should be focused on the prevention of VVF.

Adolescent↗

PubMed2007

Mayer Rokitansky Kuster Hauser syndrome with urogenital sinus anomaly.

Mayer Rokitansky Kuster Hauser (MRKH) syndrome is a rare disorder, characterized by the congenital absence of uterus and associated renal tract anomalies. The case presented with primary amenorrhea and primary infertility, despite development of normal female secondary sexual characteristics. CT scan revealed absent uterus, a solitary left sided pelvic kidney and a vesicovaginal communication that, on cystoscopy, revealed urogenital sinus anomaly manifesting as a common channel formed due to absent anterior wall of vagina and posterior wall of urethra. The urogenital sinus anomaly in MRKH syndrome has not been reported earlier.

Abnormalities, Multiple↗

PubMed1986

The treated histories of patients with Ta grade 1 transitional-cell carcinoma of the bladder.

One hundred sixty patients with grade 1 transitional-cell carcinoma of the bladder were evaluated and treated at the Massachusetts General Hospital, Boston. The mean follow-up period was 57 months. There were 92 new patients and 68 patients who had a history of transitional-cell carcinoma. Fifty-three patients (33%) never had another transitional-cell carcinoma. Sixty-eight (43%) of the remaining 107 patients had recurrent Ta grade 1 transitional-cell carcinoma. In 32 patients (20%) disease progressed in grade, in seven patients (4%) invasive transitional-cell carcinoma developed, five patients underwent cystectomy, and one patient died of transitional-cell carcinoma. High-risk factors included positive results of cytologic studies after therapy and three or more recurrences. Multiple therapies were used, but it is impossible to determine if anything other than transurethral resection altered the course in these patients. The data suggest that patients with low-risk factors and Ta grade 1 tumors might be followed up with a quarterly cytologic examination and cystoscopy once or twice a year, unless a change in symptoms occurs.

Adult↗

PubMed1996

Primary leiomyosarcoma of the ureter.

We report the thirteenth case of primary leiomyosarcoma of the ureter, as well as a summary of previous cases. It is the first case reported to be studied by computer tomography and immunohistochemical procedure. Further evaluation included intravenous pyelogram, cystoscopy with retrograde pyelogram, cell block for cytology, and electron microscopy. Leiomyosarcoma is a very rare disease that is difficult to diagnose. It has a very poor 5-year disease-specific survival.

Diagnosis, Differential↗

PubMed1997

Role of finasteride in the treatment of recurrent hematuria secondary to benign prostatic hyperplasia.

OBJECTIVES: We evaluated the efficacy of finasteride for the treatment of gross hematuria secondary to benign prostatic hyperplasia in a prospective fashion. METHODS: Twelve patients with recurrent episodes of gross hematuria secondary to benign prostatic hyperplasia were treated with finasteride 5 mg/day. Before initiating treatment, we excluded other sources of hematuria using intravenous urography, cystoscopy, and urine culture. RESULTS: Bleeding subsided within 2 weeks of treatment in all 12 patients. Minimum follow-up was 6 months. Finasteride was well tolerated by all 12 patients. CONCLUSIONS: Finasteride appears to be effective in treating recurrent gross hematuria secondary to benign prostatic hyperplasia. This therapy should be considered an alternative to transurethral resection of the prostate or hormonal ablation in patients with recurrent hematuria and no significant obstructive uropathy or adenocarcinoma of the prostate.

Enzyme Inhibitors↗

PubMed1998

Image analysis combined with visual cytology in the early detection of recurrent bladder carcinoma.

BACKGROUND: Early detection of recurrent transitional cell carcinoma of the bladder (TCC) is important to permit early treatment, which produces maximal preservation of the bladder and maximum survival. METHODS: This retrospective cohort study attempted to determine the period of time over which urinary DNA image analysis combined with visual cytology is useful in the early detection of recurrent TCC of the bladder. The authors believe this study is unique in that it measured the effectiveness of this test (image analysis plus visual cytology combined) at varying times before clinical diagnosis of recurrence was made. The cohort was comprised of 175 urologic patients from urologic practices across the U.S. Data, collected between January 1991 and February 1994, included cystoscopy, biopsy, DNA image analysis, and visual cytologic reports. RESULTS: Sixty patients in the cohort were found to have active TCC whereas 115 patients had a history of, but no active, disease during the follow-up period. As expected, the sensitivity and specificity of DNA image analysis in combination with visual cytology, and DNA image analysis alone, were greatest when urinary samples were obtained close to the time of diagnosis. In general, the longer the interval from the combined tests to the time of diagnosis, the lower the sensitivity. The combined tests had predictive value up to 3 months prior to clinical diagnosis when any detectable cytologic abnormality was considered positive. At the optimal cutoff points as determined from receiver operating characteristic curves, sensitivity increased when DNA image analysis was supplemented with visual cytology. CONCLUSIONS: The combination of DNA image analysis and visual cytology provides a better method for the early detection of recurrent TCC than DNA image analysis alone. This test potentially may be useful in providing information regarding bladder tumor recurrence up to 3 months prior to clinical evidence of disease.

Adult↗

PubMed1999

Rationale for bladder-sparing surgery in patients with locally advanced colorectal carcinoma.

BACKGROUND: Total pelvic exenteration (TPE) with urinary diversion is a standard surgical approach for patients with locally advanced rectal carcinoma. Because only approximately 50% of patients undergoing TPE have tumor involving the bladder, the authors evaluated the feasibility of bladder salvage in this setting. The current study presents the results of a retrospective study of patients with advanced colorectal carcinoma (classification of >/= T3) to formulate criteria for selecting patients for bladder-sparing procedures. METHODS: The charts of 81 patients with rectal carcinoma classified as >/= T3 were reviewed for age, gender, computed tomography (CT) findings, results of intraoperative examination under anesthesia, final pathologic evaluation, urologic complications, local recurrence, and patient survival. RESULTS: Among the 46 patients who underwent TPE, final pathologic evaluation demonstrated tumor involvement of the bladder in 58% of patients. Preoperative identification of a bladder mucosal abnormality accurately predicted bladder involvement in only 57% of the 30 patients who underwent cystoscopy. CT and intraoperative palpation of the bladder individually predicted the final pathologic findings in 69% and 70% of patients, respectively; of the 21 patients in whom both were positive, 90% had bladder involvement. Of the 35 patients (26 females and 9 males) who underwent bladder-sparing procedures, 22 had complete sparing of the bladder, 9 underwent partial cystectomy (5 with ureteroneocystostomy), 4 underwent ureteroneocystostomy alone, and 2 underwent prostatectomy alone. Ninety-four percent of these 35 patients had negative histologic margins. There was no difference in the incidence rate of urinary complications between patients who underwent TPE and those who underwent a bladder-sparing surgery (17% each). The incidence rates of local recurrence (14% vs. 17%) and the 3-year survival rates (49% vs. 39%) did not differ significantly between the 2 groups. CONCLUSIONS: Bladder-sparing surgery to treat patients with locally invasive colorectal carcinoma provides good local control without sacrificing survival. Women, whose reproductive organs act as a natural barrier, and selected men in whom CT and intraoperative evaluation identify only localized involvement of the prostate or bladder appear to be reasonable candidates for bladder-sparing procedures.

Adult↗

PubMed1999

Detection of messenger RNA for the beta-subunit of chorionic gonadotropin in urinary cells from patients with transitional cell carcinoma of the bladder by reverse transcription-polymerase chain reaction.

We studied whether detection of messenger-RNA (mRNA) for the beta-subunit of chorionic gonadotropin (CGbeta) in urinary cells from bladder cancer patients could be used as a marker of disease activity. Sixty-eight urine samples from patients under follow-up for bladder cancer and 23 samples from patients with other malignancies and non-malignant surgical conditions, as well as 14 samples from healthy controls were analyzed. RNA was isolated from urinary cells collected by centrifugation. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect CGbeta mRNA. The results were compared to those obtained by cystoscopy and urinary cytology. For comparison, we determined CG and CGbeta in serum and urine and the core fragment of CGbeta (CGbeta cf) in urine by immunofluorometric assays. CGbeta mRNA was detected in 29 of 68 urine samples from patients with a history of bladder cancer, whereas all 14 samples from healthy controls tested negative. Elevated levels of CGbeta were observed in serum in 18 of 45 bladder cancer patients, but the association with CGbeta mRNA was weak. However, CGbeta mRNA expression in the absence of detectable cancer also occurred in some conditions associated with cellular atypia such as urinary tract infection, instrumentation and certain therapies. There was a highly significant association between histologically verified transitional cell carcinoma of the bladder and CGbeta mRNA in urine (p = 0.0014), implying CGbeta mRNA expression in tumor tissue. We conclude that CGbeta mRNA is a potential new marker for monitoring of bladder cancer. Further studies are needed to evaluate whether it provides independent clinical information.

Carcinoma, Transitional Cell↗

PubMed1996

Detection of bladder tumor by urine cytology in cases of prostatic hypertrophy.

Routine urine cytology has been performed for 809 male patients presenting with symptoms due to prostatic hypertrophy. In 6.42% of the cases, bladder tumor was revealed incidentally diagnosed by urine cytology. Cystoscopy and bladder biopsies were performed to confirm malignancy. The age of these patients ranged from 48-84 years (mean 65.2) and they complained mainly of irritative bladder symptoms. It is therefore strongly indicated that all patients with prostatic disease should have routine cytological examination of urine sediments.

Aged↗

PubMed1997

Does p53 immunostaining improve diagnostic accuracy in urine cytology?

The frequent change of the transitional cell carcinoma of the urinary tract accounts for the fact that cytological abnormalities in urinary specimens are often not sufficient to enable a definitive diagnosis of malignancy. The purpose of this work was to evaluate the possible use of p53 protein in increasing the diagnostic accuracy of urinary cytology. The expression of p53 was investigated by immunocytochemistry in two groups of urinary specimens, one cytologically positive and the other cytologically negative for cancer. Immunostaining was carried out using a monoclonal antibody to p53. In the positive group, in which bladder cancer was confirmed by cystoscopy and biopsy (31 cases), positive reaction for p53 was found in 55% of the cases (17 cases). In the negative group (92 cases), presence of cancer was histologically ascertained in 64 cases and in this group 15 cases (23.4%) showed positive p53 staining. In the remaining 28 cases of this group, where TCC was not present, 7 cases showed p53 positivity in non-neoplastic urothelial cells. This result shows that, while immunocytochemical detection of p53 in urinary specimens may be used for prognostic evaluation of patients with bladder cancer, it does not contribute to the diagnostic accuracy in cases with morphologically inconclusive or negative cytology. The sensitivity and specificity of the method in detecting bladder carcinoma were 23.5 and 75%, respectively.

Biomarkers↗

PubMed1998

Combining QUANTICYT karyometric analysis with architectural confocal-aided cytology to prognosticate superficial bladder cancer.

For this study, bladder washings of 923 patients with a follow-up for superficial bladder cancer were used. For the prognostication of each case (follow-up period up to 20 mo), two parameters were used: tumor recurrence and the event of (progressing) invasive growth. Each sample was classified as negative, low grade or high grade, based on confocal-aided architectural cytology. The feature architecture was based on the images of the epithelial fragments as seen in the Feulgen stain, which also could be visualized in confocal microscopy. The same three classes were also used for grading the samples according to the QUANTICYT system, in which DNA and morphometry of nuclei were automatically assessed. The 532 cases graded as QUANTICYT high had a worse prognosis than the 391 cases with QUANTICYT low. In addition, architectural cytology contributed significantly for the prognostication of cases classified as QUANTICYT high, the 228 nonconcording cases faring better than the 304 concording ones. For QUANTICYT low, the 156 nonconcording cases had also a lower recurrence rate than the 235 concording ones, but this difference was only significant in patients followed for up to 8 mo. These findings indicate that QUANTICYT grading supplemented by architectural cytology supplies the clinician with valuable prognostic information which can be used to limit cystoscopies.

Automation↗

PubMed1999

Cytologic diagnosis of metastatic ovarian adenocarcinoma in the urinary bladder: a case report and review of the literature.

A 53-yr-old woman with a 13-mo history of recurrent ovarian papillary serous adenocarcinoma presented with persistent microscopic hematuria. The patient was undergoing chemotherapy for her recurrent ovarian tumor when she was referred to the urology service for microscopic hematuria. An intravenous pyelogram was normal. Cystoscopy was performed, as well as a urinary bladder washing and mucosal biopsies for examination. Adenocarcinoma similar to the patient's primary ovarian tumor was detected in both cytology and histopathology specimens. Ovarian carcinoma comprises 1.3-4.0% of all metastatic neoplasms to the urinary bladder and is an important consideration in the differential diagnosis of a cytologic finding of adenocarcinoma in urine specimens of female patients, where it accounts for an even higher percentage of cases (1 of 3 adenocarcinoma diagnoses in a series of 4,677 urine specimens from female patients).

Adenocarcinoma↗

PubMed2000

Prospective phase II trial of alternating intravesical Bacillus Calmette-Guérin (BCG) and interferon alpha IIB in the treatment and prevention of superficial transitional cell carcinoma of the urinary bladder: preliminary results.

BACKGROUND AND OBJECTIVE: Evaluate the efficacy and toxicity of alternating intravesical instillation of Bacillus Calmette-Guerin(BCG) and Interferon alpha2-b (IFN) in the treatment and prevention of recurrence of superficial transitional cell carcinoma (TCC) of the urinary bladder. METHODS: Patients with Ta, T1 tumors and carcinoma in situ, either recurrent (TaG1, T1G1) or primary/recurrent TaG2 TaG3, T1G2, T1G3 and Tis (T: Tumor stage, G: grade) are eligible. All patients received intravesical BCG 81 mg on Weeks 1, 3, 5 and 7 and IFN 100 million units on Weeks 2, 4, 6 and 8. Cystoscopy performed 4 weeks after completion of therapy, and every 3 months thereafter. RESULTS: There was a total of 37 patients. Thirteen had TaG2, 13 T1G2, 1 T1G1, 4 TaG1, 1 TaG3, 3 T1G3 and 7 Tis (5 concurrent with other above tumors). Index lesion cleared in 7/10 patients. With a median follow-up of 26.2 month, 22 patients (59%) failed above therapy. Median time to treatment failure was 7 months. Seven, 6 and 9 patients recurred at a higher, lower and same stage or grade respectively. No grade 3 or 4 toxicity was encountered. CONCLUSIONS: Alternating intravesical BCG and IFN is effective and well tolerated therapy for superficial TCC of urinary bladder.

Administration, Intravesical↗

PubMed1975

Lymphangiomyomatosis: report of a case with ureteral involvement and chyluria.

A 54-year-old woman, presenting with chyluria and progressive dyspnea, is reported. Necropsy revealed co-existent lymphangiomyomatosis and pneumoconiosis in the lungs. Retroperitoneal lymphangiomyomas surrounded the distal ureters, and cystoscopy revealed pyelolymphatic backflow into renal lymphatic sinuses. The finding of chyluria with atypical smooth muscle hyperplasia within the ureters is extremely rare. Previously reported cases of lymphangiomyomatosis are discussed and compared with our own. Electron micrographs of involved lymph nodes are presented and the findings briefly evaluated.

Autopsy↗

PubMed1975

Measurement of urinary CEA-like substance. An aid in management of patients with bladder carcinoma.

Urine and serum samples from patients with bladder carcinomas were studied for the occurrence of and variations in CEA content before, during, and after radiation therapy. The concentration of CEA-like substances in urine increased with a more advanced clinical stage of the tumor, although there were large intercase variations. In serum, slightly increased values were noted only in advanced cases. During radiation therapy, high CEA values were found at around mid-course. This could be related to a breakdown of tumor tissue. Judging from data for urine from radiation-treated prostatic carcinomas without known tumors in the bladder, radiation alone was not responsible for the elevation of CEA. Urinary infections contributed to raised levels of CEA-like substances in some cases. At the end of successful radiation therapy (as verified by cystoscopy, cytology, and clinical examination), 25 patients had CEA values in the urine comparable to normal values (14 +/- 7 ng CEA/ml). The decrease was significant from the initial values to those after radiotherapy (p less than 0.01). Four patients whose tumors persisted had high values (68 +/- 46 ng CEA/ml). In patients who had previously received radiation treatment for bladder carcinomas, CEA values were high in 20 with recurrences (58 +/- 36 ng CEA/ml) while they were lower in 13 who were free of recurrence (14 +/- 6 ng CEA/ml). These findings indicate that urinary CEA determinations may be used in the immediate followup and management of patients treated for bladder carcinoma. It also appears to be of prognostic significance.

Aged↗