A Case of Large Cell Neuroendocrine Carcinoma of the Bladder With Long‐Term Control by Metastasectomy

Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-up

Objectives To investigate clinical efficacy and adverse reactions of bladder-sparing therapy combined with emcitabine and cisplatin (GC) for muscle invasive bladder cancer (MIBC) . Methods 30 patients with MIBC underwent transurethral resection of the bladder tumor(TURBT) in our hospital from January 2008 to December 2010 were collected. The tumor staging was T2aN0M0~T3aN0M0 , and maximum tumor diameter was less than 4cm, single or multiple. The GC chemotherapy was given by gemcitabine (1000mg/m2 ) on day 1 and day 8, cisplatin (30mg/m2 ) on day 2 and day 4. The regimen was repeated every 21 days, Results 30 patients were followed up for average 36 months, 20 patients remained recurrence and metastasis free, 10 cases recurred, 2 cases recurred after 2 cycles of chemotherapy, and again underwent TURBT after four cycles of chemotherapy, without recurrence during follow-up.4 patients received radical cystectomy, 4 patients received radiotherapy after TURBT, and 2 patients died of tumor recurrence.No patients with serious side effects of chemotherapy were included and well tolerable. Conclusions Bladder-sparing therapy combined with gemcitabine and cisplatin in treatment of patients with muscle invasive bladder cancer who underwent TURBT, which would significantly improve the curative effect and reduce recurrence of tumor, compared with total cystectomy, which could be easily accepted by the patients, improve the quality of life of patients and provide a new way for the patients who unable or unwilling to underwent radical cystectomy. Key words: Urinary Bladder Neoplasms; Cystectomy; Cisplatin

ObjectivesTransurethral resection of bladder tumor with photodynamic diagnosis has been reported to result in lower residual tumor and intravesical recurrence rates in non‐muscle invasive bladder cancer. We aimed to evaluate the usefulness of photodynamic diagnosis‐transurethral resection of bladder tumor combined with oral 5‐aminolevulinic acid hydrochloride for high‐risk non‐muscle invasive bladder cancer.MethodsHigh‐risk non‐muscle invasive bladder cancer patients with an initial photodynamic diagnosis‐transurethral resection of bladder tumor (photodynamic diagnosis group) were prospectively registered between 2018 to 2020. High‐risk non‐muscle invasive bladder cancer cases with a history of initial white‐light transurethral resection of bladder tumor (white‐light group) were retrospectively registered. Propensity score‐matching analysis was used to compare residual tumor rates, and factors that could predict residual tumors at the first transurethral resection of bladder tumor were evaluated.ResultsAnalyses were conducted with 177 and 306 cases in the photodynamic diagnosis and white‐light groups, respectively. The residual tumor rates in the photodynamic diagnosis and white‐light groups were 25.7% and 47.3%, respectively. Factor analysis for predicting residual tumors in the photodynamic diagnosis group showed that the residual tumor rate was significantly higher in cases with a current/past smoking history, multiple tumors, and pT1/pTis. When each factor was set as a risk level of 1, cases with a total risk score ≤1 showed a significantly lower residual tumor rate than cases with a total risk score ≥2 (8.3% vs 33.3%, odds ratio 5.46 [1.81–22.28]).ConclusionsIn high‐risk non‐muscle invasive bladder cancer cases, the odds of a residual tumor after initial photodynamic diagnosis‐transurethral resection of bladder tumor were 0.39‐fold that of the odds of those after initial white‐light transurethral resection of bladder tumor. A risk stratification model could be used to omit the second transurethral resection of bladder tumor in 27% of the cases.

Differences in Gene Expression in Muscle– Invasive Bladder Cancer: A Comparison of Italian and American Patients

Transurethral resection of the bladder tumor (TURBT) followed by intravesical instillation therapy is the standard treatment for non-muscle invasive bladder cancer (NMIBC). One of the factors that may affect the risk of recurrence after TURBT is the quality of surgery that may vary between individual surgeons. While there has been a large number of studies demonstrating the ability to reduce the risk of recurrence of NMIBC with different types of the intravesical therapy, less attention was paid to the quality of TURBT in improving long-term treatment results. The aim of the study is to evaluate the effect of the quality of TURBT on the recurrence rate of NMIBC based on surgeon experience. The study is a double blinded prospective randomized study conducted on 50 patients with NMIBC. who underwent 126 procedures (50 primary cystoscopies ,26 restaging cystoscopies and 50 check cystoscopies at three months). All Treatment-naive patients with NMIBC candidate for TURBT were included, with exclusion of patients with previous history of TURBT, previous open bladder surgery, patients with urethral stricture, patients with muscle invasive bladder cancer. And patients who lost follow up. Patients were randomized by closed envelope into two groups; Group A included 25 patients who underwent TURBT by a senior surgeon (more than 5 years' experience), and Group B included 25 patients underwent TURBT by a qualified junior surgeon (less than 5 years' experience). Restaging cystoscopy at 2-6 weeks (if indicated) and follow up cystoscopy at three months were performed by another senior surgeon (who was blinded to the name of the first surgeon). No statistically significant difference was found between both groups regarding the incidence of complications (urethral injury, bladder perforation, ureteric injury, obturator reflex), Group B showed a statistically significant longer operative time, postoperative irrigation time, more hemoglobin loss, longer hospital stay, and higher 3 months' recurrence rates. Moreover, senior surgeons' specimens were more likely to include detrusor muscles. surgeon's experience has significant impact on the quality of TURBT and risk of recurrence of NMIBC. With less operative time, less hemoglobin drop, and less hospital stay.

Background: Patients with non-muscle invasive bladder cancer (NMIBC) often have transurethral resection of the bladder tumor (TURBT). Inadequate TURBT, floating tumor cell implantation theory, and non-visualized microtumors are major factors for the recurrence of bladder cancer. According to guideline recommendations, after primary TURBT, there is a role of restage TURBT within 2–6 weeks in high-risk patients. The present study’s goal was to assess the role of restage TURBT in high-risk NMIBC. Aims and Objectives: The aim of the study was to identify the group of patients with high-risk NMIBC who may skip the commonly performed restage TURBT operation. Materials and Methods: In this prospective and observational study, biopsy-proven NMIBC patients with gross total painless hematuria secondary to urinary bladder mass from October 2017 to June 2019 were enrolled. Patients with high-risk disease will undergo restage TURBT after 2–6 weeks of primary TURBT. Residual/recurrent disease and tumor upstaging were recorded. To investigate the risk variables for tumor upstaging after restaging TURBT and residual/recurrent disease, logistic regression analysis was utilized. Results: A total of 250 patients (deep muscle involvement, n = 237 and no muscle involvement, n = 13) with histopathologic ally-confirmed high-risk disease following re-TURBT were included in the final analysis. During re-TURBT, 18% of patients had residual or recurrent tumors. The presence of upper tract changes, presence of perivesical fat stranding and tumor size >3 cm, high-grade histopathology, and positive urine for malignant cytology had a higher risk of residual or recurrent disease. Histopathological specimens showing the absence of muscle in the primary TURBT specimen, the presence of recurrent/residual growth in restage TURBT specimen, and bladder tumor antigen increased the risk of upstaging. Conclusion: Despite the low recurrence rate of tumors in restage TURBT, restage TURBT within 2–6 weeks of primary TURBT is an essential step for the accurate diagnosis among NMIBC patients. This further aids in deciding the subsequent treatment step in patients having upstaging and recurrent/residual tumors.

IntroductionParaganglioma of the urinary bladder is a very rare disease accounting for 0.06% of all bladder tumors. Owing to their rarity and symptomatic variability, preoperative diagnosis is often difficult.Case presentationA 70‐year‐old male was referred to our department for hematuria. Cystoscopy showed a non‐papillary broad‐based tumor. Computed tomography and magnetic resonance imaging revealed a 32‐mm bladder tumor at the top of the bladder, which suggested muscle‐invasive bladder tumor. We diagnosed muscle‐invasive bladder cancer or urachal carcinoma, and transurethral resection of the bladder tumor was performed. At the initiation of transurethral resection of the bladder tumor, the systolic blood pressure was elevated to over 200 mmHg. The pathological findings revealed paraganglioma of the urinary bladder, and afterward, a partial cystectomy was performed.ConclusionWe herein reported the case of paraganglioma in the bladder whose blood pressure became extremely elevated during transurethral resection of the bladder tumor. In addition, we analyzed important factors for preoperative diagnosis using 162 cases reported in Japan.

Inflammatory myofibroblastic tumors (IMTs) are intermediate-grade lesions that frequently recur and rarely metastasize. There are currently no guidelines on the management of bladder IMTs. This systematic review aims to describe the clinical presentation and compare the management options for bladder IMTs. A PubMed/Medline search was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the following Mesh terms: ("inflammatory myofibroblastic") AND ("tumor") OR ("tumor") AND ("bladder") AND ("case report"). A total of 75 case reports were included in the analysis. The mean age of the patients was 36 years. 65% of the cases initially presented with hematuria. 68% of the tumors stained positive for anaplastic lymphoma kinase, and 20% invaded the muscularis. Patients underwent either transurethral resection of the bladder tumor (TURBT) only (34%), TURBT followed by complementary partial cystectomy (16%), or TURBT followed by radical cystectomy (4%). 36% and 9% of the cases underwent partial and radical cystectomy after the initial diagnosis, respectively. Cystectomies were performed using an open (74%), laparoscopic (14%), robotic-assisted (10%), or unknown (2%) approach. At a mean follow-up of 14 months, the recurrence and metastasis rates were about 9% and 4%, respectively. In addition, we present the case of a 49-year-old woman with a bladder IMT who underwent TURBT followed by laparoscopic partial cystectomy. The patient remains tumor free postoperatively (follow-up period of 12 months). A complete surgical excision of the bladder IMT is crucial for the optimal management of these cases. Proper differentiation of this tumor from sarcoma or leiomyosarcoma leads to the best outcomes.

Background: The average age of diagnosis for bladder cancer is 73 and about 75 percent of all bladder cancers are non-muscle invasive at initial diagnosis. It is recommended that non-muscle invasive bladder cancers (NMIBC) should be treated with transurethral resection of the bladder tumor (TURBT) followed by chemotherapy. However, there is no large-scale study from real-world databases to show the effectiveness of chemotherapy on the survival of older adults with NMIBC that have undergone TURBT. This study aimed to investigate the effects of chemotherapy on survival among older NMIBC patients with TURBT. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), we performed analyses of cancer-specific mortality and overall mortality comparing chemotherapy versus no chemotherapy after TURBT. Coarsened exact matching was performed to balance the baseline patient characteristics. Cox proportional hazards and Kaplan-Meir analyses were used to evaluate survival outcomes. Results: A total of 3,222 matched patients with 1,611 in each arm (chemotherapy and no chemotherapy) were included in our study. After adjusting for covariates, multivariable Cox regression analyses show chemotherapy was associated with lower cancer-specific mortality (HR 0.63; 95% CI 0.42-0.94; p value 0.024). However, chemotherapy did not have any effect on overall mortality (HR 0.84; 95% CI 0.65-1.07; p value 0.159). The Kaplan-Meier curves show the protective effects of chemotherapy on cancer specific survival (p=0.032), but not on overall survival (p=0.34). Conclusion: Chemotherapy improved cancer specific survival among older patients with non-muscle invasive bladder cancer undergoing TURBT surgery, but it had no effect on overall survival. There is a need for more granular level real-world data on chemotherapy regimens and dosage to effectively investigate the effects of chemotherapy on the survival of older patients with NMIBC that have undergone TURBT.

BackgroundThe gold standard treatment for non-muscle invasive bladder cancer (NMIBC) is transurethral resection of the bladder tumor (TURBT). En bloc transurethral resection is a new method for non-muscle invasive bladder cancer that may improve some shortcomings of TURBT. The aim of this systematic review and meta-analysis was to compare the perioperative and prognostic outcomes of en bloc transurethral resection and TURBT for NMIBC.MethodsLiterature searches were conducted using PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), WanFang Data (WanFang) and VIP Information Network (VIP). We only included randomized controlled trials (RCTs). We used the Cochrane risk of bias 2.0 tool and modified Jadad scale to assess the quality of the literature. Statistical analyses were conducted using Review Manager 5.3 software (RevMan) and Stata SE software.ResultsWe included 16 RCTs comprising 1,505 patients (experimental group: 827; control group: 678). There were no significant differences between en bloc transurethral resection and TURBT in operation time [standard mean difference (SMD) =−0.21, 95% confidence interval (CI): −0.70 to −0.28, P=0.40] and 3-month recurrence rate [relative risk (RR) =0.14, 95% CI: 0.02–1.08, P=0.06]. Compared with TURBT, en bloc transurethral resection significantly decreased 6-month recurrence rate (RR =0.43, 95% CI: 0.26–0.69, P<0.001), 1-year recurrence rate (RR =0.36, 95% CI: 0.25–0.53, P<0.001), positive number of the biopsy at the tumor base (RR =0.17, 95% CI: 0.07–0.43, P<0.001), vesical perforation (RR =0.22, 95% CI: 0.11–0.43, P<0.001), obturator nerve reflex (RR =0.39, 95% CI: 0.18–0.83, P=0.01), postoperative complications (RR =0.10, 95% CI: 0.02–0.41, P=0.002), hemorrhage (SMD =−2.13, 95% CI: −2.89 to −1.37, P<0.001), hospital stay [mean difference (MD) =−2.14, 95% CI: −2.81 to −1.47, P<0.001], bladder irrigation time (SMD =−2.80, 95% CI: −3.36 to −2.24, P<0.001), and catheterization period (SMD =−1.77, 95% CI: −2.63 to −0.91, P<0.001).ConclusionsCompared with TURBT, en bloc transurethral resection appears to be a better treatment option for NMIBC.

IntroductionNon-muscle invasive bladder cancer (NMIBC) is one of the most expensive cancers to treat, driven by high recurrence rates and disease progression. Mortality rates in the UK for all bladder cancers have remained relatively stable over the past decade. NMIBC can be curatively treated with transurethral resection of the bladder tumour (TURBT). Despite international evidence-based guidelines on the TURBT procedure and postoperative single instillation of mitomycin-C, TURBT quality continues to vary widely. RESECT will be the first ever international study of TURBT surgery evaluating the achievement of TURBT quality indicators globally and assessing if audit and performance feedback can improve surgical outcomes.MethodsRESECT is a prospective, multicentre international observational cohort study. Collaborators at each site will collect data using REDCap about local TURBT practice, early recurrence rates and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators. Advertisement for the study launched in 2020.ResultsAs of October 1st, 2020, 524 collaborators have registered to participate. Collaborators represent 334 centres from 54 countries, with the highest number of centres from the United Kingdom (133), Spain (17), and India (16). 50.8% are trainees, 30.3% consultants, and 17.2% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.ConclusionRESECT has attracted many collaborators internationally from consultants and trainees at all stages. RESECT has significant potential to positively impact TURBT practice, health economics and ultimately improve outcomes for patients with NMIBC globally.

Transurethral resection of the bladder tumour (TURBT) is the standard surgical procedure for non-muscle invasive bladder cancer. We believe that all urologists should be trained in this procedure. This DVD provides an overview of TURBT with particular focus on basic skills, including basic surgical techniques such as the obturator nerve block. Important basic surgical skills required for complete TURBT in non-muscle invasive bladder cancer are: (i) resection of all visible tumors; (ii) resection of apparently normal mucosa on the border of the tumor; (iii) resection of the muscle layer at the base of the tumor until normal muscle fibers are visible; (iv) in applicable cases, random biopsy of apparently normal urothelium of the bladder wall and transurethral resection (TUR) biopsy of both sides of the prostatic urethra; and (v) when possible, after these procedures are completed, a different operating surgeon should inspect the bladder lumen to confirm that there are no remaining tumors. In particular, sampling resection should be implemented in apparently normal mucosa for approximately 1 cm around the tumor, and at the base of the tumor down to the superficial muscle layer. Resected specimens should be examined histopathologically in order to confirm the absence of malignant findings. Fundamental procedures for TURBT include both one-stage and two-stage resection. One-stage resection is used for relatively small tumors and involves a single procedure with simultaneous resection of both the tumor and the tissue at the tumor base down to the superficial muscle layer. In the two-stage resection, the first resection exposes the lower level of the mucosa and the second resection removes that lower mucosal layer in order to sample the superficial muscle layer for cancer staging. At the start of the resection, the loop is electrified before it makes contact with the mucosa. Delicate movements of the sheath should be used, along with delicate movement of the loop itself to adjust the depth of resection. The illustration of surgical techniques shows not only the basic techniques but also some points for caution during the resection. For actual resection, it is important to fully understand the properties of the tumor and to combine these techniques appropriately for each individual resection procedure. When resecting multiple tumors, the same basic resection techniques used for single tumors should be applied, and repeated as necessary. (This is a translated section of a video article originally published in Japanese as a DVD in the Audio-Visual Journal Vol.14 No.1. 2008 by The Japanese Urological Association.).

Bladder cancer is the fourth most prevalent tumor in men and eighth in women. Approximately 50,000 new cases are diagnosed annually in the around the world. The study aims at: assess nurse’s knowledge regarding management of patients who undergo the transurethral resection of the bladder tumor. A descriptive study is conducted during the periods of July 29th 2018 to December 25th 2019.The study conducted in Hilla Teaching Hospital and Al’imam Alsadiq Teaching Hospital were the designated site for data collection. By non-probability “purposive sample” of (51) nurses, data were collected for pre-post test and analyzed a descriptive and inferential statistical data analysis approach. Results of the study depicts that age of the nurses ranged from 20- 43 years, (60%) of nurses in the control group, there were somewhat less female nurses (45.2%) than male nurses (54.8%) in the study group and (32%) were female and (68%) nurses male in the control group, (80.6%were married in the study group and 22 (88%) were married in the control group, education was from a secondary nursing school and institute degree (35.5%) for each degree in the study group, and (48%) institute degree in the control group, (1-5) years was (67.7%) in the study group and (68%) in the control group. Nurses knowledge in the study group has increased from (M.S. 1.3026) in the pretest time to (M.S. 1.6787) in post test time for the control group, this score has slightly increase from pre test (M.S. 1.2985) to post tests (M.S. 1.3343). There were concluded improving in nurses’ knowledge after post-test for study group for educational program concerning management of patients with transurethral resection of the bladder tumor. While control group did not present any improvement in their knowledge concerning management of patients with transurethral resection of the bladder tumor at pre and post-test. It is need to be encouraging nurses to be enrolled in training sessions to improve their knowledge to keep them up to date toward management of patients with transurethral resection of the bladder tumor.

Introduction: Neuroendocrine carcinomas of the urinary bladder are relatively rare, accounting for less than 1% of all bladder carcinomas. These tumors can be divided into the more indolent typical or atypical carcinoid tumors and the aggressive small cell and large cell neuroendocrine carcinomas. Objective: To report 2 clinical cases of large cell neuroendocrine carcinoma of the bladder (LCCB) and to review the epidemiology, prognosis, and current treatment algorithms for patients with bladder small and large cell neuroendocrine carcinomas. Results: In both cases hematuria was the presenting symptom. One patient was submitted to partial cystectomy and the other to trans-urethral resection of the bladder tumor. The former patient died on the third month postoperatively. The latter patient had extensive liver metastasis at the time of diagnosis and died from acute liver failure on the 14th postoperative day. In review LCCB is associated with a more aggressive behavior and poorer prognosis than transitional cell bladder carcinoma. No standard approach exists. Surgery (transurethral ressection, partial cystectomy, radical cystectomy), chemotherapy and radiotherapy are current treatment modalities. Conclusion: LCCB is an aggressive tumor which usually presents itself in an advanced stage. Neoadjuvant chemotherapy with platinum regimen plus aggressive surgical approach should be the treatment of choice.

There are no guidelines regarding whether to perform either a radical transurethral resection of the bladder tumor (TUR-BT) or a total cystectomy after TUR biopsy for huge bladder cancer, and this decision is entrusted to each institution. Of 439 patients in whom TUR-BT was performed from 2005 through 2009, the weight of the total resected volume was > 50 g in 6 patients, and among these 6 patients the following variables were compared: operating time, weight of resected volume, transfusion volume, presence or absence of hydronephrosis, preoperative urinary cytology, serum cytokeratin 19 fragment (CYFRA) level, intraoperative bladder compliance, and histopathological findings. The median age, operating time, weight of resected volume, transfusion volume, and length of follow-up were 72 years, 300 minutes, 88 g, 202 mL, 16 months, respectively. The serum CYFRA level in patients with muscle-invasive cancer (11.8 ng/mL) was higher than that in patients with non-muscle-invasive cancer (5.06 ng/mL). All patients with non-muscle-invasive bladder cancer survived without recurrence. Although the mean length of follow-up was only 16 months (5-59 months), the 1 patient who was followed up for 59 months had no recurrence. In cases of muscle-invasive bladder cancer, all patients, except for a relatively recent patient, have died. In cases without muscle invasion, lymph node metastasis, distal metastasis, or preoperative renal dysfunction accompanied by hydronephrosis, with favorable bladder compliance, we believe that radical TUR-BT should be actively performed to preserve the bladder. A second TUR-BT should be performed in cases of non-muscle-invasive cancer without G3 components to treat the huge bladder cancer.