Non-muscle Invasive Bladder Tumors Research Articles

Clamp for Safety: Improving Intravesical Chemotherapy Practices.

Processes for intravesical chemotherapy after transurethral resection of nonmuscle invasive bladder tumors may lack standardization. In 2019, at a large health care system in Los Angeles, California, five incident reports involving chemotherapeutic agent spills from urinary catheters after bladder tumor procedures necessitated a quality improvement project. The project lead determined that a cost-effective alternative device for securing the chemotherapeutic agent in the bladder was needed at four surgical locations of the health care system. In addition, a review of the literature and an observational assessment revealed lack of adherence to standard and recommended processes for using personal protective equipment (PPE) when handling hazardous medications. After revising existing processes, acquiring a cost-effective clamp and recommended chemotherapy PPE, instructing personnel on the clamping process and use of PPE, and implementing use of the clamp, there have been no spills associated with intravesical chemotherapy across the four surgical locations.

Documento multidisciplinar de consenso sobre el tratamiento actual del tumor vesical no-músculo invasor que no responde al tratamiento con bacilo Calmette-Guérin

Radical cystectomy is the current treatment of choice for patients with BCG-unresponsive non-muscle invasive bladder cancer (NMIBC). However, the high comorbidity of this surgery and its effects on the quality of life of patients require the investigation and implementation of bladder-sparing treatment options. These must be evaluated individually by the uro-oncology committee based on the characteristics of the BCG failure, type of tumor, patient preferences and treatment options available in each center. Based on FDA-required oncologic outcomes (6-month complete response rate for CIS: 50%; duration of response in responders for CIS and papillary: 30% at 12 months and 25% at 18 months), there is not currently a strong preference for one treatment over another, although the intravesical route seems to offer less toxicity. This work summarizes the evidence on the management of BCG-unresponsive NMIBC based on current scientific evidence and provides consensus recommendations on the most appropriate treatment.

Bladder tumor ablation with 980-nm and 980-/1470-nm diode lasers: a retrospective study

Abstract Purpose This study evaluated the safety and feasibility of ablation of both non-muscle invasive and muscle invasive bladder tumors using single- and dual-wavelength diode lasers (980 nm and 980/1470 nm). Methods We retrospectively examined 151 patients with bladder tumors of any type from 2009 to 2021 who underwent V-LABT (visual laser ablation of bladder tumor) with both single- and dual-wavelength diode lasers at Shalamar Hospital Lahore, Pakistan. All procedures were performed by the same surgeon. Shalamar Medical and Dental College review board approved this retrospective cohort study (IRB No. -623-2023). The collected clinical data were consolidated into a single group, encompassing various variables such as the patients’ age, tumor size, number of tumors, tumor location, tumor grade, ablation duration, postoperative catheterization time, bladder discomfort, obturator nerve reflex, intraoperative and postoperative complications, and recurrence of tumors at the ablation sites. The patients were monitored for a minimum of 12 months to observe recurrence at the ablation sites through cystoscopy performed postoperatively every three months. The data were analyzed using Chi-square test, and p value < 0.05 was considered significant. Results The average age of the 151 patients was found to be 64.72 ± 13.85 years. The size of the tumors was 4.88 ± 2.16 cm, with 48/151 (31.7%) patients having tumors larger than 3 cm. Among the cases studied, 117/151 (77.4%) patients had a single tumor, while the remaining patients had multiple tumors ranging in size from 5 to 7 cm in aggregate. Ablation took 1.57 ± 0.73 h to complete on average. None of the patients required a conversion to TURBT in 151 patients. No obturator reflexes or bladder perforations were observed in any case. Postoperatively, histopathology results showed 53/151 (35%) and 92/151 (60.9%) high- and low-grade tumors. The average catheterization duration was 6.58 ± 1.47 days. Tumors located on difficult sites, such as the anterior wall, lateral wall, and bladder neck, were ablated with ease. There was no recurrence seen on previously tumor ablated sites till 12-month follow-up. Conclusion Ablation of bladder tumors of any type using single- or dual-wavelength diode laser (980 nm and 980/1470 nm) is safe and feasible. These lasers possess the capability to effectively ablate/coagulate bladder tumors in challenging anatomical locations including diverticular tumors with minimal difficulty.

Management of T1G3 Transitional Cell Carcinoma of Urinary Bladder with Intravesical Bacillus Calmette-Guerin (BCG): Our Experience

Aim: To determine efficacy of BCG in T1G3 urinary bladder tumors at department of urology Chandka Medical College Larkana. Patients and Methods: This is retrospective study, patient were selected from hospital record from July 2016 to June 2022. Around 80 included in our study group who were treated in our department for management of high grade non-muscle invasive bladder tumor. After following inclusion and exclusion criteria TURBT were performed and BCG was installed intravesically for induction and maintenance purpose. Patients were followed for 5 years and data was collected on study specific proforma. Results: 80 patients were included in our study with mean age 35year +5.5 SD. Transurethral resection of urinary bladder tumor was performed in all patients with bladder growth. Induction and maintenance instillation of bacillus Calmette-Guerin (BCG) therapy was given to all. The recurrence was noted in 5 patients (6.25%) and the progression was also seen in these 5 patients (6.25%). Disease-specific survival is 93.75% at the follow-up of 5 years. As prevalence of ca bladder is increasing day by day and bladder is sole organ for storing urine so nowadays strategies of treatment is bladder saving surgery. So patient will feel comfortable with natural bladder and on other hand it will minimize complication related to artificially generated urinary bladder. Conclusion: Maintenance BCG therapy for T1G3 bladder tumors is an effective treatment, with satisfactory results and bladder preservation. Keywords: Ca bladder, intravesival chemotherapy, BCG, T1G3 and management.

Pilot study on quantifying the epithelial/mesenchymal hybrid state in the non-muscle invasive and muscle invasive bladder tumors: A promising marker of diagnosis and prognosis

BackgroundManifestation of epithelial-to-mesenchymal transition (EMT) program in tumor cells is associated with the occurrence of multiple intermediate phenotypic states namely epithelial (E), mesenchymal (M) and hybrid E/M across the epithelial-mesenchymal spectrum and these states exhibit different invasive properties. Understanding the cellular and molecular mechanisms defining the E/M hybrid state of the cells during bladder tumor development may significantly aid in the identification of novel diagnostic and prognostic markers. Materials and methodsThe present study is taken up to identify hybrid E/M score based on the immunohistochemical localization and surface expressions of epithelial proteins [E-cadherin and Beta-catenin] and mesenchymal marker proteins [N-cadherin and Vimentin] on formalin fixed paraffin embedded tumor sections of the prospective series of 99 non-muscle invasive bladder cancer (NMIBC) and 87 muscle invasive bladder cancer (MIBC) patients. E/M score was then statistically examined with patients’ demographics to assess its potential in the diagnosis and prognosis of UCB patients. ResultsAmong the E (E-cadherinhigh, β-cateninhigh), hybrid E/M (E-cadherinlow, β-cateninlow, N- cadherinhigh and Vimentinhigh) and M (N-cadherinhigh and Vimentinhigh) phenotypes, E/M phenotype was observed to be more prevalent in MIBC compared to E phenotype in NMIBC subtype. The current study reports the statistical association of tumor stage and tumor grade with the hybrid E/M state of urothelial tumor cells across both the subtypes. Hybrid E/M phenotype in MIBC patients was significantly shown to lower the overall survival time period compared to NMIBC patients. This supports the contribution of hybrid E/M state of tumor cells to the.aggressiveness of the disease. ConclusionsCharacterizing the hybrid E/M state instead of all or none phenotype becomes an imperative to understand the dynamics of EMT and MET in the tumor pathophysiology of NMIBC and MIBC subtypes, and could contribute to better patient stratification and therapeutic strategies.

International Bladder Cancer Group Intermediate-risk Non-muscle Invasive Bladder Cancer (IBCG IR-NMIBC) Scoring System Predicts Outcomes of Patients on Active Surveillance.

To determine if the International Bladder Cancer Group (IBCG) intermediate risk (IR)-NMIBC scoring system can predict the requirement of delayed transurethral resection of bladder tumor (TURBT) in low grade (LG) non-muscle invasive bladder cancer (NMIBC) managed by active surveillance (AS). A prospective study of recurrent LG Ta/T1 NMIBC patients managed with AS with the following characteristics were used: LG papillary NMIBC, ≤5 apparent LG NMIBC, tumor diameter ≤1 cm, absence of gross hematuria and negative urinary cytology. Subsequent TURBT was offered to patients who no longer met the inclusion criteria or patient choice. The ability of the IBCG IR-NMIBC scoring system to predict receipt of subsequent TURBT was determined. Multivariable Cox proportional-hazards analysis was used to determine factors associated with subsequent TURBT. A total of 163 patients with LG Ta/T1 NMIBC were included for analysis. After a median follow-up of 33 months (21-46), TURBT was performed on 109 patients. At landmark timepoint of 24 months, patients with 0 RF factors were over two-fold more likely to continue AS compared to patients with ≥3 RF (59% versus 24%). Multivariable Cox regression suggest that the IBCG IR-NMIBC scoring system was associated with subsequent TURBT (1-2 RF [HR: 1.66, 95% CI: 0.96-2.90, P = .072], ≥3 RF [HR: 3.21, 95% CI: 1.70-6.09, P < .001]) after adjusting for age, T-stage and sex. The IBCG IR-NMIBC scoring system can predict the risk of a subsequent TURBT in patients with LG NMIBC on AS.

A systematic review of the efficacy of intravesical electromotive drug administration therapy for non-muscle invasive bladder cancer.

Non-muscle invasive bladder cancer (NMIBC) is characterized by a high rate of recurrence and progression, despite surgery and adjuvant therapies. To analyze the published results on the effectiveness of mitomycin C (MMC) applied with an electromotive drug administration device (EMDA) in the treatment of patients with non-muscle invasive bladder tumors. A systematic review was conducted using the PubMed and Google Scholar search platforms. We selected the studies that included the recurrence and/or progression rates or complete response rate in patients diagnosed with NMIBC according to their treatment and included MMC applied with EMDA. The last search was performed in November 2021. The search yielded 64 articles; 11 articles met the selection criteria. In two of the 11 selected articles, mitomycin C was applied with an EMDA device (MMC-EMDA) as an ablative treatment, avoiding surgery in 50% of the patients. In 1 of the 11 studies, the application of MMC-EMDA was used as an induction treatment using a single preoperative instillation with promising results. In the remaining 8 studies, adjuvant MMC was applied with the EMDA device; in 3 of these 8 cases, treatment with MMC-EMDA alone was applied initially. In another3 cases the same treatment was applied after nonresponse to bacillus Calmette Guerin (BCG), and in the last 2 studies, MMC-EMDA was applied in combination with the classic therapy (BCG). All the studies selected supported the efficacy and safety of MMC-EMDA in patients with intermediate and high- risk bladder cancer. In 3 studies, adjuvant therapy with MMC-EMDA was performed in nonresponders to BCG, finding that adjuvant therapy with MMC-EMDA applied to BCG nonresponders without CIS avoided or delayed surgery. The application of EMDA-enhanced MMC has been studied at different times of disease and with different administration protocols. It appears to delay bladder tumor recurrence and progression in certain populations. However, the methodological limitations of the published studies prevent definitive conclusions about its efficacy.

Development of a predictive model for optimizing the selection of patients for second transurethral resection bladder

Background: Transurethral resection of bladder (TURB) is considered the gold standard treatment of non-muscle invasive bladder tumor (NMIBT). The urological clinical practice guidelines recommend second-TURB (re-TURB), in certain situations, to achieve a complete resection and appropriately stratify the tumor. Objective: To design a predictive model of residual tumor in re-TURB, to optimize patient selection and avoid unnecessary surgeries. Methods: Retrospective analysis of 413 NMIBT with a macroscopically complete TURB and identification of the muscle layer, with subsequent re-TURB (2-6 weeks), according to EAU Clinical Guidelines criteria, from January 2010 to December 2021. We have identified predictive variables of residual tumor through univariate and multivariate analysis using logistic regression. The evaluation of the exactitude of the predictive model has been made using AUC (area under curve-ROC curve). Results: Median age in the series was 74 (38-91) years old, and 86.7% were male. Tumors that required second-TURB were mostly primary (64.6%), stage T1 (84.5%), high grade (82.6%), multifocal (54.8%) and with a size less than 3 cm (73.1%). Residual tumor was found in 28.1% of re-TURB. The independent predictors factors of residual tumor identified were: recurrence tumor (OR 1.87; IQ 1.14-3.06, p=0.01) and multifocality tumors (OR 2.11; IQ 1.31-3.4; p=0.002). High-grade shows a trend to statistical signification as risk factor (p=0.07) and early administration of mitomycin-C behaved as an independent protector factor (OR 0.40; IQ 0.3-0.81; p=0.006). The predictive model shows an AUC=0.7 (IQ 0.62-0.73; p=0.0001). Conclusion: Our predictive model evaluates the probability of finding residual tumor in second-TURB with a 70% accuracy. This way, we could optimize the selection of patients in low risk of residual tumor, thus avoiding unnecessary surgeries.

Evaluation of Dynamic Thiol/Disulfide Homeostasis in Patients with Non-Muscle Invasive Bladder Tumor

Evaluation of Dynamic Thiol/Disulfide Homeostasis in Patients with Non-Muscle Invasive Bladder Tumor

BCG shortage for intravesical instillation is associated with early tumoral recurrence in patients with high-risk non-muscle invasive bladder tumours

IntroductionDuring 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective was to analyze the impact on tumoral relapse secondary to BCG shortage in our center. Secondary outcomes included recurrence and progression–free survival rates and tumoral relapse specific characteristics. MethodsRetrospective cohort study including 158 subjects (64 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG in a tertiary hospital in Spain.Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated with Kaplan–Meier survival analysis. Disease-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. ResultsMedian follow-up in the 2019 sample was 24 months and 50 months in the 2017 group with a median number of instillations of 8 and 12 respectively. Median time to relapse of 285 days (145–448) during 2019 and 382 days (215–567) in 2017 were observed (logRank p = 0.025). Further multivariable analysis revealed a proportional hazard ratio (HR) for disease-free survival rate of 1.87 (95% CI: 1.04–3.37 p = 0.036). No statistically significant differences in tumoral relapse characteristics were observed. ConclusionBCG shortage and subsequent reduced-dose schemes used for intravesical instillation due to limited availability, increase early tumoral relapse rates. These findings are consistent with available evidence, showing the need for full-dose BCG courses.

Quality of life in patients with non-muscle invasive bladder tumor undergoing adjuvant intravesical treatment

IntroductionThe objective of the study was to establish a possible relationship between mitomycin-C (MMC) and bacillus Calmette-Guérin (BCG) treatments and quality of life impairment. Material and MethodsQuasi-experimental, prospective, and longitudinal study including patients undergoing adjuvant treatment in NMIBC. The Short form-12 (SF-12) and Urogenital Distress Inventory-6 (UDI-6) questionnaires were used to measure quality of life. Questionnaire scores were compared between cases with MMC and BCG before induction (M1), at 4 weeks (M2) and at 2 months (M3). ResultsOf the 90 patients enrolled, 54 were in the BCG group and 36 in the MMC group. It was found that BCG patients had worse perceived physical quality of life compared to MMC patients in M2 (OR:2.59, p=0.046). In addition, significant changes were found in the urinary quality of life of patients on MMC treatment between the different time points (UDI-6 score: 33.33 in M1, 27.78 in M2 and 16.67 in M3, p=0.001). ConclusionsThere are no differences in urinary quality of life between patients treated with MMC and BCG. Patients with MMC show a significant recovery of urinary quality of life from the completion of the induction course, which becomes even more significant after 2 months. In addition, BCG-treated patients have worse physical quality of life after 4 weeks of treatment than those treated with MMC.

Urinary Cotinine: A Promising Marker of Recurrence of Non-muscle Invasive Bladder Tumor

Introduction and objectives: Nicotine is well known to be an addictive compound of tobacco, but it is not primarily carcinogenic. It is metabolized to cotinine, which is considered the best marker of tobacco exposure. Little is known whether recurrence rate of bladder cancer is related to nicotine metabolites eliminated in urine. We aim by this study to evaluate the relation between urinary cotinine level and the recurrence of bladder cancer. Materials and Methods: Between January 2018 and June 2022, a cross sectional study was conducted. Enrolled patients were smokers already diagnosed with non-muscle invasive bladder cancer, treated by resection only, and presenting for a follow up cystoscopy. Included patients had unchanged smoking habits in the day before the procedure, same ethnicity (Caucasians) and no additional professional exposure. Cotinine level was measured on a sample of voided urine before cystoscopy. Tumor recurrence was considered positive independently from the histological type, and was assessed by direct vision cystoscopy. Patients were considered moderate or heavy smokers depending on the level of cotinine in their urine samples (&lt; or &gt; 550 ng/ml respectively). A Fisher Exact Test was used to assess the relationship between variables. Results: A total of 135 patients was included. Mean age was 64 years (range 36 to 78). The mean duration of smoking was 30.3 years. Urinary cotinine level was &gt; 550 ng/ml in 80 patients (59.26%) and &lt; 550 ng/ml in 55 patients (40.74%). Recurrence was identified in 70 patients (51.85%) and was absent in the remaining 65 (48.15%). Recurrence was observed in 68.75% of the heavy smokers and in 27.27 % of moderate smokers. Cotinine level higher than 550 ng/mL was linked to an increased risk of bladder cancer, with a relative risk of 4.16 (p-value &lt; 0,025). Conclusion: High urinary cotinine levels (&gt;550 ng/ml) conveys a 4 folds’ risk for the recurrence of bladder cancer in smokers. Additional prospective studies are needed to better understand the relation between urinary cotinine levels and bladder cancer, and its usefulness in bladder cancer surveillance.

Long-term effect of transurethral partial cystectomy with a 2-micrometer continuous-wave laser for non-muscle-invasive bladder cancer.

We have reported the efficacy and safety of 2-micrometer continuous-wave laser cystectomy of non-muscle invasive bladder tumor (NMIBC) (J Urol. 2009;182:66-9). In this study, we evaluated the long-term outcomes of patients with NMIBC who underwent transurethral partial cystectomy with a 2-micrometer continuous-wave laser, and explored the risk factors for tumor recurrence. This was a retrospective study of patients with NMIBC planned to undergo transurethral partial cystectomy with a 2-micrometer continuous-wave laser at the Fourth Medical Center of the PLA General Hospital between January 2012 and December 2014. The primary outcome was bladder cancer recurrence. A total of 75 patients were enrolled. Sixty-two (82.7%) were male. The patients were 59.8 ± 12.9 years of age. The mean operation time was 38.7 ± 20.4 min. No Clavien grade >2 complications occurred. The duration of catheter indwelling was 3.6 ± 1.8 days. The hospital stay was 6.0 ± 2.3 days. The median follow-up was 80 months. A total of 17 patients had a recurrence during follow-up, and the recurrence-free survival (RFS) rate was 77.3%. In the multivariable analysis, the tumor risk group were independently associated with the recurrence of NMIBC (p = 0.026). After TURBT with a 2-micrometer continuous-wave laser, RFS was 77.3% at the median follow-up of 80 months. All complications were mild. Only tumor risk group was independently associated with the recurrence of NMIBC.

Role of preoperative neutrophil to lymphocyte ratio in prediction of recurrence, progression, and BCG failure in non-muscle invasive bladder cancer: a retrospective study.

neutrophil/lymphocyte ratio (NLR), as a biomarker of the systemic inflammatory response, has been studied for diverse tumors. Our study aims to determine whether the NLR can be reliably used as a tool to predict disease course in patients diagnosed with primary non-muscle invasive bladder tumors (NMIBC). a retrospective study between 2009 to 2014 was conducted on 300 patients newly diagnosed with NMIBC at our institution. The cut-off value of NLR was set at 2.5. Survival curves were compared using the log-rank test. The association between recurrence, progression, and NLR was assessed univariate, and the prognostic significance of high NLR was assessed using multivariate analysis. one hundred and seventy-five patients had an NLR <2.5 and 125 patients had an NLR ≥ 2.5. The survival rate with recurrence at 5 years was higher in the group with an NLR >2.5 (p<0.001, 35 vs 18 months), similarly, the survival rate with progression at 5 years was higher in the group with an NLR > 2.5 (p=0.001, 36 vs. 27 months). The failure rate of immunotherapy using BCG was higher when the NLR was over 2.5. In a multivariate analysis, the factors associated with recurrence were NLR>2.5 (HR=2.03, 95% CI=1.32-3.11, p=0.001), pathologic stage pT1 (HR=2.42, 95% CI=1.52-3.85, p=0.001), high-grade (HR=1.76, 95% CI=1.52-3.92, p=0.01), concomitant CIS lesions (HR=2.31, 95% CI=1.36-3.92, p=0.001), presence of lymphovascular emboli (HR=5.77, 95% CI=1.77-18.78, p=0.004), and BCG immunotherapy failure (HR=5.29, 95% CI=2.88-9.70, p=0.001). With regard to progression, in a multivariate study, the significant factors were NLR>2.5(HR=2.91, 95% CI=1.17-7.23, p=0.01), BCG immunotherapy failure (HR=5.68, 95% CI=3.16-10.22, p=0.001), and the presence of lymphovascular emboli (HR=5.01, 95% CI=1.50-16.05, p=0.001). preoperative NLR value could predict recurrence, progression, and failure of BCG immunotherapy in NMIBC patients.

Initial experience with surrounding en bloc transurethral resection of bladder tumor and simultaneous intravesical treating for non-muscle invasive bladder cancer

PurposeThe high recurrence rate after traditional transurethral resection of bladder tumor (TURBT) remains a challenge for management of non-muscle invasive bladder tumor (NMIBC). The aim of this study was to evaluate feasibility, efficacy and safety of surrounding en bloc resection using a general wire bipolar loop electrode and simultaneous intravesical chemotherapy.MethodsWe retrospectively analyzed data of 111 consecutive patients with NMIBC treated from June 2018 to December 2021. These patients underwent conventional TURBT and immediate intravesical chemotherapy (n = 45) or surrounding en bloc TURBT and simultaneous intravesical chemotherapy in the Urology Department of Harbin Medical University Cancer Hospital, The former and latter were defined as the conventional TURBT group and the surrounding en bloc TURBT group, respectively. All patients were followed up from 6 to 40 months, with an average of 24 months. Demographic characteristics, location and number of tumors, perioperative and postoperative data, pathological results and recurrence were documented.ResultsThere were no significant differences in clinicopathological data between the conventional TURBT group (n = 45) and the surrounding en bloc TURBT group (n = 66). Operative time and complications associated with TURBT were comparable in the two groups. Recurrent tumors were found during follow-up in 2 (3.0%) of 66 patients in the surrounding en bloc group and 9 (20%) of 45 patients in the conventional group (p < 0.05). Lower urinary tract symptoms developed in 2 (3.0%) of 66 patients after surrounding en bloc TURBT and in 11(24.4%) of 45 patients after conventional TURBT (p < 0.05).ConclusionSurrounding en bloc TURBT and simultaneous intravesical chemotherapy might significantly decrease the recurrence rate of NMIBC, and showed favorable safety and tolerability profiles. The general bipolar loop electrode was appropriate to complete the procedure.

The use of natural killer cell activity and PPD test in the prediction of results in intravesical BCG treatment of patients with nonmuscle-invasive bladder cancer.

To predict the efficacy of intravesical BCG therapy in patients with nonmuscle-invasive bladder tumors (NIBC) by using components of the cellular immune response such as the tuberculin skin test (PPD) and natural killer (NK) activity measurement. Ninety-nine patients who were started on intravesical BCG therapy for NIBC were evaluated prospectively. Patients who were included in the intermediate, high, and very high-risk groups according to the EAU NMIBC Scoring System and who had never received intravesical BCG therapy previously were included. The clinical and demographic characteristics of the patients (age, gender, EAU NMBIC risk group, EORTC progression and recurrence scores, CUETO progression and recurrence scores, presence and types of comorbidity) were recorded. NK activity was measured and the PPD test was applied 3days before the start of intravesical BCG therapy. The results of PPD were measured in millimeters 72h after the test. PPD values measured before BCG treatment, as an independent variable, were found to be significantly lower in patients with recurrence. A significant correlation was detected between NK activity results obtained before BCG treatment and recurrence after treatment, when the cutoff was 200-500pg/dl. There was no significant relationship between the time to recurrence and PPD and NKA measurements. We conclude that the results of PPD test and NK activity measurement performed before starting intravesical BCG therapy in NIBC may be a marker that can be used to predict the risk of recurrence under treatment.

The prognostic impact of tumor necrosis in non-muscle invasive bladder cancer.

We aimed to investigate the impact of tumor necrosis in non-muscle invasive bladder cancer on patients' recurrence and progression rates and survival outcomes. This study was conducted retrospectively in a single tertiary center in Turkey. Medical records of patients who underwent transurethral resection of the bladder tumor between January 2016 and January 2021 were reviewed. Patients with pTa and pT1 non-muscle invasive bladder cancer who had undergone complete resection were included in our study. All pathological specimens were reevaluated for the presence of tumor necrosis. A total of 287 patients (244 males and 43 females) were included in our study. Of them, 33 (11.5%) patients had tumor necrosis. The rates of multiple and large tumors (>3 cm) were higher in patients with tumor necrosis (p=0.002 and p<0.001, respectively). Tumor necrosis was associated with higher rates of pT1 diseases (p<0.001), high-grade tumors (p<0.001), and the presence of lymphovascular invasion (p=0.007). The mean recurrence-free survival of patients with tumor necrosis was 42.3 (4.6) months, and the recurrence-free survival of patients without tumor necrosis was 43.5 (1.8) months (p=0.720). The mean progression-free survival of patients with tumor necrosis was 43.1 (4.6) months, and the progression-free survival of patients without tumor necrosis was 58.4 (0.9) months. In log-rank analysis, there was a statistically significant difference between patients with and without tumor necrosis in terms of progression-free survival (p<0.001). In this study, we demonstrated that patients with non-muscle invasive bladder cancer and tumor necrosis in pathological specimens have shorter progression-free survival and more adverse pathological features.

Outcome of Post-resection Intravesical BCG and Mitomycin C Therapy on Non-muscle Invasive High- Grade Transitional Cell Carcinoma of Urinary Bladder

Objective: This study aimed to compare the outcome of postoperative intravesical BCG and Mitomycin C therapy on non-muscle invasive high grade superficial bladder tumor. Methods: This prospective quasi experimental study was carried out among the patients with non-muscle invasive high grade transitional cell carcinoma (TCC) of urinary bladder, who underwent complete transurethral resection of bladder tumor of primary tumor attended at the urology department of DMCH, during March 2017 to August 2019. After pre-operative evaluation and counselling, 70 patients with histologically documented high grade superficial bladder tumor were included and divided in two groups. We instilled intravesical BCG in one group and Mitomycin C (MMC) therapy in other group. The patients were followed up at 3rd ,6th , 9th , 12th and 18th month. Results: The mean age of BCG group was 55.8 years while 60.2years in MMC group with majority between 45 to 65 years (&gt;80%). Sex distribution in both groups were almost equal (p=0.062). There were equal number of TaG3 and T1G3 disease in each group (p=0.809). Local adverse reactions were significant in BCG group (p= 0.016), among them UTI, between two groups, was statistically significant (p=0.039). Incidence of hematuria (p=0.324), voiding frequency (p=0.163) and local rash (P=0.642) had no statistically significant difference. The incidence of post-instillation systemic adverse reactions between two groups were statistically significant (p=0.034). Fever (p=0.028) was significant among them. Intavesical BCG was significantly more effective than MMC in terms of disease recurrence (p=0.047) and progression (p=0.008). Conclusions: We analysed the efficacy and safety of intravesical BCG and MMC in two groups, showing that BCG was more effective in terms of disease recurrence and progression but local and systemic side effects were higher in BCG group. Bangladesh J. Urol. 2021; 24(1): 62-71

Frequency of Complications Post-Intravesical BCG Instillation in Patients with Superficial Urinary Bladder Carcinoma

Objectives: To analyze patients who underwent intravesical BCG instillation for non-muscle invasive bladder tumor and to determine the frequency of complications after intravesical BCG instillation. Study Design: Cross-sectional study. Place and Duration of Study: Departments of Urology and General Surgery, Pakistan Ordinance Factories Hospital Wah Cantt from 1st January 2019 till 31st December 2020. Methodology: Fifty patients; Results: The mean age was 57.06±7.93 years. Forty two patients (84%) were male and 8 patients (16%) were female. Four patients (8%) were Ta stage, 34 patients (68%) were Tis stage and 12 patients (24%) were T1 stage. Mean time interval between TURBT and BCG instillation was 28.68±5.07 days, mean number of BCG instillation cycles was 6.80±2.06 days. Ten (20%) patients had urinary tract infection, 19 (38%) patients had bladder TB, 9 (18%) patients had BCG sepsis, 5 (10%) patients had miliary TB, 2 (4%) patients had epidimo-orchitis, 2 (4%) patients developed ophthalmic complications, 1 (2%) patient had polyarthralgia, 1 (2%) patient had septic arthritis and 1 (2%) patient developed spinal Conclusion: Bacillus Calmette-Guérin is most commonly used drug as chemotherapeutic agent for superficial bladder tumors after TURBT. Repeated cycles of BCG i.e. 6-12 cycles have been administered to patients. Previously most of symptoms i.e. LUTS, dysuria, hematuria were being associated with presence of tumor but now many case reports and few studies have associated these symptoms with BCG administration. Keywords: Superficial bladder carcinoma, Intravesical BCG, Lower urinary tract symptoms

The value of surgeon's perception during transurethral resection of bladder tumors: can we trust in our eyes and experience to predict grade and staging?

Background:Transurethral resection of newly diagnosed bladder tumors (TURBT) is a hallmark ¡n the treatment of bladder cancer. We evaluated the surgeon capacity to predict bladder tumor stage (T), grade, and presence of muscular layer based upon cystoscopic characteristics during primary TURBT.Methods:Prospective study enrolling 100 consecutive patients undergoing primary TURBT for newly diagnosed bladder cancers. Cystoscop¡c tumor characteristics at the time of TURBT was evaluated by an urology senior and a resident regarding histological grade, invasion (T stage), and presence of muscular layer in the specimen. We analyzed the surgeon’s accuracy in predicting these parameters using the final histology as gold standard. In addition, the predictive capacity between seniors and residents was compared.Results:The resident’s arm correctly predicted tumor invasiveness in 76% of cases, while seniors correctly predicted 87% of cases. Regarding tumor grade, high grade cancer was reported in 78% of the specimens and 75% and 77% of them were correctly predicted by residents and seniors, respectively. Finally, 80% of the TURBT specimens had muscle representativeness. In nearly 75% of the cases, both resident and senior correctly predicted the TURBT resection depth (presence of detrusor muscle in the specimen). The positive predictive value for this parameter was 79% for the resident, and 81% for the senior, and the negative predictive value was 25% and 40%, respectively.Conclusion:The surgeon’s naked eye analysis showed a good, but limited predictive ability to detect non-muscle invasive and high-grade bladder tumors in TURBT specimens. Positive predictive value for muscle representativeness is around 80%, which reinforces the need of carrying out a careful and extensive TURBT, irrespective of the surgeon experience.