Superficial Transitional Cell Carcinoma Research Articles

Granulomatous Cholangitis as a Complication of Intravesical BCG Administration for Bladder Cancer

Intravesical instillation of Bacillus Calmette-Guerin (BCG) remains a first-line treatment for superficial transitional cell carcinoma of the bladder. Although uncommon, clinicians should be aware of major adverse effects and complications resulting from intravesical BCG therapy in order to promptly arrive at the diagnosis and initiate therapeutic measures. Herein, we describe a patient who presented with findings suggestive of acute cholecystitis and cholangitis. He was started on antibiotics and underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) with sphincterectomy and stent placement. However, his liver function tests remained abnormal. Further inquiry delineated a history of bladder cancer treated with intravesical BCG instillation. A liver biopsy obtained during laparoscopic cholecystectomy confirmed granulomatous cholangitis. The patient received anti-tuberculous therapy and a tapering course of corticosteroids with a successful outcome.

Cancer stroma proteome expression profile of superficial bladder transitional cell carcinoma and biomarker discovery

To globally characterize the stroma expression profile of superficial bladder transitional cell carcinoma and to discuss the cancer biology as well as biomarker discovery from stromal cells. Laser capture microdissection was used to harvest purified bladder cancer stromal cells and normal stromal cells from 4 paired samples. Next, two-dimensional liquid chromatography-tandem mass spectrometry was used to identify the proteome expression profile. The differential proteins were further analyzed using bioinformatics tools and compared with the published literature. A total of 606/601 proteins commonly appeared in 4 paired samples. Six hundred and thirty-seven proteins were differentially expressed between cancer and normal stroma. Among them, 321/316 proteins specific expressed in cancer/normal stromal cells. Differential proteins were compared with the entire list of the international protein index (IPI). 36/49 GO terms exhibited as enriched and 25/14 exhibited as depleted in biological process; 39/40 GO terms exhibited as enriched and 9/4 exhibited as depleted in cellular component, respectively. Significantly altered pathways between cancer/normal stroma mainly include focal adhesion, EHEC, oxidative phosphorylation, glycolysis/gluconeogenesis, TCA cycle. Finally, descriptive statistics show the data that PI≤8 have normal distribution and the proteins with extremes of PI and MW have the same probability to be a biomarker. The present study identified the proteome expression profile of bladder cancer stromal cells and normal stromal cells. Furthermore, our results confirm proteins origin from stroma play important role in cancer biology and highlight a novel view of cancer and stress the importance of including factors related to the cancer stroma into biomarker discovery.

Attenuated but live: a pelvic abscess caused by bacille Calmette-Guerin

A 64-year-old man presented with a three-week history of a tender suprapubic mass. His medical history included superficial (stage T1) transitional cell carcinoma of the bladder for which he had undergone transurethral resection of the tumour 10 months earlier. At the time of surgery, he had

Mycotic aneurysm of the aorta as a complication of Bacillus Calmette-Guérin instillation

Bacillus Calmette-Guérin (BCG) is a live attenuated strain of Mycobacterium bovis that has been widely used for the treatment of superficial transitional cell carcinoma of the bladder. We describe a rare case of supra-renal mycotic aortic aneurysm secondary to BCG instillation in a 75-year-old male. Patients presenting with systemic symptoms post-instillation, possibly with an aneurysm, should raise suspicion of BCG dissemination, which requires early instigation of anti-mycobacterial drugs.

Two Case Reports on the Use of Genistein Combined Polysaccharide (GCP) Against Bladder Cancer Recurrence

We followed two subjects with resected stage Ta superficial transitional cell carcinoma (TCC) of the bladder who had not received intravesicle bacillus Calmette-Guerin (BCG) and received supplementation with the agent Genistein Combined Polysaccharide (GCP) in an IRB approved study. The observation period was 12 months for both cases. After the yearly oral dosage of GCP, there was no recurrence in either of the subjects as determined by cytoscopy, urine cytology, and fluorescence in-situ hybridization analysis of urine (UrovysionTM FISH Assay). The intravenous pyelogram (IVP), obtained at baseline and after 12 months, was also negative. There were no adverse events over the course of treatment and had full patient compliance and tolerability of the GCP agent in both cases.

Interaction between fibronectin-bearing surfaces and Bacillus Calmette-Guérin (BCG) or gelatin microparticles.

Gelatin, prepared commercially by degradation of animal collagen, was studied to see whether it had an affinity for fibronectin, which has a known affinity for collagen, and whether gelatin-based drugs could be used to target fibronectin-excreting tumours. Bacillus Calmette-Guérin (BCG) vaccine, an attenuated strain of Mycobacterium bovis, is currently the most effective treatment for superficial transitional cell carcinoma of the bladder. The living cells of the BCG vaccine associate with the fibronectin-bearing surfaces of the tumour. Using a multi-well culture plate technique, gelatin microparticles were shown to be adsorbed onto murine S180 sarcoma cells and this reaction was substantially inhibited by the addition of human plasma fibronectin. The avidities of various BCG substrains and gelatin microparticles for glass-bound fibronectin were measured and the association constants determined. The gelatin microparticles associated with the fibronectin with equal avidity as the BCG cells. The results suggest that this model system may allow the investigation of gelatin-based drug delivery devices capable of targeting fibronectin-bearing surfaces associated with some tumours.

TGF-B1 pathway as biological marker of bladder carcinoma schistosomal and non-schistosomal

ObjectivesStudy TGF-β1 pathway in bladder carcinoma. Design and methodsEighty-one patients were enrolled: 16 chronic cystitis and 60 malignant bladder lesions; 15 schistosomal squamous cell carcinoma (SQCC), 45 transitional cell carcinoma (TCC). Five healthy individuals served as controls. mTGF-β1, protein, and its receptor expression in urine and bladder tissue were measured using in situ hybridization and immunohistochemical techniques, respectively. ResultsOverexpression of TGF-mRNA in invasive TCC group was compared with superficial TCC, high grade TCC was compared with low grade, and SQCC was compared with TCC. TGF-β1 protein and its receptor I (TGF-βR1) were overexpressed in urine samples in malignant group compared with chronic cystitis and in SQCC group compared with TCC group. TGF-ß1 protein and its receptor were significantly increased in schistosomal malignant group compared with non-schistosomal group. ConclusionExpression of TGF-ß1 and TGF-ßR1 could be used as biological markers of bladder carcinoma.

V861 LAPAROSCOPIC TRANSVESICAL URETERIC RESECTION AND RE-IMPLANTION

You have accessJournal of UrologyReconstruction, Transitional Cell Carcinoma & Adrenal1 Apr 2011V861 LAPAROSCOPIC TRANSVESICAL URETERIC RESECTION AND RE-IMPLANTION Philippe Grange, Amrith Rao, Davinder Sharma, Christian Brown, and Angelika Zang Philippe GrangePhilippe Grange London, United Kingdom More articles by this author , Amrith RaoAmrith Rao London, United Kingdom More articles by this author , Davinder SharmaDavinder Sharma London, United Kingdom More articles by this author , Christian BrownChristian Brown London, United Kingdom More articles by this author , and Angelika ZangAngelika Zang London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.683AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Segmental excision and ureteric re-implantation is an accepted surgical option for benign stricture or localised transitional cell carcinoma (TCC) affecting the lower 1/3rd of the ureter. Most often, the operation is performed by an open approach, but increasingly laparoscopic approach is favoured because of the obvious advantages. One of the difficulties with the laparoscopic approach is dealing with the ureteric orifice & the intra-mural part of the ureter. Although we have performed this technique for benign ureteric strictures, this particular video is about a 62 year old lady with recurrent high-grade superficial TCC in the right lower ureter. With this high definition video, we demonstrate a transvesical laparoscopic lower ureteric excision and re-implantation. METHODS With the patient in lithotomy position, ureteroscopy is performed to look at the length that requires excision. Cystoscopic dismembering of the intramural ureter is carried out upto the perivesical fat using a Collin's knife. The bladder is then distended using the gas insufflation connected to the urethral catheter. A 10 mm VisiportTM along with the camera allows access to the bladder under direct vision. Further two 5 mm ports were inserted under the camera guidance. Bladder was also suspended using two percutaneous stitches, which allowed sufficient working space. Entire operation was performed with gas insufflation of the bladder. Ureter is mobilized further till the desired length of excision. A neo-orifice is created distally and the ureter is brought through this opening into the bladder. The site of the old ureteric orifice is then closed. The diseased distal segment is useful to manipulate the ureter and spatulation is carried out. The ureter is then anchored to the neo-orifice using interrupted sutures. The diseased segment is excised and retrieved urethrally. The guide-wire is passed via the urethra and directed into the ureter. JJ stent is subsequently inserted. RESULTS The total operative time was 180 minutes with blood loss < 50 mL. There were no intra- or post-operative complications. The in-hospital stay was 3 days. The patient was discharged home with a urethral catheter on free drainage, which was removed in 2 weeks after cystogram showing no evidence of leak. At the last follow-up ureteroscopy and multiple biospies, there was no evidence of stricture or disease recurrence. CONCLUSIONS We demonstrate in this video our technique of transvesical laparoscopic excision and ureteric re-implantation. We demonstrate that the short-term functional and oncological outcome is equivalent to the established open approach. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e345 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philippe Grange London, United Kingdom More articles by this author Amrith Rao London, United Kingdom More articles by this author Davinder Sharma London, United Kingdom More articles by this author Christian Brown London, United Kingdom More articles by this author Angelika Zang London, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Superficial bladder tumours: recurrence and progression.

To determine various presentations of superficial bladder cancer, its management, recurrence and progression rates. Case series. Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 2002 to December 2009. Patients with pathologically proven superficial transitional cell carcinoma (TCC) with minimal 2 years of follow-up were included. Their clinical presentations and management was recorded. Complete transurethral resection of bladder tumour (TURBT) was attempted in all patients. Tumour grading and staging was performed. Intra-vesical single instillation of Mitomycin-C was given postoperatively in selected patients. Cystoscopic surveillance was used to assess recurrence in all patients according to standard protocol. Metastatic work-up and biopsy record of follow-up TURBT was used to document progression in high risk patients. Results were described as simple descriptive statistics. A total of 92 patients were studied. The median age of patient was 62 years, with male preponderance (88%). Hematuria with lower urinary tract symptoms (LUTS) was most common presentation (47.8%), followed by hematuria alone (25.7%), LUTS alone (9.2%) and upper tract symptom in 1.8% of patients. Complete TURBT in first attempt was possible in 72 patients (78.3%). Multiple tumours were seen in 34 patients (39.6%). Intravesical mitomycin was given in 70% patients. Over-all recurrence rate of 68.4% was noted. Patients with TaG2-3 showed recurrence rate of 58.8% which occurred late with good recurrence free interval. T1G2-3 patients have more and early recurrences (80.4%). Progression seen in 13 patients (14%), 6 patients have up-grading, four showed stage progression, one developed pelvic lymphadenopathy and another one had bone metastasis. One female patient (TaG2) developed right renal pelvic recurrence and progression while her bladder disease was well controlled. The number of patients with T1 disease was 45% in this study which is comparatively higher than other studies. Early recurrences and progression were observed with T1G2-3, while late recurrence were seen with Ta disease, having tumour free interval between 6 months to 2 years. Early radical cystectomy was advised to T1G3 disease and with multiple recurrences, but patient's compliance was poor..

Co‐administration of intravesical bacillus Calmette‐Guérin and interferon α‐2B as first line in treating superficial transitional cell carcinoma of the urinary bladdera

• To evaluate the efficacy and toxicity of the combination of bacillus Calmette-Guérin (BCG) and interferon α-2B (IFNα-2B) in treating superficial bladder cancer (SBC). The mentioned combination has shown synergism in pre-clinical studies. • The present study is a single-arm, open-label, single-institution prospective trial. Patients with Ta, T1 or in situ carcinoma and no previous intravesical therapy were included between July 2002 and June 2009. • Patients were treated with weekly intravesical instillation of 27 mg of BCG mixed with 10 million units (MU) of IFNα-2B for six consecutive weeks followed by 3-weekly booster instillations at 3 months if there was no recurrence. • The primary endpoint was disease recurrence. Secondary endpoints were disease progression and toxicity. • Patients were followed-up with cystoscopy and urine cytology every 3 months. • In all, 50 patients were included. • At a median follow-up of 55.8 months, 31 (62%) patients were recurrence-free. • Progression to muscle invasion occurred in two (4%) and metastasis occurred in two (4%) patients. • Treatment was well tolerated, with grade III dysuria and frequency occurring in 18 and 14% of patients, respectively, and with 74% of patients being able to complete the maintenance dosage. • The combination of BCG and IFNα-2B in the patient population with SBC has similar efficacy and toxicity to BCG monotherapy.

Prognostic Value of Cyclooxygenase-2 Expression in Squamous Cell Carcinoma of the Bladder

Inflammation is associated with the pathogenesis of carcinoma, including squamous cell carcinoma of the bladder. Cyclooxygenase-2 is an enzyme that is induced at inflammation sites. We assessed the expression pattern of cyclooxygenase-2 in patients with squamous cell carcinoma of the bladder and determined whether cyclooxygenase-2 expression is associated with clinical outcomes after radical cystectomy. Immunohistochemical staining for cyclooxygenase-2 was done on archival bladder specimens from 152 patients treated with radical cystectomy for squamous cell carcinoma on the Autostainer (DakoCytomation, Carpinteria, California). Bright field microscopy imaging coupled with advanced color detection software was used. Cyclooxygenase-2 was defined as over expressed when greater than 20% cells were positive. We assessed the relationship of cyclooxygenase-2 expression with pathological parameters and clinical outcome. The study included 99 male and 53 female patients with a mean age of 52 years who had squamous cell carcinoma, including 80.9% with bilharziasis. Presenting stage was T2 or greater and presenting grade was GII or less in 93.4% of patients. Median followup was 63.2 months. Cyclooxygenase-2 was over expressed in 74 cystectomy specimens (48.7%) and associated with higher pathological stage (p=0.003) and grade (p=0.049). On multivariate Cox proportional hazards regression analysis cyclooxygenase-2 over expression was associated with disease recurrence (p=0.031) and bladder cancer specific mortality (p=0.046). Cyclooxygenase-2 over expression is associated with pathological stage, grade and worse outcomes after radical cystectomy, suggesting a role in bladder squamous cell carcinoma progression. Our findings support the need for further evaluation of cyclooxygenase-2 and inflammatory signaling pathways, and cyclooxygenase-2 targeted prevention or therapy in patients with bladder squamous cell carcinoma.

An analysis of the recurrence–progression process in bladder carcinoma by means of joint frailty models

Multiple sequential recurrences are one of the most important characteristics of superficial transitional cell carcinoma of the bladder, more than 50% of the patients will have recurrences (reappearance of a new superficial tumor). When in the same subject recurrent events are considered and these observed events are clustered into groups, independence between the clustered survival times cannot be assumed. A natural way to model the dependence of clustered event times is through the introduction of a cluster-specific random effect: the frailty term. On the other hand, between 10% and 30% of patients diagnosed with bladder carcinoma will present a muscle invasive progression, so the observation process of recurrences could be interrupted by a major failure event ( progression). In this regard, a joint modelling of the two processes could make the study of a joint evolution over time possible, giving unbiased and efficient parameters. We jointly analyze recurrences and progression processes by means of the joint frailty model.

Overexpression of BDNF and TrkB in human bladder cancer specimens

BDNF (brain-derived neurotrophic factor) and TrkB (tropomyosin receptor kinase B) are expressed in several tumor types. However, the existence of BDNF and TrkB in human bladder cancer, especially transitional cell carcinoma (TCC), has not been established. In this study, commercial TCC tissue arrays were used. Slides of paraffin-fixed human bladder tissues included all grades of TCC (13, 30 and 22 tissue samples in grade I, II and III, respectively), superficial and invasive TCC (31 and 34 tissue samples, respectively), paired malignancy-uninvolved urothelium (35 tissue samples) and normal urothelial tissues (12 tissue samples). The intensities of BDNF and TrkB immunostaining were graded as background, mild and strong (score as 0, 1 and 2, respectively). The results showed significantly overexpressed BDNF and TrkB in TCC samples compared to normal urothelium. According to grade assignment of TCC samples, BDNF in grade III and TrkB in grade I and III appeared to be overexpressed. BDNF and TrkB were overexpressed in superficial TCC samples according to staging classification. The score between the paired TCC and its uninvolved urothelium was not statistically different. In conclusion, the existence of overexpressed BDNF and TrkB in human TCC has been demonstrated in our study. A strategy involving BDNF/TrkB blockade may be a new hope for TCC target therapy.

Implication of RAF and RKIP Genes in Urinary Bladder Cancer

RKIP has been shown to regulate the RAS-RAF-MEK-ERK kinase cascade acting as modulator of apoptosis and metastasis in prostate cancer. Our goal was to examine the expression of the RAF (A-RAF, B-RAF and RAF-1) and RKIP genes in urinary bladder cancer. Microarray analysis and qPCR was employed to investigate the expression of RAF and RKIP, in 30 patients with transitional cell carcinoma (TCC) of the urinary bladder vs. the corresponding levels of adjacent normal tissue. Computational analysis was also performed on Gene Expression Omnibus (GEO) datasets, to unravel differences in the expression of RAF or RKIP between tumor and control samples, and between superficial and muscle invasive tumors. Microarray analysis revealed >2-fold expression of BRAF and RKIP in T2, T3, grade III tumors vs. controls. B-RAF over-expression was verified by qPCR in pT1, grade III tumors vs. their normal counterparts (p = 0.016). qPCR revealed a significant RKIP reduction in TCC vs. normal tissue (p = 0.002 and p < 0.001 for T1, grade II and Ta-T1, grade III, respectively); All RAF genes were positively correlated among each other (A-RAF/B-RAF, p = 0.003; A-RAF/RAF-1, p < 0.001; B-RAF/RAF-1, p = 0.050), whereas B-RAF was negatively correlated with RKIP in TCC (p = 0.050). Further computational analysis revealed different expression profiles for the genes of interest, among muscle invasive carcinomas, superficial TCCs, cystectomy specimens and normal tissue. The reduced RKIP mRNA levels in TCC and the elevated levels of B-RAF in pT1, grade III tumors vs. normal tissue, corroborate that these genes are involved in the pathogenesis of urinary bladder cancer.

Safety and Efficacy of Intravesical Bacillus Calmette-Guérin Plus Interferon α-2b Therapy for Nonmuscle Invasive Bladder Cancer in Patients With Prosthetic Devices

Patients with bladder cancer who have prosthetic devices, such as a cardiac pacemaker, artificial heart valve or orthopedic hardware, and who undergo intravesical bacillus Calmette-Guérin therapy are theoretically at higher risk for complications, including bacterial seeding of pacemaker wires or orthopedic hardware, and at further risk for infective endocarditis. We assessed the safety and efficacy of bacillus Calmette-Guérin plus interferon α-2b therapy in patients with nonmuscle invasive bladder cancer and a pacemaker, artificial heart valve or orthopedic hardware. We evaluated 1,045 patients with nonmuscle invasive bladder cancer enrolled in a multicenter American phase II trial of bacillus Calmette-Guérin plus interferon α-2b therapy, including 143 with a prosthetic device (pacemaker in 87, artificial heart valve in 13 and orthopedic hardware in 43). Weekly physician toxicity assessments and standard adverse effect reporting were done. No patient had infective endocarditis or hardware infection. One patient with a pacemaker, 2 with orthopedic hardware and none with an artificial heart valve required treatment cessation for fever greater than 102.5F. All defervesced within 24 hours and had no long-term sequelae. Due to intolerable, nonlife threatening side effects 12 patients with a pacemaker, 2 with orthopedic hardware and 1 with an artificial heart valve stopped treatment. Of the remaining patients with a prosthesis 99 and 24 stopped treatment due to intolerable, nonlife threatening and serious side effects, respectively. Patients with a pacemaker, artificial heart valve or orthopedic hardware were no more likely than the general population to have infection or fever, or discontinue treatment due to side effects. These patients should not be excluded from intravesical bacillus Calmette-Guérin plus interferon α-2b therapy for nonmuscle invasive bladder cancer.

Audit of safety, efficacy, and cost-effectiveness of local anaesthetic cystodiathermy

The aim of this study was to audit our experience of cystodiathermy under local anaesthetic (LA) at the time of flexible cystoscopy for recurrent superficial bladder transitional cell carcinoma (TCC). A total of 264 flexible cystoscopies were performed on patients with a past history of TCC. The number and site of recurrences were recorded and selected patients were offered cystodiathermy. Patient tolerability was noted. At follow-up, any recurrence was recorded. Eighty patients (30%) had 91 procedures showing one or more recurrences. Fifty-one of the 80 patients (64%) were treated with cystodiathermy under LA. All completed treatment. Forty-five (88%) tolerated the procedure well. Forty-seven (92%) treatments were completed within 5 min. At a median follow-up of 15 weeks, 30 (59%) treated patients had no recurrence and three (6%) had recurrence at the site of treatment. LA cystodiathermy is an effective and well-tolerated alternative to general anaesthetic cystodiathermy that enables treatment at the time of detection and may, thereby, reduce patient anxiety.

Identification of genes correlated with early-stage bladder cancer progression.

Transitional cell carcinoma (TCC) of the bladder ranks fourth in incidence of all cancers in the developed world, yet the mechanisms of its origin and progression remain poorly understood. There are also few useful diagnostic or prognostic biomarkers for this disease. We have combined a transgenic mouse model for invasive bladder cancer (UPII-SV40Tag mice) with DNA microarray technology to determine molecular mechanisms involved in early TCC development and to identify new biomarkers for detection, diagnosis, and prognosis of TCC. We have identified genes that are differentially expressed between the bladders of UPII-SV40Tag mice and their age-matched wild-type littermates at 3, 6, 20, and 30 weeks of age. These are ages that correspond to premalignant, carcinoma in situ, and early-stage and later stage invasive TCC, respectively. Our preliminary analysis of the microarray data sets has revealed approximately 1,900 unique genes differentially expressed (> or =3-fold difference at one or more time points) between wild-type and UPII-SV40Tag urothelium during the time course of tumor development. Among these, there were a high proportion of cell cycle regulatory genes and a proliferation signaling genes that are more strongly expressed in the UPII-SV40Tag bladder urothelium. We show that several of the genes upregulated in UPII-SV40Tag urothelium, including RacGAP1, PCNA, and Hmmr, are expressed at high levels in superficial bladder TCC patient samples. These findings provide insight into the earliest events in the development of bladder TCC as well as identify several promising early-stage biomarkers.

1473 IMMEDIATE MITOMYCIN C INSTILLATION FOLLOWED BY USUAL BCG COURSE VERSUS USUAL BCG ALONE FOR SUPERFICIAL TRANSITIONAL CELL CARCINOMA OF THE BLADDER (4 YEARS EXPERIENCE)

You have accessJournal of UrologyBladder Cancer: Superficial II1 Apr 20101473 IMMEDIATE MITOMYCIN C INSTILLATION FOLLOWED BY USUAL BCG COURSE VERSUS USUAL BCG ALONE FOR SUPERFICIAL TRANSITIONAL CELL CARCINOMA OF THE BLADDER (4 YEARS EXPERIENCE) Osman Abd El Kader Osman Abd El KaderOsman Abd El Kader More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1188AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES we present our experience with combination of chemo-immunotherapy fËmitomycin (MMC) + Bacillus Callmette ¡VGuerin (BCG) fÍ in comparison to single agent BCG immunotherapy as regard efficacy and side effects for superficial cancer bladder transitional cell carcinoma TCC with 6 months follow up at least. METHODS between July 2004 and June 2008, 128 patients (86 men and 42 women) with histologically proven bladder TCC and a mean age of 54 years were included into this prospective study, the definitive stage was Ta in 5 patients and T1 in 123 patients, while thegrade was grade I in 18, grade II in 86 patients and grade III in 24 patients, all patients underwent transurethral resection of the bladder tumor (TURBT) then randomly divided into two groups, group one 68 patients received immediate 40 mg mitomycinC (MMC) followed by BCG weekly for 6 weeks 3 weeks post TURBT, group two 60 patients underwent BCG instillation weekly for 6 weeks post TURBT by 3 weeks with follow up cystoscopy. RESULTS follow up ranged from 6-45 months with a mean of 26 months. Out of the group 1, 43 patients (63 %) were free at last follow up, 17 (25 %) showed recurrence and 8 (12%) showed muscle invasive progression and in group 2; 27 patients (45%) were free at last follow up, 20 (33%) showed recurrence and 13 (22%) showed muscle invasive progression. The mean interval to recurrence was 15 months range (3-45) in group 1 and 13 months range (3-45) in group 2 and the mean interval to progression in group 1 was 18 months (range 3-45) and in group 2 was 15 months range (3-45), Side effect of intravesical instillation distributed in both groups approximately in the same level, in group I; 20 patients (30%) with post instillation symptoms in the form of lower urinary tract symptoms (LUTS) in 14 patients (21%), 2 patients (3%) epidydmitis, 2 patients (3%) by hematuria and 2 patients (3%) presented by fever, chills and flue like symptoms, in group II 18 patients (30%) presented by post instillation symptoms in the form of (LUTS) in 12 patients (20%), one patients (1.5%) epidydmitis, 2 patients (3.5%) by hematuria and 3 patients (5%) presented by fever, chills and flue like symptoms. CONCLUSIONS the efficacy of chemo-immunotherapy in superficial cancer bladder TCC is evident over immunotherapy alone however side effects not appear to be increased however multicenter trial was indicated to consolidate these results. Fakous, Egypt© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e567-e568 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Osman Abd El Kader More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

413 DOES THE POSTOPERATIVE PLACEMENT OF A URETERAL STENT LEAD TO A REFLUX IN THE UPPER URINARY TRACT?

You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors1 Apr 2010413 DOES THE POSTOPERATIVE PLACEMENT OF A URETERAL STENT LEAD TO A REFLUX IN THE UPPER URINARY TRACT? Gunnar Wendt-Nordahl, Patrick Honeck, and Thomas Knoll Gunnar Wendt-NordahlGunnar Wendt-Nordahl More articles by this author , Patrick HoneckPatrick Honeck More articles by this author , and Thomas KnollThomas Knoll More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.483AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Endoscopic treatment of superficial transitional cell carcinoma of the upper urinary tract offers an alternative to nephroureterectomy in selected cases. The postoperative instillation therapy (e.g. with mitomycin C) is postulated to reduce the recurrence rate. A proposed application mode is placing an ureteral stent after the procedure and instillating the substance in the bladder. Via a vesico-ureteral reflux (VUR) an effect in the upper urinary tract is postulated. Aim of our study was to determine the occurrence of a VUR after placement of an ureteral stent. METHODS 12 consecutive patients receiving an ureteral stent after ureterorenoscopic stone treatment were instillated with 50ml of contrast agent in the empty bladder. After radiologic check for a VUR, additional 200ml were instillated and another radiologic check for VUR was performed. The same experiment was repeated on postoperative day one. RESULTS None of the patients displayed a VUR after the instillation of 50ml contrast agent. After instillating 250ml a VUR could be observed in 6/12 patients. The results were confirmed in the experiments performed one day later. CONCLUSIONS Despite the placement of an ureteral stent, instillation of volumes under 50ml did not lead to a VUR. Therefore, the instillation therapy of volumes <50ml does not seem effective. Dilution to 250ml leads to a reflux in 50% of the patients. However, the effect of such a diluted instillation therapy is not known. Sindelfingen, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e163 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gunnar Wendt-Nordahl More articles by this author Patrick Honeck More articles by this author Thomas Knoll More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Loss of Heterozygosis on IFN-α Locus is a Prognostic Indicator of Bacillus Calmette-Guerin Response for Nonmuscle Invasive Bladder Cancer

We evaluated the role of loss of heterozygosity on the interferon-alpha locus to predict the response to bacillus Calmette-Guerin therapy in patients with nonmuscle invasive bladder cancer. A total of 117 consecutive patients were selected, including 77 with nonmuscle invasive bladder cancer and 40 controls. Loss of heterozygosity on the interferon-alpha locus (chromosome 9p21) was assessed in blood and urine samples before transurethral resection. All patients underwent transurethral resection and then 6 weekly bacillus Calmette-Guerin instillations. Those with nonmuscle invasive bladder cancer were assigned to groups 1 and 2 with and without loss of heterozygosity on the interferon-alpha locus, respectively. Of the 77 patients with nonmuscle invasive bladder cancer 39 (50.6%) had loss of heterozygosity on the interferon-alpha locus (group 1) and 38 (49.4%) had no alteration (group 2). Only 1 of 40 controls showed loss of heterozygosity on the interferon-alpha locus. At the end of followup 13 patients in group 1 and 27 in group 2 were alive without recurrence. We noted a significant difference between loss of heterozygosity on interferon-alpha and followup status (dF 01, LR 11.252, p = 0.003). Kaplan-Meier analysis revealed a significant difference in recurrence probability (response to bacillus Calmette-Guerin) and loss of heterozygosity on interferon-alpha (p <0.0001). On multivariate analysis loss of heterozygosity (HR 4.09, 95% CI 2.59-6.28, p = 0.002), grade (grade 3 HR 3.31, 95% CI 1.38-3.35, p = 0.03) and the number of lesions (3 or greater HR 2.31, 95% CI 1.38-3.25, p = 0.03) were independent predictors of the bacillus Calmette-Guerin response. This study highlights the predictive value of loss of heterozygosity analysis on interferon-alpha in patients with nonmuscle invasive bladder cancer treated with bacillus Calmette-Guerin.