Cytological Examination Of Urine Research Articles

Diagnostic accuracy of cytology and urine methylation test in patients with non-muscle invasive bladder cancer: a systematic review and meta-analysis.

Multiple clinical studies have demonstrated the numerous advantages of urine methylation test over cytology for monitoring patients with non-muscle invasive bladder cancer (NMIBC) following surgery. This research aims to provide a systematic review and meta-analysis to evaluate the efficacy and limits of urine methylation test in the clinical management of NMIBC. This research was carried out by conducting a comprehensive search of clinical trials comparing cytology and urine methylation test for NMIBC follow-up using databases such as PubMed, Embase, Web of Science, and the Cochrane Library up until May 2023, including references from relevant articles. The study is registered on PROSPERO with ID CRD42023398969. This study comprised six studies with a total of 1676 patients. The analysis revealed that the AUC of urine methylation test had a greater AUC than that of the cytology examination (0.89 vs 0.71). In post-operative follow-up of patients with NMIBC, the urine methylation test demonstrated a significant sensitivity (0.69 vs 0.52), but with lower specificity (0.87 vs 0.93) than cytology examination. The urine methylation test and cytology examination have both shown strong diagnostic performance in screening for NMIBC patients. However, urine methylation test outperforms cytology examination in terms of accuracy and sensitivity. PROSPERO, identifier CRD42023398969.

Cytology of the Urinary Tract: Specimen Sampling, Preparation, Adequacy, and Normal Cellular Components

Urine evaluation is one of the oldest tests used in ancient medicine. Cytologic examination of urine is a simple, non-invasive, cost effective, and reliable method to uncover a wide variety of reactive and neoplastic processes in urothelium. Urinary tract lesions are often multifocal, may be inapparent on cystoscopic examination or inaccessible to directly biopsy. Thus, urine cytology remains one of the most common methods for the initial diagnosis of urothelial carcinoma that may be manageable with early detection. In this article we review indications for urine cytology, sampling techniques, preparatory methods, adequacy, and elements of normal urine.

A Model Based on Automated Urinalysis Parameters for Urothelial Carcinoma Risk Stratification in Suspected Patients.

The aim of this study was to develop and validate a risk stratification model for the screening of patients with suspected urothelial carcinoma (UC). We enrolled 671 consecutive patients with suspected UC and generated a risk stratification model based on urinary parameters by using an automated urinalysis analyzer (Sysmex UN-9000). All patients received urine cytology examination from January 1, 2019, to October 31, 2022. Out of the 671 patients, 191 (28.5%) were ultimately diagnosed with UC. The four features associated with the presence of malignancy on multivariable analysis can be summarized by using the mnemonic UC-PAAS: UC, protein vs. creatinine ratio (P/C), age, atypical cells (Atyp.C), and small round epithelial cell (SRC). Major criteria include Atyp.C ≥ 0.1/μL (2 points) and age ≥ 65 years (2 points); minor criteria include SRC ≥ 2.7/μL (1 point) and abnormal P/C results (1 point). The model evidenced good discrimination (area under the curve = 0.802, 95% confidence interval [0.756, 0.848]) in the training group. A UC-PAAS cutoff of more than 4 points identified a high-risk population, of whom 37 of 59 (62.7%) had UC; the negative predictive value was 0.867. The validation group yielded similar findings. We present a urinalysis-based screening model, the UC-PAAS, that may serve as an accessory clinical tool for the evaluation of patients with suspected UC, because the model identifies patients at higher risk who require closer follow-up than others or additional examinations.

Epigenetic and Immunological Features of Bladder Cancer.

Bladder cancer (BLCA) is one of the most common types of malignant tumors of the urogenital system in adults. Globally, the incidence of BLCA is more than 500,000 new cases worldwide annually, and every year, the number of registered cases of BLCA increases noticeably. Currently, the diagnosis of BLCA is based on cystoscopy and cytological examination of urine and additional laboratory and instrumental studies. However, cystoscopy is an invasive study, and voided urine cytology has a low level of sensitivity, so there is a clear need to develop more reliable markers and test systems for detecting the disease with high sensitivity and specificity. Human body fluids (urine, serum, and plasma) are known to contain significant amounts of tumorigenic nucleic acids, circulating immune cells and proinflammatory mediators that can serve as noninvasive biomarkers, particularly useful for early cancer detection, follow-up of patients, and personalization of their treatment. The review describes the most significant advances in epigenetics of BLCA.

Urinary microRNA-10a levels in diagnosis and prognosis of urinary bladder cancer.

Urinary bladder cancer (UBC) is a disease quite common in developed countries; however, its incidence is increasing in developing countries as well. The diagnosis of UBC is generally based on a number of methods, of which urinary cytology is a very commonly used one. But it is not very reliable. Therefore many new markers and methods are being investigated to make non-invasive diagnosis of UBC easy and reliable. This study was carried out to find the usefulness of microRNA (miRNA)-10a as a diagnostic and prognostic marker in non-muscle-invasive urinary bladder carcinoma. Twenty patients with UBC were taken as cases with 20 controls. Urine cytological examination was done, as well as histopathological examination of tumor tissue of cases. Urinary miRNA-10a estimation of both the cases and controls were done. It was found that miRNA-10a is significantly high in urine of patients with UBC. Its value also significantly correlated with the grade and stage of the tumor. Hence it can be concluded that urinary miRNA-10a is a potential candidate in the diagnosis and prognosis of UBC.

Biomarkers of Bladder Cancer: Cell-Free DNA, Epigenetic Modifications and Non-Coding RNAs.

Bladder cancer (BC) is the 10th most frequent cancer in the world. The initial diagnosis and surveillance of BC require a combination of invasive and non-invasive methods, which are costly and suffer from several limitations. Cystoscopy with urine cytology and histological examination presents the standard diagnostic approach. Various biomarkers (e.g., proteins, genes, and RNAs) have been extensively studied in relation to BC. However, the new trend of liquid biopsy slowly proves to be almost equally effective. Cell-free DNA, non-coding RNA, and other subcellular structures are now being tested for the best predictive and diagnostic value. In this review, we focused on published gene mutations, especially in DNA fragments, but also epigenetic modifications, and non-coding RNA (ncRNA) molecules acquired by liquid biopsy. We performed an online search in PubMed/Medline, Scopus, and Web of Science databases using the terms "bladder cancer", in combination with "markers" or "biomarkers" published until August 2022. If applicable, we set the sensitivity and specificity threshold to 80%. In the era of precision medicine, the development of complex laboratory techniques fuels the search and development of more sensitive and specific biomarkers for diagnosis, follow-up, and screening of BC. Future efforts will be focused on the validation of their sensitivity, specificity, predictive value, and their utility in everyday clinical practice.

Risk Factors Leading to Radical Cystectomy in Patients Who Had Undergone Nephroureterectomy

Purpose: To identify the risk factors leading to radical cystectomy in patients who had undergone nephroureterectomy (NUx).Materials and Methods: We retrospectively reviewed the medical records of patients with upper tract urothelial carcinoma who underwent NUx during 2011–2019 and excluded patients with metastatic cancer. In total 646 patients were included in this study; of these, 532 had no previous bladder cancer history. Follow-up was performed every 3 months for 2 years after NUx was administered, and recurrence was confirmed using cystoscopy, urine cytology, computed tomography, and chest radiography. Bladder recurrence was confirmed through biopsy, urine cytology, or radiologic examination. Univariate and multivariate Cox regression analyzes were performed for statistical analysis of risk factors leading to radical cystectomy in patients undergoing NUx.Results: Lymphovascular invasion (LVI) (hazard ratio [HR], 4.728; 95% confidence interval [CI], 1.463–15.570; p=0.011), previous transurethral resection of bladder tumor history (HR, 3.825; 95% CI, 1.164–12.571; p=0.027), and intravesical recurrence (IVR) within 6 months (HR, 3.733; 95% CI, 1.091–12.778; p=0.036) in patients undergoing NUx are predictors of radical cystectomy implementation. In a multivariate analysis of patients without bladder cancer history, bladder recurrence was identified as a predictor of radical cystectomy implementation, if it occurred within 6 months of NUx (HR, 8.608; 95% CI, 1.545–47.976; p=0.014).Conclusions: LVI and IVR within 6 months and previous bladder cancer history are factors that can predict the need for radical cystectomy after NUx. Even in patients without bladder cancer history, early bladder recurrence within 6 months is a major predictor of radical cystectomy.

Morphometric analysis of nuclear symmetry in urothelial carcinoma for predicting tumor recurrence.

Urothelial carcinoma is the ninth most common cancer in the world. Cytological analysis of the urine is used for screening, as well as for cases suspected for neoplasia of the urinary tract. However, the sensitivity of urine cytology examination is low. The golden standard for diagnosing bladder cancer relies upon cystoscopy followed by a biopsy, which is microscopically assessed by the pathologist. Treatment decisions are based on the histological grade and stage of the tumor. Posttreatment tumor recurrence is 50%. The purpose of this study is to predict recurrence of urothelial carcinoma using a novel morphometric method of nuclear symmetry analysis. This method may help tailor the appropriate treatment and may reduce the need of invasive surgical procedures in patients. Computerized morphometry was applied to develop multiple symmetry indices of the nuclei of the tumor cells as follows: each nucleus was physically divided along its digital axis in two segments that were separately analyzed for their shape, size, optical density, and texture. Subsequently, ratios were obtained by mathematically dividing between the morphometric values of the two nuclear segments where the denominator contained the largest value of the two. These ratios were named symmetry indices and were included as variables to predict the recurrence time of the tumors. The change in the symmetry indices (loss of symmetry) of the nuclear roundness, fractal dimension and margination were the only independent predictors of recurrence time. Computerized morphometry of nuclear symmetry indices may help to predict tumor recurrence in urothelial carcinomas.

Urinary Cytology in the Diagnosis of Bladder Cancer

The examination of urine is an ancient medical procedure dating back thousands of years. Microscopic examination of cells in the urine is being done since the invention of microscope. Presently the cytological examination of urine or other fluid samples from the urinary tract is a routine non-invasive diagnostic procedure to detect cancer of the urinary tract, especially in patients with painless haematuria. It is also used in the follow-up of patients previously treated for bladder cancer to detect recurrence or a new primary. It is a highly specific method for the diagnosis of invasive and in situ urothelial carcinoma and high-grade papillary carcinoma. However, it is unreliable for the detection of low-grade papillary neoplasms. Malignant cytomorphological characteristics of the exfoliated cells in urine or bladder washing can facilitate the diagnosis of bladder cancer. The Paris System (TPS) Working Group has proposed. The Paris System (TPS) authorities have proposed a standard reporting stem which includes specified diagnostic categories and cytomorphologic criteria for diagnosis of High-grade Urothelial Carcinoma (HGUC).

Current prospects of urine cytology in diagnosis and follow-up urinary tract malignancies - the short review

Introduction and purpose: Cytology of urine sediment is a diagnostic tool used to screen for urinary tract lesions in two cases: surveillance of patients with a history of urothelial malignancies and patients with unexplained, new onset haematuria. Since 2015 histopathological laboratories have been able to report urine cytology according to The Paris System (TPS). Current studies suggest usefulness of urinary cytology in follow-up of urinary tract malignancies, especially urinary bladder cancer, which is the 13th most deadly throughout the world being responsible for 200 000 deaths in 2018 among neoplasms.Objective: To review currently available data on PubMed about usefulness urine cytology reporting in follow-up and diagnosis of urinary tract malignancies.A brief description of the state of knowledge: Advantages of urine cytology examination contain non-invasiveness, high specificity, lower cost than cystoscopy and enable immunohistochemistry performance as well. Implementation of The Paris System for reporting urine cytology has created an universally acceptable and globally used report system. Reporting according to TPS significantly reduced the number of cases described as atypical changes.Conclusions: Urinary cytology is used to supplement endoscopic evaluation of the urinary tract in the screening and the surveillance of urothelial carcinoma. The Paris System for reporting urinary cytology has clarified the diagnostic categories of urine sediment examination. Cystoscopy and urine cytology are the standard tools for monitoring urinary tract malignancies.

Abstract B13: Applying machine learning for urine cytology—computational urothelial carcinoma analysis and diagnosis

Abstract Urothelial carcinoma is estimated to be the fourth most common cancer among men in the U.S. in 2019. The key to successful management of this cancer is early detection and timely monitoring after treatment. Urine cytology is an inexpensive, noninvasive, and easily available diagnostic method of urine analysis, but the usage of this tool for urothelial malignancy is still not satisfactory in its sensitivity and specificity. It is time-consuming and labor-intensive to find rare neoplastic cells from hundreds or even thousands of a variety of types of cells in the background, even by well-trained cytopathologists or cytotechnicians. Therefore, it is a crucial issue to avoid false-positive and false-negative results when applying urine cytology in clinical practice. Recent advances in artificial intelligence (AI) offer potential solutions to these issues through the development of an automated, impartial, and specialized computation model to 1) reduce false-negative rates and interpretation times and 2) assist pathologists with reporting using The Paris System for Reporting Urinary Cytopathology. In this study, we tested a deep learning-based image analysis model for cell classification and enumeration in urine cytology. Deidentified whole-slide images were digitalized after performing standard urine cytology examination. We used an “active learning” approach that requires minimal upfront training and improves with more usage. We collected 3 sub-images (total 3,335 cells) from one whole-slide image annotated by 3 domain experts to train the initial model. Cells were classified into seven categories: high-grade urothelial carcinoma (HGUC), cluster HGUC, atypical neoplastic cell, atypical reactive cell, inflammatory cell, epithelial cell, and unidentified cell. Domain experts reviewed and provided feedback to initiate the model training process. After the initial model was established, we performed a pilot study using 2 sub-images from five digitalized sample slides (total 10 sub-images) to further improve the training model. Our results showed that the AI model was able to learn the morphologies of six cell types. It was then able to automatically quantify total cell counts in each class that correlated with annotations by domain experts. We are now attempting to integrate this AI model with The Paris System to create a clinical decision support system for urologists, as there is a clear unmet clinical need to establish a computational model since The Paris System requires a significant amount of complex and accurate analysis, which many clinical decisions are based upon. In conclusion, our AI model demonstrates its value in providing an automated and unbiased method to analyze urine cytology with high throughput, accuracy, and reproducibility. Introduction and integration of our AI model with The Paris System will be a giant stride to optimize clinical practices in the field of urology in the imminent future. Citation Format: Wei-Lei Yang, Ching-Ming Lee, Mei-Ling Wu, Yu-Ching Peng, Ten-Jen Liu, Yi-Hsin Liu. Applying machine learning for urine cytology—computational urothelial carcinoma analysis and diagnosis [abstract]. In: Proceedings of the AACR Special Conference on Advances in Liquid Biopsies; Jan 13-16, 2020; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(11_Suppl):Abstract nr B13.

A Diagnostic Nomogram of Pathologic Grade for Preoperative Risk Stratification in Upper Tract Urothelial Carcinoma.

Background:To develop a novel nomogram to improve the preoperative diagnosis of pathological grade of upper tract urothelial carcinoma (UTUC).Methods:Retrospective study was conducted with 245 patients with UTUC treated by radical nephroureterectomy from 2002 to 2016. Of the cohort, 57.6% received ureteroscopic (URS) biopsy and 35.9% received urine cytology examination. Preoperative clinical characteristics and examination results were collected. Final pathological grade was diagnosed by postoperative pathology. Univariable and multivariable binary logistic regressions were applied to establish a preoperative predictive model for tumor grade, and significant factors were included in the nomogram. The area under curve (AUC) was used to show the predictive efficacy, and the calibration plot was drawn for validation.Results:Of the 245 patients, 72.7% were diagnosed with pathological high-grade disease. Age (odds ratio [OR] = 1.03, P = .039), sessile (OR = 3.86, P = .021), positive urinary cytology (OR = 6.87, P = .035), and biopsy high-grade result (OR = 10.85, P < .001) were independent predictors for pathological high-grade disease. The predictive nomogram containing these factors achieved an AUC of 0.78, which was significantly better than URS biopsy alone (AUC = 0.62, P = .003) in the whole cohort. In the URS biopsy subgroup, the nomogram achieved an AUC of 0.79, better than biopsy alone (AUC = 0.76), but was not statistically significant (P = .431). When the cutoff value of the nomogram was set at 0.64, the sensitivity of detecting a high-grade lesion versus low-grade lesion was 80.3%, better than that of URS biopsy alone (sensitivity = 65.7%).Conclusions:Advanced age, sessile, positive urinary cytology, and biopsy high-grade were independent predictors of pathological high-grade disease in patients with UTUC. A nomogram containing these factors can improve diagnostic accuracy, potentially reducing the risk of “undergrading” by URS biopsy.

Urine cytological examination: an appropriate method that can be used to detect a wide range of urinary abnormalities

Background:Urine cytology is a method that can be used for the primary detection of urothelial carcinoma, as well as other diseases related to the urinary system, including hematuria and infectious agents. In this study we aimed at investigating urine abnormalities among Sudanese patients attending Omdurman teaching hospital.Methods:A descriptive cross-sectional study was conducted from November 2016 to October 2017. A voided urine samples were collected and stained using Papanicolaou stain.Results:A total of 1238 urine samples were meticulously examined, 832 (67.2%) from males (mean age 41.7±12.67), and 406 (32.8%) from females (mean age 43.8±10.94). 147 (11.9%) patients had an underlying medical condition, either AIDs, diabetes mellitus type 2 or historical renal transplantation. Hematuria was more frequent amongst males than females, 100 (68.9%) and 45 (31.1%), respectively. Urine cytology diagnosis was 43 cases (3.5%) of candidiasis, 36 cases (2.9%) of reactive urothelial cells, 11 cases (0.9%) of cryptococcosis, 9 cases (0.7%) of urothelial carcinoma, 9 (0.7%) human papilloma virus (HPV) diagnoses, 8 (0.6%) polyomavirus (BKV) diagnoses, 6 (0.5%) schistosomiasis diagnoses and 3 cases (0.2%) of low grade urothelial cells.Conclusion:Urine cytology seems to be a non-invasive technique that is suitable for all patients with urinary tract infections; those with diabetes, renal transplants, and HIV; and patients with macroscopic or microscopic hematuria for the detection of infectious agents and malignancy.

Quantitative Proteomic Analysis Identifies AHNAK (Neuroblast Differentiation-associated Protein AHNAK) as a Novel Candidate Biomarker for Bladder Urothelial Carcinoma Diagnosis by Liquid-based Cytology

Cytological examination of urine is the most widely used noninvasive pathologic screen for bladder urothelial carcinoma (BLCA); however, inadequate diagnostic accuracy remains a major challenge. We performed mass spectrometry-based proteomic analysis of urine samples of ten patients with BLCA and ten paired patients with benign urothelial lesion (BUL) to identify ancillary proteomic markers for use in liquid-based cytology (LBC). A total of 4,839 proteins were identified and 112 proteins were confirmed as expressed at significantly different levels between the two groups. We also performed an independent proteomic profiling of tumor tissue samples where we identified 7,916 proteins of which 758 were differentially expressed. Cross-platform comparisons of these data with comparative mRNA expression profiles from The Cancer Genome Atlas identified four putative candidate proteins, AHNAK, EPPK1, MYH14 and OLFM4. To determine their immunocytochemical expression levels in LBC, we examined protein expression data from The Human Protein Atlas and in-house FFPE samples. We further investigated the expression of the four candidate proteins in urine cytology samples from two independent validation cohorts. These analyses revealed AHNAK as a unique intracellular protein differing in immunohistochemical expression and subcellular localization between tumor and non-tumor cells. In conclusion, this study identified a new biomarker, AHNAK, applicable to discrimination between BLCA and BUL by LBC. To our knowledge, the present study provides the first identification of a clinical biomarker for LBC based on in-depth proteomics.

Electromagnetic and Electrohydraulic Shock Wave Lithotripsy-Induced Urothelial Damage: Is There a Difference?

To evaluate and compare the acute effect of electromagnetic and electrohydraulic extracorporeal shockwave lithotripsy (SWL) on the urothelial layers of kidney and ureter. Fifty patients, 29 males (58%) and 21 females (42%), with an average age of 51.68 years (range: 37-70) who underwent SWL application in two different centers were included. Twenty-eight patients (56%) were treated with electrohydraulic and 22 (44%) were treated with electromagnetic lithotripsy. Urinary cytologic examinations were done immediately before and after SWL therapy and 10 days later. The average numbers of epithelial cells, red blood cells (RBC), and myocytes were counted under 40 × magnification. There were significant differences in the number of epithelial cells and RBC before and after immediate application of SWL: 1.66 and 14.9 cells/field, (p = 0.001), 5.44 and 113.45 cells/field, respectively (p = 0.001). The number of RBC was significantly higher in patients treated with electromagnetic lithotripsy than those treated with electrohydraulic: 141.9 and 93.4 cells/field, respectively (p = 0.02). No myocyte or basement membrane elements were detected in any of the cytologic examinations. Cytologic examinations done after 10 days of SWL therapy revealed recovery of all abnormal cytologic findings. The acute increments in the number of epithelial cells and RBC after SWL were statistically significant but it was not permanent. SWL-induced urinary urothelial lesion is limited to the mucosal layer and there was no evidence of damage to the basal membrane or muscle layer. Electromagnetic lithotripsy caused high numbers of RBC than the electrohydraulic device on the postimmediate urine cytologic examination.

MP13-10 THE INCIDENCE OF LATE BLADDER TUMOR RECURRENCE OF UPPER TRACT UROTHELIAL CARCINOMA AND OPTIMAL CYSTOSCOPIC FOLLOW-UP: A MULTICENTER STUDY

INTRODUCTION AND OBJECTIVES: We conducted a randomized, prospective, multicenter study comparing one immediate postoperative intravesical chemotherapy with short-term adjuvant intravesical chemotherapy after transurethral resection of bladder tumor (TURBT) in non-muscle invasive bladder carcinoma (NMIBC) with low or intermediate recurrent risk. The objective is to evaluate the efficacy of intravesical chemotherapy using pirarubicin for patients with low or intermediate risk. METHODS: This studywas approved by the ethics committees of KyotoPrefectural University ofMedicine inSeptember 2010. The recurrent risk was stratified using EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Between October 2010 and January 2015, 216 patients was enrolled in this study and 97 patients were excluded from this studyafter TURBT for their high recurrent riskofNMIBC. Remaining 109 with low or intermediate recurrent risk of NMIBC were randomized to one immediate postoperative intravesical instillation of pirarubicin (THP) 30mg (GroupA), or additional intravesical chemotherapy of THP 30mg weekly for 8 weeks (Group B). The patients were examined by cystoscopy and urine cytological examination every 3 months after TURBt to determine bladder tumor recurrence. RESULTS: The 2-year recurrence free rate were 65.3% for Group A and 87.2% forGroupB, respectively (log rank test, p1⁄4 0.038). In patients with intermediate recurrent risk, the 2year recurrence free rate were 62.3% inGroupAand86.8% in groupB, respectively (log rank test, p1⁄4 0.0261). In patients with recurrent score between 5 and 9, the 2-year recurrence free ratewere91.7% inGroupAand25.0% inGroupB (log rank test, p1⁄40.0052). There was no patient with progression during this period. Adverse events were documented in 0% and 24.4% in Group A and Group B, respectively. There was no patient with severe adverse event (Grade 3 or more). CONCLUSIONS: Additional instillation of THP 30mg weekly for 8 weeks reduced the risk of tumor recurrence without severe toxicity in NMIBC patients with intermediate recurrent risk. Our data provide a rationale for adjuvant intravesical chemotherapy after TURBT in NMIBC patients with intermediate recurrent risk.

MP13-08 THE COMPARISON ONE IMMEDIATE POSTOPERATIVE INTRAVESICAL CHEMOTHERAPY WITH SHORT-TERM ADJUVANT INTRAVESICAL CHEMOTHERAPY AFTER TURBT IN LOW- AND INTERMEDIATE RECURRENT RISK OF NON-MUSCLE-INVASIVE BLADDER CANCER- A RANDOMIZED PROSPECTIVE STUDY IN JAPAN.

You have accessJournal of UrologyBladder Cancer: Non-Invasive I1 Apr 2016MP13-08 THE COMPARISON ONE IMMEDIATE POSTOPERATIVE INTRAVESICAL CHEMOTHERAPY WITH SHORT-TERM ADJUVANT INTRAVESICAL CHEMOTHERAPY AFTER TURBT IN LOW- AND INTERMEDIATE RECURRENT RISK OF NON-MUSCLE-INVASIVE BLADDER CANCER- A RANDOMIZED PROSPECTIVE STUDY IN JAPAN. Yoshio Naya, Takumi Shiraishi, Masakatsu Oishi, Takashi Ueda, Hiroyuki Nakanshi, Yasuyuki Naitoh, Terukazu Nakamura, Fumiya Hongo, Kazumi Kamoi, Koji Okihara, Kazuya Mikami, Tsuyoshi Iwata, and Osamu Ukimura Yoshio NayaYoshio Naya More articles by this author , Takumi ShiraishiTakumi Shiraishi More articles by this author , Masakatsu OishiMasakatsu Oishi More articles by this author , Takashi UedaTakashi Ueda More articles by this author , Hiroyuki NakanshiHiroyuki Nakanshi More articles by this author , Yasuyuki NaitohYasuyuki Naitoh More articles by this author , Terukazu NakamuraTerukazu Nakamura More articles by this author , Fumiya HongoFumiya Hongo More articles by this author , Kazumi KamoiKazumi Kamoi More articles by this author , Koji OkiharaKoji Okihara More articles by this author , Kazuya MikamiKazuya Mikami More articles by this author , Tsuyoshi IwataTsuyoshi Iwata More articles by this author , and Osamu UkimuraOsamu Ukimura More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2489AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We conducted a randomized, prospective, multicenter study comparing one immediate postoperative intravesical chemotherapy with short-term adjuvant intravesical chemotherapy after transurethral resection of bladder tumor (TURBT) in non-muscle invasive bladder carcinoma (NMIBC) with low or intermediate recurrent risk. The objective is to evaluate the efficacy of intravesical chemotherapy using pirarubicin for patients with low or intermediate risk. METHODS This study was approved by the ethics committees of Kyoto Prefectural University of Medicine in September 2010. The recurrent risk was stratified using EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Between October 2010 and January 2015, 216 patients was enrolled in this study and 97 patients were excluded from this study after TURBT for their high recurrent risk of NMIBC. Remaining 109 with low or intermediate recurrent risk of NMIBC were randomized to one immediate postoperative intravesical instillation of pirarubicin (THP) 30mg (Group A), or additional intravesical chemotherapy of THP 30mg weekly for 8 weeks (Group B). The patients were examined by cystoscopy and urine cytological examination every 3 months after TURBt to determine bladder tumor recurrence. RESULTS The 2-year recurrence free rate were 65.3% for Group A and 87.2% for Group B, respectively (log rank test, p = 0.038). In patients with intermediate recurrent risk, the 2year recurrence free rate were 62.3% in Group A and 86.8% in group B, respectively (log rank test, p = 0.0261). In patients with recurrent score between 5 and 9, the 2-year recurrence free rate were 91.7% in Group A and 25.0% in Group B (log rank test, p=0.0052). There was no patient with progression during this period. Adverse events were documented in 0% and 24.4% in Group A and Group B, respectively. There was no patient with severe adverse event (Grade 3 or more). CONCLUSIONS Additional instillation of THP 30mg weekly for 8 weeks reduced the risk of tumor recurrence without severe toxicity in NMIBC patients with intermediate recurrent risk. Our data provide a rationale for adjuvant intravesical chemotherapy after TURBT in NMIBC patients with intermediate recurrent risk. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e137 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yoshio Naya More articles by this author Takumi Shiraishi More articles by this author Masakatsu Oishi More articles by this author Takashi Ueda More articles by this author Hiroyuki Nakanshi More articles by this author Yasuyuki Naitoh More articles by this author Terukazu Nakamura More articles by this author Fumiya Hongo More articles by this author Kazumi Kamoi More articles by this author Koji Okihara More articles by this author Kazuya Mikami More articles by this author Tsuyoshi Iwata More articles by this author Osamu Ukimura More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Innovations in the Endoscopic Management of Bladder Cancer: Is the Era of White Light Cystoscopy Over?

Bladder cancer is the most common tumor of the urinary tract, with a worldwide incidence of 8.6 x 100000 in men and 2.6 x 100000 in women (1). The majority of patients (75-85%) present as non-muscle invasive bladder cancer (NMIBC); within this category the most represented stage is Ta (70%), followed by T1 (20%) and, less frequently, carcinoma in situ (CIS) (10%) (2). The diagnosis of NMIBC and, more generally, of bladder cancer, depends on urine cytology and endoscopic examination with histological evaluation of the resected tissue. Clearly, an optimal cystoscopy with accurate transurethral resection (TUR) is of great importance in order to improve the detection rate and to reduce the probability of recurrence and progression. Today the cystoscopy is routinely performed with the white light technique (WLC), the same of about 80 years ago (3). Several studies have demonstrated that an initial TUR with WLC can miss small papillary lesions and, particularly, flat lesions such as CIS. Moreover, recurrence rates of non-muscle invasive bladder cancer (NMIBC) are directly related to the possibility of achieving a complete resection: residual cancer is present in a large percentage of re-TUR, showing a not so good performance of resection with this method. For these reasons new methodologies have been investigated in order to improve the sensitivity and specificity of WLC, such as photodynamic diagnosis (PDD), narrow band imaging (NBI), optical coherence tomography (OCT) and CT virtual cystoscopy. Some of them have been well established and supported by consistent literature while others are still to be viewed as experimental. The purpose of this review is to investigate the state of the art of these new techniques.

Successful treatment of bilateral paecilomyces pyelonephritis in a German shepherd dog

A six-year-old female entire German shepherd dog was investigated for polyuria, polydipsia and lethargy. Investigations revealed a mild azotaemia and abdominal ultrasound revealed marked bilateral dilation of the renal pelves with echogenic material and proximal left hydroureter. Urine cytological examination and aspirates from the right renal pelvis revealed mats of fungal hyphae consistent with fungal bezoar formation. Fungal cultures revealed a profuse growth of Paecilomyces variotii. Initial treatment with oral itraconazole was unsuccessful, leading to bilateral nephrotomies to remove the fungal material. Postoperatively the Paecilomyces infection persisted despite continued itraconazole therapy. Treatment was commenced with amphotericin B, leading to resolution of the dog's clinical signs. To the authors' knowledge this is the first report of canine Paecilomyces pyelonephritis, without disseminated systemic disease, which documents its successful treatment.

Immunoprofiles of Chromophobe Renal Cell Carcinoma (RCC) and Oncocytoma

Materials and Methods: One hundred and twenty nine patients attending the Veterans Administration Medical Center in Washington DC were studied after approval from the local Institutional Review Board. The study period was 2008 to 2011 and focused on those patients with atypical urine cytology. The UroVysion test was performed as a reflex test on the residual aliquot of the fixed urine samples with atypical cytology. The specimens included 19 voided and 110 cystoscopic urines. Results were correlated with clinical history, cytomorphological features, cystoscopic examination and, where available, bladder biopsy. Results: All patients except one were male, with an age range of 31 to 90 years (median 65 years; mean 66.7 years). Overall, 34/129 (26%) of cytologically atypical samples were UroVysion positive. These included 6/18 voided and 28/107 cystoscopic urine specimens. Four specimens were borderline or quantity insufficient by standard UroVysion manufacturer’s guidelines. Biopsies were performed on 18 UroVysion positive cases (2 voided and 16 cystoscopic urines) within 0 to 3 months of the test. Urothelial neoplasia was seen in 2/2 voided and 16/16 cystoscopic urine specimens resulting in a high specificity. On the other hand, biopsy proven urothelial carcinoma was seen in 6 of 14 UroVysion negative specimens, cases with tumor present on cystoscopic examination, resulting in low sensitivity. The most common Urovysion abnormality was gain of chromosomes 3, 7 and 17. Loss of 9p21 occurred in 6 cases and was the sole abnormality in 3. Conclusions: This study indicates that the UroVysion test could be a useful test in the diagnosis of bladder cancer in conjunction with urine cytology and cystoscopic examination, especially in cases with atypical cytology in voided urine and atypical cytology and no tumor identified on cystoscopic examination in cystoscopic urine. In our study in all UroVysion positive cases, follow up biopsy showed neoplastic changes, indicating that UroVysion has high specificity and that UroVysion positive cases need periodic further evaluation.