1
|
Herzberg H, Babaoof R, Marom R, Veredgorn Y, Savin Z, Lifshitz K, Noefeld S, Lasmanovitz R, Bercovich S, Lamhoot T, Amir S, Beri A, Margel D, Baniel J, Mano R, Yossepowitch O. Sterile Water Versus Glycine in Transurethral Resection of Bladder Tumors-Immunogenic and Clinical Implications. Eur Urol Focus 2024:S2405-4569(24)00046-4. [PMID: 38508896 DOI: 10.1016/j.euf.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/14/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND OBJECTIVE We compared the oncologic outcomes of patients with non-muscle invasive bladder cancer (NMIBC) who underwent transurethral resection of bladder tumor (TUBRT) using sterile water vs glycine irrigation. The tumoricidal and immunogenic effects of these solutions on urothelial cancer cell lines were investigated. METHODS The medical records of 530 consecutive patients who underwent TURBT using sterile water or glycine irrigation for NMIBC were reviewed. Recurrence and progression rates were evaluated using time dependent analyses.Bladder cancer cell lines (RT4, T24 and 5637) were treated with glycine and sterile water. Cell viability was evaluated with the XTT assay. Cell membrane calreticulin levels were evaluated with flow cytometry. Extracellular high mobility group box 1 (HMGB1) and heat shock 70 (HSP70) protein levels were evaluated using western blots. KEY FINDINGS AND LIMITATIONS After propensity score matching each study arm comprised 161 patients. Median follow-up was 13.6 months (IQR 6.2, 24.5). The 2-year recurrence free survival was significantly lower in the sterile water vs glycine group (43% vs 71%, respectively, p<0.0001). Similarly, the 2-years progression free survival was significantly lower in the sterile water vs glycine group (85% vs 94%, respectively, p<0.014). Sterile water treatment resulted in the lowest number of viable cells. Early and late immunogenic cell death markers were markedly elevated in cells treated with glycine. CONCLUSIONS AND CLINICAL IMPLICATIONS Sterile water compared to glycine irrigation during TURBT for NMIBC was associated with higher recurrence and progression rates. Possible explanation for these findings is the diminished immune response associated with sterile water reflected in a comparatively lesser expression of immune response inducers. PATIENT SUMMARY We compared two irrigation fluids in non-muscle-invasive bladder cancer surgery: glycine and sterile water. Glycine outperformed sterile water in cancer recurrence, possibly boosting immunogenicity over sterile water.
Collapse
Affiliation(s)
- Haim Herzberg
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel.
| | - Roi Babaoof
- Division of Urology, Rabin Medical Center, Peth Tikva, Israel
| | - Ron Marom
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yotam Veredgorn
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ziv Savin
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Karin Lifshitz
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
| | | | | | | | - Tomer Lamhoot
- Urology Research Laboratory, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Sharon Amir
- Urology Research Laboratory, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Avi Beri
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - David Margel
- Division of Urology, Rabin Medical Center, Peth Tikva, Israel
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Peth Tikva, Israel
| | - Roy Mano
- Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
| | | |
Collapse
|
2
|
Teng L, Li C, Wang W, Li D. Initial experience with surrounding en bloc transurethral resection of bladder tumor and simultaneous intravesical treating for non-muscle invasive bladder cancer. BMC Urol 2022; 22:189. [PMID: 36419012 PMCID: PMC9686079 DOI: 10.1186/s12894-022-01140-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/05/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The 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. Methods We 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. Results There 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). Conclusion Surrounding 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. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01140-2. Surrounding en bloc TURBT combining simultaneous
intravesical chemotherapy might decrease recurrent rate in intermediate-term. Surrounding en bloc TURBT can be completed with
general bipolar electrode loop. Simultaneous intravesical chemotherapy might increase efficacy and compromise uncomfortability of agents Surrounding en bloc TURBT can be completed with general bipolar electrode loop. The novel technique is feasible and safe for patients with NMIBC.
Collapse
|
3
|
Sionov BV, Tsivian M, Bakaleyschik P, Sidi AA, Tsivian A. Oncological safety of simultaneous transurethral resection of high-grade urothelial carcinoma of the bladder and benign prostatic hyperplasia. Arab J Urol 2022; 21:102-107. [PMID: 37234675 PMCID: PMC10208128 DOI: 10.1080/2090598x.2022.2142365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives To examine the oncological safety of simultaneous resection of bladder tumor and prostate in the presence of non-muscle invasive high-grade urothelial carcinoma of the bladder (UCB). Materials and Methods Between 2007 and 2019, 170 men with high-grade UCB who had a follow-up of at least 12 months were included in the study, including 123 with transurethral resection of bladder tumor (TURBT) only and 47 with simultaneous TURBT and transurethral resection of the prostate (TURP). We recorded and compared patients' clinicopathological parameters, recurrence, and progression rates during the follow-up period, as well as time to UCB recurrence in the bladder and the prostatic urethra/fossa. Results Baseline demographic and pathological characteristics were comparable between the groups. At a median follow-up of 31 months in both groups, there were no significant differences in recurrence rates in the bladder and the prostatic urethra/fossa in either group (34.1% and 7.3% vs. 36.2 and 6.4%, p=0.402, p=0.363). No statistically significant differences were found between the two groups in terms of follow-up time, elapsed time to recurrence, or and progression in the bladder or prostatic urethra/fossa. Conclusions Simultaneous TURBT and TURP in the presence of high-grade UCB appears to be oncologically safe in selected patients.
Collapse
Affiliation(s)
- Ben Valery Sionov
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matvey Tsivian
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Pavel Bakaleyschik
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel
| | - Ami Abraham Sidi
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Tsivian
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Assessment of Therapeutic Benefit and Option Strategy on Intravesical Instillation for Preventing Bladder Cancer Recurrence after Radical Nephroureterectomy in Patients with Upper Urinary Tract Urothelial Carcinoma. JOURNAL OF ONCOLOGY 2022; 2022:1755368. [PMID: 35677889 PMCID: PMC9170511 DOI: 10.1155/2022/1755368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022]
Abstract
Objective Upper urinary tract urothelial carcinoma (UUT-UC) is a very aggressive disease, characterized by 22%–50% of patients suffering from subsequent bladder recurrence after radical nephroureterectomy (RNU). Although the therapy of intravesical instillation is reported to be effective in preventing bladder recurrence, no study had been reported in Northeast China. The findings relating to the clinical effectiveness of intravesical instillation after RNU are somewhat controversial, and the best efficacy and least adverse effects of instillation drugs have not been widely accepted. Here, we aimed at evaluating the efficacy of intravesical instillation for the prevention intravesical recurrence systematically. Methods In this retrospective cohort study, from October 2006 to September 2017, 158 UUT-UC patients underwent RNU were divided into 4 groups: epirubicin (EPB) instillation group, hydroxycamptothecin (HCPT) instillation group, bacillus Calmette–Guerin (BCG) instillation group, and noninstillation group. Cox univariate and multivariate analyses were employed to identify the risk factors for intravesical recurrence-free survival (IVRFS). The nomogram model was also applied to predict patient outcomes. Subsequently, to evaluate the clinical significance of intravesical instillation comprehensively, several databases including PubMed, Ovid, and Embase were searched and data from published studies with our results were combined by direct meta-analysis. Moreover, a network meta-analysis comparing instillation therapies was conducted to evaluate the clinical efficacy of different instillation drugs. Results In our retrospective cohort study, the Kaplan–Meier survival curve demonstrated noninstillation groups were associated with worsened IVRFS. Meanwhile, multivariate analysis indicated that intravesical instillation was independent protective factors for IVRFS (hazard ratio [HR] = 0.731). Moreover, calibration plots, receiver operating characteristic (ROC) curves, area under the curve (AUC) values, and the C-index showed the priority of nomogram's predictive accuracy. Next, direct meta-analysis including 19 studies showed that intravesical instillation could prevent the recurrence of bladder cancer with a pooled risk ratio (RR) estimate of 0.53. Subgroup analysis by study type, year of intravesical recurrence, first instillation time, and instillation times also confirmed the robustness of the results. Moreover, intraoperative instillation was associated with a decrease in the risk of bladder recurrence compared with postoperative instillation. Then, a network meta-analysis including 7 studies indicated that pirarubicin (THP) (surface under the cumulative ranking curve [SUCRA] = 89.2%) is the most effective therapy to reduce the risk of bladder recurrence, followed by BCG (SUCRA = 83.5%), mitomycin C (MMC) (SUCRA = 53.6%), EPB (SUCRA = 52.6%), and HCPT (SUCRA = 5.1%) after the analysis of the value ranking. Conclusions A maintenance schedule of intravesical instillation prevents the recurrence of bladder cancer after RNU in UUT-UC patients effectively. Large, prospective trials are needed to further confirm its value. Compared with other chemotherapy regimens, THP may be a promising drug with favorable efficacy to prevent bladder recurrence. As included studies had moderate risk of bias, the results of network meta-analysis should be applied with caution.
Collapse
|
5
|
Fujita N, Hatakeyama S, Momota M, Narita T, Tobisawa Y, Yoneyama T, Yamamoto H, Ito H, Yoneyama T, Hashimoto Y, Yoshikawa K, Ohyama C. Single immediate instillation of chemotherapy is associated with decreased recurrence and progression in patients with high-risk non-muscle-invasive bladder cancer who receive adjuvant induction bacillus Calmette-Guérin therapy. Int J Urol 2022; 29:867-875. [PMID: 35577361 DOI: 10.1111/iju.14926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate whether a single intravesical instillation of chemotherapy is associated with improved oncological outcomes in patients with high-risk non-muscle-invasive bladder cancer who receive adjuvant induction bacillus Calmette-Guérin therapy. METHODS This multi-institutional retrospective study included 205 patients with high-risk non-muscle-invasive bladder cancer who received adjuvant induction bacillus Calmette-Guérin therapy. Patients were divided into two groups: those who received the combined therapy of a single instillation of chemotherapy plus subsequent adjuvant induction bacillus Calmette-Guérin therapy (combined therapy group), and those who received adjuvant induction bacillus Calmette-Guérin therapy alone (bacillus Calmette-Guérin monotherapy group). Multivariable analyses using the inverse probability of treatment weighting method and Fine-Gray competing risk regression models were performed to evaluate the impact of a single instillation of chemotherapy on intravesical recurrence-free survival and muscle-invasive bladder cancer-free survival. RESULTS Among the 205 patients, 130 (63%) and 75 (37%) were classified as the combined therapy and bacillus Calmette-Guérin monotherapy groups, respectively. Multivariable analyses using the inverse probability of treatment weighting method showed that a single instillation of chemotherapy was significantly associated with longer intravesical recurrence-free survival (hazard ratio 0.279; P < 0.001) and muscle-invasive bladder cancer-free survival (hazard ratio 0.078; P < 0.001). Fine-Gray competing risk regression model revealed that a single instillation of chemotherapy was associated with a significantly lower probability of intravesical recurrence and muscle-invasive bladder cancer progression, with an adjusted subdistribution hazard ratio of 0.477 (P = 0.008) and 0.261 (P = 0.043), respectively. CONCLUSION A single intravesical instillation of chemotherapy may be a potential treatment option in patients with high-risk non-muscle-invasive bladder cancer who receive adjuvant induction bacillus Calmette-Guérin therapy.
Collapse
Affiliation(s)
- Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroyuki Ito
- Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
6
|
Comparison of various types of lasers and transurethral resection in the treatment of bladder tumors: a systematic review and meta-analysis. Lasers Med Sci 2022; 37:95-101. [PMID: 35022872 DOI: 10.1007/s10103-021-03479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
Bladder cancer is one of the most common cancers of the urinary tract. The two available treatments for this malignancy are laser and Transurethral Resection of the Bladder Tumor (TURBT). The aim of this study was to compare the different parameters of these two methods. A systematic search was performed on PubMed, Scopus and Google Scholar between 2000 and 2021. All articles related to non-muscle invasive bladder cancer (NMIBC) were extracted. All analyses were performed using R-studio statistical software version 1.0.136. In total, 11 studies that reported tumor recurrence in two methods were evaluated. A total of 626 and 742 patients were treated with laser and TURBT, respectively. Tumor recurrence, duration of operation, hospitalization and catheterization in laser therapy were significantly lower than TURBT. In addition, the incidence of complications was lower in patients treated with laser. The incidence of obturator nerve reflex, bladder perforation and postoperative bladder irrigation was significantly higher in patients treated with TURBT. Only in relation to postoperative urethral stricture, no significant difference was observed between the two treatment methods. Laser therapy compared to TURBT in patients with NMIBC has fewer complications and faster recovery. Also, the risk of tumor recurrence in laser therapy is less than TURBT.
Collapse
|
7
|
Tse RTH, Zhao H, Wong CYP, Kong AWY, Chan RCK, To KF, Ng CF, Teoh JYC. In vitro assessment of intra-operative and post-operative environment in reducing bladder cancer recurrence. Sci Rep 2022; 12:22. [PMID: 34997063 PMCID: PMC8741939 DOI: 10.1038/s41598-021-04035-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/07/2021] [Indexed: 01/11/2023] Open
Abstract
Urinary bladder cancer is a common cancer worldwide. Currently, the modality of treating and monitoring bladder cancer is wide. Nonetheless, the high recurrence rate of non-muscle-invasive bladder cancer after surgical resection is still unsatisfactory. Hereby, our study demonstrated whether the intra-operative and post-operative environments will affect bladder cancer recurrence utilizing in vitro cell line model. Bladder cancer cell lines were submerged in four different irrigating fluids for assessing their tumorigenic properties. Our results showed that sterile water performed the best in terms of the magnitude of cytotoxicity to cell lines. Besides, we also investigated cytotoxic effects of the four irrigating agents as well as mitomycin C (MMC) in normothermic and hyperthermic conditions. We observed that sterile water and MMC had an increased cytotoxic effect to bladder cancer cell lines in hyperthermic conditions. Altogether, our results could be translated into clinical practice in the future by manipulating the intra-operative and post-operative conditions in order to lower the chance of residual cancer cells reimplant onto the bladder, which in turns, reducing the recurrence rate of bladder cancers.
Collapse
Affiliation(s)
- Ryan Tsz-Hei Tse
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Hongda Zhao
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Christine Yim-Ping Wong
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Angel Wing-Yan Kong
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Ronald Cheong-Kin Chan
- grid.10784.3a0000 0004 1937 0482Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Fai To
- grid.10784.3a0000 0004 1937 0482Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China ,European Association of Urology-Young Academic Urologists (EAU-YAU) Urothelial Cancer Working Group, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Eilender BM, Katims AB, Pfail JL, Sfakianos J. Evolving Treatment in Non-muscle-Invasive Bladder Cancer. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
9
|
Liu Z, Long G, Zhang Y, Sun G, Ouyang W, Wang S, Xu H, Wang Z, Guan W, Yu X, Hu Z, Chen Z, Wang S, Li H. Thulium Laser Resection of Bladder Tumors vs. Conventional Transurethral Resection of Bladder Tumors for Intermediate and High Risk Non-Muscle-Invasive Bladder Cancer Followed by Intravesical BCG Immunotherapy. Front Surg 2021; 8:759487. [PMID: 34820417 PMCID: PMC8606824 DOI: 10.3389/fsurg.2021.759487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/18/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Thulium laser resection of bladder tumors (TmLRBT) is recently considered as a common treatment option for non-muscle-invasive bladder cancers (NMIBC), but whether it is superior to Transurethral resection of bladder tumors (TURBT) are still undetermined. Materials and Methods: We retrospectively screened our institution database to identify patients who were treated by conventional TURBT or TmLRBT for NMIBC and followed by intravesical bacillus Calmette-Guérin (BCG) immunotherapy. The preoperative characteristics, perioperative outcomes, and recurrence-free survival were compared to assess the safety and efficacy of the two procedures. Results: Eventually, 90 patients who underwent TmLRBT (n = 37) or TURBT (n = 53) followed by intravesical BCG immunotherapy were included. Two groups were similar in baseline characteristics except for the smaller tumor size of the TmLRBT group(1.7 cm vs. 2.2 cm; P = 0.036). Obturator nerve reflex occurred in eight patients in the TURBT group and 3 of them suffered from bladder perforation while none happened in the TmLRBT group. The TmLRBT also had a shorter irrigation duration. In the multivariate Cox regression, the TmLRBT was related to less recurrence risk (HR: 0.268; 95% CI, 0.095–0.759; P = 0.013). Conclusion: Our results suggested that TmLRBT is safer than conventional TURBT with fewer perioperative complications, and it offers better cancer control, therefore might be a superior option for NMIBC patients with intermediate and high recurrence risk.
Collapse
Affiliation(s)
- Zheng Liu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Gongwei Long
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Geriatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guoliang Sun
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Ouyang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shen Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Xu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihua Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhong Chen
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
10
|
Liu Z, Zhang Y, Sun G, Ouyang W, Wang S, Xu H, Hu H, Li F, Yang J, Wang Z, Guan W, Yu X, Hu Z, Chen Z, Wang S, Long G, Li H. Comparison of Thulium Laser Resection of Bladder Tumors and Conventional Transurethral Resection of Bladder Tumors for Non-Muscle-Invasive Bladder Cancer. Urol Int 2021; 106:116-121. [PMID: 33784709 DOI: 10.1159/000514042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The thulium laser resection of bladder tumors (TmLRBT) was increasingly used in the treatment of non-muscle-invasive bladder cancer (NMIBC) recently, and here we report the relevant outcomes of our institution to evaluate its efficacy and safety. METHODS We retrospectively collected the data of NMIBC patients who underwent either TmLRBT or transurethral resection of bladder tumor (TURBT). The baseline characteristics and perioperative outcomes were compared in these 2 groups. RESULTS The TmLRBT had a higher rate of detrusor identification than TURBT (97.4 vs. 87.6%, p = 0.001). After screening, 134 patients who underwent TmLRBT and 152 patients who received TURBT were enrolled in the analysis, and their baseline characteristics were similar. During the TURBT, 24 (15.8%) obturator nerve reflexes and 9 (5.9%) bladder perforations occurred, while none happened during the TmLRBT. After surgery, TmLRBT patients had fewer postoperative gross hematuria (38.1 vs. 96.7%, p < 0.001) and postoperative irrigation (27.6 vs. 92.7%, p < 0.001), and its irrigation duration was significantly shorter (2.3 vs. 3.3 day, p < 0.001). During the follow-up, no significant difference in the recurrence rate was detected (p = 0.315). CONCLUSIONS TmLRBT is a safer technique than conventional TURBT in the treatment of NMIBC, and it could offer better specimens for pathologic assessment while the cancer control was not compromised.
Collapse
Affiliation(s)
- Zheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoliang Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Ouyang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shen Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Henglong Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihua Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhong Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gongwei Long
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
11
|
Freifeld Y, Ghandour R, Singla N, Woldu S, Bagrodia A, Lotan Y, Rapoport LM, Gazimiev M, Delafuente K, Kulangara R, Robyak H, Petros FG, Raman JD, Matin SF, Margulis V. Intraoperative prophylactic intravesical chemotherapy to reduce bladder recurrence following radical nephroureterectomy. Urol Oncol 2020; 38:737.e11-737.e16. [PMID: 32641241 DOI: 10.1016/j.urolonc.2020.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Single, postoperative instillation of prophylactic intravesical chemotherapy (pIVC) is effective in reducing bladder cancer recurrences following radical nephroureterectomy (RNU). Despite high level evidence, pIVC is underutilized. Intraoperative pIVC (I-pIVC) may be easier and safer to implement than postoperative pIVC (P-pIVC). We aimed to evaluate the efficacy of I-pIVC during RNU. MATERIALS AND METHODS Retrospective analysis of patients undergoing RNU and I-pIVC or postoperative pIVC (P-pVC) with 20 to 40 mg mitomycin-C or 1 to 2 g gemcitabine. Recurrence rates were evaluated using the Kaplan-Meier curves and log rank test. Cox regression was used for univariable and multivariable analysis. RESULTS One hundred and thirty-seven patients were included in the final analysis. 81% (111/137) had I-pIVC and 19% (26/137) had P-pIVC. In the I-pIVC group higher rates of HG, muscle invasive disease and gemcitabine use were observed. Overall, 74% (101/137) and 26% (36/137) had mitomycin-C and gemcitabine instillations, respectively. Within 12 months 14% (19/137) of the patients experienced bladder recurrence. Median time to bladder recurrence was 7 months (range 3-27). Twelve months bladder recurrence-free survival rates were 82% for the I-pIVC group, and 72% for the P-pIVC group ((log rank P = 0.365). CONCLUSIONS I-pIVC during RNU may reduce bladder recurrence rates. Bladder recurrence rates are comparable to those reported using postoperative instillations. Intraoperative instillations may be easier to implement and may increase usage rates.
Collapse
Affiliation(s)
- Yuval Freifeld
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Solomon Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Leonid M Rapoport
- Research institute of Uronephrology and Human Reproductive Health, I.M Sechenov First Moscow State Medical University, Moscow, Russia
| | - Magomet Gazimiev
- Research institute of Uronephrology and Human Reproductive Health, I.M Sechenov First Moscow State Medical University, Moscow, Russia
| | - Karen Delafuente
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Haley Robyak
- Division of Urology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Firas G Petros
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jay D Raman
- Division of Urology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Surena F Matin
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Research institute of Uronephrology and Human Reproductive Health, I.M Sechenov First Moscow State Medical University, Moscow, Russia.
| |
Collapse
|
12
|
Matulay JT, Soloway M, Witjes JA, Buckley R, Persad R, Lamm DL, Boehle A, Palou J, Colombel M, Brausi M, Kamat AM. Risk‐adapted management of low‐grade bladder tumours: recommendations from the International Bladder Cancer Group (IBCG). BJU Int 2020; 125:497-505. [DOI: 10.1111/bju.14995] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/29/2019] [Accepted: 01/08/2020] [Indexed: 01/05/2023]
Affiliation(s)
| | - Mark Soloway
- Memorial Cancer Institute Memorial Hospital Hollywood FL USA
| | - J. Alfred Witjes
- Radboud University Nijmegen Medical Centre Nijmegen the Netherlands
| | | | - Raj Persad
- Bristol Royal Infirmary and Bristol Urological Institute Bristol UK
| | | | | | - Joan Palou
- Fundació Puigvert Universitat Autònoma de Barcelona Barcelona Spain
| | - Marc Colombel
- Claude Bernard University Hôpital Edouard Herriot Lyon France
| | | | - Ashish M. Kamat
- University of Texas MD Anderson Cancer Center Houston TX USA
| |
Collapse
|
13
|
Schmidt S, Kunath F, Coles B, Draeger DL, Krabbe L, Dersch R, Kilian S, Jensen K, Dahm P, Meerpohl JJ. Intravesical Bacillus Calmette-Guérin versus mitomycin C for Ta and T1 bladder cancer. Cochrane Database Syst Rev 2020; 1:CD011935. [PMID: 31912907 PMCID: PMC6956215 DOI: 10.1002/14651858.cd011935.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND People with urothelial carcinoma of the bladder are at risk for recurrence and progression following transurethral resection of a bladder tumour (TURBT). Mitomycin C (MMC) and Bacillus Calmette-Guérin (BCG) are commonly used, competing forms of intravesical therapy for intermediate- or high-risk non-muscle invasive (Ta and T1) urothelial bladder cancer but their relative merits are somewhat uncertain. OBJECTIVES To assess the effects of BCG intravesical therapy compared to MMC intravesical therapy for treating intermediate- and high-risk Ta and T1 bladder cancer in adults. SEARCH METHODS We performed a systematic literature search in multiple databases (CENTRAL, MEDLINE, Embase, Web of Science, Scopus, LILACS), as well as in two clinical trial registries. We searched reference lists of relevant publications and abstract proceedings. We applied no language restrictions. The latest search was conducted in September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared intravesical BCG with intravesical MMC therapy for non-muscle invasive urothelial bladder cancer. DATA COLLECTION AND ANALYSIS Two review authors independently screened the literature, extracted data, assessed risk of bias and rated the quality of evidence according to GRADE per outcome. In the meta-analyses, we used the random-effects model. MAIN RESULTS We identified 12 RCTs comparing BCG versus MMC in participants with intermediate- and high-risk non-muscle invasive bladder tumours (published from 1995 to 2013). In total, 2932 participants were randomised. Time to death from any cause: BCG may make little or no difference on time to death from any cause compared to MMC (hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.79 to 1.20; participants = 1132, studies = 5; 567 participants in the BCG arm and 565 in the MMC arm; low-certainty evidence). This corresponds to 6 fewer deaths (40 fewer to 36 more) per 1000 participants treated with BCG at five years. We downgraded the certainty of the evidence two levels due to study limitations and imprecision. Serious adverse effects: 12/577 participants treated with BCG experienced serious non-fatal adverse effects compared to 4/447 participants in the MMC group. The pooled risk ratio (RR) is 2.31 (95% CI 0.82 to 6.52; participants = 1024, studies = 5; low-certainty evidence). Therefore, BCG may increase the risk for serious adverse effects compared to MMC. This corresponds to nine more serious adverse effects (one fewer to 37 more) with BCG. We downgraded the certainty of the evidence two levels due to study limitations and imprecision. Time to recurrence: BCG may reduce the time to recurrence compared to MMC (HR 0.88, 95% CI 0.71 to 1.09; participants = 2616, studies = 11, 1273 participants in the BCG arm and 1343 in the MMC arm; low-certainty evidence). This corresponds to 41 fewer recurrences (104 fewer to 29 more) with BCG at five years. We downgraded the certainty of the evidence two levels due to study limitations, imprecision and inconsistency. Time to progression: BCG may make little or no difference on time to progression compared to MMC (HR 0.96, 95% CI 0.73 to 1.26; participants = 1622, studies = 6; 804 participants in the BCG arm and 818 in the MMC arm; low-certainty evidence). This corresponds to four fewer progressions (29 fewer to 27 more) with BCG at five years. We downgraded the certainty of the evidence two levels due to study limitations and imprecision. Quality of life: we found very limited data for this outcomes and were unable to estimate an effect size. AUTHORS' CONCLUSIONS Based on our findings, BCG may reduce the risk of recurrence over time although the Confidence Intervals include the possibility of no difference. It may have no effect on either the risk of progression or risk of death from any cause over time. BCG may cause more serious adverse events although the Confidence Intervals once again include the possibility of no difference. We were unable to determine the impact on quality of life. The certainty of the evidence was consistently low, due to concerns that include possible selection bias, performance bias, given the lack of blinding in these studies, and imprecision.
Collapse
Affiliation(s)
- Stefanie Schmidt
- UroEvidence@Deutsche Gesellschaft für UrologieMartin‐Buber‐Str. 10BerlinGermany14163
| | - Frank Kunath
- UroEvidence@Deutsche Gesellschaft für UrologieMartin‐Buber‐Str. 10BerlinGermany14163
- University Hospital ErlangenDepartment of UrologyKrankenhausstrasse 12ErlangenGermany91054
| | - Bernadette Coles
- Cardiff University Library ServicesVelindre NHS TrustVelindre Cancer CentreWhitchurchCardiffUKCF14 2TL
| | - Desiree Louise Draeger
- UroEvidence@Deutsche Gesellschaft für UrologieMartin‐Buber‐Str. 10BerlinGermany14163
- University of RostockDepartment of UrologyErnst‐Heydemann‐Strasse 7RostockMecklenburg‐VorpommernGermany18057
| | - Laura‐Maria Krabbe
- UroEvidence@Deutsche Gesellschaft für UrologieMartin‐Buber‐Str. 10BerlinGermany14163
- University of Muenster Medical CenterDepartment of UrologyAlbert‐Schweitzer Campus 1, GB A1MuensterNRWGermany48149
| | - Rick Dersch
- Medical Center – University of FreiburgDepartment of Neurology and NeurophysiologyBerliner Allee 29FreiburgGermany79110
| | - Samuel Kilian
- University of HeidelbergInstitute of Medical Biometry and InformaticsHeidelbergGermany
| | - Katrin Jensen
- University of HeidelbergInstitute of Medical Biometry and InformaticsHeidelbergGermany
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
- University of MinnesotaDepartment of Urology420 Delaware Street SEMMC 394MinneapolisMinnesotaUSA55455
| | - Joerg J Meerpohl
- Medical Center ‐ University of Freiburg, Faculty of Medicine, University of
FreiburgInstitute for Evidence in MedicineBreisacher Str. 153FreiburgGermanyD‐79110
| | | |
Collapse
|
14
|
Tao W, Sun C, Yao Q, Fu K, Shan Y, Zhang Y, Xue B, Yang D. The clinical study of en bloc transurethral resection with 980 nm laser for treatment of primary non-muscle invasive bladder cancer. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:563-571. [PMID: 32224536 DOI: 10.3233/xst-190616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To elevate safety and efficacy of en bloc transurethral resection with 980 nm laser as treatment for primary non-muscle-invasive bladder cancer (NMIBC). METHODS Total 84 cases were enrolled in this study. Among them, 36 and 48 cases underwent treatment using the 980 nm laser and the traditional TUR-BT procedure, respectively. The peri-operative characteristics (tumor size, tumor multiplicity, tumor grade, etc.) and intra-operative complications (obturator nerve reflex, bladder perforation, bladder irrigation, etc.) were recorded and compared between the two groups. RESULTS There are no significant difference in baseline characteristics between laser and TUR-Bt treatment groups. Operation time also has no significant difference in two groups. Obturator nerve reflex and bladder perforation were noted in 6 patients and in 3 patients during TUR-Bt group, respectively. No obturator nerve reflex and bladder perforation were observed in the laser group. The patients who need bladder irrigation was lower in laser group than in TUR-Bt group. There were no significant differences in catheterization time and hospitalization time between two groups. No significant difference in the overall recurrence rate were observed among the two groups during the follow-up periods. CONCLUSION En bloc transurethral resection using 980 nm laser is an effective and safe treatment option for non-muscle-invasive bladder cancer. Compared to the traditional TUR-Bt procedure, the procedure using 980 nm laser has fewer perioperative complications and similar oncological results.
Collapse
Affiliation(s)
- Wei Tao
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chuanyang Sun
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiu Yao
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Fu
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuxi Shan
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuanyuan Zhang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Boxin Xue
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Dongrong Yang
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
15
|
Abstract
Bladder cancer is a heterogeneous disease that poses unique challenges to the treating clinician. It can be limited to a relatively indolent papillary tumor with low potential for progression beyond this stage to muscle-invasive disease prone to distant metastasis. The former is best treated as conservatively as possible, whereas the latter requires aggressive surgical intervention with adjuvant therapies in order to provide the best clinical outcomes. Risk stratification traditionally uses clinicopathologic features of the disease to provide prognostic information that assists in choosing the best therapy for each individual patient. For bladder cancer, this informs decisions regarding the type of intravesical therapy that is most appropriate for non-muscle-invasive disease or whether or not to administer neoadjuvant chemotherapy prior to radical cystectomy. More recently, tumor genetic sequencing data have been married to clinical outcomes data to add further sophistication and personalization. In the next generation of risk classification, we are likely to see the inclusion of molecular subtyping with specific treatment considerations based on a tumor’s mutational profile.
Collapse
Affiliation(s)
- Justin T Matulay
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Suite 853, Houston, TX, 77030, USA
| | - Ashish M Kamat
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Suite 853, Houston, TX, 77030, USA
| |
Collapse
|
16
|
Oncological safety and quality of life in men undergoing simultaneous transurethral resection of bladder tumor and prostate: results from a randomized controlled trial. World J Urol 2018; 36:1629-1634. [PMID: 29725805 DOI: 10.1007/s00345-018-2317-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/27/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To assess oncological safety and quality of life (QL) of men undergoing simultaneous transurethral resection of bladder tumor (TURBT) and transurethral resection of the prostate (TURP) for symptomatic benign prostatic hyperplasia (BPH). METHODS Ninety-five men with a new diagnosis of bladder cancer (BC) and symptomatic BPH were randomized to receive TURBT + tamsulosin (Group 1) or TURBT + TURP (Group 2). Inclusion criteria were age ≤ 75 years, first diagnosis of BC up to 4 cm, and prostate volume ≤ 80 ml. All patients were evaluated preoperatively with digital rectal examination, PSA, maximal urine flow rate (Qmax), and International Prostate Symptom Score (IPSS). IPSS and Qmax were repeated at 1-year follow-up. QL was evaluated at 1 year using a modified version of the self-report bladder cancer subscale of the Functional Assessment of Cancer Therapy. RESULTS Eighty-five men completed the study (43 in Group 1 and 42 in Group 2). Adjuvant instillation therapy was given to 26 patients in Group 1 and to 27 in Group 2. Average time to the first recurrence was 16.64 months in Group 1 and 17.7 in Group 2. Total recurrences were 27 in Group 1 and 22 in Group 2. Bladder neck/prostatic urethra recurrences were 9 in Group 1 vs. 8 in Group 2. QL, IPSS, and Qmax 12 months after surgery were better in Group 2. CONCLUSION Concomitant TURBT and TURP appear to be oncologically safe procedures in terms of total and prostatic urethra recurrence, and improve QL in men with BC who require surgery for symptomatic BPH.
Collapse
|
17
|
Bosschieter J, van Moorselaar RJA, Vis AN, van Ginkel T, Lissenberg-Witte BI, Beckers GMA, Nieuwenhuijzen JA. The effect of timing of an immediate instillation of mitomycin C after transurethral resection in 941 patients with non-muscle-invasive bladder cancer. BJU Int 2018; 122:571-575. [PMID: 29319922 DOI: 10.1111/bju.14124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether the timing of an immediate instillation of mitomycin C (on the day of transurethral resection of bladder tumour [TURBT] or 1 day later) has an impact on time to recurrence of non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS All patients with NMIBC who were enrolled in a prospective trial between 1998 and 2003, and treated with an early mitomycin C instillation (on the day of TURBT or 1 day later), were selected. Statistical analysis was performed with Kaplan-Meier curves and multivariable Cox regression. RESULTS Administering an instillation of mitomycin C on the day of TURBT or 1 day later did not show a statistically significant difference in time to recurrence in a univariable model (log-rank P = 0.99). After correcting for the number of scheduled adjuvant instillations, no statistically significant difference could be detected either: hazard ratio 1.05 (95% confidence interval 0.81-1.35, P = 0.74). CONCLUSION These data do not support the hypothesis that a very early instillation (on the day of TURBT) of mitomycin C decreases the risk of recurrence as compared with an early instillation (1 day after TURBT).
Collapse
Affiliation(s)
- Judith Bosschieter
- Department of Urology, VU university Medical Center, Amsterdam, The Netherlands
| | | | - André N Vis
- Department of Urology, VU university Medical Center, Amsterdam, The Netherlands
| | - Tessa van Ginkel
- Department of Urology, VU university Medical Center, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Goedele M A Beckers
- Department of Urology, VU university Medical Center, Amsterdam, The Netherlands
| | | |
Collapse
|
18
|
Xu H, Ma J, Chen Z, Yang J, Yuan H, Wang T, Liu J, Yang W, Ye Z. Safety and Efficacy of En Bloc Transurethral Resection With 1.9 µm Vela Laser for Treatment of Non-Muscle-invasive Bladder Cancer. Urology 2017; 113:246-250. [PMID: 29198850 DOI: 10.1016/j.urology.2017.11.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/07/2017] [Accepted: 11/18/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of 1.9 µm Vela laser in treatment of primary non-muscle-invasive bladder cancer. METHODS The data of the patients with non-muscle-invasive bladder cancer treated by either en bloc transurethral resection with 1.9 µm Vela laser (n = 26) or conventional transurethral resection of bladder tumor (n = 44) were analyzed retrospectively. The preoperative characteristics and intraoperative complications were compared in the 2 groups. RESULTS Patients who were treated by 1.9 µm Vela laser obtained a higher rate of specimens meeting the requirements of pathologic assessment for tumor staging compared with the patients treated by conventional transurethral resection of bladder tumor. No obturator nerve reflex and bladder perforation occurred during surgery in the 1.9 µm Vela laser group. However, 7 patients in the conventional transurethral resection of bladder tumor group encountered obturator nerve reflex, and 3 of them encountered bladder perforation (P <.05). There were no significant differences between the 2 groups in operative duration and transfusion rate. Patients in the 1.9 µm Vela laser group had shorter postoperative continuous bladder irrigation time than that in the conventional transurethral resection of bladder tumor group. There was no significant difference in the overall recurrence rate between the 2 groups during the follow-up periods. CONCLUSION En bloc transurethral resection with 1.9 µm Vela laser in the treatment of non-muscle-invasive bladder cancer demonstrates an advantage over conventional transurethral resection of bladder tumor in reducing intraoperative complications, improving the quality of the specimens admitted for pathologic assessment, and shortening the duration of postoperative continuous bladder irrigation.
Collapse
Affiliation(s)
- Hao Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jun Ma
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhong Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Huixin Yuan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Weimin Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| |
Collapse
|
19
|
New developments in the management of nonmuscle invasive bladder cancer. Curr Opin Oncol 2017; 29:179-183. [PMID: 28282341 DOI: 10.1097/cco.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In this review, we summarize the core principles in the management of nonmuscle invasive bladder cancer (NMIBC) with an emphasis on new developments that have emerged over the last year. RECENT FINDINGS NMIBC has a propensity to recur and progress. Risk stratification has facilitated appropriate patient selection for treatment but improved tools, including biomarkers, are still needed. Enhanced cystoscopy with photodynamic imaging and narrow band imaging show promise for diagnosis, risk stratification, and disease monitoring and has been formally recommended this year by the American Urological Association. Attempts at better treatment, especially in refractory high-risk cases, include the addition of intravesical hyperthermia, combination and sequential therapy with existing agents, and the use of novel agents such as mycobacterial cell wall extract. New data are emerging regarding the potential role of early cystectomy in bacillus Calmette-Guerin-refractory NMIBC patients. SUMMARY NMIBC represents an assortment of disease states and continues to pose management challenges. Continued research is needed to bolster the evidence needed for patients and providers to make data-driven treatment decisions.
Collapse
|
20
|
Bijalwan P, Pooleri GK, Thomas A. Comparison of sterile water irrigation versus intravesical mitomycin C in preventing recurrence of nonmuscle invasive bladder cancer after transurethral resection. Indian J Urol 2017; 33:144-148. [PMID: 28469303 PMCID: PMC5396403 DOI: 10.4103/iju.iju_371_16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Early recurrence of nonmuscle invasive bladder cancer (NMIBC) following transurethral resection (TUR) remains relatively high. An immediate single instillation of mitomycin C (MMC) reduces the recurrence rates in the first 2 years but has not shown benefits in tumor progression or overall survival. Distilled water irrigation has shown to delay tumor recurrence by osmolysis of tumor cells. There are only limited clinical studies comparing the efficacy of MMC with continuous sterile water irrigation (CSWI) in preventing the recurrence of NMIBC after TUR in clinical setting. Materials and Methods: A prospective, randomized, open-label, two-arm, single-center, pilot study was conducted between December 2013 and September 2015 at a tertiary-care center in South India. Patients were randomized into CSWI group (n = 19) or single dose intravesical MMC group (n = 17) following TUR for NMIBC and analyzed. All patients were followed up with flexible cystoscopy and urine cytology at 3 months interval for 1 year. Recurrence-free rate was estimated as the primary criterion for outcome analysis. Results: At the end of 12 months, recurrence-free rates for MMC and CSWI groups were 47.1% and 52.6%, respectively. The mean recurrence-free interval for MMC and CSWI groups were 10.9 months and 9.8 months, respectively. The difference in recurrence-free rate or recurrence-free interval between two groups was statistically nonsignificant. Further, the complications in MMC group were significantly higher than that in CSWI group (P = 0.047). Conclusions: Continuous bladder irrigation with sterile water after TUR may be comparable to immediate single dose intravesical MMC in preventing tumor recurrence in NMIBC.
Collapse
Affiliation(s)
- Priyank Bijalwan
- Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ginil Kumar Pooleri
- Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Appu Thomas
- Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| |
Collapse
|
21
|
Schmidt S, Kunath F, Coles B, Draeger DL, Krabbe LM, Dersch R, Jensen K, Dahm P, Meerpohl JJ. Intravesical bacillus Calmette-Guérin versus mitomycin C for Ta and T1 bladder cancer. Hippokratia 2015. [DOI: 10.1002/14651858.cd011935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stefanie Schmidt
- UroEvidence@Deutsche Gesellschaft für Urologie; Kuno-Fischer-Strasse 8 Berlin Germany 14057
| | - Frank Kunath
- University Hospital Erlangen; Department of Urology; Krankenhausstrasse 12 Erlangen Germany 91054
| | - Bernadette Coles
- Cardiff University; Cancer Research Wales Library; Velindre Cancer Centre Whitchurch Cardiff UK CF14 2TL
| | - Desiree Louise Draeger
- University of Rostock; Department of Urology; Ernst-Heydemann-Strasse 7 Rostock Mecklenburg-Vorpommern Germany 18057
| | - Laura-Maria Krabbe
- University of Muenster Medical Center; Department of Urology; Albert-Schweitzer Campus 1, GB A1 Muenster NRW Germany 48149
| | - Rick Dersch
- Medical Center - University of Freiburg; Department of Neurology and Neurophysiology; Berliner Allee 29 Freiburg Germany 79110
| | - Katrin Jensen
- University Hospital Heidelberg; Institute of Medical Biometry and Informatics; Im Neuenheimer Feld 305 Heidelberg Germany 69120
| | - Philipp Dahm
- Minneapolis VA Health Care System; Urology Section; One Veterans Drive Mail Code 112D Minneapolis Minnesota USA 55417
- University of Minnesota; Department of Urology; 420 Delaware Street SE MMC 394 Minneapolis Minnesota USA 55455
| | - Joerg J Meerpohl
- Medical Center - University of Freiburg; Cochrane Germany; Berliner Allee 29 Freiburg Germany 79110
| |
Collapse
|
22
|
Jancke G, Rosell J, Jahnson S. Tumour location adjacent to the ureteric orifice in primary Ta/T1 bladder cancer is predictive of recurrence. Scand J Urol 2015. [PMID: 26202687 DOI: 10.3109/21681805.2015.1066849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate tumour growth located around the ureteric orifice (LUO) at primary diagnosis of Ta/T1 urinary bladder cancer in relation to effects on recurrence and progression. MATERIALS AND METHODS Clinical and pathological characteristics of patients diagnosed with primary Ta/T1 urinary bladder cancer from 1992 to 2007 were recorded prospectively. Location of the primary tumour and growth around the ureteric orifice (within 1 cm) were recorded and correlated with recurrence and progression during further follow-up. Hazard ratios (HRs) were estimated using Cox regression with 95% confidence intervals (CIs) in both univariate and multivariate analysis. RESULTS The study included 768 evaluable patients with a median follow-up of 60 months. Recurrence was observed in 478 patients (62%) and progression in 71 (9%). Growth of a primary tumour adjacent to the ureteric orifice was associated with recurrence (HR = 1.28, 95% CI = 1.07-1.54) but not progression (HR = 1.04, 95% CI = 0.65-1.67). The most common location of the first recurrence was the posterior bladder wall (29%). Other locations in the bladder did not predict recurrence or progression. Additional factors affecting recurrence were tumour size greater than 15 mm, T1 tumour category, multiplicity, malignant or missing/not representative bladder wash cytology and surgery performed by residents. CONCLUSIONS A primary tumour located around the ureteric orifice was predictive of recurrence, which could be taken into account in future follow-up schedules.
Collapse
Affiliation(s)
- Georg Jancke
- a 1 Division of Urology, Department of Clinical and Experimental Medicine, Linköping University , Linköping, Sweden
| | - Johan Rosell
- b 2 Oncology Centre, University Hospital , Linköping, Sweden
| | - Staffan Jahnson
- a 1 Division of Urology, Department of Clinical and Experimental Medicine, Linköping University , Linköping, Sweden
| |
Collapse
|
23
|
Xu Y, Guan W, Chen W, Xie C, Ouyang Y, Wu Y, Liu C. Comparing the treatment outcomes of potassium-titanyl-phosphate laser vaporization and transurethral electroresection for primary nonmuscle-invasive bladder cancer: A prospective, randomized study. Lasers Surg Med 2015; 47:306-11. [PMID: 25864416 DOI: 10.1002/lsm.22342] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Yansheng Xu
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Weimin Guan
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Weihao Chen
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Changliang Xie
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Yun Ouyang
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Yiguang Wu
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| | - Cuilong Liu
- Department of Urology; Navy General Hospital of the People's Liberation Army; No. 6 Fucheng Street Haidian District Beijing 100048 People's Republic of China
| |
Collapse
|
24
|
Patel SG, Cohen A, Weiner AB, Steinberg GD. Intravesical therapy for bladder cancer. Expert Opin Pharmacother 2015; 16:889-901. [DOI: 10.1517/14656566.2015.1024656] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
25
|
Yoshida T, Okuyama H, Nakayama M, Endo H, Nonomura N, Nishimura K, Inoue M. High-dose chemotherapeutics of intravesical chemotherapy rapidly induce mitochondrial dysfunction in bladder cancer-derived spheroids. Cancer Sci 2014; 106:69-77. [PMID: 25363302 PMCID: PMC4317779 DOI: 10.1111/cas.12567] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/21/2014] [Accepted: 10/29/2014] [Indexed: 01/24/2023] Open
Abstract
Non-muscle invasive bladder cancer is treated with intravesical chemotherapy (IVC) after transurethral resection (TUR) to reduce the probability of recurrence. Despite improvement, the recurrence rate remains high. Intravesical chemotherapeutics at high doses are expected to ablate unresected tumors and floating cancer cells after TUR, although the fate of bladder cancer cells exposed to high-dose chemotherapeutics remains unclear. In this study, we utilized cancer tissue-originated spheroids (CTOS) prepared from bladder cancers or patient-derived xenografts, which may recapitulate human tumors better than 2-D cultures of established cell lines. We exposed CTOS to 1 mg/mL of epirubicin (EPI) or mitomycin C (MMC) for 2 h. EPI was promptly and homogeneously distributed into cancer cells in the CTOS. Two hours after exposure to MMC, the mitochondrial membrane potential decreased and the mitochondria were fragmented, while plasma membrane integrity was maintained. ATP levels rapidly decreased in CTOS after exposure to EPI or MMC. Although activation of the apoptotic pathway was confirmed by the advent of cleaved poly (ADP-ribose) polymerase, fragmentation of DNA (a hallmark of apoptosis) was not observed in CTOS after exposure to EPI and MMC. In the CTOS prepared directly from 19 surgical specimens exposed to EPI and MMC, the decrease of ATP levels varied among patients. Further establishment of the test might help the drug selection and the prediction of recurrence for individual patients.
Collapse
Affiliation(s)
- Takahiro Yoshida
- Department of Biochemistry, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | | | | | | | | |
Collapse
|
26
|
Jancke G, Rosell J, Jahnson S. Impact of surgical experience on recurrence and progression after transurethral resection of bladder tumour in non-muscle-invasive bladder cancer. Scand J Urol 2013; 48:276-83. [DOI: 10.3109/21681805.2013.864327] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
27
|
Li Z, Hou R, Li J. The efficacy and safety of simultaneous transurethral GreenLight photoselective vaporization of bladder tumor and prostate in patients with bladder tumor and lower urinary tract symptoms. Int Urol Nephrol 2013; 46:691-4. [PMID: 24097277 DOI: 10.1007/s11255-013-0572-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/18/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE We compared the safety and efficacy of simultaneous transurethral GreenLight photoselective vaporization of bladder tumor and prostate (PVBT/PVP) in patients with bladder tumor and bladder outlet obstruction caused by benign prostate hyperplasia (BPH). METHODS Sixty-two patients with bladder tumor were enrolled in our prospective and randomized trial. A total of 37 men underwent simultaneous transurethral PVBT/PVP, and 25 patients underwent PVBT alone. The clinicopathological parameters and the recurrence of bladder tumor on the bladder neck/prostatic fossa were evaluated in all patients. RESULTS Clinicopathological parameters of both groups were similar. The rates of recurrence, progression and tumor recurrence of bladder neck/prostatic fossa were 16.0, 4.0 and 4.0 % in the simultaneous resection group, and 18.9, 5.4 and 8.1 % in the group PVBT, respectively. No statistically significant differences were found between the two groups (P > 0.05). CONCLUSIONS Simultaneous PVBT/PVP may help decrease the overall recurrence rate and tumor recurrence in bladder neck/prostatic fossa. PVBT/PVP can be performed effectively and safely in patients with bladder tumor and BPH.
Collapse
Affiliation(s)
- Zhaoyi Li
- Department of Urology, The Union Medical Center of Tianjin, Tianjin, 300121, China
| | | | | |
Collapse
|
28
|
Yang X, Huang H, Zeng Z, Zhao L, Hu P, He D, Tang X, Zeng Z. Diagnostic value of bladder tumor fibronectin in patients with bladder tumor: A systematic review with meta-analysis. Clin Biochem 2013; 46:1377-82. [DOI: 10.1016/j.clinbiochem.2013.05.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/14/2013] [Accepted: 05/22/2013] [Indexed: 01/26/2023]
|
29
|
Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BWG, Compérat E, Sylvester RJ, Kaasinen E, Böhle A, Palou Redorta J, Rouprêt M. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol 2013; 64:639-53. [PMID: 23827737 DOI: 10.1016/j.eururo.2013.06.003] [Citation(s) in RCA: 913] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT The first European Association of Urology (EAU) guidelines on bladder cancer were published in 2002 [1]. Since then, the guidelines have been continuously updated. OBJECTIVE To present the 2013 EAU guidelines on non-muscle-invasive bladder cancer (NMIBC). EVIDENCE ACQUISITION Literature published between 2010 and 2012 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the levels of evidence and grades of recommendation were assigned. EVIDENCE SYNTHESIS Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient's prognosis. Where the initial resection is incomplete, where there is no muscle in the specimen, or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. The risks of both recurrence and progression may be estimated for individual patients using the EORTC scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups is pivotal to recommending adjuvant treatment. For patients with a low-risk tumour, one immediate instillation of chemotherapy is recommended. Patients with an intermediate-risk tumour should receive one immediate instillation of chemotherapy followed by 1 yr of full-dose bacillus Calmette-Guérin (BCG) intravesical immunotherapy or by further instillations of chemotherapy for a maximum of 1 yr. In patients with high-risk tumours, full-dose intravesical BCG for 1-3 yr is indicated. In patients at highest risk of tumour progression, immediate radical cystectomy should be considered. Cystectomy is recommended in BCG-refractory tumours. The long version of the guidelines is available from the EAU Web site: http://www.uroweb.org/guidelines/. CONCLUSIONS These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice. PATIENT SUMMARY The EAU Panel on Non-muscle Invasive Bladder Cancer released an updated version of their guidelines. Current clinical studies support patient selection into different risk groups; low, intermediate and high risk. These risk groups indicate the likelihood of the development of a new (recurrent) cancer after initial treatment (endoscopic resection) or progression to more aggressive (muscle-invasive) bladder cancer and are most important for the decision to provide chemo- or immunotherapy (bladder installations). Surgical removal of the bladder (radical cystectomy) should only be considered in patients who have failed chemo- or immunotherapy, or who are in the highest risk group for progression.
Collapse
Affiliation(s)
- Marko Babjuk
- Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Ersoy H, Yaytokgil M, Karakoyunlu AN, Topaloglu H, Sagnak L, Ozok HU. Single early instillation of mitomycin C and urinary alkalinization in low-risk non-muscle-invasive bladder cancer: a preliminary study. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:1-6. [PMID: 23300343 PMCID: PMC3536351 DOI: 10.2147/dddt.s39541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The purpose of this study was to determine the effectiveness of a single early instillation of mitomycin C (MMC) after transurethral resection of bladder tumor (TURBT) together with urinary alkalinization in patients with low-risk non-muscle-invasive bladder cancer (NMIBC). Methods Between February 2006 and November 2010, patients diagnosed as having a primary bladder tumor were randomized into standard and optimized treatment groups. The treatment groups were formed prospectively from patients with NMIBC according to results of pathological examination postoperatively, whereas the control group was formed retrospectively. Patients in the standard group (n = 11) were given intravesical MMC 40 mg in the first 6 hours after TURBT, while the patients in the optimized group (n = 15) underwent urinary alkalinization prior to MMC. In the control group (n = 23), no drug treatment was given. The patients were followed after surgery at months 3 and 12, and then annually for the first 5 years using cystoscopy and ultrasound. Time to recurrence and recurrence-free survival rates were calculated. Results There were no statistically significant differences between the standard and optimized groups, between the control and optimized groups, or between the control and standard groups in terms of mean recurrence-free survival rates (P = 0.132, 0.645, and 0.173, respectively). The mean time to recurrence was 34.8 (range 28.5–41.1) months in the optimized group and 51.8 (range 44.3–59.2) months in the control group. There was no recurrence during the follow-up period in the standard group. Conclusion The results of this preliminary study could not demonstrate the efficacy of urinary alkalinization before a single dose of early MMC following TURBT to increase the effectiveness of the MMC, so we did not continue the study further.
Collapse
Affiliation(s)
- Hamit Ersoy
- Department of Urology, Diskapı Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
31
|
Jancke G, Rosell J, Jahnson S. Residual tumour in the marginal resection after a complete transurethral resection is associated with local recurrence in Ta/T1 urinary bladder cancer. ACTA ACUST UNITED AC 2012; 46:343-7. [DOI: 10.3109/00365599.2012.684700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Georg Jancke
- Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | | | - Staffan Jahnson
- Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Sweden
| |
Collapse
|
32
|
Maruyama T, Higuchi Y, Suzuki T, Qiu J, Yamamoto S, Shima H. Double short-time exposure to pirarubicin produces higher cytotoxicity against T24 bladder cancer cells. J Infect Chemother 2011; 17:11-6. [DOI: 10.1007/s10156-010-0088-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 06/23/2010] [Indexed: 11/29/2022]
|
33
|
Luo S, Lin Y, Zhang W. Does simultaneous transurethral resection of bladder tumor and prostate affect the recurrence of bladder tumor? A meta-analysis. J Endourol 2010; 25:291-6. [PMID: 20977373 DOI: 10.1089/end.2010.0314] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of simultaneous resection in the treatment of nonmuscle invasive bladder cancer (NMIBC) with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Combined published data from comparative studies on simultaneous transurethral resection of bladder tumor/transurethral resection of the prostate (TURBT/TURP) vs TURBT alone in NMIBC were analyzed, considering possible confounding factors. Odds ratios (ORs) and 95% confidence intervals (CIs) were used as the primary effect size to estimate the outcome of overall tumor recurrence, recurrence in bladder neck/prostatic fossa. RESULTS In six eligible clinical trials, 483 patients were treated with simultaneous resection and 500 with TURBT alone. Within the follow-up period, tumor recurrence developed in 203 (42%) patients in the simultaneous resection group and 256 (51.2%) patients in the control group. The combined analysis indicated that the recurrence rate in the simultaneous resection group was statistically significantly lower than in the control group in the overall pooled data (combined OR = 0.67; 95% CI 0.52 to 0.88, P = 0.003). Tumor recurrence of bladder neck/prostatic fossa developed in 37(7.7%) patients in the simultaneous resection group and 42 (8.4%) patients in the control group. No statistically significant difference was found between the two groups (combined OR = 0.92; 95% CI 0.57 to 1.49, P = 0.74). Potential confounders, such as mean age, mean follow-up duration, multiplicity of tumor, and year of publication did not significantly influence the results. CONCLUSION There was at least the evidence that simultaneous TURBT/TURP did not increase the overall recurrence rate and recurrence rate in bladder neck/prostatic fossa. Simultaneous TURBT/TURP might be preferable for patients with NMIBC and BPH.
Collapse
Affiliation(s)
- Shengjun Luo
- Department of Urologic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | | |
Collapse
|
34
|
Jaidane M, Bouicha T, Slama A, Hmida W, Hidoussi A, Sorba NB, Mosbah F. Tumor Recurrence in Prostatic Urethra Following Simultaneous Resection of Bladder Tumor and Prostate: A Comparative Retrospective Study. Urology 2010; 75:1392-5. [DOI: 10.1016/j.urology.2009.06.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 06/18/2009] [Accepted: 06/28/2009] [Indexed: 10/20/2022]
|
35
|
Singh V, Sinha RJ, Sankhwar S. Outcome of Simultaneous Transurethral Resection of Bladder Tumor and Transurethral Resection of the Prostate in Comparison with the Procedures in Two Separate Sittings in Patients with Bladder Tumor and Urodynamically Proven Bladder Outflow Obstruction. J Endourol 2009; 23:2007-11. [DOI: 10.1089/end.2009.0009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vishwajeet Singh
- Department of Urology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
| | - Rahul J. Sinha
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - S.N. Sankhwar
- Department of Urology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
| |
Collapse
|
36
|
Ham WS, Kim WT, Jeon HJ, Lee DH, Choi YD. Long-Term Outcome of Simultaneous Transurethral Resection of Bladder Tumor and Prostate in Patients With Nonmuscle Invasive Bladder Tumor and Bladder Outlet Obstruction. J Urol 2009; 181:1594-9; discussion 1599. [DOI: 10.1016/j.juro.2008.11.099] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Won Sik Ham
- Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Tae Kim
- Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jin Jeon
- Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
37
|
Park SH, Kim SI, Kim SJ. Effects of Simultaneous Transurethral Resection of Non-Muscle-Invasive Bladder Cancer and Benign Prostatic Hyperplasia. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.6.534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sung Hoon Park
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Sun Il Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Se Joong Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
38
|
Nakamura K, Fujiyama C, Tokuda Y, Sugihara H, Masaki Z. Bladder cancer cell implantation in reconstructed bladder in vitro: a model of tumour recurrence. BJU Int 2008. [DOI: 10.1046/j.1464-410x.2002.02522.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
39
|
Ham WS, Kim WT, Jeon HJ, Lee DH, Choi YD. The Significance of Simultaneous Transurethral Resection of Bladder Tumor and the Prostate in Patient who have Superficial Bladder Cancer with Bladder Outlet Obstruction. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.9.791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Won Sik Ham
- Department of Urology and the Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Tae Kim
- Department of Urology and the Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jin Jeon
- Department of Urology and the Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Department of Urology and the Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology and the Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
40
|
Ugurlu O, Gonulalan U, Adsan O, Kosan M, Oztekin V, Cetinkaya M. Effects of Simultaneous Transurethral Resection of Prostate and Solitary Bladder Tumors Smaller Than 3 cm on Oncologic Results. Urology 2007; 70:55-9. [PMID: 17656208 DOI: 10.1016/j.urology.2007.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2006] [Revised: 01/27/2007] [Accepted: 03/02/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate the effect on the oncologic outcomes of treatment with transurethral resection of patients with a solitary bladder tumor smaller than 3 cm with a superficial appearance and benign prostatic hyperplasia. METHODS The follow-up data from 34 men (group 1) who had undergone transurethral bladder tumor resection alone and 31 men who had undergone both transurethral prostate resection and transurethral bladder tumor resection at the same operation (group 2) in our clinic from 1996 to 2004 were retrospectively examined. The groups were also compared with each other. The recurrence and progression rates, elapsed time to recurrence, and the recurrence rates in the bladder neck and prostatic urethra were determined and compared. Statistical analysis was performed using the Mann-Whitney U and chi-square tests. RESULTS The patients were followed up for at least 12 months (mean 28.9, range 12 to 98). The average follow-up period for group 1 was 27.4 months (range 12 to 91) and was 30.5 months (range 12 to 98) for group 2. The recurrence and progression rates for groups 1 and 2 were 41.2% and 8.8% and 35.5% and 9.7%, respectively. Recurrence in the bladder neck and/or prostatic urethra developed in 1 patient in each group. No statistically significant differences were found between groups in terms of follow-up time, recurrence, progression, recurrence in the prostatic urethra and/or bladder neck, and elapsed time to recurrence. CONCLUSIONS According to our results, transurethral prostate resection can be safely performed with transurethral bladder tumor resection simultaneously in selected patients with severe lower urinary tract symptoms and a superficial solitary tumor smaller than 3 cm.
Collapse
Affiliation(s)
- Ozgur Ugurlu
- Department of 2nd Urology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
41
|
Langbein S, Badawi K, Haecker A, Weiss C, Hatzinger M, Alken P, Siegsmund M. Persistence, recurrence, and progression rates of superficial bladder tumours after resection using the differentiated technique. Med Princ Pract 2006; 15:215-8. [PMID: 16651838 DOI: 10.1159/000092184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Accepted: 09/27/2005] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate whether the differentiated resection technique for excising superficial bladder cancer leads to higher recurrence and progression rates as compared with regular resection. SUBJECTS AND METHODS We evaluated 163 patients, 66 undergoing a differentiated and 97 a regular resection. All patients underwent a routine second resection within 6-10 weeks. Recurrence and progression rates as well as tumour persistence on second resection were analyzed. RESULTS Patients with differentiated resections of bladder tumours did not have higher tumour recurrence and progression rates. Also, these patients had a significantly higher percentage of tumour-free second resections (p = 0.03). CONCLUSION The differentiated resection technique for excising superficial bladder cancer has no negative influence on recurrence and progression rates, but it leads to a reduced tumour persistence.
Collapse
Affiliation(s)
- S Langbein
- Abteilungen fur Urologie, Universitatsklinikum Mannheim, Germany.
| | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
The high recurrence rate in superficial bladder cancer (>70%) is caused by the adhesion of free floating tumor cells during transurethral treatment, by incomplete resections, and by overlooked and new tumors. Frequent follow-ups and reoperations are necessary. A single immediate instillation after TUR shows positive effects in reducing recurrence rates and is therefore recommended in the European Guidelines from 2001. The amount, concentration, instillation time, and substances have not yet been standardized. By analyzing the literature we found many different techniques of early instillation therapy. Different substances, concentrations, varying instillation times, and application times make a comparison of these studies very difficult. Further studies are needed to standardize early postoperative instillation therapy.
Collapse
Affiliation(s)
- S Langbein
- Urologische Universitätsklinik Mannheim.
| | | | | | | | | |
Collapse
|
43
|
Tsivian A, Shtricker A, Sidi AA. Simultaneous Transurethral Resection of Bladder Tumor and Benign Prostatic Hyperplasia: Hazardous or A Safe Timesaver? J Urol 2003; 170:2241-3. [PMID: 14634388 DOI: 10.1097/01.ju.0000096273.64448.e7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluated the effect of simultaneous transurethral resection of bladder tumor (TURBT) and benign prostatic hyperplasia (TURP) on recurrences at the bladder neck and prostatic urethra. MATERIAL AND METHODS During the 10-year study period 51 patients fulfilled the entry criteria of past simultaneous TURBT and TURP, histologically confirmed transitional cell carcinoma of the bladder and benign prostatic hyperplasia, a preserved bladder and a minimal followup of 12 months. Their records were analyzed retrospectively. Patients were divided into 28 with single (group 1) and 23 with multiple (group 2) bladder tumors. RESULTS During the 12 to 120 months of followup (mean 37.3) the average tumor recurrence rate was 68.6%, that is 53.6% in group 1 and 86.9% in group 2. Recurrences appeared within an average of 14.9 months, that is within 18 (range 4 to 36) in group 1 and 13.5 (range 3 to 36) in group 2. Tumor recurrence was at the bladder neck and/or prostatic urethra in 11 of the 51 cases (21.5%). Average time to recurrence at the prostatic fossa was 23.8 months, that is 27 (range 13 to 46) in group 1 and 21.6 (range 4 to 60) in group 2. Only 1 patient had a single recurrence in the prostatic fossa, while the others also had synchronous and metachronous recurrences at other bladder sites. Tumor progression to invasiveness was diagnosed in 3 of the 51 patients (5.9%). CONCLUSIONS Our data indicate that simultaneous TURBT and TURP do not negatively affect tumor recurrence at the bladder neck and prostatic urethra.
Collapse
Affiliation(s)
- Alexander Tsivian
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel.
| | | | | |
Collapse
|
44
|
INHIBITION OF BLADDER CARCINOMA CELL ADHESION BY OLIGOPEPTIDE COMBINATIONS IN VITRO AND IN VIVO. J Urol 2002. [DOI: 10.1097/00005392-200201000-00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
|
46
|
Crook TJ, Hall IS, Solomon LZ, Birch BR, Cooper AJ. A model of superficial bladder cancer using fluorescent tumour cells in an organ-culture system. BJU Int 2000; 86:886-93. [PMID: 11069418 DOI: 10.1046/j.1464-410x.2000.00923.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop a reproducible in vitro simulation of superficial bladder cancer for testing cytotoxic agents at clinically relevant concentrations. MATERIALS AND METHODS Square explants (5 mm) of rat bladder were cultured in Petri dishes in minimal volumes of Waymouth's MB 752/1 medium supplemented with 10% fetal calf serum, antibiotics and glutamine. Parental and resistant MGH-U1 urothelial cancer cells were transfected with a green fluorescent protein (GFP) vector. Transfectants were purified by flow cytometry. Cells were seeded onto the prepared organ cultures and images obtained using confocal microscopy. The tumour colonies were confirmed using scanning electron microscopy. Conventional intravesical cytotoxic agents including epirubicin, mitomycin-C and estramustine were tested in the system. RESULTS Colonies of GFP-MGH-U1 cells became established on the explants and were identified by confocal microscopy; the development of the colonies was then followed over several days. Staining the explant for viability allowed imaging of normal urothelium on the explant surface or surrounding skirt of urothelial cells. The conventional cytotoxic agents epirubicin, mitomycin C and estramustine showed the expected differential responses to parental and resistant cell types. The colonies were able to survive high concentrations of the drug, equivalent to those in clinical use. The colonies were imaged serially over a period of several days. CONCLUSION This system provides a more realistic model for testing cytotoxic agents for use in intravesical therapy, by allowing clinically relevant concentrations of drugs to be tested. The differential properties of the parental and resistant cells are maintained. The model also enables the same tumour colony to be imaged over several days in culture. The model may also be adapted for use in testing the effects of drugs on normal urothelium and the study of the effects of growth factors.
Collapse
Affiliation(s)
- T J Crook
- MDR Research Group, Department of Urology, Southampton General Hospital, Southampton, UK.
| | | | | | | | | |
Collapse
|
47
|
Laufer M, Kaver I, Sela B, Matzkin H. Elevated urinary fibronectin levels after transurethral resection of bladder tumour: a possible role in patients failing therapy with bacillus Calmette-Guérin. BJU Int 1999; 84:428-32. [PMID: 10468755 DOI: 10.1046/j.1464-410x.1999.00208.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate fibronectin levels in urine samples from patients with noninvasive transitional cell carcinoma (TCC) of the bladder immediately and for 4 weeks after transurethral resection of bladder tumour (TURBT), to determine whether soluble fibronectin within the bladder, which blocks the attachment of bacillus Calmette-Guérin (BCG), might lower the efficacy of BCG therapy over this period. PATIENTS AND METHODS Urinary fibronectin was measured using an enzyme-linked immunosorbent assay in 25 patients with superficial bladder TCC who underwent TURBT for complete resection. Eight samples were collected for each patient, one before and seven during the 4 weeks after TURBT. RESULTS High levels of urinary fibronectin were detected in 18 patients (72%) after TURBT. In 16 patients the fibronectin level returned to normal within 2 weeks of surgery. The other two patients showed elevated levels of fibronectin for > 4 weeks. CONCLUSIONS These results show that urinary fibronectin concentration is significantly increased in most patients after TURBT and this should be considered in patients who receive BCG therapy. Treatment within the first 2 weeks after TURBT may be associated with a high failure rate, as urinary fibronectin levels were increased significantly in about three-quarters of these patients during that period. Indeed, the persistent elevation of fibronectin, occurring in two of the present patients, may be responsible for some of the failures of BCG therapy when it is administered 2-5 weeks after surgery.
Collapse
Affiliation(s)
- M Laufer
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | |
Collapse
|
48
|
Hyacinthe LM, Jarrett TW, Gordon CS, Vaughan ED, Whalen GF. Inhibition of bladder tumor cell implantation in cauterized urothelium, without inhibition of healing, by a fibronectin-related peptide (GRGDS). Ann Surg Oncol 1995; 2:450-6. [PMID: 7496842 DOI: 10.1007/bf02306380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Local recurrence after transurethral resection of bladder tumors (TURB) is common and might be diminished if free tumor cells within the bladder are prevented from reattaching. METHODS In vitro inhibition of murine bladder tumor cells to an approximation of urothelial matrix with agents that might block attachment to components of the extracellular matrix, and in vivo inhibition of attachment in cautery-injured murine bladder. RESULTS GRGDS, (0.1-2.5 mg/ml), a fibronectin-related peptide, mannose-6-phosphate, (0.1-20 mg/ml), a carbohydrate, and heparin (1-625 units/ml) all inhibited attachment in vitro in a dose-dependent fashion. YIGSR (0.1-2 mg/ml), a laminin-related peptide, did not. Mannose (10 mg/ml) did not significantly inhibit attachment of tumor cells to cauterized urothelium in vivo, whereas there was a 77% reduction of attachment in bladders irrigated with GRGDS (6.25 mg/ml) (p < 0.05), and the appearance of subsequent tumors in the bladder was inhibited. Finally, GRGDS (6.25 mg/ml) did not inhibit healing of the cautery ulcer. CONCLUSIONS RGD-containing peptides may be useful as adjuvant therapy to decrease local recurrence after TURB and perhaps in other circumstances in which tumor cells spilled into a wound or body cavity threaten surgical success.
Collapse
Affiliation(s)
- L M Hyacinthe
- Department of Surgery, New York Hospital-Cornell University Medical Center, New York, USA
| | | | | | | | | |
Collapse
|
49
|
Abstract
Patients with superficial transitional cell cancer of the urinary bladder were entered into a randomized trial to compare the effects of immediate and short-term postoperative instillation of peplomycin sulfate with simple irrigation. Although the recurrence-free rate of the 46 peplomycin-treated patients was lower, the difference was not significant. Repeated washing of the bladder at the end of transurethral resection might partly replace the role of cytotoxic therapy.
Collapse
Affiliation(s)
- K Fujita
- Department of Urology, National Medical Center, Tokyo, Japan
| |
Collapse
|
50
|
Malmström PU, Larsson A, Johansson S. Urinary fibronectin in diagnosis and follow-up of patients with urinary bladder cancer. BRITISH JOURNAL OF UROLOGY 1993; 72:307-10. [PMID: 8220992 DOI: 10.1111/j.1464-410x.1993.tb00723.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The levels of fibronectin in urine from 106 patients with urinary bladder cancer, from 13 patients with benign urological disease and from 24 healthy control individuals were determined by an enzyme-linked immunosorbent assay (ELISA). The fibronectin levels in urine from patients with bladder cancer were higher than in patients with benign urothelial disease and in healthy controls. In 9 patients with bladder cancer, sampling was done both pre- and post-operatively. In these cases the fibronectin levels after operation were significantly lower than they had been before. Among 14 patients treated with BCG intravesically for superficial bladder tumours, those with complete remission of disease had less urinary fibronectin than those who did not respond to treatment. The data suggest that urinary fibronectin may be a useful marker for detecting urinary bladder cancer and for selecting patients for BCG treatment.
Collapse
Affiliation(s)
- P U Malmström
- Department of Urology, University of Uppsala, Sweden
| | | | | |
Collapse
|