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PubMed1998

Bladder tumor markers: need, nature and application. 1. Nucleus-based markers.

Urothelial tumors are common: their diagnosis and long-term management represent a large part of most urologists' workload. The majority of such tumors are 'superficial' and are mostly managed by repeated cystoscopic surveillance and treatment. A smaller but significant group of patients either start with, or subsequently progress to, more invasive disease, thus requiring an alternative and more invasive treatment. Maximizing the benefit/risk ratio of the diagnosis and the various treatment options of bladder tumors requires the availability of a reliable tumor marker. The concept of tumor markers encompasses the utilization of any detectable deviation from normality that is indicative of neoplasia. For bladder cancer, most of these markers are present in urine. In this part of the review we examine, from the clinician's point of view, the literature verdict on older techniques such as cytology and cytometry, as well as the current status of new nucleus-based tests such as P53, telomerase, NMP22 and Ki67.

Biomarkers, Tumor↗

PubMed1982

Urethral narrowing and its treatment: a possible solution for the problems of recurrent urinary infection and the "irritable bladder".

A surgical treatment for longstanding urinary and pelvic complaints of women is described and evaluated. The procedure includes urethral dilatation to 40 F and "snowplowing" (dull curettage) of urethral, bladder neck, and trigonal mucosa with the heel of the cystoscope, removing granulated tissue, polyps, and villous fronds, and unroofing infected periurethral glands. Vigorous urethral massage is performed, and the patient is hospitalized overnight with large-catheter drainage to continue dilatation. Follow-up dilatations in the office are essential. The procedure was evaluated by comparing presenting and post-treatment symptoms for each patient and by asking each patient to rate the effectiveness of the treatment. Results suggest that treatment is very effective, with 80 per cent of respondents rating it either excellent or good.

Dilatation↗

PubMed1979

A comparative study of electrosurgical vs. cold urethrotomy in the treatment of urethral strictures.

Thirty-one patients with urethral stricture were subjected to internal urethrotomy under visual control. The patients were divided into two groups according to the surgical procedure: electrosurgical or cold resection. A modification of the Sachse knife was introduced in order to permit its use with the American Cystoscope Makers Inc. instruments. The success rate with cold resection was 81.81% and with the electrosurgical procedure 40%. Internal urethrotomy with cold resection is a simple and harmless operation, being a first choice in the treatment of urethral stricture.

Adolescent↗

PubMed1985

The value of transurethral sonography in tumours of the urinary bladder.

The authors report on their first experience obtained in the field of transurethral sonography in cases of tumours of the urinary bladder. Sonography is a method without complication and risks. TNM classification of urinary bladder tumours is possible. A special advantage of this method of investigation is that sonography can be performed directly before transurethral tumour resection. Moreover, during the postoperative period, sonography can be combined with any kind of control cystoscopic investigation. The determination of the depth of infiltration and extension of the tumour is a prerequisite of therapeutic procedures in cases of cancer of the bladder.

Evaluation Studies as Topic↗

PubMed1986

Endosonographic staging of carcinoma of the uterine cervix.

The advantages of a new endosonic technique for staging carcinoma of the cervix are demonstrated. Using this method virtually all palpable findings can be objectified, and in most cases, assessing the size of the tumor inside the cervix seems to allow further differentiation in stage Ib. By imaging the parametrium, rectal sonography provides an important diagnostic aid for making the differentiation between stages Ib, IIb and IIIb. For assessment of the extent of vaginal infiltration, rectal ultrasound diagnosis and in particular vaginosonography can be used. Rectal and especially transurethral sonography are useful for detecting an infiltration of the bladder wall and for further evaluation of cystoscopically visible vesiculated oedema.

Female↗

PubMed1988

Current diagnostic and therapeutic methods in the treatment of vesical tumours.

Reviewing the contemporary therapy of vesical tumour, the authors point to the basic principles that govern the daily practice, the precise application of which may go a long way to improving the results. Not ignorable is the experience that one part of these tumours defies discovery by multifocal and cystoscopic examination. The fundamental tenet of tumour surgery to remove the tumour by incision into sound tissue, must be respected. A brief review is given of the main lines that promise headway in dealing with the disease.

Adenoma↗

PubMed1988

Local adriamycin treatment for prevention of recurrence of superficial bladder tumours.

Forty-nine patients with superficial Ta-Tl, G1-G2 vesical tumours were subjected to local Adriamycin treatment. Following transurethral resection (TUR), 50 mg doses of Adriamycin in 50 ml physiological salt solution were instilled into the bladder 4 times at intervals of one week and then 12 times at intervals of one month (i.e. a total of 15 times). Upon exclusion of two patients who failed to appear at follow-ups and one more in whom treatment was discontinued because of side effects, the remaining 46 were followed up cystoscopically for 2 years at intervals of 3 months. The recurrence rates of 12% and 24% for the primary and secondary tumours, respectively, were found to be significantly lower than those found in the control group (37% and 65%).

Administration, Intravesical↗

PubMed1995

Hyperbaric oxygenation therapy for cyclophosphamide-induced haemorrhagic cystitis.

A 41-year-old female patient undergoing cyclophosphamide therapy for ovarian tumour suffered from haemorrhagic cystitis. Hyperbaric oxygenation (HBO) (100% of oxygen concentration at 2 atmospheric absolute pressures for 60 minutes a day for 30 days) was performed. After treatment the symptom subsided and haematuria disappeared. Cystoscopic findings demonstrated marked improvement. During the course of therapy no side effect was noted. Thus, HBO treatment appeared to have a beneficial effect on cyclophosphamide cystitis.

Adult↗

PubMed1998

Successful treatment of radiation cystitis with hyperbaric oxygen therapy: resolution of bleeding event and changes of histopathological findings of the bladder mucosa.

To assess the effect of hyperbaric oxygen (HBO) therapy on radiation cystitis, clinical and histopathological characteristics were examined. Three women with radiation cystitis were treated with HBO therapy. Macrohaematuria was arrested in all patients. Cystoscopy demonstrated abnormal telangiectasia and inflammatory mucosa before treatment. After HBO therapy, the inflammatory mucosae were healed. However, abnormal vessels did not completely disappear. Histopathologically, the epithelium was atrophic and dilated lymph vessels and inflammatory cells were seen in the submucosa. These changes improved after treatment. HBO therapy is effective against radiation cystitis. With improvement of the clinical symptoms also the cystoscopic and histopathological findings changed favourably.

Aged↗

PubMed1997

Inverted papilloma of the urinary bladder: a case evaluated for malignant potential.

We report a case of inverted papilloma in the urinary bladder with special reference to its malignant potential. A 77-year-old male patient complaining of microhaematuria was subjected to cystoscopic examination, which showed a non-papillary pedunculated tumour at the postero-lateral wall, and was treated with transurethral resection. The histological findings of the specimen were compatible with inverted papilloma of the urinary bladder, except for the presence of low grade dysplastic changes in the tumour nuclei. We revealed the malignant potential of this tumour, analyzing and evaluating nuclear DNA content, proliferating cell nuclear antigen (PCNA) as well as p53 expression.

Aged↗

PubMed1994

Ureteric injuries during gynaecological surgery.

Thirty-two patients with 35 ureteric injuries encountered during gynaecological surgery are presented. Their mean age was 41 years. Eight ureteric injuries were recognized during surgery, the nature and sites of injury were diagnosed peroperatively using an illuminated size 5 F ureteric probe (Storz) passed through a cystoscope. Three ureteric injuries were diagnosed during convalescence as continuous drainage of urine or urinoma collection, while three patients developed total anuria due to ligation of both ureters. Eighteen patients presented with late urinary fistulae, being uretero-uterine in 8 and ureterovaginal in 10. The ureteric injury occurred during emergency Caesarean section in 15 patients, the indication for Caesarean section being obstructed prolonged labour in 70% of them. Twelve urinary fistulae followed hysterectomy. Intravenous urography, antegrade and retrograde ureterography were useful methods of locating the sites of the fistulae. Ureteroneocystostomy was performed in 18 patients, utilizing a Boari flap in 3 and a bladder psoas hitch in 2. Other methods of treatment are discussed. The mean follow-up was 3 years.

Adult↗

PubMed2003

Analysis on pathogenesis of 50 cases of bladder proliferative lesions.

In order to study the pathogenesis, clinical and pathological characteristics of proliferative lesions of the bladder, 50 cases of proliferative lesions of the bladder from 150 patients with complaints of frequency, urgency, hematuria and dysuria were subjected to cystoscopic biopsy of the suspicious foci in the bladder. In combination with the symptoms, urine and urodynamics, the relationship of proliferative lesions of the bladder to the inflammation and obstruction of the lower urinary tract was analyzed. Of the 50 cases of proliferative bladder lesions, 44 cases (88%) had lower urinary tract infection and 29 (58%) lower urinary tract obstruction. The patients with lower urinary tract obstruction were all complicated with infection. Three cases were associated with transitional cell carcinoma. Malignant cells were detected in 1 case by urinary cytologic examination. Proliferative lesions of the bladder, especially those without other obvious mucosa changes under cystoscopy, are common histological variants of urothelium in the patients with chronic inflammation and obstruction of the lower urinary tract. Chronic inflammation and obstruction of the lower urinary tract might be the causes for proliferative lesions of the bladder. It is suggested that different treatments should be applied according to the scope and histological type of the proliferative lesions.

Adult↗

PubMed2004

Clinical investigation on the correlation between lower urinary tract infection and cystitis glandularis.

In order to study the association between lower urinary tract infection and cystitis glandularis (CG), 120 cases of CG were diagnosed by cystoscopic biopsy in the suspicious foci of the bladder. Among them, 72 cases were subjected to bacterial counting culture of urine and microscopic examination of urinary sediment, and 60 cases to fluorescence quantitative polymerase chain reaction (FQ-PCR) assay to detect HPV, CMV and HSV DNA in urine samples. In the 72 cases of CG, the positive rate of bacterial counting culture of urine was 15.3% (11/72), and gray zone rate was 18.1% (13/72). 31.9% (23/72) patients were positive in bacterioscopy of urinary sediment. There was statistically significant difference as compared with the control group (P<0.01). Only 4 of 60 urine samples were positive by FQ-PCR in detection of the three viruses mentioned above with the positive rate being 6.67%. Compared with the control group, there was no significant difference (P>0.05). It was concluded that the genesis of CG was closely correlated with the chronic lower urinary tract infection, especially caused by Esch coli.

Adult↗

PubMed1987

Diagnosis of cystitis glandularis.

Bladder tumor mass may represent a benign lesion and the diagnosis of cystitis glandularis should be considered and cystoscopically evaluated.

Adult↗

PubMed2000

Comparison of human telomerase reverse transcriptase messenger RNA and telomerase activity as urine markers for diagnosis of bladder carcinoma.

BACKGROUND: Human telomerase reverse transcriptase (hTERT) has been identified as the catalytic subunit of telomerase ribonucleoprotein complex known to be required for cellular immortality and oncogenesis. Although human telomerase activity (hTA) is considered as a general marker for malignancy based on its presence in most malignant tumors including bladder cancer, its detection in urine is affected by many factors. The objective of this study was to compare the clinical utility of detecting urine hTERT messenger RNA (mRNA) by multiplex hTERT/GAPDH RT-PCR and urine hTA by telomerase repeat amplification protocol (TRAP) in the diagnosis of bladder cancer. METHODS AND RESULTS: Cystoscopy urine samples or bladder washes prospectively collected from 35 patients with confirmed (35) or clinically suspected (5) transitional cell carcinoma (TCC) of the bladder were examined by TRAP, hTERT/GAPDH RT-PCR, and urine cytology. The control group comprised 21 healthy volunteers and 3 patients without TCC. The hTERT/GAPDH RT-PCR test showed significantly higher diagnostic sensitivity than TRAP assay (94.3% vs 48.6%, P <.001) and urine cytology (95.2% vs 61.9%, P =.008) for confirmed TCCs. In particular, for superficial TCCs low grade (I-II), the hTERT/GAPDH RT-PCR test outperformed TRAP (90% vs 25%, P <.001) and urine cytology (91.7% vs 58.3%, P =.46). The overall specificity of the hTERT/GAPDH RT-PCR, TRAP and urine cytology was 92% (22/24), 100% (24/24), and 100% (3/3), respectively. A positive hTERT mRNA expression was also detected in urologic specimens from 3 patients with previous history of TCC, 3 to 6 months before cystoscopic evidence of cancer. CONCLUSION: In this pilot study, the hTERT mRNA expression in urine sediments is a more sensitive marker for diagnosis of TCC of the bladder than hTA and cytology. However, there is a higher false-positive rate.

Adult↗

PubMed1999

Suture injury to the urinary tract in urethral suspension procedures for stress incontinence.

The case histories of women attending the Urogynecology Department at the Royal Women's Hospital and Mercy Hospital for Women were reviewed between 1986 and 1998 to determine the incidence and postoperative morbidity caused by suture injury to the urinary tract following urethral suspension surgery for stress incontinence. In our department 1103 Burch colposuspensions and 61 Stamey urethral suspensions have been performed. Intraoperative cystourethroscopy was performed routinely for the early detection and treatment of urinary tract injury. Intravesical sutures were found by routine intraoperative cystoscopy in 1 Stamey suspension, 1 open Burch colposuspension and 3 laparoscopic Burch colposuspensions. Ureteric suture ligation was diagnosed in 2 women intraoperatively and 1 women postoperatively after laparoscopic Burch colposuspension. Two women presented with late complications from intravesical sutures following open Burch colposuspension. A further 7 women referred with urinary symptoms were found to have intravesical sutures, 2 following Burch colposuspension, 4 following Stamey urethral suspension and 1 following the Marshall-Marchetti-Kranz procedure. Seven of the 9 women diagnosed with intravesical sutures presented with bladder or pelvic pain, frequency or urinary tract infection. Two women had recurrent stress incontinence and were found to have a intravesical suture on routine cystoscopy at the time of stress incontinence surgery. Suture removal, with any accompanying calculus, was achieved cystoscopically with almost immediate resolution of symptoms without loss of urinary control in all cases. Non-absorbable intravesical sutures occurring as a result of suture misplacement or erosion is an infrequent but important complication of stress incontinence surgery, but should be suspected if pain and irritative bladder symptoms or recurrent urinary infection occur postoperatively. Cystourethroscopy performed intra-operatively or postoperatively is essential for early diagnosis and treatment.

Adult↗

PubMed1999

A unique cause of unconscious urinary incontinence.

The authors present a case of a healthy 55-year-old woman with a 1-year history of vaginal malodor and perineal dampness. A pyridium (phenazopyridine) pad test revealed a well-defined stain area no greater than 3 cm. Cystoscopic examination revealed multiple multilobulated polypoid neoplasms, which we feel probably represent pedunculated hemangiomas. Removal of the neoplasms cured the dampness, malodor and recurrent vaginal infections. We submit this case as a unique cause of extraurethral incontinence.

Female↗

PubMed2003

[The frequency-doubled double-pulse Neodym:YAG laser lithotripter (FREDDY) in lithotripsy of urinary stones. First clinical experience].

Laser lithotripsy does not play an important role in urinary stone treatment, mostly due to ineffective fragmentation efficiency, and high purchase and maintenance costs. The aim of the following retrospective study was to show the clinical significance and efficiency of an innovative laser lithotripsy system for urinary stone treatment. Between November 1998 and October 1999, 48 patients were treated with the innovative frequency- doubled double-pulse Neodym: YAG laser lithotripter FREDDY. A total of 50 renal units were treated, 43 ureteroscopically, four ureterorenoscopically, three percutaneous-nephroscopically, and one bladder stone cystoscopically. With a median laser operation time of 5 min (range: 1-30 min) and a total procedure duration of 60 min (range: 15-180 min), a stone-free rate of upper ureteral stones of 62%, middle ureteral stones of 91% and distal ureteral stones of 100% were documented on the first day after treatment. In an observation period of 6 months, no complications were seen. In our experience Laser lithotripsy with FREDDY is an effective, simple and reliable method for the treatment of ureteral stones, with low purchase and maintenance costs. The extremely thin and highly flexible quartz fibre may extend the endoscopic spectrum to otherwise poorly accessible upper ureteral stones, the renal pelvis and renal calix stones. Therefore, a prospective validation study for comparison with ballistic lithotriptors is of great interest.

Adolescent↗