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PubMedDate not supplied

Free DNA in urine: a new marker for bladder cancer? Preliminary data.

The aim of the present preliminary study was to investigate the presence of free DNA (FDNA) in urine as a possible marker for the diagnosis of bladder cancer. Naturally voided morning urine specimens were collected from 57 patients with suspected bladder cancer before cystoscopy. A standard urine test was performed; the specimens were then processed in order to obtain a quantitative evaluation of the presence of free DNA in the urine. Twenty-two patients were excluded from the study because they had leukocyturia and/or bacteriuria. Free DNA concentrations higher than 250 ng/mL were found in all 16 patients showing bladder cancer at cystoscopy and in seven (36.8%) of the 19 patients with negative cystoscopy. Urinary FDNA seems to have an excellent sensitivity: we observed no false negative cases and 36.8% false positive cases. By contrast, only 6.25% of the bladder cancer patients had positive urine cytology. Our results seem promising, although further studies and larger numbers are needed to define urinary free DNA as a reliable marker of bladder cancer.

Aged↗
PubMed2026

A stratified urine-based molecular diagnostic and prognostic model for non-muscle-invasive bladder cancer management.

BACKGROUND: Non-muscle-invasive bladder cancer (NMIBC) is characterized by a high recurrence rate requiring lifelong cystoscopic surveillance. Existing urine-based molecular assays mainly rely on mutations or methylation, which fail to capture large-scale genomic instability. Copy number variation (CNV) profiling offers complementary information on tumor evolution and aggressiveness, but its application in urinary diagnosis remains limited. We aimed to integrate CNV and DNA methylation signals from urinary DNA to establish a noninvasive and biologically informed stratified diagnostic model for NMIBC recurrence surveillance and risk stratification. METHODS: Urine samples were prospectively collected from 91 patients (75 evaluable) between June 2021 and August 2023. Shallow whole-genome sequencing (sWGS) was used to detect CNVs at chromosomal arm and focal gene levels, while ONECUT2 promoter methylation was quantified by qPCR. Diagnostic and prognostic performance was evaluated by ROC analysis, Kaplan-Meier survival, and stratified recurrence assessment. RESULTS: We evaluated a stratified diagnostic model combining CNV and ONECUT2 methylation testing in a cohort of 79 patients. CNV analysis alone showed high specificity (0.923) for NMIBC diagnosis. A combined model, using CNV as an initial screen followed by ONECUT2 methylation testing in CNV-positive cases, achieved a sensitivity of 0.783, specificity of 0.981, and a negative predictive value (NPV) of 0.911. This approach reduced the number of required ONECUT2 tests by 35% and identified a high proportion of true-negative patients (98.1%), which may help reduce unnecessary cystoscopy procedures. The model also demonstrated significant prognostic value, with the molecularly defined high-risk group showing significantly shorter recurrence-free survival (RFS) than the low-risk group (median RFS: 4.33 months vs. not reached; p&#x2009;<&#x2009;0.001). Additional, in patients with initially negative cystoscopy after urine sample collection, the model demonstrated a predictive accuracy of 0.922 for recurrence, with molecular positivity observed a median of 9.6 months prior to clinical diagnosis. CONCLUSIONS: Integrating CNV and DNA methylation profiling from urinary DNA provides a powerful and noninvasive molecular framework for NMIBC surveillance. By combining early epigenetic changes with genomic instability signals, this approach enhances recurrence risk assessment and enables earlier detection compared with conventional cystoscopy. It offers a practical route toward personalized and adaptive post-treatment monitoring of NMIBC. TRIAL REGISTRATION: NCT04994197.

Humans↗
PubMed2005

Hexyl aminolevulinate: 5-ALA hexylester, 5-ALA hexylesther, aminolevulinic acid hexyl ester, hexaminolevulinate, hexyl 5-aminolevulinate, P 1206.

Hexyl aminolevulinate [aminolevulinic acid hexyl ester, hexyl 5-aminolevulinate, 5-ALA hexylester, hexaminolevulinate, Hexvix, Hexvix PD, Hexvix PDT, P 1206] is being developed by PhotoCure, a Norwegian company, for the diagnosis and treatment of bladder cancer. The current standard diagnosis of bladder cancer involves cystoscopic examination of urine and bladder washings and is combined with biopsy for better detection of low-grade malignancies. However, the method largely relies on the experience of the surgeon and often results in false negatives especially for low-grade malignancies and pre-cancerous tissues. Photocure believes that imaging with hexyl aminolevulinate (Hexvix) offers significant advantages over standard diagnostic methods for detection of bladder cancer and also can be used in combination with those to ensure the optimal diagnostic accuracy. PhotoCure's procedure for diagnosis of bladder cancer involves filling of the patient's bladder with hexyl aminolevulinate solution and allowing the active agent to accumulate in the cancerous tissue. Following bladder emptying, blue light illumination is applied to the bladder causing red fluorescence that is clearly visible, thus identifying the cancerous tissue. Imaging with hexyl aminolevulinate improves detection of bladder tumours and also can be used together with transurethral resection to check the completeness of tumour removal. PhotoCure is looking for the opportunity to out-license hexaminolevulinate for all regions except the Nordic regions. PhotoCure has proprietary rights for hexyl aminolevulinate from the Norwegian Radium Hospital. Under the terms of the agreement with the Norwegian Radium Hospital, PhotoCure gains an access to, and an option to acquire, all of the new photodynamic therapy technologies developed by the Norwegian Radium Hospital. For its part, PhotoCure provides research and development funding to the Norwegian Radium Hospital. This 3-year agreement was extended in February 2003 until December 2006. PhotoCure and Karl Storz GmbH of Germany have signed a formal collaboration for the development and marketing of hexyl aminolevulinate (Hexvix) and Karl Storz's D-light system. The two systems will be used in the diagnosis of bladder cancer. PhotoCure and Karl Storz GmbH will jointly apply for a marketing approval of hexyl aminolevulinate (Hexvix) and Karl Storz' D-light system in the US for detection of bladder cancer. The D-light system is already approved in Europe. PhotoCure has also formed a collaborative agreement with the Swiss Federal Institute of Lausanne and the Municipal University Hospital in Lausanne. These institutions have conducted preclinical studies and some exploratory clinical research on the active ingredient of Hexvix in approximately 100 patients. The first MAA for hexyl aminolevulinate fluorescence was filed in Sweden, the reference member state, in December 2002, and was approved in September 2004. PhotoCure plans to launch hexyl aminolevulinate in Sweden in June 2005. Phase II clinical trials were conducted in 52 patients with known or suspected bladder cancer at the university clinics in Switzerland, Germany, Sweden and Norway. Clinical data suggests that hexyl aminolevulinate (Hexvix) is useful in the early diagnosis of bladder cancers allowing treatment to be performed at an earlier stage and, thus, improve the chance of a successful clinical outcome. The company believes that the data from the US phase III programme at 19 leading urology clinics and two multicentre European trials at 28 leading hospitals across nine countries, will sufficiently support an NDA with the US FDA. The US phase III programme with hexyl aminolevulinate was initiated in December 2001. The results from the first European multicentre study conducted in 19 centres in 286 patients confirmed the advantages of hexaminolevulinate fluorescence cystoscopy over standard white light cystoscopy in the detection of bladder cancer. The second multicentre phase III study at ten centres in Germany and the Netherlands in 146 patients with known or suspected bladder cancer was sucessfully completed in March 2003. The independent blind reviewer acknowledged that imaging with hexyl aminolevulinate would result in better treatment options in every fifth patient compared with standard cystoscopy. Hexaminolevulinate is also undergoing early feasibility studies for the diagnosis and treatment of gynaecological and gastrointestinal conditions. PhotoCure was granted a European patent No. 0820432 covering hexyl aminolevulinate, an active ingredient used in Hexvix for the diagnosis and treatment of bladder cancer. The company was also granted patents in Australia, China, the Czech Republic, New Zealand, Russia, Singapore, South Korea and the US.

Aminolevulinic Acid↗
PubMed1991

Bacillus Calmette-Guérin treatment of 39 patients with superficial transitional cell carcinoma of the bladder.

The effect of intravesical Pasteur-F strain Bacillus Calmette-Guérin (BCG) on bladder carcinoma was studied in 39 patients. Multiple recurrent superficial transitional cell carcinoma was present in 36 cases, including 11 with concomitant carcinoma in situ (CIS), and primary CIS in three. The mean age of the 27 men and 12 women was 72 years. A 6-week induction course was given, beginning usually 4-6 weeks after transurethral tumor resection (TUR) or random biopsies, with periodic followup cystoscopies and cytologic analyses. A second 6-week course was given only to patients with incomplete response (positive urinary cytology or recurrent tumor). Three patients received maintenance intravesical BCG. If there was no response at the first cystoscopy after the induction course, no further BCG was given. Side effects were mostly local, moderate and transient, subsiding spontaneously or responding to symptomatic treatment. Severe systemic side effects occurred in three patients. Two with arthritis/arthralgia were managed as out-patients, while one with BCG pneumonitis/hepatitis required hospitalization, triple antituberculosis medication, cloxacillin and prednisolone. Complete response, defined as negative cystoscopy, cytology and histology, was obtained in 11 of 21 cases of papillary carcinoma without concomitant CIS. These patients were followed up for 8-47 months. Of the ten non-responders, two died and eight underwent further TUR. Of the 11 patients with concomitant CIS, six showed complete and five no response. Two of the latter died and three had further TUR. In all three cases of primary CIS there was complete response.

Administration, Intravesical↗
PubMed2006

Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation.

OBJECTIVES: To determine the most effective diagnostic strategy for the investigation of microscopic and macroscopic haematuria in adults. DATA SOURCES: Electronic databases from inception to October 2003, updated in August 2004. REVIEW METHODS: A systematic review was undertaken according to published guidelines. Decision analytic modelling was undertaken, based on the findings of the review, expert opinion and additional information from the literature, to assess the relative cost-effectiveness of plausible alternative tests that are part of diagnostic algorithms for haematuria. RESULTS: A total of 118 studies met the inclusion criteria. No studies that evaluated the effectiveness of diagnostic algorithms for haematuria or the effectiveness of screening for haematuria or investigating its underlying cause were identified. Eighteen out of 19 identified studies evaluated dipstick tests and data from these suggested that these are moderately useful in establishing the presence of, but cannot be used to rule out, haematuria. Six studies using haematuria as a test for the presence of a disease indicated that the detection of microhaematuria cannot alone be considered a useful test either to rule in or rule out the presence of a significant underlying pathology (urinary calculi or bladder cancer). Forty-eight of 80 studies addressed methods to localise the source of bleeding (renal or lower urinary tract). The methods and thresholds described in these studies varied greatly, precluding any estimate of a 'best performance' threshold that could be applied across patient groups. However, studies of red blood cell morphology that used a cut-off value of 80% dysmorphic cells for glomerular disease reported consistently high specificities (potentially useful in ruling in a renal cause for haematuria). The reported sensitivities were generally low. Twenty-eight studies included data on the accuracy of laboratory tests (tumour markers, cytology) for the diagnosis of bladder cancer. The majority of tumour marker studies evaluated nuclear matrix protein 22 or bladder tumour antigen. The sensitivity and specificity ranges suggested that neither of these would be useful either for diagnosing bladder cancer or for ruling out patients for further investigation (cystoscopy). However, the evidence remains sparse and the diagnostic accuracy estimates varied widely between studies. Fifteen studies evaluating urine cytology as a test for urinary tract malignancies were heterogeneous and poorly reported. The calculated specificity values were generally high, suggesting some possible utility in confirming malignancy. However, the evidence suggests that urine cytology has no application in ruling out malignancy or excluding patients from further investigation. Fifteen studies evaluated imaging techniques [computed tomography (CT), intravenous urography (IVU) or ultrasound scanning (US)] to detect the underlying cause of haematuria. The target condition and the reference standard varied greatly between these studies. The diagnostic accuracy data for several individual studies appeared promising but meaningful comparison of the available imaging technologies was impossible. Eight studies met the inclusion criteria but addressed different parts of the diagnostic chain (e.g. screening programmes, laboratory investigations, full urological work-up). No single study addressed the complete diagnostic process. The review also highlighted a number of methodological limitations of these studies, including their lack of generalisability to the UK context. Separate decision analytic models were therefore developed to progress estimation of the optimal strategy for the diagnostic management of haematuria. The economic model for the detection of microhaematuria found that immediate microscopy following a positive dipstick test would improve diagnostic efficiency as it eliminates the high number of false positives produced by dipstick testing. Strategies that use routine microscopy may be associated with high numbers of false results, but evidence was lacking regarding the accuracy of routine microscopy and estimates were adopted for the model. The model for imaging the upper urinary tract showed that US detects more tumours than IVU at one-third of the cost, and is also associated with fewer false results. For any cause of haematuria, CT was shown to have a mean incremental cost-effectiveness ratio of pounds sterling 9939 in comparison with the next best option, US. When US is followed up with CT for negative results with persistent haematuria, it dominates the initial use of CT alone, with a saving of pounds sterling 235,000 for the evaluation of 1000 patients. The model for investigation of the lower urinary tract showed that for low-risk patients the use of immediate cystoscopy could be avoided if cystoscopy were used for follow-up patients with a negative initial test using tumour markers and/or cytology, resulting in a saving of pounds sterling 483,000 for the evaluation of 1000 patients. The clinical and economic impact on delayed detection of both upper and lower urinary tract tumours through the use of follow-up testing should be evaluated in future studies. CONCLUSIONS: There are insufficient data currently available to derive an evidence-based algorithm of the diagnostic pathway for haematuria. A hypothetical algorithm based on the opinion and practice of clinical experts in the review team, other published algorithms and the results of economic modelling is presented in this report. This algorithm is presented, for comparative purposes, alongside current US and UK guidelines. The ideas contained in these algorithms and the specific questions outlined should form the basis of future research. Quality assessment of the diagnostic accuracy studies included in this review highlighted several areas of deficiency.

Algorithms↗
PubMed1994

[Transitional cell carcinoma of bladder occurring during pregnancy: report of two patients].

Primary transitional cell carcinoma (TCC) of the bladder occurring during pregnancy is extremely rare and only 16 patients have been reported in the literature. Patient 1: A 24-year-old primigravida at 33 weeks of gestation presented with gross hematuria. Cystoscopy revealed a large bladder tumor. After delivery TUR-Bt was performed. Because of frequent reccurrences after TUR-Bt, radical cystectomy was done. Pathological study revealed transitional cell carcinoma, G1-G2, pTa. Patient 2: A 34-year-old gravida 11 at 6 weeks of gestation presented with gross hematuria. Cystoscopy revealed a papillary bladder tumor. TUR-Bt was performed after artificial abortion. Pathological study revealed papillary transitional cell carcinoma, G1 > G2, pTa. Eighteen patients of TCC of the bladder occurring during pregnancy were reviewed. Fifteen of the 18 patients presented with gross hematuria. All patients had superficial, solitary, grade 1 or 2 papillary TCC, except one grade 3 patient. Cystoscopy should be considered in all pregnant women with gross hematuria. Small TCCs of the bladder during pregnancy can be treated safely by TUR-Bt during pregnancy or after delivery.

Adult↗
PubMed1999

Multicenter trial of the quantitative BTA TRAK assay in the detection of bladder cancer.

BACKGROUND: Human complement factor H-related protein (hCFHrp) is produced by several bladder cancer cell lines and may be useful as a cancer marker. The aim of this study was to compare urinary hCFHrp and cytology for the detection of bladder cancer found by cystoscopy in patients with suggestive signs, symptoms, or preliminary test results. METHODS: The BTA TRAK assay, a quantitative enzyme immunoassay for the bladder tumor-associated antigen in urine, was compared with exfoliative cytology in 220 patients (155 men, 65 women; mean age, 64.2 years) presenting with signs, symptoms, or preliminary diagnostic results suggestive of this disease. Cystoscopy was the standard of detection. RESULTS: In the 100 patients found to have bladder cancer, the overall sensitivities of the BTA TRAK assay (at a previously determined decision threshold of 14 kilounits/L) and cytology were 66% (66 of 100) and 33% (33 of 100), respectively (P <0.001). The BTA TRAK assay proved to be statistically more sensitive than cytology for tumor grades I and II and for stage Ta and T1 tumors. In contrast, the overall specificity of the BTA TRAK assay in the 120 patients without cystoscopically confirmed bladder cancer was 69% (83 of 120) and that of cytology was 99% (119 of 120; P <0.001). The specificity of the BTA TRAK assay was higher in patients without benign or malignant genitourinary disease other than bladder cancer (76%; n = 89) than in patients with these conditions. When the BTA TRAK assay and cytology were used together such that a positive result in either test was scored as positive and the results compared with those of the BTA TRAK assay alone, increases in overall sensitivity and equivalent specificity were observed. CONCLUSION: Because of its relatively high sensitivity, the BTA TRAK assay could complement cytology as an adjunct to cystoscopy in the diagnosis and follow-up of most patients with bladder cancer.

Adult↗
PubMed2000

[Modern follow-up strategies for the treatment of patients with superficial bladder carcinoma].

In this retrospective study the efficacy of tumor dispensaire in patients with superficial transitional cell carcinoma of the bladder was investigated in a population of 246 patients. Special attention was payed to follow up cystoscopy. Furthermore our goal was to identify and confirm prognostic factors relevant to recurrence rate and tumor progression. After transurethral resection 241 patients suffering from superficial bladder cancer were enclosed. The first of them were diagnosed in 1984 with a mean follow up range of 6.1 years and a minimum of 1 year. The evaluation was closed in 1995. The 1-year recurrence free rate of all cases amounts to 60%, whereas 42% of patients with a pT1-primary tumor and 45% with a pTa-primum developed a relapse within 2 years after the first diagnosis. All in all more than 50% of all recurrent tumors occurred within the first two years if illness. Patients with pTa and pT1 tumor are progressed in 10.7% and 18%. In 8% we saw lymphogen metastases in patients with pT1 carcinoma. 149 patients (62%) were followed up exactly (+/- 1 cystoscopy) according to the investigation schedule. More than +/- 3 aberrant cystoscopies contrary to the follow up instructions happened very seldom. Prognostic factors to be found of significance for tumor progression and recurrence risk are: tumor staging and grading, multiplicity in occurrence, period of time between first diagnosis and first relapse, associated dysplasia or carcinoma in situ. Chest X-ray and urography should be performed in accordance to the patients individual clinical situation, not routinely (2 cases of pulmonary metastasis occurred after pT1G2-3 tumor progression in 496 regular chest X-rays and 1 ureter tumor was diagnosed by routine urography). As a main result of our investigation we defined two groups of patients with superficial bladder cancer: a "low risk" group (pTa, G1-2, late recurrence (> 2 yrs.) and a "high risk" group (pT1, G3, early recurrence (< 2 yrs.), multifocal occurrence). Group 1 ("low risk") should be followed up for 5 years and group 2 ("high risk") for 10 years. Cystoscopic investigations are scheduled with regard to the group risk of recurrence and tumor progression. For patients of both groups the need of chest X-ray and urography should be evaluated individually.

Follow-Up Studies↗
PubMed2000

Urinary level of nuclear matrix protein 22 in the diagnosis of bladder cancer: experience with 130 patients with biopsy confirmed tumor.

PURPOSE: We prospectively evaluated the value of nuclear matrix protein 22 (NMP22dagger) and cytology in the diagnosis of bladder cancer. MATERIALS AND METHODS: We analyzed NMP22 in voided urine from 235 patients before cystoscopy. Of the patients 130 had transitional cell carcinoma of the bladder and subsequently underwent surgery. In a subset of 200 patients bladder washout samples for cytology were collected during cystoscopy. The cutoff for NMP22 was 10.0 units per ml. For cytology only high grade atypia was considered positive. RESULTS: Histology showed 77 superficial (pTa, pTis) and 53 invasive (pT1 or greater) tumors. Sensitivity of NMP22 was 51% and specificity was 83%. NMP22 sensitivity was 36% for superficial tumors and 73% for invasive transitional cell carcinoma. Overall sensitivity of cytology was 52% and specificity was 89%. Cytology sensitivity was 38% for superficial tumors and 83% for invasive transitional cell carcinoma. NMP22 sensitivity for grades 1, 2 and 3 tumors was 30%, 56% and 68%, respectively. Cytology sensitivity for grades 1, 2 and 3 tumors was 30%, 50% and 91%, respectively. Combined NMP22 and cytology had a sensitivity of 70%. CONCLUSIONS: NMP22 has sensitivity and specificity similar to those of cytology from bladder washout samples. Particularly in low stage and low grade tumors both tests show the same disappointing sensitivity. Because of a false-negative rate of 49%, NMP22 cannot replace cystoscopy in clinical practice, as the danger of missing NMP22 negative tumors is too high to rely on its results in an individual patient.

Biomarkers, Tumor↗
PubMed2000

Economic evaluation of NMP22 in the management of bladder cancer.

The purpose of this study was to evaluate, from the perspective of the Quebec health system, the cost and cost-efficacy of using NMP22 compared with the currently recommended monitoring procedure following a transurethral resection of a bladder tumor (TURBT). This evaluation was based on results from the study by Soloway, et al. It was performed using a decision analysis technique which compared a follow-up modality using NMP22 with the conventional follow-up monitoring procedure for the first 6 months after an initial transurethral resection of a bladder tumor. Each routine cystoscopy and cytology costs a total of $155. For the 6 months following initial TURBT, the cost for standard follow-up monitoring totaled $311, while the cost for the NMP22 monitoring modality was $257. On average, using NMP22 would have saved $55 per patient during the first 6 months of follow-up, resulting in a cost saving of approximately 18%. As well, 64.3% of patients would have undergone only one cystoscopy during the 6 month period, instead of the two done using the conventional modality. The trade-off for using NMP22 is that some patients would have a 3 month delay before diagnosis of a recurrence. This would occur in 8.9% of patients. NMP22 is less expensive than conventional monitoring follow-up of bladder cancer, and it can decrease patient discomfort by reducing the need for cystoscopy. Implementing it as routine follow-up monitoring should be considered, particularly for patients with low-grade tumors.

Biomarkers, Tumor↗
PubMed2001

Congenital posterior urethral membrane: variable morphological expression.

PURPOSE: We assessed the variable morphological expression of posterior urethral membrane by reviewing video recorded cystoscopy. MATERIALS AND METHODS: Between December 1990 and July 2000, 86 males newborn to 15 years old undergoing cystoscopy for urethral anomalies were identified with a posterior urethral membrane. Recorded cystoscopy was reviewed and membrane degree was graded as minimal, moderate or severe. RESULTS: Of the 86 boys with a membranous lesion in the posterior urethra the condition was considered severe in 40, moderate in 21 and minimal in 21. Four patients on whom data were too inadequately recorded to be properly classified were excluded from study. CONCLUSIONS: This study demonstrates that congenital posterior urethral membrane represents a spectrum of lesions and may vary in the degree of obstruction.

Adolescent↗
PubMed2001

Comparative evaluation of the diagnostic performance of the BTA stat test, NMP22 and urinary bladder cancer antigen for primary and recurrent bladder tumors.

PURPOSE: We compared overall sensitivity and specificity of the urinary bladder cancer antigen enzyme-linked immunosorbent assay (UBC, IDL Biotech, Sollentuna, Sweden), BTA stat test (Bion Diagnostic Sciences, Inc., Redmond, Washington) and NMP22 test kit (Matritech, Newton, Massachusetts), and the differential sensitivity regarding the histological pattern of tumors. MATERIALS AND METHODS: A total of 213 patients with clinical and/or imaging signs of bladder cancer provided a single voided urine sample for the bladder cancer antigen, BTA stat test and NMP22 before cystoscopy. Of these patients 95 were monitored for superficial bladder cancer, while the remaining 118 had no history of bladder cancer. All detected bladder tumors or suspicious lesions were resected transurethrally. A group of 21 age and sex matched healthy volunteers were also evaluated with the same tests. RESULTS: Bladder cancer was confirmed histologically in 118 patients, of whom primary and recurrent tumors were in 68 and 50, respectively. The optimal cutoffs calculated with receiver operating characteristics curves were 8 units per ml. for NMP22 and 12 microg./l. for bladder cancer antigen. Overall sensitivity and specificity were 72.9% and 64.6% for the BTA stat test, 63.5% and 75.0% for NMP22, and 80.5% and 80.2%, respectively, for bladder cancer antigen. Bladder cancer antigen proved significantly more sensitive than NMP22 for detecting bladder cancer (p = 0.001) but not more than the BTA stat test, while the specificity of it was significantly higher than that of the BTA stat test (p = 0.009). Bladder cancer antigen had a sensitivity of 80.7% for stage Ta tumors, which was significantly higher than NMP22 (52.6%, p = 0.001) and the BTA stat test (57.9%, p = 0.01). In grade I tumors the sensitivity of bladder cancer antigen (70%) did not differ significantly than that of the BTA stat test (50%) and NMP22 (50%, p = 0.14). Bladder cancer antigen had the least false-positive results in patients with a history of bladder cancer and negative cystoscopy, and those with urological disease other than bladder cancer. CONCLUSIONS: Our data indicate that bladder cancer antigen may be a more potent diagnostic marker for bladder cancer than NMP22 and the BTA stat test based on the higher sensitivity for detecting low stage and low grade tumors, and the higher specificity. The contribution of these tests for detection of bladder cancer should still be considered adjunctive to cystoscopy.

Adult↗
PubMed2001

Chronic pelvic pain. Laparoscopic and cystoscopic findings.

OBJECTIVE: To study the laparoscopic and cystoscopic findings in women with chronic pelvic pain referred to the Gynecology Clinic at Sultan Qaboos University Hospital. METHODS: Women referred to Sultan Qaboos University Hospital, Sultanate of Oman from October 1998-September 2000 with pelvic pain of more than 6 months duration were clinically evaluated. Laparoscopic examination was always combined with cystoscopy. Bladder biopsy was performed only if there were doubts regarding the nature of pathology that was found. RESULTS: The mean age of the patients was 31 years and mean parity was 3.0. The minimum duration of symptoms was 6 months, but one 3rd of the patients had pain for more than 2 years. Bladder symptoms were present in 50% and bowel symptoms in 25% of patients. Laparoscopic examination revealed pathological findings in 80% of the cases. Adhesions of the omentum to the uterus or to the laparotomy or laparoscopy scar were the most common pathology (50%). Cystoscopy revealed one case of trigonitis and one case of cystitis. CONCLUSION: Pelvic adhesions were the most common cause of pelvic pain in our study group. Cystoscopy was normal in most of the patients.

Adult↗
PubMed2002

Four bladder tumor markers have a disappointingly low sensitivity for small size and low grade recurrence.

PURPOSE: We determine the sensitivity and specificity of 3 bladder tumor markers in urine, including NMP22 assay (Matritech, Newton, Massachusetts), BTA stat test (Bion Diagnostic Sciences, Inc., Redmond, Washington) and UBC antigen (IDL Biotech, Sollentuna, Sweden), and bladder wash cytology for new and recurrent bladder cancer. We examine whether tumor size, grade, and stage influence sensitivity and specificity of the markers. MATERIALS AND METHODS: A total of 304 samples in 250 patients were studied. There were 174 patients who had a history of bladder cancer, including 93 with and 81 without recurrent tumor at cystoscopy. The other group of patients consisted of 66 with newly diagnosed bladder tumor and 64 investigated for microscopic hematuria that was found to be idiopathic. BTA stat was assayed according to manufacturer instructions. NMP22 and UBC were measured in urine with an enzyme-linked immunosorbent assay. A cutoff level of 4 for NMP22 and 1 for UBC was chosen to get the same specificity for new tumors as BTA stat (75%) RESULTS: There was a highly significant difference (p <0.001) in all markers between patients with new bladder tumors and those without. The difference was less pronounced for tumor recurrence for NMP22, UBC and BTA stat (p=0.002, 0.016 and 0.244, respectively). The difference between new and recurrent tumors disappeared when corrected for tumor size, grade and stage. The sensitivity for new tumors was 65%, 75% and 60% for NMP22, BTA stat and UBC, respectively. Cytology had a sensitivity of 41% for new tumors at a specificity of 94%. The specificity for recurrence was 64% for NMP22, 54% BTA stat and 72% UBC. The sensitivity was 45% for NMP22, 55% BTA stat and 40% UBC. CONCLUSIONS: Tumor size, grade and stage have a strong impact on sensitivity, and specificity for all 3 tested tumor markers as well as bladder wash cytology. The tumor markers or any combination of them cannot replace followup cystoscopy, mainly because most recurrences are small. The role of the markers for screening high risk populations and as a complement to followup cystoscopy remains to be evaluated.

Aged↗
PubMed2002

[Localization diagnosis of chyluria by radionuclide lymphoscintigraphy].

OBJECTIVE: To study the effect of radionuclide lymphoscintigraphy, a new method of localization diagnosis of chyluria. METHODS: Radionuclide lymphoscintigraphy was used to examine 34 patients with chyluria and the results of radionuclide lymphoscintigraphy was compared with those of cystoscopy and lymphangiography. RESULTS: Among the 34 patients 85.3% of unilateral localization diagnosis by radionuclide lymphoscintigraphy was coincident with that by cystoscopy. The positive rate of bilateral localization diagnosis was higher than that by cystoscopy. CONCLUSION: A less invasive technique, radionuclide lymphoscintigraphy can be used as a new option for the localization diagnosis of chyluria.

Adult↗
PubMed2003

[Value of helical CT in bladder tumor].

OBJECTIVE: To evaluate the diagnostic effect of helical CT on bladder tumor. METHODS: In 28 patients with bladder tumors which had been confirmed by conventional fiberoptic cystoscopy (FC) and pathology, precontrast and four-phase postcontrast helical CT scans were performed with multiple plane reconstruction (MPR), three dimensional (3D) reconstruction and CT virtual cystoscopy (CTVC) images constructed from the volumetric data of the excretory phase. The results were then compared with the findings of conventional fiberoptic cystoscopy and surgery through a double-blind manner. RESULTS: The sensitivity of the helical CT axial, 3D and CTVC images in detecting bladder tumor were 92.3%, 76.9% and 96.2% respectively. The accuracy in preoperative tumor staging of helical CT was 83.0%. The axial images could provide excellent intramural and extravesical information, and MPR could directly show the origin and extravesical invasion of the tumor and its relation to the ureter. 3D and CTVC images were useful in displaying the surface morphology of the tumor and its relation with the ureteric orifices, whereas CTVC images could depict a tumor smaller than 5 mm that could not be visualized on the axial images. CONCLUSION: Combining interpretation of axial, MPR, 3D and CTVC images, helical CT is able to provide comprehensive information for the diagnosis and treatment of bladder tumor.

Adult↗
PubMedDate not supplied

Accuracy of the ImmunoCyt assay in the diagnosis of transitional cell carcinoma of the urinary bladder.

The ImmunoCyt assay (Diagnocure Inc., Québec, Canada) is a new immunocytological fluorescence test for identifying two different mucins and a high-molecular-weight glycosylated carcinoembryonic antigen (CEA) present in tumours originating from transitional epithelial cells. The test promises a higher diagnostic sensitivity in transitional cell carcinoma (TCC) of the bladder than voided urine cytology. Our study was designed to evaluate this test especially for TaG1 carcinomas, which are characterised by a low detection rate in urinary cytology. A total of 121 spontaneous urine samples of 92 patients (age range 28 to 86, mean 62.5 years) were examined. The samples were taken from patients suspected of having TCC (41 out of 121) or tumor recurrence (46 out of 121), or who were part of a follow-up protocol (34 out of 121). Cystoscopy was practiced in all patients. The ImmunoCyt test was carried out according to the manufacturer's protocol. For cytology cytospins were made from the same urine samples and stained according to the method of Papanicolaou. One hundred and thirteen specimens could be evaluated. In 87 cystoscopy and/or histology were negative. There was histological evidence of 7 pTaG1, 4 pTaG2, 8 pT1G2/G3 and 7 pT2G2/G3 TCC. As for ImmunoCyt and cytology, specificity was 83.9% and 91.9%, respectively. A combination of either test indicated 81.6% specificity. The sensitivity amounted to 38.5% and 34.6%, respectively, and the combined sensitivity to 53.8%. The sensitivity for TaG1 carcinomas was 14.3% each, for TaG2 carcinomas 25% and 50%, for T1G2/G3 carcinomas it amounted to 37.5% each, while for T2G2/G3 carcinomas it was 71.4% and 42.9%, respectively. The higher sensitivity of the ImmunoCyt test as compared to urinary cytology renders improved identification of exfoliated tumour cells in bladder cancer possible. In our study, however, the expected increase in detecting TaG1 carcinomas was not found. Because of its lower specificity, the test should only be used in combination with voided urine cytology. On account of its low sensitivity, the ImmunoCyt test cannot replace cystoscopy (with biopsy) in the diagnosis and monitoring of bladder cancer.

Adult↗
PubMed2003

Bladder perforation presenting as vulvar edema after the tension-free vaginal tape procedure. A case report.

BACKGROUND: Bladder perforation during the tension-free vaginal tape (TVT) procedure is a common complication. CASE: Vulvar edema was noted 4 hours after application of TVT, and cystoscopy revealed bladder perforation. The patient had a history of a previous vaginal hysterectomy with anterior colporrhaphy. CONCLUSION: To our knowledge, this is the first case report of vulvar edema following TVT. Bladder filling to 250 mL, 70 degrees cystoscopy, good skills in cystoscopy and familiarity with retropubic anatomy are key issues for the TVT procedure. A cystoscopic examination before the TVT procedure should be considered for patients with previous pelvic surgery.

Aged↗