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PubMed2002

Bladder cancer detection with urinary survivin, an inhibitor of apoptosis.

The current "gold standard" for the diagnosis of bladder cancer is cystoscopy and urine cytology. Cystoscopy, a naked eye assessment of the bladder, is invasive, uncomfortable and costly while cytology has high specificity but low sensitivity (40-60%) particularly for low-grade lesions. Therefore, there is a need for a molecular tumor marker assay that is simple to perform and sensitive, particularly for low-grade lesions. By looking to the pathophysiology of bladder cancer, we identified survivin, an inhibitor of apoptosis that is not generally expressed in fully differentiated adult tissue and is highly expressed in bladder cancer. Survivin is detected in whole urine of patients with TCC using a simple antibody based test. The sensitivity of survivin testing for new or recurrent bladder cancer is 100% while the specificity for other neoplastic and non-neoplastic genitourinary disease is 95%. The high sensitivity of this simple, noninvasive test is well suited to bladder cancer, a disease with high rates of recurrence.

Apoptosis↗
PubMed1986

Predictive values of diagnostic tests in the evaluation of female urinary stress incontinence.

Preoperatively a collaboration between gynecologists, urologists and radiologists is essential for the diagnostic accuracy of urinary incontinence especially to isolate stress incontinence for surgical treatment. The aim of this study was to estimate the value of these combined efforts. 212 women referred for urinary incontinence were assessed by history of micturition, pelvic examination, cystoscopy, cystometry, stress test for urine loss, uroflowmetry and colpo-cysto-urethrography. A final diagnosis obtained on this basis classified the patients in stress incontinence (130), urge incontinence (47), neuromuscular dysfunction (6), uncertain type (10), other disease (8) and no incontinence (11). According to calculations of predictive values of positive and negative tests, respectively, each single test in the preoperative investigation programme was evaluated regarding the final diagnosis stress incontinence. It was assumed that the symptom stress incontinence, the pelvic examination and the colpo-cysto-urethrography were of minor or no importance for the diagnosis stress incontinence but might have been for the choice of surgical treatment. Cystoscopy and uroflowmetry had no place in daily routine. In contrast normal cystometry and especially the sign stress incontinence deserved consideration of refinements.

Adult↗
PubMed1997

Preoperative evaluation of tumor extension in patients with recurrent cervical cancer.

BACKGROUND: Pelvic exenteration is an option in the treatment of locally recurrent cervical cancer. Various preoperative diagnostic procedures in the estimation of tumor invasion of the bladder and rectum or lymphonodal involvement were evaluated. DESIGN: The sensitivity and specificity of cystoscopy, intravenous pyelography, irrigoscopy, rectoscopy, and computed tomography were evaluated by comparing the preoperative findings with the histological result as the 'golden standards'. RESULTS: In the assessment of bladder invasion the sensitivity of cystoscopy, intravenous pyelography and computed tomography was 22.2%, 55.6% and 55.6%, respectively. The overall sensitivity of the three diagnostic procedures was 77.8%. In the assessment of invasion of the rectum irrigoscopy, rectoscopy and CT revealed a sensitivity of 33.3%, respectively. Only 50% of all cases with tumor infiltration of the rectum showed positive results when all three diagnostic procedures were combined. The sensitivity and specificity of computed tomography in the diagnosis of lymphonodal involvement were 75% and 83.3%, respectively. CONCLUSION: We think that there is an obvious necessity for all diagnostic procedures for patient selection prior to pelvic exenteration. However, all these investigations are not conclusive but complement each other. Prior to pelvic exenteration, critical interpretation of all preoperative diagnostic procedures is mandatory, otherwise surgery results in an unintended palliative procedure.

Adult↗
PubMed1986

Bladder tumour control by abdominal ultrasound and urine cytology.

A blind study comparing abdominal ultrasound and cystoscopy was carried out in 186 patients. 20 bladder tumours sized from 2 to 5 mm were overlooked. Combination with urine cytology increased the diagnostic sensitivity. In order to reduce costs and patient inconvenience in the bladder tumour control population abdominal ultrasound and urine cytology is advocated as an alternative to cystoscopy. This control modality seems safe in patients with "low-risk" bladder tumour disease.

Cystoscopy↗
PubMed1982

Cystosonography in the detection of bladder tumors: a prospective and retrospective study.

To determine the sensitivity of real-time abdominal ultrasound as a screening test to detect bladder tumors, a prospective study of 100 patients with painless hematuria was undertaken. Each patient was examined by excretory urography, bladder ultrasound, and cystoscopy. Results of the ultrasound and intravenous urography examinations were compared with cystoscopy results. Of 14 bladder lesions noted, ultrasound detected seven prospectively whereas intravenous urography detected 12. With awareness of the ultrasonographic appearance of bladder tumors, 12 lesions could be detected retrospectively. A fully distended bladder is necessary to avoid simulation of a neoplasm and false-positive ultrasound findings. Awareness of the cystosonographic appearance of bladder tumors may allow detection of asymptomatic tumors during routine pelvic ultrasound examinations.

Carcinoma, Transitional Cell↗
PubMedDate not supplied

BTA-TRAK--a useful diagnostic tool in urinary bladder cancer?

During recent years the BTA-TRAK-assay (Bard Diagnostics, Redmont, USA) has been described in several investigations to be of clinical utility for patients suffering from bladder cancer. In a prospective study we investigated over four months the voided urine samples of all consecutive patients undergoing cystoscopy independent of their clinical background (n = 244) with the BTA-TRAK-assay. With a specificity of 95% for benign urological diseases (cut off: 1300 U/mL) we found a sensitivity of 13% for active bladder tumours. Using healthy individuals as a reference group (cut off: 40 U/mL) we found a sensitivity of 56% (specificity 67%). Using the cut off value recommended by the manufacturer (14 U/mL) a specificity of 54% and a sensitivity of 62% was found. For patients without relapse (NED) versus patients with active bladder tumours we got a specificity of 55% and a sensitivity of 62%. Due to an insufficient specificity and sensitivity the BTA-TRAK-test is not able to replace cystoscopy nor to improve existing diagnostic strategies in bladder cancer.

Cystoscopy↗
PubMed1999

Use of urine-based markers for detection and monitoring of bladder cancer.

Diagnosis and monitoring of bladder cancer present a difficult clinical problem. Urine cytology with confirmatory cystoscopy form the cornerstone of diagnosis at the present time. The subjectivity and low sensitivity of cytology led to the development of numerous tests as adjuncts to cystoscopy for the diagnosis and follow-up of bladder cancer patients. These tests usually are objective, quantitative (NMP-22, BTA TRAK, BLCA-4, telomerase activity, etc.), or qualitative (BTA Stat and FDP) and have higher sensitivity than cytology, but some have lower specificity. We review the different, new urine-based tests that were developed recently for the diagnosis and monitoring of patients with bladder cancer. The advantages and disadvantages of these tests are discussed, as well as their possible future role in the management of patients with bladder cancer.

Antigens, Neoplasm↗
PubMed2000

[Primary AA type amyloidosis of the urinary bladder: a case report].

Primary amyloidosis of the urinary bladder is a rare disease entity. A total of 61 cases have been reported in the Japanese literature, and most of them were AL type amyloidosis. We report here a case of primary AA type amyloidosis. A 52-year-old man presented with a chief complaint of asymptomatic gross hematuria. Cystoscopy revealed yellowish elevated lesions, transurethral mucosal biopsies were performed, and the histopathological diagnosis indicated a primary AA type amyloidosis of the urinary bladder. Systemic amyloidosis was clinically eliminated. The yellowish lesions in the bladder through cystoscopy disappeared spontaneously one year later without any specific treatment, but periodical work-up may be necessary to rule out recurrence of the disease or bladder tumor.

Amyloidosis↗
PubMed2000

Follow-up of patients with noninvasive and superficially invasive bladder cancer.

Low-grade carcinomas (pTaG1) comprise 50% of all stage pTa-pT1 carcinomas and have an almost benign course of disease. Follow-up policies may be changed so that patients with a single tumor at diagnosis and a negative cystoscopy at 3 months should be examined 9 months later. Check cystoscopies may be performed with flexible instruments and a considerable number of the recurrences could be managed with fulguration under urethral anesthesia only. Because low-grade carcinomas are so common, the seriousness of the other tumors in stages pTa-pT1 is not fully appreciated. Patients with high-grade carcinoma (pTaG2-G3, pT1G2-G3) have at least a 70% risk for recurrence and a 20% risk for stage progression. The course of disease is more unpredictable than for patients with low-grade carcinoma, and there are at present no firm data that support a change in follow-up routines. Routine follow-up urographies are not necessary.

Carcinoma, Transitional Cell↗
PubMed2001

Comparative predictive values of urinary cytology, urinary bladder cancer antigen, CYFRA 21-1 and NMP22 for evaluating symptomatic patients at risk for bladder cancer.

PURPOSE: We study the potential diagnostic use of urinary bladder cancer antigen, CYFRA 21-1 and NMP22*; for evaluating symptomatic patients who present with microscopic hematuria and are at risk for bladder cancer. MATERIALS AND METHODS: Urinary tumor markers were determined in 187 samples from 112 patients symptomatic of bladder cancer (group 1), and 75 with benign and other urological conditions (group 2). Immunoassays were used to measure the 3 selected biomarkers. Sensitivity and specificity were established by previously defined cut points. Biomarker results were reported as corrected and uncorrected for urinary creatinine. Urinalysis was performed in all samples. RESULTS: Positive and negative predictive values were 85.5%, 80.5% and 81.1%, and 80.8%, 79.2% and 76.5% for urinary bladder cancer antigen, CYFRA 21-1 and NMP22, with the cutoffs 9.7 microg./l., 5.4 microg./l and 10.0 units per ml., respectively. These predictives values were 85.2% and 72.5%, respectively, for urinary cytology. The combination of biomarkers decreased the positive predictive values to 72.3% to 78.6% and increased negative predictive values to 84.2% to 86.1%. Urinary tract infection, inflammation and malignancy associated with other genitourinary organs were the primary cause for false-positive test results in the 3 assays evaluated. CONCLUSIONS: With a single biomarker, around 80% of the positive results would have correctly identified symptomatic patients for cystoscopy. Of the negative results 75% would have correctly reduced the number of cystoscopies. Sensitivity and negative predictive values could be improved with the combination of biomarkers but with a loss of specificity and positive predictive values. Urinary tract inflammation and other genitourinary malignancies might contribute to the reduction in specificity of these tests.

Adult↗
PubMed2001

Interstitial cystitis: urgency and frequency syndrome.

Interstitial cystitis is a chronic, severely debilitating disease of the urinary bladder. Excessive urgency and frequency of urination, suprapubic pain, dyspareunia, chronic pelvic pain and negative urine cultures are characteristic of interstitial cystitis. The course of the disease is usually marked by flare-ups and remissions. Other conditions that should be ruled out include bacterial cystitis, urethritis, neoplasia, vaginitis and vulvar vestibulitis. Interstitial cystitis is diagnosed by cystoscopy and hydrodistention of the bladder. Glomerulations or Hunner's ulcers found at cystoscopy are diagnostic. Oral treatments of interstitial cystitis include pentosan polysulfate, tricyclic antidepressants and antihistamines. Intravesicular therapies include hydrodistention, dimethyl sulfoxide and heparin, or a combination of agents. Referral to a support group should be offered to all patients with interstitial cystitis.

Administration, Intravesical↗
PubMed2001

[When is it meaningful to investigate hematuria? Macroscopic hematuria--investigate always. Microscopic hematuria--symptoms and age decide].

All patients (n = 578) referred during one year and for whom hematuria was mentioned in the referral form were monitored following urological evaluation including urography and cystoscopy. Evaluation of macroscopic hematuria was often associated with significant findings at both urography (stones) and cystoscopy (bladder tumors). The situation was the same even if not as pronounced for evaluation of microscopic hematuria with concomitant urinary tract symptoms. The evaluation of asymptomatic microscopic hematuria was, however, very rarely associated with significant findings, which were moreover totally lacking among women and younger males.

Adult↗
PubMed2002

A comparison of BTA stat, hemoglobin dipstick, telomerase and Vysis UroVysion assays for the detection of urothelial carcinoma in urine.

PURPOSE: We determine the sensitivity and specificity of various assays for the detection of urothelial carcinoma. MATERIALS AND METHODS: A total of 280 voided urine specimens from 265 patients were obtained immediately before cystoscopy for BTA stat, (Bard Diagnostic, Redmond, Washington) hemoglobin dipstick, (Bayer, Elkhart, Indiana) telomerase and UroVysion (Vysis, a wholly owned subsidiary of Abbott Laboratories, Abbott Park, Illinois) analysis. RESULTS: Of the 265 patients 75 had biopsy proven urothelial carcinoma, and the sensitivity of the assays was determined from these patients. From most sensitive to least sensitive, the overall sensitivity of UroVysion (73 cases), BTA stat (72), hemoglobin dipstick (73) and telomerase (70) was 81%, 78%, 74%, and 46%, respectively. Each of the first 3 tests was statistically significantly more sensitive than the telomerase assay (p <0.05). However, the differences in overall sensitivity of UroVysion, BTA stat and hemoglobin dipstick were not statistically significant. The specificity of the tests was calculated for 80 of the 265 patients in this study who had no history of urothelial carcinoma and negative cystoscopy findings despite common urological complaints. From most specific to least specific, the specificity of UroVysion, telomerase, BTA stat and hemoglobin dipstick was 96%, 91%, 74% and 51%, respectively. UroVysion and telomerase were statistically significantly (p <0.01) more specific than the BTA stat and hemoglobin dipstick assays, and all of the assays were more specific than hemoglobin dipstick testing (p <0.001). CONCLUSIONS: Our study reveals that UroVysion is the most sensitive and specific assay among those tested for the detection of urothelial carcinoma. Telomerase testing had good specificity but poor sensitivity. The BTA stat and hemoglobin dipstick tests had good sensitivity but relatively poor specificity. UroVysion is a promising new assay for the detection of urothelial carcinoma in urine specimens. However, further studies are needed to explore the role of the various assays in the treatment of patients with superficial urothelial carcinoma.

Adult↗
PubMed2002

Urologic complications of placenta percreta invading the urinary bladder: a case report and review of the literature.

INTRODUCTION: Placenta percreta invading the urinary bladder may cause hemorrhagic shock, hematuria and urologic complications at parturition. This retrospective survey of 54 patients reviews maternal characteristics, presentations, urologic complications, and management. METHODS: The first reported case of placenta percreta with urinary bladder invasion in Hawaii is presented. Medline search and literature review identified an additional 53 patients. A meta-analysis of all 54 cases was performed. RESULTS: Hematuria was present initially in 31% (17/54) patients. Of these, 9 of 17 required transfusion support. A preoperative diagnosis was established by ultrasound or MRI in 33% of patients. Cystoscopy was performed in 12 patients and did not make a preoperative diagnosis in any patient. 39 urologic complications included bladder laceration 26%, urinary fistula 13%, gross hematuria 9%, ureteral transection 6%, and small capacity bladder 4%. Partial cystectomy was performed in 44% (24/54). Three maternal deaths and 14 fetal deaths occurred. Only 1 patient subsequently had a delivery. CONCLUSION: Readily identifiable risk factors by history are important to suggest placenta percreta in pregnant patients with gross hematuria. Ultrasound and/or MRI can establish a preoperative diagnosis. Cystoscopy did not identify any patient preoperatively. Partial cystectomy is commonly required for extensive or deep bladder invasion.

Adult↗
PubMed2002

Comparative evaluation of the nuclear matrix protein, fibronectin, urinary bladder cancer antigen and voided urine cytology in the detection of bladder tumors.

PURPOSE: We evaluate the diagnostic efficacy of nuclear matrix protein-22 (NMP22, Matritech, Newton, Massachusetts), fibronectin and urinary bladder cancer antigen (UBC, IDL Biotech, Borlange, Sweden) compared with voided urine cytology in the detection of bladder cancer. MATERIALS AND METHODS: A total of 168 patients provided a single voided urine sample for NMP22, fibronectin an ideal monoclonal for urinary bladder cancer and cytology before cystoscopy. Cystoscopy was done for all patients as the reference standard for identification of bladder cancer. Biopsy of any suspicious lesion was performed for histopathological examination. Of the 168 cases 100 were histologically diagnosed as bladder cancer, whereas the remaining 68 had benign urological disorders. A group of 47 healthy volunteers were also enrolled in this study. Voided urine was evaluated by NMP22, fibronectin and UBC, and their values were expressed relative to mg. creatinine. RESULTS: The optimal threshold values for NMP22, fibronectin and UBC were calculated by receiver operator characteristics curves as 27 units per mg. creatinine, 198 mg./mg. creatinine and 13 ng./mg. creatinine, respectively. The levels and positive rates of the 3 parameters were significantly higher in the malignant group compared to either the benign group or normal controls. Of the entire group NMP22, fibronectin and UBC were positive in 93.2%, 91% and 68.2%, respectively in bladder cancer cases with positive cytology. Moreover, these positive rates were significantly higher in bilharzial bladder cancer cases (58.8%, 67.5%, 58.8%, respectively) compared to nonbilharzial cases (35.6%, 36.3%, 31.1%). Overall sensitivity and specificity were 85% and 91.3% for NMP22, 83% and 82.6% for fibronectin, 67% and 80.8% for UBC and 44% and 100% for voided urine cytology. Combined sensitivity of voided urine cytology with the 3 biomarkers together was higher than either combined sensitivity of voided urine cytology with 1 of the biomarkers or than that of the biomarker alone. CONCLUSIONS: Our data indicate that NMP22 and fibronectin had superior sensitivities compared to UBC and voided urine cytology, while NMP22 and voided urine cytology had the highest specificities. The combined use of markers increased the sensitivity of cytology from 44% to 95.3%. The higher sensitivities of markers in bilharzial than nonbilharzial bladder cancer highlight their clinical use in screening patients with urinary bilharziasis.

Adult↗
PubMed2002

[Reduction of the hospital stay in the surgical treatment of hydronephrosis in children].

UNLABELLED: A Hydronephrosis operation represents a relatively frequent surgery in childhood. There is not agreement about the necessity of using drainage neither on the type to use, decisions that rebound in the patient's hospital stay. The objective of the study is to show the reduction of the days of stay according to the type of drainage used. MATERIAL AND METHODS: We present 14 children diagnosed of hydronephrosis operated on by Anderson-Hynes technique with an internal drainage double J type no 3 or 4. There were left side predominance (10 kidneys). Age of diagnosis varied from 0 to 11 years. We analysed the decrease of the stay with regard to the system that we used previously, nephrostomy drainage and stent, as well as the presence of complications related with the drainage. A cystoscopy was performed fifteen days later, in ambulatory way, to remove the catheter. A questionnaire of satisfaction was requested to the parents. RESULTS: Thirteen patients abandoned the hospital 2 days postoperatively and 2 three days postoperatively. There were 3 complications, being 2 minor and 1 mayor (double J ascension removed by ureteroscopy and an additional one day stay hospital). The reduction of the stay with regard to the traditional method varied between 7 and 8 days what represents an important saving of costs. In the questionnaire, the methods has appealed to the parents. CONCLUSION: We believe that the placement of a double J catheter represents an improvement that saves time and diminishes nuisances to patients, although a cystoscopy procedure is necessary for its removal. The double J catheters with a straight prolonged end, like a nephrostomy tube, recently in the market can avoid this last procedure.

Algorithms↗
PubMed2002

[NMP-22 test. Is it useful in the follow-up of patients with superficial bladder tumor?].

OBJECTIVES: 1.--To evaluate the efficacy of the NMP-22 as a diagnostic test for bladder tumor recidives; 2.--To compare the efficacy of NMP-22 vs. urine cytology. METHODS: 90 Patients with superficial bladder tumors were included in the study, undergoing cytologic, cystoscopic and NMP-22 marker controls. NMP 22 test was considered positive when the marker signal was higher than 10 U/ml. Cistoscopy was the reference test. RESULTS: Patients in the study had an average age of 69 years, ranging from 45 to 91. 88% were males and 12% females. 61.2% of the tumors were Ta, 37.6% T1 and 1.2% Cis, being 17.8% grade I, 63.4% grade II and 18.8% grade III. NMP-22 showed a global sensitivity of 32.1%, and a specificity of 5.1%. Positive predictive value (PPV) was 75% and negative predictive value (NPV) 75.3% for a relapse rate of 27.7%. Urine cytology showed an overall sensitivity of 28.6%, 95.2% specificity, PPV 72.7% and NPV 74.7%. When both tests were used altogether sensitivity was 46.4%, specificity 90.3%, PPV 68.43% and NPV 78.9%. CONCLUSIONS: The NMP-22 marker has shown low sensitivity so that control by cystoscopy may not be avoided. The combination of NMP-22 and urine cytology increases sensitivity minimally. It is not possible to replace cystoscopy in the follow-up of patients with superficial bladder tumors.

Aged↗
PubMed2003

[Non-epithelial tissue tumors of the urinary bladder].

OBJECTIVE: To summarize the experience in the diagnosis and treatment of non-epithelial tissue tumor of urinary bladder. METHODS: >From 1953 to April 2002, a total of 28 patients with non-epithelial tissue tumor in 3 925 bladder tumor cases were analyzed. RESULTS: Painless gross hematuria, pelvic mass, urinary frequency and dysuria are symptoms of non-epithelial bladder tumor. Ultrasonic examination, computed tomography (CT) scan, cystoscopy and biopsy is used for diagnosis of the tumor. Seventeen of 28 patients (61.7%) were malignant neoplasms in 7 kinds of pathologic types, which was small cell carcinoma (5 cases), rhabdomyosarcoma (4 cases), leiomyosarcoma (4 cases), lymphoma (1 case), malignant fibrous histiocytoma (1 case), liposarcoma(1 case), melanoma (1 case) respectively. Eleven of 28 patients (39.3%) were benign tumors with 4 kinds of histologic types including 2 cases of cavernous hemangioma, 1 case of fibroma, 1 case of leiomyoma, 7 cases of pheochromocytoma. All benign tumor patients were treated with partial cystectomy, transurethral bladder tumor resect (TURBT) and fulguration. In 17 malignant neoplasms patients, 7 of them received partial cystectomy, 9 received radical cystectomy, and 1 patient's tumor was unresectable. Those malignant bladder tumor patient are followed up, but 3 years survival rates is only 8/17. CONCLUSIONS: Non-epithelial tissue tumor of the urinary bladder is rare with complicated pathologic types. Malignant neoplasms are more than benign tumors with very poor prognosis, benign tumors' prognosis is good. Diagnosis rate which was confirmed before operation is low. Dip biopsy under cystoscopy may enhance the diagnosis rate. Surgical treatment is the main therapy for non-epithelial tissue tumor of the urinary bladder. Because of the aggressive biologic behavior of malignant tumors, they should be identified promptly and treated appropriately. According to the histologic appearance radiotherapy and chemotherapy is mandatory in some cases.

Adolescent↗