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At least 1,333 records · Page 74Linked to original sources
PubMed1993

A plea for cold biopsy, fulguration and immediate bladder instillation with Epirubicin in small superficial bladder tumors. Data from the EORTC GU Group Study 30863.

The sensitivity of cystoscopy to distinguish infiltrating from superficial bladder tumors is very high. Only 28 (5.6%) of 501 single tumors, which were considered to be superficial by the urologist at visual inspection, were found to be infiltrating on pathological examination. If the size of the tumor and/or the cytological grade are considered, one can further reduce the number of infiltrating tumors missed, but it was impossible to identify them all. The recurrence rate of tumors at the resection site 4 weeks after TUR suggests the importance of trauma of the bladder mucosa in promoting recurrence. A single instillation of Epirubicin immediately after TUR prevents implantation of tumor cells and reduces the recurrence rate to nearly 50%. A combination of cold forceps biopsy and fulguration may be the most reasonable treatment for small bladder tumors.

Administration, Intravesical↗
PubMed1992

Immunophenotypic characterization of the bladder mucosa infiltrating lymphocytes after intravesical BCG treatment for superficial bladder carcinoma.

The lymphocytes infiltrating the bladder mucosa of 28 patients treated with bacillus Calmette-Guérin (BCG) for superficial bladder carcinoma were characterized using an immunohistochemical technique on frozen sections of biopsy specimens obtained during cystoscopy. The inflammatory response induced by BCG consisted mainly of T lymphocytes (CD3+), most of which had the helper/inducer phenotype (CD4+), with a CD4/CD8 ratio greater than 1. A minor subset of lymphocytes were of B phenotype (CD22+). These findings persisted for the whole follow-up period (6-12 months) in spite of a progressive decrease of the inflammatory infiltrate. No difference in the lymphocyte phenotype was observed between nonresponding patients and those who responded to BCG in the short term. It is concluded that, although intravesical BCG therapy does affect the immunocompetent cells of the bladder wall, the BCG-induced antitumor activity is unlikely to depend exclusively on a local immune mechanism.

Administration, Intravesical↗
PubMed1992

Changes in prostate-specific antigen and prostatic acid phosphatase concentration following prostatic examination in benign prostatic hypertrophy and prostate cancer patients.

The authors measured serum prostate-specific antigen (PSA) and prostatic acid phosphatase concentration in histologically positive prostate hyperplastic and carcinomatous patients before, and 30-60 min and 24 h after prostate manipulation (rectal digital examination, cystoscopy and perineal punch biopsy). After rectal examination, PSA, and after other interventions, both markers changed significantly, although in different points of time and to a different extent. The authors call the attention to the importance of the point of time of the examination. Examination following prostate manipulation may result in wrong diagnosis or in erroneous therapeutic consequences in the follow-up period.

Acid Phosphatase↗
PubMed1995

Effect of ejaculation on prostate-specific antigen levels in normal men.

While several manipulations such as digital rectal examination and cystoscopy have been shown to increase prostate-specific antigen (PSA) levels, lack of ejaculation for a period of time has been implicated as a cause of decreased serum PSA concentrations. However, the effect of ejaculation on the serum PSA concentration is not clear. This work determined the effect of ejaculation on serum PSA levels in normal men. Blood samples of 19 healthy subjects were taken before and 5 consecutive days after ejaculation. One subject was withdrawn from the study because of ejaculation during sleep, since another ejaculation was prohibited during the study. The mean PSA levels of the men before and 5 consecutive days after ejaculation were 0.79, 0.72, 0.63, 1.01, 0.71, and 0.74 ng/ml--not statistically significantly different. We conclude that ejaculation does not seem to affect the serum PSA concentration.

Adult↗
PubMed1979

Changes in serum creatine kinase isoenzyme activities after surgical procedures and cardioversion.

Serum activities of creatine kinase (CK) and its isoenzymes were monitored before and 16 to 20 hours after a variety of surgical procedures and cardioversion. Changes in total CK and CK MM activities in the surgical patients were consistent with the extent of trauma; changes in these activities in the cardioversion patients were more variable, ranging from -2 to 1829 U/l, and were unrelated to the applied electrical force. CK MB activity was unchanged after cystoscopy but rose moderately in 60% of patients after cholecystectomy, in 43% of patients requiring only implantation of a new pacemaker box, and in 87% of patients after implantation of an entire pacemaker system. No increase exceeded 6U/l. Fifty per cent of patients requiring cardioversion showed rises; the maximum value was 40.9 U/l.

Adult↗
PubMed1988

Intra-arterial chemotherapy for advanced bladder cancer.

The results of prolonged intra-arterial chemotherapy in 61 patients with locally advanced bladder cancer (T3-T4) are discussed. Regional internal iliac artery infusion of chemotherapeutic agents was done daily for 5 or 7 days at a rate of 1 to 3 ml/h over an 18-20-h period. The total dosages of each course were 60-120 mg/m2 adriamycin, 2.5-3.5 g/m2 5-fluorouracil (5-FU), 20-40 mg/m2 methotrexate or 30-50 mg/m2 cisplatin. At 3 to 4 weeks after the completion of infusional chemotherapy the results were evaluated, based on data from control cystoscopy and sonography. One patient (1.6%) was free of tumor; an objective response of greater than 50% reduction in tumor size occurred in 26 (42.7%) patients; 34 (55.7%) demonstrated objective responses of less than 50%. No further increase in tumor size during the management was detected. Hematuria, dysuria and urine infection were controlled and pain was relieved. The use of cytostatics and prolonged iliac artery catheterization did not incur any serious complications.

Adult↗
PubMed2002

An undiagnosed phaeochromocytoma of the urinary bladder.

Phaeochromocytoma of the urinary bladder is rare. We report a case of a patient with undiagnosed bladder phaeochromocytoma who developed haemodynamic disturbances during routine diagnostic cystoscopy. The diagnosis was only confirmed postoperatively.

Aged↗
PubMed1980

Etomidate: a foreshortened clinical trial.

A clinical evaluation of etomidate for outpatient cystoscopy was embarked upon. Unpremedicated patients were given fentanyl 1 microgram/kg followed by etomidate 0.3 mg/kg. Anaesthesia was maintained with intermittent etomidate in 2-4 mg doses. Patients were interviewed personally later the same day, and by questionnaire three to four weeks later. The trial was discontinued after 20 cases because of an unacceptable incidence of side effects. Venous pain occurred in 68% of patients and 50% had redness, pain or swelling related to the injection site, in some cases lasting up to three weeks after anaesthesia. Skeletal movements occurred in 50% of patients; 30% experienced respiratory upset, one sufficiently severe to necessitate abandoning the technique. Nausea and vomiting occurred in 40% and 25% had disturbing emergence psychoses.

Anesthesia, Intravenous↗
PubMed1989

A comparison of alfentanil, halothane and enflurane as supplements for outpatient urological surgery.

Seventy-seven patients presenting for outpatient cystoscopy participated in a trial to assess postoperative recovery when either alfentanil, halothane, or enflurane were used in combination with nitrous oxide/oxygen anaesthesia. Anaesthesia was uneventful in all cases. Apnoea occurred once with alfentanil, but naloxone was not required. Vomiting occurred once with alfentanil and once with enflurane. Anti-emetics were not required. Blood pressure and pulse rate variations from preoperative levels occurred with similar frequency in all groups. Times to open eyes, show left thumb, and give correct date of birth were significantly less with alfentanil than with the other agents tested. Trieger testing failed to demonstrate an advantage of alfentanil, although two patients in each of the halothane and enflurane groups were insufficiently recovered to complete the tests. As tested, alfentanil represents a useful alternative to halothane or enflurane as postoperative recovery of mental function is significantly more rapid than with the inhalational agents.

Alfentanil↗
PubMedDate not supplied

Surgical management of bladder carcinoma.

BACKGROUND: Despite advances in medical oncology, radiation therapy, and molecular and cell biology, the mainstay in the management of bladder cancer continues to be surgery. METHODS: The authors reviewed the literature regarding the endoscopic diagnosis and management of bladder cancer as well the role of partial and radical cystectomy. RESULTS: Cystoscopy and transurethral resection are required to diagnose and stage bladder cancer. The indications for random bladder biopsies, prostatic urethral biopsy, and re-resection of the tumor bed are examined. The results and complications of endoscopic resection in the management of Ta, T1, and T2 or greater bladder cancer are reported. The roles of partial cystectomy, radical cystectomy, extent of lymphadenectomy, and indications for urethrectomy are also examined. The results and complications of radical cystectomy for the management of T2, T3, T4, and N+ bladder cancer are reported. CONCLUSIONS: Surgery remains a critical element in the management of bladder cancer. Improvements in surgical technique, urinary reconstruction, and multimodal therapy continue to improve the prognosis and quality of life of patients with transitional cell cancer of the bladder.

Cystectomy↗
PubMed2004

Cancers of the bladder.

Bladder cancer is the fifth most common malignancy in Europe and the fourth most common malignancy in the United States. It affects one in 4000 people and accounts for 5% of all diagnosed cancers. The peak incidence is in the fifth and seventh decade. There is a strong association between smoking and bladder cancer. Smokers have a fourfold higher incidence of developing bladder cancer than the general population. The disease has a spectrum of clinical severity varying from superficial bladder cancer to muscle invasive or metastatic disease which carries a poor prognosis. Currently the superficial form of the disease is managed by endoscopic resection of the tumour, often followed by the instillation into the bladder of cytotoxic agents. Due to the tendency of bladder cancer to recur repeated cystoscopies and resections are often required. Because of this, one of the main thrusts of research is to find a way of preventing the progression from superficial disease to muscle invasive and metastatic bladder cancer.

Age Factors↗
PubMed1987

A prospective randomized trial of maintenance versus nonmaintenance intravesical bacillus Calmette-Guérin therapy of superficial bladder cancer.

Between August 1981 and July 1984, 93 patients with polychronotopic superficial papillary carcinoma (Ta and/or T1), flat carcinoma in situ (Tis), or concomitant superficial papillary and in situ bladder carcinoma were entered into a prospective randomized trial of maintenance v nonmaintenance intravesical bacillus Calmette-Guérin (BCG) therapy. Forty-six patients who received BCG weekly for 6 weeks were compared with 47 patients receiving the six-weekly doses of BCG plus monthly BCG for 2 years. Both groups were evaluated every 3 months by cytology, cystoscopy, and biopsy. A significant reduction in the number of recurrent tumors per patient-month was demonstrated for both groups (P less than .0001); however, the difference in reduction of tumors between the two groups was not significant. Additionally, patients receiving maintenance and nonmaintenance therapy had similar tumor recurrence and progression rates. These results indicate that monthly maintenance BCG does not prevent, delay, or reduce tumor recurrence or progression observed with the 6-week regimen. Maintenance BCG was associated with increased local toxicity, primarily dysuria, frequency, and urgency. Dosage reduction was required in 22 of 47 patients (46.8%). When the data were subjected to multivariate analysis, the presence or absence of tumor following induction BCG and PPD skin test results were found to be significant variables. Controlling for either the presence or absence of tumor following induction BCG, tumor recurrence and progression rates were not significantly different for the two treatment groups. However, the absence of tumor after induction BCG was associated with a longer disease-free duration (P = .00001) and time to progression (P = .095). Patients with a reactive tuberculin skin test before and after induction BCG had significantly less tumor recurrences than patients with different PPD skin tests results (P = .02). Tumor progression was not related to tuberculin skin testing.

BCG Vaccine↗
PubMed1996

Case report: paravesical suture granuloma resembling bladder carcinoma on CT scanning.

Paravesical granuloma formation is a rare complication of inguinal herniorrhaphy. Infected non-absorbable suture material is the usual cause. We present a case of paravesical granuloma that was initially thought to be bladder carcinoma both clinically and on CT scanning. The patient presented with urinary symptoms. Repeated biopsies revealed only reactive changes with no evidence of malignancy. CT showed a mass which appeared to arise from the anterior aspect of the bladder with a central area of low attenuation. The diagnosis was established at cystoscopy with deep resection of the mass, when two retained silk stitches with surrounding pus and granulation tissue was found. The diagnosis of paravesical suture granuloma (PSG) should be considered in patients with suprapubic symptoms, no haematuria, an atypical mass and a history of herniorrhaphy, which may have been many years prior to the time of presentation.

Cystoscopy↗
PubMed2003

Near misses in bladder cancer - an airline safety approach to urology.

INTRODUCTION: Traditionally, surgical audit has identified and highlighted the incidence of adverse events complicating a patient's care. The airline industry has taken this concept a step further back by identifying and studying near misses, i.e. events that have the potential to do harm. We have applied this approach to patients with known or suspected bladder cancer. PATIENTS AND METHODS: A prospective study was performed by two urology firms on all patients with known or suspected bladder cancer over a 3-week period. Patients presented to either a central (hub) hospital, or to an associated (spoke) hospital. Four stages in bladder cancer care were considered: (i) diagnostic or check flexible cystoscopy; (ii) admission to hospital prior to TURBT; (iii) peri-operative period; and (iv) first out-patient consultation. A separate proforma, comprising various aspects of management was used for each of these stages of care. If any one criterion was not met, the episode was recorded as a near miss. Near misses were classified as due to capacity limitations in the system, clerical error, equipment failure, clinical error and patient failure. RESULTS: A total of 115 completed episodes were recorded. A near miss was recorded in 65 (56.5%) of all episodes. Capacity limitations accounted for 54%, clinical error for 23%, clerical error for 16%, patient failure for 5% and equipment failure for 2% of all recorded near misses. Of particular note is that near misses relating to diagnosis were more common at the spoke hospital, delayed referral from GPs accounted for more than 25% of clinical error, diagnosis of 5 new bladder tumours was delayed and availability of upper tract imaging was a problem at all phases of patient management. CONCLUSIONS: Near misses are very common in the management of patients with bladder cancer, and their identification should provide a useful framework for identifying potential areas for improvement in patient care.

Ambulatory Care↗
PubMed1998

Limited evaluation of microscopic hematuria in pediatrics.

OBJECTIVE: The purpose was to determine the value of the standard laboratory and radiologic evaluation of microscopic hematuria in children, and to determine the prevalence of idiopathic hypercalciuria in those children referred for evaluation of unexplained microscopic hematuria. METHODS: This was a retrospective study of 325 children referred from 1985 to 1994 for the evaluation of asymptomatic microscopic hematuria. The diagnostic studies reviewed included serum creatinine, blood urea nitrogen, serum electrolyte studies, serum complement concentration, antinuclear antibody, urinalysis, urine calcium to creatinine ratios, urinary protein to creatinine ratio and/or 24-hour urinary protein excretion, renal ultrasounds, intravenous pyelograms, voiding cystourethrograms, and historical information. RESULTS: All creatinine and electrolyte values were normal for age, and none of the biochemical tests obtained in the children with hypercalciuria was abnormal. Of the 325 patients with idiopathic microscopic hematuria, only 18 had abnormal renal ultrasound examinations and 9 voiding cystourethrograms showed low-grade reflux. Hypercalciuria was found in 29 patients. The family history was positive for urolithiasis in 16% of patients without hypercalciuria compared with 14% of patients with hypercalciuria. A positive family history of hematuria was reported in 25% of patients; 62 patients did not have hypercalciuria and 4 of the patients had hypercalciuria. Microscopic hematuria in children is a benign finding in the vast majority of children. CONCLUSIONS: Our data demonstrate that a renal ultrasound, voiding cystourethrogram, cystoscopy, and renal biopsy are not indicated in the work-up of microscopic hematuria, and microhematuria in the otherwise healthy child is a minimal health threat, rarely indicative of serious illness.

Adolescent↗
PubMed2005

Therapeutic failure of praziquantel in the treatment of Schistosoma haematobium infection in Brazilians returning from Africa.

Several cases of therapeutic failure of praziquantel used for the treatment of urinary schistosomiasis have been reported. Alternative drugs, like niridazol and metrifonate, have shown a lower therapeutic effect and more side effects than praziquantel. Twenty-six Brazilian military men (median age of 29 years) with a positive urine parasitological exam who were part of a United Nation peace mission in Mozambique in 1994 were treated with 40 mg/kg body weight praziquantel, single dose. They swam in Licungo river (Mocuba city, Mozambique) during the weekends. After this, they presented haematuria, dysuria, polakiuria, and lumbar pain. Control cystoscopy examinations carried out between 6 and 24 months after each treatment (including two additional treatments at a minimum interval of 6 months) revealed the presence of viable eggs. Granulomas in the vesical submucosa were observed in 46.2% (12/26) of the individuals. A vesical biopsy confirmed the presence of granulomas in all of these patients and the presence of viable eggs in 34.3% (9/26) of individuals who no longer excreted eggs in urine. The eggs filled with miracidia showed characteristics of viability. Histopathological examination using different strains demonstrated therapeutic failure and the need for repeated treatment. In this study, we demonstrated a low efficacy of praziquantel in the treatment of schistosomiasis haematobia, and the necessity of the urinary bladder biopsy as criterion of cure.

Adult↗
PubMedDate not supplied

Orthotopic ureterocele masquerading as a bladder tumor in a woman with pelvic pain.

Single system orthotopic ureteroceles often present in adulthood are associated with characteristic radiographic findings. We present the case of a 54 year old woman with 8 months of urgency/frequency and pelvic pain that has the cystoscopic appearance of a bladder tumor. Cystoscopic images, radiographs and intraoperative photos demonstrate the work-up, evaluation, and treatment of this unique single system orthotopic ureterocele containing a calculus. This patient demonstrates the need for cystoscopy accompanied by upper tract imaging in patients with new onset pelvic pain, urgency/frequency, and frequent urinary tract infections.

Cystoscopy↗
PubMed2006

Photodynamic applications in superficial bladder cancer: facts and hopes!

As a disease characterized by a polymorphic and fluctuant nature in its evolution, superficial transitional cell carcinoma of the bladder remains a perpetual therapeutic challenge. This raises a great interest in the development of new diagnostic and therapeutic photodynamic applications. This article describes recent facts in the field of bladder cancer photodiagnosis and gives a survey on ongoing research in photodynamic therapy. Fluorescence cystoscopy induced by different aminolevulinic acid compounds (e.g., ALA-HAL) is well accepted in the urological community as a user-friendly new diagnostic tool in the endoscopic management of bladder tumors and CIS. Photodynamic therapy based on the same photosensitizing agents remains experimental, but recent results raise hopes of new therapeutic directions.

Aminolevulinic Acid↗