Safe duration of silicon catheter replacement in urological patients

Objectives: This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks, six weeks, and eight weeks). Design: A cross-sectional study with stratified simple random sampling Setting: Urology Unit, Korle Bu Teaching Hospital Participants: One hundred and thirty-seven male patients with long-term urinary catheters Interventions: Participants were grouped into 3 weeks, 6 weeks, and 8 weeks duration of catheter replacementsPrimary outcomes measures: Symptoms due to the urinary catheters, urinalysis, urine and catheter tip cultures, sensitivity, and catheter encrustations were assessed. Results: Eighty-six patients had a primary diagnosis of benign prostatic hyperplasia (BPH), 35 had urethral strictures,13 had prostate cancer, two had BPH and urethral strictures, and one participant had bladder cancer. There was no difference in the symptoms the participants in the different groups experienced due to the urinary catheters (p > 0.05). The frequency of occurrence of complications (pyuria, p = 0.784; blocked catheter, p=0.097; urethral bleeding, p=0.148; epididymo-orchitis, p=0.769 and bladder spasms, p=1.000) showed no differences in the three groups. There was no statistical difference in the urinalysis for the three groups (p>0.05) and the degree of encrustations (3 weeks: 0.03 ± 0.06, 6 weeks: 0.11±0.27 and eight weeks: 0.12 ±0.27) with p=0.065. Conclusions: In this study, the duration of urinary catheterisation using silicone Foley's catheters did not influence the complication and symptom rates; hence silicon catheters can be placed in situ for up to 8 weeks before replacement instead of the traditional three-weekly change.

L'hyper-expression du HER2 dans le carcinome urothélial de la vessie à propos d'une étude de 30 cas / HER2 hyper-expression in urothelial carcinoma of the bladder in a 30 cases study

Objectif. L'objectif de notre étude est d'évaluer l'expression du HER 2 dans le carcinome urothélial de la vessie sur 30 cas sélectionnés parmi une série de 361 cas colligée au service d'anatomie pathologie du CHU de Batna et de comparer nos résultats aux données de la littérature. Matériels et méthodes. Dans notre étude, nous avons évalué la surexpression de l'HER2 par technique immunohistochimique sur 30 cas, en utilisant les mêmes critères d'interprétation que pour le cancer du sein. Les résultats ont été évalués en utilisant le score d'interprétation de l'American Society of Clinical Oncology (l'ASCO), basé sur le pourcentage de cellules marquées, et l'intensité du marquage dans la perspective d'un traitement par le Trastuzumab (Herceptine). Dans notre étude, seul le score 3 + est considéré comme positif. Résultats et discussion. Nous avons constaté qu'aucun cas de tumeurs à faible potentiel de malignité (TFPM) n'a exprimé le HER2, et que 40 % des carcinomes de haut grade (HG) ont exprimé un marquage intense. Une surexpression de HER2 a été retrouvée dans 23,33% de nos échantillons tumoraux. Ce taux est proche de ceux décrits dans la littérature, allant de 23% à 80% avec d'importants écarts qui pourraient être expliqué par plusieurs hypothèses. Les résultats discordants rapportés dans la littérature nécessitent la standardisation des méthodes des laboratoires. Les différentes études démontrent que les décisions et l'algorithme actuellement utilisés dans les cancers du sein sont également adaptables dans les cancers de la vessie. Conclusion. Malgré la taille réduite de notre échantillon, l'expression de l'HER2 est présente surtout dans les carcinomes de haut grade ce qui concorde avec les données de la littérature des grandes séries. Ces résultats peuvent avoir des implications cliniques sur la prise en charge des tumeurs HER2-positifs localement avancées et/ou métastatiques. Ces patients sont donc des candidats potentiels pour la thérapie ciblée anti HER 2 (Herceptine).

Aim. The aim of the study was to evaluate the expression of HER 2 in urothelial carcinoma of the bladder in 30 cases selected from a series of 361 cases collected at the anatomy pathology department of the CHU of Batna and to compare our results with data from the literature. Method. In our study, we evaluated the overexpression of HER2 immunohistochemically in 30 cases, using the same interpretive criteria as for breast cancer. Results were assessed using the American Society of Clinical Oncology (ASCO) Interpretive Score, based on the percentage of cells labeled, and the intensity of labeling in the perspective of Trastuzumab treatment. (Herceptin). In our study, only the score of 3+ is considered positive. Results and discussion. We found that no cases of low potential malignancy (LPM) tumors expressed HER2, and 40% of high-grade carcinomas (HG) expressed strong staining. Overexpression of HER2 was found in 23.33% of our tumor samples. This rate is close to those described in the literature, ranging from 23% to 80% with large differences that could be explained by several hypotheses. The discordant results reported in the literature require the standardization of laboratory methods. The various studies show that the decisions and the algorithm currently used in breast cancer are also adaptable in bladder cancers. Conclusion. Despite the small size of our sample, the expression of HER2 is present mainly in high-grade carcinomas, which is consistent with data from the literature of large series. These results may have clinical implications for the management of locally advanced and / or metastatic HER2-positive tumors. These patients are therefore potential candidates for targeted anti HER 2 therapy (Herceptin).

One-stop haematuria clinic: first experience in South Africa

Background. Haematuria is the most common symptom of urological cancers, specifically bladder cancer, and timely diagnosis can prevent disease from progressing to a more advanced or incurable stage. One-stop haematuria clinics (OSHCs) have become commonplace in urological services in developed countries during the past three decades.Objectives. To assess the efficacy of this specialised clinic, aimed at providing an investigative service for patients with haematuria, in decreasing morbidity and mortality by earlier diagnosis of urological malignancy. We also report on the outcomes of this study.Methods. A total of 275 patients who attended the weekly OSHC at Groote Schuur Hospital, Cape Town, South Africa (SA), between January 2012 and October 2015 were retrospectively included in the study (out of 477 folders reviewed). Only patients with visible haematuria (275/477) were included, and characteristics such as gender, age, self-identified ethnicity, and outcomes following OSHC attendance (diagnoses and stage/grade/type of cancers) were recorded.Results. While the majority of cases were classified as indeterminate following investigation, one-fifth (55/275) of the patients were diagnosed with urological neoplasms, mainly bladder cancer (87.2%, n=48). The 50 - 69-year age group was the most common window for diagnosis of a neoplasm. Forty-six patients (46/55) with urothelial cancers were diagnosed at a relatively early stage and were therefore offered curative management; 5 patients presented with late-stage disease and risked poor outcomes after management. The remaining 4 identified cases were adenocarcinomas and squamous cell carcinomas. Most patients presented with high-grade cancers (43.2%). A small subset of patients were diagnosed with renal cell carcinoma (11.6%) and upper-tract transitional cell carcinoma (1.6%).Conclusions. This audit revealed that an OSHC can streamline diagnosis of urological malignancies in the SA setting, and highlights the fact that the patients most at risk for developing malignant conditions were the ones frequently diagnosed at a later stage and hence potentially facing a poorer prognosis. These findings support the setting up of such clinics in other SA hospitals to improve ease of early access to the urological service

Panorama des tumeurs urologiques au CNHU-HKM de Cotonou

Introduction : Les tumeurs urologiques sont très fréquentes dans la pratique courante de l'Urologie et constitue l'essentiel de l'activité de l'urologue Objectifs : Etudier les aspects épidémiologiques et évolutives des tumeurs urologiques à la Clinique Universitaire d'Urologie-Andrologie du CNHU HKM de Cotonou Patients et Méthodes : Il s'agissait d'une étude rétrospective et descriptive des aspects épidémiologiques et évolutives des tumeurs urologiques reçues au CNHU-HKM de Cotonou sur la période allant du 1er janvier 2008 au 31 décembre 2017. Les paramètres étudiés étaient : l'âge, le sexe des patients, le diagnostic, la localisation et la nature suspectée de la tumeur, le délai de recours aux soins et la mortalité hospitalière. Résultats : 1047 dossiers ont été colligés. La majorité (82,14%) de nos patients ont un âge supérieur à 50 ans. Les hommes sont majoritairement atteints avec un taux de 92,36%. La sex-ratio est de 0,92 en faveur des hommes H/F. La majorité de nos patients (87,68%) avait vu leurs symptomatologies évoluer plus de 6 mois avant de recourir aux soins médicaux. Un total de 532 patients avait une tumeur bénigne et 515, une tumeur maligne. La glande prostatique est l'organe génital masculin le plus affecté. Les tumeurs prostatiques représentent 75, 54% des tumeurs uro-génitaux dont 43,83% bénignes et 31,70% malignes. Conclusion : Les tumeurs urogénitales sont des affections fréquentes dominées par les tumeurs de la prostate, de la vessie et des reins. Au Bénin, elles sont diagnostiquées tardivement

Cancer de la vessie : aspects épidémiologiques, diagnostiques et thérapeutiques au service d'OncoHématologie de l'Hôpital National de Niamey : à propos de 159 cas colligés de 2007 à 2014

Titre : CANCER DE LA VESSIE : aspects épidémiologiques, diagnostiques et thérapeutiques au service d'Onco-Hématologie de l'Hôpital National de Niamey. A propos de 159 cas colligés de 2007 à 2014. Objectifs : Objectif Général :  Contribuer à l'amélioration la prise en charge du cancer de la vessie. PATIENTS ET METHODES : Il s'agit d'une étude rétrospective sur huit (8) ans, réalisé du 1er Janvier 2007 au 31 Décembre 2014. L'étude a inclus les patients des deux sexes, tout âge confondu qui ont été pris en charge pour cancer vésical avec ou sans confirmation histologique au service d'OncoHématologie de l'HNN. RESULTATS : Au terme de notre étude, nous avons colligé 159 cas de tumeurs de la vessie. L'âge moyen est de 41 ans avec des extrêmes de 11 et 71 ans. La majorité des patients était des cultivateurs (38,36%) et des ménagères (27%) et proviennent de la région de Tillabéry (33,96%). Le sexe masculin était prédominant (69,20%) et sex ratio de 2,24. L'hématurie est le signe clinique le plus fréquent avec 69,18%. L'échographie abdomino-pelvienne a été réalisée chez 73,58% des patients, la radiographie pulmonaire dans 67,92% des cas, cystoscopie dans 59,75%, cytologie urinaire dans 9,43%, examen histologique dans 8,18% des cas et le carcinome épidermoïde retrouvé dans 77,77% des cas. La chimiothérapie a constitué le principal traitement dans 58,49% des cas et la chirurgie 5,66% des cas. Conclusion : Le cancer de la vessie est fréquent à l'HNN. Malgré les moyens d'explorations relativement limités, les patients bénéficient d'une prise en charge multi-disciplinaire. Le retard de consultation constitue un frein pour cette prise en charge et dans la majorité des cas la tumeur est diagnostiquée à un stade très avancé de maladie d'où un fort taux de décès est enregistré

Semiquantitative Smoothelin Expression in Detection of Muscle Invasion in Transurethral Resection and Cystectomy Specimens in Cases of Urinary Bladder Carcinoma

Objectives: To examine the usefulness of smoothelin - a new immunohistochemical (IHC) marker that is expressed predominantly in visceral smooth muscle - in recognizing muscularis propria (MP) in transurethral resection (TUR) and matched cystectomy specimens and to compare thepattern of its expression in muscularis mucosae (MM) and MP in radical cystectomy specimens. Methods: IHC staining for smoothelin was performed in 49 cases of urothelial carcinoma removed by radical cystectomy (16 had undergone TUR before the cystectomy). Results: In cystectomy specimens; smoothelin staining in the MP was strong (+3); moderate (+2) and weak (+1) in 49; 44.9and 6.1of cases; respectively; whereas smoothelin positivity in the MM was absent and weak in 77.6and 22.4of cases; respectively. In TUR specimens; smoothelin immunoreactivity was moderate to strong in 68.8and weak in 6.3of cases and all of them proved to have MP invasion in cystectomy specimens. Conclusion: Smoothelin is a useful marker for the detection of MP in TUR specimens. Moderate to strong smoothelin staining of the muscles included in TUR specimens and split by the tumor is a sign of MP invasion. It may be useful in cancer staging and treatment decision making

Intravesical Gemcitabine for Treatment of Superficial Bladder Cancer not Responding to Bacillus Calmette-Guerin Vaccine

Objectives: Intravesical Bacillus Calmette-Guerin (BCG) vaccine is the mainstay of treatment and prophylaxis in superficial bladder cancer (SBC) as it reduces tumor recurrence and disease progression. About one-third of patients do not respond to BCG. The aim of this study was to determine the efficacy of intravesical gemcitabine in patients with BCG-refractory SBC. Methods: Twenty three patients with SBC; TaG3; T1G2-G3 or carcinoma in situ (CIS); refractory (after at least 2 courses of intravesical BCG) or intolerant to intravesical BCG therapy were included. Two weeks after complete tumor resection; patients received intravesical gemcitabine twice weekly at a dose of 2.000 mg/100 ml normal saline for 6 consecutive weeks. Two months after the last dose; recurrence-free patients underwent cystoscopy; urinary cytology and 6 random bladder biopsies. Thereafter; patients were evaluated by the same measures every 3 months; as long as there was no recurrence. Patients with complete response (negative cytology and random biopsies) at the first follow-up cystoscopy received a similar maintenance dose once weekly for another 6 weeks. Results: Twenty one patients completed the study: 15 males and 6 females with a mean age of 48.1 (38-72) years. The follow-up was 15 months (range 2-19 months). Thirteen (61.9) patients were recurrence-free after a mean of 17 months. Superficial recurrences were detected in 6 (28.6) patients and progression by stage in 2 patients (9.5). During follow-up; 8 patients had tumor recurrences and 2 had progression to a higher stage. The median recurrence-free time was 14.7 months (5-19 months). The drug was well tolerated and side-effects were mild in all patients; except two: one had easily controlled hematuria and the other had leucopenia. Conclusion: In properly selected patients; gemcitabine seems to be a promising option in the management of high-risk BCG-refractory SBC; especially in those who refuse or are unfit for cystectomy. Long-term efficacy and the role of maintenance therapy have to be properly studied

A Clinicopathological Study of Urinary Bladder Neoplasms in Patients at Three Centers in Khartoum; Sudan

OBJECTIVES:To present the histopathological pattern of urinary bladder neoplasms using the WHO/ISUP classification system and relate it to the outcome.METHODS:This study was conducted in the period from January 2004 through December 2005 at three centres in Khartoum; Sudan. One hundred and six patients with urinary bladder neoplasms were included in the study.RESULTS:The commonest affected age group was 60-80 years with male to female ratio 4.6:1. Urothelial neoplasms were found in 72 (67.9); Squamous cell carcinoma (SCC) in 26 (24.5); urothelial neoplasms with Squamous differentiation in 3 (2.8); and other types in 5 (4.7) of the patients.There were 43.4of the urothelial neoplasms graded as papillary carcinoma of high grade; 52.6papillary carcinoma of low grade;1.3papillary neoplasm of low malignant potential;1.3papilloma; and 1.3was graded as flat neoplasm.Of the SCCs; twelve (42.9) were poorly differentiated SCCs;nine (32.1) moderately differentiated; and seven (25) cases were well differentiated SCCs. Follow-up information was available in 32 patients.At last followup; fifteen (46.9) patients were dead of the disease; twelve (35.5) were alive with no evidence of disease; four (12.5) were alive with disease; and one (3.1) was alive and terminally ill Conclusion:Histological grade (P: 0.006); and muscle invasion (P: 0.002) were significantly associated with survival.A subset of the cases could not be assessed for muscle invasion due to inadequate sampling; we thus recommend proper trans-urethral bladder biopsy (TUBP) sampling

Les cancers de la vessie vus au CHU Joseph Ravoahangy Andrianavalona

Le cancer de la vessie regroupe des lesions tres diverses sur le plan clinique et surtout histopronostique. Aucune etude n'a ete realisee a Madagascar sur cette pathologie. L'objectif de cette etude est de determiner les aspects epidemio-cliniques et therapeutiques de cette pathologie cancereuse. Patients et methodes: Une etude retrospective sur une periode de 6 ans portant sur les dossiers des patients presentant un cancer de la vessie a ete faite au service d'urologie du CHU Joseph Ravoahangy Andrianavalona. Nous avons inclus dans cette etude 31 patients avec 20 hommes et 11 femmes. Resultats : L'age moyen est de 52 ans. Les facteurs de risque sont representes surtout par le tabagisme et la schistosomiase. L'hematurie et des signes urinaires constituent les signes revelateurs a part un seul cas decouvert fortuitement au cours d'une lithiase vesicale. L'echographie a decouvert la tumeur vesicale dans 25 cas. La cystoscopie; realisee seulement chez 23 patients; a permis de visualiser la tumeur et de faire une biopsie dans tous les cas et une exerese-biopsique dans 13 cas. Le carcinome a ete retrouve dans 25 cas et l'adenocarcinome dans 6 cas. Seulement 12 cas ont eu un traitement curatif. Conclusion: Le cancer vesical est une pathologie grave. Son pronostic depend de la precocite du diagnostic. L'apparition d'une hematurie doit toujours alerter le clinicien

Blader tumors in Benin city : a 15 year histopathological study

A 15 year (1988 - 2002) retrospective study was undertaken to determine the frequency and histological pattern of bladder neoplasms seen in the University of Benin Teaching Hospital; Benin City; Nigeria. Forty-five cases were diagnosed. Males predominated constituting 35 (77.8) cases; giving a M:F ratio of 3.5:1 with ages ranging from 1.5 - 75 years. Malignant neoplasms (40 cases) accounted for 88.9of the bladder tumours and 1.85of all malignant neoplasms seen during the study period. Contrary to most reports; the malignant neoplasms were predominantly transitional cell carcinoma constituting 27(67.2) cases; with peak in the 7th and 8th decades; mean age of 61 years (SD + 13.3) and an age range of 33 - 75 years. Squamous cell carcinoma (SqCC) was relatively rare accounting for 15malignant tumours. SqCC patients had a lower mean age 42 years (SD + 27.5) with ages ranging from 11 - 64 years. None of the SqCC cases showed evidence of schistosoma ova. Rhabdomyosarcoma; fibrosarcoma; non Hodgkin's lymphoma and metastatic tumours constituted 7.5; 2.5; 2.5and 5of the malignant tumours respectively. The benign tumours were all squamous papillomas comprising 5(11.1) cases. Haematuria screening for individuals in high risk occupation; and provision of pipe borne water were recommended

Bladder Tumors in Benin City : a 15 Year Histopathological Study

A 15 year (1988 - 2002) retrospective study was undertaken to determine the frequency and histological pattern of bladder neoplasms seen in the University of Benin Teaching Hospital; Benin City; Nigeria. Forty-five cases were diagnosed. Males predominated constituting 35 (77.8) cases; giving a M:F ratio of 3.5:1 with ages ranging from 1.5 - 75 years. Malignant neoplasms (40 cases) accounted for 88.9 of the bladder tumours and 1.85 of all malignant neoplasms seen during the study period. Contrary to most reports; the malignant neoplasms were predominantly transitional cell carcinoma constituting 27(67.2) cases; with peak in the 7th and 8th decades; mean age of 61 years (SD + 13.3) and an age range of 33 - 75 years. Squamous cell carcinoma (SqCC) was relatively rare accounting for 15 malignant tumours. SqCC patients had a lower mean age 42 years (SD + 27.5) with ages ranging from 11 - 64 years. None of the SqCC cases showed evidence of schistosoma ova. Rhabdomyosarcoma; fibrosarcoma; non Hodgkin's lymphoma and metastatic tumours constituted 7.5; 2.5; 2.5 and 5 of the malignant tumours respectively. The benign tumours were all squamous papillomas comprising 5(11.1) cases. Haematuria screening for individuals in high risk occupation; and provision of pipe borne water were recommended

Value of P53 protein as a tumor marker in patients with transitional cell bladder cancer

Objective: The aim of this work is to determine the value of P53 as a biochemical marker in patients with bladder cancer. Patients and Methods: This study was conducted on 30 patients with transitional cell carcinoma (TCC) of different grades and 10 healthy men as a control group who had been admitted to the Urology Department; Benha Faculty of Medicine between August 1999 and November 2001. The mean age of the patients was 56.3 years (range 38-80 years). They were evaluated by history taking; clinical examination; laboratory investigations; radiological examination and cysto-scopy-guided biopsies. P53 was determined in the serum preoperatively and postoperatively after 21 days and 6 months; as well as in the tissue specimens taken by transurethral resection or by radical cystectomy. Results: The mean serum P53 value in the control group was 10.0 + 1.83 Pg/ml. In the patients with grade-1 tumors it was 25.6 + 4.8 Pg/ml compared to 44.8 + 14.73 Pg/ml and 131.1 + 15.28 Pg/ml for grade-2 and grade-3 tumors; respectively (P 0.05). In tumors larger than 2 cm the mean serum P53 value was 87.54 + 10.81 Pg/ml; while in tumors less than 2 cm it was 32.91 + 2.32 Pg/ml (P 0.05). The mean serum P53 value in a single tumor was 27.8 + 7.1 Pg/ml compared to 102.3 + 20.4 Pg/ml in multiple tumors (P 0.05). On follow-up after 21 days the mean serum P53 value was 14.0 + 2.71 Pg/ml in grade-1 tumors; 17.0 + 3.79 Pg in grade-2 and 55.3 + 12.4 Pg/ml in grade-3 tumors (P 0.05). Eleven patients developed recurrence; their mean serum P53 was 125.6 + 13.46 Pg/ml preoperatively and significantly decreased to 59.9 + 18.2 Pg/ml postoperatively; but then rose again to 91.5 + 20.1 Pg/ml. The mean P53 in the tissues of the control group was 11.3 + 2.31 Pg/ml; while the tissues of the cancer patients showed values of 29.8 + 4.42 Pg/ml; 46.6 + 11.08 and 140.2 + 14.85 Pg/ml for grade-1; grade-2 and grade-3 tumors; respectively (P 0.05). Conclusion: P53 seems to be a promising tumor marker for transitional cell bladder cancer and a valuable tool for identifying subgroups of patients that may have a poor prognosis

Adenocarcinome primitif de la vessie : a propos de 7 cas

Objective: The analysis of the etiopathologic; diagnostic and therapeutic aspects of the primary adenocarcinoma of the bladder. Patients and Methods: We report on a series of 7 cases of primary adenocarcinoma of the bladder out of a total of 564 cases of bladder tumors seen at our institution during a period of 14 years (1989-2003). All 7 patients with primary adenocarcinoma of the bladder presented with gross hematuria. Treatment consisted of chemotherapy using 5-fluorouracil (5-FU) in 3 cases where the tumor was locally advanced or metastatic; radical cystectomy with bilateral pelvic lymph node dissection and urinary diversion in 2 cases where the tumor was located in the bladder neck and trigone; partial cystectomy with pelvic lymph node dissection and bladder augmentation ileoplasty followed by an adjuvant chemotherapy in one case where the tumor was located at the dome of the bladder; and transurethral bladder resection followed by a chemotherapy with intravesical instillation of mitomycin-C in the remaining patient with superficial lesions. Follow-up ranged from 6 months to 15 years with a mean follow-up of 93 months. Results: The two patients treated by radical cystectomy had no recurrence after 12 months; while the patient treated by transurethral resection followed by intravesical instillation of mitomycin-C was free of disease 15 years after the intervention. The patient treated by partial cystectomy did not show any local recurrence after 10 months. Among the patients treated by chemotherapy (5-FU); a partial response was achieved in two with a mean survival of 12 months; while the remaining patient died within 6 months from treatment. Conclusion: Adenocarcinoma of the bladder is often diagnosed late. No consensus on therapy has been achieved so far. Radical cystectomy remains the gold standard for organ-confined tumors. Superficial lesions are very rare and may be treated conservatively

Long-term follow up of superficial bladder tumors

Objective: To study the recurrence rate of superficial bladder tumors at Cairo university hospitals. Patients and Methods: Sixty-six patients with superficial transitional cell carcinoma who were treated by either Nd: YAG laser therapy (16 patients) or transurethral resection (50 patients) were followed for a mean of 5.5 years. Results: Local tumor recurrence at the same site of the original tumor occurred in 39of patients while remote recurrence occurred in 33of patients. The total recurrence rate was 59. Tumor progression to invasive carcinoma occurred in 7 patients (11); and 3 patients (4.5) died of disease-related causes. Conclusion: The treatment of superficial TCC may be done by relatively minor endoscopic procedures; but the disease itself is a serious condition that merits close long-term follow-up

Sequential intravesical immunochemotherapy for stages Ta and T1 transitional cell carcinoma of the bladder : an update

Objectives: To present an update of our experience with sequential immuno-chemotherapy using bacillus Calmette-Guerin (BCG) and epirubicin in superficial bladder tumors. In addition; the question of whether to start with BCG or epirubicin is answered. Methods: Between January 1993 and December 2001; 156 patients with histologically proven Ta and T1 bladder transitional cell carcinoma were included in a prospective randomized study. Following transurethral resection of the bladder tumor (TURBT); patients were randomly assigned to 1 of 2 groups. Patients in group 1 received weekly doses of 150 mg BCG alternating with 50 mg epirubicin for 6 weeks. Maintenance was carried out by a monthly dose of BCG alternating with epirubicin; to complete 1 year of treatment. Patients in group 2 received the same protocol; but with a reversed order with epirubicin being used initially. Results: 149 patients; 114 men and 35 women with a mean age of 55 years; were evaluable. 7 patients were excluded due to severe side effects. Mean and median follow-up was 42.8 and 43 months; respectively. In the whole series recurrence rate was 18.1; recurrence rate per year was 0.06; mean interval to first recurrence was 29 months and progression rate was 12. Side effects developed in 40 patients (25.6) and were mostly in the form of mild cystitis (26 patients). The 2 groups of therapy were comparable regarding recurrence rate; recurrence rate per year; progression rate and side effects. Conclusions: The sequential therapy is effective in recurrence prophylaxis of superficial bladder tumors. The side effects were less frequent than in our historical controls treated with BCG alone. It does not matter to start with epirubicin or BCG in this regimen

Statistical analysis of the factors influencing the recurrence of urinary bladder cancer after radical cystectomy

Objective To evaluate the risk factors influencing the recurrence of urinary bladder cancer; and to predict the probability of recurrence within two years after radical cystectomy. Patients and Methods Between 1986 and 1994; 857 patients were admitted at the Urology and Nephrology Center of Mansoura University; Egypt; for treatment of bladder malignancy by radical cystectomy. The number of male patients was 682 (80) versus 175 females (20) with a mean age of 49 years (range 18 - 90 years). The median follow-up period was 38 months (range 0.03-138 months). Histopathology revealed squamous carcinoma in 440 patients (51); transitional carcinoma in 223 patients (26); adenocarcinoma in 94 patients (11) and mixed (two or more) types in 100 patients (11.7). Most of the patients presented with advanced-stage disease (defined as P3 or P4): 611 patients (71) had stage P3; 68 patients (6) stage P4. Bilharzial ova were seen in 80of the specimens; while regional lymph nodes were involved in 16of the cases. Results Cancer-related mortality was encountered in 199 patients (23.2) and mortality from unknown causes in 54 patients (6.3). Fifty-five patients (6.3) were alive with recurrence. Univariate and multivariate analysis of the survival rates showed that lymph node involvement (P = 0.0000); tumor grade (P = 0.0017); pathological stage (P = 0.0008); sex (P = 0.0005); urinary diversion (P=0.0080) and histopathology (P=0.0253) significantly influenced the recurrence-free survival after radical cystectomy. The 5-year survival rate was 61.7; and the 5-year hazard rate was 48.3. Using the logistic regression model for estimating and predicting the probability of recurrence within two years after radical cystectomy; we found that only one variable (lymph node involvement) had a significant effect on the prediction of the probability of recurrence. Conclusion These findings suggest that positive lymph nodes; tumor grade; stage; sex; urinary diversion and histopathology of tumor cells are independent predictors of survival in patients with bladder cancer. Positive lymph nodes are the most important indicators for recurrence in general and especially for predicting the probability of recurrence within two years after radical cystectomy

Complications of orthotopic ileal W-neobladder with serous lined extramural tunnel in 520 patients

Objective: To report on the complications following orthotopic ileal W-neobladder with serous lined extramural antireflux ureteral implantation. Patients and Methods The records of 520 patients that had undergone one-stage radical cystectomy and orthotopic ileal neobladder were reviewed retrospectively including the follow-up files. Special attention was directed towards the mortality; morbidity and late complications recorded during the follow-up evaluation. Results Hospital mortality was reported in 5 cases. Eighty-one early complications were observed in 60 patients (11.5); including GIT complications in 13; wound infection in 22 and pouchovaginal fistulae in 3. Out of 520 patients 400 were evaluable (308 men and 92 women). Tumor recurrence was documented in 101 patients (20) including 5 with isolated urethral recurrence (0.9). Late complications included pouch stones in 13; outflow obstruction in 12; mucus retention in 4 and adhesive bowel obstruction in 5. Urinary incontinence was found in 9and 18of patients during the day and night times; respectively. Hypercontinence was documented in 9 females. Upper tract deterioration was observed in 36 out of 785 renal units (4.5) due to anastomotic stricture in 32 and chronic pyelonephritis in 4. Poucho-ureteral reflux was seen in 28 units (3.6). Bacteria were isolated in the urine of 32 of 316 examined patients. Serum creatinine was normal in all but 4 patients and 44 patients (11) suffered from subclinical chemical metabolic acidosis. Conclusion The incidence of complications following ileal W-neobladder is low and amenable to treatment in most of the patients. Furthermore; the technique has proved its efficacy and durability