Evolution and prognosis of bladder papillomatosis managed by endoscopic resection and endovesical BCG therapy: about 24 cases

Bladder papillomatosis is a diffuse tumor proliferation even up almost all of the bladder mucosa. We analyzed prognosis of this rare entity after conservative treatment. We retrospectively analyzed epidemiological, clinical, therapeutic and evolutive data in 24 patients with newly diagnosed bladder transitional cell carcinoma papillomatosis. All patients underwent a complete endoscopic transurethral resection [TUR] with curative intent. A second look was performed within 30 days. The intravesical therapy regimen consisted on weekly instillations for 6 weeks, and then monthly for 6 months. If the tumor recurred without muscle invasion, TUR was repeated with a second intravesical BCGtherapy regimen. Parameters investigated included age, gender, risk factors, cystoscopic findings [aspect, multiplicity and location of bladder lesion], tumor stage, tumor grade, recurrences and progression times from diagnosis to last follow up. The mean age of the patients at initial diagnosis was 64,9 +/- 6,1 years. They were males in 23 cases. Initial cancer staging was as follow: pTa [n=6] and pT1 [n=18]. The recurring tumors were reported in 17 patients [70,8%]. They were stage Ta in 5 patients and stage T1 in 12. The median interval of time between the initial TUR and the first recurrence was 10,3 months. Six patients remain tumor free. From the 17 recurrences, 6 patients developed progression with muscle invasion in 4 of them. Radical cystectomy with ileal conduit was performed in 3 patients and one patient died before radical treatment. Univariate analysis didn't reveal any prognostic factor: age [p=0,7], tumor location and aspect [p= 0,7 and p= 0,5 respectively], tumor stage [p=0,7] and grade [p=0,09]. TCC bladder papillomatosis is a rare entity. TUR with intravesical BCG therapy may be indicated as a first option despite correct follow up. Radical cystectomy should be considered in cases of recurrent or non-resectable tumours

Fournier's gangrene: what are the prognostic factors? Our experience with 40 patients

Fournier's gangrene [FG] is a serious, extensive fulminant infection of the genitals and perineum. Indeed, despite antibiotics and aggressive debridement, the mortality rate of FG remains high. Through our experience, we intent to identify effective factors in the survival of patients with FG and we try to determine how the Fournier's gangrene severity index score [FGSIS] is accurate. Between 1995 and 2010, 40 patients with Fournier's gangrene were treated in our institution. All of them were treated with broad spectrum triple antimicrobial therapy, broad debridement and exhaustive cleaning. Then they underwent skin grafts or delayed closure as needed. Data were collected on demographics, medical history, predisposing factors of FG, etiological infection agents, admission signs and symptoms, physical examination, admission laboratory studies and bacteriology. Timing and degree of surgical debridement as well as outcomes were also reviewed. The extent of disease was calculated from body surface area nomograms. All the 40 patients included in this study were males; their mean age was 52,75 years [21-75 years]. Twelve patients [30%] had FG secondary to anorectal pathological conditions. No etiologic factors of FG were found in 6 patients [15%]. Diabetes mellitus as predisposing factor was found in 13 patients [32.5%]. The mean hospital stay was 8.72 days [range, 3 to 30]. All the patients underwent surgical debridement. Orchidectomy was done in 7 cases [17.5%]. Skin grafts were applied to 6 patients [15%] and the remaining wounds, once cleaned, were approximated. The overall mortality rate was 17.5% [7 patients] due to severe metabolic acidosis in relation to diabetic decompensation and sepsis. We individualized two groups: those who died [n = 7] and those who survived [n = 33]. We evaluated the admission laboratory parameters that are significantly correlated with outcome included hematocrit [p=0.003] and serum sodium [p=0.05]. The extent of body surface area involved among patients who died was not found significantly different statistically between the two groups [4.07% and 3,14%, p=0,4]. The mean FGSIS [without counting bicarbonate serum level] for survivors was 9.1 compared with 6,8 for non-survivors [p=0.16]. FG is a rapidly progressive, fulminant infection's condition. Hematocrit and serum sodium levels were found to be the only prognostic factors. It doesn't seem that the FGSIS has a prognostic value