Comparative study of diode laser and plasma kinetic resection for treating superficial bladder tumor / 重庆医学

Objective To investigate the clinical effect of the 1 470 nm diode laser for the treatment of superficial bladder tumor.Methods Two hundreds and sixteen patients diagnosed with superficial bladder tumor were treated in our hospital from January 2012 to January 2014 and divided into the laser group and electric cutting group.The two groups were treated by 1 470 nm diode laser and transurethral plasma kinetic resection respectively.The basic data and the observation indexes were compared be tween the two groups.Results The operation time,intraoperative bleeding volume,indwelling catheter time and hospital stay time in the laser group were significantly less than those in the electric cutting group.The levels of epinephrine,norepinephrine and an giotensin Ⅱ in operation and at postoperative 6 h in the laser group were significantly lower than those in the electric cutting group (P＜0.05).The obturator nerve reflex and bladder perforation did not occur in the laser group,and the total complications occurrence rate was 5.1％,the bladder tumor recurrence rate in postoperative 24 months was 7.1％.The obturator nerve reflex occurrence rate was 7.6％,the vesical perforation rate was 1.7％,the total complications occurrence rate was 15.3％,the bladder tumor recurrence rate in postoperative 24 months was 17.8 ％ in the electric cutting group.The above indexes of the laser group were significantly lower than those of the electric cut group(P＜0.05).Conclusion The 1 470 nm diode laser for the treatment of noninvasive superficial bladder tumor has definitely curative effect,is easy to operate with low postoperative complication occurrence rate,high safety and low middle and long term recurrence rate,moreover has little influence on patient's stress level.

Comparative Study of Greenlight Photos Selective Vaporization and Revolix 2 Micron Continuous Wave Laser Vaporesection for the Treatment of Superficial Bladder Tumor / 中国微创外科杂志

Objective To compare the safety and efficacy of greenlight photos selective vaporization and RevoLix 2 micron continuous wave laser vaporesection for the treatment of superficial bladder tumor. Methods Under sacral anesthesia or epidural anesthesia,a total of 42 patients with superficial bladder tumor were treated with greenlight photos selective vaporization while the other 42 patients received the RevoLix 2 micron continuous wave laser Vaporesection. The clinical stage of the patients was T1-T2,and the pathology grade was G1-G2. Results The greenlight photos selective vaporization and RevoLix 2 micron continuous wave laser vaporesection were successfully completed in all of the patients. No patients required blood transfusion. No complications such as obturator nerve reflex,bladder perforation or overhydration occurred. No significant difference was noticed in the operation time [(15.3?10.5) min vs (14.3?6.5) min,t=0.525,P=0.601],catheterization time [(6.3?0.5) d vs (6.3?1.2) d,t=0.000,P=0.999],and postoperative hospital stay [(6.3?3.5) d vs (7.2?2.4) d,t=-1.374,P=0.173]. The patients were followed up for 6 months,during the period the recurrence rate was 11.9%(5/42) and 7.1%(3/42) respectively in the greenlight group and RevoLix group (?2=0.138,P=0.710). Conclusions Both greenlight photos selective vaporization and RevoLix 2 micron continuous wave laser vaporesection are effective and safe for superficial bladder tumor and lead to low rates of postoperative complications and recurrence. Further studies are necessary to evaluate its long-term effect. For T2 and higher grades of bladder tumors,open surgery should be performed.

Transurethral Plasmakinetic Resection for Bladder Tumor Complicated with BPH:Report of 41 Cases / 中国微创外科杂志

Objective To evaluate the efficacy and safety of transurethral plasmakinetic resection for patients with superficial bladder tumor(SBT) complicated with benign prostate hyperplasia(BPH).Methods A total of 41 patients with SBT complicated with BPH were treated by transurethral plasmakinetic resection in our hospital.Various procedures were selected basing on the location,size,quantity of the bladder tumors,size of the prostate,and degree of adhesion around the gland.Results The opertion was completed in all of the 41 cases.The mean operation time was(67.2?25.3) min for resection of the bladder tumors and(72.3?23.2) min for the prostate.During the surgery,7 cases showed obturator nerve reflex and 2 developed bladder perforation.No patients died or had transurethral resection syndrome or rectal perforation.Six months after the operation,reexamination showed a mean IPSS of 6.2?3.7 and Qmax of(20.1?4.2) ml/s,which were significantly imporved compared with those detected before the surgery [25.3?4.1,(8.9?4.1)ml/s,t=22.209 and -12.174 respectively;and both P=0.000].The patients were followed up for 1 to 4 years,during which 9 cases showed recurent bladder tumor.Conclusions Transurethral plasmakinetic resection is safe and effective for patients with SBT complicated with BPH.The surgical procedure should be determined accordingly.

Pathologic Prognostic Indicators in Recurrence and Progression of Superficial Bladder Tumor / 대한비뇨기과학회지

PURPOSE: The identification of factors present at the time of initial evaluation may be important to predict the prognosis in patients with superficial bladder carcinoma. Attempts were made to identify predictive factors of recurrence and progression. MATERIALS AND METHODS: This study included twenty seven patients with superficial bladder tumor(pTa-pTl) who had no recurrence within 5 years. A comparative non-randomized study was performed of a control group of twenty six patients with same superficial bladder tumor who had recurrence within 1 year after transurethral resection of bladder tumor(TURBT) was done. Between the former and the latter patients cumulative and multivariate analyses were performed to estabilish predictive factors of pathological recurrence and progression. The resected tumors were immunohistochemically stained with anti-lamin rabbit serum to evaluate the presence or absence of basement membrane breakage, the vascular and/or lymphatic invasion, and to count number of neovascularizasion. RESULTS: In superficial bladder carcinoma, invasion of basement membrane, grade, invasion of lymphatics and vessels, and neoangiogenesis were significant factors affecting recurrence and progression, and these factors acted independently. CONCLUSIONS: These factors used to predict recurrence and progression of superficial bladder tumor were thought to be the important risk factors. These results suggested that close follow-up and aggressive treatment such as BCG instillation should be considered for the treatment of superficial bladder cancer with unfavourable prognostic factors.

Prophylactic Effect of Mitomycin C and Bacillus Calmette-Guerin in Stage T1 of the Superficial Bladder Cancer / 대한비뇨기과학회지

We compared the efficacy and toxicity of mitomycin C and Bacillus Calmette-Guerin (BCG) intravesical instillation in 86 patients with stage T1 of the superficial bladder tumor. Of them, 34 patients were received mitomycin C (40 mg/40 ml sodium chloride, once a week for 8 weeks) and 26 patients were received BCG (120 mg/50 ml sodium chlorids, once a week for 6 weeks) after transurethrat resection of bladder tumor and 24 patients (control) underwent transurethral resection alone. The mean follow up period was 24.8 months in control group, 26.8 months in mitomycin C group and 25.7 months in BCG group. The mean time to recur was 11.3 months in control group, 11.5 months in mitomcyin C group and 15.9 in BCG group but there was no significant difference among each groups (p>0.05). The overall recurrence rate was 34.6% in BCG group compared with 70.5% in mitomycin C group and 75.0% in control group, showing significant difference (p<0.05). Side effects were more common after BCG instillation than mitomycin C instillation. The most common side effect after BCG instillation was hematuria in 14 patients (53.8%). That of mitomycin C was cystitis in 10 patients (29.4%). Our study suggests that the prophylactic efficacy of BCG was significantly superior to that of mitomycin C, but there was no significant superiority regarding prophylactic effect of reduced mean time to recur in stage T1 bladder cancer patients. Additionally, further follow up studies were needed in mitomycln C.

Intravesical Bacillus Calmette-Guerin Therapy of Superficial Bladder Tumor : Result of Long-Term Follow-Up / 대한비뇨기과학회지

PURPOSE: Bacillus Calmette-Guerin (BCG) is the most effective intravesical agent for patients with superficial bladder cancer, but the long-term efficacy of BCG has not been established. We report our long-term experience of intravesical BCG therapy in the recurrence and progression for superficial bladder cancer. PATIENTS AND METHODS: Between 1985 and 1993. high risk patients with superficial bladder cancer were received complete TURB plus intravesical BCG (n=77). 120mg Tice-Chicago strain BCG was administered weekly for 6 weeks and then monthly for 3 months. Patients were considered treatment failure if either urinary cytology or biopsy results were positive for tumor on every 3 to 6 months followup examination. All patients reported have had a minimum 2-year followup, with the mean of 63 months. RESULTS: The 1st course of BCG was successful in 47 (6696) of 71 patients treated for prophylaxis and 3 (50%) of 6 treated for carcinoma in situ. Subsequent progression of disease occurred in 6 patients (8%) and cystectomy was performed in 2 patients (3%). The response rate for the total patients population treated with the 1st course was 65% (50 of 77). Of 27 patients who failed the 1st treatment course 21 patients were given the 2nd BCG treatment course. Of the 2nd BCG course, subsequent progression of disease occurred in 3 patients (14%), and cystectomy was performed in 2 patients (9%). Thirteen (68%) had complete response and 5 (26%) had new tumors, who had rendered free of disease after TURB plus intravesical therapy (mitomycin and/ or BCG). Although serious BCG complications (hepatitis, miliary Tbc, sepsis) were observed in 2 patients, side-effects were self-limiting and well controlled in the majority of patients (fever, bladder irritability, and hematuria). CONCLUSIONS: Intravesical BCG therapy seems to be effective to prevent recurrence and progression of superficial bladder cancer with long-term follow-up. However, we must note the possibility of fatal generalized complications in patients with grossly trauma of lower urinary tract.

The Efficacy of Intravesical Irrigation with Distilled Water After Transurethral Resection for Superficial Bladder Tumor / 대한비뇨기과학회지

We evaluated the prophylactic efficacy of intravesical irrigation with distilled water immediately after transurethral resection(IUR) of superficial bladder tumor patients. Control group(n=30), with normal saline irrigation immediately after TUR(=15 min.) and continuous intravesical instillation of adriamycin 150mg with 3000ml normal saline for 2 days postoperatively. Distilled water group(n=28), with the same modality as control group, except for distilled water as the irrigation solution. The overall recurrence rates were 35.7% in distilled water group, which were more effective than 60.0% in control group. The 2 yeas tumor free rates by Kaplan-Meier method was higher in distilled water group ( 71.4% ) than control group (46.4% ), respectively with statistical significance. But, the mean time to recurrence were 13.3 months in control group and 14.1 months in distilled water group, without significant differences between two groups. These results support that the reasonable benefits of distilled water for prophylaxis of recurrence in superficial bladder tumor.

Prophylactic Efficacy of Intravesical Bacillus Calmette-Guerin for High Risk Superficial Bladder Tumor / 대한비뇨기과학회지

A study was performed to determine the prophylactic efficacy of intravesical BCG instillation in 82 patients with high risk superficial bladder tumors. Recurrent, grade III, multiple(more than 3) or large(more than 3cm) stage Ta orT1 tumors were included. They were treated with 6 weekly instillation of 120mg of BCG after transurethral resection. Another thirty six patients treated with transurethral resection alone were selected as a control group. All the patients were followed more than 24 months, with the mean of 32 months. The one year recurrence rate was 54% in BCG group and 74% in controls, which was statistically different(p0.05). The median interval of recurrence from treatment was l4.5 months in the BCG group which was longer than that of 7 months in controls and the recurrence per l00 patient months was 7.86 and l4. 68(p<0.05), respectively. In 56 patients with recurrent tumors after BCG treatment, the tumor stage, grade, number and size of the recurrent tumors were lowered significantly compared to the initial tumors (p<0.05). One patient of the BCG group and 3 of the controls had recurrent tumors with progression to muscle invasion. In summary, BCG instillation improved stage and grade, decreased number and size of the recurrent tumors, and delayed the time of recurrence in patients with high risk superficial bladder tumors. Also the overall one year recurrence rate was significantly improved. but two year recurrence rate was not significantly improved.

Changes of Nitric Oxide Metabolite and Tumor Necrosis Factor-alpha in the Urine of Patients with Superficial Bladder Tumors after BCG Immunotherapy / 대한비뇨기과학회지

Bacillus Calmette-Guerin(BCG) is widely used in the therapy of superficial bladder tumors. Clinical and animal studies suggest that immunological responsiveness to BCG antigens correlates with anti-tumor activity. But its mode of action is unclear. In this studies, we evaluated the changes of nitric oxide(NO) metabolite and tumor necrosis factor-alpha(TNF-alpha) in the urine of patients with superficial bladder tumors after BCG immunotherapy. Both NO and TNF-alpha in the urine specimens of patients treated with BCG were analyzed prior to BCG instillation and 4, 8 and 24 hours afterwards. After 6th BCG instillation. urinary NO increased significantly and showed a maximum of secretion at eight hours(p<0.05). After 6th BCG instillation, urinary TNF-alpha increased and showed a maximum of secretion at eight hours but had no statistical significance. These results suggest that intravesical BCG therapy increased the urinary NO and TNF-alpha secretion which may be related to the anti-tumor activity.

A Comparison of Prophylactic Efficacy of Intravesical Instillation with Bacillus Calmette-Guerin and Thiotepa in Superficial Bladder Cancer / 대한비뇨기과학회지

We compared the prophylactic efficacy of intravesical BCG with thiotepa instillation after complete removal of superficial bladder cancer. Forty patients received BCG and 32 received thiotepa. The mean followup period was 29 months in BCG group, and 34 months in thiotepa group. The overall recurrence rate was 35% in BCG group compared with 53% in thiotepa group, showing difference statistically(p0.05). The overall recurrence index per 100 patient-months was also lower for the BCG versus the thiotepa group(1.21 versus 1.56, p>0.05). One patient in the BCG group and 4 in the thiotepa group had recurrent tumors with progression in stage. Side effects were irritative voiding symptoms(100%), fever and chills(10%), and inguinal lymphadenitis(2.5%) in BCG group, while irritative voiding symptoms(25%), fever and chills(6.3%), and myelosuppression (6.3%) in thiotepa group. Our results suggest that BCG is significantly superior to thiotepa in reducing bladder tumor recurrence and in retarding tumor progression.

Evaluation of T-subsets and NK cell activity in patients with superficial bladder cancer after intravesical treatment with bacillus calmette-guerin / 대한비뇨기과학회지

Intravesical instillation of Bacillus Calmette-Guerin(BCG) currently is considered the most effective treatment for recurrent superficial bladder cancer, but little is known about the mechanism of action. Total 21 patients receiving intravesical BCG treatment for superficial bladder cancer were entered into this study to investigate the cellular immune response with T-subsets and NK cell activity in peripheral blood before and after intravesical BCG instillation consisted of weekly administration with BCG for six consecutive weeks. Among the 21 patients. 11 had Grade 1 and 10 had Grade 2 bladder cancer and 14 of them had history of recurrence more than 2 times. The results showed that there were no significant differences in the changes of CD4 cell. CD8 cell as T- subsets and NK cell activity before and after treatment(P greater than 0.06 in all). Among 7 patients with recurrence after BCG treatment, there was also no difference in any immune response (P greater than 0.05 in all). Considering the response of the individual patients. We observed that recurrence rates were similar between a group containing the patients with increased value more than 20% after treatment and other in all immune parameters such as CD4. CD8, CD4/CD8 ratio and NK cell activity(P greater than 0.0S in all). We conclude that these parameters are not major contributors to the antitumor activity of BCG and had no prognostic value for the clinical outcome after BCG treatment.

Diagnostic Efficacy of the Combination of Urine Cytology, Urinalysis and History in the Follow-up of Bladder Tumor / 대한비뇨기과학회지

We studied a retrospective analysis of the diagnostic value of the non-invasive modalities in 6O patients with primary superficial bladder tumors (pTa, pT1) who underwent treated at the Han. yang University Hospital From March 1980 to February 1990. In this study, using empirical cystoscopy follow-up scheme. 17 cystoscopies had to be done to detect each new recurrence. Because of this excessive number of cystosoopies. the diagnostic value of the combination of the following tests were calculated and the sensitivity of the following tests (singly and combined) has been assessed ; (l) urine cytology, (2) red blood cell count in urine sediment and (3) history of symptoms or irritative bladder and hematuria. This study indicated that a combination of non-invasive tests may produce a more rational approach to the follow-up of patients with low stage. low grade transitional cell carcinoma by minimizing the number of cystoscopies. The result indicated that over all recurrence rate was 36.7% (22,60) and 19 cases (86%) were recurred within 2 years and these patients had poor prognosis than patients after 2 years. There were significant increase of recurrence in initial high stage, high grade. high class tumors and the recurrence rate was decreased in patient with instilled adriamycin more than 10 times. The combination of these non-invasive diagnostic tests may constitute a sensitive procedure for the follow-up of bladder tumors. In the case of grade III and muscle-invasive recurrences (>T1), the sensitivity rate was 100%.

Prognostic Factors in Superficial Bladder Tumor / 대한비뇨기과학회지

A retrospective analysis of prognostic factors based on 249 patients with primary superficial bladder tumors (78 Ta, 166 T1, 5 Tis) during a 10-year period beginning 1978 was performed. Easily available routine clinical and pathological data such as stage (Ta, T1 or Tis) , grade( I, II or III), size (smaller or larger than 3cm), number (less or more than 3) and recurrence pattern (early :recurrence within 6 months of followup or late) were tested. Univariate analysis was performed with generalized Wilcoxon test and univariate analysis of significance of the data was done with Cox's proportional hazard model. The most significant prognostic factors with respect to the recurrence were multiplicity in time and space and grade, while the stage and size were less significant. The most influential factor with tumor progression was tumor grade. Based on these 5 variables 3 different subgroups of patients can be identified. In good risk group including grade I , single, small and late recurrent tumor, 2 year recurrence rate ( recurrences per 100 patients' months) was 44% (3.82) and 96 patients (38%) were comprised in. In poor risk group including all grade III or Tis tumor, the recurrence rate was 96% (15.12% ) and 29 patients (12% ) were comprised in Tumor progression was noticed in 140% of this group. The third is intermediate risk group (G I-II with various number, size and recurrent pattern) which comprised 124 patients(50%) and was less distinctive and less homogeneous than other group. In this group the recurrence rate was 71 % (7.25 ) and progression rate was 16%, The patients in this group subsequently can be recategorized with further followup. Followup plan and definite treatment decision has to be made according to the classification. Intensive followup and aggressive treatment in poor risk group and less stringent followup in good risk group appeared to be imperative. This kind of approach would minimize the possibility of treatment which is too much or too little for the patients.

The Factors Influencing Prognosis of Superficial Bladder Tumor / 대한비뇨기과학회지

The biologic behavior of the superficial bladder tumor is pleomorphic depending on tumor characteristics and there are many different ways to manage these superficial bladder tumor accordingly. Careful analysis of these characteristics can be provided for categorizing patients if those have low or high risk in the rate of recurrence and spread or progression of the tumor. 90 patients of superficial bladder tumor were analyzed to assess the prognostic importance of following variables : Tumor stage, grade, shape, multiplicity of tumor, ABH (0) blood group antigen from bladder mucosa and the modality of management, and the incidence of some variables was compared to 34 patients of invasive bladder tumor. The results showed that the recurrence rate was low and the prognosis was favorable in the case of low grade, low stage and solitary tumor, which has been performed transurethral resection followed by intravesical chemotherapy. Further study may be needed to give any significance of ABH(0) antigen as a factor which might suggest the prognosis of superficial bladder tumor in this analysis because the number of patients are not enough statistically.

Prognostic Factors in Superficial Bladder Cancer: An Analysis of 178 Cases / 대한비뇨기과학회지

Superficial bladder cancer is a disease with variable biologic potential. The behavior of the disease varies, depending upon the tumor characteristics evident on initial evaluation. A retrospective study of 178 patients with superficial transitional cell carcinoma and a follow up of at least 6 months is reported. Transurethral resection was done in all cases. Using Cox's proportional hazards model, the following results were obtained : 1. Grade was the most important factor followed by. in order of importance, the number of tumors, patient age, tumor size, shape of the tumor, and associated bladder mucosal changes. A previous history of a superficial bladder tumor was another independent prognostic factor. 2. Other variables such as sex the interval between transurethral resection and initial symptom or first recurred period were not prognostic factors. The high risk factors were grade 3, more than 2 tumors, more than 51 year old, tumor site more then 3cm, non-papillary shapes and associated bladder mucosal changes. More aggressive therapy should be considered for patients showing high risk factors.

Aspect of Recurrence in Superficial Bladder Tumor Treated by TUR / 대한비뇨기과학회지

Superficial bladder tumors are usually treated by TUR and the result of this treatment was known to have good prognosis. However, recurrence of the tumor after complete resection occurs in about 40-70% of the patients, a significant percentage of these recurrences showing a higher degree of malignancy. There are many factors affecting the recurrence and progression. Understanding the aspect of recurrence will help in the management of patients. So we studied to evaluate the relationship in 43 cases with superficial bladder tumors admitted to the Department of Urology, Inje college of Medicine, Pusan Baik Hospital during the period from April, l981 through March, l986. Thirty three patients were followed up for more than 3 Months. Following results were obtained: 1. No. of patients with recurrence was l8 (54.5 %). 2. Nine cases (50%) were recurred within 1 year and these patients had poor prognosis than patients recurred after 1 year. 3. The recurrence around the initial tumor site were 6 cases (33.3 %) and these patients had poor prognosis than recurrence at other site. 4. There was more significant increase of malignant progression and recurrence in multiple tumor or large tumor than solitary or small one. 5. There was significant increase of malignant progression and recurrence in initial high grade tumor than low grade tumor. 6. The recurrence rate was decreased in patients instilled adriamycin more than 4 times (45.5%, than less than 4 times (75%).

Prophylactic Intravesical Chemotherapy in Superficial Bladder Tumors / 대한비뇨기과학회지

Superficial bladder tumors are usually treated by TUR. However, recurrence of the tumor after complete resection occurs in about 50-70%, of the patients with a significant percentage of these recurrences showing a higher degree of malignancy. In 10% of the cases, the tumor progresses to invasive carcinoma. Most of these recurrent tumors will occur within 6-12 months. The multifocal nature of these tumors and the frequent recurrences after TUR indicate a need for adjuvant chemotherapy to reduce or delay the incidence of recurrence tumors. We studied to evaluate prophylactic effects of topical chemotherapy in 116 cases with superficial bladder tumors admitted to the Department of Urology, Keimyung University School of Medicine during the period from Jenuary, 1971 through July, 1985. All patients were followed up for more than 6 months. Study group consists of 83 cases (Thio-tepa: 39, Adriamycin; 44) treated with topical chemotherapy following TUR during the period from January, 1978 through July, 1985. Control group consists of 33 cases treated by TUR only during the period from January 1971 through December, 1977. Following results were obtained: 1. No. of patients with recurrence; In study group, 36Pr In control group. 67% 2. Average interval of recurrence: In study group, 38 months. In control group, 30 months 3. Recurrence rate; In study group, 2.58 In control group, 3.16 4. Complication: local side effects; In TUR + Thio-tepa, 20.5% In TUR + Adriamycin, 15.9%.

Prophylactic Effectiveness of Intravesical Chemotherapy in Superficial Bladder Tumors / 대한비뇨기과학회지

Recurrence in patients with superficial bladder tumor is a serious problem. In one series, the recurrence rate was 73%, and invasive cancer developed in 10% of patients with recurrences. To eliminate or reduce the rate of recurrence, topical chemotherapy has been tried and showed adjunct effects. We studied to evaluate prophylactic effects of topical chemotherapy in 51 patients with superficial bladder tumor admitted to the Department of Urology, Kyung Hee University Hospital during the period from April, 1979 to April, 1984. Patients were divided into 2 groups. Group A comprised 19 patients (Adriamycin; 8, Thio-TEPA; 11) treated with topical chemotherapy following initial TUR and 27 patients treated by TUR only. Group B comprised 5 patients treated with topical chemotherapy (Adriamycin) after repeated TUR and 7 patients among 27 patients who had repeated TUR for recurrence. Patients treated by TUR only were defined as control group. Recurrence rate was analyzed in each group. Following results were obtained. 1. In group A, recurrence rate was 2.54 in patients with chemotherapy comparing to 3.35 in control patients. Average interval of recurrence was 39.3 months in chemotherapy patients and 29.8 months in control patients. 2. In group B, recurrence rate was higher in chemotherapy patients than in control patients with rate of 6.6 and 5.3, respectively. But recurrence rate was diminished to 6.6 after chemotherapy comparing to pre-chemotherapy period (10.3). 3. There was no difference in recurrence rate relating to multiplicity of tumor as a whole.

Therapy and Prophylaxis for superficial Bladder Tumors: Doxorubicin and Thio-tepa / 대한비뇨기과학회지

20 cases of study group whose follow-up period is over 6 months among 22 cases of bladder tumors treated with doxorubicin instillation following TUR during the period from December, 1981 through December, 1983 were compared with 30 cases of controlled group whose follow-up period is over 6 months among 32 cases of bladder tumors treated with thio-tepa instillation following TUR during the period from January, 1978 through June, 1981. Following result were obtained. 1. Recurrence rate In TUR + doxorubicin, 25%, In TUR+thio-tepa,30% 2. Interval between TUR & the first recurrence: In TUR + doxorubicin, average 9 months, In TUR + thio-tepa, average 8.1 months 3. Complication: In TUR + doxorubicin, painful urination in 2 cases(10%), In TUR + thio-tepa, hematuria, dysuria, painful urination, and urethral stricture in 8 cases(26.7%).