Nephrogenic adenoma of the bladder: a single institution experience assessing clinical factors

ABSTRACT Introduction: Nephrogenic adenoma (NA) was first described by Davis in 1949 as a "hamartoma" of the bladder. There are many proposed predisposing factors for NA including chronic inflammation, renal transplantation, and bladder cancer. We examined our experience with NA to determine predisposing factors and determine if there was any increased risk for development of subsequent malignancy. Materials and Methods: All patients with a pathologic diagnosis of bladder NA from 2001-2013 were included. Patient history, clinical factors including possible predisposing factors for NA, and follow-up were reviewed. Results: Among 60 patients, 68% were males with an average age of 61, an average BMI of 28.7, and 60% had a smoking history. In evaluating pro-inflammatory factors, 26.7% underwent either Bacillus Calmette-Guerin or mitomycin C, 30% had recurrent urinary tract infections, and 25% had a history of catheterization. Recurrence of NA after initial resection occurred only in 14.7% of patients who underwent follow-up cystoscopy. A history of concurrent bladder cancer was seen in 41.7% of patients, but there were no cases of de novo bladder cancer diagnosed after NA. Conclusion: To the best of our knowledge, this is the largest series of patients with NA of the bladder. NA occurs in a heterogeneous population of patients, but most often with underlying inflammation. NA occurred concurrent with bladder cancer; however there were no cases of de novo bladder cancer after NA, reassuring that NA is likely a benign reactive condition.

The awareness of patients with non - muscle invasive bladder cancer regarding the importance of smoking cessation and their access to smoking cessation programs

ABSTRACT Objectives Smoking is the most important risk factor for bladder cancer and smoking cessation is associated with reduced risk of tumor recurrence and progression. The aim of this study is to assess the awareness of non-muscle invasive bladder cancer (NMIBC) patients regarding the importance of smoking cessation, determine their access to smoking cessation programs and the effects of smoking cessation on recurrence rates of NMIBC. Materials and Methods NMIBC patients who were followed with cystoscopy were included in the study. Their demographic properties were recorded, along with their smoking habits, awareness regarding the effects of smoking on bladder cancer and previous attempts for smoking cessation. Moreover, the patients were asked whether they applied for a smoking cessation program. Recurrence of bladder cancer during the follow-up period was also noted. Results A total of 187 patients were included in the study. The mean age was 64.68±12.05 (range: 15-90) and the male to female ratio was 167/20. At the time of diagnosis, 114 patients (61.0%) were active smokers, 35 patients (18.7%) were ex-smokers and 38 patients (20.3%) had never smoked before. After the diagnosis, 83.3% of the actively smoking patients were advised to quit smoking and 57.9% of them quit smoking. At the time of the study, 46.52% of the NMIBC patients were aware of the link between smoking and bladder cancer, whereas only 4.1% of the smoking patients were referred to smoking cessation programs. After a mean follow-up of 32.28±11.42 months, 84 patients (44.91%) had recurrence; however, current smoking status or awareness of the causative role of smoking on NMIBC did not affect the recurrence. Conclusion In our study group, the majority of the NMIBC patients were not aware of the association between smoking and bladder cancer. Although most of the physicians advised patients to quit smoking, a significant amount of the patients were still active smokers during follow-up. Only a small proportion of patients were referred to smoking cessation programs. Urologists should take a more active role in the battle against smoking and refer those patients to smoking cessation programs. Larger study populations with longer follow-up periods are needed to better demonstrate the beneficial effects of smoking cessation on recurrence rates.

Carcinogenesis in rats subjected to a new model ureterosigmoidostomy and treated with L-lysine

ABSTRACT PURPOSE: To evaluate the effects of L-lysine on the intestinal and urothelial epithelium of rats subjected to ureterosigmoidostomy (new model for surgical carcinogenesis). METHODS: Forty-two rats, 9 weeks of age, were divided into 6 groups. Animals in groups A, B, C were subjected to ureterosigmoidostomy (US) and treated with L-lysine, celecoxib and H2O, respectively. Groups D, E and F (non-operated controls) received L-lysine, celecoxib and H2O, respectively. The L-lysine dose was 150 mg/kg and that of celecoxib was 20 mg/kg. The colon was analyzed for the presence of aberrant crypt foci (ACF) under a stereomicroscope.The tissue was stained with hematoxylin and eosin and PAS alcian blue. RESULTS: There were rare ACF, and there was no statistically significant difference between the groups. Histopathologic study of the ureteral epithelium identified moderate to severe urothelial hyperplasia in rats with ureterosigmoidostomy. Transitional hyperplasia in the ureters of animals receiving L-lysine (A) showed an apparent difference compared to the control (C) (P=0.2424). There was no dysplasia or atypia CONCLUSION: L-lysine does not promote carcinogenesis of the intestinal and urethelial epithelium of rats subjected to ureterosigmoidostomy at the doses and times studied.

Tobacco experimental model to induce urinary bladder neoplasms / Modelo experimental de tabagismo para indução de neoplasia da bexiga urinária

OBJECTIVE: to develop an experimental model of exposure to tobacco burning (cigarette) products to assess the effects of its chronic use in relation to cancers of the bladder. METHODS: the animals were chronically exposed to the burning tobacco products in a semi-open chamber to simulate smoking. Thirty young Wistar rats were divided into two groups: one with 20 animals simulating smoking for six months, and ten not exposed control animals for the same period. After exposure by inhalation of cigarette smoke, animals were euthanized and subjected to histopathological study of the bladder wall. RESULTS: no tumor was found but mild and non significant alterations. The studies of hemo-oximetry (carboxyhemoglobin and methemoglobin) and the concentration of carbon dioxide (CO2) confirm that the animals were exposed to high concentrations of tobacco smoke and its derivatives. CONCLUSION: no bladder mucosal neoplasia was found in the pathological study of animals. The developed experimental models were highly efficient, practical and easy to use and can be used in other similar studies to determine the harmful effects caused by smoking. .

OBJETIVO: desenvolver modelo experimental de exposição aos produtos da queima do tabaco (cigarro) para avaliar os efeitos do seu uso crônico em relação às neoplasias de bexiga. MÉTODOS: Os animais foram expostos cronicamente aos produtos da queima do tabaco em câmara semi-aberta para simular o tabagismo. Trinta ratos jovens da raça Wistar foram distribuídos em dois grupos: um com 20 animais simulando o tabagismo por período de seis meses, e um com dez animais controle sem exposição por igual período. Após exposição por inalação da fumaça do cigarro, os animais foram eutanasiados e submetidos a estudo histopatológico da parede da bexiga. RESULTADOS: Não foi encontrada neoplasia e sim alterações leves e não significativas. Os estudos da hemo-oximetria (carboxiemoglobina e metemoglobina) e da concentração de dióxido de carbono (CO2) confirmam que os animais foram expostos a altas concentrações da fumaça do tabaco e de seus derivados. CONCLUSÃO: No estudo anatomopatológico dos animais não foi encontrada neoplasia na mucosa da bexiga. Os modelos experimentais desenvolvidos foram altamente eficientes, práticos e fáceis de usar podendo ser empregados em outros estudos semelhantes para determinar os efeitos nocivos causados pelo tabagismo. .

Occupational risk of bladder cancer among Iranian male workers

Approximately 5-10% of human cancers are thought to be caused by occupational exposure to carcinogens. Compare to other cancers, bladder cancer is most strongly linked to occupational exposure to chemical toxins. This study has been performed to understand which occupations and exposures are related to bladder cancer in Iran. This study is a case-control study which is conducted on cases with bladder cancer [160 cases] diagnosed in Baharlou hospital in 2007-2009. One hundred sixty cases without any occupational exposure were considered as controls matched for demographic characteristics. Demographic data and characteristics of occupation were compared. Mean age of cases and controls were 63.7 and 64 years, respectively [P = 0.841]. History of urinary tract stone had significantly difference in two groups [P = 0.039]. Occupations such as bus and truck driving, road and asphalt making, mechanics, working in refinery and Petrochemical, plastic, metal manufactory, welding, and pipeline founded a higher risk for bladder cancer rather than controls. Our findings on Iranian workers are concurrent and compatible with findings of previous reports about occupational and environmental risk factors of bladder cancer. Although our study population was not little, further studies are needed to declare the risk of working in some occupations such as drivers and metal factories for bladder cancer

Risk factors of urinary bladder cancer in Peshawar region of Khyber Pukhtoonkhawa

Urinary Bladder cancer is a fatal disease. No work about its risk factors has been conducted in northern Pakistan. This case control study was conducted in order to investigate the risk factors of the urinary bladder cancer in that area. For this study 150 subjects including 50 cases and 100 controls were interviewed from the 2 tertiary care hospitals of Peshawar and the information was collected about the characteristics like gender, age, smoking habits, family history of cancer, etc. Descriptive and inferential statistics were used to explain the risk factors of the disease. Odds ratios and 95% Confidence Intervals were computed by using logistic regression model. The odds ratio and 95% confidence interval for chemical exposure are 4.637 and [1.022-21.053], for cigarette smoking 19.526 and [4.688-81.329], for lifestyle 0.171 and [0.031-0.943], for fluid consumption 0.025 and [0.005-0.115], for fried items 5.934 and [1.429-24.648], and for fruits are 0.173 [0.045-0.660], respectively. Chemical exposure, cigarette smoking, and high use of fried items increase the risk of urinary bladder cancer. Moderate lifestyle, high fluid consumption and use of fruits are protective against the disease

Association of parasitic infections and cancers.

Recent advances in the fields of molecular biology, epidemiology and infectious diseases have led to significant revelations to clarify the relationship between cancer and infective agents. This article reviews the relationship between parasitic infections and carcinogenesis and the possible mechanisms involved. Few parasites, e.g., Schistosoma haematobium and Opisthorchis viverrini have been found to be strongly associated with bladder cancer and cholangiocarcinoma respectively. The evidence for the association of several other parasites and cancers has also been postulated.

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

Schistosoma induced squamous cell carcinoma of the bladder.

Schistosomiasis or Bilharziasis caused by S. hematobium is endemic in Africa, Egypt, southern tips of Europe and Japan. Though not unknown in India, it is a much less common occurrence. Schistosomiasis of the bladder is known to be a causative factor for bladder carcinoma; which is usually of the squamous type. These cancers are usually of a higher grade and the average initial stage is higher than those for transitional cell carcinomas. We present a case of schistosoma induced squamous carcinoma of the bladder as this is not a common association in India.

El impacto del tabaquismo sobre el riñón y el aparato genitourinario / The impact of smoking on the kidney and genitourinary system

El tabaquismo tiene múltiples efectos sobre el aparato genitourinario. El más conocido es su efecto carcinogénico, pues es una causa importante de cáncer de riñón, vejiga, pelvis renal y ureteros. Los agentes causales son las aminas aromáticas del tabaco, y parece existir una susceptibilidad variable a estas sustancias que depende del genotipo de cada persona. En el sexo masculino el tabaquismo se ha relacionado con la impotencia sexual, infertilidad, desbalances hormonales y teratogenicidad. También se han observado alteraciones en el control del balance de agua, así como un mayor deterioro de algunos padecimientos glomerulares

Study of carcinoembryonic antigen in bilharzial and non bilharzial carcinoma of the urinary bladder

Urine and serum carcinoembryonic antigen [C.E.A] were determined in 43 patients with bilharzial bladder carcinoma [22 patients] and non- bilharzial bladder carcinoma [21 patients] as well as in 10 normal controls. Significant increase of both urine and serum C.E.A. levels in bladder carcinoma patients compared to control levels was detected. Urinary C.E.A. Was elevated in 86% of bilharzial bladder carcinomal versus 62% in non-bilharzial bladder carcinoma while serum C.E.A. Was raised in 39% of bilharzial bladder carcinoma versus 10.5% in non- bilharzial carcinoma. The mean urinary C.E.A. in bilharzial carcinoma was higher than that of non-bilharzial carcinoma but the difference was not statistically significant. There was a definite relationship between urine C.E.A. And the stage of malignancy, the higher the stage, the higher the level of urine C.E.A. No relationship could be detected between the stage of malignancy and serum C.E.A. or between the grade of malignancy and urine or serum C.E.A levels

Quantitative assessment of the risk of urinary schistosomiasis and other potential risk factor for bladder cancer in Egypt

A case-control study was conducted to assess magnitude of the risk of urinary schistosomiasis and other possible risk factors for squamous and transitional cell types of bladder cancer [BC] in Egypt. Cases included 301 patients who were recruited from National Institute of Cancer at Cairo presenting with an early stage of BC; 148 with squamous cell carcinoma [SCC] and 153 patients with transitional cell carcinoma [TCC]. A definitive diagnosis of BC and its cell type was based on histopathological examination of biopsy. Controls included 154 subjects admitted for surgery other than cancer. Urinalysis and ultrasound examinations were used to exclude controls with evidence of lesions suspicious of BC. Both cases and controls were interviewed using a structured risk-assessment questionnaire. The collected data included age, gender, diagnosis of urinary schistosomiasis, and urinary stones, smoking status, exposure to pesticides, and petrochemical products. Resuits of the bivariate analysis, showed increased significant risks for both types of BC with age >/= 50 years, male sex, urinary schistosomiasis, urinary stones and exposure to pesticides. To measure the adjusted OR and 95% confidence limits [CL] of each risk factor, stepwise logistic regression [LR] was computed to control for effects of the confounding variables. The main results of LR analysis were: 1- Elevated significant risk for SCC with urinary schistosomiasis [OR: 2.5, CL: 1.5-4.1], and urinary stones [OR: 2.2, CL: 1.1-4.2]. 2- Elevated risk for TCC with age of snore man 50 years [OR: 5.3, CL: 3.1-9.0], and urinary schistosomiasis [OR: 2.5, CL: 1.4-4.2]. 3- Increased risks for SCC and TCC, albeit non-significant on exposure to pesticides [OR: 2.0, CL: 0.9-4.8 for SCC], and [OR: 1.5 CL: 0.6-3.8 for TCC]. 4- Non-significant increased risk for SCC and TCC with cigarette smoking. Urinary schistosomiasis is a significant risk factor for SCC and TCC and its risk is almost unaffected by other confounding variables. Albeit statisticallt non-significant, the environmental and occupational factors are associated with high risk for BC

Tumour necrosis factor in squamous cell carcinoma of urinary bladder

This study aimed to demonstrate the role of tumor necrosis factor [TNF] in malignancy. TNF level has been estimated by ELISA techniques method in 30 patients with cancer bladder and 10 normal control subjects. It was found that preoperative TNF levels were significantly higher in comparing to the normal control subjects, and this level dropped postoperatively in 80% of the cases. These findings led to the conclusion that TNF may be used as a tumor marker for regular check up and that the TNF level may be used to assess the radicality of the operative procedure if the postoperative sample was taken after a longer duration in the absence of surgical complications

Papiloma invertido de vías urinarias en la infancia: informe de un caso / Childhood urinary tract inverted papilloma: report of a case

Se presenta un caso de papiloma invertido vesical en un niño de 11 años de edad, el cuarto notificado en la infancia. Se realiza una breve revisión de la literatura con insistencia especial en las teorías etiológicas, los criterios histopatológicos y el tratamiento de esta enfermedad. PALABRAS CLAVES: Infancia, papiloma invertido, tumor vesical, vejiga urinaria.

Revisión de 21 casos de carcinoma vesical y de 3 caso de carcinoma de la pelvis renal / Review of 21 cases of carcinoma of the bladder and of 3 cases of the renal pelvis

Se presentan los casos de 21 pacientes de carcinoma vesical y tres de carcinoma de pelvis renal bajo control de la Consulta Externa del Servicio de Urología, Hospital de Especialidades, Centro Médico de Puebla, IMSS. Se encontró carcinoma vesical superficial en 15 (71.4%) de los pacientes; de éstos siete (46.6%) se trataron mediante resección transuretral a la que se añadió quimioterapia intravesical, y uno (6.6%) mediante radioterapia radical. La enfermedad resultó invasora en seis (28.5%). De los 21 pacientes, 16 (76.2%) se encontraban vivos sin datos de actividad tumoral en el momento de terminar la redacción de este informe; otros más (4.7%) lo estaba pero con actividad tumoral, tres habían fallecido a causa del padecimiento, y el deceso del último se debió a una causa ajena al mismo. Dos de los pacientes que padecían carcinoma de la pelvis renal se sometieron a nefroureterectomía con resección de un segmento vesical, y el otro a operación conservadora de la pelvis renal. Los tres se encontraban libres de actividad tumoral en el momento de terminarse de redactar este informe. La finalidad de este artículo es valorar los aspectos aplicados e informar las experiencias obtenidas con el tratamiento de los carcinomas de estos tipos.

Biochemical studies on the effect of some schistosomicidal drugs on the production of the bladder carcinogen xanthurenic acid

Male Swiss albino mice were studied to demonstrate the in vitro effect of two antimonial antibilharzial drugs [anthiomaline and Astiban] and two non-antimonial drugs [Vansil and Bilarcil] on the activity of vitamin B-dependent 3-hydroxy kynureninc aminotransferase enzyme. The effect of increasing pyridoxal phosphate concentration on the enzyme activity was also studied. The results revealed that both antimonial and non-antimoial drugs inhibited the B-dependent 3-hydroxy kynurenine aminotransferase in vitro. Increasing the concentration of pyridoxal phosphate could not completely overcome the inhibitory effect of these drugs. Moeover, there was no interaction between the used antibilharzial drugs and pyridoxal phosphate in vitro. Also, the direct interaction of the drugs with the enzyme is not likely. Therefore, the inhibitory efect o the studied anti-bilharzial drugs on the activity of B-dependent 3-hydroxy kynurenine aminotransferase enzyme could lead to the accumulation of the bladder carcinogenic compound 3-hydroxy kynurenine

Cáncer de la vejiga urinaria y hábito de fumar / Cancer of the urinary bladder and smoking habit

Se informa que los derivados orthohidroxilados de las aminas aromáticas son metabolitos que se liberan en la vejiga donde originan carcinomas. Se producen en el metabolismo del triptófano cuerpos con estructura similar, entre ellos la 3-hidrosciquinurenina y el ácido carcinogenético. Se encuentran estos cuerpos en cantidades excesivas en la orina de los fumadores, quienes son incapaces de transformarlos en nicotenamida. Los fumadores en un grupo de 90 enfermos con carcinoma transicional de vejiga, alcanzaron el 90%, en tanto que en el grupo control, constituido por 90 enfermos con carcinoma del colon, sólo alcanzaron el 40%: 5% > 2