Recurrence and progression of T1G3 transitional cell carcinoma of the bladder treated with intravesical bacillus Calmette-Guérin.

OBJECTIVE: To examine the incidence of recurrence and progression in patients with stage T1, grade-3 carcinoma of the bladder treated with endovesical bacillus Calmette-Guérin (BCG) after complete transurethral resection. MATERIAL AND METHODS: From May 1995 to June 2002, 937 patients with superficial bladder cancer underwent transurethral resection. 46 patients (4.9%) had T1G3 tumors. All patients received endovesical BCG therapy 2-3 weeks after transurethral resection, given in 6 sessions as weekly instillations of 120 ml Pasteur strain BCG in 50 ml saline. Success was defined by normal cytology and cystoscopy, and normal bladder biopsies. Recurrent tumors were resected and a second or third cycle of therapy was given according to pathological status. Progressive tumors were managed by radical cystectomy, radiotherapy and/or chemotherapy depending on the nature of the tumor or clinical status of the patient. RESULTS: During follow-up 60.7% of the patients (28 of 46) remained tumor free after only 1 BCG cycle and 73.9% (34 of 46) after the third BCG cycle, and the bladder was preserved in all. Muscle-invasive progression was noted in 10 (21.7%) patients at the end of the BCG cycles. Radical cystectomy was done in 10 patients. The tumor-free survival rate of all patients including those who underwent cystectomy is 84.8% (39 of 46) with a median follow-up of 61 (range 39-118) months. CONCLUSION: Adjuvant immunotherapy with BCG after complete transurethral resection of the bladder tumor represents a highly effective treatment for bladder preservation in stage pT1, grade-3 carcinoma of the bladder. pT1G3 tumors with early high-grade recurrence after failed immunotherapy should be regarded as candidates for early radical cystectomy.

A case report: Leukaemic infiltration and hyperplasia of the prostate.

Leukaemic infiltration of prostate with hyperplasia is a rare manifestation and is usually found in known cases of leukaemia, but it may be the first sign of an undiagnosed leukaemia. In this report, a rare case of leukaemic infiltration of the prostate in a 64-year-old man is represented.

A case report: renal metastasis of prostate cancer.

In this report, a rare case of renal metastasis of prostate cancer in a 55-year-old man is presented.

Role of interferon-alpha-2B in prevention of testicular atrophy with unilateral mumps orchitis.

OBJECTIVES: To determine the effectiveness of intravenously administered interferon-alpha-2B for the prevention of testicular atrophy in postpubertal men with mumps orchitis. METHODS: Eighteen patients with mumps orchitis were evaluated. The patients were hospitalized, and 3 x 1,000,000 IU intravenous interferon-alpha-2B was administered daily for a total of 7 days. All patients were evaluated by testicular biopsy on the 12th month after interferon treatment. RESULTS: Biopsy results demonstrated total atrophy of the seminiferous tubules in seven (38.8%), 10% atrophy in three (16.6%), and no apparent histopathologic alterations except an arrest in spermatogenesis in eight (44.6%) testes. CONCLUSIONS: Systematic treatment with interferon-alpha-2B does not seem completely effective in preventing testicular atrophy after mumps orchitis. Further investigations involving larger populations are needed.

Primary cyst hydatid of adrenal: a case report.

Adrenal cysts are very rare lesions, especially with parasitic origin. Here, primary cyst hydatid of adrenal in a 51 years old woman who consulted with a left flonk pain, is presented and the literature is reviewed.

Comparision of intracorporeal lithotripsy methods and forceps use for distal ureteral stones: seven years experience.

OBJECTIVES: To evaluate and to compare the safety and efficacy of ureteroscopic lithotripsy methods and forceps use for distal ureteral stones. MATERIALS AND METHODS: 514 patients were evaluated retrospectively who were treated by dye laser, electrohydraulic or ultrasonic lithotripsy or direct forceps extraction for distal ureteral stones between May 1992-October 1999. RESULTS: Laser lithotripsy was determined to be the most effective method with 86.9% success, while ultrasonic lithotripsy was the least effective method with 77.3% success rate. For smaller stones forceps extraction had a 88.5% success rate. CONCLUSION: Ureteroscopic lithotripsy methods are all alternative choice of treatment methods in distal ureteral stones. To our experience, laser lithotripsy is the most effective method of all intracorporeal lithotripsy methods as far as the success and complication rates are concerned.

Management of testicular cancer with combined-modality treatment.

Thirty consecutive patients with germinal testis tumours were treated with combined-modality programme. Seven patients were entered in the surveillance protocol, 7 patients had irradiation of the paraaortic and ipsilateral pelvic lymph nodes, 16 patients were treated with four courses of chemotherapy. Of the patients 5 underwent surgical removal of residual masses. After the combined-modality treatment 27 (90%) patients had complete remission, 2 patients showed progression on therapy and the other had incomplete resection of residual masses. After a median follow-up period of 41.5 months, 27 (90%) remain continuously disease-free, 2 patients died and one patient is still alive with his enlarged mediastinal lymph nodes. The treatment policy stage by stage was defined by the current roles of surgery, irradiation and chemotherapy in our efforts.

Conservative management of advanced bladder cancer.

Between January 1991 and October 1993, 32 consecutive patients with documented primary bladder tumours invading muscle received 3 cycles of methotrexate, vinblastin, doxorubicin and cisplatin (MVAC). The disease was re-staged by bimanual examination with the patient under anaesthesia, CT scanning and transurethral biopsy or resection. Of the 32 patients 2 underwent total or partial cystectomy and 30 did not, because re-staging showed no residual tumour in 8 (25%), stage T1-2 in 12 (37.5%) and far-advanced tumour in 10 (31.2%). The median follow-up was 2.8 years. Twelve patients with stage T1-2 tumour have required TUR, and cystectomy has not been necessary. Two patients who underwent total/partial cystectomy were all downstaged pathologically. Of the 10 failures 5 patients died of disease and 5 are alive with metastatic disease. The overall survival rate was 84.3% (27 of 32) and was 96.8% for patients with a functioning bladder. The data suggested that this active regimen can clinically induce downstaging in a significant number of patients with primary muscle-infiltrating bladder tumours. Transurethral resection plus MVAC chemotherapy is important for increased curability in patients with advanced bladder cancer.

NAG, GGT, creatinine, urea and creatinine clearance before and after ESWL.

N-acetyl-beta glucosaminidase (NAG) and gamma-glutamyltransferase (GGT) were measured in the urine and serum before, 24 hours and one week after extracorporeal shock wave lithotripsy in 25 patients. Although ESWL is the preferred method in the treatment of kidney stones, its effect on renal parenchymal cells has not been sufficiently elucidated. Since radiographic methods remain inadequate in the estimation and management of parenchymal damage, it is useful to establish the specific renal cell proteins in urine and serum, reflecting renal tubular cell destruction.