Intravesical bacillus Calmette-Guerin immunoprophylaxis of superficial bladder cancer: results of a controlled prospective trial with modified treatment schedule.

A controlled prospective trial on 94 patients evaluated the efficacy of intravesical Pasteur strain bacillus Calmette-Guerin (BCG) administration as prophylaxis against tumor recurrences after complete endoscopic resection of superficial bladder cancer. The treatment schedule, consisting of an initial 6-week course of instillations and a single quarterly maintenance dose to the responders, was modified to those of the latter who were at high risk for recurrence and who received an additional separate 4-week course of therapy. The percentage of the patients treated prophylactically with BCG and who remained free of recurrences (68%, mean followup 33.8 months) was significantly higher than that of the controls who underwent transurethral resection only (41%, mean followup 30.2 months). In terms of relative risk of recurrences, recurrence rate per 100 patient-months and disease-free interval, comparisons between the 2 groups of patients revealed a significant benefit for the BCG group overall as for those subjects having stages Ta and T1 tumors, multifocal tumors, a history of disease, and grades 2 and 3 carcinoma. Drug-induced toxicity was acceptable. Our study suggests that our modified treatment protocol is notably safe and effective against recurrent superficial bladder cancer.

Primary endourologic re-establishment of urethral continuity after disruption of prostatomembranous urethra.

A new technique for the early management of traumatic disruption of the prostatomembranous urethra has been used in 4 consecutive young patients. Urethral realignment by stenting the injured urethra with a catheter was achieved by combined urethroscopy and suprapubic instrumentation one to three days after the injury. We describe herein our experience with this technique and we suggest that it could be a valuable alternative in posterior urethral repair.

Primary non-Hodgkin's lymphoma of the urinary bladder.

Primary non-Hodgkin's lymphoma of the bladder is a rare entity and when found in such an unusual location is often difficult to distinguish from other vesical or extravesical neoplasms. Understanding of the pathobiological characteristics of this malignancy has been hampered not only because of its rarity but also by the previous confusion in its nomenclature. Factors that influence survival most strongly are the stage and the bulk of disease at presentation and the histologic classification of the tumor. We report a case of primary non-Hodgkin's lymphoma of the bladder presenting as a large pelvic mass which dramatically regressed with systemic chemotherapy with simultaneous restoration of the upper dilated urinary tracts. In addition, the incidence, clinical picture, staging procedures, histologic classification and treatment modalities of this disease are reviewed.

Intravesical bacillus Calmette-Guérin administration in the prophylaxis of superficial bladder cancer.

A total of 68 patients received prophylactic/adjuvant intravesical Pasteur strain bacillus Calmette-Guérin (BCG) instillations following transurethral resection for superficial bladder carcinoma. An induction phase consisting of 6 weekly instillations was followed by a maintenance phase consisting of 1 instillation given every 3 months. A second 6-week course of BCG was administered to initial failure followed again by a quarterly maintenance therapy. The response rate for patients treated with one 6-week course was 56%, while complete response was achieved in 72% when both treatment courses were considered. Follow-up period lasted at least 2 years after each course of BCG. These results suggest that additional courses of BCG increase the prophylactic efficacy of intracavitary BCG. Regarding the purified protein derivative (PPD) skin test and granulomatous response in the bladder, it has been shown in the present study that, although favourable results occurred more frequently among patients with either PPD conversion from negative to positive or vesical granuloma formation, neither of these indices should be considered reliable prognostic indicators.