Immunocytology in the assessment of patients with asymptomatic microhaematuria.

INTRODUCTION: Discrimination between malignant and nonmalignant conditions remains the key problem in assessing microhaematuria. This prospective study investigated the role of immunocytology in the evaluation of patients with microhaematuria. METHODS: uCyt+ is a commercially available immunocytologic assay based on microscopic detection of tumour-associated antigens on the membrane of urothelial cells by immunofluorescence. Between October 2000 and August 2005, 189 consecutive patients with newly diagnosed painless microhaematuria without prior transitional cell carcinoma were included. All urine samples were examined cytologically and immunocytologically. Of the 189 samples, 178 (94%) were assessable. RESULTS: Clinical assessment by physical examination, laboratory tests, endoscopy, and imaging modalities found bladder cancer in 8 patients (4%). Further diagnoses were benign prostatic hyperplasia (54 cases, 29%), cystitis (including interstitial cystitis; 20 cases, 11%), urolithiasis (18 cases, 9%), tumours of other origin (6 cases, 2%), and "further conditions" (26 cases, 13%). In 57 patients (30%) the reasons for haematuria were not disclosed. Immunocytology was positive in 7 of 8 bladder tumours (87%) and negative in 154 of 170 patients with haematuria for other reasons (91%). CONCLUSIONS: The high sensitivity and good specificity of immunocytology in the diagnosis of bladder cancer was confirmed in this population with a low disease prevalence. Only one tumour of low malignant potential was missed by immunocytology. If assessment of these patients would have been based only on immunocytology, 154 costly and invasive diagnostic procedures could have been avoided, with only 16 of 170 individuals (9%) undergoing these examinations unnecessarily. The findings justify a prospective investigation of this issue.

Nephron sparing surgery in renal cancer--individual decision or standard procedure?

Organ-preserving surgery has gained widespread acceptance within the international urological community through the last decade. In consequence, the question of radical vs. nephron sparing surgery for the treatment of renal cancer is increasingly discussed in a controversial way. Today, even advocates of a radical nephrectomy must admit that long-term results obtained through nephron sparing surgery are excellent. In consequence, heminephrectomy has become a standard treatment in patients with impaired renal function. However, in patients with a normal contralateral kidney, national and international guidelines still favor radical nephrectomy. An increased morbidity and doubts on the efficacy of heminephrectomy concerning tumor control are the key reasons behind this strategy. Within this analysis the authors stress the hypothesis that the actual differences between organ-preserving surgery and radical nephrectomy concerning survival are marginal if the requirements for heminephrectomy are met. Therefore, the actual controversy appears to be rather based upon assumptions and convictions than on actual facts. To definitively answer this question a prospective randomized trial is suggested, however, the problems of this study may not be underestimated.

Cirugía conservadora de la nefrona en el cáncer de riñón - ¿decisión individual oprocedimiento normalizado? / Nephron sparing surgery in renal cancer individual decision or standard procedure?

A lo largo de la última década, la cirugía conservadora del órgano ha alcanzado reconocimiento generalizado dentro de la comunidad urológica internacional. En consecuencia, la cuestión de la cirugía radical frente a la cirugía conservadora del órgano está siendo cada vez más debatida de forma polémica. A día de hoy, incluso los defensores de la nefrectomía radical deben admitir que los resultados a largo plazo obtenidos con la cirugía conservadora de la nefrona son excelentes. Por consiguiente, la heminefrectomía se ha convertido en un tratamiento habitual en pacientes con función renal comprometida. Sin embargo, en pacientes cuyo riñón contralateral es normal, las directrices nacionales e internacionales siguen mostrándose favorables a la nefrectomía radical. El aumento de la morbilidad y las dudas sobre la eficacia de la heminefrectomía en relación con el control tumoral son los motivos clave tras esta estrategia. Como parte de este análisis, los autores destacan la hipótesis de que las diferencias actuales entre cirugía conservadora del órgano y nefrectomía radical en relación con la supervivencia son marginales siempre que se cumplan los requisitos para la heminefrectomía. Así pues, la polémica actual parece basarse sobre todo en suposiciones y convicciones más que en hechos reales. Para responder definitivamente a esta pregunta se ha sugerido la realización de un ensayo clínico prospectivo y aleatorizado, aunque sin subestimar los problemas que conlleva dicho estudio. (AU)