Urinary basic fibroblast growth factor in bladder cancer patients. Histopathological correlation and clinical potential.

INTRODUCTION: Angiogenesis plays a significant role in the growth and progress of cancer, thus we evaluated the levels of urinary basic fibroblast growth factor (bFGF) in bladder cancer (Ca) patients and investigated any possible correlation between this angiogenic factor with tumor stage and grade. MATERIALS AND METHODS: Urine samples from 41 patients with bladder Ca, 11 patients with history of bladder Ca but negative follow-up cystoscopy, 18 patients with benign prostate hyperplasia (BPH) and 15 normal healthy volunteers were assayed using an enzyme-linked immunosorbent assay for bFGF. Resulting values were normalized against urine creatinine and expressed as pg/g. RESULTS: The median urinary bFGF level of patients with active disease, history of bladder carcinoma and negative follow-up cystoscopy, BPH, and healthy volunteers were 2,717, 1,009, 1,414 and 1,100 pg/g, respectively. There was a statistically significant difference between median bFGF levels of patients with active bladder Ca and those of the other groups (p = 0.000). Eleven patients with invasive bladder Ca had a median bFGF value of 6,880 pg/g that was significantly increased (p = 0.002) compared to the median of 2,312 pg/g of those with superficial tumors (Ta 14, T1 16). Grades 1, 2 and 3 carcinoma were found in 5, 19 and 17 patients which had a median bFGF of 2,717, 1,762 and 3,617 pg/g, respectively, but the difference was not statistically significant (p = 0.13). CONCLUSIONS: Our results confirm the implication of bFGF in the biology of bladder cancer, and demonstrate that urinary bFGF concentration seems to be significantly related to the stage but not to the grade of the disease supporting the proposed mechanisms of release of bFGF. Further studies are required in order to validate the potential clinical applications of bFGF for specific groups of bladder cancer patients.

Responses of renal function to elevated intravesical pressure.

This experimental study was designed to investigate the responses of renal function to elevated intravesical pressure. Ten male New Zealand type rabbits were used. A supravesical ureterocutaneous urinary diversion was performed in all rabbits to disconnect bladder and kidneys and to ensure a free urine flow. Two parameters of renal function were measured simultaneously: urine output by simple collection and glomerular filtration rate (GFR) by total plasma clearance of 51Cr-EDTA. Measurements were performed initially with the bladder empty and then with intravesical pressure 60 cm H2O. A significant decrease in urine output and in GFR was observed in all rabbits when the bladder was overdistended. Urine output returned to the initial levels after relief of the increased intravesical pressure. The results suggest that for these responses a vesicorenal reflex activated by the elevated intravesical pressure is responsible.

Response of urinary sodium excretion to elevated intravesical pressure.

This experimental study was designed to investigate the possibility of an interaction between elevated intravesical pressure and urinary sodium excretion. Fourteen male New Zealand rabbits were used. After performing a ureterocutaneous diversion, urinary sodium excretion was measured in two situations: with the bladder empty and with the bladder overdistended and an intravesical pressure of 60 cm H2O. There was a significant decrease in urinary sodium excretion at an elevated intravesical pressure. The urinary sodium excretion returned to normal after relief of the pressure. The results suggest the existence of a neurogenic pathway activated by the elevated intravesical pressure.

Primary non-Hodgkin lymphoma of the prostate gland.

We present a case of non-Hodgkin lymphoma of the prostate referring to an 86-year-old male, who was admitted with a history of urine retention of 10 days' duration. The symptoms and signs were compatible with a diagnosis of benign prostatic hypertrophy, with no preoperative evidence of malignancy. Following transvesical prostatectomy, immunocytochemical analysis of the specimen showed a highly malignant non-Hodgkin lymphoma of the large immunoblastic B-cell type, with a cIgM (kappa) phenotype.

Metastatic tumors to the urinary tract. Review a propos of two cases.

The problems of clinical diagnosis and treatment of metastatic tumors of the urinary tract remain very important, despite the relative rarity of these tumors and the development of new imaging techniques. We report two such cases. The first one refers to a 63-year-old man, who presented with a tumor of the right kidney. Postoperatively, the lesion proved to be a metastasis of a small-cell lung carcinoma. In the second case, a 59-year-old man was admitted with acute anuria and a history of infiltrating ductal carcinoma of the breast. His anuria was resolved by passage of ureteral stents, but relapsed soon after their removal. Thus, a ureterostomy was performed. Intraoperatively, an extensive metastatic infiltration of the ureters by the mammary tumor was discovered. Reviewing the world literature, we discuss the diagnostic and therapeutic clues of these tumors.