Prediction of histological stage based on cystoscopic appearances of newly diagnosed bladder tumours.

INTRODUCTION In the 75-80% of urothelial bladder cancers (UBC) presenting as non-muscle invasive bladder cancer (NMIBC), transurethral resection of bladder tumour (TURBT) is the key treatment and staging procedure. In the 20-25% of patients with muscle invasive bladder cancer (MIBC), further cross-sectional imaging is required to complete the staging process before considering radical treatment. Given the adverse effects of ionising radiation, clinicians identify patients believed to have MIBC, and so requiring further imaging pre-TURBT, at the tumour histology/stage based on the tumour's visual characteristics. There is minimal evidence describing the accuracy of such predictions in newly-diagnosed patients. METHODS Over a 6-year period, a database of patients undergoing resection of newly-diagnosed bladder lesions in a single UK centre was prospectively established. Predictions based on histology were simultaneously recorded, and the accuracy of these predictions of histology/stage subsequently assessed. RESULTS One hundred and twenty two (73.1%) patients with histologically confirmed NMIBC had predictions recorded versus 45 (26.9%) patients with MIBC. Visual assessment predictions of MIBC had a sensitivity of 88.9% (95% confidence interval [CI] 76.5%-95.2%) and a specificity of 91.0% (95% CI 84.6%-94.9%), giving a positive predictive value of 78.4% (95% CI 65.4%-87.5%) and a negative predictive value of 95.7% (95% CI 90.3%-98.1%). CONCLUSIONS We find that visual assessment is accurate in predicting the presence of MIBC. This supports the practice of stratifying patients at the time of initial cystoscopy for those requiring further radiological staging pre-TURBT.

Ureteropyelostomy: a simple and effective treatment for symptomatic ureteroureteric reflux.

Partial ureteric duplication may cause delayed drainage of urine from the upper tracts because of ureteroureteric "see-saw" reflux. This can be eliminated by the procedure of ureteropyelostomy, in which the partially duplicated ureter is converted into a bifid renal pelvis. This operation leaves a short anastomotic suture line and has a low complication rate. We report seven patients who have undergone ureteropyelostomy for symptomatic ureteroureteric reflux. All remain symptom-free after follow-up for a minimum of 1 year.

The mutagenic potency of chrysoidines and bismark brown dyes.

Chrysoidine dyes are used by fishermen to colour bait and recent epidemiological evidence has suggested that this may explain why they are at increased risk of urothelial cancer. In recent years Bismark brown dyes have been used as chrysoidine substitutes. Previous mutagenicity studies on these azo-dyes have examined only one variety of dye and used only one type of activating enzyme. In this study six samples of chrysoidine and three samples of Bismark brown dye have been obtained from chemical suppliers and from angling sources. They have been analysed by n.m.r. spectroscopy to determine whether they contain ring methyl groups. The mutagenic potency of each dye has been assessed by the Salmonella typhimurium/mammalian microsomal mutagenicity assay utilizing the TA100 and TA98 stains. Those dyes with methyl substitutions have been found to be more potent mutagens than their non-methylated counterparts using either human or rat metabolic preparations and irrespective of whether the enzymes have been induced with phenobarbitone.

A symptomatic and cystometric comparison of terodiline with emepronium in the treatment of women with frequency, urgency and incontinence.

Terodiline has been compared with emepronium in the treatment of 20 women suffering with frequency, urgency and incontinence in a double-blind, two-way cross-over study with fixed placebo as wash-out. A significant number of patients preferred terodiline treatment and a closer correlation between symptomatic and cystometric improvement has been seen during treatment with this drug. Regression analyses indicate that patients with high micturition frequencies (12 to 15 per 24 hours) benefit more from treatment than those with lower frequencies do.

The effects of microsurgical transection of neurite bundles in vitro before and after exposure to colchicine.

Chick dorsal root ganglia were cultured in a fluid medium. Outgrowing neurite bundles were transected with a cataract knife. Their cut ends withdrew from the site of transection and the extent of this movement was measured. Some cultures were treated with colchicine prior to transection and comparable measurements were made on them. Both proximal and distal ends of neurite bundles so treated retracted but to a lesser extent than controls. The EM appearances of control and treated groups are contrasted.