Tissue culture model of transitional cell carcinoma: characterization of twenty-two human urothelial cell lines.

Twenty-two continuous cell lines derived from normal and neoplastic urothelium, maintained under identical culture conditions, were characterized in terms of isozyme phenotype, tumorigenicity, and xenograft morphology following xenotransplantation to nude mice, cytological appearance, in vitro growth rate, labelling index, and colony-forming efficiency, in parallel with separate studies of in vitro drug sensitivities and monoclonal antibody reactivities. Three groups were identified: (a) distinct lines with differing isozyme patterns, a broad spectrum of growth characteristics, and xenograft morphologies similar to the histopathology of the parent tumors after periods of up to 17 yr following establishment in vitro; (b) cross-contaminated sublines (maintained separately in different laboratories for periods of up to 10 yr), with identical isozyme patterns and similar growth characteristics, but differing markedly in tumorigenicity and xenograft morphology; and (c) lines derived from normal urothelium which were nontumorigenic and had an isozyme pattern usually only encountered in untransformed cells. These data indicate that cell lines representative of human transitional cell carcinomas can be selected on the basis of xenograft morphology and isozyme patterns, and that a panel of lines derived from normal and neoplastic urothelium could provide a model system to study the biology and treatment of this disease.

Metastatic deposits from a previously treated carcinoma of the lung presenting as a renal cell carcinoma.

Two patients are presented who had each previously undergone resection of a primary lung carcinoma. They later developed the classical triad of loin pain, haematuria and an abdominal mass suggestive of a primary renal tumour. Investigations, including intravenous urography, ultrasound and renal arteriography, supported the diagnosis. However, at operation both patients had para-aortic lymph node metastases from the lung carcinoma surrounding the renal pedicle and invading the renal parenchyma. It is suggested that further investigations might allow pre-operative diagnosis and thus avoid the need for surgery in such patients.

Urinary diversion for incontinence--a beneficial procedure?

In the past 8 years at St George's Hospital, 13 women underwent urinary diversion for disabling incontinence. Seven patients had multiple sclerosis, 2 had suffered trauma to the lumbar spine and 4 had failed repeated surgery for urethral sphincter incompetence. One patient died several months postoperatively due to relapse of her multiple sclerosis. The remaining 12 were interviewed to determine the effect of the operation on their quality of life. Preoperatively, 9 patients (75%) were either housebound or only ventured out to do the shopping and none led a full social life. Postoperatively 8 patients (67%) managed a full social life and all were improved. Most managed their stomas proficiently and none regretted having the operation. The most common late complication was pyocystis. We conclude that patients with disabling incontinence can have their quality of life substantially improved by urinary diversion. The incidence of pyocystis is probably high enough to warrant vaginal vesicostomy to be performed routinely at the time of diversion, at least in those women with chronic urinary infection.

Bilateral total ureteric bypass in the management of renal tubular acidosis.

Nephrocalcinosis and the subsequent obstruction of the ureters by urinary calculi can be a major problem in the management of a patient with renal tubular acidosis. We describe the case history of a girl with this condition in whom the interposition of segments of ileum between the kidneys and bladder, thus bypassing the ureters, had been used in an attempt to overcome the problem of recurrent ureteric obstruction by calculi.

Morbidity and mortality in 100 consecutive radical cystectomies.

A personal series of 100 consecutive radical cystectomies performed for bladder cancer is reported. Improvements in operative mortality are discussed in relationship to the development of a management regime for these patients. Attention is drawn to the high operative morbidity associated with this procedure.

Nephroureterectomy after radical cystectomy.

We report 6 cases of upper tract transitional cell carcinoma that developed after total cystectomy with ileal loop diversion. We conclude that if nephroureterectomy is to be used as treatment, excision of the ureteroileal anastomoses should be done.

The role of preoperative embolization in renal cell carcinoma.

A prospective study was done to assess the effect of embolization on the technical ease of nephrectomy, change in the immunological status of the patient and subsequent behavior of tumors and/or metastases in 55 patients with renal cell carcinoma. We found that embolization makes the operation easier technically. No changes in responses to delayed hypersensitivity skin tests were found after embolization with or without nephrectomy. There may be a response following embolization and adjuvant radical nephrectomy in some patients with limited lung metastases. No significant regression of renal cell carcinoma and/or metastases after embolization alone or with nephrectomy and hormonal/chemotherapeutic treatment was demonstrated. Survival of patients with metastatic renal cell carcinoma was longer for those who underwent embolization and nephrectomy than for those who underwent embolization alone.

The accuracy of ultrasound in the measurement of changes in bladder volume.

Ultrasound is an established method of assessing bladder and residual urine volumes. The aim of this study was to improve the accuracy of ultrasound in measuring changes in bladder volume and to avoid bladder catheterisation. Seventeen patients took part in the trial; their bladders were scanned before and after micturition and bladder volumes were estimated. Fifteen patients had bladder outflow obstruction. Further mathematical analysis showed that a correction factor yielded greater accuracy in measuring bladder volume (mean error 21% in this series against 28% in previous studies). Ultrasound is a quick, non-invasive and quantitative method of studying bladder volume, especially in the conservative management of patients with bladder outflow obstruction.

Procidentia and ureteric obstruction.

3 cases of renal failure, due to procidentia, presenting as emergencies are described. The upper urinary tracts of 4 asymptomatic patients with procidentia were investigated; dilatation was found in 1 instance only.

Hyponatraemia during transurethral resection--its practical prevention.

Haemodilutional consequences of transurethral resection of the prostate (TURP) can present clinical problems during or in the immediate period following this procedure. Recognition of large and rapid changes in the plasma sodium by inference from an ion selective electrode may avert the development of this potentially life-threatening complication.

Prognostic factors influencing survival of patients receiving intravesical epodyl.

Results from a retrospective analysis of 139 patients with recurrent superficial bladder tumors treated by intravesical epodyl are reviewed. Of patients who had complete clearance of tumor from the bladder 95 per cent became free of disease within 12 months of starting intravesical therapy. No patient who had persistent tumors at 2 years was free of tumor subsequently. The majority of complete responders who suffered recurrences did so within 3 years and 80 per cent of a small series of patients who remained free of tumor after 3 years and then stopped treatment continued to be free of tumor for a further 2 years. Failure to respond within 12 months or early invasion of the submucosa on biopsy (stage P1b tumors) was associated with poor survival. In patients who underwent salvage cystectomy the demonstration that 35 per cent had involved metastatic lymph nodes and 38 per cent had invasion of muscle is a clear indication of the dangers of delaying radical treatment once the patient has failed to respond completely to intravesical therapy.

Diagnosis of clinically occult bladder cancer by in vivo staining with methylene blue.

In vivo staining of the bladder mucosa with 0.1% methylene blue in normal saline was performed on 23 randomly selected patients with known and previously treated transitional cell tumours of the bladder in whom routine check cystoscopy failed to demonstrate any mucosal abnormality. In 21 patients differential staining of the bladder mucosa resulted, with no mucosal staining in 2. Cold cup biopsies were obtained from stained as well as unstained areas. Although positive staining did not prove the presence of a pre-malignant or malignant area, lack of staining was more likely to exclude mucosal abnormalities.

Outcome in carcinoma in situ of bladder treated with intravesical bacille Calmette-Guérin.

Fifty-three patients with carcinoma in situ of the bladder were treated with Evans strain BCG given intravesically. Complete remission was achieved after either one or two 6-weekly courses in 53% of patients. The median duration of remission was 32 months. Treatment-related bladder symptoms were minor during the first course, more severe during the second. There was no relation between severity of symptoms and likelihood of response. With a median follow-up of 32 months, disease progression has occurred in 10% of complete responders, whereas failure to respond on either cystoscopic, histological or cytological grounds was associated with a 48% progression rate. Although intravesical BCG produces impressive responses in carcinoma in situ of the bladder, managed conservatively the condition remains a dangerous one.

Flat carcinoma in Situ of bladder.

36 patients with flat carcinoma in situ of the bladder have been reviewed. Those with widespread disease usually presented with dysuria or obstructive outflow tract symptoms and radical surgery appeared to give better results than radiotherapy. However, when the lesion was confined to small areas of the bladder mucosa, haematuria or pain were the main presenting symptoms and a conservative approach seemed justified. It is suggested that the term flat carcinoma in situ be used for this lesion whose behavior differs significantly from that of the commoner papillary or invasive tumours. The pathological appearances are to be reported elsewhere in full.

Long-term follow-up in patients with superficial bladder tumours treated with intravesical Epodyl.

Sixty-four patients with multiple, superficial papillary bladder tumours which had ceased to be controlled by endoscopic resection and diathermy were treated before July 1972 with intravesical Epodyl instillations. Of these, 19 had developed no further recurrences; 20 patients were free of tumour to one year, but later developed recurrences. Twenty-four patients were never entirely free of tumour after starting Epodyl and one patient became free of recurrences 2 years after starting Epodyl. Only the patients whose histology showed no invasion of the lamina propria responded to treatment. The overall 5-year survival rate was 66%, with a disease-free interval of 61% at one year and 25% at 5 years. Failure to clear the bladder of tumour after 12 months' treatment, or worsening of biopsy stage from PIS to Pla or Plb while on treatment, were associated with a high risk of dying of invasive tumour and in future should be used as immediate indications for radical treatment.

The use of transabdominal ultrasound in the detection of early bladder tumours.

We have studied the accuracy of transabdominal ultrasound (TAUS) in the diagnosis of early superficial bladder carcinoma. One hundred and twenty-six patients returning for check cystoscopy were scanned pre-operatively with the Technicare Autosector Scanner and the results compared with the endoscopic findings. Forty-four patients (37%) had a tumour recurrence. TAUS demonstrated a lesion in 50% of these with a false positive rate of 11%. The diagnostic accuracy was proportional to the tumour size (82% of patients with tumours above 5 mm were detected compared with 38% below 5 mm), but was not affected by grade, stage or position in the bladder. TAUS may prove a useful adjunct to cytology as a screening test for bladder cancer.

Is delayed treatment justified in carcinoma of the prostate?

We report a retrospective survey of 263 patients with prostate cancer presenting between 1975 and 1979, with a minimum follow-up period of 5 years. We have evaluated the effects of anti-cancer therapy on survival and disease-free interval. The mean survival time of all patients was 39.6 months. Of 91 patients (37.7%) with demonstrable bone metastases at presentation, 64 (70.3%) have died of prostatic cancer, the mean duration of survival being 25 months. There was no difference in terms of response to treatment or of duration of symptom-free life between patients treated by immediate hormone manipulation and those in whom treatment was delayed. Of 115 patients without metastases at presentation, 42 (36.5%) received no anti-cancer treatment. Thirty-seven (32.2%) have died of unrelated causes and 39 (33.9%) are alive and well. Neither survival nor subjective response to treatment was adversely affected by delaying treatment.

Pituitary ablation in the relief of pain in advanced prostatic carcinoma.

Fifty-five patients with diffuse pain due to bone metastases from prostate carcinoma were treated by pituitary ablation (53 with intrasellar Yttrium 90 and 2 with intrapituitary alcohol instillation). The provisional criteria of the British Prostate Group were used to assess results. Post-operatively, 44 patients (80%) were significantly free of pain and 12 of them were completely pain-free. In only 11 cases (20%) was there no relief of pain. Of the 39 patients who required narcotics before ablation, only 12 required them post-operatively. Pituitary ablation with Yttrium 90 has an important place in the relief of pain in advanced carcinoma of the prostate, although survival is not increased.