Oncological followup after radical cystectomy for bladder cancer-is there any benefit?

PURPOSE: Tumor recurrence after radical cystectomy for bladder cancer can be detected in an asymptomatic patient by regular followup or in a symptomatic patient by symptom guided examination. To our knowledge it is still unknown whether detecting tumor recurrence at an asymptomatic stage offers a better survival rate. MATERIALS AND METHODS: A total of 1,270 radical cystectomies for bladder cancer were performed at a single institution between January 1, 1986 and December 2006. All patients had regular followup examinations with chest x-ray and abdominal ultrasound every 3 months, computerized tomography of the abdomen every 6 months, and bone scan and excretory urography every 12 months. Additional examinations were required for symptomatic disease. We analyzed the first site and date of tumor recurrence. Survival was compared using the log rank test. RESULTS: The 20-year recurrence rate was 48.6% in the complete series. Tumor recurrence developed in 444 patients, including 154 asymptomatic and 290 symptomatic patients, with a mean time after radical cystectomy of 20 and 17.5 months, respectively. The most frequent symptoms were pain, ileus, acute urinary retention, hydronephrosis with flank pain, hematuria, neurological symptoms and a palpable mass. Of the 444 patients 182 (41%) had local recurrence and 324 (73%) had distant failure at the time of first recurrence. The overall survival rate 1, 2 and 5 years after first recurrence was 22.5%, 10.1% and 5.5% in asymptomatic patients, and 18.9%, 8.2% and 2.9% in symptomatic patients, respectively (log rank not significant). CONCLUSIONS: This study fails to demonstrate a survival benefit for detecting tumor recurrence early at an asymptomatic stage by regular followup examinations. These data show that symptom guided followup examinations may provide similar results at lower cost.

Nosocomial bacteriuria in patients with indwelling catheter after radical retropubic prostatectomy for prostate cancer.

INTRODUCTION: Patients with prolonged catheter drainage following pelvic surgery are at increased risk for bacteriuria that may have an impact on the clinical course. MATERIALS AND METHODS: We retrieved all urine analyses from 148 consecutive patients that underwent open retropubic radical prostatectomy at our institution in 2002. The following data were generated: number of bacteriuria with day of onset, used antibiotics, microbiological analysis, resistogram, day of catheter removal and clinical postoperative course. RESULTS: 44.6% of the investigated patients presented with bacteriuria. The highest incidence of bacteriuria was between day 13-15 (40.4%). The most common bacteria detected over the hospital stay were Staphylococcus spp. (24.3%). The most common used antibiotic was trimethoprim/sulfamethoxazole (44.6%). The highest susceptibility was found for levofloxacin (62.4%). No difference in time period of catheter drainage was noticeable in patients with bacteriuria compared to patients without bacteriuria. CONCLUSIONS: Bacteriuria is common after radical prostatectomy. To minor the risk of complications related to bacterial infection, the catheter should be removed 7-10 days after surgery. In case of the necessity of longer catheter drainage, an empiric antibiotic therapy seems rational.

Tissue engineered venous matrices for potential applications in the urogenital tract.

Tissue engineering is lacking inexpensive, easily applicable techniques for tissue replacement. We investigated the potential use of native veins for tissue-engineering applications in the urological field. Forty-eight porcine veins, half seeded with urothelial cells and half unseeded, were kept in vitro for 7 days. Four seeded and four unseeded scaffolds were analyzed after 3 and 7 days. The remaining 32 veins were implanted subcutaneously into 16 athymic mice. Four athymic mice were sacrificed after 2, 4, 8, and 12 weeks. Histochemistry, immunohistochemistry (anti-pancytokeratin AE1/AE3, anti-desmin), western blot analyses (CD31), and scanning electron microscopy were performed in the retrieved specimens. The histochemistry of the seeded matrices showed the presence of urothelial cells in vitro and in vivo. After 12 weeks, a multilayer of urothelial cells was present in the hemotoxylin and eosin staining, positive for anti-pancytokeratin AE1/AE3. The western blot analyses showed vascularization of the veins in vivo. The results of scanning electron microscopy revealed a cellular layer on the veins. Native venous matrices may be used as tissue-engineered constructs for reconstructing the urinary tract. The clinical relevance of this approach must be proven in a large-animal model.

Hydronephrosis as a prognostic marker in bladder cancer in a cystectomy-only series.

OBJECTIVES: Hydronephrosis in patients with bladder cancer is caused by tumour at the ureteral orifice, secondary ureteral tumours, intramural or extravesical tumour infiltration, or compression of the ureter. This study investigated the prognostic impact of hydronephrosis in bladder cancer. METHODS: A series of 788 patients were treated with radical cystectomy with curative intent for transitional cell carcinoma of the bladder without neoadjuvant/adjuvant radiotherapy/chemotherapy between January 1986 and September 2003. All patients had a complete follow-up until death or until the study's end date. Survival rates were calculated using the Kaplan-Meier method. A multivariate analysis with a Cox regression model was performed with respect to potential influencing factors. RESULTS: A total of 108 patients (13.7%) had unilateral and 25 patients (3.2%) had bilateral hydronephrosis. The rate of organ-confined tumours was significantly higher in patients without hydronephrosis (67.9% vs. 37.6%; p<0.001). Forty-three (32.3%) of the 133 hydronephrotic patients had a tumour involving the ureteral orifice. In this group the rate of organ-confined tumours was significantly higher than in the other patients with hydronephrosis (53.5% vs. 30.0%; p=0.009). In the multivariate analysis, preoperative hydronephrosis was determined as an independent prognostic marker for recurrence-free survival besides the pT classification and lymph node status (p=0.0015). The etiology of hydronephrosis did not affect the tumour-specific survival. CONCLUSIONS: Hydronephrosis at the time of diagnosis of bladder cancer is associated with a high probability of advanced tumours. It is an independent prognostic factor for recurrence-free survival.

CO-alkene polymers are biocompatible scaffolds for primary urothelial cells in vitro and in vivo.

OBJECTIVE: To investigate CO-alkene polymers, novel synthetic nonbiodegradable polymers, as a potential biomaterial for urological applications. MATERIALS AND METHODS: Porcine urothelial cells were seeded on cover glasses (96 wells; 10 000 cells/well) coated with CO-alkene polymers [propylene/N-Acetyl-O'-(hex-5-enyl)-l-tyrosine ethyl ester/CO (PTCO) and hexene-CO (HxCO)]. The following conditions were investigated: cells seeded; (i) on PTCO, (ii) on HxCO, (iii) in PTCO-conditioned medium, (iv) in HxCO-conditioned medium, (v) on glass without polymers, (vi) on polystyrene, and (vii) on polystyrene treated with 1.25% NaCl (toxic control). Cell counts, cell death detection assay, and a cell activity assay (XTT, a tetrazolium-based colorimetric assay) were performed after 3, 6 and 9 days. Urothelial-cell seeded-PTCO films (0.5 x 10(6) cells/cm(2)) were implanted into the subcutaneous space of athymic mice for up to 12 weeks and unseeded PTCO polymers were implanted as a negative control. RESULTS: The urothelial cell adherence rates on the polymers were similar to those for glass and polystyrene. The cell activity (XTT assay) was higher in cells seeded on the polymers than in cells seeded on polystyrene and glass after 3 and 6 days. There were no significant differences between the apoptosis rates of all groups at the given sample times, except for the high levels in the toxic control. In vivo the urothelial cells survived on the polymers for 12 weeks with no adverse reactions in any of the mice. CONCLUSIONS: CO-alkene polymers are biocompatible materials for urothelial cells in vitro and in vivo, and thus are potential biomaterials for the urogenital tract.