Is it possible to stop follow-up of patients with primary T1G3 urothelial carcinoma of the bladder managed with intravesical bacille Calmette-Guérin immunotherapy?

BACKGROUND: Recurrence and progression of T1 grade 3 (T1G3) urothelial bladder carcinomas (UBCs) treated with bacille Calmette-Guérin (BCG) are common events, but the long-term follow-up of the disease remains controversial. OBJECTIVE: To evaluate the long-term outcomes of BCG intravesical therapy in relation to disease recurrence and progression in primary T1G3 UBCs and upper tract disease. PATIENTS AND METHODS: A single-institution, retrospective, population-based analysis of 316 patients with primary T1G3 UBC treated with transurethral resection (TUR) and BCG induction intravesical instillations was performed. Response was determined and monitored by routine periodic urine cytology, cystoscopy, and upper tract imaging. RESULTS: The median follow-up was 70 months (maximum 210 months). Among all of the tumours, 49.4 % did not relapse, 48.7 % recurred in the bladder during the first 5 years of surveillance, and only 6 patients (1.9 %) recurred after being free of disease during the first 5 years of follow-up. Nineteen percentage of the UBCs progressed to stage T2, and only 2 patients (1.2 %) progressed after the first 5 years of surveillance. An upper urinary tract recurrence was detected in 9.2 % of the patients; 65.5 % were diagnosed within the upper urinary tract during the first 5 years of follow-up. CONCLUSIONS: Following a 5-year tumour-free period, there is minimal risk of recurrence and progression in T1G3 UBCs treated with TUR and BCG induction intravesical instillations. This finding supports a less intensive and potentially less invasive surveillance scheme of bladder follow-up and upper urinary tract imaging in patients without any recurrence.

Robotic kidney transplantation: one year after the beginning.

INTRODUCTION: Kidney transplantation (KT) is the preferred treatment for patients with end-stage renal disease (ESRD). To reduce the morbidity of the open surgery, a robotic-assisted approach has been recently introduced. Our aim is to evaluate surgical and functional results on 17 cases of robotic-assisted kidney transplantation (RAKT) performed at the same institution. MATERIALS AND METHODS: From July 2015 to June 2016, we performed 17 cases of RAKT from living donors in pre-emptive patients, who underwent laparoscopic nephrectomy. A prospective pilot study was made at Fundació Puigvert (Barcelona), evaluating functional and surgical outcomes. In this series, we considered the functional results, surgical outcomes and complications rates. RESULTS: Seventeen patients successfully underwent RAKT, in particular surgical console time was 181 min (150-200) with vascular suture time 42 min (32-48), and estimated blood loss <70 ml. Overall ischemia time was 98.9 min (84-140). No patient was converted to open transplantation. No major surgical intra-operative complications were observed. The mean post-operative serum creatinine level 160 µmol/L (81-479). We reported a case of delayed graft function (DGF), one case of graft arterial thrombosis and one case of intraperitoneal hematoma. No anastomosis revision and wounds infections occurred. CONCLUSION: RAKT with regional hypothermia appears to be a safe surgical procedure in a properly selected group of patients. The potential advantages of RAKT are related to the quality of the vascular anastomosis, the possible lower complication rate and the shorter recovery of the recipients.

Acute Renal Failure Secondary to Rhabdomyolysis as a Complication of Major Urological Surgery: The Experience of a High-Volume Urological Center.

OBJECTIVE: The aim of this study was to determine the incidence of acute renal failure secondary to rhabdomyolysis (ARFSR) as a complication of major urological surgery (MUS), as well as to describe the clinical characteristics and identify possible risk and protective factors. SUBJECTS AND METHODS: Cases of ARFSR due to MUS between January 1997 and August 2011 were identified using the institutional database. The incidence was estimated and the clinical characteristics were analyzed using simple scatterplot graphs to identify possible risk and protective factors. RESULTS: In this period, 14,337 MUS procedures were performed, in which 4 cases suffered from ARFSR (the incidence rate was 0.03%). The incidence rates after radical cystectomy and urethroplasty were 0.26% (3/1,175 cases) and 0.15% (1/651 cases), respectively. No case of rhabdomyolysis was reported among the patients who underwent other major surgical procedures. Two patients required dialysis, and all 4 patients recovered to their baseline renal function at an average of 11 days (7-17) with the appropriate treatment. Male gender, younger age, lower ASA score, prolonged operative time, high body mass index, elevated preoperative serum creatinine and estimated blood loss were possible risk factors for developing ARFSR due to MUS. We found that a higher intraoperative administered volume was a possible protective factor. The operative position and type of surgery seemed to play minor roles. Early diagnosis and treatment possibly leads to an improved outcome. CONCLUSION: In our study, ARFSR due to MUS was a rare entity and had a good prognosis. It was more frequent as a complication of radical cystectomy. Further studies are required to confirm our findings.

ΔNp63 expression is a protective factor of progression in clinical high grade T1 bladder cancer.

PURPOSE: Several risk factors have been claimed to predict the progression of clinically high grade T1 bladder tumors. However, these factors are not specific enough to define which patients should be treated immediately with radical cystectomy. Therefore, it is critical to identify molecular markers that can help provide individualized, risk stratified decision making. Our main goal was to evaluate the role of total p63, p53 and ΔNp63 expression in cases of clinically high grade T1 bladder cancer progression. MATERIALS AND METHODS: Total p63, p53 and ΔNp63 expression was analyzed by immunohistochemistry in 134 clinically high grade T1 tumors. We assessed clinical progression to muscle invasive disease or radical cystectomy as a patient outcome end point. Survival analysis was done for recurrence-free, progression-free, disease specific and overall survival. RESULTS: A total of 132 patients (98.5%) underwent repeat transurethral resection. Cases of early progression (less than 3 months) were excluded from study to avoid under staging. Of the tumors 90 (67.2%) showed ΔNp63 expression loss. During a median followup of 62.1 months 19 patients (14.2%) progressed to muscle invasive disease. The progression rate was 21.1% in patients with tumors characterized by ΔNp63 loss but no progression was observed in those with tumors with ΔNp63 expression (p <0.001). There was no difference in the number of patients who underwent repeat transurethral resection, had associated carcinoma in situ, showed lymphovascular invasion or received followup intravesical bacillus Calmette-Guérin courses. CONCLUSIONS: ΔNp63 expression is a favorable prognostic factor in clinically high grade T1 bladder cancer. This marker identifies patients at low risk for progression who could benefit from conservative therapy with transurethral bladder tumor resection and bacillus Calmette-Guérin, avoiding over treatment with immediate radical cystectomy.

Mini-laparoscopic live donor nephrectomy with the use of 3-mm instruments and laparoscope.

PURPOSE: To analyze our preliminary outcomes on the use of 3 mm instruments for laparoscopic live donor nephrectomy (LLDN). METHODS: Our series includes thirteen patients, who underwent LLDN using 3-mm instruments and laparoscope and 5-mm transumbilical trocar. The patients were followed at 7 and 14 days from discharge and were specifically asked about their cosmetic satisfaction. At follow-up, the recipient graft function was controlled, as well as the donor's cosmetic results. Eight months after surgery, all thirteen patients were asked to fill out the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). RESULTS: All patients presented good recovery after surgery. Regarding cosmetic outcomes, the donors expressed their satisfaction toward the minimal incision size and optimal esthetic results at 7 and 14 days from discharge home. The low scores on each section of the PSAQ confirmed the favorable outcomes. Early graft function was satisfactory at 1 and 3 months after the kidney transplantation. Furthermore, there were no major complications in the recipients. CONCLUSIONS: Our persistent positive results with the use of 3-mm instruments during LLDN support this technique as a good alternative to the standard laparoscopic approach for minimizing the incision site, while maintaining safety and excellent clinical outcomes. The fact that the general laparoscopic standards are maintained could make this approach a very attractive alternative to the other minimally invasive approaches for live donor nephrectomy. The hope is in that the higher degree of satisfaction in the donor population demonstrated in this study may likely enhance living kidney donation.

Clinical and pathological outcomes of renal cell carcinoma (RCC) in native kidneys of patients with end-stage renal disease: a long-term comparative retrospective study with RCC diagnosed in the general population.

PURPOSE: Patients with end-stage renal disease (ESRD) have an increased risk of developing renal cell carcinoma (RCC). This retrospective study compared clinical and pathological outcomes of RCC occurring in native kidneys of patients with ESRD (whether they underwent kidney transplantation or not) with those of renal tumors diagnosed in the general population. METHODS: The study included a total of 533 patients with RCC. The ESRD cohort included 92 patients with RCC in native kidneys. Of these, 58 and 34 cases were identified before (pre-Tx group) and after kidney transplantation (post-Tx group), respectively. The control group was composed of 441 RCCs diagnosed in the general population. Variables were compared by chi-square and Student's t tests. Cancer-specific survival was assessed by Kaplan-Meier and Cox methods. RESULTS: The ESRD groups had smaller (P = 0.001), lower-grade, and lower-stage tumors than the non-ESRD group (P = 0.001). The papillary RCC rate was higher in the ESRD groups (P = 0.01). Ten-year cancer-specific survivals were 94.5, 87.9, and 74.6 % in pre-Tx, post-Tx, and non-ESRD patients, respectively (P = 0.003). Mean follow-up was 90.2 months. At multivariate analysis, tumor size (HR = 1.10), pathological stage (HR = 1.46), presence of nodal (HR = 2.22) and visceral metastases (HR = 3.49), and Fuhrman grade (HR = 1.48) were independent adverse prognostic factors for cancer-specific survival. CONCLUSIONS: Native kidney RCCs arising in ESRD patients are lower stage and lower grade as compared to RCCs diagnosed in the general population, and these tumors exhibit favorable clinical and outcome features.

Prostate cancer incidence and newly diagnosed patient profile in Spain in 2010.

UNLABELLED: What's known on the subject? and What does the study add? Prostate cancer (PCa) accounts for 12% of newly diagnosed cases of cancer in Europe. It is one of the most frequently diagnosed tumours in the developed world. Since the introduction of prostate specific antigen as a test for early detection of PCa, the rate of diagnosis has increased significantly and specific mortality has reduced in most western countries. Most of the data on the incidence of PCa are obtained from population-based cancer registries which frequently do not cover the whole population. This first national hospital-based PCa registry aims not only to estimate the incidence of the disease but to ascertain the clinical profile of newly diagnosed PCa patients, a useful tool for evaluating the impact of the disease and its socio-health management. OBJECTIVES: • To estimate the 2010 incidence of prostate cancer (PCa) in Spain. • To describe the clinical profile of newly diagnosed cases using a nationwide hospital-based registry. PATIENTS AND METHODS: • This was a national epidemiological observational study in 25 public hospitals with a specific reference population according to the National Health System. • Sociodemographic and clinical variables of all newly diagnosed, histopathologically confirmed PCa cases were collected in 2010, in the area of influence of each centre. Cases diagnosed in private practice were not collected (estimated nearly 10% in Spain). • Data monitoring was external to guarantee quality and homogeneity. • The age-standardized PCa incidence was determined based on the age distribution of the European standard population. RESULTS: • In all, 4087 new cases of PCa were diagnosed for a reference population of 4933940 men (21.8% of the Spanish male population). • The estimated age-standardized PCa incidence was 70.75 cases per 100000 men. • Mean age at diagnosis was 69 years; 11.6% of patients presented with tumour-related symptoms and 39.5% with LUTS. Median PSA was 8 ng/mL. Gleason score was ≤ 6 in 56.5%, 7 in 26.7% and >7 in 16.8% of patients. At diagnosis, 89.8% had localized, 6.4% locally advanced and 3.8% metastatic disease. CONCLUSIONS: • This study on PCa incidence in Spain, a western country with intensive opportunistic PSA screening, shows that PCa is a high incidence tumour, diagnosed close to 70 years, usually asymptomatic. • Almost 40% of cases have low risk disease with a risk of over-diagnosis and over-treatment. • Around 55% of patients with intermediate or high risk disease are candidates for active therapy which may result in a reduction of cancer-specific mortality.

Clinical predictive factors of poor outcome in patients with stage pT0 disease at radical cystectomy.

PURPOSE: We evaluated new pre-cystectomy predictive factors for outcomes in patients with no evidence of residual tumor at cystectomy (pT0). MATERIALS AND METHODS: A total of 1,114 patients underwent radical cystectomy at our institution between August 1978 and June 2002, of whom 141 (12.66%) had stage pT0. We analyzed overall and disease specific survival in relation to pre-cystectomy predictive factors, such as clinical stage, grade, size, previous nonmuscle invasive disease, number of previous recurrences, associated carcinoma in situ and lymphovascular invasion in the transurethral resection. Other factors analyzed were lymph node (N+) at cystectomy and induction chemotherapy. RESULTS: Clinical stage was cTa in 10 patients, cT1 in 34, cT2 in 55, cT3 in 30 and cTis in 12. At a median followup of 42.5 months overall survival was 62.53% and disease specific survival was 79.14%. Metastatic disease developed in 17 cases (12.1%). Univariate analysis revealed worse disease specific survival in patients in whom muscle invasive tumor developed after nonmuscle invasive disease (p<0.05), and in those who presented with 5 or more previous recurrences (p<0.05), lymphovascular invasion in the transurethral resection (p<0.05) and N+ at cystectomy (p<0.05). Multivariate analysis confirmed a statistically significant association between disease specific survival and 5 or more previous recurrences (HR 1.5, 95% CI 1.07-2.10, p=0.018), muscle invasive tumor after nonmuscle invasive disease (HR 4.4, 95% CI 1.20-16.5, p=0.026) and lymphovascular invasion in the transurethral resection (HR 1.7, 95% CI 1.12-2.30, p=0.04). CONCLUSIONS: Although clinical outcomes in patients with stage pT0 disease are often excellent, metastatic disease develops in a percentage of them. Muscle invasive tumor after primary nonmuscle invasive disease, 5 or more previous recurrences and lymphovascular invasion in the transurethral resection predict poor survival.

Prepubertal testicular tumours and efficacy of testicular preserving surgery.

STUDY TYPE: Therapy (case series). LEVEL OF EVIDENCE: 4. What's known on the subject? and What does the study add? Testicular tumours in childhood are very rare. Historically, most of these tumours have been considered malignant, but more recent studies indicate that benign lesions, particularly teratoma, are much more frequent than previously thought. Testicular tumours in this age group have traditionally been treated with inguinal radical orchiectomy, but more conservative management has been proposed in view of the higher frequency of benign tumours. In children, most testicular tumours are benign, especially before puberty. A testis-sparing procedure should be performed in children with a palpable testicular mass and negative tumour markers. OBJECTIVE: To report our experience of testicular tumours in children aged≤13 years, including our experience with testis-sparing surgery. PATIENTS AND METHODS: A retrospective study was performed of 15 patients with testicular tumours aged≤13 years who presented at our centre between 1984 and 2008. The use of testis-preserving surgery according to indication was investigated and outcomes were recorded. RESULTS: The clinical presentation was increased testicular size with a palpable mass in 80% of the cases. All 15 patients underwent surgery. The tumour was benign in 12 (80%) patients and malignant in three (20%) patients. Organ-preserving surgery was planned and achieved in 11 patients (73%). Pathology of the tumourectomy specimens disclosed benign tumours in all cases: four epidermoid cysts, two teratomas, one juvenile granulosa cell tumour, one haemangioma, one lipoma, one fibrous hamartoma and one splenogonadal fusion. In four patients who underwent radical orchiectomy, pathology identified one yolk sac tumour (stage I), two mixed germ cell tumours and one gonadoblastoma. CONCLUSIONS: In children, most testicular tumours are benign, especially before puberty. A testis-sparing procedure should be performed in children with a palpable testicular mass and negative tumour markers. The lesion, however, should be thoroughly excised to avoid recurrences.

Can we identify those patients who will benefit from prostate-sparing surgery? Predictive factors for invasive prostatic involvement by transitional cell carcinoma.

OBJECTIVES: To determine which patients may benefit from prostate-sparing surgery and which factors are predictive of invasive prostatic involvement. MATERIALS AND METHODS: A total of 717 men underwent radical cystoprostatectomy (RC) for bladder transitional cell carcinoma (TCC) between 1978 and 2002. Analysis of prostatic urethral involvement by transitional cell carcinoma (pTCC) and of invasive prostatic involvement by TCC was performed according to recurrence, presence of carcinoma in situ (CIS) and multifocality, previous intravesical chemotherapy, grade, stage and location of bladder tumor, presence of CIS in precystectomy transurethral resection (TUR) and indication for RC. RESULTS: pTCC was present in specimens from 140 patients (19.5%), of whom 83 (59.3%) showed invasive prostatic involvement. Tumor location at the trigone or bladder neck (p = 0.011, OR 2.29, 95% CI 1.21-4.33) and a history of CIS (p = 0.003, OR 2.03, 95% CI 1.27-3.22) were independent predictors of pTCC. Presence of a solitary T2-T3 bladder tumor was a predictive factor for invasive prostatic involvement (p = 0.001, OR 3.73, 95% CI 1.70-8.16). Neither solitary tumors nor T2-T3 bladder tumors showed significant differences in 5 year specific survival (p = 0.277 and p = 0.618 respectively) when comparing patients according to the presence of superficial or invasive prostatic involvement. Bladder tumor stage in precystectomy TUR was a predictor of disease-specific survival (p = 0.018, OR 1.62, 95% CI 1.08-2.44). CONCLUSIONS: Patients with a history of CIS and bladder tumor location at the trigone or bladder neck are not candidates for prostate-sparing surgery. The only variables that can predict invasive prostatic involvement are the presence of a solitary T2-T3 bladder tumor at the trigone or bladder neck.

Laparoscopic management of spontaneous retroperitoneal hemorrhage.

Wünderlich's syndrome is a spontaneous nontraumatic massive retroperitoneal hemorrhage. It is usually secondary to a renal neoplasm, with angiomyolipoma being the most frequent followed by renal cell carcinoma. The management of spontaneous retroperitoneal bleeding varies depending on the hemodynamic status of the patient. We present the first report of a transperitoneal laparoscopic nephrectomy in a patient with spontaneous retroperitoneal active bleeding secondary to a right renal mass.

Invasive bladder cancer in the eighties: transurethral resection or cystectomy?

PURPOSE: Describe morbidity and survival in patients older than 80 years with muscle invasive bladder cancer (MIBC) treated with radical cystectomy (RC) or transurethral resection (TUR) in our institution. MATERIALS AND METHODS: We reviewed our database of all patients older than 80 years treated with RC and TUR for MIBC between 1993 and 2005 in our institution. Twenty-seven patients were submitted to RC, with mean age of 82 years and mean follow-up of 16.4 months. RC was carried out following diagnosis of previous MIBC in 14 cases (51.9%). The American Society of Anesthesiology (ASA) score was III or IV in 23 patients (85.1%). Seventy-two patients with a mean age of 84 years and mean follow-up of 33 months, diagnosed with MIBC, were managed by means of TUR. The ASA score was III-IV in 64 (88.8%) patients. RESULTS: Pathological stage of the RC specimen was pT3 in 18 cases (66.7%). Mean hospital stay was 16 days. Early complications were assessed in 8 patients (29.6%), with an overall survival (OS) of 42.94%, and cancer-specific survival (CSS) of 60.54%. In patients submitted to TUR, clinical stage was T2 in 36 cases (50%). The mean hospital stay was 7 days, with a readmission rate (RR) of 87.5%. OS and CSS was less than 20%. CONCLUSIONS: RC in octogenarian patients is a safe procedure, with complication and survival rates comparable to RC series in general population. Transurethral resection (TUR) for patients with MIBC within this age range is a much less morbid procedure, but disease specific survival is lower.

A re-adjustable sling for female recurrent stress incontinence and sphincteric deficiency: Outcomes and complications in 125 patients using the Remeex sling system.

AIMS: To evaluate the outcomes, complications, and quality of life of patients after a Remeex re-adjustable sling for recurrent stress urinary incontinence (SUI) and intrinsic sphincteric deficiency (ISD) indications. METHODS: One hundred twenty-five patients with SUI were prospectively evaluated following a re-adjustable sling in a single tertiary academic Center. Patients were classified by Q-tip, urodynamic and clinical criteria into ISD (70) and recurrent SUI (55). All patients underwent a re-adjustable sling placement. Outcome measures included pad-test, urodynamics, and the King's Health Questionnaire. RESULTS: After a mean follow-up of 38 months (26-72), 109 patients (87%) are cured of SUI based on pad-test, clinical, and urodynamic criteria. Sixteen patients (13%) remain incontinent. Nine of those (7%) are satisfied to the point that they decline re-adjustment of the sling, and seven (6%) are on the waiting list for re-adjustment. Nineteen patients show urge incontinence (9 with previous urodynamic mixed incontinence, 10 (8%) with de novo detrusor overactivity). Twenty-one patients benefited from a re-adjustment of the sling during the follow-up. The tension was increased in 17 cases (continent at discharge) due to recurrence of SUI, and reduced in 4 due to obstruction. The Varitensor was removed in 1 case due to infection. No other complications were seen. CONCLUSIONS: The Remeex re-adjustable sling system provides a good cure rate for recurrent SUI and ISD with a low complication rate. The ability to increase or decrease sling tension allowed us to achieve cure in patients who were not initially dry, and to relieve obstruction in every case attempted.

The case for conservative management in the treatment of patients with non-muscle-invasive micropapillary bladder carcinoma without carcinoma in situ.

INTRODUCTION: Micropapillary carcinoma is a rare pathologic variant of urothelial cell carcinoma. Intravesical bacillus Calmette-Guérin (BCG) has been reported to be ineffective and to entail an increased risk of development of non-organ-confined, metastatic disease. We assess the treatment response and disease progression in patients with micropapillary carcinoma of the bladder. MATERIALS AND METHODS: The study comprised 18 patients with micropapillary carcinoma of the bladder who underwent transurethral resection of a bladder tumor and multiple random biopsies between 1997 and 2003. We retrospectively analyzed treatment response and clinical and pathological cancer evolution related to cancer stage and the percentage of the micropapillary component of the cancer. RESULTS: Seven of the 18 patients (38.8%) had carcinoma in situ. At diagnosis, 8 of the 18 patients had non-muscle-invasive bladder cancer; 6 of these patients were treated with intravesical BCG therapy and were alive and free of disease at a median follow up of more than 5 years. Ten of the 18 patients had muscle-invasive bladder cancer; 8 of these patients underwent radical cystectomy, and 7 of the 8 patients (87.5%) had non-organ-confined disease in cystectomy specimens. Seventy percent of patients with muscle-invasive disease at diagnosis had a micropapillary carcinoma component of more than 50% in transurethral resection of the bladder specimens, compared with only 25% of patients with non-muscle-invasive disease. Patients treated successfully with intravesical BCG therapy had a low micropapillary carcinoma component. The 5-year disease-specific survival rate was significantly lower in patients with muscle-invasive disease (30%) than in patients with non-muscle-invasive disease (87.5%) after a median follow up of 52 months (p = 0.001), and it was also significantly lower in patients with a high percentage of the micropapillary component of the carcinoma. CONCLUSIONS: This retrospective study of 18 patients with micropapillary carcinoma of the bladder suggests that tumor stage and patient outcome may be related to the percentage of the micropapillary component of the carcinoma. Radical surgery is mandatory in muscle-invasive disease, even though patients with lymph node involvement die from the disease. In non-muscle-invasive disease and in the absence of associated carcinoma in situ, intravesical BCG treatment may be offered when the micropapillary component of the carcinoma component is a small percentage.

Bladder preservation strategy based on combined therapy in patients with muscle-invasive bladder cancer: management and results at long-term follow-up.

OBJECTIVE: To evaluate a bladder preservation strategy in patients with either muscle-invasive bladder cancer (MIBC) or development of MIBC cancer due to progression of non-muscle-invasive bladder cancer (NMIBC). METHODS: Between October 1982 and March 1998, 48 patients (mean age 61 years, range 45-75) with MIBC (T2a-b and T3a) were treated using transurethral resection followed by three cycles of systemic chemotherapy. 42 patients (87.5%) had primary MIBC and 6 (12.5%) had MIBC subsequent to NMIBC. After chemotherapy, 39 patients (81.25%) achieved complete remission and 4 (8.3%) partial remission. RESULTS: With a median follow-up of 98.5 months (13-246), the overall survival of the 48 patients was 62.6%. The cancer-specific survival (CSS) of the 39 patients with complete remission was 80.8%. Among the 39 patients with complete remission, 19 had invasive recurrence during follow-up with a CSS of 53.2%; by comparison, among patients with preserved bladders, CSS was 72.1% (p = 0.046). Predictive factors analysed were age, sex, tumour size >3 cm, grade, associated carcinoma in situ (CIS), number of tumours and number of previous recurrences. In multivariate analysis only tumour size and CIS were significant predictive factors for progression after preservation. Of the 6 patients with MIBC after NMIBC, 3 (50%) had no remission and underwent cystectomy and 15 patients (38.6%) had NMIBC recurrences during follow-up. CIS and high-grade tumours were treated with bacillus Calmette-Guérin. A bladder preservation rate of 81% and a CSS rate of 89% were obtained in the group with NMIBC recurrences. CONCLUSIONS: Conservative management of MIBC cancer is a feasible alternative to cystectomy in selected cases. Patients with MIBC after progression of primary NMIBC are not good candidates for a bladder preservation approach. NMIBC recurrences after bladder preservation in patients with MIBC respond to transurethral resection and bacillus Calmette-Guérin instillations.

DNA microarray expression profiling of bladder cancer allows identification of noninvasive diagnostic markers.

PURPOSE: There is a need in urological practice to identify new bladder cancer molecular markers to further develop noninvasive diagnostic tests. We analyzed bladder cancer gene expression profiles to determine the relevant differentially expressed genes and whether this differential expression is maintained in urine samples. MATERIALS AND METHODS: We collected 55 tissue specimens from a total of 43 patients with bladder cancer and 12 controls, and 49 urine samples from bladder washings from a total of 36 patients with bladder cancer and 13 controls between September 2003 and December 2004. DNA microarrays (GeneChip Human Genome U133 Plus 2.0 Array) were used to identify differentially expressed genes at 3 bladder cancer stages. Selected differentially expressed genes were validated in an independent set of bladder washings by quantitative reverse transcriptase-polymerase chain reaction. RESULTS: Unsupervised cluster analysis of DNA microarray data showed a clear distinction in control vs tumor samples and low vs high grade tumors. Genes with at least 2-fold differential expression in controls vs tumors (2,937 probe sets or 2,295 genes) and in low vs high grade tumors (674 probe sets or 530 genes) were identified and ranked. Gene expression measurements in bladder washings of the 6 most differentially expressed genes in controls vs tumors were confirmed for the 2 over expressed genes tested by quantitative reverse transcriptase-polymerase chain reaction. All 8 selected differentially expressed genes in low vs high grade tumors were confirmed in bladder washing samples. CONCLUSIONS: Bladder cancer analysis by DNA microarrays provides new putative mRNA markers for bladder cancer diagnosis and/or prognosis that can be extrapolated to bladder fluids.

Efficiency of endoscopic treatment for vesico-ureteric reflux in adults.

OBJECTIVE: To evaluate the results of our experience with endoscopic management of vesico-ureteric reflux (VUR) in adults, and to describe factors and complications that might contribute to the failure of the technique. PATIENTS AND METHODS: Between 1992 and 2006, 21 patients (17 women and four men; mean age 32.1 years, SD 15.6) had endoscopic treatment for VUR (14 unilateral and seven bilateral ureteric units, UU). Patients previously operated for VUR were excluded. The VUR grades were II, III, IV and V in 10, 12, five and one UUs, respectively. The main indication for treatment was a history of repeated episodes of acute pyelonephritis (61%). Complications after surgery were evaluated. RESULTS: The success rate of the first endoscopic treatment was 69%, and was 81% after the second. Two UUs with grade IV VUR were endoscopically managed for a third time with complete resolution. Only one UU with grade V VUR required open surgery. The success rate for VUR grades II, III and IV after the first treatment was five of eight, 12/12 and one of five, respectively. After the second treatment the success rate increased to seven of eight and two of five for grades II and IV, respectively. There were no complications related to the intervention. Factors related to a failure of technique were duplex ureter and dysfunctional voiding in eight UUs (seven patients). CONCLUSIONS: The endoscopic management of VUR in previously untreated adult patients is a simple and efficient technique, with low comorbidity.

Health-related quality of life 2 years after treatment with radical prostatectomy, prostate brachytherapy, or external beam radiotherapy in patients with clinically localized prostate cancer.

PURPOSE: To compare treatment impact on health-related quality of life (HRQL) in patients with localized prostate cancer, from before treatment to 2 years after the intervention. METHODS AND MATERIALS: This was a longitudinal, prospective study of 614 patients with localized prostate cancer treated with radical prostatectomy (134), three-dimensional external conformal radiotherapy (205), and brachytherapy (275). The HRQL questionnaires administered before and after treatment (months 1, 3, 6, 12, and 24) were the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Association Symptom Index. Differences between groups were tested by analysis of variance and within-group changes by univariate repeated-measures analysis of variance. Generalized estimating equations (GEE) models were constructed to assess between-group differences in HRQL at 2 years of follow-up after adjusting for clinical variables. RESULTS: In each treatment group, HRQL initially deteriorated after treatment with subsequent partial recovery. However, some dimension scores were still significantly lower after 2 years of treatment. The GEE models showed that, compared with the brachytherapy group, radical prostatectomy patients had worse EPIC sexual summary and urinary incontinence scores (-20.4 and -14.1; p < 0.001), and external radiotherapy patients had worse EPIC bowel, sexual, and hormonal summary scores (-3.55, -5.24, and -1.94; p < 0.05). Prostatectomy patients had significantly better EPIC urinary irritation scores than brachytherapy patients (+4.16; p < 0.001). CONCLUSIONS: Relevant differences between treatment groups persisted after 2 years of follow-up. Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence. Three-dimensional conformal radiotherapy had a moderate negative impact on bowel functioning, and brachytherapy caused moderate urinary irritation. These results provide relevant information for clinical decision making.

Sorafenib: tolerance in patients on chronic hemodialysis: a single-center experience.

BACKGROUND/OBJECTIVE: Improved understanding of renal cell carcinomas (RCC) and recent contributions in the field of RCC biology led to the development of a novel class of drugs, i.e. multiple-kinase inhibitors, targeting growth factor receptors (e.g. sorafenib). Sorafenib has proven significant benefit in terms of progression-free survival in a phase II trial in RCC patients. A subsequent randomized phase III study (Treatment Approaches in Renal Cancer Global Evaluation Trial) confirmed the significantly prolonged progression-free survival and improvement in the quality of life compared to patients receiving placebo. In the USA and Europe, sorafenib has been approved for the treatment of advanced RCC. PATIENTS: Two RCC patients on chronic hemodialysis were treated with sorafenib. RESULTS: Both patients responded to sorafenib treatment. Apart from high blood pressure, a major adverse effect of sorafenib treatment, treatment was well tolerated, in agreement with previous results. CONCLUSION: The results of our study confirm the beneficial effect of sorafenib in the treatment of RCC in our 2 patients on dialysis.