Intermediate-risk group in patients with transitional cell carcinoma of the bladder: prediction of high-risk patients in this heterogeneous group.

OBJECTIVE: To determine whether recurrence at first follow-up cystoscopy predicts future recurrence in patients with an intermediate risk of superficial bladder cancer. METHODS: In total, 304 patients were classified as low (n = 60), intermediate (n = 177) or high risk (n = 67) based on the primary pathological/clinical findings, as previously described in literature. The intermediate-risk group was further divided into 2 subgroups based on recurrence at the first follow-up cystoscopy: A (recurrence negative) and B (recurrence positive). RESULTS: The mean recurrence rates of low-, intermediate- and high-risk patients were 1.76, 6.41 and 9.49, respectively (p < 0.05). Similarly, the difference in the recurrence rates between subgroups A (4.37) and B (9.12) was found to be statistically significant (p = 0.00). Additionally, while the difference between the low-risk group and subgroup A was statistically significant (p = 0.008), there was no significance between subgroup B and the high-risk group (p = 0.892). In the multivariate analysis, the most significant prognostic parameter for recurrence was the outcome of the first follow-up cystoscopy, followed by tumor multiplicity and grade. CONCLUSIONS: Patients showing recurrence at first follow-up cystoscopy in the intermediate-risk group should be classified as high-risk patients and treated accordingly.

Urinary excretion of sialic acid in patients with superficial bladder tumors.

Urinary total sialic acid/creatinine (TSA/Cr) ratio was determined in 73 patients with superficial bladder tumors and 34 healthy volunteers. The mean TSA/Cr value in the tumor group was higher than the control group (P < 0.001) and this difference was significant. Comparing the urinary TSA/Cr ratio of Tl, Ta, grade I-II, grade III, single, multiple, primary and recurrent tumors, with the control group revealed significant results (P < 0.001). Therefore the urinary TSA/Cr ratio determination in the follow-up of these patients may be used as a non-invasive procedure.

Repetition of color Doppler ultrasonography: is it necessary?

The aim of the study was to determine whether any difference would occur in peak systolic velocity (PSV) and end diastolic velocity (EDV) measurements of color Doppler ultrasonography (CDU) between proximal and distal segments of the cavernous arteries obtained at different times. Twenty-six cases have undergone CDU three times in weekly intervals. PSV and EDV measurements of cavernous arteries were obtained both proximally and distally. The results have shown that statistically there was no difference between each measurement obtained on either sides at three different tests. (ANOVA PSV F(2-50) = 0.63, EDV F(2-50) = 0.81). Four of the 26 cases had different PSV results and six cases had different EDV results in three CDU tests. There was a statistical difference in measurements between proximal and distal segments of the cavernous arteries. (t-test t = 2.53, P = 0.015) In conclusion, repetition of CDU would not be necessary in majority of the cases. However investigators should always be aware and cautious about falsely abnormal results of CDU. Proximal segments of the cavernous arteries should be the site to obtain true CDU measurements.

Transitional cell carcinoma of the bladder in patients under 40 years of age.

There are conflicting reports about the natural history and prognosis of bladder tumours in patients under 40 years of age. A review of 156 patients younger than 40 treated at our Department between 1960 and 1991 with transitional cell carcinoma of the bladder revealed that 89.1% had superficial (Ta/T1) disease and the remaining 10.9% presented with invasive disease. Slightly more than half of the patients with superficial disease had multiple tumours. The follow-up of 97 patients over a period of 12-372 months revealed that there was a recurrence rate of 10.3% and 38.4% for Ta and T1 tumours, respectively (p < 0.01). Further analysis comparing patients under 30 to those between 30 and 40 years revealed recurrence rates of 7.5% and 22%, respectively (p < 0.05). Progression rates for Ta and T1 tumours are 3.5% and 19.3% (p < 0.05). In the invasive disease group 8 patients were lost for follow-up, 2 died of the disease and the remaining 7 are alive, with a mean follow-up of 3.6 years. We conclude that while transitional cell carcinoma of the bladder in patients under 30 behave less aggressively, the behaviour of the disease in patients 30 to 40 years old is similar to the older age group and should be monitored closely, especially when risk factors for recurrence and progression are present.

The value of serum prostate specific antigen and other parameters in detecting bone metastases in prostate cancer.

The cut-off value of serum prostate-specific antigen (PSA) level in prediction of bone metastases and the correlation of serum PSA with the clinical stage, grade, score and the rate of bone metastases have been investigated in cases of prostate cancer (PCa). The study population consisted of 160 patients with histologically proven PCa between April, 1993 and August, 1996. The negative predictive value and the sensitivity were the highest (94%) in patients with a serum PSA value less than 10 ng/ml. We claim that in patients with PSA values less than 10 ng/ml whole body bone scan is not necessary.

Retrovesical leiomyosarcoma.

A case of retrovesical leiomyosarcoma in a male patient is described. The preoperative radiological and laboratory studies were inconclusive in determining the primary origin of the tumor. Diagnosis of a malignant tumor with smooth muscle origin was suggested by needle biopsy. However, the definitive diagnosis and the primary site of origin could only be determined by surgical exploration and subsequent histopathologic examination after excision. No sign of recurrence or metastasis was present 12 months after complete surgical resection.

Complications of the Mainz pouch II (sigma rectum pouch).

OBJECTIVE: The complications of the sigma rectum pouch were analyzed. METHODS: A total of 60 patients who underwent a construction of the Mainz pouch II was analyzed retrospectively. Data on early complications was available for all patients, while long-term follow-up data was available for 50 patients. RESULTS: Perioperative mortality was nil. Early complications were encountered in 2 (3.3%) patients. Oral alkalizing supplementation therapy was required in 30 (60%) of the patients; 3 (6%) patients needed hospitalization for severe acidosis and hypokalemia. Hydronephrosis developed in 5 (5%) of 98 renoureteral units anastomosed. Acute pyelonephritis was observed in 3 (8%) patients. All of the patients were continent except for 1 female patient who had had previous radiotherapy to the pelvis. The mean voiding frequency during the day and night was 5.1+/-1.1 and 1.9+/-0.7, respectively. The psychological state and general health of 2 patients became progressively worse until they died of probable malnutrition and metabolic abnormalities. Mechanical bowel obstruction developed in 1 patient 2 years after surgery. CONCLUSION: The complication rate of the Mainz pouch II appears to be acceptable with a median follow-up of 31 months. Patient selection and cooperation are of paramount importance for a successful outcome.

Urinary excretion of glycosaminoglycans in patients with superficial bladder tumors.

Urinary glycosaminoglycan/creatinine (GAG/Cr) ratio was determined in 73 patients with superficial bladder tumors and 34 healthy volunteers. While the mean GAG/Cr value in the tumor group was higher than the control group (11.25 +/- 5.36 vs. 10.11 +/- 2.67) this difference was not statistically significant. However, comparing the urinary GAG/Cr ratio of T1, Grade III and recurrent tumors with the control group revealed statistically significant results (p < 0.01, p < 0.001 and p < 0.02 respectively). Therefore, the urinary GAG/Cr ratio determination in the follow-up of these patients may be used as noninvasive procedure and high levels may be signs of higher grade, higher stage disease.