River plastic transport and storage budget.

Rivers are one of the main conduits that deliver plastic from land into the sea, and also act as reservoirs for plastic retention. Yet, our understanding of the extent of river exposure to plastic pollution remains limited. In particular, there has been no comprehensive quantification of the contributions from different river compartments, such as the water surface, water column, riverbank and floodplain to the overall river plastic transport and storage. This study aims to provide an initial quantification of these contributions. We first identified the main relevant transport processes for each river compartment considered. We then estimated the transport and storage terms, by harmonizing available observations on surface, suspended and floodplain plastic. We applied our approach to two river sections in The Netherlands, with a focus on macroplastics (≥2.5 cm). Our analysis revealed that for the studied river sections, suspended plastics account for over 96% of item transport within the river channel, while their relative contribution to mass transport is only 30%-37% (depending on the river section considered). Surface plastics predominantly consisted of heavier items (mean mass: 7.1 g/#), whereas suspended plastics were dominated by lighter fragments (mean mass: 0.1 g/#). Additionally, the majority (98%) of plastic mass was stored within the floodplains, with the river channel accounting for only 2% of the total storage. Our study developed a harmonized approach for quantifying plastic transport and storage across different river compartments, providing a replicable methodology applicable to different regions. Our findings emphasize the importance of systematic monitoring programs across river compartments for comprehensive insights into riverine plastic pollution.

Water hyacinths retain river plastics.

Rivers represent one of the main conduits for the delivery of plastics to the sea, while also functioning as reservoirs for plastic retention. In tropical regions, rivers are exposed to both high levels of plastic pollution and invasion of water hyacinths. This aquatic plant forms dense patches at the river surface that drift due to winds and currents. Recent work suggests that water hyacinths play a crucial role in influencing plastic transport, by efficiently trapping the majority of surface plastic within their patches. However, a comprehensive understanding of the interaction between water hyacinths and plastics is still lacking. We hypothesize that the properties relevant to plastic transport change due to their trapping in water hyacinth patches. In particular, the length scale, defined as the characteristic size of the transported material, is a key property in understanding how materials move within rivers. Here, we show that water hyacinth patches trap on average 54%-77% of all observed surface plastics at the measurement site (Saigon river, Vietnam). Both temporally and spatially, we found that plastic and water hyacinth presence co-occur. The formation of plastic-plant aggregates carries significant implications for both clean-up and monitoring purposes, as these aggregates can be detected from space and need to be jointly removed. In addition, the length scale of trapped plastics (∼4.0 m) was found to be forty times larger than that of open water plastics (∼0.1 m). The implications of this increased length scale for plastic transport dynamics are yet to be fully understood, calling for further investigation into travel distances and trajectories. The effects of plastic trapping likely extend to other key properties of plastic-plant aggregates, such as effective buoyancy and mass. Given the prevalence of plant invasion and plastic pollution in rivers worldwide, this research offers valuable insights into the complex environmental challenges faced by numerous rivers.

Defining plastic pollution hotspots.

Plastic pollution in the natural environment poses a growing threat to ecosystems and human health, prompting urgent needs for monitoring, prevention and clean-up measures, and new policies. To effectively prioritize resource allocation and mitigation strategies, it is key to identify and define plastic hotspots. UNEP's draft global agreement on plastic pollution mandates prioritizing hotspots, suggesting a potential need for a defined term. Yet, the delineation of hotspots varies considerably across plastic pollution studies, and a definition is often lacking or inconsistent without a clear purpose and boundaries of the term. In this paper, we applied four common definitions of hotspot locations to plastic pollution datasets ranging from urban areas to a global scale. Our findings reveal that these hotspot definitions encompass between 0.8 % to 93.3 % of the total plastic pollution, covering <0.1 % to 50.3 % of the total locations. Given this wide range of results and the possibility of temporal inconsistency in hotspots, we emphasize the need for fit-for-purpose criteria and a unified approach to defining plastic hotspots. Therefore, we designed a step-wise framework to define hotspots by determining the purpose, units, spatial scale, temporal scale, and threshold values. Incorporating these steps in research and policymaking yields a harmonized definition of hotspots, facilitating the development of effective plastic pollution prevention and reduction measures.

Combined effects of precipitation anomalies and dams on streamwater-groundwater interaction in the Fen River basin, China.

Both water management measures like damming and changes in precipitation as a result of anthropogenic induced climate change have exerted profound effects on the dynamics of streamwater-groundwater interaction (SGI). However, their compound effects on SGI have not been investigated so far. Taking the Fen River of China as an example, this study aims to examine the synergistic impacts of damming and precipitation anomalies on SGI dynamics. The sampling considered the seasonal and interannual variability of precipitation (May and September in 2019 representing a dry year; May and August in 2021 representing a wet year), and long-term daily observational data, including water levels and water discharge, were combined to elucidate the compound effects. Precipitation anomalies and damming exert significant individual and combined influences on SGI. Separately, dams and reservoirs reversed the SGI dynamics, significantly increasing the contributions of streamwater to groundwater from 0 to 29 % to 78 % in the dam-affected areas. Further, the groundwater discharge ratios behind the dam (about 60 %) were three times higher than those in front of the dam. Precipitation anomalies significantly amplified interannual variability in SGI patterns, and groundwater discharge ratios increased by 47 % during the dry period (2019) compared to flood period (2021). The combined influence of precipitation anomalies and dam regulation remarkably changed the lateral, vertical, and longitudinal water exchange dynamics. Precipitation anomalies affected the SGI dynamics at the whole watershed scale, whereas dam regulation regimes exhibited a stronger control at the local scale. The compound effects of dam regulation and precipitation anomalies can result in different SGI patterns under various climate scenarios. More attention should be paid to the interrelated feedback mechanisms between damming, extreme precipitation events, and their impact on the watershed-scale hydrological cycle.

Catchment scale assessment of macroplastic pollution in the Odaw river, Ghana.

Catchment-scale plastic pollution assessments provide insights in its sources, sinks, and pathways. We present an approach to quantify macroplastic transport and density across the Odaw catchment, Ghana. We divided the catchment into the non-urban riverine, urban riverine, and urban tidal zones. Macroplastic transport and density on riverbanks and land were monitored at ten locations in December 2021. The urban riverine zone had the highest transport, and the urban tidal zone had the highest riverbank and land macroplastic density. Water sachets, soft fragments, and foam fragments were the most abundant items. Our approach aims to be transferable to other catchments globally.

Amsterdam urban water system as entry point of river plastic pollution.

Accumulation of plastic litter in aquatic environments negatively impacts ecosystems and human livelihood. Urban areas are assumed to be the main source of plastic pollution in these environments because of high anthropogenic activity. Yet, the drivers of plastic emissions, abundance, and retention within these systems and subsequent transport to river systems are poorly understood. In this study, we demonstrate that urban water systems function as major contributors to river plastic pollution, and explore the potential driving factors contributing to the transport dynamics. Monthly visual counting of floating litter at six outlets of the Amsterdam water system results in an estimated 2.7 million items entering the closely connected IJ river annually, ranking it among the most polluting systems measured in the Netherlands and Europe. Subsequent analyses of environmental drivers (including rainfall, sunlight, wind speed, and tidal regimes) and litter flux showed very weak and insignificant correlations (r = [Formula: see text]0.19-0.16), implying additional investigation of potential drivers is required. High-frequency observations at various locations within the urban water system and advanced monitoring using novel technologies could be explored to harmonize and automate monitoring. Once litter type and abundance are well-defined with a clear origin, communication of the results with local communities and stakeholders could help co-develop solutions and stimulate behavioral change geared to reduce plastic pollution in urban environments.

Soil microbiota as game-changers in restoration of degraded lands.

Land degradation reduces soil functioning and, consequently, the services that soil provides. Soil hydrological functions are critical to combat soil degradation and promote soil restoration. Soil microorganisms affect soil hydrology, but the role of soil microbiota in forming and sustaining soil is not well explored. Case studies indicate the potential of soil microorganisms as game-changers in restoring soil functions. We review the state of the art of microorganism use in land restoration technology, the groups of microorganisms with the greatest potential for soil restoration, knowledge of the effect of microorganisms on soil physical properties, and proposed strategies for the long-term restoration of degraded lands. We also emphasize the need to advance the emerging research field of biophysical landscape interactions to support soil-plant ecosystem restoration practices.

Global environmental changes impact soil hydraulic functions through biophysical feedbacks.

Although only representing 0.05% of global freshwater, or 0.001% of all global water, soil water supports all terrestrial biological life. Soil moisture behaviour in most models is constrained by hydraulic parameters that do not change. Here we argue that biological feedbacks from plants, macro-fauna and the microbiome influence soil structure, and thus the soil hydraulic parameters and the soil water content signals we observe. Incorporating biological feedbacks into soil hydrological models is therefore important for understanding environmental change and its impacts on ecosystems. We anticipate that environmental change will accelerate and modify soil hydraulic function. Increasingly, we understand the vital role that soil moisture exerts on the carbon cycle and other environmental threats such as heatwaves, droughts and floods, wildfires, regional precipitation patterns, disease regulation and infrastructure stability, in addition to agricultural production. Biological feedbacks may result in changes to soil hydraulic function that could be irreversible, resulting in alternative stable states (ASS) of soil moisture. To explore this, we need models that consider all the major feedbacks between soil properties and soil-plant-faunal-microbial-atmospheric processes, which is something we currently do not have. Therefore, a new direction is required to incorporate a dynamic description of soil structure and hydraulic property evolution into soil-plant-atmosphere, or land surface, models that consider feedbacks from land use and climate drivers of change, so as to better model ecosystem dynamics.

Tracking the Transport of Silver Nanoparticles in Soil: a Saturated Column Experiment.

Silver nanoparticles (AgNPs) can enter the environment when released from products containing them. As AgNPs enter soil, they are often retained in the soil profile and/or leached to the groundwater. This research assessed the transport of AgNPs in their "particle form" through the soil profile using a series of columns. Three soil types were put into soil columns: LSH (loam with high organic matter (OM)), LSL (loam with low OM), and Sand (no OM). The results showed that AgNP transport and retention in soil as well as particle size changes are affected by soil organic matter (OM) and the cation exchange capacity (CEC) of soil. OM affected the transport and retention of AgNPs. This was evident in the LSH columns where the OM concentration was the highest and the AgNP content the lowest in the soil layers and in the effluent water. The highest transported AgNP content was detected in the Sand columns where OM was the lowest. CEC had an impact on the particle size of the AgNPs that were retained in the soil layers. This was clear in columns packed with high CEC-containing soils (LSL and LSH) where AgNP particle size decreased more substantially than in the columns packed with sand. However, the decrease in AgNP sizes in the effluent water was less than the decrease in particle size of AgNPs transported through but retained in the soil. This means that the AgNPs that reached the effluent were transported directly from the first layer through the soil macropores. This work highlights the ability to track AgNPs at low concentrations (50 µg kg-1) and monitor the changes in particle size potential as the particles leach through soil all of which increases our knowledge about AgNP transport mechanisms in porous media.

Field evidence for transfer of plastic debris along a terrestrial food chain.

Although plastic pollution happens globally, the micro- (<5 mm) and macroplastic (5-150 mm) transfer of plastic to terrestrial species relevant to human consumption has not been examined. We provide first-time evidence for micro- and macroplastic transfer from soil to chickens in traditional Mayan home gardens in Southeast Mexico where waste mismanagement is common. We assessed micro- and macroplastic in soil, earthworm casts, chicken feces, crops and gizzards (used for human consumption). Microplastic concentrations increased from soil (0.87 ± 1.9 particles g-1), to earthworm casts (14.8 ± 28.8 particles g-1), to chicken feces (129.8 ± 82.3 particles g-1). Chicken gizzards contained 10.2 ± 13.8 microplastic particles, while no microplastic was found in crops. An average of 45.82 ± 42.6 macroplastic particles were found per gizzard and 11 ± 15.3 macroplastic particles per crop, with 1-10 mm particles being significantly more abundant per gizzard (31.8 ± 27.27 particles) compared to the crop (1 ± 2.2 particles). The data show that micro- and macroplastic are capable of entering terrestrial food webs.

Incorporation of microplastics from litter into burrows of Lumbricus terrestris.

Pollution caused by plastic debris is an urgent environmental problem. Here, we assessed the effects of microplastics in the soil surface litter on the formation and characterization of burrows built by the anecic earthworm Lumbricus terrestris in soil and quantified the amount of microplastics that was transported and deposited in L. terrestris burrows. Worms were exposed to soil surface litter treatments containing microplastics (Low Density Polyethylene) for 2 weeks at concentrations of 0%, 7%, 28%, 45% and 60%. The latter representing environmentally realistic concentrations found in hot spot soil locations. There were significantly more burrows found when soil was exposed to the surface treatment composed of 7% microplastics than in all other treatments. The highest amount of organic matter in the walls of the burrows was observed after using the treatments containing 28 and 45% microplastics. The highest microplastic bioturbation efficiency ratio (total microplastics (mg) in burrow walls/initial total surface litter microplastics (mg)) was found using the concentration of 7% microplastics, where L. terrestris introduced 73.5% of the surface microplastics into the burrow walls. The highest burrow wall microplastic content per unit weight of soil (11.8 ± 4.8 g kg-1) was found using a concentration of 60% microplastics. L. terrestris was responsible for size-selective downward transport when exposed to concentrations of 7, 28 and 45% microplastics in the surface litter, as the fraction ≤50 µm microplastics in burrow walls increased by 65% compared to this fraction in the original surface litter plastic. We conclude that the high biogenic incorporation rate of the small-fraction microplastics from surface litter into burrow walls causes a risk of leaching through preferential flow into groundwater bodies. Furthermore, this leaching may have implications for the subsequent availability of microplastics to terrestrial organisms or for the transport of plastic-associated organic contaminants in soil.

Microplastics in the Terrestrial Ecosystem: Implications for Lumbricus terrestris (Oligochaeta, Lumbricidae).

Plastic debris is widespread in the environment, but information on the effects of microplastics on terrestrial fauna is completely lacking. Here, we studied the survival and fitness of the earthworm Lumbricus terrestris (Oligochaeta, Lumbricidae) exposed to microplastics (Polyethylene, <150 µm) in litter at concentrations of 7, 28, 45, and 60% dry weight, percentages that, after bioturbation, translate to 0.2 to 1.2% in bulk soil. Mortality after 60 days was higher at 28, 45, and 60% of microplastics in the litter than at 7% w/w and in the control (0%). Growth rate was significantly reduced at 28, 45, and 60% w/w microplastics, compared to the 7% and control treatments. Due to the digestion of ingested organic matter, microplastic was concentrated in cast, especially at the lowest dose (i.e., 7% in litter) because that dose had the highest proportion of digestible organic matter. Whereas 50 percent of the microplastics had a size of <50 µm in the original litter, 90 percent of the microplastics in the casts was <50 µm in all treatments, which suggests size-selective egestion by the earthworms. These concentration-transport and size-selection mechanisms may have important implications for fate and risk of microplastic in terrestrial ecosystems.

Do Orthotopic Ileal Diversions Induce Immunological Changes in Retained Urethral Tissue?

BACKGROUND: A second primary tumors of the urethra (urethral recurrence) after radical cystectomy has been reported to be more infrequent in patients with ileal orthotopic (neobladder) compared to incontinent diversions. OBJECTIVE: To investigate whether an altered immunogenic environment of urethral tissue is induced by urethro-ileal anastomosis. METHODS: Between 10/2008 and 12/2009 urethral biopsies of 19 patients (9 neobladder patients, 10 control patients without urethra-ileal anastomosis) were evaluated by conventional histopathological examination and immunohistochemistry for T- (CD3/CD5, CD4, CD8) and B-cell markers (CD20/22, CD79a, CD138). After semi-quantitative assessment, relative cell fractions (B vs. T cells) and subclasses (T4-helper vs. T8-killer cells vs. B cell clones, plasma cells) in neobladder vs. control patients were studied. Unpaired t-test was used for statistical analysis. RESULTS: Of 19 included patients, 16 were eligible for analysis (7x neobladder, 9x controls). All neobladder patients had undergone cystectomy for UBC. Comparing relative fractions of cells positive for T- and B-cell markers in NB and CO patients, no statistical differences were observed. In 4/7 neobladder patients relative fraction of CD79a positive B-cells was higher than relative fraction of CD3/CD5 positive T-cells (B/T-ratio 1.3). B cells were predominantly CD138 positive plasma cells (5/7 NB patients). Relative B-cell fraction was lower than T-cell fraction in 7/9 control patients (B/T-ratio 0.6). Neither CD 138 positive plasma cells nor CD22 positive B cell clones were predominant. T-helper and CD8 positive T-killer cells were equally distributed in both neobladder (CD4/CD8-ratio: 2.1) and control patients (CD4/CD8-ratio: 1.9). CONCLUSIONS: Comparing neobadder and control patients the distribution of B- and T-cells was statistically not different. However, a trend towards an increased presence of B-cells in urethral tissues of NB patients that could become relevant in a larger study might be suggestive for an immunological response induced by connecting urethral and ileal tissue.

The clinical epidemiology of urachal carcinoma: results of a large, population based study.

PURPOSE: Survival data on urachal carcinoma are sparse due to the low prevalence of this cancer. We report urachal carcinoma clinical outcomes and prognostic factors in a large, population based cohort of patients with long-term followup. MATERIALS AND METHODS: Data were collected from the nationwide Netherlands Cancer Registry. Urachal carcinoma cases were also cross-referenced using the PALGA (Nationwide Network and Registry of Histology and Cytopathology) database. Pathology report summaries were reviewed. A total of 152 patients diagnosed with urachal carcinoma between 1989 and 2009 were included in analysis. The Sheldon staging system was used to classify urachal carcinoma. Median followup was 9.2 years. Primary outcomes were overall and relative survival. Prognostic factors were calculated using univariate and multivariate hazard regression models. RESULTS: The incidence of urachal carcinoma was 0.2% of all bladder cancers. A total of 45 patients (30%) presented with lymph node or distant metastasis. Five-year overall and relative survival was 45% and 48%, respectively. On multivariate analysis prognostic factors for impaired survival were lymph node metastasis (HR 1.7, 95% CI 1.2-2.6), tumor growth in the abdominal wall, peritoneum and/or adjacent organs (HR 5.2, 95% CI 2.6-10.3), distant metastasis (HR 5.3, 95% CI 2.8-9.9) and macroscopic residual tumor (HR 5.2, 95% CI 1.2-21.8). CONCLUSIONS: Urachal carcinoma is rare, accounting for 0.2% of all bladder cancers. Many patients present with advanced disease. The prognosis of urachal carcinoma depends mostly on tumor stage, particularly the presence or absence of metastatic disease.

Discrepancy between clinical staging through bimanual palpation and pathological staging after cystectomy.

OBJECTIVES: In muscle invasive bladder cancer (MIBC), careful clinical staging is essential for patient counseling and decision-making. Bimanual palpation (BP) is an integral part and guideline advice of clinical staging. Until now, however, the value of BP has never been studied. With this study, we aim to determine the accuracy of clinical staging through BP. METHODS: Detailed clinical data were collected from a population-based series of 1,409 patients with MIBC, diagnosed between 1989 and 2005, in the region of the Comprehensive Cancer Centre East in The Netherlands. Selected were all patients who underwent BP (n = 738). Preoperative tumor-stage (cT-stage) determined through BP was compared with post-cystectomy pT-stage. Contingency tables were made to determine the correlation between cT-stage and pT-stage. RESULTS: In 18 of 142 patients in whom BP showed an organ-confined tumor, the tumor was unresectable (pT4) at the time of surgery. Four out of 9 patients who had a suspected T4 tumor on BP but who underwent cystectomy anyway appeared to have operable tumors at cystectomy. In 87 patients (57.6%), accurate staging through BP was observed. In 17 patients (11.3%), clinical overstaging was found, and in 47 patients, (31.1%) clinical understaging. CONCLUSIONS: Frequently, pT-stage after cystectomy does not correlate with preoperative cT-stage based on BP. Discrepancy was observed in 42% of the patients: in 11%, clinical overstaging and in 31%, clinical understaging. Based on these data, some caution is suggested when interpreting the outcome of BP. Prospective data is needed for a more formal evaluation of the staging accuracy of BP.

Prognostic factors for survival in patients with recurrence of muscle invasive bladder cancer after treatment with curative intent.

UNLABELLED: Prognostic factors for survival after recurrent MIBC are unknown and were evaluated using a population-based series of 1409 MIBC patients. 330 Patients who underwent RC or RT with curative intent and who suffered from recurrence were selected. Multivariable survival analyses were performed. Clinicopathological factors that predict survival after recurrence are recurrence location, treatment for recurrence and age at recurrence diagnosis. PURPOSE: We conducted this study to evaluate the prognostic factors for survival among patients with recurrent muscle-invasive bladder cancer (MIBC) after initial treatment with curative intent. PATIENTS AND METHODS: Clinical data were collected from a population-based series of 1409 patients with MIBC. We selected 330 patients who underwent radical cystectomy (RC) or radiotherapy (RT) for urothelial carcinoma with curative intent and who experienced recurrence. Multivariate survival analyses were performed with death from MIBC as the endpoint. Covariates were gender, time to recurrence, age at diagnosis of recurrence, recurrence multiplicity, localization, and treatment for recurrence. Analyses were performed separately for patients initially treated with RC (i-RC) or external beam radiotherapy (i-EBRT). RESULTS: Patients with recurrence after i-RC showed a 1- and 3-year survival of 17% and 6%, respectively. Localization and treatment for recurrence were significantly associated with survival. Patients with recurrence after i-EBRT showed a 1- and 3-year survival of 31% and 12%, respectively. Age at diagnosis of recurrence, localization, and treatment for recurrence were significantly associated with survival. CONCLUSION: This study confirms the extremely poor prognosis after recurrence of MIBC in patients initially treated with surgery or RT. Clinicopathologic factors that predict survival after disease recurrence are location of recurrence, treatment for recurrence, and age at diagnosis of recurrence. Improved diagnosis of primary MIBC to detect extravesical disease and more effective therapeutic approaches to target recurrent MIBC are needed.

Clinical epidemiology of nonurothelial bladder cancer: analysis of the Netherlands Cancer Registry.

PURPOSE: Nonurothelial malignancies represent a small fraction of bladder malignancies and are less extensively studied, resulting in sparse empirical data on these tumors. We sought insight into tumor characteristics and survival. MATERIALS AND METHODS: Data were obtained from the nationwide Netherlands Cancer Registry on patient and tumor characteristics, and followup in all patients with primary invasive (T1 or greater) bladder tumors in The Netherlands between 1995 and 2006. Data were analyzed using frequency tables. Relative survival analysis was done. RESULTS: We identified 28,807 patients with invasive bladder cancer, of whom 7.7% presented with nonurothelial carcinoma. Mean patient age range at diagnosis of adenocarcinoma and soft tissue tumors was 66.4 years, and 78.3 years at diagnosis of nonspecified tumors. Most histological subtypes were more common in males except squamous cell carcinoma and lymphoma. Muscle invasion was seen in 52.2% of urothelial carcinoma cases vs 87.5%, 71.9% and 89.0% of squamous cell carcinoma, adenocarcinoma and neuroendocrine tumor cases, respectively. For urothelial carcinoma, squamous cell carcinoma and adenocarcinoma women presented at more advanced stage. In the neuroendocrine group this stage difference was the opposite. Survival analysis showed a 5-year relative survival rate of 32.2%, 22.9%, 31.8% and 21.1% for T2 or greater urothelial carcinoma, squamous cell carcinoma, adenocarcinoma and neuroendocrine tumors, respectively. CONCLUSIONS: Patients with nonurothelial carcinoma present at more advanced stage and overall have worse survival. Relative survival of muscle invasive adenocarcinoma equals survival of muscle invasive urothelial carcinoma. For stage II and III disease these cases do even better. Muscle invasive squamous cell carcinoma and neuroendocrine tumors show worse survival regardless of stage.

Brachytherapy versus cystectomy in solitary bladder cancer: a case control, multicentre, East-Netherlands study.

PURPOSE: Comparing the outcome of surgery and brachytherapy-based radiotherapy in patients with solitary T1G3/T2 bladder tumour in, a retrospective case-control study, because efforts for a randomised clinical trial comparing these modalities have failed. MATERIALS AND METHODS: Cystectomy group. Patients were selected using the pathological registration system (PALGA). 289 cases of TURT followed by cystectomy, indicated by a muscle--invading bladder tumour were performed in three East-Netherlands medical centres between 1991 and 2001. Out of this group 179 patients with clinical T2N0M0 bladder tumour were selected. All the consecutive files were analysed by a urologist and a radiation oncologist and 65 of those patients (mean age 63.7 years) would have been eligible for brachytherapy, based on an initial analysis: cystoscopy estimated tumour size, post-TURT pathological report, completed by CT-scan and/or, MRI-scan. A final pathological report after radical cystectomy was not considered for patients' selection. Brachytherapy group. Patients were selected using a prospective registration study aiming at determination of our treatment results. 89 Patients (mean age 68.4 years) underwent TURT followed by a course of external beam irradiation and interstitial brachytherapy from 1983 till 2005 in the Arnhem Radiotherapy Institute. RESULTS: The median follow-up for the brachytherapy group was 5.7 years (range 0.2-21.4 years), for the cystectomy group was 5.05 years (range: 0.04-16.8 years). No difference in disease-specific survival (DSS) could be detected with a 5- and 10-year DSS of 71% and 66% in the brachytherapy group and 60% and 57% in the cystectomy group, respectively. Five-year overall survival (OS) was 57% in the brachytherapy group and 52% in the cystectomy group, however, the 10-year OS was better in the cystectomy than in the brachytherapy group (42% and 33%, respectively). This is caused by the significant age difference in favour of the cystectomy group. Cystectomy-free survival in the brachytherapy group was 70%. CONCLUSION: Radical cystectomy is the treatment of choice for patients with muscle-invasive bladder carcinoma. However, in a selected patient population a bladder sparing treatment, i.e. a combination of transurethral tumour resection (TURT), external beam irradiation and interstitial brachytherapy, can be applied successfully. This concerns a solitary, T1G3 or T2 bladder tumour, with a diameter<5 cm.

The present and future burden of urinary bladder cancer in the world.

Urinary bladder cancer (UBC) is a common disease worldwide. At any point in time 2.7 million people have a history of UBC. The incidence of UBC varies over the world with highest rates in developed communities. But the burden of UBC will increase in less developed areas of the world. These changes can be attributed to global changes in exposure to risk factors for UBC and growth and aging of the world population.

Allelic imbalance analysis using a single-nucleotide polymorphism microarray for the detection of bladder cancer recurrence.

PURPOSE: Non-muscle-invasive bladder cancer is a frequently occurring cancer, with an extremely high recurrence risk. Recurrence detection is based on cytology and urethrocystoscopy. A previous study suggested that a single-nucleotide polymorphism (SNP) array may be effective for noninvasive detection of allelic imbalances in urine. We investigated whether this method is suitable to detect allelic imbalance as an indicator of recurrences in non-muscle-invasive bladder cancer follow-up. EXPERIMENTAL DESIGN: DNA from blood and urine from 158 patients (113 with and 45 without recurrence) was hybridized to the Affymetrix GeneChip Mapping 10K 2.0. Allelic imbalance detection was based on SNPs showing changes from heterozygosity in blood to homozygosity in urine and on automatic analysis of copy number changes using Copy Number Analyser for GeneChip. RESULTS: Urine samples with tumor showed allelic imbalance at 0.4% of all informative SNPs. In samples without tumors, 0.04% of these SNPs were affected (P = 0.07). In addition, Copy Number Analyser for GeneChip analysis showed more copy number changes in samples with a tumor (P = 0.001). Losses and gains of chromosomal regions showed clustering, overlapping with known bladder cancer loci. However, 25 (22%) patients with a tumor recurrence did not display any regions with copy number changes, whereas 24 (53%) individuals without a recurrence did. Receiver operating characteristic curve analysis using the number of SNPs displaying copy number changes from the Copy Number Analyser for GeneChip analysis resulted in an area under the curve of only 0.67 (95% confidence interval, 0.58-0.76). CONCLUSION: Single-nucleotide polymorphism microarray analysis of allelic imbalance in urine cannot replace urethrocystoscopy and cytology for the detection of recurrences in non-muscle-invasive bladder cancer follow-up.