Treatment of Low-grade Intermediate-risk Nonmuscle-invasive Bladder Cancer With UGN-102 ± Transurethral Resection of Bladder Tumor Compared to Transurethral Resection of Bladder Tumor Monotherapy: A Randomized, Controlled, Phase 3 Trial (ATLAS).

PURPOSE: Low-grade intermediate-risk nonmuscle-invasive bladder cancer is a chronic illness commonly treated by repetitive transurethral resection of bladder tumor. We compared the efficacy and safety of intravesical chemoablation with UGN-102 (a reverse thermal gel containing mitomycin), with or without subsequent transurethral resection of bladder tumor, to transurethral resection of bladder tumor alone in patients with low-grade intermediate-risk nonmuscle-invasive bladder cancer. MATERIALS AND METHODS: This prospective, randomized, phase 3 trial recruited patients with new or recurrent low-grade intermediate-risk nonmuscle-invasive bladder cancer to receive initial treatment with either UGN-102 once weekly for 6 weeks or transurethral resection of bladder tumor. Patients were followed quarterly by endoscopy, cytology, and for-cause biopsy. The primary end point was disease-free survival. All patients were followed for adverse events. RESULTS: Trial enrollment was halted by the sponsor to pursue an alternative development strategy after 282 of a planned 632 patients were randomized to UGN-102 ± subsequent transurethral resection of bladder tumor (n=142) or transurethral resection of bladder tumor monotherapy (n=140), rendering the trial underpowered to perform hypothesis testing. Patients were predominantly male and ≥65 years of age. Tumor-free complete response 3 months after initial treatment was achieved by 92 patients (65%) who received UGN-102 and 89 patients (64%) treated by transurethral resection of bladder tumor. The estimated probability of disease-free survival 15 months after randomization was 72% for UGN-102 ± transurethral resection of bladder tumor and 50% for transurethral resection of bladder tumor (hazard ratio 0.45). The most common adverse events (incidence ≥10%) in the UGN-102 group were dysuria, micturition urgency, nocturia, and pollakiuria. CONCLUSIONS: Primary, nonsurgical chemoablation with UGN-102 for the management of low-grade intermediate-risk nonmuscle-invasive bladder cancer offers a potential therapeutic alternative to immediate transurethral resection of bladder tumor monotherapy and warrants further investigation.

Subcutaneous nephrovesical bypass in a patient with advanced prostate cancer.

In the presence of hydronephrosis, as a result of ureteral malignant invasion, advanced pelvic tumor or retroperitoneal fibrosis, we most often perform a double J stent or percutaneous nephrostomy. In the search for a better quality of life for our patients in recent years in urological practice is increasingly becoming the use of subcutaneous nephrovesical bypass due to its proven safety, effectiveness and minimal invasiveness.

Successful in vitro fertilization in a 30 years old man with bilateral abdominal cryptorchidism.

Retention of the testis is one of the most common congenital malformation in male infants. The incidence of this disease is 1-2% at 1 year of age. As nonpalpable are reported around 20% of cases and in up to 30% of neonates may affect both sides. For optimal results, orchidopexy should be performed between the ages of six and eighteen months. We presented a rare case of successful in vitro fertilization after laparoscopic Fowler-Stephens orchidopexy in 30 years old man with bilateral abdominal cryptorchidism.

A rare case of huge villous adenoma of the renal pelvis deforming the abdominal wall.

The villous adenoma is a benign epithelial tumor affecting most often the gastrointestinal tract, especially the colon and rectum. The incidence of this disease in the genitourinary tract is less than 1% as the most commonly affected organs are bladder, urethra, prostate, vulva and vagina. Only several cases of villous adenoma in the renal pelvis have been reported in the scientific literature. The disease is more common in men between the ages of 40 and 70. We presented a rare case of huge villous adenoma of the renal pelvis in 61 years old man.

Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction after penile trauma.

In urology low-intensity extracorporeal shockwave therapy (LI-ESWT) finds major application in the treatment of erectile dysfunction (ED) after nerve-sparing radical retropubic prostatectomy and Peyronie's disease. We presented a rare case of application of LI-ESWT in a 39-years old man with erectile dysfunction after penile trauma obtained during sexual intercourse.

Torsion of the testis with perineal ectopy.

Congenital testicular anomalies affect about 5% of newborn boys. Testicular torsion is a rare anomaly that occurs in 1 in 4000 men under the age of 25. Perineal ectopia is an even more rare anomaly. It occurs in less than 1% of all cases of cryptorchidism. In this study, we present a rare case of testicular torsion with perineal ectopia in a boy of 18 months. To establish the anomaly, we used Doppler ultrasound and MRI. We performed inguinal exploration with subsequent detorsion testis and orchiopexy using the dartos pouch technique.

A rare case of iatrogenic vesicovaginal fistula arising from a forgotten gauze strip during Caesarean section.

The incidence of iatrogenic vesicovaginal fistulas in women after gynecological surgery is 82%, as hysterectomy being the most common cause for them - 88%. We presented a rare case of iatrogenic vesicovaginal fistula resulting from a series of errors and forgotten gauze strip in a 26-years-old woman after a third Caesarean section.