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.

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.

Urinary zinc levels in patients with superficial bladder cancer.

Urinary zinc levels were determined in 30 healthy people and 42 patients with bladder cancer on admission to hospital. There was a significant difference in values between the two groups (p < 0.001). The patient group was classified according to stage, grade, multiplicity and recurrence. No significant difference was found between these groups but each group showed a significant difference in comparison with the control group. Patients were treated by transurethral resection (TURT) and then classified according to intravesical chemotherapy [epirubicin (n = 12), BCG (n = 20), interferon alpha-2 (n = 10)]. One month after treatment, 24-h urinary zinc excretion was determined. When this value was compared to the excretion of patients before treatment a significant decrease was observed (p < 0.001). However, no significant differences were found between the treatment groups. The increase in urinary zinc excretion may be related to the activity of the tumor and determination may be of value during follow up.

The importance urinary glycosaminoglycan as a marker for superficial bladder tumors.

Urinary glycosaminoglycan/creatinine ratio (GAG/Cr) was determined in 42 patients with superficial bladder tumors (before and after the treatment) and in 34 healthy subjects. Before the treatment, the mean GAG/Cr ratio in patients group was not significantly different from the control group's figure (11.65 +/- 3.25 and 10.11 +/- 2.67). However, comparison of urinary GAG levels of T1 and Grade III tumors with the control group revealed statistically significant results (p<0.01 and p<0.001, respectively). All patients were previously operated by transurethral resection (TUR) and then intravesical chemotherapy applied [(BCG (n:20), 4-epidoxorubicin (n:12), interferon alpha-2 (n:10)]. Three months after the treatment, urinary GAG levels were determined. In 19 of the 24 patients whose pretreatment urinary GAG levels were higher than the control group, tumor completely remitted and their urinary GAG excretion decreased. The tumors of three cases gradually progressed and their GAG excretions were normal. Two cases hadn't any tumor mass and their urinary GAG excretion was higher than the pretreatment levels. The remaining 18 patients didn't show any clinical modification and their urinary GAG excretion did not differ from the control's and pretreatment levels. The results indicated that this test can be used as a noninvasive adjunct procedure in the follow up of patients with bladder tumors, and that urinary GAG level can not be considered as an ideal marker for bladder tumor.

Urinary excretion of sialic acid in patients with bladder tumors.

The pre- and post-treatment urinary total sialic acid/creatinine (TSA/Cr) ratios of patients with bladder tumor (n = 60) were determined. We found a significant increase in the mean urinary TSA/Cr ratio in patients with bladder tumors than in healthy people (99.80 +/- 15.60 micrograms/g Cr, 52.57 +/- 15.60 micrograms/g Cr, P < 0.001). We determined that the mean post-treatment TSA/Cr ratio of 44 patients was significantly lower than their pretreatment ratio and this value also decreased to the level in healthy people. (TSA/Cr; healthy people, 52.57 +/- 15.60 micrograms/g Cr, P < 0.001). The patients with decreased TSA/Cr ratio in the post-treatment period showed complete or partial regression of their disease. In 8 patients, urinary TSA/Cr ratio in the post-treatment period increased to 105 +/- 14.5 micrograms/g Cr value. In clinical and pathologic evaluation, it was shown that disease progressed in all of these 8 patients. The mean post-treatment TAS/Cr ratio of 8 patients did not differ from the pretreatment ratio (87.44 +/- 20.20 micrograms/Cr) and it was shown that their clinical status did not change. These findings show that urinary excretion of TSA correlates with the clinical status of bladder tumor and it could be used to follow the course of the disease, and follow-up treatment.

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.

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.

A decade of experience in the surgical treatment of vesicoureteral reflux.

Our ten years of experience in the treatment of vesicoureteral reflux is presented. The results have been presented with respect to the grade and the antireflux technique employed, with special emphasis on grade IV and V cases.

Correction of vesicoureteral reflux by the Gil-Vernet procedure.

Gil-Vernet antireflux procedure has been carried out for 22 refluxing renal units (14 patients), yielding a positive outcome in all, with disappearance of refluxing in 94% of the renal units with grade II, III and IV vesicoureteral reflux. The efficiency and simplicity of the technique is emphasized.

Xanthogranulomatous pyelonephritis in children and adults.

Sixteen patients with xanthogranulomatous pyelonephritis (XGP) are reported. The preoperative diagnosis of XGP may be difficult because of its clinical and radiological similarities to various other renal lesions, but in four patients XGP was suspected pre-operatively. Nephrectomy is necessary in most patients, although medical treatment may help a few.