Intravesical sequential chemo - immunotherapy in superficial transitional cell bladder cancer

Thirty-five patients of [Ta/Tl] bladder tumors that initially treated with transurethral resection were randomized into three groups. Group A included patients received intravesical 2 g of gemcitabine in 100 ml saline once weekly for six consecutive weeks. Group B received 150 mg of BCG diluted in 50 ml saline once weekly for six consecutive weeks. Group C received sequential combination of weekly intravesical 2 g of gemcitabine in 100 ml saline for six consecutive weeks, then six weekly intravesical 75 mg of BCG diluted in 50 ml saline. After median follow up of 17 months, recurrence of progression was assessed as terminal events of the study. High risk cases that may have either multiple bladder lesions or more than grade I or associated with CIS were present in 72.7% and 66.7% in arm A, B and C, respectively. The most common local side effects were dysuria, hematuria, frequency and cystitis either bacterial or chemical. Systemic toxicities included neutropenia, thrombocytopenia, fever and malaise. Patients treated with intravesical chemo-immunotherapy had higher incidence of systemic toxicities. 36.4%, 66.7% and 75% were disease-free cases; however recurrence was present in 45.5%, 25% and 16.7% of cases in groups A, B and C, respectively

Role of varicocele recurrence in male subfertility

This study was carried out on 49 patients who did varicocele ligation by different approaches without correction of semen parameters, Doppler or duplex scan were used for examination of all patients, which showed that, from the 23 patients who did bilateral varicocele ligation, 18 cases recur also bilateral- and 5 unilateral, the 10 patients who did right side ligation all recur again and the 61 patients who did left side ligation 42 recur again, 3 in the left and 16 in the right alone. The study showed also that the incidence of recurrence was 34.6% in high ligation, 28.2% in inguinal, 19.2% in scrotal neck, 103 in scrotal, 7.6% in laparoscopic approachs and that 17% of the total as persistent not recurrent. Operative findings were dilated anterior group, posterior group, cremastric or tunical veins which show reflux with surgical Doppler which also showed injury of 36 testecular artery. It was concluded that, surgical Doppler is very important in surgery of varicocele and helpn selective varicocele ligation, high and laparoscopic approaches has a high recurrence rate than low approaches