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Cimier A, Thach S, Lacroix B, Mariat C. [Evaluation of the efficacy and safety of HIVEC intravesical thermochemotherapy with intermediate-risk and high-risk non-muscle-invasive bladder cancer]. Prog Urol 2023; 33:254-264. [PMID: 36906430 DOI: 10.1016/j.purol.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/25/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Non-muscle-infiltrating cancers (NMIBC) represent 75% of bladder tumors. The objective of our study is to report a single-center experience of the efficacy and tolerability of HIVEC on intermediate- and high-risk NMIBC in adjuvant therapy. MATERIAL AND METHOD Between December 2016 and October 2020, patients with intermediate-risk or high-risk NMIBC were included. They were all treated with HIVEC as an adjuvant therapy to bladder resection. Efficacy was assessed by endoscopic follow-up and tolerance by a standardized questionnaire. RESULTS A total of 50 patients were included. The median age was 70years (34-88). The median follow-up time was 31 months (4-48). Forty-nine patients had cystoscopy as part of the follow-up. Nine recurred. One patient progressed to Cis. The 24-month recurrence-free survival was 86.6%. There were no severe adverse events (grade 3 or 4). The ratio of delivered instillations to planned instillations was 93%. CONCLUSION HIVEC with the COMBAT system is well tolerated in adjuvant treatment. However, it is not better than standard treatments, especially for intermediate-risk NMIBC. While waiting for recommendations, it cannot be proposed as an alternative to standard treatment. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- A Cimier
- Service d'urologie, CHU de Saint-Étienne, hôpital Nord, 42055 Saint-Étienne, France.
| | - S Thach
- Service d'urologie, clinique Mutualiste, 3, rue Le Verrier, 42000 Saint-Étienne, France
| | - B Lacroix
- Service d'urologie, clinique Mutualiste, 3, rue Le Verrier, 42000 Saint-Étienne, France
| | - C Mariat
- Service d'urologie, CHU de Saint-Étienne, hôpital Nord, 42055 Saint-Étienne, France
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2
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Koimtzis G, Alexandrou V, Chalklin CG, Carrington-Windo E, Ramsden M, Karakasis N, Lam KW, Tsakaldimis G. The Role of Adjuvant Single Postoperative Instillation of Gemcitabine for Non-Muscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12051154. [PMID: 35626309 PMCID: PMC9140686 DOI: 10.3390/diagnostics12051154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/05/2022] [Accepted: 04/29/2022] [Indexed: 02/05/2023] Open
Abstract
Bladder cancer is a heterogeneous disease with variable natural history. Non-muscle-invasive bladder cancer has a favorable prognosis following transurethral resection, but the optimal adjuvant chemotherapy plan is still in debate. The aim of this study was to evaluate the effect of the adjuvant intravesical administration of a single dose of gemcitabine in the outcome of this disease. For that purpose, we performed a systematic review and meta-analysis on available randomized control trials on MEDLINE, EMBASE, Cochrane, Scopus, and Google Scholar databases. Ultimately, two studies were included with a total number of 654 patients. The statistical analysis performed showed that a single post-operative intravesical dose of gemcitabine does not affect the recurrence rate of non-muscle-invasive bladder cancer compared to placebo. Therefore, this therapeutic strategy does not offer any significant improvement on the outcomes of the disease. Nonetheless, due to the plethora of available therapeutic agents and treatment strategies, further research is needed to establish the optimal treatment in this category of patients.
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Affiliation(s)
- Georgios Koimtzis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.); (K.W.L.)
- Correspondence: ; Tel.: +44-7716466710
| | - Vyron Alexandrou
- Urology Department, General Hospital of Thessaloniki “G. Gennimata-Agios Dimitrios”, Elenis Zografou 2, 546 34 Thessaloniki, Greece; (V.A.); (N.K.); (G.T.)
| | - Christopher G. Chalklin
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.); (K.W.L.)
| | - Eliot Carrington-Windo
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.); (K.W.L.)
| | - Mark Ramsden
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.); (K.W.L.)
| | - Nikolaos Karakasis
- Urology Department, General Hospital of Thessaloniki “G. Gennimata-Agios Dimitrios”, Elenis Zografou 2, 546 34 Thessaloniki, Greece; (V.A.); (N.K.); (G.T.)
| | - Kit W. Lam
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.); (K.W.L.)
| | - Georgios Tsakaldimis
- Urology Department, General Hospital of Thessaloniki “G. Gennimata-Agios Dimitrios”, Elenis Zografou 2, 546 34 Thessaloniki, Greece; (V.A.); (N.K.); (G.T.)
- Department of Medicine, Democritus University of Thrace, Administrative Building, 6th km, 681 00 Alexandroupoli, Greece
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Transurethral Incision with Transverse Mucosal Realignment for the Management of Bladder Neck Contracture and Vesicourethral Anastomotic Stenosis. Urology 2021; 152:102-108. [PMID: 33766717 DOI: 10.1016/j.urology.2021.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess efficacy and safety of a novel cystoscopic technique for definitive repair of bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS). METHODS A retrospective review of patients who underwent a transurethral incision with transverse mucosal realignment between July 2019 and December 2020 by a single surgeon was completed. This is novel procedure of incising a scar cystoscopically and using a laparoscopic suturing device transurethrally to bring healthy bladder mucosa across the defect, like a YV plasty. Patients were only included if they had ≥4 months follow-up. Surgical success was defined as ability to pass a 17 French flexible cystoscope through the previously stenotic segment at 4 month follow up. RESULTS Nineteen patients with a median follow-up of 6 months were included in this analysis. Etiology of posterior urethral stenosis was 53% from VUAS and 47% from BNC, with 32% of patients having prior pelvic radiation. Success was achieved in 89% of patients after 1 procedure and 100% of patients achieved success after a second procedure. There was no de novo incontinence or major complications. CONCLUSION Transurethral incision with transverse mucosal realignment for VUAS and BNC has a high success rate after only 1 procedure. This is the first reported series of an endoscopic Y-V plasty type repair for BNC and VUAS. Longer term follow up to ensure durability and reporting from other institutions will be needed to establish reproducibility.
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Alrabadi A, Abuhamad M, Mansi H, Alhamss S, Bustami N, Al Demour S, Al-Abbadi MA. Delayed Bladder Perforation Related to Immediate Single Dose Intravesical Doxorubicin Instillation After TURBT: A Case Report and Literature Review. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:1179547620986158. [PMID: 33473244 PMCID: PMC7797580 DOI: 10.1177/1179547620986158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/11/2020] [Indexed: 11/15/2022]
Abstract
Introduction Intravesical chemotherapy instillation immediately after tumor resection is a well-known practice in the management of non-muscle invasive bladder cancer. Despite being largely well tolerated in most cases, it is not devoid of severe and life-threatening complications. Case Presentation We present an unusual case of bladder perforation that happened 2 weeks after bladder tumor resection. The patient had received single dose intra-vesical instillation of doxorubicin after TUR-BT. Conservative managements failed to achieve bladder healing; as a result, open surgical repair was performed. To the best of our knowledge, this is the first reported case of bladder perforation after intra-vesical doxorubicin instillation. Conclusion The occurrence of such a rare serious complication in a mostly safe intervention must be taken into consideration. A high index of suspicion, timely management, and proceeding to more invasive surgical treatments when necessary are cornerstones in the management and preserving the bladder.
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Affiliation(s)
- Adel Alrabadi
- Department of Special Surgery/Division of Urology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohannad Abuhamad
- Department of Special Surgery/Division of Urology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Hammam Mansi
- Department of Special Surgery/Division of Urology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Sohaib Alhamss
- Department of Special Surgery/Division of Urology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Nadwa Bustami
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Saddam Al Demour
- Department of Special Surgery/Division of Urology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mousa A Al-Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Amman, Jordan
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Abstract
IMPORTANCE Bladder cancer is a common malignancy in women and is the fourth most common malignancy in men. Bladder cancer ranges from unaggressive and usually noninvasive tumors that recur and commit patients to long-term invasive surveillance, to aggressive and invasive tumors with high disease-specific mortality. OBSERVATIONS Advanced age, male sex, and cigarette smoking contribute to the development of bladder cancer. Bladder tumors can present with gross or microscopic hematuria, which is evaluated with cystoscopy and upper tract imaging depending on the degree of hematuria and risk of malignancy. Non-muscle-invasive tumors are treated with endoscopic resection and adjuvant intravesical therapy, depending on the risk classification. Enhanced cystoscopy includes technology used to improve the detection of tumors and can reduce the risk of recurrence. Patients with high-risk non-muscle invasive tumors that do not respond to adjuvant therapy with the standard-of-care immunotherapy, bacille Calmette-Guérin (BCG), constitute a challenging patient population to manage and many alternative therapies are being studied. For patients with muscle-invasive disease, more aggressive therapy with radical cystectomy and urinary diversion or trimodal therapy with maximal endoscopic resection, radiosensitizing chemotherapy, and radiation is warranted to curb the risk of metastasis and disease-specific mortality. Treatment of patients with advanced disease is undergoing rapid changes as immunotherapy with checkpoint inhibitors, targeted therapies, and antibody-drug conjugates have become options for certain patients with various stages of disease. CONCLUSIONS AND RELEVANCE Improved understanding of the molecular biology and genetics of bladder cancer has evolved the way localized and advanced disease is diagnosed and treated. While intravesical BCG has remained the mainstay of therapy for intermediate and high-risk non-muscle-invasive bladder cancer, the therapeutic options for muscle-invasive and advanced disease has expanded to include immunotherapy with checkpoint inhibition, targeted therapies, and antibody-drug conjugates.
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Affiliation(s)
- Andrew T Lenis
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
| | - Patrick M Lec
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
| | | | - M D Mshs
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine, University of California, Los Angeles
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Shu HQ, Wang L, Jin CR, Hu XY, Gu J, Sa YL. Laparoscopic T-Plasty for the Treatment of Refractory Bladder Neck Stenosis. Am J Mens Health 2020; 13:1557988319873517. [PMID: 31470756 PMCID: PMC6719475 DOI: 10.1177/1557988319873517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Preliminary results of a case series on refractory bladder neck stenosis treated with laparoscopic T-plasty are presented in this article. This study retrospectively identified nine patients with refractory bladder neck stenosis aged 60 to 80 years between May 2016 and December 2017, who had undergone laparoscopic T-plasty. All patients presented voiding difficulty and failed after two or more prior endoscopic treatments. Laparoscopic T-plasty was performed by incising the anterior wall of the bladder neck in a T-shaped manner and creating two well-vascularized and tension-free flaps, which offer the possibility to reconstruct a wide bladder neck. After a mean follow-up of 14.7 months (ranging 3–22 months), a successful outcome was achieved in eight patients without incontinence secondary to surgery. Recurrent voiding difficulty developed in one patient, which was cured after a following endoscopic treatment. Through these nine patients, a preliminary conclusion can be drawn that a wider bladder neck can be obtained through modified YV-reconstruction of the bladder neck, while avoiding external urethral sphincter injury. And laparoscopic T-plasty has clear advantages compared with an open approach. It is an available and effective option for refractory bladder neck stenosis.
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Affiliation(s)
- Hui-Quan Shu
- 1 Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lin Wang
- 1 Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.,2 Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chong-Rui Jin
- 1 Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Yong Hu
- 1 Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Gu
- 1 Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying-Long Sa
- 1 Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Galindo-Ferreiro A, Torres Nieto MA, Ali MJ. Orbital fat necrosis following a revision endoscopic dacryocystorhinostomy. Eur J Ophthalmol 2020; 31:NP18-NP21. [PMID: 32486851 DOI: 10.1177/1120672120932087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This report details a case of a preseptal fat necrosis in a 55-year old female, following a revision endoscopic dacryocystorhinostomy (DCR). CASE DESCRIPTION Upon initial examination, significant right eyelid swelling, tenderness, and pain in the peritrochlear area, was observed. An overlying skin edema was noted in the supero-medial portion of the right upper eyelid. This edema was palpable, firm, and tender. Orbital computed tomography revealed heterogeneous infiltration including an ill-defined margin in the preseptal regions of the clinically evident location. Marked, soft tissue edema and thickening in the inner preseptal area were demonstrated through magnetic resonance images (MRI). An excision biopsy was required as the lesion did not respond to medical treatment. A necrosis of adipose tissue surrounded by abundant foamy macrophages and inflammatory infiltrates, was exposed. CONCLUSION This is an exceptionally rare case of orbital fat necrosis following a DCR. Four possible mechanisms for the development of fat necrosis are discussed.
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Affiliation(s)
| | | | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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8
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Lenis AT, Asanad K, Blaibel M, Donin NM, Chamie K. Continuous saline bladder irrigation for two hours following transurethral resection of bladder tumors in patients with non-muscle invasive bladder cancer does not prevent recurrence or progression compared with intravesical Mitomycin-C. BMC Urol 2018; 18:93. [PMID: 30355350 PMCID: PMC6201555 DOI: 10.1186/s12894-018-0408-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intravesical Mitomycin-C (MMC) following transurethral resection of bladder tumor (TURBT), while efficacious, is associated with side effects and poor utilization. Continuous saline bladder irrigation (CSBI) has been examined as an alternative. In this study we sought to compare the rates of recurrence and/or progression in patients with NMIBC who were treated with either MMC or CSBI after TURBT. METHODS We retrospectively reviewed records of patients with NMIBC at our institution in 2012-2015. Perioperative use of MMC (40 mg in 20 mL), CSBI (two hours), or neither were recorded. Primary outcome was time to recurrence or progression. Descriptive statistics, chi-squared analysis, Kaplan-Meier survival analysis, and Cox multivariable regression analyses were performed. RESULTS 205 patients met inclusion criteria. Forty-five (22.0%) patients received CSBI, 71 (34.6%) received MMC, and 89 (43.4%) received no perioperative therapy. On survival analysis, MMC was associated with improved DFS compared with CSBI (p = 0.001) and no treatment (p = 0.0009). On multivariable analysis, high risk disease was associated with increased risk of recurrence or progression (HR 2.77, 95% CI: 1.28-6.01), whereas adjuvant therapy (HR 0.35, 95% CI: 0.20-0.59) and MMC (HR 0.43, 95% CI: 0.25-0.75) were associated with decreased risk. CONCLUSIONS Postoperative MMC was associated with improved DFS compared with CSBI and no treatment. The DFS benefit seen with CSBI in other studies may be limited to patients receiving prolonged irrigation. New intravesical agents being evaluated may consider saline as a control given our data demonstrating that short-term CSBI is not superior to TURBT alone.
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Affiliation(s)
- Andrew T. Lenis
- David Geffen School of Medicine at the University of California Los Angeles, 300 Stein Plaza, Suite 348, Los Angeles, California 90095 USA
- Department of Urology, Health Services Research Group, David Geffen School of Medicine at UCLA, Los Angeles, California USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California USA
| | - Kian Asanad
- David Geffen School of Medicine at the University of California Los Angeles, 300 Stein Plaza, Suite 348, Los Angeles, California 90095 USA
| | - Maher Blaibel
- Riverside School of Medicine, University of California, Riverside, California USA
| | - Nicholas M. Donin
- David Geffen School of Medicine at the University of California Los Angeles, 300 Stein Plaza, Suite 348, Los Angeles, California 90095 USA
- Department of Urology, Health Services Research Group, David Geffen School of Medicine at UCLA, Los Angeles, California USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California USA
| | - Karim Chamie
- David Geffen School of Medicine at the University of California Los Angeles, 300 Stein Plaza, Suite 348, Los Angeles, California 90095 USA
- Department of Urology, Health Services Research Group, David Geffen School of Medicine at UCLA, Los Angeles, California USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California USA
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Abstract
The urologist must prevent, identify and properly treat the complications of intravesical chemotherapy and immunotherapy. Both local and systemic toxicity of adjuvant intravesical therapy is herein analyzed. Topical toxicity is mainly due to the inflammation induced by the contact between the instilled agent and the bladder mucosa. Material and Methods The factors predisposing to topical toxicity must be identified and removed before starting the treatment. The choice of the agent, its dose, concentration and dosage must be tailored, whenever possible, to the presence of the above mentioned factors. Mitomycin and BCG can rarely provoke chronic cystitis, severely compromising bladder function. Results The most dangerous complication of early intravesical chemotherapy is the instillation in presence of an unrecognized bladder perforation. Flu-like syndrome, fever, chills, arthralgia are reported in almost 20% of patients receiving BCG. If fever persists for more than 48 hours or exceeds 38.5 °C, isoniazid must be administered and BCG stopped until complete remission. BCG sepsis is a rare but severe complication that must be promptly recognized and treated. If not, a life-threatening multi-organ failure syndrome can arise. Isoniazid and rifampicin, adding ethambutol when required, must be administered for a prolonged period until complete remission. Conclusions Granulomatous lesions represent the main other rare systemic complications of BCG therapy. Systemic toxicity of intravesical chemotherapy is rare, due to the high molecular weight of the drugs, limiting systemic absorption.
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Affiliation(s)
- V. Serretta
- Dipartimento di Medicina Interna Malattie Cardiovascolari e Nefrourologiche, Sezione di Urologia, Università degli Studi di Palermo
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Luckenbaugh AN, Marks RM, Miller DC, Weizer AZ, Stoffel JT, Montgomery JS. A Management Algorithm for Mitomycin C Induced Cystitis. Bladder Cancer 2017; 3:133-138. [PMID: 28516158 PMCID: PMC5409048 DOI: 10.3233/blc-160089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background/Objective: A post-bladder tumor resection dose of MMC can reduce non-invasive papillary (pTa) bladder cancer recurrences by up to 40%; this treatment is recommended in both the AUA and EUA non-muscle-invasive bladder cancer guidelines. A common complication of this treatment is eosinophilic cystitis. Symptoms range from mild urinary frequency and urgency to debilitating pain and dysuria. Currently, there is no established treatment algorithm for MMC-induced cystitis. Methods: Members of the Urologic Surgery Quality Collaborative (USQC), a group composed of over 160 private and academic urologists, met to discuss the management of patients with cystitis following MMC therapy. They devised a treatment algorithm based on experiences of urologic oncologists and neurourologists to aid in the diagnosis and management of MMC-induced cystitis. Results: The assessment begins with urinalysis and culture, followed by cystoscopy. For mild symptoms, behavioral therapy, including timed voids, fluid restriction and Kegel exercises are trialed. If symptoms have not resolved, treatment with an antihistamine, followed by a combination of anticholinergic and alpha-blocker medications. For persistent symptoms or severe symptoms at presentation, a course of prednisone plus antihistamine is prescribed. If symptoms are improving but have not resolved, this treatment is extended for a full 4 weeks prior to steroid taper. If symptoms do not improve, any visible bladder ulcerations are resected intraoperatively followed by an additional course of prednisone and antihistamine. Intravesical DMSO instillations and intra-ulcer steroid injection can be used as a final effort to treat this condition. Conclusion: We present the first formal management algorithm with escalating treatment intensity tailored to patient symptoms.
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Affiliation(s)
- Amy N Luckenbaugh
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Rory M Marks
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - David C Miller
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - John T Stoffel
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
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Abstract
Bladder neck contracture (BNC) is a well-described complication of the surgical treatment of benign and malignant prostate conditions. Nevertheless, etiologies of BNC development are highly dependent on the primary treatment modality undertaken with BNC also occurring after pelvic radiation. The treatment options for BNC can range from simple, office-based dilation procedures to more invasive, complex abdomino-perineal reconstructive surgery. Although numerous strategies have been described, a patient-specific approach is usually necessary in the management of these complex patients. In this review, we highlight various therapeutic maneuvers described for the management of BNC and further delineate a tailored approach utilized at our institution in these complicated patients.
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Affiliation(s)
- Jay Simhan
- 1 Department of Urology, UT Southwestern, Dallas, TX, USA ; 2 Urology Section, Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Daniel Ramirez
- 1 Department of Urology, UT Southwestern, Dallas, TX, USA ; 2 Urology Section, Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Steven J Hudak
- 1 Department of Urology, UT Southwestern, Dallas, TX, USA ; 2 Urology Section, Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | - Allen F Morey
- 1 Department of Urology, UT Southwestern, Dallas, TX, USA ; 2 Urology Section, Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
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Management of Bladder Neck Contracture in the Prostate Cancer Survivor. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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Redshaw JD, Broghammer JA, Smith TG, Voelzke BB, Erickson BA, McClung CD, Elliott SP, Alsikafi NF, Presson AP, Aberger ME, Craig JR, Brant WO, Myers JB. Intralesional injection of mitomycin C at transurethral incision of bladder neck contracture may offer limited benefit: TURNS Study Group. J Urol 2014; 193:587-92. [PMID: 25200807 DOI: 10.1016/j.juro.2014.08.104] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Injection of mitomycin C may increase the success of transurethral incision of the bladder neck for the treatment of bladder neck contracture. We evaluated the efficacy of mitomycin C injection across multiple institutions. MATERIALS AND METHODS Data on all patients who underwent transurethral incision of the bladder neck with mitomycin C from 2009 to 2014 were retrospectively reviewed from 6 centers in the TURNS. Patients with at least 3 months of cystoscopic followup were included in the analysis. RESULTS A total of 66 patients underwent transurethral incision of the bladder neck with mitomycin C and 55 meeting the study inclusion criteria were analyzed. Mean ± SD patient age was 64 ± 7.6 years. Dilation or prior transurethral incision of the bladder neck failed in 80% (44 of 55) of patients. Overall 58% (32 of 55) of patients achieved resolution of bladder neck contracture after 1 transurethral incision of the bladder neck with mitomycin C at a median followup of 9.2 months (IQR 11.7). There were 23 patients who had recurrence at a median of 3.7 months (IQR 4.2), 15 who underwent repeat transurethral incision of the bladder neck with mitomycin C and 9 of 15 (60%) who were free of another recurrence at a median of 8.6 months (IQR 8.8), for an overall success rate of 75% (41 of 55). Incision with electrocautery (Collins knife) was predictive of success compared with cold knife incision (63% vs 50%, p=0.03). Four patients experienced serious adverse events related to mitomycin C and 3 needed or are planning cystectomy. CONCLUSIONS The efficacy of intralesional injection of mitomycin C at transurethral incision of the bladder neck was lower than previously reported and was associated with a 7% rate of serious adverse events.
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Affiliation(s)
- Jeffrey D Redshaw
- Department of Surgery, the Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joshua A Broghammer
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas
| | - Thomas G Smith
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Bryan B Voelzke
- Department of Urology, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington
| | - Bradley A Erickson
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Sean P Elliott
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Nejd F Alsikafi
- Department of Urology, Loyola University Chicago, Maywood, Illinois
| | - Angela P Presson
- Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Michael E Aberger
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas
| | - James R Craig
- Department of Surgery, the Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah
| | - William O Brant
- Department of Surgery, the Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jeremy B Myers
- Department of Surgery, the Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah
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Management of Bladder Neck Contractures in the Elderly. CURRENT GERIATRICS REPORTS 2014. [DOI: 10.1007/s13670-013-0074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Elmamoun MH, Christmas TJ, Woodhouse CRJ. Destruction of the bladder by single dose Mitomycin C for low-stage transitional cell carcinoma (TCC)--avoidance, recognition, management and consent. BJU Int 2013; 113:E34-8. [PMID: 24053461 DOI: 10.1111/bju.12340] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify a cohort of patients under our care who have had significant and in some cases irreparable damage to their bladders after Mitomycin C (MMC) instillation. To highlight the importance of avoidance and recognition of bladder perforations during transurethral resection of bladder tumour (TURBT) and explore the issue of consent regarding MMC given the serious complications that may occur after its instillation. PATIENTS AND METHODS Patients referred to our tertiary centre for a second opinion to manage their complications after a suspected MMC leak was identified from the departmental database between January 2000 and December 2010. After collection of all the records, we established a cohort of six patients. All patients had their initial tumour resection elsewhere and were referred for specialist management thereafter. Details of the operating surgeon and cystoscopic findings were known only in half of the cases. Retrospective analysis of their notes including documentation from the referring centre was undertaken. This included a review of all the histology and imaging. RESULTS All patients had immediate severe pelvic pain on instillation of the MMC. Four of the six continue to have chronic pelvic pain. Two patients had urinary retention and three had severe lower urinary tract symptoms. One patient developed a frozen pelvis. Initial treatment was with an indwelling catheter for a period of 2-52 weeks to aid healing. Two patients had reconstructive surgery, one with success and the other with failure, as an intestinal patch failed to close the fistula and he continues with a catheter. One patient had an ileal conduit. No patient was warned of such complications. CONCLUSIONS Although rare, prophylactic MMC can have devastating consequences. Patients should be aware of such major risks. Strong emphasis should be placed on the quality of the initial TURBT coupled with the judgement of an experienced surgeon before to MMC instillation. The real clinical benefit could be reviewed and intravesical MMC offered only to patients who have a good chance of benefit.
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Filson CP, Montgomery JS, Dailey SM, Crossley HS, Lentz H, Tallman CT, He C, Weizer AZ. Complications associated with single-dose, perioperative mitomycin-C for patients undergoing bladder tumor resection. Urol Oncol 2013; 32:40.e1-8. [PMID: 23787296 DOI: 10.1016/j.urolonc.2013.04.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/24/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To better understand the risk of short-term complications associated with perioperative intravesical mitomycin-C (MMC) therapy for patients undergoing endoscopic management of non-muscle invasive bladder cancer. METHODS AND MATERIALS Using an institutional database of patients with bladder cancer, we performed a retrospective case-control study of patients receiving perioperative MMC after tumor resection (2008-2012). MMC cases were matched by clinical stage to controls receiving endoscopic resection alone. Demographic information, clinicopathologic details, and outcomes were compared between groups. Outcomes of interest included overall, genitourinary, and major complications. Chi-square tests and multivariable logistic regression were used to evaluate associations among patient characteristics, clinical factors, exposure to MMC, and outcomes of interest. RESULTS One-hundred sixteen patients treated with MMC were matched to 116 controls. Patients receiving MMC were younger (P = 0.04) and more likely to have invasive disease (i.e. T1 or greater) (23% vs. 15%, P = 0.02). Complications were more frequent among patients who were treated with MMC (34.5% vs. 19.8%, Odds Ratio 2.89, 95% Confidence Interval 1.43-5.81). The most common complication among MMC patients that required medical management was dysuria (17%). Major complications were more common among MMC patients (5.2% vs. 0.9%), but this difference did not reach statistical significance (P = 0.11). CONCLUSIONS Use of MMC is associated with a greater odds of complications compared with controls. Patients should be counseled regarding both the benefits and potential risks of perioperative intravesical MMC. Continued research is required to understand the safety implications associated with the use of perioperative, intravesical MMC.
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Affiliation(s)
- Christopher P Filson
- Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Jeffrey S Montgomery
- Division of Urologic Oncology, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Stephen M Dailey
- Division of Urologic Oncology, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Heather S Crossley
- Division of Urologic Oncology, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Heidi Lentz
- Division of Urologic Oncology, Department of Urology, University of Michigan Medical School, Ann Arbor, MI; Michigan State University, East Lansing, MI
| | - Christopher T Tallman
- Division of Urologic Oncology, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Chang He
- Division of Urologic Oncology, Department of Urology, University of Michigan Medical School, Ann Arbor, MI
| | - Alon Z Weizer
- Division of Urologic Oncology, Department of Urology, University of Michigan Medical School, Ann Arbor, MI.
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Ramirez D, Simhan J, Hudak SJ, Morey AF. Standardized approach for the treatment of refractory bladder neck contractures. Urol Clin North Am 2013; 40:371-80. [PMID: 23905935 DOI: 10.1016/j.ucl.2013.04.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Bladder neck contracture is a relatively uncommon but well-described complication after the surgical treatment of prostate cancer. Although numerous treatments have been described as an initial management strategy for patients with this condition, the management of refractory cases remains highly variable. This article evaluates various therapeutic maneuvers used for the treatment of refractory bladder neck contracture and further describes the preliminary results of an endoscopic balloon dilation with concomitant deep traunsurethral incision procedure. Short- and long-term management algorithms for patients with recurrent bladder neck contractures are reviewed.
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Affiliation(s)
- Daniel Ramirez
- Department of Urology, UT Southwestern Medical Center, Dallas, TX 75390-9110, USA
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Side effects of perioperative intravesical treatment and treatment strategies for these side effects. Urol Clin North Am 2013; 40:197-210. [PMID: 23540778 DOI: 10.1016/j.ucl.2013.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Perioperative intravesical chemotherapy has a well-established role in the treatment of non-muscle invasive bladder cancer. There are multiple agents that can be used in this fashion with varying properties. Although chemical cystitis is the most common side effect and is usually self-limiting, significant toxicity can occur with intravesical chemotherapy. It is imperative that the urologist is aware of the acute and delayed side effects of intravesical chemotherapy and how to manage potential complications. Both local and systemic toxicities are discussed, as well as strategies to minimize and manage them.
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Intravesical instillation of mitomycin C: a cause of delayed bladder perforation? Case Rep Urol 2012; 2012:576519. [PMID: 23326749 PMCID: PMC3540648 DOI: 10.1155/2012/576519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 12/16/2012] [Indexed: 11/18/2022] Open
Abstract
We present a case of bladder perforation secondary to intravesical instillation of mitomycin C following transurethral resection of bladder tumour (TURBT) and the role of early detection leading to successful conservative management. We also review the key relevant literature.
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20
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Mertens LS, Meinhardt W, Rier WB, Nooter RI, Horenblas S. Extravasation of Intravesical Chemotherapy for Non-Muscle-Invasive Bladder Cancer. Urol Int 2012; 89:332-6. [DOI: 10.1159/000341900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/14/2012] [Indexed: 11/19/2022]
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Lim D, Izawa JI, Middlebrook P, Chin JL. Bladder perforation after immediate postoperative intravesical instillation of mitomycin C. Can Urol Assoc J 2011; 4:E1-3. [PMID: 20174483 DOI: 10.5489/cuaj.781] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intravesical chemotherapy after transurethral resection of a bladder tumour (TURBT) has been observed to significantly decrease recurrence rates compared to TURBT alone. Though immediate postoperative intravesical treatment with chemotherapeutic agents after transurethral resection for superficial bladder carcinoma is generally considered a safe and effective adjunctive therapy in decreasing recurrence rates, its instillation is not always completely innocuous. Lately, a more serious complication of bladder perforation associated with immediate instillation of intravesical mitomycin C (MMC) after TURBT was reported. We report our own experience of a male patient with bladder perforation after an early instillation of a single dose of MMC. In this case, systemic toxicity occurred which required intensive care after surgical repair.
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Affiliation(s)
- Darwin Lim
- Departments of Surgery & Oncology, Divisions of Urology & Surgical Oncology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON
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Abstract
Bladder cancer is the 5th commonest cancer in the UK and up to 85% will present with superficial disease. Considering the principals of oncological surgery, best practice is to excise a tumour whole with clear circumferential margins. The inherent flaw of transurethral resection (TUR) is tumour fragmentation. However, high quality resection and immediate single-dose chemotherapy decreases recurrence rates and disease progression for superficial disease. TUR is the current gold standard for diagnosis and treatment of superficial bladder cancer. The associated morbidity is usually low. Good quality TUR can be difficult with tumours in diverticula, over ureteric orifices, on the dome/anterior/posterior wall or if obturator nerve stimulation occurs. As such technical tips are provided. Modern TUR relies on white light. The use of fluorescence cystoscopy will almost certainly increase, challenging white light TUR as the current gold standard. Furthermore, the development of bladder cancer urinary markers may provide a cost effective and non-invasive means of determining the frequency of surveillance cystoscopy.
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Branchereau J, Luyckx F, Hitier M, Karam G, Bouchot O, Rigaud J. Nécrose vésicale dans les suites d’une instillation postopératoire précoce (Ipop) de mitomycine C. Prog Urol 2011; 21:151-3. [DOI: 10.1016/j.purol.2010.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 02/17/2010] [Accepted: 02/22/2010] [Indexed: 10/19/2022]
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24
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Jones JS. Routine Use of Perioperative Intravesical Chemotherapy After TURBT: Against. Urology 2010; 76:797-8. [DOI: 10.1016/j.urology.2010.06.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 05/23/2010] [Accepted: 06/27/2010] [Indexed: 11/30/2022]
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25
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Prevention of tumor cell reimplantation during transurethral resection: the in-vitro antiadhesive and cytotoxic properties of an irrigant containing polyethylene glycol 400. Anticancer Drugs 2010; 21:645-50. [DOI: 10.1097/cad.0b013e32833a148d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Neulander EZ, Katz T, Klein J, Kaneti J. Re: Transurethral partial cystectomy with continuous wave laser for bladder carcinoma. Y. Yang, Z.-t. Wei, X. Zhang, B.-F. Hong and G. Guo. J Urol 2009; 182: 66-69. J Urol 2010; 183:1257. [PMID: 20096882 DOI: 10.1016/j.juro.2009.11.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Indexed: 11/20/2022]
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27
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Perioperative instillation therapy in superficial bladder cancer: is it effective regarding outcome and costs? Curr Opin Urol 2009; 19:511-5. [PMID: 19553821 DOI: 10.1097/mou.0b013e32832eb449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews the current knowledge concerning immediate intravesical instillation therapy in nonmuscle-invasive bladder cancer after transurethral resection of the bladder tumour, with emphasis on the literature of the last few years. RECENT FINDINGS A review was conducted on the recent literature available by PubMed database on the subject of immediate bladder chemotherapy after transurethral resection of the bladder tumour and its recent developments. SUMMARY A single immediate bladder instillation with chemotherapy will give 39% reduction of recurrence. Numbers needed to treat to prevent one recurrence are estimated at 8.5. In intermediate and high-risk bladder cancer, the immediate postoperative instillation does not give sufficient reduction in recurrence rate to leave out subsequent bladder instillations. The significant reduction of recurrences, the mild side-effects of the treatment and the clear cost-effectiveness make one immediate instillation a valuable addition to transurethral resection of the bladder tumour in the treatment of nonmuscle-invasive bladder cancer. Points of controversy are the true numbers needed to treat to prevent a recurrence and the type of recurrences that will be prevented. No new types of instillation are added recently to the ones available, but promising types are under investigation of which pharmacokinetic studies have shown acceptable rates of side-effects.
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Holmäng S. Early Single-Instillation Chemotherapy Has No Real Benefit and Should Be Abandoned in Non–Muscle-Invasive Bladder Cancer. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.eursup.2008.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Complications associated with primary and secondary perforation of the bladder following immediate instillations of epirubicin after transurethral resection of superficial urothelial tumours. Int Urol Nephrol 2009; 41:865-8. [DOI: 10.1007/s11255-009-9536-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 01/22/2009] [Indexed: 10/21/2022]
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30
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Rao PK, Stephen Jones J. Routine perioperative chemotherapy instillation with initial bladder tumor resection. Cancer 2009; 115:997-1004. [DOI: 10.1002/cncr.24104] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Bolenz C, Cao Y, Arancibia MF, Trojan L, Alken P, Michel MS. Intravesical mitomycin C for superficial transitional cell carcinoma. Expert Rev Anticancer Ther 2006; 6:1273-82. [PMID: 16925493 DOI: 10.1586/14737140.6.8.1273] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intravesical instillation of mitomycin C after a transurethral resection of a bladder tumor constitutes a standard treatment modality in the management of superficial transitional cell carcinoma in the urinary bladder. An immediate instillation of mitomycin C after transurethral resection has been shown to reduce the recurrence rate of superficial transitional cell carcinoma. Intravesical mitomycin C is generally considered to be a safe treatment option, but the past few years have seen the publication of a number of case reports on severe complications following mitomycin C instillation. This article reports on the mode of action, as well as the intravesical effects and current indications for mitomycin C instillation. This review will summarize the oncological benefits of mitomycin C in comparison with other intravesical treatments, such as bacillus Calmette-Guérin, and elucidate the incidence and types of possible complications associated with intravesical mitomycin C chemotherapy.
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Affiliation(s)
- Christian Bolenz
- Department of Urology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Koya MP, Simon MA, Soloway MS. Complications of intravesical therapy for urothelial cancer of the bladder. J Urol 2006; 175:2004-10. [PMID: 16697786 DOI: 10.1016/s0022-5347(06)00264-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE Intravesical therapy is an integral part of treatment in patients with superficial urothelial carcinoma of the bladder. The American Urological Association and European Association of Urology guidelines on bladder cancer incorporate it for the treatment of superficial bladder cancer. Given the extensive use of intravesical immunotherapy and chemotherapy, it is essential for the practicing urologist to be aware of the local and systemic side effects of these therapies. MATERIALS AND METHODS We reviewed the literature on intravesical immunotherapy and chemotherapy with particular emphasis on side effects, complications and their management. A Medline search of the English language literature for the last 25 years was done on Entrez PubMed and all relevant articles were studied in full. All side effects and complications were studied and their management was reviewed. RESULTS Intravesical therapy for transitional cell carcinoma of the bladder is generally safe. There is a high incidence of local, usually self-limiting, relatively minor side effects and infrequent, potentially severe local and systemic side effects. Most side effects are avoidable. CONCLUSIONS Although intravesical therapy is generally safe, local and systemic side effects occur and it is important to be aware of them. Identifying complications early, preventing them when possible and managing them efficiently are critical. Most complications are preventable. Knowing the risks and benefits of chemotherapeutic and immunotherapeutic agents may decrease the short-term and long-term toxicity of these agents. Adherence to guidelines may prevent inappropriate use, which can lead to unnecessary complications, resulting in bladder dysfunction and even cystectomy.
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Affiliation(s)
- Madhusudan P Koya
- Department of Urology, University of Miami School of Medicine, Miami, Florida 33136, USA
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Oosterlinck W, Solsona E, Akaza H, Busch C, Goebell PJ, Malmström PU, Ozen H, Sved P. Low-grade Ta (noninvasive) urothelial carcinoma of the bladder. Urology 2006; 66:75-89. [PMID: 16399417 DOI: 10.1016/j.urology.2005.07.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 07/06/2005] [Indexed: 10/25/2022]
Abstract
This article discusses the development of international guidelines for the diagnosis, treatment, follow-up, and prevention of low-grade Ta urothelial carcinoma of the bladder. The authors, who are experts in this field from 3 continents and 7 countries, reviewed the English language literature through September 2004. The results of the authors' deliberations are presented here as a consensus document. The objective of this study was to determine the optimal diagnostic workup, treatment, follow-up, and prevention of low-grade, Ta urothelial carcinoma of the bladder. A consensus conference convened by the World Health Organization (WHO) and the Société Internationale d'Urologie (SIU) met to critically review the literature on the diagnosis and treatment of low-grade Ta urothelial carcinoma of the bladder. Research was conducted using Medline; this search engine also was used to identify additional works not detected at the initial search. Evidence-based recommendations for diagnosis and management of the disease were made with reference to a 4-point scale. Low-grade Ta urothelial carcinoma of the bladder is a well-studied subject with many level 1 and 2 evidence references that support clinical practice. Findings from 135 reviewed citations are summarized. Many grade A and B recommendations on the diagnostic workup and management of this disease can be given with level 1 and 2 evidence based on prospective randomized clinical trials of sufficient statistical power. This should improve the quality of the treatment of this disease.
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Oddens JR, van der Meijden APM, Sylvester R. One Immediate Postoperative Instillation of Chemotherapy in Low Risk Ta, T1 Bladder Cancer Patients. Is it Always Safe? Eur Urol 2004; 46:336-8. [PMID: 15306104 DOI: 10.1016/j.eururo.2004.05.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The optimal treatment for solitary low grade, low stage papillary bladder tumours consists of transurethral resection (TUR) followed by one immediate postoperative instillation with a chemotherapeutic drug. However, when during TUR a bladder perforation or a near-perforation occurs, instillation of a chemotherapeutic drug may lead to leakage outside the bladder, possibly causing severe morbidity. So far, few case reports dealing with complications using mitomycin C have been published, but severe complications of leakage after an early adjuvant instillation with epirubicin have not been reported. METHODS We describe 3 patients in whom we observed serious complications of one immediate postoperative instillation of epirubicin. RESULTS Two of the patients recovered after conservative therapy, one patient died due to multi organ failure after explorative laparotomy. CONCLUSION In order to prevent such complications, an immediate postoperative instillation has to be avoided when there is overt or even suspicion of bladder wall perforation.
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Affiliation(s)
- J R Oddens
- Department of Urology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
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35
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Nieuwenhuijzen JA, Bex A, Horenblas S. Unusual complication after immediate postoperative intravesical mitomycin C instillation. Eur Urol 2003; 43:711-2. [PMID: 12767376 DOI: 10.1016/s0302-2838(03)00151-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Immediate adjuvant Mitomycin C (MMC) instillation is routine practice in the treatment of superficial bladder cancer. Despite relative safety we describe a case of MMC extravasation after intravesical instillation. This resulted in severe continuous pain in the pelvic region without tendency of spontaneous healing, and required surgical debridement. To assess perivesical soft tissue injury prior to surgery MRI imaging turned out to be more accurate than computer tomography. Suggestions about how to avoid, diagnose and treat this symptomatic extravasation are made.
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Affiliation(s)
- Jakko A Nieuwenhuijzen
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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NEULANDER ENDREZ, LISMER LEONARD, KANETI JACOB. NECROSIS OF THE GLANS PENIS: A RARE COMPLICATION OF INTRAVESICAL THERAPY WITH MITOMYCIN C. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67168-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- ENDRE Z. NEULANDER
- From the Department of Urology, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - LEONARD LISMER
- From the Department of Urology, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - JACOB KANETI
- From the Department of Urology, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel
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Affiliation(s)
- A M Cliff
- Department of Urology, Royal Liverpool University Hospital, Liverpool, UK
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