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Jhaveri JK, Dahmen A, Lazarovich A, Nusbaum D, Trinh QD, Gupta N, Agarwal PK. Necrotizing granulomatous epididymo-orchitis post intravesical BCG administration after brachytherapy for prostate cancer. Urol Case Rep 2024; 54:102694. [PMID: 38516176 PMCID: PMC10951466 DOI: 10.1016/j.eucr.2024.102694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/18/2024] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
Urothelial carcinoma of the bladder remains a challenging disease to treat. Intravesical instillation of BCG has demonstrated tremendous efficacy in preventing recurrence. BCG related necrotizing granulomatous epididymo-orchitis is rare and has not been previously linked to brachytherapy for adenocarcinoma of the prostate. We hypothesize that prior brachytherapy has a deleterious effect on the verumontanum that can result in retrograde transmission of BCG particles leading to granulomatous epididymo-orchitis. This is the first case report of necrotizing granulomatous epididymo-orchitis related to BCG in a patient status post brachytherapy for adenocarcinoma of the prostate.
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Affiliation(s)
- Jay K. Jhaveri
- Department of Urology, Henry Ford Health System, Detroit, MI, USA
| | - Aaron Dahmen
- Department of Surgery, Division of Urology, University of Chicago, Chicago, IL, USA
| | - Alon Lazarovich
- Department of Surgery, Division of Urology, University of Chicago, Chicago, IL, USA
| | - David Nusbaum
- Department of Surgery, Division of Urology, University of Chicago, Chicago, IL, USA
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Nilesh Gupta
- Department of Pathology, Henry Ford Health System, Detroit, MI, USA
| | - Piyush K. Agarwal
- Department of Surgery, Division of Urology, University of Chicago, Chicago, IL, USA
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Melgarejo Segura MT, Yáñez Castillo Y, Lozano Lorca M, Morales Martínez A, Arrabal Polo MÁ, Arrabal Martín M. Efficacy of conduction hyperthermia in the treatment of non-muscle invasive bladder cancer: A systematic review. Urol Oncol 2024:S1078-1439(24)00399-5. [PMID: 38670818 DOI: 10.1016/j.urolonc.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/01/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Intravesical treatment for non-muscle invasive bladder cancer (NMIBC) aims to reduce recurrences and stop progression. Hyperthermia-enhanced chemotherapy with devices like COMBAT BRS, Unithermia, and BR-TRG-I is a promising alternative to conventional Bacillus de Calmette Guerin (BCG) therapy. OBJECTIVE To systematically review the efficacy of hyperthermia generated by conduction devices in the treatment of NMIBC. MATERIAL AND METHODS The review followed the preferred reporting items for systematic reviews and meta-analyses guidelines. A search was performed in the PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov databases. Two reviewers independently assessed the eligibility of candidate studies and abstracted data from studies that met the inclusion criteria. The primary endpoint was assessment of recurrence. Secondary objectives included evaluation of treatment progression and safety. RESULTS Thirty studies meeting inclusion criteria underwent data extraction. In intermediate-risk NMIBC patients, COMBAT versus mitomycin C (MMC) in normothermia revealed no superiority in reducing recurrence or progression. High-risk NMIBC patients using COMBAT achieved similar or superior outcomes to BCG. BR-TRG-I demonstrated superior results over normothermia in intermediate- and high-risk NMIBC patients. Unithermia proved less effective than BCG in high-risk NMIBC. Progression outcomes were promising with COMBAT and BR-TRG-I, but comprehensive analysis was limited due to inconsistent assessment across studies. Adverse events were primarily mild-moderate, with some device-specific differences. CONCLUSIONS Studies on conduction hyperthermia present great variability, which do not allow us to determine the superiority of 1 device over another in terms of recurrence, progression, and/or adverse effects. Further research with consistent administration protocols is crucial for definitive conclusions.
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Affiliation(s)
| | | | - Macarena Lozano Lorca
- Department of Preventive Medicine and Public Health, University of Granada, Melilla, Spain; Institute of Biosanitary Research ibs. Granada, Granada, Spain
| | | | - Miguel Ángel Arrabal Polo
- Department of Urology, University Hospital San Cecilio, Granada, Spain; Institute of Biosanitary Research ibs. Granada, Granada, Spain
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Park JJ, Kim KT, Lee EJ, Chun J, Lee S, Shim SR, Kim JH. Current updates relating to treatment for interstitial cystitis/bladder pain syndrome: systematic review and network meta-analysis. BMC Urol 2024; 24:95. [PMID: 38658949 PMCID: PMC11040764 DOI: 10.1186/s12894-024-01485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Despite the publication of several meta-analyses regarding the efficacy of certain therapies in helping individuals with interstitial cystitis (IC) / bladder pain syndrome (BPS), these have not provided a comprehensive review of therapeutic strategies. The study aimed to determine the efficacy of various therapies for IC/BPS and identify potential moderating factors using randomized controlled trials (RCTs). METHODS We queried the PubMed, Cochrane, and Embase databases to identify prospective RCTs using inclusion criteria: 1) patients diagnosed with IC, 2) interventions included relevant treatments, 3) comparisons were a specified control or placebo, 4) outcomes were mean differences for individual symptoms and structured questionnaires. The pairwise meta-analysis and network meta-analysis (NMA) were performed to compare the treatments used in IC/BPS. Hedges' g standardized mean differences (SMDs) were used for improvement in all outcomes using random-effects models. Efficacy outcomes included individual symptoms such as pain, frequency, urgency, and nocturia, as well as structured questionnaires measuring IC/BPS symptoms. RESULTS A comprehensive literature search was conducted which identified 70 RCTs with 3,651 patients. The analysis revealed that certain treatments, such as instillation and intravesical injection, showed statistically significant improvements in pain and urgency compared to control or placebo groups in traditional pairwise meta-analysis. However, no specific treatment demonstrated significant improvement in all outcomes measured in the NMA. The results of moderator analyses to explore influential variables indicated that increasing age was associated with increased nocturia, while longer follow-up periods were associated with decreased frequency. CONCLUSION This systematic review and meta-analysis provide insights into the efficacy of various treatments for IC. Current research suggests that a combination of therapies may have a positive clinical outcome for patients with IC, despite the fact that treatment for this condition is not straightforward. TRIAL REGISTRATION PROSPERO CRD42022384024.
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Affiliation(s)
- Jae Joon Park
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsangu, Seoul, 04401, Republic of Korea
| | - Kwang Taek Kim
- Department of Urology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Joey Chun
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsangu, Seoul, 04401, Republic of Korea
- Cranbrook Kingswood Upper School, Bloomfield Hills, Michigan, United States
| | - Serin Lee
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsangu, Seoul, 04401, Republic of Korea
- Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio, United States
| | - Sung Ryul Shim
- Department of Biomedical Informatics, College of Medicine, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea.
- Konyang Medical data Research group-KYMERA, Konyang University Hospital, Daejeon, Republic of Korea.
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsangu, Seoul, 04401, Republic of Korea.
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Li M, Nandurkar R, Toniolo J, Davis ID, Sengupta S. A phase 2 pilot study of water irrigation after transurethral resection of bladder tumor (WATIP) demonstrating safety, feasibility and activity. World J Urol 2024; 42:115. [PMID: 38436768 DOI: 10.1007/s00345-024-04800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/16/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE Non-muscle-invasive bladder cancer (NMIBC) can recur, partly due to seeding of free tumour cells after transurethral resection of bladder tumour (TURBT). Intravesical chemotherapy post-TURBT can reduce the risk but is used infrequently and inconsistently due to cost, complexity and side effects. The objective of this study was to prospectively assess continuous bladder irrigation using water, which may be a safer and easier alternative with comparable effectiveness. METHODS WATIP was a prospective, single-arm phase 2 study of water irrigation during and for at least 3 h after TURBT for bladder tumours noted on imaging or flexible cystoscopy. Participants were assessed clinically for adverse effects and with blood tests within 24 h for sodium, haemoglobin and lactate dehydrogenase. The primary endpoints were safety (defined as < 10% adverse events of CTCAE grade ≥ 3), and feasibility (defined as the intervention being delivered as planned in > 90% of cases) and secondary endpoint was recurrence-free rates (RFR). RESULTS Water irrigation was delivered as planned in 29 (97%) of 30 participants (median age 67 years, 25 (83%) males). The only adverse event (grade 2) was clot retention in one (3.3%) participant. Water irrigation significantly reduced urothelial cell counts in catheter effluent over time, unlike saline irrigation which did not. RFR was 56.2% (9/16 participants with low-risk NMIBC) at first cystoscopy (median interval 108 days) and 62.5% (5/8 evaluable low-risk NMIBC) at 12 months. CONCLUSION Water irrigation during and after TURBT is feasible and safe. Prospective assessment of its effect on NMIBC recurrence compared to post-TURBT intravesical chemotherapy is needed before recommending its use in routine clinical practice. Trial registration ANZCTR registration ID ACTRN12619000517178 on 1 April 2019.
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Affiliation(s)
- Mo Li
- Eastern Health Clinical School, Monash University, Level 2, 5 Arnold St, Box Hill, VIC, 3128, Australia
- Department of Urology, Eastern Health, Box Hill, VIC, Australia
| | - Ruchira Nandurkar
- Eastern Health Clinical School, Monash University, Level 2, 5 Arnold St, Box Hill, VIC, 3128, Australia
- Department of Urology, Eastern Health, Box Hill, VIC, Australia
| | - Jason Toniolo
- Department of Urology, Eastern Health, Box Hill, VIC, Australia
| | - Ian D Davis
- Eastern Health Clinical School, Monash University, Level 2, 5 Arnold St, Box Hill, VIC, 3128, Australia
- Department of Oncology, Eastern Health, Box Hill, VIC, Australia
| | - Shomik Sengupta
- Eastern Health Clinical School, Monash University, Level 2, 5 Arnold St, Box Hill, VIC, 3128, Australia.
- Department of Urology, Eastern Health, Box Hill, VIC, Australia.
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Lee JH, Lee CU, Chung JH, Song W, Kang M, Jeon HG, Jeong BC, Seo SI, Jeon SS, Sung HH. Single Early Intravesical Instillation of Epirubicin for Preventing Bladder Recurrence After Nephroureterectomy in Upper Urinary Tract Urothelial Carcinoma. Cancer Res Treat 2024:crt.2023.1219. [PMID: 38271926 DOI: 10.4143/crt.2023.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Purpose We aimed to assess the effectiveness of early single intravesical administration of epirubicin in preventing intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. Materials and Methods Patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy between November 2018 and May 2022 were retrospectively reviewed. Intravesical epirubicin was administered within 48 hours if no evidence of leakage was observed. Epirubicin (50 mg) in 50 mL normal saline solution was introduced into the bladder via a catheter and maintained for 60 min. The severity of adverse events was graded using the Clavien-Dindo classification. We compared intravesical recurrence rate between the two groups. Multivariate analyses were performed to identify the independent predictors of bladder recurrence following radical nephroureterectomy. Results Epirubicin (n=55) and control (n=116) groups were included in the analysis. No grade 1 or higher bladder symptoms have been reported. A statistically significant difference in the intravesical recurrence rate was observed between the two groups (11.8% at 1 year in the epirubicin group vs. 28.4% at 1 year in the control group; log-rank p=0.039). In multivariate analysis, epirubicin instillation (HR, 0.43; 95% CI, 0.20-0.93; p=0.033) and adjuvant chemotherapy (HR, 0.29; 95% CI, 0.13-0.65; p=0.003) were independently predictive of a reduced incidence of bladder recurrence. Conclusion This retrospective review revealed that a single immediate intravesical instillation of epirubicin is safe and can reduce the incidence of intravesical recurrence after radical nephroureterectomy. However, further prospective trials are required to confirm these findings.
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Affiliation(s)
- Jong Hoon Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chen CY, Chang CH, Yang CR, Hsieh KL, Tsing WH, Chen IHA, Lin JT, Huang CY, Hong JH, Tseng JS, Lin WR, Tsai YC, Wu SY, Shen CH, Cheong IS, Chen CS, Yang CK, Jiang YH, Tsai CY, Hsueh TY, Chen YT, Wu CC, Lo SH, Chiang BJ, Lin WY, Lin PH, Tai TY, Li WM, Lee HY. Prognostic factors of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 2024; 42:22. [PMID: 38197890 DOI: 10.1007/s00345-023-04700-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/30/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE To evaluate predictive factors of increasing intravesical recurrence (IVR) rate in patients with upper tract urothelial carcinoma (UTUC) after receiving radical nephroureterectomy (RNUx) with bladder cuff excision (BCE). MATERIALS AND METHODS A total of 2114 patients were included from the updated data of the Taiwan UTUC Collaboration Group. It was divided into two groups: IVR-free and IVR after RNUx, with 1527 and 587 patients, respectively. To determine the factors affecting IVR, TNM stage, the usage of pre-operative ureteroscopy, and pathological outcomes were evaluated. The Kaplan-Meier estimator was used to estimate the rates of prognostic outcomes in overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and bladder recurrence-free survival (BRFS), and the survival curves were compared using the stratified log-rank test. RESULTS Based on our research, ureter tumor, female, smoking history, age (< 70 years old), multifocal tumor, history of bladder cancer were determined to increase the risk of IVR after univariate analysis. The multivariable analysis revealed that female (BRFS for male: HR 0.566, 95% CI 0.469-0.681, p < 0.001), ureter tumor (BRFS: HR 1.359, 95% CI 1.133-1.631, p = 0.001), multifocal (BRFS: HR 1.200, 95% CI 1.001-1.439, p = 0.049), history of bladder cancer (BRFS: HR 1.480, 95% CI 1.118-1.959, p = 0.006) were the prognostic factors for IVR. Patients who ever received ureterorenoscopy (URS) did not increase the risk of IVR. CONCLUSION Patients with ureter tumor and previous bladder UC history are important factors to increase the risk of IVR after RNUx. Pre-operative URS manipulation is not associated with higher risk of IVR and diagnostic URS is feasible especially for insufficient information of image study. More frequent surveillance regimen may be needed for these patients.
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Affiliation(s)
- Chen-Ya Chen
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Rei Yang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Kun-Lin Hsieh
- Division of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Hsin Tsing
- Division of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
- Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Jian-Hua Hong
- Department of Urology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Mackay Medical College, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Mackay Medical College, Taipei, Taiwan
| | - Yao-Chou Tsai
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
- Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Shu-Yu Wu
- Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- Department of Urology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Cheng-Huang Shen
- Department of Urology, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Ian-Seng Cheong
- Department of Urology, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Chuan-Shu Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung City, Taiwan
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chung-You Tsai
- Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Thomas Y Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei City, Taiwan
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
| | - Shih-Hsiu Lo
- Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Wei Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
- Chang Gung University of Science and Technology, Chia-Yi, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Yao Tai
- Department of Urology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Rahnama'i MS, Bagheri A, Jahantabi E, Salehi-Pourmehr H, Mostafaei H, Schurch B, Javan Balegh Marand A, Hajebrahimi S. Long-term follow-up of intravesical abobotulinumtoxinA (Dysport®) injections in women with idiopathic detrusor overactivity. Asian J Urol 2024; 11:93-98. [PMID: 38312815 PMCID: PMC10837662 DOI: 10.1016/j.ajur.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/08/2022] [Indexed: 10/14/2022] Open
Abstract
Objective Only a few numbers of studies have been published on the use of abobotulinumtoxinA (Dysport®) in idiopathic detrusor overactivity (IDO). This study reported the long-term follow-up of women with IDO who were treated with intravesical Dysport® injections. Methods Two hundred and thirty-six patients with IDO who had failed first-line conservative and antimuscarinic therapy received 500-900 units of Dysport® between April 2014 and July 2015. All patients were followed up for 5 years after their initial injection and interviewed on the phone. Results A total of 236 women with IDO aged from 18 years to 84 years (mean±standard deviation: 49.6±15.9 years) were included in our study. The median follow-up time for patients was 36.5 (range: 10-70) months, and the median recovery time after injection was 18.5 (range: 0-70) months. A total of 83 (35.2%) patients stated that they had subjective improvement of their symptoms whereas 84 (35.6%) patients did not report any improvement in symptoms. The initial International Consultation on Incontinence Questionnaire Overactive Bladder mean score was 6.9 (standard deviation 3.4). There was a positive association between the median recovery time and the components of the International Consultation on Incontinence Questionnaire Overactive Bladder questionnaire. Conclusion In a sub-population of overactive bladder patients with IDO who have failed first-line therapy, a single intravesical Dysport® injection can resolve patient symptoms completely or reduce the symptoms to an acceptable level that can be controlled with antimuscarinics or re-injection on demands.
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Affiliation(s)
| | - Amin Bagheri
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elham Jahantabi
- Urology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | - Sakineh Hajebrahimi
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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Contieri R, Hensley PJ, Tan WS, Grajales V, Bree K, Nogueras-Gonzalez GM, Lee BH, Navai N, Dinney CP, Kamat AM. Oncological Outcomes for Patients with European Association of Urology Very High-risk Non-muscle-Invasive Bladder Cancer Treated with Bacillus Calmette-Guérin or Early Radical Cystectomy. Eur Urol Oncol 2023; 6:590-596. [PMID: 37558542 DOI: 10.1016/j.euo.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND European Urology Association (EAU) guidelines recommend immediate radical cystectomy (early RC) for patients with very high-risk (VHR) non-muscle invasive bladder cancer (NMIBC), with bacillus Calmette-Guérin (BCG) recommended only for those who refuse or are unfit for RC. OBJECTIVE To describe oncological outcomes following BCG or early RC in a contemporary cohort of patients with VHR NMIBC (EAU criteria). DESIGN, SETTING, AND PARTICIPANTS Patients diagnosed with VHR NMIBC between 2000 and 2020 were identified from our institutional NMIBC registry. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcomes were overall survival (OS) and cancer-specific mortality (CSM). Secondary outcomes were the progression rate and high-grade recurrence (HGR) rate for patients receiving BCG. RESULTS AND LIMITATIONS We identified 235 patients with VHR NMIBC, of whom 157 (67%) received BCG and 78 (33%) underwent early RC. The median follow-up was 52.8 mo. OS and CSM rates were 80.2% and 5.3% in the BCG group, and 88.1% and 4.9% in the early RC group, respectively with no significant difference in OS (p = 0.6) or CSM (p = 0.8) between the two groups. Among the patients treated with BCG, 5-yr HGR and progression rates were 41.9% and 17.4%, respectively; 39 patients (25%) underwent delayed RC after BCG. No significant difference in CSM emerged when comparing patients treated with delayed RC (after BCG) with those undergoing early RC (p = 0.86). CONCLUSIONS Our findings suggest that intravesical BCG can be offered to patients as a resonable alternative to early RC for selected patients with VHR NMIBC. PATIENT SUMMARY We evaluated outcomes for patients with very high-risk non-muscle-invasive bladder cancer (NMIBC) treated with BCG (bacillus Calmette-Guérin) versus early surgical removal of the bladder and found no differences in survival. We conclude that BCG could be offered to selected patients with this type of bladder cancer as a reasonable alternative to early bladder removal.
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Affiliation(s)
- Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Wei Shen Tan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valentina Grajales
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Byron H Lee
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Colin P Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Tan WS, Grajales V, Contieri R, Hensley P, Bree K, Msaouel P, Guo CC, Nogueras-Gonzalez GM, Navai N, Dinney CP, Kamat AM. Bladder-sparing Treatment in Patients with Bacillus Calmette-Guerin-unresponsive Non-muscle-invasive Bladder Cancer: An Analysis of Long-term Survival Outcomes. EUR UROL SUPPL 2023; 53:16-22. [PMID: 37441349 PMCID: PMC10334230 DOI: 10.1016/j.euros.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 07/15/2023] Open
Abstract
Background Data for bladder-sparing treatment (BST) in bacillus Calmette-Guerin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) patients report short-term outcomes limited to 1-2 yr. Objective To assess long-term survival outcomes of BCG-unresponsive NMIBC patients treated with BST. Design setting and participants BCG-unresponsive NMIBC patients diagnosed between January 2000 and September 2021 from an institutional NMIBC registry were evaluated. Intervention Long-term survival outcomes for patients receiving BST, early radical cystectomy (RC), and delayed RC were compared. Outcome measurements and statistical analysis The primary endpoints were overall survival (OS) and cancer-specific survival (CSS). Results and limitations In total, 114 patients with a median follow-up of 71.2 mo (interquartile range: 32.6-132.2) were analyzed. There were no significant differences in OS (hazard ratio [HR]: 1.40, 95% confidence interval [CI]: 0.68-2.89, p = 0.4) or CSS (HR: 0.88, 95% CI: 0.22-3.55, p = 0.9) between patients undergoing early RC (n = 38) and BST (n = 76). At 60 mo, BST patients had a high-grade recurrence-free rate, muscle-invasive disease/metastasis progression-free rate, and avoidance of RC rate of 37%, 83%, and 58%, respectively. Current smoker status (HR: 4.44, 95% CI: 1.41-13.97, p = 0.011) was the only variable predictive of high-grade recurrence following a multivariable analysis. The median time to RC from BCG-unresponsive date was 2.1 and 11.7 mo for those undergoing early RC and delayed RC (after BST), respectively. Patients treated with early RC had a higher incidence of cT1 disease (53% vs 36%, p = 0.049) and lymphovascular invasion (LVI; 11% vs 0%, p = 0.011) compared to patients treated with BST. Survival outcomes were similar between groups: 10-yr OS-58% versus 50% (HR: 1.40, 95% CI: 0.68-2.89, p = 0.4), and 10-yr CSS-81% versus 85% (HR: 0.88, 95% CI: 0.22-3.55, p = 0.9). Conclusions An analysis of long-term survival of BCG-unresponsive NMIBC patients receiving BST suggests that it may be safe in patients without LVI and/or variant histology and nonsmokers. Survival outcomes for patients treated with BST may not be inferior to those receiving early RC. Patient summary Bladder-sparing treatment can be offered to appropriately selected patients who have bacillus Calmette-Guerin (BCG)-unresponsive non-muscle-invasive bladder cancer. Long-term outcomes may not be inferior to those for patients who opt for early radical cystectomy.
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Affiliation(s)
- Wei Shen Tan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valentina Grajales
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick Hensley
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Kelly Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles C. Guo
- Department of Genitourinary Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Colin P. Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M. Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Kawada T, Yanagisawa T, Bekku K, Laukhtina E, von Deimling M, Chlosta M, Pradere B, Teoh JYC, Babjuk M, Araki M, Shariat SF. The efficacy and safety outcomes of lower dose BCG compared to intravesical chemotherapy in non-muscle-invasive bladder cancer: A network meta-analysis. Urol Oncol 2023:S1078-1439(23)00118-7. [PMID: 37137745 DOI: 10.1016/j.urolonc.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/01/2023] [Indexed: 05/05/2023]
Abstract
This study aimed to assess both efficacy and safety outcomes of lowering the dose of BCG compared to intravesical chemotherapies in non-muscle-invasive bladder cancer (NMIBC) patients using a systematic review, meta-analysis, and network meta-analysis approach. A comprehensive literature search was performed through Pubmed®, Web of Science™, and Scopus® in December 2022 to identify randomized controlled trials comparing the oncologic and/or safety outcomes of reduced dose intravesical BCG and/or intravesical chemotherapies according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement. The outcomes of interest were risk of recurrence, progression, treatment-related adverse events, and discontinuation. Overall, 24 studies were eligible for quantitative synthesis. Among 22 studies that adopted induction followed by maintenance intravesical therapy, with reference to the lower-dose BCG, epirubicin was associated with a significantly higher risk of recurrence (Odds ratio [OR]: 2.82, 95% CI: 1.54-5.15), but not other intravesical chemotherapies. There were no significant differences in risk of progression among the intravesical therapies. On the other hand, standard-dose BCG was associated with a higher risk of any AEs (OR: 1.91, 95% CI: 1.07-3.41) but other intravesical chemotherapies had a comparable risk of AEs compared to lower-dose BCG. The discontinuation rate did not significantly differ between lower-dose and standard-dose BCG (OR: 1.40, 95% CI: 0.81-2.43) as well as other intravesical. According to the surface under the cumulative ranking curve, gemcitabine, and standard-dose BCG were preferable to lower-dose BCG in terms of recurrence risk; gemcitabine was also preferable to lower-dose BCG in terms of risk of AEs. In patients with NMIBC, lowering the dose of BCG decreases the risks of AEs and discontinuation rate compared to standard-dose BCG, but there is no difference in these endpoints compared to other intravesical chemotherapies. Standard-dose of BCG is preferred for all intermediate and high-risk NMIBC patients based on oncologic efficacy; however, lower-dose BCG and intravesical chemotherapies, especially gemcitabine, could be considered a reasonable alternative to BCG in selected patients who suffer from significant AEs or in case standard-dose BCG is not available.
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Affiliation(s)
- Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kensuke Bekku
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcin Chlosta
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Benjamin Pradere
- Department of Urology UROSUD, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Marko Babjuk
- Department of Urology, Second Faculty of Medicine of Charles University, University Hospital Motol, Prague, Czech Republic
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
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Chevuru PT, McElree IM, Mott SL, Steinberg RL, O'Donnell MA, Packiam VT. Long-term follow-up of sequential intravesical gemcitabine and docetaxel salvage therapy for non-muscle invasive bladder cancer. Urol Oncol 2023; 41:148.e1-148.e7. [PMID: 36456454 DOI: 10.1016/j.urolonc.2022.10.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/13/2022] [Accepted: 10/30/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Intravesical gemcitabine and docetaxel (Gem/Doce) has been established as a safe and efficacious salvage treatment for recurrent NMIBC since 2015. Despite widespread adoption of this regimen, long-term outcomes have not been described. We report our experience with intravesical Gem/Doce following BCG failure in a large cohort of patients with extended follow-up. METHODS We retrospectively identified 97 patients at our institution treated with Gem/Doce for high-risk NMIBC after BCG failure between 2009 and 2017. Patients received six weekly intravesical Gem/Doce instillations. Monthly maintenance for 2 years was initiated if disease free at first follow-up. Outcomes included recurrence-free survival (RFS), high-grade recurrence-free survival (HG-RFS), progression-free survival (PFS), cystectomy-free survival (CFS), cancer-specific survival (CSS), and overall survival (OS). Survival probabilities were estimated using the Kaplan-Meier method. RESULTS Median follow-up was 49 months. Median age was 73 years, and 71% of the cohort had CIS containing disease. Thirty five percent of the cohort had BCG-unresponsive disease. Complete response at 3-month surveillance was 74% and median duration of response was 25 months. At 1, 2, and 5 years, HG-RFS was 60%, 50%, and 30%, respectively. HG-RFS was similar among BCG-unresponsive patients and the overall cohort. During follow-up, 20 patients underwent cystectomy and 15 patients experienced disease progression. Five-year PFS, CFS, CSS, and OS were 82%, 75%, 91%, and 64%, respectively. CONCLUSIONS In this long-term analysis, intravesical Gem/Doce for high-risk NMIBC after BCG failure yielded a 75% 5-year bladder preservation rate and a 91% 5-year cancer-specific survival rate. Further prospective trials are warranted.
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Affiliation(s)
- Phani T Chevuru
- Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Ian M McElree
- Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City
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Anderson CB, Chen L, Chang SS, McKiernan JM, Wright J. Intravesical Therapy Compared to Radical Cystectomy Among Patients With Non-Muscle Invasive Bladder Cancer Requiring Additional Treatment After Induction BCG. Clin Genitourin Cancer 2022; 20:595-603. [PMID: 35948482 DOI: 10.1016/j.clgc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/05/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Many patients with recurrent high-risk non-muscle invasive bladder cancer after intravesical bacillus calmette-guerin (BCG) face a difficult decision between radical cystectomy (RC) or salvage intravesical therapy (IVT). We sought to determine if there is a difference in overall survival RC and IVT after previous treatment with BCG. METHODS We performed a retrospective cohort study of patients with Ta, T1, and Tis bladder cancer treated with induction BCG in the SEER-Medicare dataset from 2000 to 2015. We used a proportional hazards regression model to compare differences in survival between patients having RC and IVT. We adjusted for confounding using a propensity score and stratified our analysis according to timing of treatment and stage at diagnosis. RESULTS We identified 3940 patients who received either IVT (79%) or RC (21%) following induction BCG. Among patients treated within 12 months of BCG, there was no significant difference in survival between RC and IVT (HR 0.92, 95% CI 0.81-1.04) and 17% of patients having early IVT ultimately required RC. Among patients treated at least 12 months after BCG, RC was associated with worse survival than IVT (HR 1.19, 95% CI 1.06-1.35) and 10% of patients having late IVT ultimately required RC. CONCLUSION Among patients with bladder cancer who required additional treatments after induction BCG, we did not observe a difference in overall survival between IVT and RC within 12 months of starting BCG. While RC remains the gold-standard for high risk recurrent NMIBC after BCG, bladder preservation with IVT may be appropriate for well-selected patients.
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Affiliation(s)
- Christopher B Anderson
- Department of Urology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY.
| | - Ling Chen
- Department of Gynecology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - James M McKiernan
- Department of Urology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY
| | - Jason Wright
- Department of Gynecology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY
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Tan WS, Steinberg G, Witjes JA, Li R, Shariat SF, Roupret M, Babjuk M, Bivalacqua TJ, Psutka SP, Williams SB, Cookson MS, Palou J, Kamat AM. Intermediate-risk Non-muscle-invasive Bladder Cancer: Updated Consensus Definition and Management Recommendations from the International Bladder Cancer Group. Eur Urol Oncol 2022; 5:505-516. [PMID: 35718695 DOI: 10.1016/j.euo.2022.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/22/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Abstract
CONTEXT Intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC) is a heterogeneous disease. OBJECTIVE To update the International Bladder Cancer Group (IBCG) guidance and provide practical recommendations on IR NMIBC management. EVIDENCE ACQUISITION A collaborative review of published randomized clinical trials, meta-analyses, systematic reviews, and clinical practice guidance on IR NMIBC published before January 2022 was undertaken using PubMed/Medline. EVIDENCE SYNTHESIS Variation exists between guidelines in defining IR NMIBC. The IBCG recommends defining IR NMIBC as any TaLG tumor that is either recurrent or multifocal or has size ≥3 cm, OR any T1LG tumor. If the 3 tier grading system is used, than any TaG2 tumor would also be considered IR diease regardless of whether new diagnosis or recurrent. Accurate grading and staging of tumor, particularly in ruling out HG/G3 disease and/or carcinoma in situ, are crucial. The IBCG recommends that management of IR NMIBC should be further based on the following risk factors: multifocal tumor (more than one), early recurrence (<1 yr), frequent recurrence (>1/yr), tumor size (≥3 cm), and failure of prior intravesical treatment. Patients with no risk factors are best managed by one dose of postoperative intravesical chemotherapy. Patients with one to two risk factors should be offered additional adjuvant induction intravesical chemotherapy (or bacillus Calmette-Guérin (BCG) if prior chemotherapy has been used). Patients with three or more risk factors should be offered induction plus 1-yr maintenance BCG. Where BCG is not available or recurrent disease following BCG is present, alternative intravesical treatments such as chemotherapy (single agent, combination, or chemohyperthermia) or a clinical trial are recommended. CONCLUSIONS Standardizing the definition of IR NMIBC is critical for appropriate management of patients and for allowing a comparison of outcomes across clinical trials. The IBCG recommends defining IR NMIBC as any TaLG tumor that is either recurrent or multifocal or ≥3 cm, OR any T1LG tumor. If the 3 tier grading system is used, than any TaG2 tumor would also be considered IR disease regardless of whether new diagnosis or recurrent. Adjunctive management should then be based on established risk factors. PATIENT SUMMARY Standardizing the definition of intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC), which is a heterogeneous disease, is critical for appropriate management of patients. The International Bladder Cancer Group recommends classification of IR NMIBC tumors and personalized management based on the following risk factors: multifocal tumor (more than one), early recurrence (<1 yr), frequent recurrence (>1/yr), tumor size (≥3 cm), and previous intravesical treatment.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals, London, UK
| | - Gary Steinberg
- Department of Urology, New York University, New York City, NY, USA
| | - J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Morgan Roupret
- Urology, GRC n°5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Marko Babjuk
- Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Praha, Czech Republic
| | - Trinity J Bivalacqua
- Department of Urology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Stephen B Williams
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Michael S Cookson
- Department of Urology, The University of Oklahoma Health Sciences Center & The Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Balasubramanian A, Gunjur A, Weickhardt A, Papa N, Bolton D, Lawrentschuk N, Perera M. Adjuvant therapies for non-muscle-invasive bladder cancer: advances during BCG shortage. World J Urol 2022. [PMID: 35083522 DOI: 10.1007/s00345-021-03908-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
Non-muscle-invasive bladder cancer (NMIBC) represents a significant global therapeutic challenge, particularly in the era of Bacillus Calmette-Guérin (BCG) shortage. High-risk NMIBC can progress to muscle invasive or metastatic disease in 25% of patients. Optimal treatment selection, according to risk stratification, is imperative. International guidelines slightly differ in their categorisation of low, intermediate and high-risk NMIBC. Nonetheless, a single post-operative instillation of chemotherapy with Mitomycin C (MMC) or Gemcitabine improves relapse-free survival (RFS) in low-risk NMIBC. Induction and maintenance intravesical BCG remains the historical gold standard for patients with intermediate or high-risk NMIBC. However, clinicians may be forced to consider alternatives given the current BCG shortage. Both intravesical MMC and Gemcitabine have been associated with similar efficacy to BCG, albeit in smaller studies. MMC may also be manipulated using a variety of methods to potentiate its effects. BCG treatment delivery may also be modified without affecting efficacy through dose reduction and abbreviation or omission of maintenance therapy. Preliminary data also highlight that directly proceeding to radical cystectomy may not adversely affect long-term quality of life measures. Access to new systemic and intravesical therapies must be prioritised for patients with BCG recurrent or unresponsive disease. When used in conjunction with molecularly defined biomarkers, these agents herald the potential for improved survival outcomes and alleviation of the current BCG shortage.
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Goldberg IP, Lichtbroun B, Singer EA, Ghodoussipour S. Pharmacologic Therapies for Non-Muscle Invasive Bladder Cancer: Current and Future Treatments. Arch Pharmacol Ther 2022; 4:13-22. [PMID: 36051251 PMCID: PMC9431226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Bladder cancer is the sixth most common malignancy in the United States and 70% of cases are non-muscle invasive at the time of diagnosis. Effective treatment is crucial to prevent progression, which occurs in about 30% of patients. The American Urological Association (AUA) guidelines recommend treatment of non-muscle invasive bladder cancer (NMIBC) with intravesical Bacille Calmette-Guerin (BCG) and chemotherapy. However, ongoing shortages and high rates of BCG unresponsiveness creates a major need for novel therapies. In this narrative review, we discuss the evolving landscape of therapeutic options for NMIBC. Pembrolizumab, an anti-programmed cell death (PD)-1 antibody, was the first systemic therapy to be FDA-approved for BCG-unresponsive, high-risk disease. Promising new agents under investigation include various other checkpoint inhibitors and adenovirus-based therapies including CG0070 and nadofaragene firadenovec (rAd-IFNa/Syn3). Finally, new mechanisms of drug delivery are under investigation, including delivery with the GemRIS (TAR-200) device and delivery of intravesical chemotherapy at higher temperatures. With the promise of novel therapies on the horizon, we can expect the role of urologists in the management of NMIBC to evolve and expand.
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Affiliation(s)
| | - Benjamin Lichtbroun
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Correspondence should be addressed to Saum Ghodoussipour, MD,
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Ntoulia A, Anupindi SA, Back SJ, Didier RA, Hwang M, Johnson AM, McCarville MB, Papadopoulou F, Piskunowicz M, Sellars ME, Darge K. Contrast-enhanced ultrasound: a comprehensive review of safety in children. Pediatr Radiol 2021; 51:2161-2180. [PMID: 34716453 DOI: 10.1007/s00247-021-05223-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/10/2021] [Accepted: 10/11/2021] [Indexed: 12/12/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) has been increasingly used in pediatric radiology practice worldwide. For nearly two decades, CEUS applications have been performed with the off-label use of gas-containing second-generation ultrasound contrast agents (UCAs). Since 2016, the United States Food and Drug Administration (FDA) has approved the UCA Lumason for three pediatric indications: the evaluation of focal liver lesions and echocardiography via intravenous administration and the assessment of vesicoureteral reflux via intravesical application (contrast-enhanced voiding urosonography, ceVUS). Prior to the FDA approval of Lumason, numerous studies with the use of second-generation UCAs had been conducted in adults and children. Comprehensive protocols for clinical safety evaluations have demonstrated the highly favorable safety profile of UCA for intravenous, intravesical and other intracavitary uses. The safety data on CEUS continue to accumulate as this imaging modality is increasingly utilized in clinical settings worldwide. As of August 2021, 57 pediatric-only original research studies encompassing a total of 4,518 children with 4,906 intravenous CEUS examinations had been published. As in adults, there were a few adverse events; the majority of these were non-serious, although very rarely serious anaphylactic reactions were reported. In the published pediatric-only intravenous CEUS studies included in our analysis, the overall incidence rate of serious adverse events was 0.22% (10/4,518) of children and 0.20% (10/4,906) of all CEUS examinations. Non-serious adverse events from the intravenous CEUS were observed in 1.20% (54/4,518) of children and 1.10% (54/4,906) of CEUS examinations. During the same time period, 31 studies with the intravesical use of UCA were conducted in 12,362 children. A few non-serious adverse events were encountered (0.31%; 38/12,362), but these were most likely attributable to the bladder catheterization rather than the UCA. Other developing clinical applications of UCA in children, including intracavitary and intralymphatic, are ongoing. To date, no serious adverse events have been reported with these applications. This article reviews the existing pediatric CEUS literature and provides an overview of safety-related information reported from UCA uses in children.
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Affiliation(s)
- Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryne A Didier
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ann M Johnson
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Maria E Sellars
- Department of Radiology, King's College Hospital, London, UK
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Packiam VT, Labbate CV, Boorjian SA, Tarrell R, Cheville JC, Avulova S, Sharma V, Tsivian M, Adamic B, Mahmoud M, Werntz RP, Smith ND, Karnes RJ, Tollefson MK, Steinberg GD, Frank I. The association of salvage intravesical therapy following BCG with pathologic outcomes and survival after radical cystectomy for patients with high-grade non-muscle invasive bladder cancer: A multi-institution analysis. Urol Oncol 2021; 39:436.e1-436.e8. [PMID: 33485764 DOI: 10.1016/j.urolonc.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/13/2020] [Accepted: 01/03/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION While numerous current clinical trials are testing novel salvage therapies (ST) for patients with recurrent nonmuscle invasive bladder cancer (NMIBC) after bacillus Calmette-Guérin (BCG), the natural history of this disease state has been poorly defined to date. Herein, we evaluated oncologic outcomes in patients previously treated with BCG and ST who subsequently underwent radical cystectomy (RC). METHODS We identified 378 patients with high-grade NMIBC who received at least one complete induction course of BCG (n = 378) with (n = 62) or without (n = 316) additional ST and who then underwent RC between 2000 and 2018. Oncologic outcomes were compared using the Kaplan-Meier method and Cox proportional hazards models. Sensitivity analyses were conducted stratifying by presenting tumor stage, matched 1:3 for receipt vs. no receipt of ST. RESULTS Patients receiving ST were more likely to initially present with CIS (26% vs. 17%) and less likely with T1 disease (34% vs. 50%, P = 0.06) compared to patients not treated with ST. Receipt of ST was not associated with increased risk of adverse pathology (≥pT2 or pN+) at RC (31% vs. 41%, P = 0.14). Likewise, 5-year cancer-specific survival did not significantly differ between groups on univariable Kaplan-Meier analysis (73% for ST and 74% for no ST, P = 0.7). Moreover, on multivariable analysis, receipt of ST was not significantly associated the risk of death from bladder cancer (HR 1.12; 95% CI 0.60-2.09, P = 0.7). Results were unchanged on sensitivity analysis. CONCLUSIONS These data suggest that, in carefully selected patients, ST following BCG for high grade NMIBC does not compromise oncologic outcomes for patients who ultimately undergo RC.
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Affiliation(s)
| | - Craig V Labbate
- Division of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | | - Robert Tarrell
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Brittany Adamic
- Division of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Mohammad Mahmoud
- Division of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Ryan P Werntz
- Division of Urology, Department of Surgery, Prisma Health-Upstate, University of South Carolina-Greenville, Greenville, SC
| | - Norm D Smith
- Division of Urology, Department of Surgery, Northshore University Health System, Evanston, IL
| | | | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN.
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Broekx S, Buelens E. Tuberculous spondylitis following intravesical bcg-instillation in the treatment of transitional cell carcinoma: Case report and systematic review. Clin Neurol Neurosurg 2020; 194:105944. [PMID: 32480296 DOI: 10.1016/j.clineuro.2020.105944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Tuberculous spondylitis (TS), also known as Pott's disease (PD), is a form of tuberculosis in which the vertebral column is affected. Since the first description by Katz et al. in 1992, it became clear that Bacillus Calmette-Guérin (BCG) instillations in the treatment of superficial transitional cell carcinoma (TCC) form a plausible way in which PD is introduced. Nowadays, BCG forms the most effective treatment modality for superficial TCC. The incidence of other than minor complications have been estimated under five per cent. Here we report a case of TS after BCG-instillation in the treatment of TCC. Furthermore, all available literature concerning this topic was gathered into a systematic review. The primary objective was to create an overview of all available literature concerning TS after intravesical BCG-instillations, with an emphasis on the neurosurgical approach of these patients, forming a scaffold at which future case reports can be compared. As a secondary objective, we tried to raise the awareness concerning this very rare complication of intravesical BCG-instillation as a possible cause of low back pain (LBP). PATIENTS AND METHODS We performed a systematic review, in which patients who developed TS after intravesical BCG-therapy in the treatment of TCC, were examined. A total of twenty-three articles (twenty-four cases) obtained from MEDLINE were included. Search terms included: "tuberculous spondylitis", "Pott's disease", "vertebral osteomyelitis", "intravesical", "Bacillus Calmette-Guérin" and "transitional cell carcinoma". Additional studies were identified by checking reference lists. Furthermore, we present a case concerning one of our own patients who consulted our Neurosurgical department with a similar clinical presentation. This systematic review is in conformity with the PRISMA-guidelines. The case report is in accordance with the CARE statement guidelines. RESULTS Results are based on twenty-five cases (twenty-four cases extracted from previous literature and our case report). All included articles are case reports written in English. Publication year and recruitment time varies from 1992 to 2018. Mean age at clinical presentation varies from 35 to 94 years old (mean 74). All patients were male. Surgery was performed in 17 out of 25 cases (68%). A posterior approach was performed in seven cases (41%), zero anterior approaches (0%), a combined approach in five cases (29%) and not specified in five cases (29%). All patients received intravesical BCG-instillation in the treatment of TCC, ranging from one month to twelve years before clinical presentation (mean 26). Radiographic abnormalities were seen in thoracic vertebral segments in thirteen cases (52%), eleven cases in lumbar segments (44%), one at the thoracolumbar transition level (4%) and not in cervical vertebral segments. CONCLUSION Although very rare, TS should be part of the differential diagnosis in patients with LBP, even years after BCG-instillation for TCC. It mostly affects elderly men and involves the thoracolumbar spine through hematogenous spread via Batson's plexus. Antitubercular therapy remains the mainstay in the treatment of TS. A posterior surgical approach, with debridement and stabilization, should be preferred when surgical intervention seems necessary. To our knowledge, this systematic review forms one of the first comprehensive reviews evaluating neurosurgical intervention for PD following intravesical BCG-therapy in the treatment of TCC.
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Affiliation(s)
- Senne Broekx
- Departement of Neurosurgery, Ziekenhuis Oost-Limburg, 3600 Genk Belgium.
| | - Eveleen Buelens
- Departement of Neurosurgery, Ziekenhuis Oost-Limburg, 3600 Genk Belgium.
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Sood R, Sharma H, Sharma B, Parekh S, Pujari P, Shewale S. A prospective comparative study to assess the efficacy and tolerability of 2 different doses of intravesical bacillus Calmette-Guerin (BCG) in patients with non-muscle-invasive bladder cancer. Urol Oncol 2020; 38:433-439. [PMID: 32037199 DOI: 10.1016/j.urolonc.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/06/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bacillus Calmette-Guerin (BCG) is widely used as an immunotherapeutic agent and recommended in management of non-muscle-invasive bladder cancer (NMIBC). There is no consensus on the optimal dose of the BCG. However, dose reduction has been assessed to decrease the side effects following instillation of BCG. This study compared the efficacy and safety of 80 and 120 mg doses of Sii Onco BCG (Moscow I, Russian strain) in patients with NMIBC. METHODS Patients with histologically confirmed, completely resected solitary or multiple Ta or T1 (with or without carcinoma in situ), grade 1 to 3 urothelial carcinoma of the bladder were included. After transurethral resection of the tumor, repeated intravesical instillations with Sii Onco BCG (80 or 120 mg) were administered, following the induction and 3 weekly maintenance schedule (at 3, 6, 9, 15, 21, 27, and 33 months). Recurrence and progression of the tumor were monitored at scheduled time intervals using cystoscopy. RESULTS A total of 104 eligible patients were enrolled to receive 80 mg (n = 51) dose or 120 mg dose (n = 53) of Sii Onco BCG. On completion of 3 years follow-up, recurrence-free survival rate of 84.31% and 86.79% and progression-free survival rate of 84.31% and 94.34% were observed for 80 and 120 mg groups, respectively; difference being statistically nonsignificant. CONCLUSION Both, 80 and 120 mg doses of Sii Onco BCG are effective and safe for prophylaxis and management of NMIBC.
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Affiliation(s)
- Rajeev Sood
- Department of Urology, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Hitt Sharma
- Serum Institute of India Pvt. Ltd., Pune, India.
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Raven PA, D’Costa NM, Moskalev I, Tan Z, Frees S, Chavez-Munoz C, So AI. Development of a murine intravesical orthotopic human bladder cancer (mio-hBC) model. Am J Clin Exp Urol 2018; 6:245-259. [PMID: 30697580 PMCID: PMC6334200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
We have developed a murine intravesical orthotopic human bladder cancer (mio-hBC) model for the establishment of superficial urothelial cell carcinomas. In this model we catheterize female atyhmic nude mice and pre-treat the bladder with poly-L-lysine for 15 minutes, followed by intravesical instillation of luciferase-transfected human UM-UC-3 cells. Cancer cells are quantified by bioluminescent imaging which has been validated by small animal ultrasound. Poly-L-lysine pre-treatment increased engraftment rate (84.4%) and resulted in faster growing tumors than trypsin pre-treatment. In addition, tumors respond through a decrease in growth and increase in apoptosis to chemotherapy with mitomycin C. Previous intravesical models utilized KU7 cells which have been later determined to be of non-bladder origin. They display markers consistent with HeLa cells, requiring a need for a true intravesical bladder model. Efficient engraftment and rapid superficial growth patterning of the human bladder tumor differentiate this in vivo orthotopic model from previous bladder models.
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Affiliation(s)
- Peter A Raven
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British ColumbiaVancouver, BC, Canada
| | - Ninadh M D’Costa
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British ColumbiaVancouver, BC, Canada
| | - Igor Moskalev
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British ColumbiaVancouver, BC, Canada
| | - Zheng Tan
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British ColumbiaVancouver, BC, Canada
| | - Sebastian Frees
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British ColumbiaVancouver, BC, Canada
- Universitätsmedizin der Johannes Gutenberg-Universität MainzMainz, Germany
| | - Claudia Chavez-Munoz
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British ColumbiaVancouver, BC, Canada
| | - Alan I So
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British ColumbiaVancouver, BC, Canada
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21
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Samannodi M, Villavicencio A, Zhao A, Chavez V, Ericsson CD. Case report: Mycobacterium bovis orchitis post intravesical Bacillus Calmette Guerin. IDCases 2018; 14:e00465. [PMID: 30479960 PMCID: PMC6251782 DOI: 10.1016/j.idcr.2018.e00465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 11/18/2022] Open
Abstract
Bacillus Calmette-Guérin (BCG) therapy is a common adjunctive therapy for superficial bladder carcinoma but there has been noted to be complications from this treatment ranging from general disseminated infections to osteomuscular involvement. We report a case regarding a 63 year old gentleman who presented with right testicular swelling and pain and later found to have evidence consistent with Mycobacterium bovis orchitis. We also detail a literature review regarding genitourinary infections secondary to BCG therapy and discussion regarding current testing modalities.
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Affiliation(s)
- Mohammed Samannodi
- Department of Medicine, Division of Infectious Diseases, UT Health McGovern Medical School, Houston, TX, United States
| | - Aasith Villavicencio
- Department of Medicine, Division of Infectious Diseases, UT Health McGovern Medical School, Houston, TX, United States
| | - Andrew Zhao
- Family Medicine Residency, La Crosse-Mayo Clinic, La Crosse, WI, United States
- Corresponding author.
| | - Violeta Chavez
- Department of Pathology and Laboratory Medicine, University of Texas, Houston, TX, United States
| | - Charles D. Ericsson
- Department of Medicine, Division of Infectious Diseases, UT Health McGovern Medical School, Houston, TX, United States
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22
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Tabayoyong WB, Kamat AM, O'Donnell MA, McKiernan JM, Ray-Zack MD, Palou J, Brausi M, Black PC, Williams SB. Systematic Review on the Utilization of Maintenance Intravesical Chemotherapy in the Management of Non-muscle-invasive Bladder Cancer. Eur Urol Focus 2018; 4:512-521. [PMID: 30190111 DOI: 10.1016/j.euf.2018.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/02/2018] [Accepted: 08/23/2018] [Indexed: 11/28/2022]
Abstract
CONTEXT Current guidelines remain ill-defined regarding the optimal intravesical chemotherapy type and regimen for the treatment of non-muscle-invasive bladder cancer (NMIBC). Although maintenance therapy is a standard part of bacillus Calmette-Guerin (BCG) therapy, its role in the context of chemotherapy remains debatable. OBJECTIVE We reviewed the literature regarding the utilization of intravesical maintenance chemotherapy in the treatment of NMIBC to determine its impact on recurrence, progression, and survival. EVIDENCE ACQUISITION A systematic search was conducted using Ovid and Medline according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2018 reporting on the utilization of maintenance intravesical chemotherapy. Only randomized controlled trials (RCTs) that included a comparison between an induction regimen and an induction plus maintenance regimen were included. EVIDENCE SYNTHESIS Sixteen RCTs were included in the final analysis. The most commonly studied intravesical chemotherapy agents used in maintenance regimens were epirubicin, doxorubicin, and mitomycin C. Several maintenance schedules were utilized, some as short as 3mo and others as long as 3 yr, while the most common maintenance regimen utilized was monthly instillation for 1 yr. Of the 16 trials, 13 reported no significant improvement in recurrence for patients receiving maintenance compared with no maintenance, and none of the trials demonstrated a significant impact on progression or survival. CONCLUSIONS Intermediate length maintenance regimens lasting 7-12mo were the most common maintenance regimens utilized. There was considerable heterogeneity between trial design and duration of follow-up, making direct comparisons for recurrence, progression, and survival outcomes between trials challenging. Although maintenance intravesical chemotherapy is suggested as a treatment option for patients with NMIBC by some guidelines, the majority of evidence suggested that it provided no significant advantage over induction therapy alone with respect to recurrence, progression, or survival. PATIENT SUMMARY In this review, we reviewed prior clinical trials to determine whether prolonged intravesical chemotherapy ("maintenance therapy") improved the rates of recurrence, progression, and survival. Where differences were found in favor of maintenance therapy, there was no statistical significance demonstrated, possibly due to the underpowered nature of the study design. While there was no consensus on an optimal agent or maintenance schedule, we found no evidence to suggest that maintenance therapy would improve recurrence, progression, or survival.
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Affiliation(s)
- William B Tabayoyong
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - James M McKiernan
- Department of Urology, Columbia University Medical Center, New York, NY, USA
| | - Mohamed D Ray-Zack
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Joan Palou
- Department of Urology, Fundacio Puigvert, Barcelona, Spain
| | - Maurizio Brausi
- Department of Urology, Azienda Unita Sanitaria Locale Modena, Modena, Italy
| | - Peter C Black
- Department of Urologic Sciences, The University of British Columbia, Vancouver, Canada
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA.
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Houman J, Moradzadeh A, Patel DN, Asanad K, Anger JT, Eilber KS. What is the ideal antibiotic prophylaxis for intravesically administered Botox injection? A comparison of two different regimens. Int Urogynecol J 2019; 30:701-4. [PMID: 30074062 DOI: 10.1007/s00192-018-3721-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/12/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Onabotulinum toxin A (Botox®) administered intravescially is an effective treatment for idiopathic detrusor overactivity, of which urinary tract infections (UTIs) are a common complication. The purpose of this study was to compare two prophylactic antibiotic regimens with the goal of decreasing UTI rates following intravesically administered Botox® injection. MATERIALS AND METHODS A retrospective review of two groups of patients undergoing intravesically administered Botox® injections was performed-one with idiopathic and one with neurogenic detrusor overactivity. One group received a dose of ceftriaxone intramuscularly (IM) at the time of Botox® injection, and a second group received a 3-day course of a fluoroquinolone orally starting the day before the procedure. The rate of postprocedure UTI was examined using a χ2 test. A secondary analysis was performed using logistic regression modeling to test the association between clinical characteristics and antibiotic regimen and risk of postprocedure UTIs. RESULTS Botox® injections were performed on 284 patients: 236 received a single dose of ceftriaxone IM and 48 received 3 days of a fluoroquinolone orally. The UTI rate was significantly lower in the fluoroquinolone group (20.8%) vs. the cephalosporin group (36%), p = 0.04. Predictors of postprocedure UTIs included single dose of antibiotics IM [odds ratio (OR 2.80, p = 0.02] and a positive preprocedure urine culture (OR 1.31, p = 0.03). CONCLUSIONS We found a significantly lower rate of UTIs when patients received a 3-day course of a fluoroquinolone orally as opposed to a single dose of a third-generation cephalosporin IM. Patients with a positive preprocedure culture might benefit from an even longer duration of antibiotics at the time of Botox® injection.
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Abstract
Contrast-enhanced ultrasound (CEUS) is a radiation-free, safe, and in specific clinical settings, highly sensitive imaging modality. Over the recent decades, there is cumulating experience and a large volume of published safety and efficacy data on pediatric CEUS applications. Many of these applications have been directly translated from adults, while others are unique to the pediatric population. The most frequently reported intravenous abdominal applications of CEUS in children are the characterization of focal liver lesions, monitoring of solid abdominal tumor response to treatment, and the evaluation of intra-abdominal parenchymal injuries in selected cases of blunt abdominal trauma. The intravesical CEUS application, namely contrast-enhanced voiding urosonography (ceVUS), is a well-established, pediatric-specific imaging technique entailing the intravesical administration of ultrasound contrast agents for detection and grading of vesicoureteral reflux. In Europe, all pediatric CEUS applications remain off-label. In 2016, the United States Food and Drug Administration (FDA) approved the most commonly used worldwide second-generation ultrasound contrast SonoVue®/Lumason® for pediatric liver and intravesical applications, giving new impetus to pediatric CEUS worldwide.
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Affiliation(s)
- Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Sherif AY, Mahrous GM, Alanazi FK. Novel in-situ gel for intravesical administration of ketorolac. Saudi Pharm J 2018; 26:845-51. [PMID: 30202226 DOI: 10.1016/j.jsps.2018.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/25/2018] [Indexed: 11/22/2022] Open
Abstract
The urinary bladder stores urine until the time of urination. Systemic administration of drugs to treat bladder diseases faces several limitations. Therefore, intravesical drug delivery is a promising alternative route of administration. An in-situ gel is used to form a gel inside the bladder cavity and ensure continuous release of the drug even after urination. The objective of the present study was to optimize an in-situ gel formulation of poloxamer and chitosan for intravesical delivery of ketorolac tromethamine. The gelling temperature of the prepared combinations ranged from 20.67 to 25.8 °C. In-vitro release of KT was sustained for up to 7 h using a poloxamer concentration ranging from 17% to 19% and a chitosan concentration ranging from 1% to 2%. Design-Expert® 10 was used to select the optimized formulation (poloxamer/chitosan 17/1.589% w/w) which significantly (p < 0.05) extended the drug release more than each polymer alone. An ex-vivo study showed the ability of the optimized formulation to sustain drug release after emptying two times to mimic urination. Furthermore, the formed gel adhered to the bladder tissue throughout the time period of the experiment. Intravesical administration of the optimized formulation to rabbits via catheter showed no obstruction of urine flow and continuous release of the drug for 12 h.
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Camargo JA, Passos GR, Ferrari KL, Billis A, Saad MJA, Reis LO. Intravesical Immunomodulatory Imiquimod Enhances Bacillus Calmette-Guérin Downregulation of Nonmuscle-invasive Bladder Cancer. Clin Genitourin Cancer 2017; 16:e587-e593. [PMID: 29174504 DOI: 10.1016/j.clgc.2017.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Toll-like receptor (TLR)2/4 agonist bacillus Calmette-Guérin (BCG), although not failure proof, has been the most efficient immunomodulatory treatment of immunogenic nonmuscle-invasive bladder cancer (NMIBC) for > 40 years. We investigated the role of the immunomodulatory molecule TLR7 agonist imiquimod through the BCG key receptors TLR2/4 and the main downstream molecules of the mammalian target of rapamycin pathway in NMIBC treatment. MATERIALS AND METHODS A total of 40 Fischer-344 rats, 7 weeks old, received 4 doses of 1.5 mg/kg N-methyl-N-nitrosourea intravesically on weeks 0, 2, 4, and 6 for cancer induction. At week 8, the rats were randomized into 4 groups (10 per group) and treated intravesically once a week for 6 weeks: control (0.2 mL of vehicle); BCG (2 × 106 colony-forming units Connaught strain in 0.2 mL); imiquimod (20 mg/kg in 0.2 mL), and associated treatment BCG plus imiquimod in 0.2 mL. The bladders were extracted and analyzed for histopathology, immunohistochemistry, cell proliferation (Ki-67), apoptosis (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling [TUNEL]), and immunoblotting for TLR2, TLR4, p-P70S6K, and p-4E-BP1 proteins. RESULTS The histopathology results showed that BCG and imiquimod decreased bladder tumorigenesis compared with the control group, with a proliferation decrease (Ki-67) and an apoptosis increase (TUNEL). BCG upregulated TLR2/4, imiquimod upregulated TLR4, and both downregulated P70S6K1. CONCLUSION Imiquimod is able to efficiently decrease bladder carcinogenesis through upregulation of TLR7/4 and downregulation of P70S6K1 protein, generating new perspectives to boost BCG effects in the future.
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Affiliation(s)
- Juliana A Camargo
- Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Gabriela R Passos
- Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Karen L Ferrari
- Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Athanase Billis
- Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Mário J A Saad
- Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Leonardo O Reis
- Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil; Department of Urologic Oncology, Pontifical Catholic University of Campinas, São Paulo, Brazil.
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Colomba C, Di Carlo P, Guadagnino G, Siracusa L, Trizzino M, Gioè C, Cascio A. A Case of Epididymo-orchitis after intravesical bacille Calmette-Guérin therapy for superficial bladder carcinoma in a patient with latent tuberculosis infection. Infect Agent Cancer 2016; 11:25. [PMID: 27257433 PMCID: PMC4890504 DOI: 10.1186/s13027-016-0072-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Intravesical instillation of bacille Calmette-Guérin (BCG) has been established as efficient therapy for superficial bladder carcinoma. Overall, intravesical BCG is well tolerated and results in complications of less than 5 %. However, adverse effects such as granulomatous prostatitis, pneumonitis, hepatitis, sepsis, and hypersensitivity reactions may occur. The reported rate for tuberculous orchitis after BCG intravesical therapy is 0.4 %. Findings We report a case of monolateral tuberculous orchitis occurring one month after the second course of intravescical instillation of bacille Calmette-Guérin in a patient with proven superficial bladder carcinoma and latent tuberculosis infection. Conclusions In our opinion intravesical instillation of BCG should be considered on an individual patient basis, with full patient disclosure of the potentially significant risks. A screening with an intradermal Mantoux before starting the first cycle of BCG instillation should be recommended and isoniazid would be indicated as the treatment for latent tuberculosis infection.
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Affiliation(s)
- C Colomba
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - P Di Carlo
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - G Guadagnino
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - L Siracusa
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - M Trizzino
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - C Gioè
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
| | - A Cascio
- Dipartimento di scienze per la promozione della salute e materno-infantile, Università di Palermo, via del vespro 129, Palermo, 90127 Italy
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Fath Elbab TK, Abdelhamid AM, Galal EM, Anwar AZ, Malek MA, Tawfiek ER. Management of intravesical self-inflicted sharp objects in children: 10-year single-center experience. J Pediatr Urol 2016; 12:97.e1-5. [PMID: 26468014 DOI: 10.1016/j.jpurol.2015.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/13/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intravesical foreign bodies (FBs) are rare and have interesting pathology for urologists. There has been an increase in reports of intravesical FBs in the last few decades, but they are still considered to be rare in children, especially young girls. Here we present our experience in the assessment and management of intravesical self-inserted sharp objects in children. PATIENTS AND METHODS We reviewed the records of children with self-introduced intravesical FBs admitted to our hospital during the last 10 years. Twenty-four cases were included in this study (20 girls and 4 boys). The presenting symptoms and methods of diagnosis and treatment were reviewed. RESULTS The ages of the patients ranged from 4 to 12 years. In all cases, foreign bodies were self-inserted. All patients were subjected to KUB (kidney, ureter, bladder radiograph) and abdominal ultrasonography. Based on the KUB findings, the FBs in girls were found to be metal pins in 12, a hair clip in four, and a wooden pencil in three (Figure). In boys, a coiled electric wire was found in three, with a urinary calculus formed over one of them. There were small metallic objects in two cases (1 boy and 1 girl). Endoscopic removal of FBs was done successfully in 19 cases (18 girls and 1 boy), and open cystostomy was performed in four cases (3 boys and 1 girl). DISCUSSION Intravesical FBs are important considerations in the differential diagnosis of pathological lower urinary tract symptoms. They represent significant challenges to urologists. Among children, the reasons for self-insertion of FBs might reflect psychiatric disorders. Routine psychiatric evaluations should be offered to all patients with intentional FB insertion to avoid missing any underlying psychiatric disorders. In our study, psychiatric evaluations have been advised for all the affected children and their parents. Self-inserted FBs are commonly seen in adults and are rarely encountered in children. To our knowledge, this is the largest reported series of children with self-inflicted intravesical FBs. In addition, all of the FBs in this study had one or more sharp edges that made their endoscopic extraction more difficult without causing bladder or urethral damage. In children, removal of intravesical FBs represents a great challenge, as the size of the pediatric urethra may hinder safe transurethral removal. Endoscopic handling of intravesical FBs is mostly unsuccessful in boys because of the long and narrow urethra, and open cystostomy might be the treatment of choice to save the urethra. In contrast, the short female urethra renders the endoscopic removal of intravesical FBs more successful. In this study, endoscopic removal of FBs was done successfully in 19 cases (18 girls and 1 boy), and open cystostomy was performed in four cases (3 boys and 1 girl). CONCLUSIONS Although FBs in the urinary tract of children are very rare, they need to be considered during any evaluation of pathological lower urinary tract symptoms. Endoscopic management is feasible for most of these patients. The size, number, nature of foreign bodies, and any associated urinary calculi determine the treatment modality.
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Affiliation(s)
| | | | - Ehab M Galal
- Department of Urology, Minia University Hospital, Minia, Egypt
| | - Ahmad Z Anwar
- Department of Urology, Minia University Hospital, Minia, Egypt
| | - Mohamed A Malek
- Department of Urology, Minia University Hospital, Minia, Egypt
| | - Ehab R Tawfiek
- Department of Urology, Minia University Hospital, Minia, Egypt
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Hozouri H, Norouzian D, Nafissi-Varcheh N, Aboofazeli R. Challenges to Improve the Stability and Efficacy of an Intravesical BCG Product. Iran J Pharm Res 2014; 13:143-50. [PMID: 24711840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this investigation was to improve the storage stability and survival rate of an intravesical BCG product, manufactured with an attenuated strain of Mycobacterium bovis (Pasteur strain 1173P2 of BCG) in the presence of sodium glutamate. Formulations with various concentrations of trehalose (a known protectant) were developed as liquid and lyophilized forms. Formulations were evaluated by different methods, including optical density measurement, safety assessment, skin reaction test, moisture content determination, viability assay, bacterial and fungal contaminations and the results were compared with those obtained for sodium glutamate-containing formulations. The stability tests were also carried out in various storage durations and different temperatures. To develop the lyophilization protocol, glass transition temperatures in the presence of both stabilizers were determined using differential scanning calorimetry. In general, results showed that trehalose could considerably increase the stability of the product against freezing and drying processes, increase the survival rate even in the liquid formulations, as well as the production of an acceptable cake. However, further studies are required to optimize the product characteristics.
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Parker SG, Kommu SS. Post- intravesical BCG epididymo-orchitis: Case report and a review of the literature. Int J Surg Case Rep 2013; 4:768-70. [PMID: 23856256 DOI: 10.1016/j.ijscr.2013.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/12/2013] [Accepted: 05/26/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Bladder cancer is a significant epidemiological disease. It is managed by primary resection and on-going surveillance for recurrent disease. Intravesical BCG therapy is used in superficial carcinomas to lower the incidence of recurrence and prolong the time to recurrence. BCG therapy is not without its rare but serious side effects. PRESENTATION OF CASE A 75-year-old man presented to the urologist with right testicular pain, after four previous TURBT operations, two courses of intravesical BCG therapy and one STAT dose of intravesical mitomycin. The patient's USS testis showed hypoechoic lesions in the right testis. An orchiectomy was carried out due to the possibility of the USS showing a malignancy. Histology confirmed BCG epididymo-orchitis. DISCUSSION This patient presented with testicular pain fifteen months after the cessation of BCG therapy. Clinicians need to be aware of the potentially long dormancy periods for BCG infections, and their complications, as well as the acute infective BCG presentations. The literature is reviewed and shows the wide range of infective BCG presentations from acute disseminated sepsis to insidious focal infections such as parotiditis and discitis. CONCLUSION This case report demonstrates that due to the delayed and gradual onset of symptoms, BCG infections are difficult to diagnose. The report and the review remind surgeons to keep BCG infection amongst their differentials when treating patients who present after BCG therapy.
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Affiliation(s)
- S G Parker
- Princess Royal University Hospital, Bromley BR6 8ND, UK.
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Chan KW, Lee KH, Tam YH, Sihoe JD. Early experience in robotic-assisted laparoscopic bilateral intravesical ureteral reimplantation for vesicoureteral reflux in children. J Robot Surg 2012; 6:259-62. [PMID: 27638284 DOI: 10.1007/s11701-011-0288-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/26/2011] [Indexed: 10/18/2022]
Abstract
A high success rate has been reported for laparoscopic intravesical ureteral reimplantation in the management of high-grade vesicoureteral reflux in children. With the introduction of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA), robotic-assisted laparoscopic intravesical ureteral reimplantation may provide additional benefits, particularly in intravesical suturing. We present here our experience in three children, all with high-grade bilateral vesicoureteral reflux, who underwent robotic-assisted laparoscopic intravesical bilateral ureteral reimplantation. The procedure was successfully performed in all cases. There were no intra-operative or post-operative complications. Operative times were 430, 240 and 220 min. Hospital stay was 7, 6 and 2 days. Postoperative voiding cystourethrogram confirmed resolution of vesicoureteral refluxes in all cases and all three children were free from urinary tract infections on follow-up. Our initial experience with robotic-assisted laparoscopic intravesical ureteral reimplantation has shown this to be a technically safe and feasible option in the management of children with bilateral high-grade vesicoureteric reflux.
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