Pharmacokinetic Study of Intravesical Gemcitabine in Carcinoma in situ of the Bladder Refractory to Bacillus Calmette-Guérin Therapy

INTRODUCTION

Gemcitabine, a chemotherapeutic agent, has been shown to be active against transitional cell cancer of the bladder. The aim of the study was to determine the pharmacokinetic profile of gemcitabine, administered intravesically in patients with carcinoma in situ(CIS).

MATERIAL AND METHODS

Nine patients with CIS refractory to intravesical bacillus Calmette-Guérin (BCG) therapy were enrolled. Gemcitabine was given in 50 ml 0.9% NaCl by catheterization and held in the bladder for 1 h, once weekly for 6 consecutive weeks. The pharmacokinetics for gemcitabine metabolites were performed in plasma and serum. Dose levels were: 1,000, 1,250, and 1,500 mg. Clinical evaluation was repeated 4 weeks after therapy and thereafter every 6 months.

RESULTS

Grade-1 neutropenia was observed only in 1 patient. Grade-1 urinary frequency and hematuria were observed in 1 and 3 patients, respectively. No grade 2-4 toxicity or clinically relevant myelosuppression were observed. Gemcitabine was detectable in serum, but with an irrelevant pharmacological effect, in only 1 patient treated with 1,500 mg of gemcitabine. With regard to activity, after 6 instillations of this drug, 4 complete responses were observed.

CONCLUSION

Intravesical gemcitabine is well tolerated and safe. No systemic absorption with a clinical or pharmacological effect was detected and only slightly irritative bladder symptoms were observed. These results warrant further investigation in phase-II trials.

Testicular fine needle aspiration as a diagnostic tool in non-obstructive azoospermia

AIM

To report the fine needle aspiration cytology (FNAC) of the testes used as a diagnostic tool in non-obstructive azoospermic patients.

METHODS

One hundred and twenty-five non-obstructive azoospermic male candidates to intracytoplasmic sperm injetion (ICSI) were analysed for follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone and inhibin B plasma levels. They were classified into three groups on the basis of FNAC: 1) Sertoli cell-only syndrome (SCOS) (70); 2) severe hypospermatogenesis (42); and 3) maturation arrest (13). Then, all men underwent testicular sperm extraction (TESE) for sperm recovery for ICSI.

RESULTS

Mature spermatozoa were detected by FNAC in 24 of 42 men with severe hypospermatogenesis and nine of 13 men with maturation arrest; while they were retrieved by TESE in 29 of 70 men with SCOS, 35 of 42 men with severe hypospermatogenesis (including the 24 by FNAC) and 10 of 13 men with maturation arrest (including the nine by FNAC). The sensitivity and specificity of FNAC were 44.6 % and 100 %, respectively. There was no difference on testicular volume and hormonal parameters in men with and without sperm retrieved.

CONCLUSION

These findings suggest that FNAC may be a simple and valid diagnostic parameter in non-obstructive azoospermic men and it may represent a valid positive prognostic parameter for sperm recovery at TESE.

Diagnostic and Prognostic Value of Testicular Fine Needle Aspiration in Non-Obstructive Azoospermia

Modern techniques of assisted reproduction may be useful also in non obstructive azoospermic men using sperm extracted from the testis (TESE). However, no clinical or hormonal parameter has reliable prognostic value in predicting the presence of testicular sperm. We report here our experience with fine needle aspiration cytology (FNAC) of the testes used as a diagnostic tool in non obstructive azoospermic patients looking at its possible role as prognostic parameter for the presence of testicular sperm at TESE.

Methods

One hundred and twenty-five non obstructive azoospermic men candidates to ICSI were analysed for FSH, LH, testosterone, and inhibin B plasma levels, and classified in three groups on the basis of FNAC: Sertoli cell-only syndrome (70), severe hypospermatogenesis (42), and maturation arrest (13). After that, all men underwent TESE for sperm recovery for ICSI.

Results

FNAC detected sperm in 24 of 42 men with severe hypospermatogenesis and 9 of 13 men with maturation arrest. TESE retrieved sperm in all such patients, as well as in additional 29 of 70 men with Sertoli cell-only syndrome, additional 11 cases of severe hypospermatogenesis (35 of 42 in total) and 1 additional case of maturation arrest (10 of 13 in total). Testicular volume and hormonal parameters were not different in men with and without sperm retrieved.

Conclusion

These findings suggest that FNAC may be a simple and valid diagnostic parameter in non obstructive azoospermic men, and it may represent a valid positive prognostic parameter for sperm recovery at TESE.

Intracavitary therapy of noninvasive transitional cell carcinomas of the upper urinary tract. A review of the literature

Noninvasive (stages Ta, T1, Tis) transitional cell carcinomas of the upper urinary tract are suitable for a conservative therapeutic approach. Intracavitary therapy (alone or as adjuvant treatment) has recently been proposed and successfully used by some authors. Even though bacillus Calmette-Guérin is the most frequent agent employed, chemotherapeutic drugs, such as mitomycin C and thiotepa, have also been successfully used. The current information available in the literature is therefore reviewed. According to the data available, intracavitary therapy is a worthwhile conservative therapeutic option for noninvasive upper urinary tract urotheliomas with acceptable side effects. For this reason it may be included in the routine urological armamentarium.

[Synchronous and metachronous bilateral tumors of the testis: a single institution experience of 11 cases and review of the literature]

Bilateral testicular tumors represent a very rare event and account for 2.7% of all testicular neoplasms. 15% of bilateral testicular tumors occurs simultaneously in both testicles, but in 85% of cases the second neoplasia appears in the remaining testicles of patients affected by unilateral testicular tumor after a very variable period of time. The aim of this work was to value our experience on 11 cases of bilateral testis tumors: six arised simultaneously in both gonads (five germ cell tumors and one Leydig cell tumor) and five with metachronous appearance (all germ cell tumors). A comprehensive valuation has been made considering other cases reported in literature until 1996, in order to identify predisposing conditions to bilateral disease. Examining separately synchronous and metachronous neoplasms, as far as we know, only 218 cases of simultaneous bilateral testicular tumors are reported in literature, and most of them are pure seminomas; however, after 1988 this result has been reversed in favour of neoplasms with non-seminomatous elements: this data suggests inadequate classification in the past. Moreover, considering 243 cases of metachronous neoplasms, 126 of them (51.9%) began as non-seminomatous tumors: this disagrees with an old belief that patients affected by seminoma are more prone to develop a second tumor in the remaining testicle. It has been also possible to confirm that testis sparing surgery allows to maintain both fertility and endocrinous function. This technique can be used in any potentially benign neoplasms (as Leydig cell tumors) while the same treatment modality, although already reported in literature, needs more experience to be considered as a successful therapy for germinal tumors.

[Prevention and early diagnosis of testicular neoplasms]

Aetiology of testicular cancer is still poorly characterized, so the prevention is unlikely to achieve. A fundamental issue is early detection as delay in presentation is a common feature in patients affected by this disease. Moreover there is much evidence suggesting a significant association between delay in diagnosis and clinical stage at presentation particularly for nonseminomas. 176 valuable patients with non seminomatous germ cell tumors of the testis had a clearly identifiable interval from first symptoms until diagnosis; mean delay was 13.9 weeks, and there was a correlation between difference in delay of I clinical stage patients (mean: 10.0 weeks) and III stage patients (mean: 18.6 weeks) ANOVA: p < 0.035. These data suggest that encouraging programmes in order to provide more informations on testicular cancer and testicular self examination (TSE) may contribute to reduce the number of young men requiring toxic treatment and major surgery and even may reduce mortality.

Solitary fibrous tumour of the retroperitoneum mimicking a renal mass

Authors report a case of solitary fibrous tumour of the retroperitoneum that mimicked a renal mass. A review of the literature and a discussion on the biologic meaning of the lesion are presented.

Granulomatosis of external genitalia: a new disease or part of a spectrum?

Several efforts have been made to classify the various diseases that can cause ulcerative necrosis of the skin and mucous membranes. All of these lesions have granulomatous inflammation as a common denominator. Wegener's granulomatosis belongs to this area of interest. Most of these diseases affect the head, eyes, nose, respiratory system and kidneys. We present a case of ulcerative necrosis with pathological findings of granulomatous inflammation involving the external genitalia, thighs, perineum and eyes. To our knowledge this is the first reported case of involvement of the external genitalia by such a disease.