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Abramson Cancer Center
NCI CANCERLIT® Search: Therapy of Bladder Cancer - October 2002
National Cancer Institute®
Last Modified: October 1, 2002
- Suicide gene therapy for urogenital cancer: current outcome and prospects.
- The quality of life in men after radical cystectomy with a continent cutaneous diversion or orthotopic bladder substitution: is there a
- Laparoscopic radical cystectomy with intracorporeal ileal conduit diversion: five cases with a 2-year follow-up.
- A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional results.
- [Short-term outcomes of radical surgery for bladder cancer]
- Intravesical instillations of interferon gamma in the prophylaxis of high risk superficial bladder cancer--results of a controlled
- A potential role of heat shock proteins and nicotinamide N-methyl transferase in predicting response to radiation in bladder cancer.
- [Urology]
- Surgery and adjunctive chemotherapy for invasive bladder cancer.
- Contemporary cystectomy combined with ileal conduit or bladder substitution.
- BCG (Bacillus of Calmette Guerin) therapy of high-risk superficial bladder cancer.
- Gemcitabine plus epirubicin in patients with advanced urothelial carcinoma who are not eligible for platinum-based regimens.
- DNA ploidy and S-phase fraction as predictive factors of response and outcome following neoadjuvant methotrexate, vinblastine, epirubicin and
- Repeated transurethral resection of recurrent superficial bladder tumors--does it affect the spread and stage of the tumor?
- Surgical management of bladder carcinoma.
- Preservation of the anterior vaginal wall during female radical cystectomy with orthotopic urinary diversion: technique and results.
- Internal bladder retractor for laparoscopic cystectomy in the female patient.
- Advanced bladder cancer...where are we now and where are we going?
- Chemotherapy in the post-MVAC era: the case for adjuvant chemotherapy.
- Contemporary cystectomy and urinary diversion.
- The role of chemotherapy and radiation in organ-preservation strategies for muscle-invasive bladder cancer.
- Management of locally advanced bladder cancer: early vs deferred chemotherapy.
- Surgical bladder preserving strategies in the treatment of muscle-invasive bladder cancer.
- Intravesical Bacillus Calmette-Guerin treatment improves patient survival in T1G3 bladder tumours.
- Recurrence and progression in stage T1G3 bladder tumour with intravesical bacille Calmette-Guerin (Danish 1331 strain).
- Experience with 'capsule sparing' cystoprostadenectomy for orthotopic bladder replacement: overcoming the problems of impotence, incontinence
- Bladder cancer in women.
- [Treatment and follow-up of superficial bladder cancer]
- Laparoscopic radical cystectomy with urinary diversion: completely intracorporeal technique.
- Laparoscopic radical cystectomy with orthotopic neobladder.
Table of Contents
1
UI - 12006245
AU - Nasu Y; Kusaka N; Saika T; Tsushima T; Kumon H
TI -
Suicide gene therapy for urogenital cancer: current outcome and
prospects.
SO - Mol Urol 2000 Summer;4(2):67-71
AD - Department of Urology, Okayama University Medical School, Shikata,
Okayama, Japan. ynasu@med.okayama-u.ac.jp
Viral-mediated transfer of the herpes simplex virus thymidine kinase
(HSV-tk) gene has been demonstrated by several investigators to confer
sensitivity to nucleoside analogs such as ganciclovir (GCV) in a variety
of tumor cells including brain, prostate, bladder, kidney, ovary, head
and neck, lung, pancreas, and liver cancers. Fourteen suicide gene
clinical protocols using adenovirus vectors have been conducted,
including four in prostate cancer. Two additional protocols for prostate
cancer are in preparation in Japan and the Netherlands. A study
conducted at Baylor College of Medicine was the first to demonstrate the
safety of HSV-tk plus GCV therapy for human prostate cancer and the
anticancer activity of gene therapy in this disease. However, it is
still in the early stage of its development, with a number of problems
to be overcome. Systemic delivery, specific introduction, and specific
expression of the target gene are the major issues to be managed in
order to establish a clinically relevant treatment strategy.
2
UI - 12175394
AU - Mansson A; Davidsson T; Hunt S; Mansson W
TI -
The quality of life in men after radical cystectomy with a continent
cutaneous diversion or orthotopic bladder substitution: is there a
difference?
SO - BJU Int 2002 Sep;90(4):386-90
AD - Department of nursing, Lund University, University Hospital, Lund,
Sweden. asa.mansson@omv.lu.se
OBJECTIVE: To compare the quality of life (QoL) in men after radical
cystectomy who had either a continent cutaneous diversion or orthotopic
bladder substitution. PATIENTS AND METHODS: Eighty men with at least 6
months of follow-up and with no signs of recurrent disease after radical
cystectomy for bladder carcinoma, and who had either a continent
cutaneous diversion or orthotopic bladder substitution, were sent two
types of questionnaire, the Functional Assessment of Cancer
Therapy-Bladder Cancer (FACT-Bl) and the Hospital Anxiety and Depression
Scale (HADS), to determine their QoL. RESULTS: The FACT-Bl and HADS
questionnaires were returned by 90% and 71% of the patients,
respectively (P < 0.05). In the replies to the generic version of
FACT-Bl there were no differences between the groups in any domain, the
scores being high in all. In questions covering intestinal, urinary and
sexual items, patients with continent diversion had less trouble
controlling urine (P < 0.0001), had to empty less often (P < 0.001), and
had fewer symptoms when emptying (P < 0.05). Patients with neobladders
had a better appreciation of appearance and better preserved erectile
function (both P < 0.05). In the answers to the HADS, the mean scores
were low (within the normal ranges) and did not differ between the
groups. CONCLUSION: Using two instruments tested for validity and
reliability, there were no differences between patients with continent
diversion and those with orthotopic substitution.
3
UI - 12175395
AU - Gupta NP; Gill IS; Fergany A; Nabi G
TI -
Laparoscopic radical cystectomy with intracorporeal ileal conduit
diversion: five cases with a 2-year follow-up.
SO - BJU Int 2002 Sep;90(4):391-6
AD - Department of Urology, All India Institute of Medical Sciences, New
Delhi, India.
OBJECTIVE: To assess the feasibility and intermediate-term outcome of
laparoscopic radical cystectomy (LRC) with ileal conduit urinary
diversion in patients with organ-confined muscle-invasive carcinoma of
the urinary bladder, the entire procedure undertaken intracorporeally
only using laparoscopic techniques. PATIENTS AND METHODS: Five patients
(four men and one woman) underwent LRC with intracorporeal ileal conduit
LRC, ileal conduit exclusion, restoration of ileo-ileal continuity, and
bilateral stented uretero-ileal anastomoses were completed
intracorporeally in all patients. The follow-up data up to 2 years are
reported. RESULTS: All procedures were completed laparoscopically with
no open conversion or intraoperative complications. The mean duration of
surgery was 7.5 h; the blood loss was 360 mL and no patient required
perioperative blood transfusion. The mean (range) hospital stay was 7
(6-22) days; the specimen weight was 225-400 g. The surgical margins of
the bladder specimen were negative in each patient. One patient
developed intestinal obstruction after surgery, requiring a diverting
ileostomy for 12 weeks. At a follow-up of 2 years, two patients died,
both from unrelated causes (myocardial infarction and septicaemia from
pulmonary infection in one each). The three surviving patients are
asymptomatic with normal upper tracts and no evidence of local
recurrence or metastatic disease. CONCLUSION: LRC with ileal conduit
diversion undertaken completely intracorporeally is a feasible option
for muscle-invasive organ-confined carcinoma of the urinary bladder,
with good outcomes over a 2-year follow-up.
4
UI - 12175396
AU - Soulie M; Seguin P; Martel P; Vazzoler N; Mouly P; Plante P
TI -
A modified intussuscepted nipple in the Kock pouch urinary diversion:
assessment of perioperative complications and functional results.
SO - BJU Int 2002 Sep;90(4):397-402
AD - Department of Urologic Surgery and Andrology, Rangueil University
Hospital, Institut Cludius Regaud, Toulouse, France.
soulie.m@chu-toulouse.fr
OBJECTIVE: To assess the complications and continence of a modified
intussuscepted nipple in Kock pouch urinary diversions. PATIENTS AND
years, range 21-74) with bladder cancer (24), gynaecological tumours
(eight) or previous lower tract reconstructive surgery (eight) underwent
cystectomy and cutaneous continent urinary diversion using the Kock
pouch procedure. The first 23 procedures (group I) used Henriet's
technique, whereas a modified fixation of the intussuscepted efferent
limb was applied in the last 17 (group II). Complications and functional
results (focused on continence and the upper urinary tract) were
reviewed. RESULTS: The median (range) follow-up was 47.6 (10-124)
months; one patient died 4 weeks after surgery. Early complications
occurred in 11 (28%) and re-operation was required in two (5%). Of the
late complications reported (38%), extussusception (8%) and efferent
nipple prolapse (3%) only occurred in group I and required surgical
revision. Late complications were minor (15%) including two asymptomatic
refluxes and four with stoma sclerosis. The continence rate at 6 months
in groups I and II were 78% and 94%, respectively (P = 0.13).
CONCLUSION: Efferent limb prolapse and extussusception of the Kock pouch
were the main complications requiring surgical revision. Applying the
modified nipple fixation the complications can be reduced and reservoir
continence improved.
5
UI - 12077814
AU - Komiakov BK; Gorelov SI; Novikov AI; Gorelov AI; Guliev BG; Idrisov ShN;
TI -
Kagan OF; Sergeev AV; Fadeev VA
[Short-term outcomes of radical surgery for bladder cancer]
SO - Urologiia 2002 Mar-Apr;(2):16-9
A total of 102 radical cystectomies have been conducted for 1996-2001
(94 males, 8 females, age 37-78 years, mean age 57.5 years). Most of the
patients (81.4%) were diagnosed to have transitional cell carcinoma.
Supravesical urine derivation was made by means of ureterocutaneostomy
and transureteroureteronephrostomy in 7(6.9) patients,
ureterosigmoanastomosis--in 41(40.2%), Sigma-rectumpouch--in 1(0.9%)
patients, ileocystoplasty, largely by Hautmann and Studer was carried
out in 52(51%) patients. Postoperative complications developed in
25(24.5%) patients who often had adhesive ileus. Four patients died: 2
of pulmonary artery thromboembolism, 1 of acute cardiac failure and 1 of
sepsis. Methods of continence urine derivation were preferred, such as
ureterosigmoanastomosis by Mainz-Pouch II and creation of orthotopic
bladder of the ileum.
6
UI - 12201939
AU - Stavropoulos NE; Hastazeris K; Filiadis I; Mihailidis I; Ioachim E;
TI -
Liamis Z; Kalomiris P
Intravesical instillations of interferon gamma in the prophylaxis of
high risk superficial bladder cancer--results of a controlled
prospective study.
SO - Scand J Urol Nephrol 2002;36(3):218-22
AD - Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece.
nstavrop@otenet.gr
OBJECTIVE: To determine if intravesically administered recombinant
interferon (IFN) gamma may serve as adjuvant first line treatment in
prophylaxis of superficial bladder cancer by reducing its risk for
recurrence, in the short term. MATERIAL AND METHODS: A total of 54
patients (43 males and 11 females) with superficial bladder tumours
(Ta/T1) initially treated with transurethral resection for their tumors
were randomized into two groups: Twenty-eight patients were left
untreated after the transurethral resection (controls) whereas 26
patients received intravesical IFN gamma adjuvantly, at a dosage of 0.7
mg per week for 8 weeks. Patients with G1 tumors and carcinoma in situ
were excluded. The follow up had a mean time of 12.1 months. Recurrence
or progression, as terminal events of the study, were recorded. The
comparison of the recurrences between the two groups was performed by
estimating: (a) the simple recurrence rate, and (b) the interval to
tumor recurrence in each group. RESULTS: Tumor recurrence was detected
in 24 controls (86%) and in 16 (62%) patients of the IFN gamma group (p
= 0.043). The comparison of the Kaplan-Meier disease-free survival
curves between the two groups of patients indicated that intravesical
instillations of IFN gamma exerted a continuous protective effect to
those who received the agent, in the follow up period (p = 0.0237). No
serious side-effects were noted. CONCLUSIONS: Intravesically
administered IFN gamma has a demonstrable protective role as first line
adjuvant treatment in superficial bladder cancer. This role is mainly
focused on prevention of recurrences in the short term. Further
prospective studies with longer follow up are required, in order to
define the exact place of the drug in the urologist's armamentarium.
7
UI - 12216074
AU - Kassem HSh; Sangar V; Cowan R; Clarke N; Margison GP
TI -
A potential role of heat shock proteins and nicotinamide N-methyl
transferase in predicting response to radiation in bladder cancer.
SO - Int J Cancer 2002 Oct 10;101(5):454-60
AD - Cancer Research UK Carcinogenesis Group, Paterson Institute for Cancer
Research, Manchester, UK.
The use of definitive radiotherapy for treatment of invasive bladder
cancer has the advantage of preserving bladder function, but tumour
regression is only achieved in approximately 40-50% of patients.
Knowledge of the molecular basis of sensitivity to ionizing radiation
and identification of potential molecular predictors will provide useful
information regarding patient response and thus help clinicians to
individualize treatment. The recent application of cDNA expression array
technology provides a useful tool to investigate hundreds or even
thousands of genes in a single experiment. In our study, we have used
the Atlas human stress cDNA array trade mark to investigate the
expression profile of stress-related and DNA repair genes in a
radioresistant bladder carcinoma cell line (MGH-U1) and its
radiosensitive subclone (S40b). This provides an ideal situation to
study genes related to radiation because the genotypes of both cell
lines are basically similar and differential changes detected are likely
to be related to the different radiosensitivity phenotype. Of 234 genes
blotted on the array, 3 genes (Heat shock protein 90, Heat shock protein
27 and Nicotinamide N-methyl transferase) showed consistent
downregulation in the radiosensitive clone in 2 independent experiments.
These results were further confirmed for HSP27 and NNMT using Sybr Green
I-based real-time QRT-PCR. The role of heat shock proteins (HSPs) in
response to radiation remains to be determined; however, the results of
our present work suggest a possible role of HSP27 in determining
radiosensitivity. Our study also opens avenues for the investigation of
genes, such as NNMT, which has not previously been linked to response to
radiation. Copyright 2002 Wiley-Liss, Inc.
8
UI - 12355941
AU - Hinotsu S; Akaza H
TI -
[Urology]
SO - Gan To Kagaku Ryoho 2002 Sep;29(9):1549-69
AD - Department of Urology, Institute of Clinical Medicine, University of
Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
We reviewed comparative clinical studies for prostate cancer and bladder
cancer performed in Japan. A systematic search was done using PubMed and
Icyushi WEB to find randomized clinical trials and the result was
verified. Each manuscript was summarized according to the seven items of
stage, entry period, exposure, endpoint, sample size, method of
randomization and result. Forty reports were found as randomized
clinical trials for prostate cancer, and sixty-two reports were
identified for bladder cancer. Most exposures for advanced prostate
cancer were hormonal therapy involving intravesical instillation after
transurethral resection for superficial bladder cancer. At minimum, we
have clarified that large scale randomized trials have been conducted in
Japan for both prostate cancer and bladder cancer.
9
UI - 12031868
AU - Raghavan D; Quinn D; Skinner DG; Stein JP
TI -
Surgery and adjunctive chemotherapy for invasive bladder cancer.
SO - Surg Oncol 2002 Jun;11(1-2):55-63
AD - Division of Medical Oncology, USC Norris Comprehensive Cancer Center,
Room 3446, Los Angeles, CA 90033, USA. raghavan_d@ccnt.hsc.usc.edu
Invasive bladder cancer has a predilection for early, occult metastasis.
Despite effective local control from radiotherapy or cystectomy,
approximately 50% of the patients with clinically localized, invasive
bladder cancer ultimately die of their disease. Over the past 25 years,
systemic chemotherapy has been combined with definitive local treatment
in an attempt to improve cure rates. Non-randomized phase I-II trials
have shown promising results, with significant tumor down-staging.
However, many randomized trials have failed to show a statistically
significant survival benefit from adjunctive systemic chemotherapy.
Recently, two intergroup randomized trials have shown a survival benefit
from neoadjuvant combination chemotherapy, although the differences
between the arms have not been dramatic. Adjuvant chemotherapy trials to
date have failed to show statistically improved survival, although most
published studies have been methodologically flawed. This review
analyzes the results of published data and constructs a practical
paradigm for patient management.
10
UI - 12031869
AU - Bhojwani AG; Mellon JK
TI -
Contemporary cystectomy combined with ileal conduit or bladder
substitution.
SO - Surg Oncol 2002 Jun;11(1-2):65-75
AD - Division of Urology, University of Leicester, Clinical Sciences Unit,
Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
Radical cystectomy remains one of the mainstay treatments for
organ-confined invasive bladder cancer. Components of this surgery
including the extent of pelvic lymph node dissection, the assessment of
ureteric margins and the indications for bladder reconstruction as
opposed to the simpler ileal conduit urinary diversion continue to
provoke debate. This review provides a broad overview of radical
cystectomy and summarises the options for bladder reconstruction.
Special emphasis is given to data concerning the role of pelvic
lymphadenectomy in the patient staged pre-operatively as N0M0.
11
UI - 12031870
AU - Bassi P
TI -
BCG (Bacillus of Calmette Guerin) therapy of high-risk superficial
bladder cancer.
SO - Surg Oncol 2002 Jun;11(1-2):77-83
AD - Department of Urology, University of Padova Medical School, Monoblocco
Ospedaliero 2, Via Giustiniani, 35100 Padova, Italy. bassipf@tin.it
BCG (Bacillus of Calmette Guerin) has been used for more than 20 years
and is currently the most active agent for superficial bladder cancer
therapy. Intravesical BCG therapy is effective in prophylaxis after
transurethral resection of papillary tumours and in the treatment of
carcinoma in situ (cis). In most series BCG is more effective than
intravesical chemotherapy, although it is more toxic. There is some
evidence that BCG therapy improves survival and progression rates of
patients with high-risk superficial bladder cancer decreasing the
proportion who require radical cystectomy. A review of the current
information on BCG therapy of high-risk superficial bladder cancer is
reported.
12
UI - 12237912
AU - Ricci S; Galli L; Chioni A; Iannopollo M; Antonuzzo A; Francesca F;
TI -
Vocaturo V; Selli C; Orlandini C; Conte P
Gemcitabine plus epirubicin in patients with advanced urothelial
carcinoma who are not eligible for platinum-based regimens.
SO - Cancer 2002 Oct 1;95(7):1444-50
AD - Division of Medical Oncology, Department of Oncology, S. Chiara
University Hospital, Pisa, Italy. s.ricci@med.unipi.it
BACKGROUND: The objective of this study was to evaluate the efficacy and
toxicity of gemcitabine plus epirubicin in previously untreated patients
with advanced urothelial carcinoma who were not eligible for
cisplatin-based regimens. METHODS: Patients with advanced urothelial
carcinoma and at least one of the following characteristics were
eligible: impaired renal function (creatinine clearance < 60 mL per
minute), an Eastern Cooperative Oncology Group performance status (PS)
>or= 2, and age >or= 75 years. The treatment included epirubicin 70
mg/m(2) as an intravenous bolus on Day 1 and gemcitabine 1000 mg/m(2)
over 30 minutes on Days 1 and 8 of a 21-day cycle. RESULTS: Thirty-eight
patients entered the study, and a total of 152 cycles were administered,
with a median of 4 cycles per patient (range, 1-6 cycles per patient).
The following Grade 3-4 hematologic toxicities were reported (percent of
cycles): neutropenia, 22.4%; anemia, 11.2%; and thrombocytopenia, 6.5%.
No cardiac, renal, or hepatic toxicities were observed. Dose intensities
of epirubicin and gemcitabine were 19.6 mg/m(2) per week (84%) and 532.2
mg/m(2) per week (80%), respectively. There were 2 complete responses
(5.3%), 13 partial responses (34.2%), 11 patients with stable disease
(28.9%), and 12 patients with progressive disease (31.6%), for an
overall response rate of 39.5% (95% confidence interval, 25.1-55.1). The
median progression free survival (PFS) and overall survival (OS) rates
were 4.8 months and 8.0 months, respectively. The 1-year survival rate
was 38%, and the median PFS and OS were 6.4 months and 16.4 months,
respectively, in patients with PS 0-1. Thirty patients were symptomatic:
Seventeen patients (56.7%) achieved a complete response, and 5 patients
(16.7%) achieved a partial symptomatic response. CONCLUSIONS: At the
doses given in this study, gemcitabine and epirubicin had a good
tolerability profile with interesting activity in patients with advanced
urothelial carcinoma who were not fit for cisplatin-based regimens.
Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10860
13
UI - 12002357
AU - Turkolmez K; Baltaci S; Beduk Y; Muftuoglu YZ; Gogus O
TI -
DNA ploidy and S-phase fraction as predictive factors of response and
outcome following neoadjuvant methotrexate, vinblastine, epirubicin and
cisplatin (M-VEC) chemotherapy for invasive bladder cancer.
SO - Scand J Urol Nephrol 2002 Feb;36(1):46-51
AD - Department of Urology, University of Ankara, School of Medicine, Turkey.
OBJECTIVE: To investigate the value of DNA ploidy and S-phase fraction
(SPF) as factors that could predict response and outcome of invasive
transitional cell carcinoma (TCC) of the bladder to neoadjuvant
methotrexate, vinblastine, epirubicin and cisplatin (MVEC) chemotherapy.
MATERIALS AND METHODS: Twenty-four patients with localized invasive TCC
of the bladder (stages T3 to T4a, NoMo) were treated with neoadjuvant
MVEC chemotherapy. DNA flow cytometry was performed in paraffin-embedded
tissue obtained by transurethral resection before chemotherapy. Radical
cystectomy specimens were utilized for complete pathologic staging. The
tumors were subdivided into high- and low-SPF tumors according to their
SPF value. DNA ploidy status was evaluated into two groups (diploidy and
nondiploidy). RESULTS: DNA ploidy was not correlated to the response to
chemotherapy (p = 0.67), and overall or disease-free survival (p = 0.27
and p = 0.69, respectively). Major response (pathologic complete
response and partial response) was more often found in the high SPF
group than among tumors with low SPF (p = 0.02). High SPF tumors were
significantly associated with increased overall and disease-free
survival (p = 0.0056 and p = 0.0059, respectively). CONCLUSION: A high
SPF, but not DNA ploidy, may be helpful to identify patient likely to
respond and survive longer following neoadjuvant MVEC chemotherapy in
the treatment of invasive bladder cancer.
14
UI - 12002360
AU - El-Abbady AA; Shoukry MS; Hanno AG; Younis LK; Abdel-Rahman M
TI -
Repeated transurethral resection of recurrent superficial bladder
tumors--does it affect the spread and stage of the tumor?
SO - Scand J Urol Nephrol 2002 Feb;36(1):60-4
AD - Department of Urology, Alexandria School of Medicine, Alexandria
University, Egypt.
OBJECTIVES: This prospective study was done to demonstrate the effect of
repeated resection of superficial bladder tumors (TURT) on deep
malignant cell infiltration in bladder wall. MATERIAL AND METHODS:
Thirty-six patients underwent radical cystectomy for invasive bladder
cancer, 16 patients originally had superficial cancer that became
invasive after repeated TURT (group I) and the other 20 patients (group
II) presented with invasive bladder cancer from the start. Each
cystectomy specimen was subjected to a thorough histopathological study.
RESULTS: There was a statistically significant difference in pattern of
local spread of malignant cells between the two groups. Isolated
clusters of malignant cells in-between normal bladder muscle fibers,
isolated subserosal malignant deposits as well as cells reaching the
adjacent cervix uteri were found only in group I. Intravesical pressure
was measured in another 10 patients during TURT and was found to be high
reaching up to 80 cm H2O. CONCLUSIONS: We conclude that some malignant
cells penetrate through the denuded urothelium during TURT by the effect
of high intravesical pressure. This may be responsible, among other
factors, for tumor recurrence with deeper stages.
15
UI - 12228754
AU - Carrion R; Seigne J
TI -
Surgical management of bladder carcinoma.
SO - Cancer Control 2002 Jul-Aug;9(4):284-92
AD - Division of Urology, University of South Florida, Tampa, 33620, USA.
BACKGROUND: Despite advances in medical oncology, radiation therapy, and
molecular and cell biology, the mainstay in the management of bladder
cancer continues to be surgery. METHODS: The authors reviewed the
literature regarding the endoscopic diagnosis and management of bladder
cancer as well the role of partial and radical cystectomy. RESULTS:
Cystoscopy and transurethral resection are required to diagnose and
stage bladder cancer. The indications for random bladder biopsies,
prostatic urethral biopsy, and re-resection of the tumor bed are
examined. The results and complications of endoscopic resection in the
management of Ta, T1, and T2 or greater bladder cancer are reported. The
roles of partial cystectomy, radical cystectomy, extent of
lymphadenectomy, and indications for urethrectomy are also examined. The
results and complications of radical cystectomy for the management of
T2, T3, T4, and N+ bladder cancer are reported. CONCLUSIONS: Surgery
remains a critical element in the management of bladder cancer.
Improvements in surgical technique, urinary reconstruction, and
multimodal therapy continue to improve the prognosis and quality of life
of patients with transitional cell cancer of the bladder.
16
UI - 12352414
AU - Chang SS; Cole E; Cookson MS; Peterson M; Smith JA Jr
TI -
Preservation of the anterior vaginal wall during female radical
cystectomy with orthotopic urinary diversion: technique and results.
SO - J Urol 2002 Oct;168(4 Pt 1):1442-5
AD - Department of Urologic Surgery, Vanderbilt University Medical Center,
Nashville, Tennessee, USA.
PURPOSE: Orthotopic urinary reconstruction has been shown to be a viable
option in women undergoing radical cystectomy. However, due to
anatomical differences and technical considerations orthotopic diversion
has been performed in a relatively small number of patients. We examined
our technique of vaginal wall preservation during female radical
cystectomy and orthotopic neobladder construction. MATERIALS AND
METHODS: We reviewed the records of all patients who underwent radical
we identified 94 females, of whom 25 (27%) underwent orthotopic
neobladder substitution. We reviewed perioperative major and minor
complications, postoperative care, followup and pathological results.
RESULTS: Overall 21 of the 25 patients (84%) underwent anterior vaginal
wall sparing. Five patients (24%) had minor complications, there were no
major perioperative complications and no patients required transfusion.
Median estimated blood loss in this group was 575 ml. (range 200 to
1,250). A single neobladder-vaginal fistula developed in a patient early
in our series in whom the anterior vaginal wall was incised and repaired
during dissection. Of the 21 patients 15 (72%) were continent.
Pathological specimens revealed a negative posterior bladder wall and
urethral margins in all cases. At a median followup of 12 months 1
patient had local recurrence. CONCLUSIONS: Anterior vaginal wall
preservation in female radical cystectomy with orthotopic neobladder
substitution is technically feasible, maintains vaginal length and
support, has an acceptable complication rate and can achieve negative
margins. Prospective evaluation is needed to assess the long-term impact
on functional outcomes and cancer control.
17
UI - 12352422
AU - Chiu W; Radhakrishnan V; Lin CH; Huan SK; Wu MP
TI -
Internal bladder retractor for laparoscopic cystectomy in the female
patient.
SO - J Urol 2002 Oct;168(4 Pt 1):1479-81
AD - Division of Urology, Department of Surgery, Chi-Mei Foundation Medical
Center, Tainan, Taiwan, Republic of China.
PURPOSE: To overcome difficult dissection of the vascular pedicles
during laparoscopic radical cystectomy we used a novel technique of
internal bladder retraction. MATERIALS AND METHODS: An internal bladder
retractor was used to facilitate dissection of the vascular pedicles
during laparoscopic radical cystectomy in a female patient. RESULTS: The
application of the retractor is easy and it allows more precise control
of the vascular pedicles and ureters. It also helps to overcome the
space limitation when dissecting the perivesical structures.
Laparoscopic cystectomy with hysterectomy was accomplished in 2.5 hours.
CONCLUSIONS: We successfully used a novel internal bladder retractor to
facilitate laparoscopic radical cystectomy in a female patient.
18
UI - 12196896
AU - Sarosdy MF; Machtens S
TI -
Advanced bladder cancer...where are we now and where are we going?
SO - World J Urol 2002 Aug;20(3):143
19
UI - 12196897
AU - Lehmann J; Retz M; Stockle M
TI -
Chemotherapy in the post-MVAC era: the case for adjuvant chemotherapy.
SO - World J Urol 2002 Aug;20(3):144-50
AD - Department of Urology and Pediatric Urology, Saarland University,
Kirrberger Strasse, 66421 Homburg/Saar, Germany.
jan.lehmann@uniklinik-saarland.de
Radical cystectomy for muscle invasive and locally advanced bladder
cancer is the standard treatment modality in most of the Western
industrialised countries. Rates of perioperative mortality from radical
cystectomy have decreased to less than 2% over the past two decades due
to advances in surgical technique and perioperative care. However, at
least 40% of patients with pT3 bladder cancer and 70% of patients with
lymph node-positive disease develop tumour recurrence after radical
treatment within the first 5 years when treated with radical cystectomy
alone. After the efficacy of combination chemotherapy for metastatic
urothelial cancer using methotrexate, vinblastine, adriamycin and
cisplatin (MVAC) was first described in 1985, several cisplatin-based
systemic regimens have been investigated as adjunctive treatment before
or after therapy for locally advanced bladder cancer by radical surgery
or radiation therapy. Three randomised studies have reported superior
results of postoperative adjuvant systemic chemotherapy compared to
radical cystectomy alone for locally advanced bladder cancer. All three
studies demonstrated a significant survival benefit for bladder cancer
patients receiving adjuvant combination therapy. Studies have been
criticised for small patient numbers and statistical shortcomings. New
effective antineoplastic agents, such as paclitaxel and gemcitabine,
have evolved during the past decade as promising substances for the
treatment of urothelial cancer. This article reviews adjuvant studies
from the era of MVAC combination chemotherapy, as well as contemporary
studies that discuss new antineoplastic agents for systemic adjuvant
chemotherapy of locally advanced bladder cancer.
20
UI - 12196898
AU - Madersbacher S; Studer UE
TI -
Contemporary cystectomy and urinary diversion.
SO - World J Urol 2002 Aug;20(3):151-7
AD - Department of Urology, University of Berne, Anna-Seiler Haus, 3010
Berne, Switzerland. stephan.madersbacher@insel.ch
Radical cystectomy has emerged as the standard therapy for patients with
invasive bladder cancer. Controversy is related to the indication, i.e.
a low or high threshold. Meticulous pelvic lymphadenectomy can cure
20%-30% of patients with lymph node metastases, particularly those with
limited node involvement. Unilateral nerve-sparing surgery is feasible
in most patients without compromising oncological outcome and, besides
erectile function, has an impact on the continence status after
orthotopic bladder substitution. The excellent local control rates
following radical cystectomy indicate that the weight of the problem in
the future lies in reducing distant metastases. Orthotopic bladder
substitution with a low-pressure ileal reservoir is currently the
preferred method to reconstruct the lower urinary tract for both sexes
following cystectomy. Long-term experience with follow-ups exceeding 10
years demonstrates a sustained favourable voiding outcome with slightly
increasing incontinence rates as patients age.
21
UI - 12196900
AU - Bradley BA; Wajsman Z
TI -
The role of chemotherapy and radiation in organ-preservation strategies
for muscle-invasive bladder cancer.
SO - World J Urol 2002 Aug;20(3):167-74
AD - University of Florida College of Medicine, Division of Urology, P.O. Box
100247, Gainesville, FL 32610-0247, USA. bbradley@ufl.edu
Radical cystectomy with pelvic lymph node dissection has been accepted
as the standard treatment for muscle-invasive bladder cancer. Radiation
therapy and chemotherapy are increasingly being implemented in
bladder-preservation protocols to provide an alternative treatment to
cystectomy. We review experience with radiation and chemotherapy in
treating bladder cancer and their use in bladder-preservation protocols.
Multimodality organ-sparing treatment strategies offer overall survival
rates comparable to radical cystectomy and pelvic lymph node dissection
in selected cases. However, bladder-preservation techniques risk local
recurrence of potentially aggressive tumors whose long-term effect on
cancer-specific survival has not been fully characterized. No
improvement in quality of life has clearly been demonstrated with
bladder-preservation regimens. Bladder-preservation protocols are costly
and require precise coordination of multiple specialists as well as
strict, life-long patient compliance. Bladder-preservation protocols
should only be performed at tertiary care centers with experience in
their administration and be limited to patients desiring an alternative
cystectomy or who are not surgical candidates.
22
UI - 12196901
AU - Syed S; Weiss GR
TI -
Management of locally advanced bladder cancer: early vs deferred
chemotherapy.
SO - World J Urol 2002 Aug;20(3):175-82
AD - The University of Texas Health Science Center at San Antonio, South
Texas Veterans Health Care System, San Antonio, TX 78284-6200, USA.
Locally advanced bladder cancer is associated with a high risk of local
recurrence and distant metastases. Clinical and pathologic variables
have been useful in predicting outcome in patients with muscle-invasive
bladder cancer. Recently, a number of molecular prognostic markers have
been identified that help predict tumor aggressiveness, response to
chemotherapy, and survival. Transitional cell carcinoma is a
chemosensitive tumor. The early use of chemotherapy to reduce the risk
of recurrence and improve survival has been the focus of many randomized
clinical trials. Unfortunately, the majority of studies have failed to
show a survival advantage for chemotherapy-treated patients.
Well-designed prospective trials that target high-risk patients, defined
by clinical, pathological, and molecular features, and incorporate new
more tolerable chemotherapeutic agents are needed to clarify the benefit
of early chemotherapy.
23
UI - 12196902
AU - Kuczyk M; Machtens S; Bokemeyer C; Kollmannsberger C; Hartmann J; Kondoh
TI -
M; Merseburger A; Jonas U
Surgical bladder preserving strategies in the treatment of
muscle-invasive bladder cancer.
SO - World J Urol 2002 Aug;20(3):183-9
AD - Department of Urology, Hanover University Medical School,
Carl-Neuberg-Str. 1, 30625 Hanover, Germany.
Single modality bladder-sparing therapy for muscle-invasive bladder
cancer, including transurethral resection (TUR), partial cystectomy,
systemic chemotherapy or radiotherapy, have been demonstrated to result
in insufficient local control of the primary tumour, as well as
decreased long-term survival in the patients when compared to radical
cystectomy. Therefore, multimodality treatment protocols that aim at
bladder preservation and involve all of the aforementioned approaches
have been established. Arguments for combining systemic chemotherapy
with radiation are to sensitise tumour tissue to radiotherapy and to
eradicate occult metastases that have already developed in as many as
50% of patients at the time of first diagnosis. It has been shown that
the clinical outcome observed with this approach approximates that after
radical cystectomy. Additionally, a substantial number of patients
survive with an intact bladder. However, bladder-sparing approaches are
costly, and require close co-operation between different clinical
specialists as well as careful follow-up. The good long-term results
that are observed after cystectomy and the creation of an orthotopic
neobladder make the substantial advantage of a bladder preservation
strategy questionable when the patient's quality of life is addressed.
Additionally, bladder-sparing therapy-related side effects might result
in an increased morbidity and mortality in those patients who need to
undergo surgery due to recurrent or progressive disease. Multimodality
bladder-sparing treatment is a therapeutic option that can be offered to
the patient at centres that have a dedicated multidisciplinary team at
their disposal. However, radical cystectomy remains the standard of care
for muscle-invasive bladder cancer.
24
UI - 12074781
AU - Patard JJ; Rodriguez A; Leray E; Rioux-Leclercq N; Guille F; Lobel B
TI -
Intravesical Bacillus Calmette-Guerin treatment improves patient
survival in T1G3 bladder tumours.
SO - Eur Urol 2002 Jun;41(6):635-41; discussion 642
AD - Department of Urology, CHU, Rennes, France.
jean-jacques.patard@chu-rennes.fr
OBJECTIVE: To study the clinical and pathological factors that affect
recurrence, progression and survival in pT1G3 bladder tumours treated
1996, 80 patients were conservatively treated for pT1G3 bladder tumours.
All patients were studied for potential prognostic factors such as: age,
sex, previous tumour recurrence, tumour size, multiple tumours,
carcinoma in situ, and intravesical instillations. A longitudinal,
retrospective, observational and analytical study was conducted to
evaluate four different types of events: recurrence, progression,
overall survival, and disease-specific survival. The chi(2) (Fischer
exact test) and student t tests were used to assess the prognostic value
of the qualitative and quantitative variables. Estimations of the
survival distributions were calculated according to the Kaplan-Meier
method and compared with the Log rank test. Multivariate analysis of the
data was performed with Cox proportional hazard models. RESULTS: Among
the 80 patients, 67 (84%) were men and 13 (16%) were women, with median
age of 65.5 years. The median tumour size was 20 mm, most had single
tumour (58.8%) and carcinoma in situ was found in six patients (7.5%).
Thirty patients were treated with transurethral resection (TUR) of the
bladder tumour and 50 patients were treated with TUR followed by BCG.
The two groups of patients were comparable and followed up during a
median time of 61 and 65 months, respectively (p=0.454). Kaplan-Meier
estimators and Log rank tests demonstrated that patients with TUR alone
recurred (p<0.0001), progressed (p<0.040) and died (overall survival:
p<0.009; disease-specific p<0.040) earlier than patients who received
intravesical instillations of BCG. The results were confirmed with Cox
models and odds-ratios are presented. CONCLUSION: In this study, BCG
adjuvant immunotherapy was the only factor affecting recurrence,
progression and survival. Conservative treatment using TUR followed by
BCG may improve disease-specific survival.
25
UI - 12230616
AU - Kulkarni JN; Gupta R
TI -
Recurrence and progression in stage T1G3 bladder tumour with
intravesical bacille Calmette-Guerin (Danish 1331 strain).
SO - BJU Int 2002 Oct;90(6):554-7
AD - Department of Urology, Tata Memorial Hospital, Mumbai, India.
jnkulkarni@hotmail.com
OBJECTIVE: To report recurrence and progression rates in patients with
T1G3 superficial bladder carcinoma treated with intravesical bacille
Calmette-Guerin (BCG, Danish 1331 strain) after complete transurethral
resection. PATIENTS AND METHODS: Data from the records of 111 patients
1999 were analysed for recurrence, progression, salvage therapy and
survival. RESULTS: Of the 111 patients with T1G3 bladder tumours, 69 had
intravesical BCG therapy, 20 radical cystectomy and 22 only
transurethral resection (TUR). Of the 69 patients receiving BCG therapy
37 (54%) had no recurrence, and 24 (35%) had a recurrence that was not
muscle-invasive (Ta/T1) and were treated with TUR only. The remaining
eight (12%) progressed to muscle invasion and had salvage cystectomy.
During the follow-up six patients died, four from disease and three from
other causes, while the remaining 63 are alive and well. Of the other 42
patients, 15 are alive after radical cystectomy and 18 after TUR.
CONCLUSION: This series further confirms the benefits of intravesical
BCG (Danish 1331) in an adjuvant setting; furthermore, this treatment
facilitates bladder preservation by reducing recurrences and delaying
the progression in many patients.
26
UI - 12230627
AU - Ghanem AN
TI -
Experience with 'capsule sparing' cystoprostadenectomy for orthotopic
bladder replacement: overcoming the problems of impotence, incontinence
and difficult urethral anastomosis.
SO - BJU Int 2002 Oct;90(6):617-20
AD - Urology Department, King Khalid Hospital, Najran, Kingdom of Saudi
Arabia. an_ghanem@hotmail.com
27
UI - 10614978
AU - Baniel J
TI -
Bladder cancer in women.
SO - Int Urogynecol J Pelvic Floor Dysfunct 1999;10(6):399-404
AD - Head, Urology Section, Rabin Medical Center, Beilinson Campus, Petach
Tikva, Israel.
In women bladder cancer usually occurs above the age of 60 and comprises
3% of all female cancers. The hallmark of presentation is hematuria,
which must be investigated by radiological imaging and cystoscopy. The
best prognostic indicators are grade and stage. Stage divides the
disease into two separate entities, superficial and invasive disease.
Approximately 70%-80% of patients will present with superficial disease,
10% will fail treatment or progress to invasive disease, and 20% present
with invasive disease. Superficial disease is managed by transurethral
resection and additional intravesical therapy when high-risk parameters
for recurrence or progression exist. Overall survival is good and the
morbidity acceptable. Invasive bladder cancer carries a worse prognosis,
with an average of 50% 5-year survival. Management of invasive disease
warrants extensive surgery, which is the best single treatment modality.
Chemotherapy and radiotherapy are implemented in the management of
progression or metastasis.
28
UI - 12238168
AU - Raitanen M
TI -
[Treatment and follow-up of superficial bladder cancer]
SO - Duodecim 2002;118(9):903-9
AD - mika.raitanen@epshp.fi
29
UI - 12227904
AU - Matin SF; Gill IS
TI -
Laparoscopic radical cystectomy with urinary diversion: completely
intracorporeal technique.
SO - J Endourol 2002 Aug;16(6):335-41; discussion 341
AD - Section of Laparoscopic and Minimally Invasive Surgery, Urological
Institute, The Cleveland Clinic, Ohio 44195, USA.
Laparoscopic radical cystectomy with urinary diversion performed using
intracorporeal techniques exclusively is a new development in the
growing field of minimally invasive urology. This report details step by
step the completely intracorporeal laparoscopic technique of cystectomy,
bilateral pelvic lymphadenectomy, and urinary diversion with creation of
an ileal conduit or neobladder, including the isolation of ileum,
restoration of bowel continuity, retroperitoneal transfer of the left
ureter to the right side, bilateral stented ureteroileal anastomoses,
and urethroileal anastomosis in case of orthotopic diversion. Although
at present, this is still a technique in development at high-volume
medical centers, it holds promise as a minimally invasive yet
appropriately radical form of treatment for patients with
muscle-invasive bladder cancer. Definition of its true role awaits
greater experience and long-term comparisons of the outcomes with those
of traditional open surgery.
30
UI - 12227913
AU - Abdel-Hakim AM; Bassiouny F; Abdel Azim MS; Rady I; Mohey T; Habib I;
TI -
Fathi H
Laparoscopic radical cystectomy with orthotopic neobladder.
SO - J Endourol 2002 Aug;16(6):377-81
AD - Department of Urology, Faculty of Medicine, Cairo University, Egypt.
ahakim@idsc.gov.eg
PURPOSE: We report our technique of laparoscopic radical cystectomy in
nine patients. Diversion was achieved by a modified Camey II orthotopic
neobladder (the Y bladder) performed by a minilaparotomy in three cases
and laparoscopically in the last six cases. PATIENTS AND METHODS: There
were eight men with muscle-invasive transitional-cell carcinoma and one
woman with verrucous squamous-cell carcinoma of the bladder. The age
range was 41 to 65 years. The control of the posterior and lateral
bladder pedicles was achieved by vascular Endo-GIA in the first three
cases and by the 10-mm Harmonic Shears (Ultracision; Ethicon) in the
last six cases. The operative specimen was extracted through a 3- to
5-cm muscle-splitting incision in the right iliac fossa. The
detubularized pouch was prepared extracorporeally through the same
incision. The urethral and ureteral anastomoses were performed using
laparoscopic intracorporeal suturing in the last six cases. RESULTS: The
operative time ranged from 6.5 to 12 hours (median 8.3 hours). The blood
loss was 150 to 500 mL. Oral feeding was resumed on the 3rd
postoperative day. The stents were usually removed on the 8th
postoperative day. A pouchogram was obtained on the 10th postoperative
day, and the urethral catheter was removed. The lymph nodes as well as
the surgical margins were tumor free. CONCLUSION: Laparoscopic radical
cystectomy and orthotopic neobladder creation is feasible, although
difficult and technically demanding. The use of the Harmonic Shears in
the cystectomy reduces the operative cost significantly. With growing
experience, laparoscopic radical cystectomy and continent urinary
diversion can be an alternative to the open technique.
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