Dystrophic calcification after turb and postoperative intravesical mitomycin-c administration

Introduction: Standard practice in our unit is to take a group and save (G+S) blood sample for all patients undergoing a transurethral resection of prostate (TURP) and transurethral resection of bladder tumour (TURBT). Modern studies show the transfusion rates for TURP are 2%–7% and for TURBT 2%. Aims: We will determine how many patients undergoing TURP and TURBT required blood transfusion, analyse the indication, timing and risk factors. Additionally we will assess the cost effectiveness of routine G+S. Methods: A retrospective analysis was conducted between 1 March 2015 and 29 February 2016 (one year). Patients were identified from OPERA database and cross-referenced with blood transfusion records. Electronic case notes for patients receiving transfusions were reviewed. Results: A total of 167 patients underwent TURP. Of these, 0.6% (1/167) received transfusion on day 4 post-op. A total of 160 patients underwent TURBT. Overall 3.8% (6/160) received transfusion: three patients on days 0–1 and three patients on days 2–30. All patients had pre-op Hb <100 g/l. All had large muscle-invasive tumours. Cost in our lab of a G+S sample is £23.52. Two samples are now required before blood can be issued. Discussion: Our study shows that risk factors for transfusion are large prostates, likely muscle-invasive bladder tumours and pre-op Hb <100 g/l. Other risks include coagulopathy. These will usually be identified by the surgeon or pre-assessment clinic prior to the procedure. Change in policy would save money and time of phlebotomists and junior doctors. Conclusions: Routine G+S is not necessary for all patients. Patients with risk factors can be identified preoperatively. This would give a potential saving of over £15,000 per year. This can be implemented without adversely affecting patient safety.

Background: Surgical treatment for ureteral orifice-invasive bladder tumors is tricky and remains controversial. Objective: This study compared the efficacy and safety of thulium laser en bloc resection of bladder tumor (ERBT) and transurethral resection of bladder tumor (TURBT) for ureteral orifice-invasive tumors. Methods: Clinical data of patients with non-muscle invasive bladder tumors close to or invading the ureteral orifice from March 2016 to October 2023 were retrospectively analyzed. Pre-operative imaging confirmed no ureteral dilation or hydronephrosis. Bladder instillation chemotherapy was administered based on the pathological findings. Follow-up with cystoscopy and imaging was conducted every 3 months for 1–2 year(s), and then every 6 months thereafter. Results: Forty-two patients were included (25 ERBT, 17 TURBT). All surgeries were completed without intraoperative complications. Median follow-up lasted for 22 months. Baseline median age (65 vs. 63 years, p=0.27), tumor number (all solitary), and size (2.85 ± 1.06 cm vs. 3.14 ± 0.82 cm, p=0.37) were comparable between the TURBT and ERBT groups. Mean operative time was shorter with ERBT (16.08 ± 3.26 min) than with TURBT (30.00 ± 3.53 min; p=0.01). Post-operative hematuria occurred in two TURBT cases and none in ERBT (p=0.006). Detrusor muscle sampling was missed in seven TURBT cases and none with ERBT (p=0.003). Hospitalization was shorter for ERBT (3.12 ± 0.73 days) than with TURBT (4.53 ± 0.80 days; p=0.04). No short-term ureteral stenosis or hydronephrosis developed in either group. Conclusion: ERBT safely resects ureteral orifice-invasive tumors, avoids double-J stenting, and protects the ureteral orifice, rendering it preferable to TURBT in this setting.

We evaluate the efficacy and safety of transurethral resection and degeneration of bladder tumour (TURD-Bt). In total, 56 patients with bladder tumour were treated by TURD-Bt. The results in these patients were compared with 32 patients treated by current transurethral resection of bladder tumour (TUR-Bt). Patients with or without disease progressive factors were respectively compared between the 2 groups. The factors included recurrent tumour, multiple tumours, tumour ≥3 cm in diameter, clinical stage T2, histological grade 3, adenocarcinoma, and ureteral obstruction or hydronephrosis. Follow-up time was 48.55 ± 23.74 months in TURD-Bt group and 56.28 ± 17.61 months in the TUR-Bt group (p > 0.05). In patients without progressive factors, no tumour recurrence was found and overall survival was 14 (100%) in the TURD-Bt group; 3 (37.50%) patients had recurrence and overall survival was 5 (62.5%) in the TUR-Bt group. In patients with progressive factors, 8 (19.05%) patients had tumour recurrence, overall survival was 32 (76.19%) and cancer death was 3 (7.14%) in TURD-Bt group; 18 (75.00%) patients had tumour recurrence (p < 0.05), overall survival was 12 (50.00%) (p < 0.01) and cancer death was 8 (33.33%) (p < 0.05) in TUR-Bt group. No significant complication was found in TURD-Bt group. This study suggests that complete resection and degeneration of bladder tumour can be expected by TURD-Bt. The surgical procedure is safe and efficacious, and could be predictable and controllable before and during surgery. We would conclude that for bladder cancers without lymph node metastasis and distal metastasis, TURD-Bt could be performed to replace radical TUR-Bt and preserve the bladder.

Bladder tumor is characterized by recurrent recurrence and distant metastasis, which determines the difficulty of completely curing bladder tumor. In recent years, the number of patients with bladder cancer is increasing, and the treatment of bladder cancer has become an important direction of clinical research. It is difficult to control bladder tumor by traditional therapy. Photodynamic therapy (PDT), as a new optical therapy, has gradually become the main method in clinical treatment of bladder tumor combined with transurethral resection of bladder tumor. In this paper, a patient with superficial recurrent bladder tumor was treated by photodynamic therapy combined with transurethral resection of bladder tumor. The advantages of photodynamic therapy in the treatment of bladder tumor and the selection of photosensitizer in the process of photodynamic therapy were discussed. After two recurrences, the patients chose photodynamic therapy. The tumors were resected one by one, and the wound was coagulated by roller electrode. After the drug was retained for 20 minutes, the bladder was empty. The spherical optical fiber was implanted into the bladder. The photodynamic energy was adjusted (light power 1.8 W, light time 1302 s). There was no recurrence after operation.Most bladder tumors are superficial tumors, and bladder is a cavity organ, which determines that bladder is an ideal organ for photodynamic therapy. As a targeted drug, photosensitizer is only absorbed by bladder tumor after being perfused into bladder. The photosensitizer forms reactive oxygen species through oxygen and kills tumor cells. Clinical practice has proved that PDT has its unique advantages for superficial and recurrent bladder tumors. As the first generation photosensitizer, xipofen also has selectivity in the treatment of bladder cancer.

Narrow Band Imaging Cystoscopy and Bipolar Plasma Vaporization for Large Nonmuscle-invasive Bladder Tumors—Results of a Prospective, Randomized Comparison to the Standard Approach

RECURRENCE AND PROGRESSION OF STAGE T1, GRADE 3 TRANSITIONAL CELL CARCINOMA OF THE BLADDER FOLLOWING INTRAVESICAL IMMUNOTHERAPY WITH BACILLUS CALMETTE-GUERIN

BackgroundThis study explores the risk factors for ureteral stricture and tumor recurrence after transurethral resection of bladder tumor (TURBT) in patients with paraureteral bladder cancer, aiming to provide references for clinicians in their treatment practices.MethodsA retrospective analysis was conducted on 164 patients with paraureteral bladder cancer who underwent TURBT from April 2017 to July 2024, among whom 133 patients had complete clinical data and follow-up data. Univariate and multivariate logistic regression analyses were used to identify the risk factors for ureteral stricture and tumor recurrence after TURBT in paraureteral bladder cancer.ResultsThe incidence of ureteral stricture after TURBT in patients with paraureteral bladder cancer was 11.28% (15/133), and the recurrence rate of bladder cancer within 1 year after surgery was 21.80% (29/133). Multivariate logistic regression analysis showed that diabetes mellitus (p = 0.021) and tumor diameter (p = 0.002) were independent risk factors for ureteral stricture within 1 year after TURBT. Additionally, multivariate logistic regression analysis revealed that sex (p = 0.021), diabetes mellitus (p = 0.008), and pathological T stage (p = 0.002) were independent risk factors for bladder tumor recurrence within 1 year after TURBT.ConclusionDiabetes mellitus and tumor diameter are independent risk factors for ureteral stricture within 1 year after TURBT in patients with paraureteral bladder cancer. Sex, diabetes mellitus, and pathological T stage are independent risk factors for bladder tumor recurrence within 1 year after TURBT in these patients.

To evaluate the oncological outcomes of second-look transurethral resection of bladder tumor (TURBT) in patients with a high grade (HG) Ta non-muscle invasive bladder cancer (NMIBC). We conducted a real-life multicenter study including all consecutive patients with HG Ta NMIBC, with or without second TURBT. Oncological outcomes included disease recurrence and progression. Multivariable Cox regression analyses were used to identify the independent predictors of bladder recurrence and progression. Of the 447 patients with HG Ta NMIBC, 240 (53.7%) underwent a second TURBT, while 207 (46.3%) did not. After a median follow-up of 30 [15-54] months, Kaplan Meier curves showed that a second TURBT was associated with significantly higher 5-year recurrence-free survival (RFS) rate but similar 5-year progression-free survival (PFS) rate. Multivariable Cox regression analysis reported that a second TURBT was not significantly associated with RFS (HR = 0.76; 95% CI=[0.50-1.16]; p = 0.2) and PFS (HR = 0.76; 95% CI=[0.37-1.56]; p = 0.4). Among the 240 patients underwent second TURBT, 151 (63%) had no residual disease. The 5-year RFS and 5-year PFS were significantly higher in patients without residual tumor at second TURBT. Multivariable Cox regression analysis confirmed that residual bladder tumor at second TURBT was the only independent predictor of bladder recurrence (HR = 1.28; p = 0.02) and progression (HR = 1.38; p = 0.03). Based on the results of our multicenter retrospective study, a systematic second TURBT in HG Ta NMIBC does not significantly improve oncologic outcomes.

The objective of this study was to retrospectively investigate the effectiveness of transurethral resection of bladder tumor (TURBT) and intravesical instillation therapy for stage T1, grade 3 (T1G3) transitional cell carcinoma (TCC) of the urinary bladder. Between January 1995 and December 1997, 97 patients with T1G3 TCC of the urinary bladder were treated by TURBT and adjuvant intravesical instillation with bacillus Calmette-Guérin (BCG) or other anticancer agents. The recurrence-free survival rates were evaluated according to several clinicopathological factors. The cases that progressed to muscle invasive disease were also analysed. In this series, the median follow-up period was 25 months (range, 5- 41) after the initial TURBT. Intravesical recurrence was noted in 44 patients (45%), and the 1, 2, and 3 year recurrence-free survival rates were 72%, 58%, and 42%, respectively. Multivariate analyses revealed that the risk of intravesical recurrence was significantly higher for patients who did not receive BCG therapy, irrespective of age, gender, tumor size, multiplicity, pathological stage, concomitant carcinoma in situ, and lymphovascular involvement. Moreover, after a median of 10 months, disease progression occurred in seven patients (7%), of which only one patient was treated by BCG therapy after initial TURBT. These findings suggest that intravesical instillation with BCG combined with TURBT is an effective conservative treatment for T1G3 TCC of the bladder. Patients with negative prognostic factors should be treated by BCG rather than other anticancer agents after TURBT.

Introduction: Bladder cancer is the ninth most commonly diagnosed cancer worldwide. The overall incidence has increased by 10% since last 30 years and 5 years survival rate by 50% in European countries.1 Transurethral resection of bladder tumor (TURBT) is the standard treatment given to the patients of superficial bladder tumors. During TURBT, local anatomical anesthesia may be given in order to block the obturator nerve thus avoiding the obturator jerk reflex. This study analyzes the surgical hazards in TURBT comparing blind versus nerve stimulator guided obturator nerve block with spinal block. Materials and Methods: A prospective randomized study was done in which 30 patients at HIMS and associated hospitals, were divided into three groups to compare the surgical hazards in TURBT comparing blind versus nerve stimulator guided obturator nerve block with spinal block. Results: 30 patients were included in this study. Mean operative time in Group 1(Obturator nerve block (ONB) during TURBT via blind technique) was 38 minutes, in Group 2 (ONB during TURBT via nerve stimulation technique) was 35 minutes and in group 3 (TURBT under spinal anesthesia only was 64 minutes. Effectiveness of blind technique of obturator nerve block (Group 1) in our study was 80% while that via nerve stimulator guided technique (Group 2) was 90%. Conclusion: This study indicates that use Obturator nerve block during TURBT via nerve stimulation technique is a better technique as compared to ONB during TURBT via blind technique. The use of nerve stimulator before ONB has better outcome. Keywords: Bladder spasm, Carcinoma, Obturator block, Spinal block, TURBT.

Background:Transurethral resection of bladder tumors (TURBT) is the standard management for urinary bladder tumors; however, new techniques as Thulium laser en bloc resection of bladder tumors (TmLRBT) have been introduced as a substitute to TURBT.Objectives:In this study safety, efficacy, and tumor recurrence after TmLRBT and TURBT were prospectively compared in patients with primary (<4 cm) bladder tumors.Patients and Methods:Between August 2019 and May 2021, patients with primary (<4 cm) bladder tumors were enrolled. Patients were randomized between the two procedures. All perioperative data were collected prospectively. Pathological specimen findings and recurrence rates were reported during follow-up visits.Results:Sixty patients underwent TURBT, and another 60 had TmLRBT. No significant differences were detected in patient demographics or preoperative tumor characteristics between the two groups. Operation time was less (28.2 vs. 38.9 min, P < 0.001), and rate of bladder perforation was lower with TmLRBT compared to TURBT (3.3% vs. 15.0%, P = 0.027). In the TmLRBT group, higher rate of muscle detection (95.0% vs. 78.3%, P < 0.001) in the pathological specimen, and lower rate of tissue destruction (0.0% vs. 21.6%, P < 0.001) were obtained compared to TURBT. Recurrence rate in cases of nonmuscle invasive bladder cancer was lower with TmLRBT (6.7% vs. 33.0%, P < 0.001).Conclusion:In this study, TmLRBT showed reduced operative time with lower perforation rates. Higher detection of detrusor muscle and less tissue destruction in the pathological specimen were obtained with TmLRBT, as well as lower rates of tumor recurrence. These findings suggest that TmLRBT is a safe and efficacious substitute to TURBT in tumors <4 cm.

Objective To study the efficacy and safety of intravesical chemotherapy combined with intravenous chemotherapy for high grade T1(T1G3) bladder cancer after transurethral resection of bladder tumor(TURBT). Methods From January 2012 to December 2015, 111 patients with high grade T1(T1G3) bladder cancer were retrospectively reviewed. Thirty-six patients received TURBT and intravesical chemotherapy and intravenous chemotherapy (group A), 75 patients received TURBT and intravesical chemotherapy(group B). In group A, there were 28 males and 8 females, with average age 66.2 years; in group B, there were 59 males and 16 females, with mean age 67.9 years. There was no statistical difference between the two groups in age, sex, smoking history, tumor diameter, tumor number. 1-year recurrence-free survival (RFS), 1-year progression-free survival(PFS), intravenous chemotherapy adverse reaction were analyzed. Results All the patients were followed-up for 12 months. 9 patients relapsed in group A, 1-year RFS rate 75%, and the median RFS of the 9 patients was 9(3-11) months. 36 patients relapsed in group B, 1-year RFS rate 52%, and the median RFS of the 36 patients was 7(3-11) months. There was statistically significant difference between the two group(P= 0.02). One patient progressed in group A, 1-year PFS rate 97.2%, and the PFS was 9 months. Six patients progressed in group B, 1-year PFS rate 92%, and the median PFS was 9.5(6-12) months. There was no statistically significant difference (P=0.305) between the two group. Only 1 case (3%) appeared III ° or above intravenous chemotherapy adverse reaction. Conclusions Intravesical chemotherapy combined with intravenous chemotherapy offers a better RFS rate than the intravesical chemotherapy alone for patients with T1G3 bladder cancer after TURBT, and there are very low rates of serious side effects. Intravenous chemotherapy may be considered as a new therapy strategy for T1G3 bladder cancer after TURBT. Key words: Bladder tumor; Intravenous chemotherapy; Recurrence; Progression

Glycosaminoglycans (GAG) are one of the main constituents of the connective tissue and cellular membrane. Their presence has been evidenced in mucosa and muscular tissue of the urinary bladder of both healthy individuals and those affected by carcinoma. This suggest their potential role in the onset of bladder carcinoma and follow-up of those patients. The aim of the study was to determine GAG levels in tumor tissue and the surrounding bladder mucosa in patients with bladder tumor, as well as in the bladder mucosa in patients with bladder carcinoma, and to compare the results according to the grade and stage of tumor and relapse. Tissue samples were taken in 61 patients (48 males and 13 females), mean age 61.5 years, range 40-92 years, obtained by transurethral resection (TUR) of bladder tumor, and 8 healthy persons. Determination of a total GAG content in the tissue samples was done by the Whiteman's method and then compared regarding the tumor grade and stage. Tumor grade and stage directly correlated with the levels of GAG. The GAG levels were significantly higher in tumor samples as compared to healthy mucosa. Higher GAG levels were recorded in all the patients with bladder tumors comparing to samples obtained from healthy individuals. GAG levels do not predict tumor relapse.

Bladder cancer is second among the most common urothelial malignancy and one of the most expensive in terms of treatment. Localized bladder cancer is classified into non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). First line approach for treatment of NMIBC is transurethral resection of bladder tumor (TURBT) followed by intravesical instillation of immuno/chemotherapeutic agents to prevent or delay recurrence or progression. Historically intravesical Bacillus Calmette Geurin (BCG) instillation has been a mainstay of therapy for NMIBC post-TURBT. Commonly followed drug delivery is intravesical instillation that maximizes exposure of the drug to the lesion and minimizes systemic side effects. Gemcitabine used in bladder cancer due to its pharmacological properties making it appropriate for intravesical instillation. Limitations of intravesical instillation is low bladder permeability leading to decreased drug concentration in bladder tissues and frequent urination causing drug wash out or dilution reducing the effect of treatment. Effective intravesical therapy depends on the penetration of the drug into the tumor. TAR200 is a novel drug delivery system that facilitates sustained release of continuous low dose gemcitabine over an indwelling period providing a uniform concentration of drug after each voiding cycle and exposure of drug to the bladder tumor. There are completed and ongoing clinical trials to evaluate the efficacy of TAR200 alone or in combination with other chemotherapeutic agents in NMIBC and MIBC. FDA has granted breakthrough therapy designation (BTD) for TAR-200 in December 2023. This review highlights the potential of TAR-200 and clinical trials that improve bladder cancer treatment outcome.

Quinolone antibiotics: a potential adjunct to intravesical chemotherapy for bladder cancer