Intravesical Treatment Modalities in Bladder Cancer: Current and Future Perspectives

Non-muscle-invasive bladder cancers encompass the pathological stages of Ta, T1, and carcinoma in situ. To prevent recurrence, intravesical therapy, which is performed after complete transurethral resection, is the current standard therapy for non-muscle-invasive bladder cancers. In patients with low-risk non–muscle-invasive bladder cancer, post-transurethral resection (TUR) management is a single immediate intravesical instillation of chemotherapy alone. For an intermediate-risk patient, a 6-week course of induction intravesical chemotherapy or immunotherapy can be adapted. Bacillus Calmette-Guerin vaccine is still the gold standard of immunomodulating intravesical treatment used to reduce recurrence and progression. Nanotechnology is being developed for the diagnosis and treatment of non-muscle-invasive bladder cancer. The newly developed technology will be able to change intravesical therapy success in non-muscle-invasive bladder cancer

Treatment of renal stones with flexible ureteroscopy in preschool age children

WOS: 000336383500008PubMed ID: 24374900The aim of the study is to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in preschool age ( 4 mm, a second-stage RIRS was performed. The pre-operative, operative and post-operative data of the patients were retrospectively analyzed. A total of 65 patients with a mean age of 4.31 +/- A 1.99 years (6 months-7 years) were included in the present study. The mean stone size was 14.66 +/- A 6.12 mm (7-30 mm). The mean operative time was 46.47 +/- A 18.27 min. In 5 (7.69 %) patients, the initial procedure failed to reach the renal collecting system and ended with the insertion of a pigtail stent. The stone-free rates were 83.07 and 92.3 % after the first and second procedures, respectively. Complications were observed in 18 (27.7 %) patients and classified according to the Clavien system. Post-operative hematuria (Clavien I) occurred in 6 (9.2 %) patients, post-operative urinary tract infection with fever (Clavien II) was observed in 10 (15.4 %) patients, and ureteral wall injury (Clavien III) was noted in 2 (3 %) patients. RIRS is an effective and safe procedure that can be used to manage renal stones in preschool age children

Bladder Cancer and Genetic Polymorphisms: A Review

The aetiology of bladder cancer (BC) is still not fully understood. Genetic factors and many different pathways could be involved in the formation and progression of the BC. Some investigators have reported genetic polymorphisms (GPMs) in various genes which might be associated with BC. As summarised below, we have seen an explosion of literature reporting an association between genetic variation and BC risk, as well as between GPM and clinical outcome. In this review GPMs are categorised based on their primary cellular functions: genes in carcinogen metabolism, DNA repair, cell cycle control, inflammation, apoptosis, methylation, genes functioning as G proteins, and cell adhesion molecules. A pathway-based genotyping approach, which assesses the combined effects of a panel of polymorphisms that act in the same pathway, may amplify the effects of individual polymorphisms and should be more advantageous to association study than the candidate gene approach

Assessment of hormonal activity in patients with premature ejaculation

ABSTRACT Purpose Premature ejaculation is considered the most common type of male sexual dysfunction. Hormonal controls of ejaculation have not been exactly elucidated. The aim of our study is to investigate the role of hormonal factors in patients with premature ejaculation. Materials and Methods Sixty-three participants who consulted our outpatient clinics with complaints of premature ejaculation and 39 healthy men as a control group selected from volunteers were included in the study. A total of 102 sexual active men aged between 21 and 76 years were included. Premature ejaculation diagnostic tool questionnaires were used to assessment of premature ejaculation. Serum levels of follicle stimulating hormone, luteinizing hormone, prolactin, total and free testosterone, thyroid-stimulating hormone, free triiodothyronine and thyroxine were measured. Results Thyroid-stimulating hormone, luteinizing hormone, and prolactin levels were significantly lower in men with premature ejaculation according to premature ejaculation diagnostic tool (p=0.017, 0.007 and 0.007, respectively). Luteinizing hormone level (OR, 1.293; p=0.014) was found to be an independent risk factor for premature ejaculation. Conclusions Luteinizing hormone, prolactin, and thyroid-stimulating hormone levels are associated with premature ejaculation which was diagnosed by premature ejaculation diagnostic tool questionnaires. The relationship between these findings have to be determined by more extensive studies

Comparative differences between T1a/b and T1e/m as substages in T1 urothelial carcinoma of the bladder

ABSTRACT Objective To evaluate the prognostic value of the depth of lamina propria invasion in patients with T1 bladder cancer and to display comparative differences between the T1a/b and T1e/m substaging systems. Patients and Methods This study included 106 patients with primary stage T1 urothelial bladder tumours who underwent surgery between January 2009 and December 2014. Pathologic specimens were re-evaluated to confirm the diagnosis of T1 and substaging by the same pathologist using two systems: T1a and T1b, and T1m and T1e. Age, tumour size, multiplicity, associated carcinoma in situ, tumour grade, and T1 substaging system were investigated to detect the relation between disease progression and recurrence. Results The recurrence rate was 52% for T1a (n=42) vs. 76% for T1b (n=20) (p=0.028) and 55% for T1m (n=32) vs. 62% for T1e (n=30), respectively (p=0.446). There was no significant difference between the substaging groups for disease progression: T1a (n=12, 15%) vs. T1b (n=7, 27%), and T1m (n=8, 13.8%) vs. T1e (n=11, 23%) (p>0.05). In the multivariate analysis, tumour size >3 cm (p=0.008), multiplicity (p=0.049), and substaging T1b (p=0.043) were independent predictive factors for tumour recurrence. According to the Kaplan-Meier actuarial method, recurrence-free survival was significantly different in patients with pT1a tumours compared with those with pT1b tumours (p=0.033). Conclusions Substaging T1 provides a prediction of disease recurrence. Regarding recurrence, T1a/b substaging can provide better knowledge of disease behaviour because it is predicted as more superior than T1 m/e, and it can help in determining the requirement for early cystectomy

Serum ve idrar fraktalkine düzeyinin primer kas invaziv olmayan mesane kanserinde klinik önemi

Objective: Fractalkine is a chemotactic agent that shows both tumorogenic and anti-tumorogenic activity in some cancer types. In this study, we investigated the role of fractalkine in the diagnosis, progression and recurrence of primer non-muscle-invasive bladder cancer (NMIBC) and compared it with the healthy population. Methods: Overall, 84 people that consisted of 44 cases with primary NMIBC and 40 healthy controls enrolled for this study. Blood and urine samples were collected and fractalkine levels were measured by the ELISA method. Urinary creatinine levels were calculated and urinary fractalkine levels were optimized. Demographic data, tumor stage (Ta, T1), grade (low and high), number of tumors, tumor size, recurrence and progression status of patients were recorded. NMP22 test was performed on the patient group and urine cytology was sent from the patients. Fractalkine levels and subgroup analyses were compared between two groups. Results: The mean age of patients was 63.9±11.1 and 62.3±9.6 in the control group. The mean urinary fractalkine level was7.8±0.9 ng/ml in the study group and 7.7±0.6 ng/ml in the control group; there was no statistically significant difference between the two groups (p=0.426). Mean urinary fractalkine/creatinine level was similar between the study group and control group (16.0±32.2 ng/mgCr and 11.1±7.0 ng/mgCr, respectively, p=0.781). Mean serum fractalkine level was 2.9±1.2 ng/ml in the study group and 2.9±0.7 ng/ml in the control group; there was not a statistically significant difference (p=0.183). Also, we could not find any relation of fractalkine levels with tumor size, number, recurrence and progression. NMP 22 test was positive in half of the study group and Fractalkine levels were higher in the patients that NMP22 tests were negative that was statistically significantly. Cytology was positive for 45.5% of patients, but there was not any statistical correlation between fractalkine levels and cytology. Conclusion: In this study, we did not find a significant difference concerning serum and urinary fractalkine level between the two groups. These findings do not support the use of fractalkine as a biomarker for bladder cancer diagnosis and follow-up.Amaç: Fraktalkine, bazı kanser tiplerinde hem tümörojenik hem de anti-tümoörojenik aktivite gösteren bir kemotaktik ajandır. Bu çalışmada, fraktalkinenin primer kas invaziv olmayan mesane kanserinde tanı, nüks ve progresyondaki rolünü araştırdık. Gereç ve Yöntem: Çalışmaya primer kas invaziv olmayan mesane kanseri tanısı konulan 44 hasta ve sağlıklı kontrol grubu olan 40 kişi olmak üzere toplam 84 kişi alındı. Kan ve idrar örnekleri toplandı ve fraktalkine düzeyi ELISA yöntemi ile değerlendirildi. İdrar kreatinin düzeyleri hesaplanıp idrar fractalkine düzeyi optimize edildi. Demografik veriler, tümör evresi (Ta, T1), derecesi (düşük, yüksek), sayısı, boyutu ve rekürrens, progresyon durumu kaydedildi. Fraktalkine düzeyleri ve alt grup analizleri her iki grup arasında karşılaştırıldı. Hasta grubuna NMP22 test yapıldı ve hastalardan idrar sitolojisi gönderildi. Bulgular: Hasta grubun ortalama yaşı, 63.9±11.1, kontrol grubunda ise 62.3±9.6 idi. Ortalama idrar fraktalkine düzeyi hastalarda 7.8±0.9 ng/ ml ve kontrol grubunda 7.7±0.6 ng/ml olup iki grup arasında istatistiksel anlamlı fark izlenmedi (p=0.426). Ortalama idrar fraktalkine/kreatinin değeri iki grup arasında benzerdi (sırasıyla, 16.0±32.2 ng/mgCr ve 11.1±7.0 ng/mgCr, p=0.781). Ortalama serum fraktalkine düzeyi hasta grubunda 2.9±1.2 ng/ml ve sağlıklı kontrol grubunda 2.9±0.7 ng/ml olup, iki grup arasında istatistiksel anlamlı fark izlenmedi (p=0.183). Aynı zamanda, fraktalkine düzeyi ile tümör boyutu, sayısı, nüks ve progresyon durumu arasında ilişki tespit edilmedi. Fraktalkine düzeyi NMP22 test pozitif hastalarda negatif olanlara göre istatiksel anlamlı olarak daha yüksekti. Sitoloji hastaların %45.5’inde pozitifti fakat fraktalkine değerleriyle istatiksel anlamlı bir ilişki görülmedi. Sonuç: Bu çalışmada, her iki grup arasında serum ve idrar fraktalkine düzeyi benzer bulunmuş olup, fraktalkinenin primer mesane kanserli hastalarda biomarker olarak kullanılamayacağı gösterilmiştir

Comparative differences between T1a/b and T1e/m as substages in T1 urothelial carcinoma of the bladder

<div><p>ABSTRACT Objective To evaluate the prognostic value of the depth of lamina propria invasion in patients with T1 bladder cancer and to display comparative differences between the T1a/b and T1e/m substaging systems. Patients and Methods This study included 106 patients with primary stage T1 urothelial bladder tumours who underwent surgery between January 2009 and December 2014. Pathologic specimens were re-evaluated to confirm the diagnosis of T1 and substaging by the same pathologist using two systems: T1a and T1b, and T1m and T1e. Age, tumour size, multiplicity, associated carcinoma in situ, tumour grade, and T1 substaging system were investigated to detect the relation between disease progression and recurrence. Results The recurrence rate was 52% for T1a (n=42) vs. 76% for T1b (n=20) (p=0.028) and 55% for T1m (n=32) vs. 62% for T1e (n=30), respectively (p=0.446). There was no significant difference between the substaging groups for disease progression: T1a (n=12, 15%) vs. T1b (n=7, 27%), and T1m (n=8, 13.8%) vs. T1e (n=11, 23%) (p>0.05). In the multivariate analysis, tumour size >3 cm (p=0.008), multiplicity (p=0.049), and substaging T1b (p=0.043) were independent predictive factors for tumour recurrence. According to the Kaplan-Meier actuarial method, recurrence-free survival was significantly different in patients with pT1a tumours compared with those with pT1b tumours (p=0.033). Conclusions Substaging T1 provides a prediction of disease recurrence. Regarding recurrence, T1a/b substaging can provide better knowledge of disease behaviour because it is predicted as more superior than T1 m/e, and it can help in determining the requirement for early cystectomy.</p></div

A new robot for flexible ureteroscopy: Development and early clinical results (IDEAL stage 1-2b)

WOS: 000344694300032PubMed ID: 25059998Background: An improved armamentarium has had a significant impact on the emerging role of flexible ureteroscopy (FURS) for the management of nephrolithiasis; however, FURS still represents a challenging technique. Objective: To examine a robotic device designed for FURS for its impact on ergonomics and outcome of the procedure based on the IDEAL (idea, development, evaluation, assessment, long-term study) framework. Design, setting, and participants: Roboflex Avicenna consists of a surgeon's console and a manipulator for the flexible ureterorenoscope. Following experimental evaluation of the prototype (IDEAL stage 1) and receipt of ethical approval, seven surgeons treated 81 patients (mean age: 42 yr [range: 6-68]) with renal calculi (mean volume: 1296 +/- 544 mm(3) [range: 432-3100 mm(3)]) in an observational study (IDEAL stage 2). Surgical procedure: Robotic FURS was performed with the Roboflex Avicenna robotic device. Outcome measurements and statistical analysis: Numerical data were analysed with the Mann-Whitney test, and categorical variables were analysed using the chi-square test or Fisher exact test. P values <0.05 were considered statistically significant. Results and limitations: Mean robot docking time was 59.6 +/- 45 s. Mean operative time was 74 min (range: 40-182). Mean fragmentation speed was 29.1 +/- 6.1 mm(3)/min. Ergonomics based on a validated questionnaire showed significant advantage for robotic FURS (total score: 5.6 vs 31.3; p < 0.01). A 10/12F-access sheath was used in 72 patients. Two cases required secondary FURS, one because of malfunction of the flexible digital ureteroscope and another because of larger residual fragments. In the remaining 79 cases, complete stone disintegration was accomplished. Conclusions: Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics. Future studies should evaluate its impact on the clinical outcome of FURS. Patient summary: Robotic flexible ureteroscopy (FURS) was performed with the Roboflex Avicenna robotic device. Results showed that Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics