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| 2. |
- Andius, Patrik, 1963, et al.
(author)
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Bacillus Calmette-Guerin therapy in stage Ta/T1 bladder cancer: prognostic factors for time to recurrence and progression.
- 2004
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In: BJU Int. ; 93:7, s. 980-984
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Journal article (peer-reviewed)abstract
- To report prognostic factors for time to recurrence and progression after bacillus Calmette-Guérin (BCG) prophylaxis in patients with stage Ta/T1 papillary bladder cancer. PATIENTS AND METHODS The clinical records were assessed retrospectively for 236 patients with papillary stage Ta/T1 bladder cancer treated with BCG between 1986 and 2000. Patients with known carcinoma in situ were excluded. The median (range) follow-up was 44 (4–155) months. The effect of 13 variables on the time to recurrence and progression was evaluated using multivariate Cox proportional hazard regression and Kaplan-Meier analyses. RESULTS The recurrence rate was markedly reduced for all grades and stages. Patients with a negative first cystoscopy and maintenance BCG had a significantly longer time to recurrence than those treated with an induction course alone (P < 0.001). Thirty-seven patients (16%) progressed in stage. The result of the first cystoscopy (P < 0.001), tumour grade (P = 0.003) and six or fewer initial instillations (P = 0.002) had prognostic importance for the time to progression. Twenty-eight patients (12%) had a history of an upper tract tumour, which was 3–10 times the expected rate. Age, number of tumours, number of positive cystoscopies, length of tumour history before BCG, BCG strain and treatment year had no influence on time to recurrence and progression. CONCLUSIONS Maintenance treatment does not seem to be necessary among patients with TaG1-G2 disease after a negative first cystoscopy, as the progression rate was very low. One new finding was that BCG seemed to be equally effective among patients with or with no history of an upper tract tumour. Another new and surprising finding was that patients treated with fewer than six induction instillations, because of very bothersome side-effects, had an increased risk of tumour progression and of local failure.
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| 3. |
- Andius, Patrik, 1963, et al.
(author)
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Intravesical bacillus Calmette-Guerin therapy: Experience with a reduced dwell-time in patients with pronounced side-effects.
- 2005
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In: Bju int. ; 96:9, s. 1290-1293
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Journal article (peer-reviewed)abstract
- To report the side-effects after a reduction in the dwell-time in patients who had pronounced symptoms after intravesical bacillus Calmette-Guèrin (BCG) treatment, as side-effects such as fever, haematuria, and frequency are common and sometimes severe after BCG treatment in patients with bladder cancer. PATIENTS AND METHODS The dwell-time was reduced to ≤ 30 min in 51 patients who had pronounced side-effects after the preceding BCG instillation. All patients self-reported side-effects after each instillation in a questionnaire. RESULTS After reducing the BCG dwell-time, fever, chills, dysuria and the overall time-to-recovery were significantly reduced but frequency and haematuria were not influenced. Patients with carcinoma in situ had significantly less dysuria than patients with papillary tumours. There was no difference in the treatment results between patients who had a normal dwell-time and a reduced dwell-time, determined at the first and second follow-up cystoscopy. CONCLUSION Reducing the BCG dwell-time to ≤ 30 min could be an alternative to a dose reduction in patients who experience pronounced side-effects after BCG instillations. The long-term outcome after reducing dwell-time and after dose reduction has not been studied and warrants further investigation.
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- Andius, Patrik, 1963, et al.
(author)
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Prognostic factors in patients with carcinoma in situ treated with intravesical bacille Calmette-Guérin.
- 2004
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In: Scand J Urol Nephrol. - : Informa UK Limited. ; 38:4, s. 285-290
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Journal article (peer-reviewed)abstract
- Abstract Objective: To report prognostic factors and follow-up data for an unselected group of patients with carcinoma in situ (CIS) of the urinary bladder treated with bacille Calmette-Guérin (BCG). Material and Methods: The clinical records of patients with CIS treated with BCG were reviewed. All 173 patients treated between 1986 and 1997 in four hospitals in two Swedish cities were included. The median follow-up period was 72 months (range 6-154 months). The impact of 18 variables on the times to recurrence and progression was studied using multivariate Cox proportional hazard regression and Kaplan-Meier analyses. Results: No pre-treatment variables, including type of CIS and T1G3 tumour, had prognostic value in terms of time to progression. The result of the first cystoscopy had a very strong prognostic importance: 44% of patients with a positive first cystoscopy progressed in stage, 59% were BCG failures and 35% died from urothelial cancer. The corresponding values for patients with a negative first cystoscopy were 11%, 18% and 8%. Fourteen patients (8%) were diagnosed with an upper urinary tract tumour but no variable had prognostic significance. The diagnoses of the upper urinary tract tumours were evenly distributed during follow-up. Conclusions: We were not able to predict which patients would respond favourably to BCG. Cystectomy should be strongly considered even after a positive first cystoscopy. The accumulated incidence of patients with bladder CIS and a subsequent upper urinary tract tumour is rather high but it is questionable whether the prognosis will improve if routine follow-up urographies are performed.
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- Berrum-Svennung, Ingela, 1963, et al.
(author)
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Costs of radical cystectomy.
- 2005
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In: Scand J Urol Nephrol. - : Informa UK Limited. ; 39:1, s. 36-41
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Journal article (peer-reviewed)abstract
- Objective . The total costs of radical cystectomy comprise a significant part of the total costs of bladder cancer treatment. The aims of this study were to determine the costs of cystectomy, with and without complications, and to investigate related prognostic factors. Material and methods . The clinical records and relevant economic files of 70 consecutive patients operated on between 1994 and 1998 were studied. Uni- and multivariate analyses were performed on 22 variables of possible prognostic significance to high total costs. Results . The total (median) costs for 53 uncomplicated and 17 complicated cystectomies were 181 096 and 290 625 SEK, respectively. The preoperative variables (patient characteristics) had no or minimal prognostic significance for high total costs. High peri-operative blood loss was the most important factor associated with high total hospital costs for radical cystectomy. Conclusions . Total costs may be very high for a cystectomy with complications. Peri-operative blood loss was the most important factor associated with high total hospital costs for radical cystectomy due to bladder cancer. If the amount of bleeding can be influenced then substantial reductions in the total costs of cystectomy would seem possible.
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- Berrum-Svennung, Ingela, 1963, et al.
(author)
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Routine postoperative urography after cystectomy and urinary diversion is not necessary.
- 2005
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In: Scand J Urol Nephrol. - : Informa UK Limited. ; 39:3, s. 211-213
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Journal article (peer-reviewed)abstract
- Objective It is routine procedure to obtain a urogram or retrograde stentogram 1-2 weeks after urinary diversion. The purpose of this is to diagnose silent urinary leakage and obstruction of the anastomosis. We registered the frequency of significant findings at routine postoperative urography in patients with bladder cancer treated with radical cystectomy and urinary diversion. Material and methods We identified a total of 200 consecutive patients who were treated with radical cystectomy and urinary diversion between 1994 and 2002. Eight patients were never evaluated radiologically and another 14 were examined earlier than planned due to symptoms or signs from the urinary tract and abdomen. The remaining 178 patients underwent a routine radiological examination. The methods of deviation in these patients were Bricker conduit (n=119), continent abdominal reservoir (n=24) and orthotopic bladder reconstruction (n=35). A total of 170 patients underwent urography, seven underwent bilateral retrograde pyelographies and one was examined by means of antegrade pyelography. Results Not a single significant finding was identified with urography in 170 patients. Minimal leakage was identified at retrograde pyelography in one patient with a Bricker conduit, which resulted in treatment for 2 weeks with a pyelostomy catheter. Conclusion Routine postoperative urography is not necessary in patients who have a normal postoperative course after cystectomy and urinary diversion.
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| 8. |
- Boman, Hans, 1955, et al.
(author)
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Newly diagnosed bladder cancer: the relationship of initial symptoms, degree of microhematuria and tumor marker status.
- 2002
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In: The Journal of urology. - 0022-5347. ; 168:5, s. 1955-9
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Journal article (peer-reviewed)abstract
- PURPOSE: We recorded initial symptoms and evaluated the frequency and intensity of hematuria in patients with newly diagnosed bladder cancer. We also evaluated and compared the sensitivity of bladder wash cytology, NMP22 (Matritech, Newton, Massachusetts), BTA Stat (Bion Diagnostic Sciences, Redmond, Washington) and UBC antigen (IDL Biotech, Sollentona, Sweden) with hematuria dipsticks and flow cytometry for determining the size of erythrocytes in urine. MATERIALS AND METHODS: Urine samples were collected from 92 patients with newly diagnosed bladder cancer, 64 with idiopathic microhematuria and 42 with nephritis. Urine was analyzed for NMP22, BTA Stat, UBC and erythrocytes size using flow cytometry. Bladder wash cytology was done at cystoscopy. Urine was analyzed for microhematuria with hematuria dipsticks at home for 7 consecutive days immediately before the operation and in the hospital on the day of surgery. RESULTS: Sensitivity was 75% for NMP22, 78% for BTA Stat, 64% for UBC and 61% for flow cytometry at 73% specificity. Cytology had 42% sensitivity at 97% specificity. Tumor size, grade and stage had a statistically significant influence on NMP22, BTA Stat, UBC and cytology. Of the patients 75% had microhematuria on the day of the operation and 75% had hematuria at least 1 of 7 days when tested at home the last week before transurethral bladder resection. The 70% of all patients with macroscopic hematuria as the initial symptom did not seem to differ from those without the condition in tumor size, grade, stage or tumor marker levels. CONCLUSIONS: Flow cytometry was not well enough able to distinguish patients with bladder cancer from controls. The sensitivity of all tested markers, including hematuria dipsticks, was high for large and high grade, high stage tumors. Further studies are needed to evaluate whether a marker could be used to determine priority among patients referred due to microhematuria.
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| 9. |
- Crockett, David G, et al.
(author)
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Upper urinary tract carcinoma in Lynch syndrome cases.
- 2011
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In: The Journal of urology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3792 .- 0022-5347. ; 185:5, s. 1627-30
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Journal article (peer-reviewed)abstract
- Patients with Lynch syndrome are much more likely to have generally rare upper urinary tract urothelial carcinoma but not bladder urothelial carcinoma. While the risk has been quantified, to our knowledge there is no description of how this population of patients with Lynch syndrome and upper urinary tract cancer differs from the general population with upper urinary tract cancer.
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