The value of urinary neopterin as an immunological parameter in patients with malignant tumors of the genitourinary tract

In 153 patients with verified neoplasias of the genitourinary tract, urinary neopterin excretion was monitored under different conditions. As control, urinary neopterin values were taken from 208 male and 209 female volunteers. Neopterin excretion was measured by high performance liquid chromatography. Patients with early tumor stages, both with bladder tumor and carcinoma of the prostate, presented almost normal urinary neopterin levels. The difference of urinary neopterin excretion between low and high stages in bladder tumor (T0-1 versus T2-4) as well in carcinoma of the prostate (stage A-B versus stage C-D) is highly significant (p less than 0.001). In the group of patients with renal cell carcinoma we could not find any correlation between tumor stage and neopterin excretion. The basal urinary neopterin values in patients with testicle tumors were as follows: 1 of 6 patients stage-I seminomatous tumors and 2 of 4 patients with stage-I non-seminomatous tumors demonstrated elevated neopterin levels. In the higher stages all patients, in both groups, exhibited pathologically increased neopterin excretion. During therapy and follow-up: all 24 stage-I (seminomatous and non-seminomatous tumors) patients showed normal neopterin levels: 1 of 3 stage-II (non-seminomatous tumors) patients and all 5 stage-IV (seminomatous and non-seminomatous tumors) patients had elevated urinary neopterin excretion. Our experience suggests that neopterin measurements may supplement laboratory examinations in patients with malignant tumor diseases of the genitourinary tract, providing meaningful information in regard to early detection of tumor progression, tumor recurrence and follow-up.     

Oligometastases in Genitourinary Tumors: Recent Insights and Future Molecular Diagnostic Approach

ContextAn oligometastatic state is an early event during tumor metastatic spread and is rarely reported in patients with genitourinary tumors. In this condition, the primary tumor has low capacity for distal dissemination because its aggressiveness has not yet reached a maximum.ObjectiveTo review recent findings on the diagnosis and treatment of oligometastatic disease in patients with genitourinary tumors.Evidence acquisitionTo identify relevant studies, we reviewed articles in PubMed from January 1966 to September 2017. The search was conducted by combining the words “oligometastasis” or “oligometastatic disease” with “bladder cancer”, “genitourinary tumor”, “prostate cancer”, and “renal cancer”.Evidence synthesisIn renal cell carcinoma (RCC), tumors from patients with multiple metastases showed a different gene signature compared to oligometastatic RCC. In addition, an oligometastatic state was an independent prognostic factor for overall survival (OS). Otherwise, the characteristics of oligometastases from bladder cancer remain unclear, as do the clinical and prognostic significance of metastasectomy in this setting. However, patients with oligometastatic prostate cancer have longer recurrence-free survival and OS and seem to benefit from local metastasis-directed therapies.ConclusionsEarly detection of oligometastatic disease in patients with genitourinary tumors is fundamental in improving outcomes by identifying patients who would benefit from local approaches with potentially curative rather than palliative intent.     

肾移植术后并发自体泌尿系统恶性肿瘤22例的临床分析

目的 分析肾移植受者并发自体泌尿系统恶性肿瘤的临床特征.方法 回顾性分析单中心1945例肾移植受者的临床资料,其中发生自体泌尿系统恶性肿瘤22例(发生率为1.13％),占所有恶性肿瘤的56.4 ％(22/39).22例中肾乳头状腺癌、肾乳头状细胞癌、肾血管肉瘤各1例;肾盂移行细胞癌1例,肾盂输尿管移行细胞癌6例,输尿管移行细胞癌7例,肾盂输尿管膀胱移行细胞癌1例;膀胱恶性肿瘤4例(包括膀胱移行细胞癌3例、膀胱交界恶性肿瘤1例).22例中,以肉眼血尿为主要症状者17例,2例反复出现镜下血尿,只有3例无明显临床症状.患者的发病年龄为(54.3±12.3)岁,诊断肿瘤的中位时间为移植术后53个月.10例采用环孢素A+硫唑嘌呤+泼尼松预防排斥反应,12例采用环孢素A+吗替麦考酚酯+泼尼松.所有患者均接受手术治疗,其中3例肾脏恶性肿瘤患者接受了根治性肾切除手术,15例肾孟、输尿管肿瘤患者接受患侧肾、输尿管切除并膀胱袖状切除,4例膀胱恶性肿瘤患者中,3例接受经尿道膀胱肿瘤电切术,1例行膀胱部分切除术.结果 随访2～97个月,死亡9例,死亡时间为肿瘤手术后6～97个月,死亡原因为骨转移1例,肺转移1例,脑转移2例,肝转移2例,全身广泛转移3例.随访截止时存活13例,存活时间最长者为单纯膀胱肿瘤患者,存活92个月,存活超过4年者4例,存活超过1年者5例.结论 自体泌尿系统恶性肿瘤是肾移植术后的一个重要并发症;无痛性肉眼血尿是最常见的症状;根治性手术切除是最主要的治 疗手段.     

Ureteral rhabdomyosarcoma

Rhabdomyosarcoma is a malignant tumor well known to urologists. These tumors arise from the genitourinary system in 20% to 25% of cases, most commonly from the bladder, prostate, vagina, and paratesticular region. This is the first reported case of a rhabdomyosarcoma arising from the ureter. The radiographic findings and ureteroscopic appearance of this tumor suggested a benign fibroepithelial polyp; however, a ureteroscopic biopsy and subsequent nephroureterectomy revealed an embryonal rhabdomyosarcoma.     

膀胱非上皮性肿瘤的诊治

目的 总结膀胱非上皮性肿瘤的诊治经验。方法 对1953～2002年收治的28例膀胱非上皮性肿瘤患者的诊治情况进行总结、分析。结果 膀胱非上皮性肿瘤的主要临床表现为血尿、盆腔肿块、尿频、排尿困难等症状。主要辅助检查为B超、CT、膀胱镜检查及镜下活检。本组28例中,经术后病理检查,恶性肿瘤17例(占61．7％),有7种病理类型,分别为膀胱横纹肌肉瘤、膀胱小细胞癌、膀胱平滑肌肉瘤、膀胱恶性淋巴瘤、膀胱恶性纤维组织细胞瘤、膀胱脂肪肉瘤、膀胱黑色素瘤;良性11例(占39．3％),有4种病理类型,分别为膀胱海绵状血管瘤、膀胱壁纤维瘤、膀胱平滑肌瘤、膀胱嗜铬细胞瘤。11例良性肿瘤均完整切除或电灼、电切。17例恶性肿瘤中,膀胱部分切除术7例、膀胱全切除术9例、无法切除1例,有7例恶性肿瘤因复发多次行手术切除。17例恶性肿瘤患者均获随访,3年存活率47．0％(8／17)。结论 膀胱非上皮性肿瘤临床少见,病理类型复杂,恶性居多且预后较差,良性肿瘤预后较好。术前诊断率低,膀胱镜下深部活检可提高诊断率。手术是该病的主要治疗方法。良性肿瘤应完整切除,恶性肿瘤应争取广泛切除,结合其病理特点辅助放化疗可能提高疗效。     

clinical studies on primary renal pelvic tumors

The 15 cases of the primary renal pelvic tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The patients ranged in age from 41 to 74 years old (average: 58.3 years old). There were 11 males and 4 females, the ratio being 2.8:1.0. The affected side was left in 9 cases and right in 6 cases. The most frequent symptom was macrohematuria, which was seen in 12 cases (80%). The major finding of IVP was non-functioning kidney, which was seen in 8 cases (53.3%). Positive urinary cytology was obtained in 8 cases (53.3%). As the surgical method, total nephroureterectomy with bladder cuff was performed in 8 cases, nephroureterectomy in one case and nephrectomy in 6 cases. Histologically, 14 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumors were seen in the bladder of 2 patients. A subsequent ureteral tumor was found in one of the 7 cases in which ureters were resected incompletely, and subsequent bladder tumors were found in 8 of the 15 cases receiving surgical treatment in the follow-up period. All of tumors were found within 2 years after operation. Over-all actual survival rates at 1, 3 and 5 years were 87%, 67%, 48%, respectively. Three and 5 year actual survival rates were 100%, 100% respectively for the low stage group and 59%, 29% respectively for the high stage group. Three and 5 year actual survival rates were 100%, 78%, respectively for the low grade group and 44%, 27% respectively for the high grade group. Among several factors, stage and grade of the tumor were the most influencing factors for prognosis.     

副乳腺肿瘤11例报告

目的:探讨副乳腺肿瘤的临床特点、诊断及治疗方法。方法:对11例患者的临床及病理资料进行回顾性分析。结果:恶性肿瘤发病年龄多见45岁以上,良性肿瘤多在45岁以下。肿瘤最常见部位是腋下。主要临床症状是局部肿块,11例术前均误诊。结论:副乳腺肿瘤较少见,手术治疗是其首选治疗方法。良性肿瘤以局部切除为主,恶性肿瘤的治疗以根治性切除为主,术后辅以化疗或放疗,可提高患者生存率。     

Genitourinary Tumor Following Kidney Transplantation: A Multicenter Study

Renal transplantation has been advocated as the treatment of choice for end-stage renal disease. Immunosuppression increases the incidence of cancer and promotes the growth of neoplasms in solid organ recipients. There have been a few reports on the incidence of cancer from transplant registries. It is difficult to precisely compare the incidence with that in the general population using data from small, single-center studies. Thus, we sought to study the prevalence of genitourinary cancer development in Iranian renal transplant recipients. We collected data from 5 kidney transplant centers in Iran between 1984 and 2008, seeking to detect the incidence, type, and outcome of cancers after kidney transplantation. Only histologically confirmed tumors, which occurred after renal transplantation, were included in the analysis. Of the 5532 patients who underwent kidney transplantation, genitourinary tumors were detected in 21 subjects (0.38%), namely, 12 males and 9 females. Transitional cell carcinoma (TCC) of the bladder, the most common genitourinary cancer (n = 7) was followed by renal cell carcinoma (RCC; n = 5), ovarian cancer (n = 3), breast cancer (n = 3), prostate cancer (n = 1), seminoma (n = 1), and uterine cancer (n = 1). The overall mean age of the patients was 46 ± 12 years (range, 19-72 years) and the median time to diagnosis after transplantation was 72 months (range, 4-240 months). Seven patients died during the follow-up. There was a male predominance among TCC of the bladder and RCC (5:2 and 4:1, respectively). In conclusion, TCC of the bladder was the most common genitourinary tumor following kidney transplantation. It was predominant in male patients.     

Rare kidney tumors

During the period from 1976 to 1986, a total of 518 kidney tumor patients were treated in the Department of Urology at the University of Freiburg, West Germany. In 34 cases (6.6%) the examination revealed a tumor that was neither a renal cell carcinoma nor a renal pelvic urothelial carcinoma (i.e., a rare renal tumor). Through diagnostic imaging procedures the presence of a tumor was correctly diagnosed in 97% of these 34 cases. Conservative treatment methods were used with 5 patients (4 with renal angiomyolipoma and 1 with hemangioma) whose conditions were clearly diagnosed. In these patients operative therapy was not indicated. The precise histological diagnosis found in 29 patients subjected to surgery was the same as the preoperative diagnosis in only 8 cases (27.6%). Histologically, 20 benign (4 epithelial, 16 mesenchymal) and 9 malignant (3 epithelial, 3 mesenchymal, 3 mixed) tumors were found. The operative methods for rare kidney tumors are the same as those used for the more common kidney tumors. Only in the presence of tumors that are clearly benign, such as angioma or angiomyolipoma, is a wait and see policy with frequent examinations recommended.     

Chemotherapy of advanced genitourinary carcinoma with cis-diamminedichloroplatinum

Eighteen patients with advanced genitourinary carcinoma have been treated with cis-diamminedichloroplatinum (CDDP) since 1978, at our University Hospital. They were 3 patients with prostatic cancer, 3 patients with bladder cancer, 6 patients with testicular tumors, 5 patients with renal cell carcinoma and 1 patient with malignant pheochromocytoma. Four patients with testicular tumors were administrated CDDP, bleomycin (BLM) and vinblastine (VBL). A testicular tumor patient was given CDDP, vincristine and actinomycin-D, a bladder cancer patient was given CDDP, VBL and Pepleomycin as combined chemotherapy. The remaining 12 patients were treated only with CDDP. Five of the 6 patients with testicular tumor and a case of choriocarcinoma of left kidney showed an objective response. As side effects, bone marrow suppression was inevitable when VBL and BLM were given along with CDDP. Renal dysfunction was seen in 5 patients on whom BVP regimen was employed. Various degrees of nausea and vomiting were present in almost all patients during CDDP administration. The combination chemotherapy with CDDP appears to be effective in nonseminomatous testicular tumor. The effectiveness of CDDP against other genitourinary carcinomas may require further investigation.     

Metastatic carcinoma to the testis: a clinicopathologic analysis of 26 nonincidental cases with emphasis on deceptive features

Metastatic carcinomas to the testis may simulate primary testicular neoplasms, even in patients with known extratesticular primaries, but information on this topic is limited. We therefore reviewed our experience with 26 cases from consultation (N=23) or hospital (N=3) files; none of the cases were from autopsy material or incidentally discovered in therapeutic orchiectomies from patients with prostate cancer. The tumors occurred in men 29 to 90 years old, with the prostate the most common primary site (N=11), followed by the renal parenchyma (N=4), colon (N=4), urinary tract (N=3), lung (N=2), esophagus (N=1), and, most probably, small intestine (carcinoid, N=1). Noteworthy findings included: the frequent absence of a known primary tumor (62%), the rarity of bilateral involvement (8%), the occasional lack of a distinct mass on gross examination (15%), the infrequency of multinodularity either grossly (8%) or microscopically (35%), the prominence of intertubular growth (42%), conspicuous intrarete or intratubular growth in some cases (especially prostate carcinoma) (19%), prominent cytoplasmic vacuoles in occasional cases (15%), and the frequent presence of lymphatic involvement (69%). Four tumors (3 prostate, 1 renal) with prominent intrarete and/or intratubular growth had submitting diagnoses of either a primary rete neoplasm or seminoma. Four tumors (2 prostate, 1 renal, and 1 bladder) with prominently vacuolated pale cells simulated Sertoli cell tumor. We conclude that, if autopsy cases and incidental tumors in therapeutic orchiectomy specimens are excluded, metastatic carcinomas to the testis are usually solitary, unilateral tumors that may simulate primary neoplasms, including rete adenocarcinoma and Sertoli cell tumor. Despite the rarity of documented cases in the literature, the bladder and renal pelvis should not be overlooked as possible sources for testicular metastasis. The pathologist must have a high index of suspicion for the possibility of a metastatic carcinoma to the testis for any testicular tumor where the routine light microscopic or immunohistochemical findings are unusual for a primary neoplasm. Clues to the likely primary site can usually be gleaned from the pathologic findings.     

Multiple primary carcinomas of the colon and associated extracolonic primary malignant tumors.

A review of 308 cases of colorectal carcinoma showed 12 cases (3.9%) of colorectal multiple primary malignant tumors and 14 cases (4.5%) of colorectal primary malignant tumor associated with extracolonic primary malignant tumor. A total of 60 tumors was involved: 14 each in the sigmoid and transverse colon; eight in the cecum; six in the rectum; one each in the ascending and descending colons; three each in the bladder and prostate; two each in the breast, cervix, and lung; and one each in the skin, nasopharynx, kidney, and endometrium. Three of the four patients with multifocal cancer were found to have in situ cancer, and 12.7% of concomitant adenomas had malignant changes. Seven patients had regional lymph node metastases. Of the six patients with rectocolonic multiple tumors who had adequate follow-up data, survival in three ranged from 19.5 to 60 months; three were alive and well 15 to 51 months after resection. Survival of patients with primary rectocolonic and extracolonic tumors was similar. From these data and the pathologic study of the resected specimens, we recommend for any patient with cancer of the rectocolon that the entire colon be searched for multiple primary malignant tumors, that extracolonic tumors be considered second primary tumors unless proved to be metastases, and that follow-up be long and include frequent rectocolonic examinations for a second primary tumor.     

A clinical study on 34 cases of urothelial cancer of upper urinary tract

Thirty-four cases of tumor of the renal pelvis or ureter or both have been treated in our department during the past decade. The primary tumor was in the renal pelvis in 11 cases, in the ureter in 21 cases and in the ureter and renal pelvis in 2 cases, a co-existent tumor in the bladder was found in 4 cases. Seventeen patients had a tumor on the right side and 17 on the left side. The most frequent symptom was gross hematuria (70.6%) and flank pain was the presenting symptom in 7 cases (20.6%). On the intravenous pyelography, a filling defect in the renal pelvis or ureter (41.2%) and nonvisualization (53.0%) were frequent findings. Twenty-nine cases had undergone total nephroureterectomy with resection of a bladder cuff, 3 had simple nephrectomy and 2 had open biopsy alone. Postoperative radiation therapy was done in 1 case, chemotherapy in 10 cases, and 6 cases of them were treated by CAP therapy (cis-dichlorodiamine platinum, doxorubicin and cyclophosphamide). Actual and relative 5-year survival rates were 53.8% and 63.5%, and no significant difference was found in survival rate between the patients with renal pelvic tumors and those with ureteral tumors.     

Salivary tumors in north Jordanians: a descriptive study.

OBJECTIVE: To evaluate the types and distribution of tumors of salivary glands in north Jordanians. STUDY DESIGN: The records of the Department of Pathology at Jordan University of Science and Technology were reviewed for patients who were treated for salivary gland tumors from 1991 to 2002. The tumors were analyzed for age of patient, sex of patient, tumor site, and tumor type. RESULTS: One hundred two true neoplasms (70% benign and 30% malignant) were found. The most frequent benign and malignant neoplasms found were pleomorphic adenoma (54%) and adenoid cystic carcinoma (13%), respectively. The most common major and minor salivary gland sites were the parotid (51%) and palatal glands (20%), respectively. Although most of major gland tumors were adenomas, carcinomas of the minor glands were only slightly less frequent than adenomas. The most frequent malignant parotid tumors were adenoid cystic carcinoma and mucoepidermoid carcinoma. The most frequent minor salivary gland malignant tumors were palatal adenoid cystic carcinoma. Age ranged from 1 to 94 (mean 40) years, with a male to female ratio of 1:1.2. CONCLUSION: North Jordanians with salivary gland tumors were found to have similar characteristics with patients of other countries with regard to tumor type, tumor site distribution, and age and sex of patients.     

Clinical study of urothelial tumors of the upper urinary tract. 1: Primary renal pelvic tumors

Forty primary renal pelvic tumors treated at our University between 1963 and 1981, were reviewed retrospectively. The conclusions of this study are as follows. Sex and age distribution of the patients were 30 males and 10 females (3: 1), and average age was 60.5 years old. The major symptoms were hematuria and flank pain; however, palpable mass was rare. The majority of patients were admitted to our clinic within 6 months from manifestation of symptoms. The major findings of IVP were non-functioning kidney and filling defect. The positive rate of urinary cytology was 46.7%. Total nephroureterectomy with bladder cuff was performed in 20 out of 32 cases. Histologically, 29 cases were transitional cell carcinoma and 4 cases were squamous cell carcinoma with renal calculi. Simultaneous urothelial tumors were seen in 10 cases, 3 in the ureter and 7 in the bladder. A subsequent ureteral tumor was found in one out of 12 cases in which ureters were resected incompletely, and 7 subsequent bladder tumors were found out of 32 cases receiving surgical treatment in the follow-up period. The 5-year survival rate by the actuarial method was 75.9%. Among several factors, grade and stage of the tumor were the most influencing factors for prognosis. An effective method of post-operative treatment could not be established.     

膀胱非上皮性肿瘤25例诊治报告

目的 总结膀胱非上皮性肿瘤的影像及临床诊断特点,探讨治疗方法与预后的关系.方法 回顾性分析25例膀胱非上皮肿瘤临床资料.男16例,女9例.年龄2～71岁.其中血尿6例,下腹部肿块2例,尿频14例,排尿困难2例,排尿晕厥1例.超声及CT检查发现22例膀胱占位病变,3例盆腔肿物及膀胱壁受累.均行膀胱镜检查,穿刺活检17例.结果 15例良性肿瘤行单纯肿瘤剜除术或膀胱部分切除术;10例恶性肿瘤行膀胱部分切除术或膀胱全切术.恶性肿瘤术后辅助化疗、放疗.随访3个月～11年.良性肿瘤均无复发,恶性肿瘤9例死于术后3年内,平均存活16个月;1例膀胱恶性淋巴瘤带瘤存活6年.结论 膀胱非上皮性肿瘤临床上少见,病理类型复杂,恶性居多,预后较差.膀胱部分切除术或膀胱全切术是本病的主要治疗方法,恶性肿瘤结合其病理特点辅助放化疗,疗效不理想,预后差别较大.     

A hundred cases of multiple primary neoplasms in association with genitourinary cancer]

There were 970 patients who were diagnosed as having genitourinary cancer at Yamagata Prefectural Central Hospital between 1975 and 1990, and of whom 100 cases (10.3%) had multiple primary malignant neoplasms in addition to their genitourinary cancer. They were compared with 220 patients having single genitourinary cancer and 274 having benign prostatic hypertrophy without past histories of cancer. The genitourinary organs involved with cancers included the prostate (50 patients), urinary bladder (43 patients), ureter or renal pelvis (15 patients) and kidney (7 patients). In the prostate cancer, the incidental carcinomas occupied 30%. The other organs accompanying the genitourinary cancers included the stomach, lung and colon. In patients of multiple primary cancers, single genitourinary cancer and benign prostatic hypertrophy, positive family histories for cancer were observed in 40.0%, 37.7% and 33.2%, respectively, with no significant difference between these groups. Histories of smoking were observed in 54.0%, 38.2% and 34.3% respectively, with significant difference between the multiple primary neoplasm patients and the other 2 groups (p < 0.01). There were two cases in whom the second cancer could be possibly caused by the exposure to radiation for the first cancer. No oncotherapeutic drugs or occupational exposure could be seriously suspected of the cause of the second cancers in the present cases.     

Long-term follow-up of ureteral stump tumors after nephrectomy for benign renal disease

OBJECTIVE: The occurrence of primary carcinoma of the ureteral stump after nephrectomy is rare. In this study, we evaluated the clinical characteristics of ureteral stump tumors after nephrectomy for benign renal disease. METHODS: During a 16-year period, 318 consecutive patients underwent simple nephrectomy for benign renal disease (216 cases) or for donation (102 cases). Eight of these 318 patients diagnosed as having an ureteral stump tumor were treated by ipsilateral ureterectomy with cuff excision of the bladder. Pathologic findings, tumor stages, and clinical characteristics were analyzed. RESULTS: The eight ureteral stump tumors comprised; 6 transitional cell carcinomas (TCCs) and 2 squamous cell carcinomas (SCCs). The mean interval between nephrectomy and ureteral stump tumor diagnosis was 76.5 months. Six of the 8 patients had pyonephrosis and two renal tuberculosis as original renal diseases. Four of the 6 TCCs were stage T1 and 2 stage T2. There was no concomitant bladder tumor at stump tumor diagnosis. Hematuria was the major presenting symptom in 3 of the 8 patients and 4 patients were diagnosed by follow-up imaging study. Two of the 6 ureteral stump TCC patients developed bladder TCC during follow-up. The 5-year survival rate of patients with ureteral stump tumor was 37.5%. T1G1 TCC was associated with a better survival than T2 or G2 TCC. No ureteral stump tumor occurred in cases of donor nephrectomy. CONCLUSION: This study demonstrate, that long-term closed observation is needed to detect ureteral stump tumor, particularly in patients that have undergo nephrectomy for a long-standing inflammatory renal disease such as pyonephrosis or tuberculosis. Hematuria is a major presenting symptom of ureteral stump tumor. However, a follow-up imaging study is also important for ureteral stump tumor detection. The prognosis is poor in cases developing ureteral stump SCC, bladder tumor recurrence, or a high-grade ureteral tumor.     

Clinical observation on renal pelvic and ureteral tumors

During the 18 years from October, 1971 to September, 1989, 40 patients with renal pelvic and ureteral tumors were treated at our Department of Urology. Thirty were male and 10 female, and were between 44 and 83 years old with a mean age of 65.5 years. Histopathologically, there were 38 transitional cell carcinomas and 2 squamous cell carcinomas. There was a positive correlation between grade and stage of tumor. Among the patients with transitional cell carcinoma, the five-year survival rate was 54.4% for all the patients, 57.1% for patients with renal pelvic tumors and 48.4% for those with ureteral tumors respectively, as measured by the Kaplan-Meier's method. Stage and intravascular invasion of the tumor were the most influential factors for prognosis. There was no evidence in this series to show the usefulness of postoperative adjuvant chemotherapy, such as bladder instillation or peroral administration of various anti-tumor drugs, as a prophylactic use for recurrence of the bladder tumor in low stage cases.