Upper urinary tract tumors following bladder cancer

We treated in total 795 patients with primary transitional cell carcinoma of the urinary bladder between April, 1964 and December, 1988. Eighteen patients of them had upper urothelial cancer during the follow-up period. Thirteen of the 18 patients had received transurethral resection for the initial bladder cancer, while 3 total cystectomy and 2 segmental resection. The over-all incidence of bladder cancer patients who subsequently developed upper urinary tract tumors was 2.3 per cent. The interval between initial treatment of the bladder cancer and treatment for the upper urinary tract tumor ranged from 2 to 74 months (median 20 months). The five-year survival rate after treatment for the upper urinary tract tumor was 31.7 per cent. We conclude that the following are high risk patients for development of upper urinary tract recurrences: 1) patients with bladder cancer near orifices, 2) patients with recurrent bladder cancer under bladder preserving treatment for a long time, 3) patients with G2 multifocal bladder cancer.     

Uroepithelial tumors of the upper urinary tract following bladder cancer

Five hundred and nineteen patients with primary bladder cancer were treated between January, 1969 and December, 1984, 12 of whom had developed upper urothelial tumors. These patients had received various transurethral treatment for the primary bladder lesions, except for one patient who had undergone total cystectomy and ileal conduit diversion. Overall incidence of patients with upper urinary tract tumors following bladder cancer was 2.3%. The incidence of patients with treated bladder tumors (13.2%) for dye workers was higher than that for the general population (1.1%). The interval between initial treatment of the bladder tumor and diagnosis of the upper tract tumor ranged from 7 to 170 months (mean 70 months). The incidence of upper tract tumors increased with the passage of time. We conclude that the occurrence of upper urinary tract tumors following primary bladder cancers is promoted by nonspecific chemical irritants against the urothelium already made unstable by certain urinary chemical carcinogens.     

Enteroplasty in bladder tumors

A total of 429 patients with urinary tumors have been operated on in the past 10 years, 80 of them have been undergone cystectomy. Intestinal plasty of the urinary bladder was performed in 38 patients. These one-stage operations in 15 patients yielded a high postoperative mortality rate (33.3%). Two-stage surgeries in 23 patients largely reduced mortality (8.9%). The authors provide recommendations how to conduct the two-stage surgery and limited indications for one-stage interventions.     

Urethral remnant tumors following simultaneous partial urethrectomy and cystectomy for bladder carcinoma

Partial urethrectomy (at least to the bulbous portion) was performed simultaneously in 128 consecutive male patients undergoing radical cystectomy for bladder cancer. Transitional cell carcinoma developed subsequently in the distal urethral remnant in 5 patients (4.0%) followed for 2.6 to 5.7 years (mean 4.1 years) postoperatively. These 5 patients originally had nonpapillary, multifocal and histologically high grade (5) and low stage (4) bladder cancer, 4 with associated carcinoma in situ. Our results suggest that simultaneous total urethrectomy should be considered strongly for patients with high grade nonpapillary multifocal bladder cancer associated with carcinoma in situ. Furthermore, the pattern of distal urethral recurrence in our patients may provide information regarding the appropriate management of the male urethra in potential candidates for continent urinary diversion.     

Plasminogen activator in bladder tumors

Summary Plasminogen activator was recovered from bladder tumors by 30% ammonium sulfate precipitation, acid treatment and concanavalin A-Sepharose affinity chromatography to a purification factor of about 80,000. The pooled fraction from the binding protein to concanavalin A-Sepharose revealed a single enzymatically active band with molecular weight of 55,000, which lost its enzymatic activity in the absence of plasminogen. The enzymatic activity was inactivated by DFP. The purified plasminogen activator reacted with antibody against UK, and not with that against t-PA. The purified plasminogen activator cleaved S-2288 to a greater extent than S-2444, although UK cleaved S-2444 to a greater extent that S-2288. The enzymatic activity was strongly inhibited by basic pancreatic trypsin inhibitor, and benzamidine. These results suggest that the plasminogen activator in bladder tumors may belong to a different category of plasminogen activator.     

Androgen receptors in bladder tumors

Cytosol androgen receptor content of transitional cell bladder cancer tissue was found to be substantially higher than its content in normal bladder mucosa and lower than in control benign prostatic hypertrophy tissue. Tumors arising in female patients had a lower androgen receptor content than those arising in male patients. High-grade tumors had a lower androgen receptor content than low-grade tumors.     

Rheumatoid factor in bladder tumors

We used the standard latex fixation test to screen 71 patients with bladder tumors and appropriate controls for the rheumatoid factor. The rheumatoid factor was present in transitional and squamous cell carcinoma of the bladder. Positivity was correlated with staging and histological grading of the tumor. In control subjects it was present in squamous cell carcinoma of the penis and anal canal. The possibility of the circulating immune complex with tumor antigen and its antibody has been discussed.     

Urine cytology in bladder tumors

A review of experience with urine cytology in the diagnosis and follow up of bladder cancer at Roswell Park Memorial Institute from 1971 to 1981 is reported. All patients had biopsy-proven transitional cell carcinoma of the bladder. A total of 677 patients underwent 2,877 cytological evaluations. Of these, 317 patients had concomitant cystoscopy, cytologic evaluations and bladder biopsies. A total of 1,091 evaluations were performed in this group. The overall incidence of positive cytology in the presence of biopsy-proven bladder tumor (all grades included) was 74.4%. A linear correlation is present with grade, stage and positive cytology; high-grade tumors and carcinoma-insitu showed 89.9% and 96.9% incidence of positive cytology, respectively. Grade II tumors showed a 64% incidence of positive cytologies. Regarding correlation with the pathological stage, submucosal involvement of the urothelium was associated with a 62% incidence of positive exfoliative urine cytology, while 80% of tumors invading the bladder muscle were found to have a positive cytology.     

Human bladder tumors in organ culture

We have established a reliable method for culturing transitional cell tumors of the human urinary bladder. Out of seventy-four set up in culture, forty-eight were successfully maintained and their behavior studied using metaphase arrest and 125IUdR uptake.     

Lectin-binding sugar chain in bladder tumors

We studied the lectin binding patterns of 40 initial superficial and 10 subsequent invasive bladder tumors by the avidin-biotin-peroxidase complex (ABC) method using the following biotin-labeled lectins: PNA, DBA, UEA-I, BS-I, ConA and WGA. We observed the relationship between lectin binding and subsequent course of initial superficial tumors, grade and stage (T). DBA or WGA staining tumors and Con A negative tumors revealed no recurrence or superficial recurrence. Low grade tumors were DBA or BS-I positive and high grade tumors were ConA positive. Low staging tumors possessed DBA or WGA positiveness and high staging tumors had ConA positiveness. From these results we considered that negative staining of WGA or DBA, or positive staining of ConA was a change accompanying the malignant potentiality.