Intravesical electromotive administration of oxybutynin in patients with detrusor hyperreflexia unresponsive to standard anticholinergic regimens

PURPOSE: About 15% to 20% of patients with detrusor hyperreflexia do not benefit from oral oxybutynin regimens, frequently because of unpleasant side effects. Several reports indicate that intravesical oxybutynin is effective in many of these patients but there are some who still fail to respond. MATERIALS AND METHODS: A select group of 10 adults with detrusor hyperreflexia unresponsive to standard oral and intravesical oxybutynin regimens were treated at weekly intervals with 5 mg. oxybutynin orally, or 5 mg. oxybutynin in 100 ml. intravesically for 60 minutes of passive diffusion and for 30 minutes with 5 mA. electrical current. Each treatment (plus oral placebo and 2 intravesical controls) was associated with an 8-hour, full urodynamic monitoring session, and periodic blood and bladder content sampling. RESULTS: There was no significant objective improvement with oral or intravesical passive diffusion oxybutynin. Conversely there was significant improvement in 5 of 6 objective urodynamic measurements with intravesical electromotive oxybutynin. Plasma profiles were a single peak and decay following oral oxybutynin and 2 distinct peaks with intravesical passive diffusion and electromotive oxybutynin. Area under the curve for intravesical passive diffusion were 709 ng. per 8 hours versus oral 1,485 (p <0.05) versus intravesical electromotive 2,781 (p <0.001). Bladder content samples confirmed oxybutynin absorption. Oral oxybutynin caused anticholinergic side effects in 7 of 10 patients. There were no side effects with intravesical passive diffusion or electromotive administrations. CONCLUSIONS: Accelerated intravesical administration results in greater bioavailability and increased objective benefits without side effects in previously unresponsive patients compared with oral and intravesical passive diffusion oxybutynin administration.     

Effects of prazosin and carbachol in patients with benign prostatic obstruction

To eight patients with benign prostatic obstruction (BPO), prazosin and placebo were given in a double blind cross-over manner. Prazosin decreased significantly residual urine volume and increased maximum and average flow rates. Neither when treated with prazosin nor with placebo, did the patients improve their ability to empty the bladder after injection of carbachol (0.25 mg) s.c. The only significant effect of carbachol on urodynamic variables was an increase in intravesical premicturition pressure. This was observed both when the patients were treated with prazosin and with placebo. Fourteen patients with BPO were given oral carbachol in maximally tolerated doses (6 or 12 mg/day) during a 2 week period. Despite producing significant systemic side effects in all patients, carbachol did not change any of the urodynamic variables tested. It is concluded that carbachol does not further improve bladder emptying in BPO patients given prazosin. Oral carbachol has no effects on bladder emptying in these patients.     

Prospective randomized comparison of intravesical BCG therapy with standard dose versus low doses in superficial bladder cancer

In this study, we evaluated low dose intravesical bacillus Calmette-Guerin (BCG) therapy following transurethral resection (TUR) in 80 patients with superficial bladder cancer. The patients were divided into two groups. Of the Connaught BCG strain 81 mg was given to 40 patients in Group 1 and 54 mg to the remainder of 40 patients in Group 2. BCG was introduced once a week for 6 weeks. Tumour recurrence was seen in 6 patients in Group 1 and in 10 patients in Group 2. Recurrence rates per month were 0.71 and 1.49, respectively. There was no significant difference in complication rates. These data suggest that while the standard dose (81 mg) intravesical therapy of BCG is more effective than the low dose, there was no significant difference in side effects between the two groups.     

Oral or intravesical bacillus Calmette-Guerin immunoprophylaxis in bladder carcinoma

A total of 71 patients with superficial transitional cell carcinoma underwent transurethral resection of bladder tumor. All patients had stage pTa or pT1 transitional cell carcinoma or carcinoma in situ without other concurrent malignancies. The patients were assigned to 3 treatment groups: control group--transurethral resection discontinued within the study, oral bacillus Calmette-Guerin (BCG) group--transurethral resection of bladder tumor plus BCG (Moreau) and intravesical BCG group--transurethral resection of bladder tumor plus BCG. Of 9 patients in the control group 8 (89%) experienced tumor recurrence during a mean followup of 20 months. Of the 28 patients in the oral BCG group 11 (39.3%) had recurrence during a mean followup of 36 months. Of the 34 patients in the intravesical group 6 (18%) had recurrence in a 24-month mean followup. The incidence of complications was higher in the intravesical (41.2%) than in the oral BCG group (28.5%). These results show that intravesical BCG is a more effective immunotherapy; however, oral BCG can be used in patients who do not accept intravesical BCG administration.     

The influence of lower urinary tract infection on the recurrence rate of superficial transitional cell carcinoma of the bladder

We studied retrospectively 78 patients with recurrent superficial bladder tumors in an effort to determine whether transitional tumor cells implant and grow preferentially in patients who have undergone endoscopic resection of stage T1 bladder tumors in the presence of an inflamed urothelium. Of the patients 32 (group 1) had an undetected lower urinary tract infection at the time transurethral resection was performed and 46 (group 2) were free of infection. All patients had intravesical chemotherapy by thiotepa (triethylenethiophosphoramide) and were treated with appropriate antibiotics as soon as the urinary tract infection was recognized from 24 to 48 hours postoperatively. Of the patients in group 1, 37.5 per cent had tumor recurrence in less than 6 months and 15.6 per cent in less than 3 months, compared to 30.4 and 6.5 per cent, respectively, in group 2. Although the tumor recurrence rates 3 and 6 months postoperatively were higher among the group 1 patients (with urinary tract infection) the difference between the 2 groups was not significant. Because the patients were treated by intravesical chemotherapy, and antibiotics in those with urinary tract infection, our study does not allow a definite conclusion regarding the contribution of urinary tract infection on the recurrence rate of superficial bladder tumors.     

A rational combination of intravesical and systemic agents for the treatment of interstitial cystitis

OBJECTIVE: Interstitial cystitis is a condition with a poorly understood etiology and, consequently, various treatment options have been described in the literature, with a less than optimal outcome. The aim of this study was to examine the role of a combination of intravesical hydrocortisone and heparin, together with oral bladder sedatives and systemic triamcinolone, for the treatment of interstitial cystitis. MATERIAL AND METHODS: A total of 26 patients who were diagnosed as having interstitial cystitis were treated with weekly intravesical hydrocortisone (200 mg) and heparin (25,000 IU) in physiological saline for 6 weeks. In addition, they were given oral bladder sedatives such as oxybutynin or tolterodine. Ulcerative, refractory and recurrent cases were treated with intramuscular triamcinolone (40 mg) weekly for 6 weeks. RESULTS: All patients experienced an improvement in symptoms within 48 h of their first intravesical instillation. While 19 patients (73%) experienced almost complete pain relief, five of the remaining seven patients improved with intramuscular triamcinolone. Frequency reduced from a mean of 23.2 to 10.9 voids per day and was acceptable in 21 patients (80%). Six patients (23%) had a relapse of symptoms in the form of pain and were treated satisfactorily by means of intramuscular triamcinolone. The mean duration of follow-up was 18.3 months. CONCLUSION: A combination of intravesical hydrocortisone and heparin, along with oral bladder sedatives and systemic steroids, has been used with encouraging results in a small group of patients with interstitial cystitis.     

口腔洁净护理对颌面外科手术患者术后愈合进程及感染的影响

目的 探讨颌面外科手术患者应用口腔洁净护理对患者术后愈合进程及感染的影响。方法 选 取2020年10月-2021年10月我院收治的行颌面外科手术治疗的患者98例,按随机数字表法分为对照组和 观察组,每组49例。对照组给予传统口腔护理,观察组给予口腔洁净护理,比较两组简明疼痛调查表 （BPI）、Spiegel睡眠量表评分、住院时间、护理不良事件发生率和感染发生率。结果 两组干预后BPI、 Spiegel评分均低于干预前,且观察组低于对照组（P＜0.05）;两组护理不良事件发生率比较,差异无统 计学意义（P＞0.05）;观察组住院时间少于对照组,感染发生率低于对照组（P＜0.05）。结论 口腔洁 净护理在颌面外科手术患者中应用效果较好,能改善患者疼痛和睡眠状况,缩短住院时间,降低感染发生 率,安全性良好。     

Side-effects of oral or intravesical oxybutynin chloride in children with spina bifida

OBJECTIVE: To evaluate the incidence of side-effects of oral and intravesical oxybutynin chloride in children with meningomyelocele (MMC) and a neurogenic bladder. PATIENTS AND METHODS: The study comprised 225 children with a neurogenic bladder from MMC who were evaluated with urodynamic testing and voiding cysto-urethrography to identify those at high risk of upper tract damage. In all, 101 children (mean age 4.2 years, range 0.25-10) had unco-ordinated detrusor-sphincter function and low compliance; they were treated with either oral or intravesical oxybutynin and clean intermittent catheterization. RESULTS: Of the 101 patients, 67 were treated with oral oxybutynin; in 11 the treatment was discontinued because of the side-effects. The other 34 patients used both clean intermittent catheterization and intravesical oxybutynin. In this group there were side-effects in six patients, including drowsiness, hallucinations and cognitive changes. CONCLUSIONS: Oral and intravesical oxybutynin is effective for managing neurogenic bladder dysfunction, but intravesical administration is safer and better tolerated than oral oxybutynin in the treatment of children with MMC. However, adverse effects such as cognitive impairment can also occur in children treated with intravesical oxybutynin and these patients must be closely monitored because these effects may differ from those with oral administration.     

Electromotive administration of intravesical bethanechol and the clinical impact on acontractile detrusor management: introduction of a new test

PURPOSE: It is often difficult to determine the functional status of the detrusor muscle in patients with detrusor areflexia. We performed a clinical study to establish a test defining residual detrusor capacity in such patients. MATERIALS AND METHODS: In phase 1, 5 controls with detrusor areflexia were tested with an intravesical instillation of 20 mg. bethanechol in 150 cc of sodium chloride 0.3% with and without 20 mA. of pulsed current applied via an electrode catheter through the saline. Cystometry simultaneously recorded intravesical pressure changes. In phase 2, 45 patients with detrusor areflexia were tested with electromotive administration of intravesical bethanechol. In phase 3, 25 mg. bethanechol given orally once daily were prescribed for 15 patients and voiding control was assessed after 6 weeks of therapy. RESULTS: Neither bethanechol without current nor current through saline only led to increased intravesical pressure. However, we noted a mean pressure increase of 34 cm. water during the electromotive administration of bethanechol in 24 of 26 patients with areflexia and neurological disease compared to only 3 cm. water in 3 of 11 with a history of chronic bladder dilatation. Oral bethanechol restored spontaneous voiding in 9 of 11 patients who had had a positive response to the electromotive administration of bethanechol, whereas all 4 without a pressure increase during the electromotive administration of bethanechol did not void spontaneously. CONCLUSIONS: Electromotive administration of intravesical bethanechol identifies patients with an atonic bladder and adequate residual detrusor muscle function who are candidates for restorative measures, such as oral bethanechol and intravesical electrostimulation. Those who do not respond to the electromotive administration of bethanechol do not benefit from oral bethanechol and are candidates for catheterization.     

Does intravesical chemotherapy prevent invasive bladder cancer?

Intravesical chemotherapy has been shown to prolong the interval free of disease and to reduce the tumor recurrence rates in patients with superficial bladder cancer. These observations led us to consider whether a course of intravesical chemotherapy might provide a long-term decrease in the recurrent tumor rate or reduce the incidence of progression to invasive carcinoma. The records of 123 patients entered into a randomized multicenter protocol between 1975 and 1978 were examined. Patients had received a 1-year course of thiotepa or VM26, or transurethral resection alone. Mean followup was 47 months. Patients receiving thiotepa or VM26 had a lower rate of tumor recurrence, expressed as recurrences per 100 patient-months, than those undergoing transurethral resection only (5.25 versus 5.71 versus 7.98) but this was not statistically significant. However, 28 per cent of the controls required therapy besides transurethral resection to control the bladder cancer and 19 per cent died of advanced bladder cancer during followup. Only 15 per cent of the patients undergoing intravesical chemotherapy required therapy other than transurethral resection and only 3 per cent died of advanced carcinoma of the bladder. This finding suggests that intravesical chemotherapy given for 1 year is associated with a significant decrease in the incidence of tumor progression, and provides the justification to conduct future trials with extended followup.     

减少肾盂癌术后再发膀胱癌的临床研究

目的 探讨减少肾盂癌术后再发膀胱癌的方法.方法 回顾性分析1997年10月至2007年12月收治并获随访的227例肾盂癌患者.男性126例,女性101例,年龄34～78岁.全程肉眼血尿176例,腰部疼痛51例.采用两种方法分离患侧管口周围膀胱壁.A方法:沿患侧输尿管分离至膀胱壁;B方法:沿输精管向下分离患侧管口周围膀胱后壁并切断膀胱侧韧带达精囊部位.采用三种方法进行膀胱灌注化疗.方法 1:术后当天开始每周灌注1次,共10次;方法2:术后当天灌注1次,3周后每周灌注1次,共10次;方法3:术后3周开始每周灌注1次,共10次.术后定期膀胱镜检查,随访1～10年.采用χ2检验和Logistic回归对膀胱癌再发率进行分析.结果 术后膀胱癌再发率27.8%(63/227).采用方法A和方法B的患者患侧管口周围区域膀胱癌再发率分别为18.0%(7/39)和12.5%(3/24),两者相比较差异有统计学意义(P<0.05).膀胱灌注化疗方法1、2、3的膀胱癌再发率分别为17.9%(11/67)、20.8%(10/48)、33.3%(17/51),方法1与方法3相比较差异有统计学意义(P<0.05).结论 充分分离确切切除患侧管口周围膀胱黏膜,术后当日开始每周1次膀胱灌注化疗是减少肾盂癌术后再发膀胱癌的有效方法.     

Optimal treatment of systemic bacillus Calmette-Guérin infection: investigations in an animal model

PURPOSE: Hematogenous spread of bacillus Calmette-Guerin (BCG) after intravesical instillation for bladder cancer is rare but it may result in systemic infection and hypersensitivity reaction. We investigated fluoroquinolones and steroids in an animal model to improve the therapeutic options in local and systemic BCG infection. Furthermore, the antitumor effectiveness of intravesical BCG with simultaneous application of fluoroquinolones and/or steroids was tested. MATERIALS AND METHODS: Oral antimicrobial therapy with and without steroids was started immediately after intraperitoneal injection using fluoroquinolones or trimethoprim-sulfamethoxazole. To evaluate the therapeutic options against a hyperergic reaction after repeat systemic BCG infection re-challenge was performed with intraperitoneal BCG 7 days after primary infection and oral therapy was given with fluoroquinolones or trimethoprim-sulfamethoxazole with and without steroids. The influence of continuous oral fluoroquinolone therapy on the antitumor effect of BCG was also tested in the MB 49 orthotopic murine bladder tumor model. RESULTS: After primary systemic infection fluoroquinolone therapy alone led to significantly prolonged survival in mice (log rank test p = 0.041), whereas trimethoprim-sulfamethoxazole was ineffective. There was no additional effect of steroid administration. Steroids alone led to premature death (log rank test p = 0.022). After secondary BCG infection only steroid treated animals had prolonged survival (log rank test p = 0.032), whereas antimicrobials alone had no effect. The therapeutic efficacy of BCG in the orthotopic bladder tumor model was not affected by continuous oral fluoroquinolones in terms of survival (log rank test p = 0.001) or bladder weight (Wilcoxon test p = 0.001) compared with untreated controls. CONCLUSIONS: In a mouse model fluoroquinolones had a beneficial effect for primary systemic BCG infections, whereas the hyperergic reaction after repeat BCG infection was susceptible only to steroids. Administering fluoroquinolones during an intravesical treatment course does not affect the antitumor efficacy of BCG.     

A randomized prospective comparison of oral versus intravesical and percutaneous bacillus Calmette-Guerin for superficial bladder cancer

Reports of a dramatic decrease in tumor recurrence and regression of muscle invasive disease with oral bacillus Calmette-Guerin prompted us to conduct a randomized prospective comparison of oral bacillus Calmette-Guerin with the standard intravesical plus percutaneous therapy. Oral therapy consisted of 200 mg. Tice bacillus Calmette-Guerin 3 times each week. Intravesical and percutaneous Tice bacillus Calmette-Guerin at a dose of 50 mg. was given weekly for 6 weeks, at 8, 10 and 12 weeks, then at 6 months and every 6 months thereafter. Minimal side effects confirmed the safety of oral bacillus Calmette-Guerin. Tumor recurrence was documented in 21 of 33 oral bacillus Calmette-Guerin patients (64%) and 18 of 55 (33%) who received intravesical plus percutaneous therapy (p less than 0.002, chi-square test). We were unable to demonstrate any antitumor activity of oral bacillus Calmette-Guerin in this study.     

The effect of antibiotic prophylaxis on wound infections after laparoscopic cholecystectomy: A randomised clinical trial

The aim of this study was to determine whether the use of prophylactic antibiotics had any effects on the development of postoperative surgical wound infections between laparoscopic cholecystectomy patients. Patients who received a single dose of prophylactic antibiotics prior to surgery were included in the prophylaxis group, and those who did not receive preoperative and postoperative intravenous and/or oral antibiotics were included in the no prophylaxis group. A total of 206 patients who underwent laparoscopic cholecystectomy were examined; the infection rate in patients who received prophylaxis was 4.5%, while it was 4.2% in the non‐prophylactic group. There was no statistically significant difference between the groups in terms of infection development rates (P > .05). We suggest that antibiotics should not be given for prophylaxis before low‐risk laparoscopic cholecystectomy as there is no statistically significant difference in the rate of postoperative wound infection among patients who were either given or not given prophylaxis.     

Kidney transplantation in children with augmentation cystoplasty

PURPOSE: Treatment of children with end stage renal disease, especially those with significant bladder dysfunction, is difficult. A high pressure and low capacity bladder is a major risk factor for a transplanted kidney. Cystoplasty can protect the kidney allograft by reducing the intravesical pressure and creating an appropriate capacity. The aim of this study was to evaluate the outcome of kidney transplantation in children with and without prior cystoplasty. MATERIALS AND METHODS: A total of 43 children with bladder dysfunction in urgent need of cystoplasty were enrolled in the study and were compared to a control group with regard to acute and chronic rejection rates, survival of the transplanted kidney, surgical complications and febrile urinary tract infection. RESULTS: The rates of febrile urinary tract infection and chronic rejection were significantly higher in patients with prior cystoplasty (p<0.001 and p=0.004, respectively). Also, graft loss was much more frequent in these patients (34.9% vs 20.9%), although this difference was not statistically significant. In patients with prior cystoplasty graft survival rates were 92%, 73%, 58% and 45% at postoperative years 1, 3, 5 and 7, respectively. In the control group these rates were 94%, 87%, 81% and 75%, respectively (p=0.007). CONCLUSIONS: Based on our findings, the survival rate of the kidney is significantly lower in children with prior cystoplasty, possibly due to the higher prevalence of chronic rejection and febrile urinary tract infection in this group.     

The novel use of intravesical docetaxel for the treatment of non-muscle invasive bladder cancer refractory to BCG therapy: a single institution experience

Objectives  Since the success of our Phase I trial of intravesical docetaxel for treatment-refractory non-muscle invasive bladder cancer (NMIBC), we have found this agent to be a favorable alternative for BCG-refractory patients unable or unwilling to undergo cystectomy. This study analyzes the safety and efficacy of intravesical docetaxel in a larger patient population with extended follow-up. Methods  A retrospective analysis of all patients who received salvage intravesical docetaxel at our institution was conducted, including 18 patients treated during the Phase I trial and 15 patients treated after the trial’s completion. Toxicity, efficacy and recurrence-free survival were analyzed. Results  Thirty-three patients with refractory NMIBC received salvage intravesical docetaxel therapy between 2003 and 2008 at a single institution. Twenty of thirty-three (61%) patients had a complete response (CR) after six weekly induction treatments. Ten patients with CRs were given maintenance docetaxel therapy, and one patient received maintenance BCG and interferon. With a median follow-up of 29 months, 1 and 2-year recurrence-free survival rates were and 45 and 32%, respectively. Twelve of thirty-three patients (36%) had Grade 1 or 2 local toxicities. No patients experienced Grade 3 or 4 toxicities. Conclusions  Docetaxel is a promising intravesical agent with minimal toxicity and significant efficacy and durability for the management of BCG-refractory NMIBC.     

INTRAVESICAL OXYBUTYNIN: MODE OF ACTION ASSESSED BY PASSIVE DIFFUSION AND ELECTROMOTIVE ADMINISTRATION WITH PHARMACOKINETICS OF OXYBUTYNIN AND N-DESETHYL OXYBUTYNIN

PURPOSE: A proportion of patients with detrusor hyperreflexia who are unresponsive to oral oxybutynin often benefit from intravesical oxybutynin instillation. To our knowledge the precise mode of action of this method is obscure. MATERIALS AND METHODS: In 12 patients with detrusor hyperreflexia who were previously unresponsive to oral and intravesical passive diffusion of 5 mg. oxybutynin we administered 5 mg. oxybutynin orally as well as increased doses of 15 mg. oxybutynin intravesically with passive diffusion and with 15 mA. associated electric current. Each administration mode per patient was associated with an 8-hour urodynamic monitoring session during which oxybutynin and N-desethyl oxybutynin plasma levels, and intravesical oxybutynin uptake were measured. RESULTS: A dose of 5 mg. oxybutynin orally induced no urodynamic improvement with an area under the plasma concentration time curve of combined N-desethyl oxybutynin plus oxybutynin of 16,297 ng./8 hours and an area under the curve ratio of N-desethyl oxybutynin-to-oxybutynin of 11:1. Passive diffusion oxybutynin resulted in 12 mg. oxybutynin intravesical uptake and significant improvement in 3 of 8 urodynamic measurements, although the area under the curve of combined N-desethyl oxybutynin plus oxybutynin was only 2,123 ng./8 hours and the N-desethyl oxybutynin-to-oxybutynin ratio was 1.1:1.0. Electromotive administration of oxybutynin resulted in almost complete intravesical uptake of the 15 mg. dose, significant improvement in all 8 urodynamic measurements and an increased oxybutynin level versus oral and passive diffusion, although the area under the curve of combined N-desethyl oxybutynin plus oxybutynin was 4,574 ng./8 hours and the N-desethyl oxybutynin-to-oxybutynin ratio was inverted at 1.0:1.4. The oral dose of 5 mg. oxybutynin caused anticholinergic side effects in 8 of the 12 patients. Neither intravesical passive diffusion nor electromotive administration caused side effects with an uptake of 12 and 15 mg., respectively. CONCLUSIONS: A large proportion of intravesical oxybutynin is sequestered, probably in the urothelium. Intravesical oxybutynin administration confers therapeutic benefits via localized direct action within the bladder wall.     

围手术期大剂量吡柔比星膀胱灌注预防膀胱癌复发的临床观察

目的 探讨围手术期大剂量吡柔比星(THP)膀胱灌注预防膀胱癌术后复发的临床疗效及安全性.方法 采用临床随机对照研究的方法,选择2003年6月至2009年5月治疗的病理诊断为膀胱移行细胞癌、TNM分期Ⅰ～Ⅱ期行膀胱部分切除术或经尿道膀胱肿瘤电切术的患者,共120例.按照随机数字表法将研究对象随机分为A、B两组.A组:62例,行围手术期大剂量THP膀胱灌注治疗;B组:58例,采用常规小剂量长期灌注治疗.观察各组患者复发及不良反应情况.结果 两组在性别构成比、年龄、病理分期、手术方法等方面差异无统计学意义(P＞0.05).A组复发5例,复发率8.1%;尿道狭窄2例,发生率3.2%;3例患者在术后短期内出现膀胱刺激症状,发生率4.8%.B组复发12例,复发率20.7%;尿道狭窄11例,发生率18.9%;16例患者在灌注的不同时期出现膀胱刺激症状或血尿,发生率27.6%.两组患者复发率和不良反应发生率的差异均有统计学意义(P＜0.05).结论 围手术期大剂量THP膀胱灌注预防膀胱癌术后复发操作简单,效果满意.     

上尿路肿瘤术后膀胱内灌注化疗价值的探讨

目的：探讨上尿路肿瘤术后预防性膀胱内灌注化疗的价值。方法：选取诊断为单侧上尿路肿瘤、无淋巴结及远处转移、不伴发膀胱肿瘤及无膀胱癌病史并行根治性肾输尿管全切除术的患者82例,对其中41例术后接受膀胱内灌注化疗者（研究组）与41例未接受膀胱内灌注化疗者（对照组）进行1：1配对研究,配对条件为肿瘤的病理分期、单发／多发和所处器官一致,患者的性别相同。研究组术后行羟基喜树碱膀胱内灌注化疗,每次40mg,每周1次,共6～8次;对照组随诊观察。结果：平均随访46（26～66）个月,研究组及对照组术后膀胱癌的发生率分别为22．0％（9例）及43．9％（18例）（P〈0．05）,再发膀胱癌的中位时间分别为13（3～59）个月及28（3～57）个月（P〈0．05）。结论：对不伴发膀胱癌及无膀胱癌病史的上尿路肿瘤患者,根治术后短疗程的羟基喜树碱膀胱内灌注化疗可有效降低膀胱癌的再发比例,延长肿瘤的再发时间。     

早期吡柔比星膀胱内灌注预防膀胱癌术后复发

目的:探讨膀胱肿瘤电切术(TURBt)后早期应用吡柔比星灌注化疗预防肿瘤复发的疗效。方法:对112例病理证实的膀胱移行细胞癌患者,59例行早期灌注(Ⅰ组),53例行常规灌注(Ⅱ组)。Ⅰ组于术后6小时内将30mg吡柔比星溶于40ml蒸馏水膀胱内灌注,保留2小时后排出,术后7天开始规律膀胱灌注;Ⅱ组于术后7天开始吡柔比星规律膀胱灌注,比较两组患者膀胱肿瘤复发率。结果:随访7~54个月,平均35个月,Ⅰ组6例膀胱肿瘤复发,Ⅱ组13例复发,差异有统计学意义;不良反应包括尿路刺激征、肉眼血尿等,两组比较差异无统计学意义。结论:TURBt后早期开始吡柔比星膀胱灌注化疗,可以显著降低膀胱肿瘤复发率。