Renal failure after intravesical mitomycin C

Severe side effects, local or systemic, are uncommon with intravesically administered mitomycin C. Bladder fibrosis and contracture, with resultant renal failure, are unusual but possible.     

Bladder wall calcification after topical mitomycin C

We report a case of calcification in the wall of the bladder following treatment of transitional cell carcinoma of the bladder with intravesical mitomycin C.     

Severely contracted bladder following intravesical mitomycin C therapy

Most superficial bladder tumors are best treated by transurethral resection. However, because of their multifocal origin and high rate of recurrence they often present challenging therapeutic problems. Intravesical chemotherapy often is used in such cases in the treatment and prevention of recurrent transitional cell carcinoma of the bladder. Recently, mitomycin C intravesical chemotherapy was shown to be effective in the treatment of superficial bladder tumors. No systemic toxicities were described but bladder irritation and drug-related palmar desquamation were noted. We report a case of a severely contracted bladder requiring urinary diversion following intravesical chemotherapy with mitomycin C. A possible relationship of this complication to the mitomycin C treatment is suggested.     

Silent urothelial cancer detected by sonography after renal transplantation

OBJECTIVES: Organ transplantation increases the incidence of cancer through unclear mechanisms. In our observation, urothelial cancer happens much more frequently in Chinese people. We reviewed the detection of urothelial cancer in our series after renal transplantation. METHODS: From July 1981 to June 2005, we performed 620 renal transplantations. We do graft and native kidney sonography survey annually even if the patient is asymptomatic. During this period, 10 urothelial tumors were detected. Herein we have reviewed the findings in these cases, along with their management and outcomes. RESULTS: Moderate to severe hydronephrosis of native kidneys was observed in 14 patients, including 9 (64.3%) who had cancer including eight asymptomatic and only one with flank pain and lymph nodes metastasis succumbing in 10 months with a functioning graft. Three patients showed similar degrees of graft hydronephrosis and graft ureteral cancer was diagnosed in one. Mean time from transplantation was 5.09 years. There was a female predominance (7:3). The bladder-to-renal pelvis-to-ureter ratio was 2:5:7, which was distinct from the usual 51:3:1 distribution. In native ureter cancer, we found the left ureter more prone to develop cancer than the right (8:1). CONCLUSION: The pattern of cancer in renal transplant patients is thoroughly different from the general population, namely female predominance, with a higher incidence of ureteral and renal pelvis versus bladder cancer. In our observation, routine periodic sonography survey even in asymptomatic patients is important for urothelial tumor detection, as the incidence of cancer is surprisingly high.     

Detecting mitomycin C in human plasma during intravesical therapy

Mitomycin C (MMC) concentrations in plasma and urine were measured in five patients with intact bladder during intravesical instillation therapy. No MMC was detected in plasma by a selective high performance liquid chromatographic (HPLC) method. The detection limit of the method is 1 ng/ml. Our results are in accordance with clinical experiences of the lack of systemic toxicity during MMC instillation therapy. There was a remarkable loss of MMC in the voided urine. The probable explanation could be that a considerable amount of MMC is absorbed into the bladder wall.     

Bone marrow suppression after intravesical mitomycin C treatment

Intravesical chemotherapy has been established as a modality for the treatment and prevention of superficial bladder tumors. However, the optimal time for instillation of chemotherapy following transurethral resection is still not clear. We report on a patient with a superficial bladder tumor treated immediately after transurethral resection with relatively high dose mitomycin C. Bone marrow failure developed within 2 weeks. A possible relationship is suggested.     

Topical mitomycin C therapy for carcinoma of the bladder

We studied 19 consecutive patients with biopsy proved carcinoma in situ of the bladder who had received 8 weekly doses of 30 mg. intravesical mitomycin C. Followup with cystoendoscopy, biopsy and cytology studies every 3 months ranged from 6 to 48 months, with an average of 21 months. A complete initial response was achieved in 15 patients, 11 of whom have remained free of tumor with no further therapy. The 4 patients who failed to respond to initial therapy subsequently were free of tumor after further intravesical mitomycin C (2), excision (1) or doxorubicin (1). Three patients died of unrelated diseases. Only 1 patient has had metastatic transitional cell carcinoma. No patient had undergone cystectomy or radiotherapy. These data indicate that mitomycin C achieves a high initial response in patients with carcinoma in situ of the bladder and maintains this control in many patients for months or years.     

Effects of mitomycin C perfusion after bladder tumor surgery

In the last ten years, 26 cases of bladder tumor in T1-T2 stage have been given Mitomycin C perfusion in cava after operation to prevent tumor recurrence. The results of follow-up for one to eight years showed no recurrence occurred in all 26 cases with Mitomycin C perfusion and in control group (64 cases) 14 had recurrence. The authors consider that Mitomycin C perfusion in a long time is effective for the prevention of recurrence of bladder tumor. The methods and untoward effects of Mitomycin C perfusion are discussed in this article.     

Unusual complication after immediate postoperative intravesical mitomycin C instillation

Immediate adjuvant Mitomycin C (MMC) instillation is routine practice in the treatment of superficial bladder cancer. Despite relative safety we describe a case of MMC extravasation after intravesical instillation. This resulted in severe continuous pain in the pelvic region without tendency of spontaneous healing, and required surgical debridement. To assess perivesical soft tissue injury prior to surgery MRI imaging turned out to be more accurate than computer tomography. Suggestions about how to avoid, diagnose and treat this symptomatic extravasation are made.     

Bladder perforation after immediate postoperative intravesical instillation of mitomycin C

Intravesical chemotherapy after transurethral resection of a bladder tumour (TURBT) has been observed to significantly decrease recurrence rates compared to TURBT alone. Though immediate postoperative intravesical treatment with chemotherapeutic agents after transurethral resection for superficial bladder carcinoma is generally considered a safe and effective adjunctive therapy in decreasing recurrence rates, its instillation is not always completely innocuous. Lately, a more serious complication of bladder perforation associated with immediate instillation of intravesical mitomycin C (MMC) after TURBT was reported. We report our own experience of a male patient with bladder perforation after an early instillation of a single dose of MMC. In this case, systemic toxicity occurred which required intensive care after surgical repair.     

Evaluation of therapeutic arterial embolization in renal cell carcinoma using microencapsulated mitomycin C

The therapeutic arterial embolization in the case of renal cell carcinoma using microencapsulated mitomycin C (MMC) was investigated by an angiographic evaluation in comparison with nonencapsulated MMC. The Gelfoam embolization supplemented with nonencapsulated MMC could not necessarily prevent the recanalization and collateral circulation, while the Gelfoarn embolization supplemented with microencapsulated MMC completely or considerably eliminated the revascularization with a distinct advantage in this degree. Moreover, peripheral blood MMC level after the embolization using microencapsulated MMC was reduced to 39 per cent of that after non-encapsulated MMC infusion. The result was consistent with the previous experiments, indicating that the transcatheter infusion of microencapsulated MMC is the therapeutic arterial embolization of the tutnor-supplying vessels together with regional anticancer chemotherapy. Further clinical application to various malignancies is in progress.     

Bladder wall calcification after intravesical mitomycin C treatment of superficial bladder cancer

Calcification of the bladder wall associated with intravesical mitomycin C for the treatment of superficial bladder cancer is a rare complication. We report on a patient with this complication and discuss the literature.     

Effect of mitomycin C on anterior urethral stricture recurrence after internal urethrotomy

OBJECTIVES: Urethral stricture is one of the oldest known urologic diseases and remains a common problem with high morbidity. Internal urethrotomy refers to any procedure that opens the stricture by incising or ablating it transurethrally. The most common complication of internal urethrotomy is stricture recurrence. The curative success rate of internal urethrotomy is approximately 20%. Mitomycin C has antifibroblast and anticollagen properties and in sporadic reports of animal and clinical studies it has increased the success rate of trabeculectomy and myringotomy. This study evaluated the efficacy of mitomycin C in the prevention of anterior urethral stricture recurrence after internal urethrotomy. PATIENTS AND METHODS: Forty male patients with anterior urethral strictures were randomized to undergo internal urethrotomy with or without urethral submucosal mitomycin C injection. Using general anaesthesia, the urethrotomy was performed under direct vision. Mitomycin C (0.1mg) was injected submucosally at the urethrotomy site in 20 patients. The patients were re-evaluated after 6 mo and the stricture recurrence rate was compared between the two groups (chi(2) analysis). RESULTS: Urethral stricture recurred in 2 patients (10%) in the mitomycin C-treated group and in 10 patients (50%) in the other group. This difference in stricture recurrence between the two groups was statistically significant (p=0.006). CONCLUSIONS: To our knowledge, this is the first prospective, randomized, clinical trial to evaluate the efficacy of mitomycin C application in internal urethrotomy. Submucosal injection of mitomycin C significantly reduced stricture recurrence after internal urethrotomy. Further investigations are warranted to confirm its efficacy and safety.     

Hyperacute renal allograft rejection in the rabbit. Vasoconstriction demonstrated by microangiography

A quantitative microangiographic study of renal allografts in rabbits was carried out to determine the pathogenesis of hyperacute rejection. A group of 10 rabbits, presensitized with multiple ear skin grafts from the kidney donor before receiving renal allografts, developed hyperacute rejection. Another 10 rabbits that were not presensitized served as a control group. The kidney grafts, excised at 2, 4, 8, 16 and 24 hr after renal transplantation, were examined histopathologically and microangiographically. In the presensitized group, striking vasoconstriction of afferent arterioles and interlobular arteries occurred within 2 hr after renal transplantation (p less than 0.01), but these vessels gradually recovered to a near-normal state after 24 hr. The number of glomeruli, however, began to decrease at 8 to 16 hours after renal transplantation (p less than 0.01), suggesting that the vasoconstriction produced thrombosis in the glomerular capillaries. These findings suggest that vasoconstriction at the level of afferent arterioles and interlobular arteries is the primary cause of hyperacute rejection.