Intravesical instillation of beta-interferon in the treatment of bladder cancer.

A total of 36 patients with single superficial bladder cancer TNM stage Ta-T1/G2 was studied over a 24-month period before entering the study to evaluate the efficacy and tolerance of high doses of beta-interferon (beta-INF); 24 patients had a primary tumour (group 1) and 12 had had more than 3 recurrences (group 2). They received 8 intravesical doses of beta-INF, 50,000,000 IU in 50 ml sterile water, at weekly intervals, 15 days after transurethral resection of the bladder (TURB). Efficacy was estimated by simple recurrence rate and by the person-years method. The recurrence rate was 25% in group 1 with a mean follow-up of 21.6 months. Comparison with the recurrence rate of a historical control group treated only by TUR showed that there was a slight statistically significant difference. Group 2 had a recurrence rate of 100% in the period before beta-INF (follow-up 24 months) and 91% after INF administration (mean follow-up 20.5 months). Patients were questioned about side effects before and after each treatment; tolerance of the drug was excellent. The results suggest that beta-interferon could be safely used as a prophylactic agent against the recurrence of primary superficial bladder cancer. Its efficacy seems comparable to that obtained with other current chemoprophylactic agents.     

Intravesical therapy. A critical review

In order to determine the effectiveness of intravesical therapy for superficial bladder cancer, the author critically reviews current data and the methodology upon which such data are based. Included is a discussion of prophylactic versus therapeutic intravesical therapy, the design of clinical trials for intravesical therapy and endpoints of response, biostatistical considerations, a review of randomized clinical trials, and selection of patients for intravesical therapy.     

Malakoplakia in urology: six cases report and review of the literature

Malakoplakia (MLP) is a rare chronic granulomatous disease that is believed to happen because of an alteration in the bacterial phagocytic system. This entity is characterized by one or multiple tumorations that can appear in any part of the body leading to it's misdiagnosing as a malignant condition. The genitourinary tract is frequently involved. Pathologic study of these lesions shows tissue infiltrated by inflammatory cells (macrophages and hystiocites) with intracytoplasmatic inclusions, which are known as Michaelis-Gutmann bodies. Usually is a benign condition self-limited and is associated with recurrent urinary tract infection (UTI), this condition has a good response to prolonged treatment with fluoroquinolones. We will report six cases that were diagnosed and treatment in our institution during an eight year period. We report still a review of the available literature.     

Intravesical formalin instillation in the treatment of massive haematuria

16 patients with massive haematuria due to bladder cancer or cytostatic or radiation cystitis have been treated with intravesical instillation of 4% formalin solution. The method proved to be effective in the control of bleeding in 15 cases, but produced complications two of which were severe. This mode of treatment should thus be limited to debilatated patients in whom other conservative methods fail to control the bleeding. Complications and mode of action of formalin instillation are discussed.     

Intravesical instillation of adriamycin: influence on bladder capacity

The bladder capacities of 75 patients with superficial bladder tumors were measured prior to and during monthly intravesical instillation therapy with adriamycin. When taken off therapy, a decrease in bladder capacity of more than 20% was observed in 18 of the patients. In 14 of the treated patients an increase in bladder capacity of more than 20% was observed. In patients with reduced bladder capacity when taken off therapy, there were no correlations between the degree of decreased bladder capacity and the number of instillations or the total instilled amount of adriamycin, indicating that the observed decrease in bladder capacity was caused by the underlying disease and not by the treatment per se.     

Intravesical capsaicin in patients with detrusor hyper-reflexia--a placebo-controlled cross-over study.

The aim of this study was to determine whether intravesical treatment with capsaicin could block detrusor hyper-reflexia (DH) and alter the substance P content, nerve fibres and mucosa of the bladder. Twelve patients with spinal cord disease with DH and urinary incontinence resistant to anticholinergic treatment underwent intravesical administration of 50 ml 2% lignocaine. followed by either 100 ml 1 mmol/l capsaicin or 100 ml physiological saline for 30 min. Cross-over to the alternative treatment took place after 4 weeks. Varying degrees of burning sensation were experienced by all but one patient during the capsaicin treatment and precluded the possibility of conducting studies of this type in a blind manner. No preference for capsaicin treatment was found, and micturition and VAS scores were unchanged after treatment with capsaicin. The mean volume of the contents of the bladder at which DH first appeared was 175 ml after saline and 195 ml after capsaicin (mean difference 20 ml with a 5% confidence interval from -25 to 65). Bladder biopsies taken 2 weeks after treatment with capsaicin showed more pronounced inflammation, superficial haemorrhage, squamous epithelial metaplasia and a more condensed bladder stroma. Immunohistochemical staining for substance P and neuronal cell adhesive molecule revealed the presence of small terminal axons and small nerve bundles in all of the biopsies. Intravesical treatment with capsaicin did not have a beneficial effect on DH or a destructive effect on nerve fibres. It did, however, produce significant reactive changes in the mucosa of the bladder.     

Intravesical foreign bodies: five-year review.

All manner of foreign bodies have been extracted from the bladder. Introduction into the bladder may be through self-insertion, iatrogenic means or migration from adjacent organs. Extraction should be tailored according to the nature of the foreign body and should minimise bladder and urethral trauma. Complete extraction should also be confirmed by panendoscopy at the end of the extraction procedure. A 5-year review of our experience in this field has been conducted and the management and complications of intravesical foreign bodies are described. Of the 15 patients presenting to this department, 11 presented acutely and 4 presented with chronic symptoms due to complications which arose later. The possibility of an intravesical foreign body should be considered in any patient with chronic unexplained lower urinary tract symptoms.     

Intravesical foreign bodies. Review of the literature

We want to make a literature review about the bladder foreign bodies. This clinical situation is not an usual emergency, but there are a lot of references in urological articles about it. In this article review we want to make a compilation about the symtoms, the different origins of the foreign bodies, and ways of diagnosis and treatment of this pathology. We also want to add our personal experience in a recent case.     

辣椒辣素类似物治疗膀胱过度活动症

目的　介绍辣椒辣素类似物RTX (Resiniferatoxin)治疗膀胱过度活动症的体会。　方法　膀胱过度活动症患者 30例 ,女 2 8例 ,男 2例。年龄 2 1～ 6 0岁 ,平均 39岁。病程 2～ 30年 ,平均 6 .9年。治疗前排尿日记显示日间排尿 9～ 2 6次 ,平均 15 .0次。夜间排尿 3～ 13次 ,平均 6 .4次。 12例经膀胱镜检查 ,10例显示黏膜呈慢性炎症改变。活检病理诊断腺性膀胱炎 1例 ,间质性膀胱炎 2例 ,其他为慢性炎症改变。膀胱灌注用 10 0nmol/LRTX溶液 10 0ml,膀胱内保留 30min。　结果　RTX灌注无膀胱刺激 ,不需用局部麻醉 ,未见明显副作用。灌注初始监测无逼尿肌收缩现象。 30例尿频症状于灌注后 1d开始改善 ,其中 2例伴尿痛者症状缓解 ;灌注 1周及 1个月后排尿日记显示日间排尿 5～15次 ,平均 8.9次 ,夜间排尿 0～ 5次 ,平均 3.0次 ;排尿频率明显减少 ,治疗前后相比 ,差异有显著性意义 (P <0 .0 0 1)。　结论　RTX膀胱灌注疗效好 ,无副作用 ,可作为膀胱过度活动症引起的下尿路症状的一种有效治疗手段。     

顺铂膀胱灌注预防膀胱癌复发

自１９９０年８月～１９９３年１１对２１例膀胱癌术后患者采用顺铂（ＰＤＤ）（４０ｍｇ／次）定期膀胱灌注，总疗程２年，平均灌注１６．３个月。平均随访１６．６个月，复发率４．８％。除排尿不适外，本组还出现了严重血尿、过敏样反应、骨髓抑制和尿道狭窄等较严重副作用，发生率为２３．８％。     

Intravesical neuromodulatory drugs: capsaicin and resiniferatoxin to treat the overactive bladder

Current pharmacologic treatment of the overactive bladder relies on anticholinergic drugs. However, these drugs often have troublesome side effects and frequently are given in doses insufficient to restore continence in patients with detrusor instability. We present the background and basic and clinical research dealing with intravesical instillation of capsaicin and resinfferatoxin as treatments for the overactive bladder. Capsaicin is the main pungent ingredient in "hot" peppers of the genus Capsicum. It is a specific neurotoxin that desensitizes C-fiber afferent neurons, which may be responsible for the signals that trigger detrusor overactivity. Studies with capsaicin over the past 8 years have demonstrated clinical efficacy with minimal long-term complications. Most of these studies have also shown that the acute pain and irritation associated with capsaicin are a major deterrent to widespread use. Resiniferatoxin (RTX), an ultrapotent analog of capsaicin that appears to have similar efficacy but with much less acute side effects may be more useful. Intravesical instillation of capsaicin or resiniferatoxin is a promising treatment for the overactive bladder.     

Intravesical instillation of resiniferatoxin for the patients with interstitial cystitis

Although hydrodistention of the bladder is accepted as the initial treatment for patients with interstitial cystitis (IC), second-line treatment for worsening symptoms is not concretely established. Resiniferatoxin (RTX) desensitizes bladder afferent c-fibers and its intravesical instillation is effective for patients with detrusor overactivity. We studied the clinical relevance of intravesical treatment with RTX for patients with IC. The treatment was performed for 3 patients with incomplete improvement after hydrodistention. All 3 patients were free of bladder pain posttreatment and had slight improvement of the maximum voided volume. Though RTX treatment requires general anesthesia against severe bladder pain it is effective for selected patients with interstitial cystitis and can be potentially used as one of the treatment options.     

Venous thromboembolism prophylaxis in urology: A review

Venous thromboembolism is potentially a lethal problem, and is associated with chronic morbidity. Venous thromboembolism is frequently diagnosed after urological surgery, yet the role of perioperative venous thromboembolism prophylaxis is not clearly defined. Any current recommendations are largely based on evidence derived from other surgical specialties. Even within different guidelines, there remains significant variation, suggesting a consensus is required. The present review aims to define the problem of venous thromboembolism within the urological population, and identifies patients at risk. It evaluates the role of various types of mechanical and pharmacological prophylaxis, along with its timing and duration of administration in common urological operations. The current guidelines are summarized and compared in order to give the reader a better perspective of this vital condition.     

Intravesical instillation of botulinum toxin A: an in vivo murine study and pilot clinical trial

Aim  

The objectives of this study were to compare the urodynamic effects of botulinum toxin A (BoNT-A) delivered via intramural injection into the bladder wall to that of intravesical instillation in a rat model of detrusor overactivity and to evaluate the effects of intravesical instillation of BoNT-A in female patients with idiopathic overactive bladder.