Background/Aim: Non-muscle invasive bladder carcinoma (NMIBC) is highly recurrent. We studied if 5-aminolevulinic acid (5-ALA) instillations before transurethral resection of bladder tumours (TURBT) and cystoscopy extend the time to recurrence during follow-up with NMIBC patients. Patients and Methods: A prospective multicenter study enrolled 328 NMIBC patients. All TURBTs and control cystoscopies during the one-year study period were done with or without 5-ALA instillations. The primary endpoint was time to recurrence. The secondary endpoints were time to recurrence after 7.5, 10.5, and 13.5 months and the number of patients with progressive disease. Results: The overall median follow-up time was 80.4 and 87.0 months for the control and study groups, respectively. There was no statistical difference in time to first recurrence between the two groups. Conclusion: We could not obtain significant differences between the control and 5-ALA groups in tumour recurrence among patients with NMIBC.

Background: It remains unclear whether patients with positive surgical margins or extracapsular extension benefit from adjuvant radiotherapy following radical prostatectomy. Objective: To compare the effectiveness and tolerability of adjuvant radiotherapy following radical prostatectomy. Design, setting, and participants: This was a randomised, open-label, parallel-group trial. A total of 250 patients were enrolled between April 2004 and October 2012 in eight Finnish hospitals, with pT2 with positive margins or pT3a, pN0, M0 cancer without seminal vesicle invasion. Intervention: A total of 126 patients received adjuvant radiotherapy at 66.6 Gy. Outcome measurements and statistical analysis: The primary endpoint was biochemical recurrence-free survival, which we analysed using the Kaplan-Meier method and Cox proportional hazard regression. Overall survival, cancer-specific survival, local recurrence, and adverse events were secondary endpoints. Results and limitations: The median follow-up time for patients who were alive when the follow-up ended was 9.3 yr in the adjuvant group and 8.6 yr in the observation group. The 10-yr survival for biochemical recurrence was 82% in the adjuvant group and 61% in the observation group (hazard ratio [HR] 0.26 [95% confidence interval {CI} 0.14-0.48], p < 0.001), and for overall survival 92% and 87%, respectively (HR 0.69 [95% CI 0.29-1.60], p = 0.4). Two and four metastatic cancers occurred, respectively. Out of the 43 patients with biochemical recurrence in the observation group, 37 patients received salvage radiotherapy. In the adjuvant group, 56% experienced grade 3 adverse events, versus 40% in the observation group (p = 0.016). Only one grade 4 adverse event occurred (adjuvant group). A limitation of this study was the number of patients. Conclusions: Adjuvant radiotherapy following radical prostatectomy is generally well tolerated and prolongs biochemical recurrence-free survival compared with radical prostatectomy alone in patients with positive margins or extracapsular extension. Patient summary: Radiotherapy given immediately after prostate cancer surgery prolongs prostate-specific antigen progression-free survival, but causes more adverse events, when compared with surgery alone. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Background: Patients with non-muscle-invasive bladder cancer (NMIBC) belonging to the intermediate-risk group should be treated with intravesical instillations to prevent recurrence and progression.Objective: We compared the outcome of a monthly maintenance bacillus Calmette-Guerin (BCG) regimen with that of epirubicin (EPI) and interferon-alpha 2a (IFN) in patients with NMIBC.Design, setting, and participants: Our prospective randomized multicenter study comprised 229 eligible patients with frequently recurrent TaT1 grade 1-2 or low-grade NMIBC enrolled between 1997 and 2008.Interventions: The four-arm study involved a single perioperative instillation of EPI plus five weekly instillations of BCG or EPI/IFN, followed by 11 monthly instillations in the 1-yr BCG or EPI/IFN maintenance arms, further followed by four additional quarterly instillations in the two 2-yr maintenance arms.Outcome measurements and statistical analysis: Time to recurrence, progression, disease-specific survival, and overall mortality were analyzed using the Kaplan-Meier and cumulative incidence analyses plus the Cox and proportional subdistribution hazards models.Results and limitations: The median follow-up time was 7.5 and 7.4 yr in the BCG and EPI/IFN groups, respectively. The probability of recurrence was significantly lower in the BCG group than in the EPI/IFN group. The probability was 39% versus 72% at 7.4 yr, respectively (hazard ratio [HR]: 0.41; 95% confidence interval [CI], 0.28-0.60; p < 0.001). There was no significant difference in the probability of progression or in overall survival. However, there was a significant difference in disease-specific mortality in favor of the BCG group (HR: 0.20; 95% CI, 0.04-0.91; p = 0.04).Conclusions: The monthly maintenance BCG regimen showed excellent efficacy and was significantly better in preventing recurrence than a similar regimen of EPI/IFN-alpha 2a.Patient summary: A monthly bacillus Calmette-Guerin (BCG) regimen showed excellent efficacy and was significantly better in preventing recurrence than a similar regimen of epirubicin and interferon-alpha 2a. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Endoscopic transanal resection (ETAR) is a scarcely used technique to treat large or sessile rectal adenomas not amenable to polypectomy. The purpose of this study was to evaluate safety and long-term results of ETAR in treating rectal adenomas in three hospitals over 15 years.

Purpose: In a multicenter, prospectively randomized study we evaluated the 5-year outcomes of bacillus Calmette-Guerin alone compared to a combination of epirubicin and interferon-alpha 2b in the treatment of patients with T1 bladder cancer.Materials and Methods: Transurethral resection was followed by a second resection and bladder mapping. Stratification was for grade and carcinoma in situ. Followup entailed regular cystoscopy and cytology during the first 5 years. The end points assessed in this analysis were recurrence-free survival, time to treatment failure and progression, cancer specific survival and prognostic factors.Results: The study recruited 250 eligible patients. The 5-year recurrence-free survival rate was 38% in the combination arm and 59% in the bacillus Calmette-Guerin arm (p = 0.001). The corresponding rates for the other end points were not significantly different, as free of progression 78% and 77%, treatment failure 75% and 75%, and cancer specific survival 90% and 92%, respectively. The type of treatment, tumor size and tumor status at second resection were independent variables associated with recurrence. Concomitant carcinoma in situ was not predictive of failure of bacillus Calmette-Guerin therapy. An independent factor for treatment failure was remaining T1 stage at second resection.Conclusions: Bacillus Calmette-Guerin was more effective than the tested combination therapy. The currently recommended management with second resection and 3-week maintenance bacillus Calmette-Guerin entails a low risk of cancer specific death. More aggressive treatment in patients with infiltrative tumors at second resection might improve these results. In particular, concomitant carcinoma in situ was not a predictive factor for poor outcome after bacillus Calmette-Guerin therapy.

Traumatic spinal cord injury is most common among men between 16 and 30 years. Prevention should be targeted both on traffic safety and individual behaviour Key issues in patient care are safe transfer from the place of injury to a hospital, diagnostic imaging (primarily CT, MRI if needed) and assessment of neurological injury by AIS-questionnaire, early surgical decompression and stabilisation for most cases, and treatment and rehabilitation starting from the emergency room and extending to life-long care carried out by a multi-professional team.

Objective. Hexaminolevulinate (HAL) is an optical imaging agent used with fluorescence cystoscopy (FC) for the detection of non-muscle-invasive bladder cancer (NMIBC). Guidelines from the European Association of Urology (EAU) and a recent, more detailed European expert consensus statement agree that HAL-FC has a role in improving detection of NMIBC and provide recommendations on situations for its use. Since the publication of the EAU guidelines and the European consensus statement, new evidence on the efficacy of HAL-FC in reducing recurrence of NMIBC, compared with white light cystoscopy (WLC), have been published. Material and methods. To consider whether these new trials have an impact on the expert guidelines and on clinical practice (e. g. supporting existing recommendations or providing evidence for a change or expansion of practice), a group of bladder cancer experts from Denmark, Finland, Norway and Sweden met to address the following questions: What is the relevance of the new data on HAL-FC for clinical practice in managing NMIBC? What impact do the new data have on European guidelines? How could HAL-FC be used in clinical practice? and What further information on HAL-FC is required to optimize the management of NMIBC? Results and conclusions. This article reports the outcomes of the discussion at the Nordic expert panel meeting, concluding that, in line with European guidance, HAL-FC has an important role in the initial detection of NMIBC and for follow-up of patients to assess tumour recurrence after WLC. It provides practical advice, with an algorithm on the use of this diagnostic procedure for urologists managing NMIBC.

Electrical stimulation of sacral nerve roots is called neuromodulation. In urology, neuromodulation has been used for the treatment of frequency syndrome, urinary incontinence and urinary retention. Faecal incontinence and constipation are the most significant indications for the use of neuromodulation in gastroenterology. Carefully selected patients should be evaluated by trial test during which the symptom diary will be filled before implantation. Permanent generator implantation can be done for patients with significant objective relief of symptoms. Generator setting can be adjusted by a remote control. Clinical trials have shown the benefit of neuromodulation in long-term. Implanted patients have to stay under routine follow-up in order to detect device malfunctions.

Objective. Sacral neuromodulation is a treatment modality for voiding dysfunction that is resistant to conventional medical and surgical treatments. In Finland, sacral neuromodulation has been used for the treatment of urgency-frequency syndrome, non-obstructive urinary retention and painful bladder/interstitial cystitis since 1996. Material and methods. The investigation retrospectively evaluated 180 tested patients, 74 of whom underwent permanent implantation of the InterStim (R) device. Results. A positive test result leading to implantation was significantly more frequent among females than males. Among urinary retention patients, the patients with a positive test leading to implantation were significantly younger than those without implantation. The implantation operation time was significantly shorter when using a tined lead device compared with open electrode insertion (76 vs 122 min). The mean follow-up time was 41 months (range 0-143). Significant improvement after implantation was noted in the mean urinated volumes and number of daily urinations, as well as in the number of catheterizations in urgency-frequency syndrome and urinary retention, respectively. The subjective long-term outcome was similar in these indications. Surgical revision was required for 15 patients (20.3% of implanted patients). Conclusions. The difference in gender distribution compared with earlier published series may be explained by a selection bias due to the limited referrals of female patients from gynaecologists. The results favour the use of a tined lead device because of the shorter operating room time. Furthermore, the outcome seems to be more favourable among patients with a staged implant procedure compared with a one-stage operation with a tined lead device.

Ureteral injuries associated with treatment procedures have been in constant rise. Laparoscopic operations within the lesser pelvis constitute their most common cause. Most injuries are detected only after days or weeks after the operation, with only one fifth being noted during the operation. In the worst case, ureteral injury may lead to complete renal failure. The earlier the injury is detected and treated by stenting or an open operation, the better is the treatment outcome. The ureter must be either stented or repaired by an open operation in order to repair the injury.

Urological and gastroenterological patients may benefit from the therapeutic use of botulinum neurotoxin. Urologic indications include overactive bladder refractory to conventional treatments, painful bladder, chronic pelvic pain syndromes and problems with bladder emptying. Currently, there are no approved therapeutic indications for urologic conditions. In general, botulinum neurotoxin treatment is well tolerated and adverse events are predictable and limited to the urogenital tract, though rare severe and fatal complications have been reported.

Purpose: To evaluate the initial clinical experience of magnetic resonance imaging (MRI)-guided percutaneous laser ablation of small RCCs.Material and Methods: Eight patients with 10 tumors were treated with percutaneous MRI-guided laser ablation. All tumors (diameter range 1.5-3.8 cm, mean 2.7 cm) were biopsy-proven RCCs. By using a 0.23 T open MRI system and general anesthesia in patients, one to four (mean 2.6) laser fibers were placed and the tumors were ablated under near real-time MRI control by observing the signal void caused by the temperature change in the heated tissue. The treatment was considered successful if the tumor showed no contrast enhancement at follow-up imaging.Results: All except one tumor were successfully ablated in one session. The first patient treated showed enhancing residual tumor in post-procedural MRI; she has thus far declined retreatment. One complication, a myocardial infarction, occurred; all other patients tolerated the procedure well. No local recurrence was discovered during the follow-up (range 12-30 months, mean 20 months).Conclusion: In this small group of patients with relatively short follow-up period, MRI-guided percutaneous laser ablation proved to be a promising treatment option for small RCCs.

Objective: Urinary bladder endometriosis is a severe form of endometriosis often requiring surgery. The several cases treated at our hospital in recent years has led us to evaluate the incidence of urinary bladder endometriosis in Finland. Methods: We performed a register-based analysis of incidence of urinary bladder endometriosis. The patients were identified according to registered diagnosis and operation codes. Results: Six urinary bladder endometriosis cases were diagnosed at Oulu University Hospital during 1991–2007. These cases have been presented. The annual incidence, as evaluated from The Finnish Care Register HILMO, increased from 3.6 to 9.4 cases/1,000,000 females aged 15–49 years per year during 1996–1999 and 2004–2007, respectively, in Finland. Conclusion: There is an apparent increase in incidence of urinary bladder endometriosis in Finland. The low number of cases detected at Oulu University Hospital, and the limitations of the incidence evaluation based on the HILMO register, exclude the presentation of an accurate incidence. The results presented warrant further and careful evaluation of potential increases in urinary bladder endometriosis elsewhere.

Background: Bacillus Calmette-Guerin (BCG) instillation is regarded as the most effective bladder-sparing treatment for patients with high-grade T1 tumours and carcinoma in situ (CIS). The major problem with this therapy is the side-effects, making maintenance therapy difficult, even impossible, in a proportion of patients. Thus, alternative schedules and drugs have been proposed.Objective: To compare BCG to the combination of epirubicin and interferon-alpha 2b as adjuvant therapy of T1 tumours.Design, setting, and participants: This is a Nordic multicenter, prospective, randomised trial in patients with primary T1 G2-G3 bladder cancer. Initial transurethral resection (TUR) was followed by a second-look resection. Patients were randomised to receive either regimen, given as induction for 6 wk followed by maintenance therapy for 2 yr.Measurements: The drugs were compared with respect to time to recurrence and progression. Also, side-effects were documented.Results and limitations: A total of 250 patients were randomised. At the primary end point, 62% were disease free in the combination arm as opposed to 73% in the BCG arm (p = 0.065). At 24 mo, there was a significant difference in favour of the BCG-treated patients (p = 0.012) regarding recurrence, although there was no difference regarding progression. The subgroup analysis showed that the superiority of BCG was mainly in those with concomitant CIS. In a multivariate analysis of association with recurrence/progression status, significant variables for outcome were type of drug, tumour size, multiplicity, status at second-look resection, and grade. A corresponding analysis was performed separately in the two treatment arms. Tumour size was the only significant variable for BCG-treated patients, while multiplicity, status at second-look resection, and grade were significant for patients treated with the combination.Conclusions: For prophylaxis of recurrence, BCG was more effective than the combination. There were no differences regarding progression and adverse events between the two treatments. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.

BACKGROUND AND PURPOSE:Endopyelotomy is an option for the management of ureteropelvic junction (UPJ) obstruction, but long-term outcome data are lacking. The purpose of this study was to evaluate the long-term outcome of endopyelotomy.PATIENTS AND METHODS:We retrospectively collected data from all endopyelotomies performed in two low-volume hospitals in Finland between 1987 and 2007. The diagnosis was based primarily on urography results. We also conducted a patient survey during the fall of 2007 for the subjective outcome of the operation. There were 18, 17, and 29 patients with a mean follow-up time 152.2, 67.1, and 77.6 months treated by percutaneous antegrade endopyelotomy, Acucise endopyelotomy, and retrograde endopyelotomy, respectively.RESULTS:Reoperation for recurrent UPJ obstruction was required for 0, 1 (6%) and 5 (17%) of the patients, the radiographic outcome of the operation was better in 17 (94%), 13 (76%), and 18 (62%) of the patients, and 0, 2 (12%), and 5 (17%) of the patients experienced no relief in pain after percutaneous antegrade endopyelotomy, Acucise endopyelotomy, and retrograde endopyelotomy, respectively. Complications necessitating intervention were recorded for 7 (38.9%), 4 (23.5%), and 4 (13.8%) patients after antegrade endopyelotomy, Acucise endopyelotomy, and retrograde endopyelotomy, respectively. According to the patient survey, 15 (100%), 11 (73%), and 19 (86%) of the respondents were satisfied with the results of the operation after antegrade endopyelotomy, Acucise endopyelotomy, and retrograde endopyelotomy, respectively. The patients were mainly monitored by radiologic examinations, not by renography.CONCLUSIONS:Endopyelotomy offers good and durable results in the long-term. Complications were common, however, and laparoscopic pyeloplasty may be a recommended option for management of primary UPJ obstruction.

You have accessJournal of Urology1 Apr 2008ADJUVANT INTRAVESICAL EPIRUBICIN AND INTERFERON α 2b IS COMPARABLE TO BCG FOR TREATMENT OF T1 TUMOURS OF THE URINARY BLADDER Per-Uno Malmstrom, Fredrik Wiklund, Milos Duchek, Oddvar Mestad, Pekka Hellstrom, and Staffan Jahnson Per-Uno MalmstromPer-Uno Malmstrom More articles by this author , Fredrik WiklundFredrik Wiklund More articles by this author , Milos DuchekMilos Duchek More articles by this author , Oddvar MestadOddvar Mestad More articles by this author , Pekka HellstromPekka Hellstrom More articles by this author , and Staffan JahnsonStaffan Jahnson More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61721-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "ADJUVANT INTRAVESICAL EPIRUBICIN AND INTERFERON α 2b IS COMPARABLE TO BCG FOR TREATMENT OF T1 TUMOURS OF THE URINARY BLADDER." The Journal of Urology, 179(4S), p. 587 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179 Issue 4S April 2008 Page: 587 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetrics Author Information Per-Uno Malmstrom More articles by this author Fredrik Wiklund More articles by this author Milos Duchek More articles by this author Oddvar Mestad More articles by this author Pekka Hellstrom More articles by this author Staffan Jahnson More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:There is an impression that ureteric injuries have become more common during the past decade, and therefore this study aimed to determine the incidence, aetiology, features, treatment and outcomes of ureteric injuries over an extended period.MATERIAL AND METHODS:Records of patients treated for ureteric injury in 1986--2006, divided into three 7-year periods, were reviewed retrospectively. The numbers of open and laparoscopic gynaecological, surgical and endourological operations were ascertained.RESULTS:All 72 ureteric injuries recorded were iatrogenic, being diagnosed in 60 females and 11 males (mean age 52 years). Only five injuries occurred during the first 7-year period (1986--1992), but the incidence was markedly higher during the following two 7-year periods, 28 (1993--1999) and 39 (2000--2006), respectively. The injuries were mostly secondary to gynaecological procedures (64%) or general surgery (25%). Only 11% occurred in association with a urological procedure. The cause was mostly laparoscopic (56%) or open surgery (33%), and the injury was in most cases located in the lower ureter (89%). The diagnosis was usually delayed (in 79%), with a median time to diagnosis of 6 days. The injuries were managed by ureteroneocystostomy (49%), a ureteral stent (19%) or end-to-end anastomosis (12%). The complication rate was 36%.CONCLUSIONS:Iatrogenic ureteric injuries have increased markedly during the past two decades. Gynaecological laparoscopic procedures account for more than half of the injuries, and the most common location is the lower ureter. Most injuries are treated by ureteroneocystostomy, but endourological treatment yields acceptable results. To improve the management of ureteric injury there must be a high index of suspicion, especially during laparoscopic operations.

T1 tumours of the urinary bladder have a high rate of recurrence and progression. Intravesical BCG substantially improves the outcome but other successful adjuvant treatments are desirable. The aim of the present Nordic randomized study on newly diagnosed T1 tumours with or without CIS was to show that treatment with immunochemotherapy is not inferior to BCG alone.