Abstract Objectives This study aimed to investigate the anti‐PD‐1 inhibitor pembrolizumab as a potential agent for use in non‐muscle‐invasive bladder cancer (NMIBC) by conducting a Phase 1 safety run‐in study to assess the safety and tolerability of intravesical pembrolizumab after transurethral resection of the bladder tumour (TURBT). Patients and methods Eligible patients had recurrent NMIBC for which adjuvant treatment post TURBT was a reasonable treatment option, Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0–1 and adequate end‐organ function. Pembrolizumab was administered by intravesical instillation once weekly for a total of six doses. Intra‐patient dose escalation was performed in three paired patient cohorts with doses starting at 50 mg and increasing through 100 mg to a maximum of 200 mg. Adverse events (AEs) were assessed using Common Terminology Criteria for Adverse Events (CTCAE) v4.03 with dose limiting toxicity (DLT) defined as a clinically significant, drug‐related, Grade 4 haematological or Grade 3 or higher non‐haematological toxicity occurring within 7 days of administration of the first treatment at a given dose for that patient. Results Six patients were treated with no DLTs seen during dose escalation. Drug‐related AEs were of low grade and included dysuria and fatigue. All patients completed six doses of treatment as planned. Pharmacokinetic and pharmacodynamic assays did not detect any pembrolizumab in the serum following repeated intravesical administration, and no changes in peripheral immune cell populations were observed. Conclusions Administration of intravesical pembrolizumab was well tolerated and did not raise any safety concerns in patients with NMIBC following TURBT. There was no evidence of systemic absorption or systemic immune effects following intravesical administration. Further studies are required to assess whether intravesical administration has anti‐tumour activity.

The first wave of the COVID-19 pandemic placed unprecedented strains on healthcare systems worldwide, with significant detriment to the routine diagnosis and follow-up of non-COVID patients. For UK bladder cancer (BC) patients, our previous survey captured and reported some of these detriments.1 By the arrival of the second wave (peaking in January 2021 and ending in April 2021),2 the UK's NHS had adjusted clinical pathways in line with national and international guidelines in order to reduce such disruption. Through this second survey, we investigated whether such reconfiguration had mitigated the impact of the second wave on BC patients. The survey was distributed via the SurveyMonkey platform (San Mateo, CA, USA) from 26 January to 30 May 2021. As previously, patients were directed to this survey via the Action Bladder Cancer (ABC) UK website (http://actionbladdercanceruk.org/), ABC UK Patient Support Groups and social media platforms. Anonymized demographic and tumour-specific characteristics were collected. Analysis of these data was approved by the King's College London Research Ethics Office. Data were predominantly analysed descriptively; chi-squared and Fisher's exact tests were conducted to compare changes to treatment and monitoring due to COVID-19 between age groups, sex and diagnosis (NMIBC/MIBC). Kruskal–Wallis tests were undertaken to determine differences in the answers to the questions ‘How concerned do you feel about COVID’ and ‘How concerned do you feel about COVID-19 affecting your BC treatment and monitoring?’ between age groups, sex, diagnosis and treatment groups. All analyses were conducted using STATA/MP 17.0 (Texas, USA). A total of 134 participants consented to take part in the survey (versus 156 in the first survey); here, we present results from the 95 participants who answered the questions (vs. 156 patients in the first survey). Fewer than one-quarter (23%) of respondents reported participation in our first survey in 2020. Most respondents lived in England (90%), were over the age of 60 (70%) and were male (57%); a larger proportion of female respondents answered this survey compared with the first (43% vs. 28%) (Table S1). Regarding BC diagnosis, 75% reported having NMIBC, 15% with MIBC and 3% with advanced disease, and 7% were unsure of their stage (Table S1). The majority of respondents (64%) were undergoing monitoring rather than active treatment, 29% were on active treatment, and a small proportion had been discharged from follow-up (6%). When asked to reflect upon their treatment during 2020, the majority of respondents reported that their treatment was delivered when expected (67%), whilst 75% of respondents reported that their BC monitoring appointment occurred when expected (Figure 1). Fourteen patients responded that their treatments were either cancelled or delayed. Fisher's exact tests did not reveal significant differences in treatment disruption between age groups, sex and NMIBC/MIBC. However, for patients undergoing monitoring/follow-up, statistically significant differences were observed for age groups (p = 0.020) and NMIBC/MIBC (p = 0.006)—a higher proportion of younger patients were not scheduled for monitoring (older patients mostly reported that their monitoring occurred as expected), and more patients with NMIBC had their monitoring appointment postponed or cancelled (n = 17) compared with MIBC patients (n = 1). Almost all respondents reported feeling some level of anxiety or concern about COVID-19 (90%) (Figure 1). Conversely, regarding concerns about COVID-19 affecting BC treatment or monitoring, one-third of respondents (28%) felt no concern at all (similar to Survey 1, 26%), 9% reported feeling very anxious, and the majority of patients reported feeling a little concerned or concerned (50%) (Figure 1). Again, these were similar to the first survey in which 51% reported feeling a little anxious and 22% very anxious. Over 60% of respondents reported feeling as supported or more supported during the pandemic than before the pandemic. When participants were asked to comment on the changes made by their hospital in response to the pandemic, seven patients reported that the implemented changes were positive—the efficiency of telephone appointments and use of different hospitals or buildings were specifically highlighted as positives. Notwithstanding, participants reported negative experiences of visiting hospital appointments alone; for example, one respondent wrote, ‘Not being able to bring anybody with you to consultations as I suffer from MCI (mild cognitive impairment)’. Our first survey, conducted during and immediately after the first wave of the pandemic in the United Kingdom, reported that 49% of patients experienced disruption to their treatment or follow-up (delays, postponements or cancellations/curtailments).1 This survey appears to report the resumption of a more ‘normal’ service within the following 9 months, with over two-thirds of patients reporting that their treatment and monitoring had occurred as expected. Notably, considerably fewer patients responded to this survey than the previous survey, suggesting an overall ‘satisfaction’ with the care received.3, 4 These data demonstrate an impressive turnaround in the delivery of care to BC patients, despite the substantial incumbent challenges of the UK's second wave of the pandemic. This is testimony to the resilience and determination of the NHS and its healthcare professionals, a resilience and determination that will be tested again as both the Omicron and Deltacron variants propagate in the United Kingdom and worldwide. Anecdotally, a number of urology units continue to experience considerable disruption, indicated here by a not insubstantial minority of respondents still describing delays to treatment and monitoring. Here, we report that most patients did not experience a delay to their treatment or monitoring appointments during the study period. Other studies have also investigated the effect of the pandemic on the time to BC treatment. Ferro et al investigated the impact of the pandemic on time to primary and secondary resection and adjuvant intravesical therapy in high-risk NMIBC patients5: Although no significant differences in TURBT quality were identified, a delay in treatment schedule and disease management was observed. The authors highlighted the need to investigate the oncological impacts of these delays,5 as we did in our first report.1 A strength of this study is that the patients who responded to this survey are representative of the general BC population in their distribution of age, sex and bladder stage grouping (NMIBC and MIBC). However, the sample size of 95 respondents represents only a very small minority of the UK's BC patient community. Despite many positive changes (including the use of telephone consultations and alternative infrastructure) and that half of respondents had been vaccinated at the time of the survey, most patients understandably still feel anxiety and concern for COVID-19 and the impact the pandemic has had, or may have, on their BC care. With the pandemic relentlessly continuing into 2022, it is imperative that research also continues to monitor the impact on BC patients such that longer-term planning for the inevitable detriments can be well informed. R. T. Bryan has contributed to advisory boards for Olympus Medical Systems and Janssen and undertakes research funded by UroGen Pharma and QED Therapeutics. ABC UK is a UK-registered charity and receives income from a variety of sources including public donations and grants, as well as educational grants from corporate supporters. In 2020 to date, ABC UK has received educational grants from Bristol Myers Squibb, Janssen-Cilag Ltd, Merck Serono Limited and Pfizer UK. Table S1. Characteristics of survey respondents. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Citation for published version (Harvard): Spencer-Bowdage, S, Russell, B, Rigby, J, O'Kelly, J, Kelly, P, Page, M, Raw, C, Allchorne, P, Harper, P, Crew, J, Kockelbergh, R, Knight, A, Van Hemelrijck, M & Bryan, R 2021, 'The experience of UK bladder cancer patients during the COVID-19 pandemic: a survey-based snapshot', BJU International , vol. 127, no. 2, pp. 179181. https://doi.org/10.1111/bju.15287

ABSTRACT The Covid-19 pandemic has placed unprecedented strain on healthcare systems worldwide. Within this context, UK cancer services have undergone significant disruption to create capacity for the National Health Service. As a charity that endeavours to support bladder cancer (BC) patients and improve outcomes, Action Bladder Cancer UK (ABCUK) designed and administered a SurveyMonkey survey to investigate the prevalence of such disruption for BC patients. From 22 nd April to 18 th June 2020, 142 BC patients responded. Across all patient groups, 46.8% of patients described disruption to their treatment or follow-up. For non-muscle-invasive BC (NMIBC) patients, disruptions included postponement of: initial transurethral resection of bladder tumour (TURBT) (33.3%), subsequent TURBT (40.0%), and surveillance cystoscopy (58.1%). For NMIBC patients undergoing intravesical therapy, 68.4% experienced treatment postponements or curtailments. For muscle-invasive BC patients, 57.1% had experienced postponement of cystectomy and 14.3% had been changed from cystectomy to radiotherapy. Half of patients undergoing systemic chemotherapy also experienced disruption. Despite the survey’s limitations, we have demonstrated considerable disruption to the care of BC patients during the UK Covid-19 pandemic. To avoid a repeat, the UK BC community should define effective contingent ways of working ready for a possible ‘second wave’ of Covid-19, or any other such threat.

To establish factors predictive of success prior to Prostate Artery Embolization (PAE) with MRI imaging. A prospective cohort study of 50 patients with Benign Prostatic Hyperplasia (BPH) were treated with PAE in a single institution. Patients had moderate to severe symptoms of BPH refractory to medical management for at least 6 months. Patients were imaged with multiparametric MRI imaging pre-PAE and at 3 months, 12 months and 24 months post-PAE. Clinical success was measured with IPSS, IIEF and EQ-5D-5L quality of life questionnaires. The technical success was 48/50 (96%).The mean age of the group was 67 (range 54–83). The mean IPSS score pre-PAE was 21 and at 24 months was 8 (p < 0.001). There was no deterioration in erectile function. The mean volume of the prostate post-PAE was reduced at 3 and 12 months post-PAE but not significantly different at 24 months. This did not correlate with the IPSS score. Patients with median lobe enlargement has similar symptomatic improvement as those without median lobe enlargement. Internally within the prostate patients with adenomatous-dominant BPH initially did better than patients with stromal enlargement; however, at 24 months patients with stromal enlargement of the prostate improved greatest. Initial volume of the prostate was not a good predictor of clinical success. PAE is a safe and effective treatment strategy for treating men with BPH. Patients with Adenomatous BPH clinically do better until 12 months but not at 24 months. Initial prostate volume does not affect outcome, and patients with median lobe enlargement do as well as those without.

AIM:This narrative review describes current guidelines for treating NMIBC, provides an overview of the principle behind immune checkpoint inhibition, and summarizes current evidence for checkpoint inhibitors in urothelial malignancy. Further, we discuss potential strategies for immune checkpoint inhibition in the management of NMIBC. BACKGROUND:Adjuvant intravesical BCG immunotherapy has been the mainstay of treatment for high-risk non-muscle-invasive bladder cancer (NMIBC) for decades but is associated with both a significant side effect profile and failure rate. Recently, a substantial body of trial data has been published demonstrating the successful use of systemic immunotherapy in the treatment of advanced urothelial malignancy and, in particular, a class of drugs known as 'immune checkpoint inhibitors'. This has led to the approval of a number of these drugs by the UK National Institute of Health and Care Excellence and the US Food and Drug Administration, and ongoing trials are examining use in the management of NMIBC. METHODS:To identify relevant published data, using the PubMed/ Medline search engine, an online search of the Pubmed/ Medline archives was conducted using the terms bladder cancer' in combination with 'checkpoint inhibitors', and limited to articles in English published between 1966 and September 2017.To identify ongoing trials of interest but not yet published, a further search of the clinical trials.gov search engine was conducted using the term 'non-muscle-invasive bladder cancer'. CONCLUSION:There has been little advance in available adjuvant therapy for NMIBC treated with TURBT. Current intravesical therapies are associated with a high recurrence rate and significant side effect profile. The impending publication of the wealth of ongoing trials, both into the delivery and efficacy of checkpoint inhibition will direct the future treatment of NMIBC.

Prostate artery embolization (PAE) has been shown to be beneficial in treating men with benign prostatic hypertrophy (BPH). Here we describe treating four patients with prostate cancer (two with organ-confined and two with metastatic prostate cancer) with prostatic bleeding with PAE. Patients had other causes of hematuria excluded and were followed up at 3, 12, and 18 months after PAE. All four cases were technically successful and all cases of hematuria had resolved by the three-month follow-up (100%). There was one case of recurrence at 13 months after PAE which was successfully treated. PAE is useful for controlling significant prostatic bleeding in patients with prostate cancer and improves quality of life. Patients may, however, need repeated treatments to control the bleeding.

High and intermediate risk non-muscle invasive bladder cancer poses a real challenge for treatment. Approximately 70% of bladder cancer presents as non-muscle invasive and 20–25% will progress to muscle invasive disease. Recurrences occur in up to 70% but treatment options are limited. Intravesical bacillus Calmette–Guérin is still considered the bladder sparing treatment of choice despite its well documented pitfalls. This review considers how bacillus Calmette–Guérin has become the recommended treatment, its benefits and risks and the alternative options for treatment. Level of evidence: Not applicable for this multicentre audit.

406 Background: Intravesical BCG has been the mainstay of therapy following TURBT for intermediate risk NMIBC for many years and is thought to act through activation of non-specific local immunity. With the recent success of checkpoint inhibitor treatment in metastatic bladder cancer, we sought to investigate the anti-PD1 inhibitor pembrolizumab as a potential agent for use in patients with intermediate risk NMIBC in a phase I/II study. The primary aim of the phase I safety run-in was to assess the safety and tolerability of intravesical pembrolizumab after TURBT in patients with intermediate risk NMIBC. Methods: Eligible patients had recurrent NMIBC for which adjuvant treatment post TURBT was a reasonable treatment option, ECOG PS 0-1 and adequate end organ function. Pembrolizumab was administered by intravesical instillation once weekly for a total of 6 doses. Intra-patient dose escalation was performed in three paired patient cohorts with doses starting at 50mg and increasing through 100mg to a maximum of 200mg. Adverse events (AEs) were assessed using CTCAE v4.03 with dose limiting toxicity (DLT) defined as a clinically significant, drug related, grade 4 haematological or ≥ grade 3 non-haematological toxicity occurring within 7 days of administration of the first treatment at a given dose for that patient. Results: In the first 4 patients treated, no DLTs were seen during dose escalation. Drug-related AEs included Grade 1 dysuria, fatigue and nausea. Grade 1-2 urinary tract infections, Grade 1 cystitis and Grade 3 urosepsis (SAE) were observed but assessed as probably not related to pembrolizumab. Recruitment of a final cohort of two patients at repeated doses of 200mg is ongoing to confirm safety and tolerability of this dose. Conclusions: Administration of intravesical pembrolizumab was safe and well tolerated in patients with NMIBC following TURBT. A randomised, parallel group, phase II marker-lesion study to assess the safety, efficacy and tolerability of either intravesical pembrolizumab or intravenous pembrolizumab in a larger cohort of patients with intermediate risk recurrent NMIBC is planned. Clinical trial information: NCT03167151.

Multidisciplinary clinics are useful where there is patient choice, but patients are often seen sequentially, rather than synchronously in the same room. The National Institute for Health and Care Excellence (NICE) guidelines for bladder and prostate cancer [ 1 NICE Bladder cancer: diagnosis and management. 2015 Google Scholar , 2 NICE Prostate cancer: diagnosis and management. 2014 Google Scholar ] do not currently recommend using synchronous joint clinics.

espanolDesde su introduccion en 1976, el Bacilo de Calmette-Guerin (BCG) se ha convertido en el estandar de tratamiento en cancer de vejiga no musculo invasivo de alto riesgo (CVNMI). A pesar de mas de 40 anos de experiencia, no conocemos la dosis de BCG optima para conseguir la maxima efectividad mientras se minimizan los efectos secundarios. Existe un acuerdo universal de que un ciclo de induccion inicial de BCG debe consistir en 6 instilaciones semanales si se tolera. Sin embargo, con respecto a la dosis real, los datos sobre la efectividad comparativa de un tercio de dosis frente a la dosis completa de BCG no son concluyentes. Del mismo modo, aunque existe una fuerte evidencia que respalda el uso de mantenimiento con BCG, no se ha adoptado universalmente. Se desconoce el regimen de mantenimiento optimo, pero la duracion minima para el mantenimiento efectivo de la terapia con BCG parece ser de 12 meses, mientras que no hay evidencia para apoyar el mantenimiento de BCG mas alla de los 36 meses.Dada la precariedad de los suministros mundiales de BCG en los ultimos anos, es imperativo que se lleven a cabo ensayos aleatorios de alta calidad para determinar la dosis minima y la duracion del tratamiento con BCG en pacientes con CVNMI. EnglishSince its introduction in 1976 Bacille Calmette- Guerin (BCG) has become the standard of care in high risk non-muscle-invasive bladder cancer (NMIBC). Despite more than 40 years of experience, we do not know the most optimal BCG dose to maximize effectiveness whilst minimizing side effects. There is universal agreement that an initial induction course of BCG should consist of 6 weekly instillations if tolerated. However, with regards to the actual dose, data on the comparative effectiveness of one third dose versus full dose BCG is inconclusive. Similarly, whilst there is strong evidence supporting the use of BCG maintenance, this has not been universally adopted. The optimal maintenance regimen is unknown but the minimum length for effective maintenance BCG therapy seems to be 12 months whilst there is no evidence to support BCG maintenance beyond 36 months. Given the precarious state of worldwide BCG supplies in the last few years, it is imperative that high quality randomized trials are carried out to determine the minimum dose and length of BCG treatment in patients with NMIBC.

To assess the effectiveness of prostate artery embolization (PAE) in the control of haematuria and in patients with benign prostatic hyperplasia (BPH) and normal upper urinary tracts.

Bladder cancer represents a significant health burden worldwide, with non-muscle-invasive tumours representing the majority of new bladder cancer diagnoses. Non-muscle-invasive bladder cancer (NMIBC) has a high prevalence and forms a large proportion of the caseload in urological practice, accounting for a significant cost in terms of urological healthcare. The last two decades have seen the development and refinement of guidelines from national and international organisations aiming to optimise management of NMIBC and bladder cancer in general. This review outlines the most recent European and United Kingdom guidelines on NMIBC, and in particular focuses on comparing and contrasting key recommendations from guidelines published by the European Association of Urology and the UK-based National Institute for Clinical Excellence. Level of evidence: Not applicable for this multicentre audit.

Since its introduction in 1976 Bacille Calmette- Guerin (BCG) has become the standard of care in high risk non-muscle-invasive bladder cancer (NMIBC). Despite more than 40 years of experience, we do not know the most optimal BCG dose to maximize effectiveness whilst minimizing side effects. There is universal agreement that an initial induction course of BCG should consist of 6 weekly instillations if tolerated. However, with regards to the actual dose, data on the comparative effectiveness of one third dose versus full dose BCG is inconclusive. Similarly, whilst there is strong evidence supporting the use of BCG maintenance, this has not been universally adopted. The optimal maintenance regimen is unknown but the minimum length for effective maintenance BCG therapy seems to be 12 months whilst there is no evidence to support BCG maintenance beyond 36 months. Given the precarious state of worldwide BCG supplies in the last few years, it is imperative that high quality randomized trials are carried out to determine the minimum dose and length of BCG treatment in patients with NMIBC.

To investigate the clinical impact of performing prostate artery embolization (PAE) on patients with adenomatous-dominant benign prostatic hyperplasia (AdBPH).

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance III1 Apr 2017PD55-08 INTRODUCING MPMRI INTO CONTEMPORARY UK ACTIVE SURVEILLANCE FOR LOCALISED PROSTATE CANCER Richard Bryant, Bob Yang, Yiannis Philippou, Karla Lam, Maureen Obiakor, Jennifer Ayers, Fergus Gleeson, Ruth MacPherson, Clare Verrill, Ian Roberts, Thomas Leslie, Jeremy Crew, Prasanna Sooriakumaran, Freddie Hamdy, and Simon Brewster Richard BryantRichard Bryant More articles by this author , Bob YangBob Yang More articles by this author , Yiannis PhilippouYiannis Philippou More articles by this author , Karla LamKarla Lam More articles by this author , Maureen ObiakorMaureen Obiakor More articles by this author , Jennifer AyersJennifer Ayers More articles by this author , Fergus GleesonFergus Gleeson More articles by this author , Ruth MacPhersonRuth MacPherson More articles by this author , Clare VerrillClare Verrill More articles by this author , Ian RobertsIan Roberts More articles by this author , Thomas LeslieThomas Leslie More articles by this author , Jeremy CrewJeremy Crew More articles by this author , Prasanna SooriakumaranPrasanna Sooriakumaran More articles by this author , Freddie HamdyFreddie Hamdy More articles by this author , and Simon BrewsterSimon Brewster More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2431AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) of localized prostate cancer (PCa) in the UK involved protocol-driven (P) transrectal repeat biopsies (RB) plus serial digital rectal examination & PSA-testing, until NICE 2014 guidelines recommended multi-parametric magnetic resonance imaging (mpMRI) should drive RB where needed or replace P-RB. Interrogating our AS follow-up (F/U) data, we hypothesized that mpMRI reduces the number of RB required to drive therapeutic intervention (TI). METHODS 445/461 (97%) AS patients had complete F/U data. Cohort features at diagnosis include median age 68.9 years (interquartile range IQR 63.7-74.8), median PSA 7.2ng/mL (IQR 5.6-9.6), median PSAD 0.11 (IQR 0.08-0.18), ≤cT1c in 80%, 54% unilateral Gleason 3+3, 23% unilateral 3+4, 2% unilateral ≥4+3, 18% bilateral ≥3+3, and median Charlson Comorbidity score 3.1 (IQR 2.5-4.2). We examined the drivers for TI and compared the utility of mpMRI prior to potential RB in AS. RESULTS 132/445 (30%) patients underwent TI (59% external beam radiotherapy/brachytherapy, 22% radical surgery, 19% other) over a median AS (inter-quartile range IQR) F/U of 2.4 (1.2-3.73) years (maximum F/U 11.3 years). Median (IQR) time to TI was 1.55 (0.71-2.4) years. Reasons for TI included rising PSA, patient choice, mpMRI abnormality alone and/or RB Gleason upgrading. Where TI was driven by RB, 43/71 (61%) had undergone mpMRI, and 39% had P-RB without mpMRI. 49/97 (51%) demonstrated upgrading on RB following mpMRI versus 38/115 (33%) for P-RB without mpMRI. Time to TI was similar for those undergoing RB following mpMRI versus P-RB without mpMRI (P=0.877). Of those upgraded at RB, the number of RB procedures needed to upgrade one patient was 1.9 if prior mpMRI was used versus 3.3 for P-RB alone. CONCLUSIONS In this UK cancer centre AS cohort, replacement of P-RB with mpMRI ± RB where indicated, benefitted patients by reducing the number of invasive interventions needed to identify disease progression (characterized by Gleason upgrade), leading to treatment intervention. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1054 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Richard Bryant More articles by this author Bob Yang More articles by this author Yiannis Philippou More articles by this author Karla Lam More articles by this author Maureen Obiakor More articles by this author Jennifer Ayers More articles by this author Fergus Gleeson More articles by this author Ruth MacPherson More articles by this author Clare Verrill More articles by this author Ian Roberts More articles by this author Thomas Leslie More articles by this author Jeremy Crew More articles by this author Prasanna Sooriakumaran More articles by this author Freddie Hamdy More articles by this author Simon Brewster More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PURPOSE:To assess the safety, success, and complications associated with retrograde ureteric stent insertion via the ileal conduit. MATERIALS AND METHODS:The study population comprised 35 consecutive patients (17 men and 18 women; mean age, 55 y; age range, 40-75 y) requiring primary (20 stents) and exchange (70 stents) retrograde ureteric stent insertion via the ileal conduit over a 3-year period. Patient demographic data, procedural and technical data, and clinical follow-up data were collected. RESULTS:Technical success was 90% (18 of 20) for primary stent placement and 100% (70 of 70) for stent exchange. There were two immediate complications (< 24 h) of sepsis and ureteric injury and one early complication (> 25 h but < 30 d) of sepsis requiring observation and medical management. Difficult procedures (defined as a fluoroscopy screening time > 31 min) and technical failures were found to be associated with encrusted stents visualized on prior computed tomography (P = .012), increased length of ileal conduit (> 20 cm) (P = .023), and ileal conduit kink (< 90 degrees) (P = .032). Only the occurrence of encrusted stents visualized on prior computed tomography (P = .022) was associated with complications. CONCLUSIONS:Retrograde placement of ureteric stents via the ileal conduit is safe and effective. Retrograde stent placement should be considered the treatment option of choice for a first-time occurrence of obstructive uropathy at the ureteroileal anastomosis.

235 Background: Meta-analysis data demonstrate a 5% absolute survival benefit for the use of neoadjuvant chemotherapy (NAC) using cisplatin-based combination regimens in the radical treatment of muscle-invasive bladder cancer (MIBC). However, there is currently no randomized controlled trial data on the optimum regimen for this setting. Accelerated MVAC (AMVAC) is effective in advanced disease, and has the potential advantage over other NAC regimens of minimising delays to definitive, potentially curative therapy. We present data regarding its use as NAC in MIBC patients. Methods: Retrospective analysis was performed on all 80 consecutive patients with muscle-invasive transitional cell carcinoma of the bladder, treated during a 50-month period at 2 U.K. centers. Patients received either 3 or 4 cycles of methotrexate 30mg/m 2 , vinblastine 3mg/m 2 , doxorubicin 30mg/m 2 and 4-hour infusion of cisplatin 70mg/m 2 at 2-week intervals, with G-CSF support, prior to definitive therapy with either radical surgery (RS) or radical radiotherapy (RT). Results: All planned cycles of chemotherapy were completed in 84% of patients. All 80 patients received their planned definitive therapy. Pathological complete response (pCR) was seen in 43% of 60 patients treated with surgery following chemotherapy. There were no chemotherapy-related deaths and grade 3 or 4 toxicities were seen in 11% of patients. Median duration of chemotherapy was 34 days. Dose reduction or delay was required in 7% and 9% of patients, respectively. Objective radiological local response was seen in 75% of patients. At a median follow-up of 27.5 months, 25 (32%) patients have relapsed and 11 (14%) died. Two-year disease-free survival was 65% overall, and was statistically significantly superior in patients who were radiologically node-negative prior to chemotherapy. Conclusions: AMVAC is a safe, well-tolerated, and easily deliverable regimen with excellent treatment outcomes and minimizes delays to definitive treatment. It is an appropriate comparator for future randomized trials. No significant financial relationships to disclose.

Urinary bladder cancer (BCa) is the most common malignancy of the urinary tract. In recent decades, the overall incidence of BCa appears to be on the increase. Despite the increase in incidence, mortality rates in North America and Europe appear to have declined in the last decade, probably due to improved detection and treatment. The mainstay of diagnosis is by cystoscopy, aided with imaging and urine tests (e.g., cytology). This article reviews the recent advances made in detection of primary and recurrent bladder cancer.