Ethanol preservation of voided and catheterized urine has long been the standard for urinary cytologic study. In this report ethanol preservation of bladder irrigation specimens was evaluated for flow cytometric analysis in a multiinstitutional study requiring specimen transport. Specimens from ten patients obtained at one center were preserved for varying periods of time in 50% ethanol, then distributed by express mail to four other participating centers, up to 3000 miles distant. On receipt, from 1 to 3 weeks after collection, the samples were processed and examined by flow cytometric study using propidium iodide as the fluorochrome. Forty-six of the 50 (92%) analyzed specimens gave satisfactory histograms. In 41 of the 46 adequate samples (89%), an aneuploid peak in the alcohol preserved (propidium iodide stained) specimen correlated well with the fresh (acridine orange stained) specimen. However, there was variable loss of DNA stainability with a broadening of the coefficient of variation in some alcohol-preserved specimens and an increase in cellular debris so that measurements of DNA index and percent hyperdiploid cells were considered unreliable. The authors conclude that ethanol preservation of bladder irrigation specimens for short periods of time may be a feasible alternative when flow cytometric analysis cannot be carried out on fresh specimens, but that this is not optimal fixation for specimens that must be transported and further studies of other fixatives are recommended.

Thirty-seven patients with superficial bladder cancer (Ta, T1) who failed local control were treated with external beam radiotherapy: 22 received full dose radiotherapy without interval cystoscopic monitoring and 15 followed a protocol in an attempt to select a subgroup of radiosensitive tumours. Both the unselected and protocol treated patients demonstrated the limited usefulness of external beam radiotherapy in the treatment of superficial bladder cancer.

The levels of the low-molecular weight keratin 18 appearing in the voided urine of 130 healthy volunteers was studied using a new immunoradiometric assay for keratin 18 (IRMAK-18). Keratin 18 was detected in 79 urines with an average level of 2.5 +/- 4.7 ng./ml. The assay does not detect complex epidermal keratins or non-keratin intermediate filaments. Only 50% of the purified keratin added to urine could be recovered. The recovered keratin had the same molecular weight as the input molecules, implying that substances in the urine physically inhibited the assay rather than destroyed the keratin. The independent variables of cell count, dead cells, and protein concentration were not found to be important in evaluating the results. However, the urine concentration, as measured by creatinine, might be an important consideration for assessing the levels of keratin detected.

The level of urinary keratin was compared in patients with and without bladder cancer using the newly developed IRMAK-18. Patients with bladder cancer had higher levels of keratin (74.6 ± 146.9) than normals (2.5 ± 4.7). When the upper limit of normal was set at keratin >20ng./ml., the test was highly specific (98%) for bladder cancer but had a sensitivity of only 46%. Adjusting to keratin >10ng./ml. increased the sensitivity to 57% but decreased the specificity to 91%. E1evated keratins were associated with stage and grade, aneuploidy and disease history. The IRMAK-18 assay for keratin may be useful for monitoring the clinical progress of some patients.

No AccessJournal of Urology1 Mar 1987Post Urethroplasty Squamous Cell Carcinoma I. Sawczuk, R. Acosta, D. Geant, and R. DeVeee White I. SawczukI. Sawczuk More articles by this author , R. AcostaR. Acosta More articles by this author , D. GeantD. Geant More articles by this author , and R. DeVeee WhiteR. DeVeee White More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)44114-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Post Urethroplasty Squamous Cell Carcinoma." The Journal of Urology, 137(3), pp. 585–586 © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 3March 1987Page: 585-586 Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information I. Sawczuk More articles by this author R. Acosta More articles by this author D. Geant More articles by this author R. DeVeee White More articles by this author Expand All Advertisement PDF DownloadLoading ...

Radical prostatectomy provides an excellent degree of disease control for the longest period of time in patients with localized prostatic cancer. Although advocates of radiation therapy point to nearly identical survival curves for patients treated with either interstitial or external techniques, an analysis of disease-free survival suggests that radical prostatectomy yields the best long-term "cure." Crude fifteen-year survival rates of 50 per cent may be achieved with radical prostatectomy, compared with 20 per cent to 25 per cent associated with radiation therapy. Additional experience with long-term survival data is necessary before a final conclusion can be drawn from comparison of the two treatment modalities.

The pathophysiology of the abnormal spermatogenesis seen in the presence of the varicocele has not been elucidated in spite of extensive study. Furthermore, no satisfactory explanation exists for the bilateral abnormal spermatogenesis seen in a process which is felt to be unilateral in the majority of cases. The present study was designed to determine if a surgically produced unilateral varicocele would lead to ipsilateral testicular changes prior to the onset of contralateral testicular alterations. Utilizing the rat model and microsurgical techniques, the effects of the varicocele on ipsilateral and contralateral spermatogenesis was studied at intervals over 49 days. Mean seminiferous tubular diameter measurements and flow cytometric analysis of testicular tissue were utilized to assess spermatogenesis. A statistically significant decrease in mean seminiferous tubular diameter was seen between day 1 and day 49 in the left testicle. The right testicle tended to demonstrate similar changes but these were not significant by the method of analysis used. Flow cytometric analysis of testis DNA content also revealed a statistically significant difference in the percentage of haploid, diploid and tetraploid cells in the left testis on day 1 as compared to day 49. The right testis again tended to demonstrate similar but not significant changes. Though primarily a unilateral process, bilateral spermatic vein abnormalities were also visualized in some animals. This observation may contribute to the bilateral effect observed. These studies demonstrate that a surgically created left varicocele will result in bilateral testicular alterations. Within the time frame of the study, the ipsilateral alterations progressed to a greater degree.

Primary transitional cell carcinoma of the prostatic periurethral ducts is c distinct histologic variety of prostate carcinoma. Traditional methods of therapy for adenocarcinoma of the prostate are ineffective. A review of the literature suggests that appropriate radical surgical therapy should be considered for early control of this disease.

Utilizing a Dunning prostate tumor model, we investigated the ability of misonidazole, a compound with known radiosensitizing properties, to act as a chemosensitizer when administered in combination with the alkylating agent cyclophosphamide. This combination caused a decrease in tumor growth rate when compared to the growth of the tumor in animals receiving cyclophosphamide alone. However, only at toxic levels was this decrease statistically significant (p less than 0.01).

This study evaluates the ability of DNA histograms obtained by flow cytometry to detect and quantify reversible alterations in spermatogenesis induced by cyclophosphamide, a known inhibitor of spermatogenesis. Evaluation of per cent of cells in each of the haploid (lc), diploid (2c), and tetraploid peaks (4c) as determined by flow cytometry in treated and control Balb/C mice over a six-week period, and comparison with routine histologic evaluation have led us to conclude that DNA histogram evaluation is a rapid and accurate means of identifying testicular damage and recovery. This technique may be useful in sequential monitoring of the effects of malignancy and/or treatments applied on spermatogenesis in young men.

Pelvic lymph node evaluation by computed tomography was correlated with histologic diagnosis in patients with prostate and bladder carcinoma. Based on computed tomography alone, the stage of the carcinomas would have been underestimated in 38 per cent of cases and overestimated in 6 per cent. Over-all, the sensitivity of pelvic CT scanning in detecting lymph node involvement was only 14 per cent with specificity of 89 per cent. Although this series is relatively small and both second and fourth generation scanners were used, the limitations of computed tomography in recognizing minimal nodal disease or microscopic invasion of adjacent organs is reemphasized.

Male Wistar Lewis rats were injected with maytansine at a total dose of 0.425 to 0.6 mg/kg over a 3-week period. Biopsies taken at 5 weeks showed that 23% of the bladders had hyperplasia or other abnormalities. Of the bladder biopsies done for the first time at 8 weeks, 80% demonstrated papillary hyperplasia. A small number of biopsies at 13 and 19 weeks still showed hyperplasia and minimal inflammatory reaction. These results were seen regardless of prior biopsy, the presence of bladder calculi, and/or the dose level used. It is not clear from the data whether the observed changes are reversible or precarcinogenic. However, these changes closely resembled the histologic features described in the evolution of bladder cancer in rats fed N-C4-(5-nitro-2-furyl)-2-thiazolyl formamide.

Analysis of DNA histograms obtained from rat renal cancer cells stained with propidium iodide and submitted to flow cytometry revealed a tumor cell population with prominent 2C and 4C peaks and with usually less than 10% each of S-phase or hyper-4C cells. The presence of an increased proportion of 4C cells was found to depend on the age and size of the tumor nodule. Sampling replicate portions of the same tumor or different tumors of the same size and age frequently revealed highly variable 4C:2C ratios. Treatment of animals bearing this tumor with a single i.p. injection of cyclophosphamide (CY), under conditions known to reduce the tumor burden by 80% within 1 week, or with 5-fluorouracil (FUra), which is ineffective against this tumor, in many cases did not yield changes in DNA histograms that permitted one to distinguish the effective drug. Either no marked difference in histogram shape occurred after therapy, or FUra induced more striking differences in cell cycle position than did CY. In tumor generations with greater than 15% S-phase cells, treatment with CY resulted in multiple effects on DNA histograms. These included detecting increased numbers of moribund cells (hypo-2C), a decrease in 4C cells, and an increase in hyper-4C cells. These changes did not occur with the ineffective agent FUra. The tumors grown in vitro show no evidence of replication of 4C cells. The DNA histograms of late-log-phase cultures have a major 2C peak and a minor S plus G2 hump. Since neither the untreated tumor in vivo nor that grown in vitro has a major hyper-4C cell population, it is probable that the tumor stem cells are chiefly 2C (diploid-hyperdiploid). Treatment in vitro of late-log-phase cultures with CY or FUra produces DNA histograms which permit identification of the effective agent. After CY, a major part of the cell population was hypo-2C (moribund) cells.

In a series of 112 patients undergoing pelvic lymphadenectomy for clinically localized prostate cancer, 37 were found to have pelvic lymph node metastases. After prostatic irradiation, these 37 patients were divided into groups receiving adjunctive chemotherapy versus no additional treatment. The patients were followed for a period ranging from twelve to sixty-five months for evidence of disease progression. Of the 12 patients administered chemotherapy, disease progression was documented in 4 (average time to progression was fifteen months). In contrast, of the 25 patients receiving no additional treatment, 12 exhibited evidence of gross metastatic disease within an average interval of 11.6 months. One death has been recorded in the chemotherapy group at twenty-nine months after diagnosis; 4 deaths have occurred in patients receiving no systemic therapy (average time to death was eighteen months).