The influence of the instillation of thiotepa or doxorubicin hydrochloride into the bladder at the end of transurethral surgical treatment on the recurrence of bladder cancer was evaluated. We studied in a randomized, double-blind, controlled fashion 89 patients with transitional cell epithelioma (carcinoma in situ or papillary carcinoma) whose tumors were considered to have been completely removed. Of these patients 28 (the control group) received a placebo (sterile water), 30 received thiotepa and 31 received doxorubicin. By 3 to 4 months postoperatively 71 per cent of the control group, and 30 and 32 per cent, respectively, of the patients treated with thiotepa and doxorubicin had recurrences (p less than 0.01). Additional treatment during the followup interval was ineffective in all groups. Patients studied also were classified according to grade, histological findings, multiplicity of tumors and history of bladder tumor. Treatment was most effective in reducing recurrence in patients with low grade, papillary or multiple tumors and in patients with a history of bladder cancer. No effect was observed in patients with single tumors and only modest effects were found in those with high grade tumors, carcinoma in situ or new tumors. The results support the concept that recurrences may arise from tumor cell implantation at the time of transurethral management of bladder tumors and may be reduced effectively by concomitant intravesical chemotherapy.

Intraoperative pyeloscopy was performed on 18 consecutive patients with indeterminate pelvic of caliceal filling defects, subsequently proved to be transitional cell carcinomas. After nephroureterectomy local tumor recurrence in the region of the renal fossa developed in 2 patients. Intraoperative pyeloscopy entails significant risks and the seeding of transitional cell carcinoma is possible.

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An increased frequency of various genitourinary anomalies, infertility, and testicular cancer among males has been reported to follow intrauterine exposure to diethylstilbestrol, but not all studies have confirmed an association. This study was designed to determine whether a cohort of males exposed in utero to diethylstilbestrol had a higher frequency of urogenital abnormalities than an unexposed cohort. Biases in selection of exposed and control participants were minimized. Of 828 exposed and 676 control men studied by medical-record review, 265 exposed men and 274 controls also underwent a special clinical examination. Overall, the data suggest that diethylstilbestrol exposure of males in utero did not increase their risk of genitourinary abnormalities, infertility, or testicular cancer. Previously reported increased frequencies of these abnormalities in diethylstilbestrol-exposed men may have resulted from selection biases or differences in diethylstilbestrol use, or both.