No abstract

Between July 1994 and July 2001, all patients with superficial transitional cell carcinoma (TCC) of urinary bladder (pT1 and pTa), 7 days after undergoing transurethral resection of tumor were subjected to intravesical instillation of 60 mg BCG (Danish 1331) combined with 5 million IU interferon alpha-2b (Intron-A) mixed with 50 ml of physiological saline weekly for 8 weeks, then fortnightly for 8 weeks, then monthly for 8 weeks, followed by maintenance dose at the end of the 9th, 12th, 18th, 24th months. Each instillation was for 2 h duration with an average follow-up period of 60 months. At the end of the 1st year of follow-up 84% of patients had no tumor recurrence which dropped to 36% at the end of 5-year follow-up, while no incidence of disease progression at the end of the first year was recorded but was 20% at the end of 5 years, thereby resulting in a disease progression-free 5-year interval in 80% of our patients. Drug tolerance was excellent with a very low incidence of toxicity.

BackgroundOveractive bladder (OAB) is a bothersome condition affecting the quality of life, financial constraint on the individual, and community. Anticholinergic drugs cannot be used for long term due to adverse side effects. Botulinum toxin has recently shown promising and encouraging result in management of OAB.AimAim was to study the safety, efficacy, tolerability, and duration of effect of 200 units of botulinum toxin in refractory idiopathic detrusor overactivity.Materials and MethodsThirty-nine female patients (average age of 52 years) clinically and urodynamically diagnosed as idiopathic OAB were injected 200 units of botulinum toxin-A mixed with 20 ml of normal saline, intradetrusally at the rate of 1 mL at each site for 20 such sites sparing the trigone and ureteric orifices. Follow up at 3rd, 6th, 9th, and 12th month with clinical and urodynamical questionnaire was done.ResultsThere were 4 dropouts and 35 patients were evaluated, of which 30 patients (85.7%) showed improvement in clinical features like frequency, urgency, nocturia, and incontinence within 1 week of injection, which lasted for mean period of 7 months (varying from 6 to 9 months). Volume at first desire to void improved from median baseline of 104-204 ml and maximum cystometric capacity of bladder increased from mean baseline value of 205-330 ml. The detrusor pressure decreased by 49% from the baseline and postresidual urine volume increased by 30% of maximum cystometric capacity of bladder. There was no adverse effect on our patient.ConclusionIntradetrusor injection of Botox-A in management of refractory overactive idiopathic bladder is not only safe and well tolerated, but also very effective with practically no side effects.

Aims and Objectives:The incidence of bladder malignancy is increasing worldwide and the projected rise is 28% by 2010 for both sexes (WHO). Though intravesical adjuvant therapy with BCG is superior to any other immunotherapeutic/chemotherapeutic agent in reducing tumor recurrences and disease progression, its real efficacy remains controversial as one-third of the patients will soon become BCG failure. Hence there is a need for an alternative intravesical agent for treatment of BCG failure. Our aim was to study the efficacy, tolerability and safety of intravesical Gemcitabine in managing BCG-refractory superficial bladder malignancy.Materials and Methods:Thirty-five BCG failure patients, 26 males and nine females between 20-72 years of age were instilled with 2000 mg of Gemcitabine in 50 ml of normal saline intravesically two weeks post tumor resection, for six consecutive weeks. Mean follow-up was for 18 months with cystoscopies.Results:Twenty-one patients (60%) showed no recurrences, 11 patients (31.4%) had superficial recurrences while three patients (8.6%) progressed to muscle invasiveness. Average time to first recurrence was 12 months and to disease progression was 16 months. Adverse event was low and mild. Therapy was well tolerated.Conclusion:Gemcitabine fulfils all requirements as an alternative agent, in treating BCG failure patients with low adverse events, is well tolerated and highly effective in reducing tumor recurrences.

Objective: Benign prostatic hyperplasia is a common disorder in ageing males worldwide affecting one out of four males over 50 years of age. The aim of the present study is to demonstrate safety and efficacy of tamsulosin in its medical management. Methods: A total of 72 patients were enrolled; 38 patients given tamsulosin and 34 in the placebo group were enrolled. The mean age group was 61 years. Patients with an International Prostate Symptom Score (IPSS) of > 10, maximum flow rate < 13 mL/s and average flow rate < 6 mL/s with post residual urine volume (PRUV) > 100 mL and prostate-specific antigen < 4 ng/mL, were given 0.4 mg of tamsulosin/placebo daily on a randomized double-blind controlled study for 2 months. Patients with renal or hepatic failure, carcinoma prostate, stricture urethra, neurogenic bladder were excluded. All patients were followed up at the end of the second, fourth and eighth week. Results: There were three dropouts leaving 69 patients for evaluation. Improvement in the IPSS score was significantly greater with tamsulosin compared with the placebo. Similarly there was significant improvement in uroflowrate with tamsulosin compared to the placebo. The PRUV decreased by 38.8% with tamsulosin compared with the placebo. No significant change in blood biochemistry was noted between the two groups excepting for blood pressure, which showed a fall with tamsulosin compared to placebo. Adverse reaction was noted in five patients (7%), but none were withdrawn from the study. Conclusions: Our study confirms tamsulosin as a very effective and safe drug in the management of benign prostatic hyperplasia patients not having absolute indication for surgery with excellent patient compliance.