The Value of Upper Tract Cytology After Transurethral Resection of Bladder Tumor in Patients With Bladder Transitional Cell Cancer

Sadek, Samih; Soloway, Mark S.; Hook, Sharon; Civantos, Francisco

doi:10.1097/00005392-199901000-00027

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…Notably, two of the present patients required additional treatment for upper tract recurrences. While the proportion of patients diagnosed with NMIBC who go on to develop upper tract TCC is traditionally considered to be <3%[23–25], patients with high‐risk superficial disease have been reported to have upper tract recurrence rates of up to 18% after BCG treatment [26,27]. It is difficult to make any inferences without a randomized controlled trial as to whether treatment with intravesical docetaxel positively or negatively altered the risk of upper tract recurrence in the present patients, who were already at increased risk from previous BCG treatment, but our observation indicates the necessity of close surveillance of the upper tract in patients having bladder recurrences after BCG therapy.…”

Section: Discussionmentioning

confidence: 60%

A single‐institution experience with induction and maintenance intravesical docetaxel in the management of non‐muscle‐invasive bladder cancer refractory to bacille Calmette‐Guérin therapy

et al. 2009

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OBJECTIVE To analyse the durability of response for patients with non‐muscle‐invasive bladder cancer (NMIBC) refractory to bacille Calmette‐Guérin (BCG) therapy and treated with intravesical docetaxel in a combined induction and maintenance regimen. PATIENTS AND METHODS A previous phase I trial showed docetaxel to be safe for intravesical therapy, with no systemic absorption and minimal toxicity after six weekly instillations for patients with BCG‐refractory NMIBC. In that trial, docetaxel gave a 56% complete response (CR) rate at 12 weeks, but the durability was only 22%. Thus a second group of patients was treated with a 6‐week induction and then given monthly maintenance therapy with intravesical docetaxel. Thirteen patients with BCG‐refractory Ta, T1, or Tis transitional cell carcinoma were treated. Induction therapy was administered as six weekly intravesical instillations of 75 mg followed by single‐dose monthly maintenance therapy for nine additional instillations in patients who had a CR. The initial response at 12 weeks from the start of induction therapy was evaluated by cystoscopy with biopsy, and urine cytology. The follow‐up consisted of quarterly cystoscopy with biopsy and cytology, and periodic imaging. RESULTS The median follow‐up was 13 months; 10 of 13 patients had a CR after induction, and six have remained disease‐free during the follow‐up. Of those in who the treatment failed, six had transurethral resection of the tumour and one a cystectomy. All 10 initial responders completed at least three instillations of maintenance therapy to date (median nine instillations), of whom six have remained recurrence‐free. CONCLUSION Monthly maintenance therapy with intravesical docetaxel appears to extend the durability of response to induction treatment for a selected group of patients with BCG‐refractory NMIBC, and might decrease the overall risk of recurrence in high‐risk NMIBC.

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Section: Discussionmentioning

confidence: 60%

A single‐institution experience with induction and maintenance intravesical docetaxel in the management of non‐muscle‐invasive bladder cancer refractory to bacille Calmette‐Guérin therapy

et al. 2009

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“…Intraoperative upper tract urine cytology examination might increase the cost, lengthen the operating period and cause urinary tract infection. To our knowledge, only one study has reported the value of upper tract urine cytology examination at the same time as TUR; that study concluded that sampling of urine from the upper tract was not accurate because of contamination . However, the number of patients was very small; in addition, the patients were diagnosed as having “no malignancy” because of normal upper tract appearance on radiography.…”

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confidence: 99%

Is it necessary to carry out intraoperative retrograde upper urinary tract cytology examination in bladder cancer patients with normal upper urinary tract appearance and suspicious or positive voided urine cytology?

et al. 2016

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Patients with BC might have concurrent UTUC, reported in approximately 2-5% of BC patients; 1,2 therefore, examination of the upper tract should be considered in BC patients. However, in BC patients with normal upper tract appearance on radiography and suspicious or positive urine cytology before TUR, which might suggest the potential presence of concomitant upper urinary carcinoma in situ in addition to BC, the necessity of retrograde upper tract cytology examination at the same time as TUR remains unclear in almost all guidelines in the USA and Europe, as well as Japan.3,4 Intraoperative upper tract urine cytology examination might increase the cost, lengthen the operating period and cause urinary tract infection. To our knowledge, only one study has reported the value of upper tract urine cytology examination at the same time as TUR; that study concluded that sampling of urine from the upper tract was not accurate because of contamination. 5However, the number of patients was very small; in addition, the patients were diagnosed as having "no malignancy" because of normal upper tract appearance on radiography. The study reported only the results of upper tract urine cytology, and not the final diagnosis of the patients with positive upper tract urine cytology. In the present study, we retrospectively examined the rate of concurrent UTUC in BC patients with normal upper tract appearance on radiography and preoperative suspicious or positive voided urine cytology.From January 2012 through December 2014, 132 BC patients underwent simultaneous TUR for BC and retrograde upper tract urine cytology examination. A total of 12 patients were excluded from the present study, because the upper tract appearance was abnormal on radiography. Therefore, 120 patients with normal upper tract appearance on radiography and preoperative suspicious or positive voided urine cytology were examined. Contrast-enhanced computed tomography, computed tomography urography, intravenous pyeloureterography or retrograde pyeloureterography was carried out for the radiographic examination. The urine cytology was evaluated by two specialists according to our strict institution criteria. Positive cytology (class IV, V) is defined as clusters of malignant cells or pathognomic cells, and suspicious (class III) cytology is defined as cells with abnormal features, but not sufficiently pathognomonic. In patients with suspicious or positive upper tract urine cytology, we carried out ureteroscopy, repeat retrograde upper tract cytology examination or careful follow up with voided urine cytology examination, as well as computed tomography urography examination, for confirmation. Table S1 shows the patients' characteristics. The median age was 73.5 years (range 38-88 years), and 104 of the 120 patients (86.7%) were men. The median follow-up time was 13 months (range 1-35 months). A total of 69 patients (57.5%) had normal urine cytology postoperatively. Figure 1 shows the clinical course of the patients. A total of 75 patients (62.5%) had positive voided u...

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The Value of Upper Tract Cytology After Transurethral Resection of Bladder Tumor in Patients With Bladder Transitional Cell Cancer

Cited by 2 publications

References 18 publications

A single‐institution experience with induction and maintenance intravesical docetaxel in the management of non‐muscle‐invasive bladder cancer refractory to bacille Calmette‐Guérin therapy

A single‐institution experience with induction and maintenance intravesical docetaxel in the management of non‐muscle‐invasive bladder cancer refractory to bacille Calmette‐Guérin therapy

Is it necessary to carry out intraoperative retrograde upper urinary tract cytology examination in bladder cancer patients with normal upper urinary tract appearance and suspicious or positive voided urine cytology?

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