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Objective: To determine whether recurrence at first follow-up cystoscopy predicts future recurrence in patients with an intermediate risk of superficial bladder cancer., Methods: In total, 304 patients were classified as low (n = 60), intermediate (n = 177) or high risk (n = 67) based on the primary pathological/clinical findings, as previously described in literature. The intermediate-risk group was further divided into 2 subgroups based on recurrence at the first follow-up cystoscopy: A (recurrence negative) and B (recurrence positive)., Results: The mean recurrence rates of low-, intermediate- and high-risk patients were 1.76, 6.41 and 9.49, respectively (p < 0.05). Similarly, the difference in the recurrence rates between subgroups A (4.37) and B (9.12) was found to be statistically significant (p = 0.00). Additionally, while the difference between the low-risk group and subgroup A was statistically significant (p = 0.008), there was no significance between subgroup B and the high-risk group (p = 0.892). In the multivariate analysis, the most significant prognostic parameter for recurrence was the outcome of the first follow-up cystoscopy, followed by tumor multiplicity and grade., Conclusions: Patients showing recurrence at first follow-up cystoscopy in the intermediate-risk group should be classified as high-risk patients and treated accordingly.

DNA, protein oxidation and lipid peroxidation possess a major impact in carcinogenesis. Also, inflammatory and oxidative events have remarkable importance in bladder cancer. Thus, in this study total protein, protein carbonyl, nitrotyrosine, thiol residues, non-protein thiols, lipid peroxidation, and also, because of their relations to the above parameters, iron and iron binding levels have been investigated in patients with bladder cancer and in control group. Statistical evaluation of the results demonstrated significantly lower plasma protein levels in the patients with bladder cancer, as compared to the healthy control group. Serum iron levels in patients with invasive bladder cancer were found to be significantly lower when compared with non-invasive group. Protein carbonyl groups were remarkably higher in bladder cancer patients than in healthy controls. Patients with bladder cancer were demonstrated to have significantly lower levels of total thiol groups and protein-bound thiol groups as compared to healthy controls. Protein-bound thiol groups in patients with invasive bladder cancer revealed a more significant decline, than in non-invasive group.

A case of retrovesical leiomyosarcoma in a male patient is described. The preoperative radiological and laboratory studies were inconclusive in determining the primary origin of the tumor. Diagnosis of a malignant tumor with smooth muscle origin was suggested by needle biopsy. However, the definitive diagnosis and the primary site of origin could only be determined by surgical exploration and subsequent histopathologic examination after excision. No sign of recurrence or metastasis was present 12 months after complete surgical resection.

Urinary total sialic acid/creatinine (TSA/Cr) ratio was determined in 73 patients with superficial bladder tumors and 34 healthy volunteers. The mean TSA/Cr value in the tumor group was higher than the control group (P < 0.001) and this difference was significant. Comparing the urinary TSA/Cr ratio of Tl, Ta, grade I-II, grade III, single, multiple, primary and recurrent tumors, with the control group revealed significant results (P < 0.001). Therefore the urinary TSA/Cr ratio determination in the follow-up of these patients may be used as a non-invasive procedure.

There are conflicting reports about the natural history and prognosis of bladder tumours in patients under 40 years of age. A review of 156 patients younger than 40 treated at our Department between 1960 and 1991 with transitional cell carcinoma of the bladder revealed that 89.1% had superficial (Ta/T1) disease and the remaining 10.9% presented with invasive disease. Slightly more than half of the patients with superficial disease had multiple tumours. The follow-up of 97 patients over a period of 12-372 months revealed that there was a recurrence rate of 10.3% and 38.4% for Ta and T1 tumours, respectively (p < 0.01). Further analysis comparing patients under 30 to those between 30 and 40 years revealed recurrence rates of 7.5% and 22%, respectively (p < 0.05). Progression rates for Ta and T1 tumours are 3.5% and 19.3% (p < 0.05). In the invasive disease group 8 patients were lost for follow-up, 2 died of the disease and the remaining 7 are alive, with a mean follow-up of 3.6 years. We conclude that while transitional cell carcinoma of the bladder in patients under 30 behave less aggressively, the behaviour of the disease in patients 30 to 40 years old is similar to the older age group and should be monitored closely, especially when risk factors for recurrence and progression are present.

Urinary glycosaminoglycan/creatinine (GAG/Cr) ratio was determined in 73 patients with superficial bladder tumors and 34 healthy volunteers. While the mean GAG/Cr value in the tumor group was higher than the control group (11.25 +/- 5.36 vs. 10.11 +/- 2.67) this difference was not statistically significant. However, comparing the urinary GAG/Cr ratio of T1, Grade III and recurrent tumors with the control group revealed statistically significant results (p < 0.01, p < 0.001 and p < 0.02 respectively). Therefore, the urinary GAG/Cr ratio determination in the follow-up of these patients may be used as noninvasive procedure and high levels may be signs of higher grade, higher stage disease.