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Objective: To decrease the risk of erectile dysfunction and incontinence by performing prostate-sparing cystectomy for bladder cancer; and to evaluate the oncological results by comparing them to those of radical cystectomy., Materials and Methods: Since 1994, 141 men have undergone cystectomy for bladder cancer. Twenty five patients with a mean age of 57 years (range: 47-75 years) underwent prostate-sparing cystectomy. The exclusion criteria were: contraindication to bladder replacement, invasion of the prostatic urethra, and associated prostatic adenocarcinoma. TURP was performed preoperatively to evaluate the prostatic urethra. All patients had a PSA < 4 ng/ml or negative prostatic needle biopsies. The Ditrovie and IIEF scores were used to evaluate the quality of voiding and erectile function., Results: The mean follow-up was 53.4 months (median: 46 months). The overall 5-year survival regardless of stage was 66%. Seven patients (28%) died, all from their cancer. Six patients (24%) developed a pelvic recurrence, 2 patients (8%) developed an urethral recurrence (1 had a multifocal lesion, and 1 had CIS) treated by TURP and 6 patients (24%) developed distant metastases. Among the patients with pelvic recurrence, 4 (66%) presented a multifocal tumour. One patient developed prostatic adenocarcinoma after 36 months, which was treated by external beam radiotherapy. At 1 year, 100% of patients reported normal daytime continence and 19 out of 22 patients (86.4%) were continent at night and had to get up 1 to 3 times per night. At 1 year, 10 out of 22 patients (45.4%) had normal erections, 9 (40.9%) reported impaired erectile function but allowing sexual intercourse, and 3 had major erectile dysfunction (13.6%). At 3 years, 93.7% of patients had normal daytime continence; 75% of patients were continent at night, 37.5% of patients reported normal erections, 37.5% of patients reported partial erections and 25% of patients reported major erectile dysfunction., Conclusion: Prostate-sparing cystectomy for the treatment of invasive bladder cancer improves continence, sexual function and quality of life of patients, with poorer oncological results to those of radical cystectomy in terms of pelvic recurrence. Rigorous patient selection should improve these results.

Purpose: The limitations of urinary cytology and the invasiveness of cystoscopy generate an increasing interest in noninvasive diagnostic tools for the management of transitional cell carcinoma. We assess the clinical performance of ImmunoCyt (DiagnoCure, Inc., Saint-Foy, Canada) in the detection of bladder cancer in a 10-center French trial., Materials and Methods: From October 2000 to April 2001, 694 patients undergoing cystoscopy were prospectively included in the study. Of the patients 458 (66%) had been previously treated for superficial transitional cell carcinoma and 236 (34%) were referred for symptoms suggestive of bladder cancer. All patients underwent ImmunoCyt test and standard urinary cytology from voided urine as well as a complete evaluation including cystoscopy and transurethral resection or biopsy of suspicious lesions. Sensitivity and specificity values of urinary cytology and ImmunoCyt whether or not combined were calculated using cystoscopy as the gold standard and histopathology when available., Results: A total of 85 recurrent and 58 newly diagnosed bladder tumors were diagnosed by cystoscopy and histologicaly confirmed. Overall sensitivity of urinary cytology was 17.9%, 46.3% and 63.8% respectively, for G1, G2 and G3 transitional cell carcinoma, whereas that of ImmunoCyt was 60.7%, 75.6% and 76.8%. Sensitivity of the combined tests was 66.7%, 78% and 87%, respectively. Moreover, 10 of 55 (18.2%) new pT1 and pT2 or greater tumors were diagnosed by ImmunoCyt alone. Specificity of urinary cytology was 94.5%, whereas that of ImmunoCyt was 84.2%. Specificity of the combined tests was 80.7%. Marked variations in urinary cytology sensitivity were observed among the different centers (27.3% to 66.7%), whereas combined assays (urinary cytology and ImmunoCyt) enhanced the overall sensitivity in the 80% range at most centers., Conclusions: This prospective multicenter series confirmed a marked increase in sensitivity without significant loss in specificity when including ImmunoCyt in standard urinary cytology protocol. This increased sensitivity was observed in high grade lesions (with 100% sensitivity for carcinoma in situ) as well in low grade, low stage tumors.

Objective: The principles of treatment of de novo bladder tumours in renal transplant patients are comparable to those applied in non-transplant patients. In the case of an invasive tumour, techniques can be used to restore urinary tract continuity after cystectomy. A case of cystectomy with enterocystoplasty for invasive bladder tumour in a renal transplant patient is reported., Material and Methods: An invasive urothelial bladder tumour was discovered in a 62-year-old man, 3 months after a 2nd renal transplantation. Treatment consisted of cystectomy with prostatic preservation and nontubulized enterocystoplasty., Result: With a follow-up of 21 months after cystectomy, the patient is alive without recurrence. He is perfectly continent during the day, with normal sexual intercourse and no reflux or residual urine. Renal function is normal., Conclusion: Cystectomy with enterocystoplasty can be an effective treatment for invasive bladder tumour in renal transplant patients. This treatment ensures oncological control and acceptable comfort while preserving the transplant.

Malignant histiocytofibroma of the bladder is a rare (16 cases reported in the literature) and very aggressive sarcoma. It is sometimes associated with a haematological malignancy. The authors report a case of malignant histiocytofibroma of the bladder in a 72-year-old haemodialysed woman with a poor general status. She had a history of chemotherapy and radiotherapy for gastrointestinal lymphoma 6 years previously. Treatment consisted of palliative cystectomy for bladder pain and haematuria. A massive pelvic and abdominal wall recurrence occurred two months after cystectomy and the patient died. The authors review the 16 cases of malignant histiocytofibroma of the bladder reported in the literature. Histiocytofibroma is a tumour which requires aggressive treatment with a combination of radical surgery and systemic chemotherapy.

Bladder cancer affects more often the male and accounts for about four per cent of death from cancer each year in France. Numerous factors may be responsible, first of which are smoking and certain carcinogens found in the workplace. Haematuria is well known as the main presenting symptom of bladder cancer but bladder tumors may present with and bladder symptom. Cystoscopy remains the key examination. Tumor resection brings details about the stage and the grade. In the case of an invasive tumor, staging procedures is necessary. This examination under estimates the stage in nearly 20% of cases. Superficial tumors are characterised by the risk of recurrence (40%).

Prostatic urothelial carcinoma concomitant with a bladder tumour is rare, but its incidence is increasing due to the precision of histological examination and the prevalence of bladder carcinoma in situ. Its prognosis depends on the depth of the prostatic lesion: carcinoma in situ, involvement of the ducts or even the stroma. In the case of high grade bladder tumour, multifocal tumour or bladder carcinoma in situ, a transurethral resection of the prostate is the best way of detecting this lesion. The therapeutic options depend on the depth of the prostatic invasion.

This single arm, open labeled, non randomized study was aimed to evaluate the toxicity of 3 cycles of MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) with rhG-CSF (5 micrograms/kg/day from day 3 to day 14), on 14 patients with previously untreated infiltrating bladder carcinoma, 42 cycles were administered. Chemotherapy toxicity was very low, with 7% of neutropenia grade 3 or 4.4% of thrombocytopenia grade 2, no mucositis above grade 2 and no nadir sepsis. Bone pain related to rhG-CSF occurred in 14% of cycles. 88% of the cycles were given at full dose without any delay and mean relative dose intensity was 96.4% (RDI was 100% for 9 patients). One patient achieved a complete pathological response (cystectomy: 1) and 6 clinical responses with negative transurethral resection. Addition of rhG-CSF to MVAC chemotherapy allows a high dose intensity of MVAC with very low toxicity over 3 cycles. This association should be compared to standard MVAC or intensified regimens to evaluate efficacy, toxicity, and cost effectiveness.

The authors report a rare association of adenocarcinoma of the urachus and urothelial bladder carcinoma. Treatment consisted of cystoprostatectomy with removal of the urachus and cutaneous ureterostomy. A review of the literature indicates that adjuvant treatment has yet to be defined. This is a chance association whose prognosis depends on the invasive nature of the urothelial tumour.

In a series of 107 patients treated over an 11-year period for upper urinary tract tumours (UTT), 30 had a synchronous or metachronous associated bladder tumour. The bladder tumour preceded the UTT in 10.3% of cases, the bladder tumour was synchronous in 6.5% of cases and the bladder tumour occurred after the UTT in 15% of cases, the incidence of UTT after cystectomy over this 11-year period was 3.3%. The median time to recurrence of the UTT after bladder tumour was 17 months. The median time to recurrence of the bladder tumour after the UTT was 12 months. The risk of bladder recurrence after treatment of the upper tract tumour was studied in relation to site, type of treatment, multifocal nature, stage and grade of the UTT and the presence of a previous or synchronous associated bladder tumour. None of these parameters constituted a predictive factor of bladder recurrence after treatment of an upper tract tumour. Comparison of survival between the UTT + bladder tumour group and the UTT alone group did not reveal any significant difference (p = 0.10). The theory of cellular implantation facilitated by vesicorenal reflux and the multifocal theory are complementary explanations of the multifocal and recurrent nature of urothelial tumours.

The authors report a series of 71 patients (sex ratio: 1F/4M, mean age: 68 years) with stage Ta (n = 20), T1a (n = 32), T1b (n = 14) and Tis (n = 5) bladder tumours treated by endoscopic resection followed by a course of intravesical BCG instillation (120 mg/week for 6 weeks). The mean follow-up was 15 months (3-36 months). The overall recurrence rate was 42%. A recurrence occurred in 50% of Ta (median time to recurrence: 10.1 months), 32% of T1a (median: 5.8 months), 65% of T1b (median: 7.3 months) and 20% of isolated Tis (median: 7 months). Disease progression was observed in 9% of stage T1 tumours. The following risk factors for recurrence were identified: stage T1b (p = 0.05), multifocal tumours (p = 0.05), resistance to previous chemotherapy (mitomycin C) (p = 0.001) and association with Tis for stages T1 (p < 0.02). The following risk factors for disease progression were identified: stage T1b (p < 0.001), grade III for stage T1 (p = 0.05) and association with Tis (p < 0.05). Ten patients (14%) developed transient BCGitis. BCG was found to be effective in the prophylaxis of recurrence of stage Ta, T1 and Tis bladder tumours. This treatment is proposed for recurrent stage Ta grade II and III tumours and stage T1 tumours in the presence of recognised risk factors. The high risk of progression for stage T1b grade III tumours associated with Tis demands rigorous surveillance.

The reserved prognosis of stage T1 (A) bladder tumours is emphasised in relation to a series of 41 cases: 95% of tumours recurred, one third of these recurrent tumours posed a therapeutic problem because of their diffuse nature (15%) or tumour progression (24%). The risk of allowing a limited tumour to progress towards and extensively infiltrating carcinoma justifies the search for a prognostic factor allowing the early recognition of the more aggressive lesions. At the present time, no one prognostic element can indicate with certainty the course of the T1 tumour. All of the data obtained from detailed histological examination of the tumour and the adjacent urothelium and from the early course of the tumour allow a better evaluation of the prognosis. The search for surface antigens (ABO) and, more recently, chromosome analysis and study of the DNA content of the tumour by flow cytometry, may complete this prognostic evaluation.

The electrocoagulation and resection of superficial tumors of the bladder leads to iatrogenic refluxes. The frequency of subsequent vesical recurrences may thus favor tumoral grafts in the upper urinary tract. Fives cases illustrate this risk. They were treated by ureteral resections and by one bilateral, and two unilateral nephroureterectomies. Should these refluxes be ignored or treated surgically in the event of repeated papillomatous recurrences?

The authors relate five cases of primary adenocarcinoma of the bladder that occurred between 1977 and 1983. Four tumours were located in the base and the lateral sides of the bladder, while the fifth was in the dome. Four tumours out of five were invading when diagnosis was done and were cured by a wide surgical cutting-away; the fifth which was a superficial one, was stopped by endoscopic resection. Bladder primary adenocarcinoma represent less than two percent of the whole epithelial tumours of this organ. They can be found under two specific topographic aspects: the first one, located in the dome or in the anterior wall is considered as a tumour of urachus, the second one, usually located in the trigonal and peri-trigonal area is considered as a vesical adenocarcinoma proper. The histogenesis of these lesions quite probably lies in a mechanism of vesical urothelium metaplasia under the influence of mechanical and infectious factors. Most of these tumours are isolated and invading when they are found out. One might distinguish adenocarcinomas similar to those of the gut, from urothelial carcinomas where the metaplastic glandular features are predominant. Clinically, glandular tumours hardly differ from the usual urothelial invading carcinoma except by a mucus secretion in the bladder that is, however quite unusual. Prognosis of such lesions is bad but a little better in urachus carcinoma cases. The treatment is surgical and involves a wide cutting-away, the extent of which can be discussed for urachus tumors. The impact of radiotherapy and chemotherapy upon them has still to be proved.(ABSTRACT TRUNCATED AT 250 WORDS)