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‘Various studies have found intravesical chemotherapy with mitomycin-C to be an effective treatment in preventing the recurrence rate of superficial bladder cancer.’ The use of intravesical therapy for the treatment of superficial bladder cancer aims to reduce morbidity and mortality by eradicating existing disease, preventing tumor recurrence and attempting to halt tumor progression. Mitomycin-C is a commonly used intravesical treatment option for superficial bladder cancer and was used for the first time by Shida and colleagues in 1967 [1]. It is an antitumor antibiotic with a molecular weight of 334.3 and is soluble in water and organic solvents. Mitomycin-C is usually minimally absorbed on intravesical instillation due to its high molecular weight and hydrophobic nature. The use of an instillate at the lowest achievable osmotic strength appears to be optimal for the intravesical instillation of the drug and, hence, sterile water is preferred over saline. Its dose is typically 40 mg per instillation – this regimen has been shown to exhibit a longer time-torecurrence and less recurrence compared with the standard regimen (20 mg) in patients with Stage Ta and grade 1–2 bladder cancer [2].

Cytomegalovirus (CMV) infection in immunocompromised patients is a major cause of morbidity and mortality. A well-documented manifestation of gastrointestinal CMV infection is gastrointestinal haemorrhage. In contrast, CMV-associated intestinal perforation has rarely been reported after transplantation, although it is well documented in AIDS patients. Three patients are reported who received their first cadaveric renal transplant in 1994 and subsequently developed CMV disease. During the course of their CMV illness, which was treated with ganciclovir, each presented with clinical suspicion of peritonitis and proceeded to laparotomy. All three were found to have sigmoid colon perforations with histological evidence of CMV infection. Following bowel resection and defunctioning, two patients made an uneventful recovery and have had the continuity of their bowel restored, but one died of overwhelming sepsis within hours of surgery. The explanation for the apparent clustering of this rare condition in transplant patients is uncertain.

The cancer pathway, from primary-care referral to specialist consultation, diagnostic test(s), decision to treat, treatment itself and, invariably, life-long follow-up, has the main aim of curing a patient with minimal morbidity, while maintaining their physical and psychological wellbeing. Recently, in the UK it was recommended that improvements in cancer outcome can be achieved through major organizational changes in cancer care by reorganizing cancer services into ‘cancer networks’ and adopting significant changes in professional practice through the promotion of specialization by individual consultants, a multidisciplinary approach and shared clinical protocols [101]. In urological oncology, it was recommended that all cancer patients should be managed by a multidisciplinary urological cancer team [102]. Taking this mandate forward, patterns of clinical practice have changed and at the heart of modern urological cancer care is the multidisciplinary team (MDT). The MDT consists of: • Consultant urologists; • Clinical and medical oncologists; • Radiologists with expertise in urological cancers to perform imaging investigations in accordance with the Royal College of Radiologists’ Guidelines [1]; • A specialist uropathologist who reports on all the information required by the current Royal College of Pathologists’ minimum dataset for the relevant cancer [103]; • Clinical nurse specialists who have a high level of skill in communication. Patient advocacy and provision of information and support for patients and carers are crucial aspects of this role; • An MDT coordinator, who organizes the weekly meeting and ensures that all required documentation is available at each meeting (e.g., patient lists and case notes); • A designated lead clinician (normally a consultant urologist) who will take overall responsibility for the service. According to the Guidance on Cancer Services: Improving Outcomes in Urological Cancers paper, the main roles of the MDT are: Provision of a rapid diagnostic and assessment service, including satisfying the 2-week-wait criterion [104]