Jeremy P. Crew

Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour.

To evaluate multidetector computed tomography urography (MDCTU) for diagnosing upper urinary tract (UUT) urothelial tumour by comparison with retrograde ureteropyelography (RUP).

COMPUTED TOMOGRAPHY UROGRAPHY FOR DIAGNOSING BLADDER CANCER

To evaluate the use of computed tomography urography (CTU) for diagnosing bladder tumours in patients with macroscopic haematuria and aged >40 years.

Radiation-induced haemorrhagic cystitis.

Objectives: In this article we review the literature concerning the frequency and management of severe haemorrhagic radiation–induced cystitis. Methods: A Medline search was performed from 1966 to 1999 for articles in English. A total of 309 references were found. Abstracts and complete articles were reviewed. Results: Severe haemorrhagic cystitis following radiotherapy remains a relatively rare event. However, the fact that it is relentlessly progressive and that treatment options are suboptimal makes it clinically important. The incidence of severe haematuria following pelvic irradiation is difficult to determine from the literature although most studies state an incidence of less than 5% which increases with time since irradiation. Methods of treatment include simple bladder irrigation, cystodiathermy, oral, parenteral and intravesical agent, hyperbaric oxygen therapy, hydrodistension, internal iliac embolisation, urinary diversion and cystectomy. No management strategy is 100% successful and a stepwise progression in treatment intensity is often required. Conclusion: The articles available on radiation–induced haemorrhagic cystitis are principally retrospective and involve small numbers of patients who have had several different treatment modalities. In the absence of randomised studies comparing treatments, it is impossible to set definitive rules about management but patients with this condition probably warrant early and aggressive treatment.

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic.

Study Type – Diagnostic (exploratory cohort)

The type 1 insulin-like growth factor receptor is over-expressed in bladder cancer

To analyse bladder cancer biopsies and investigate the pattern of expression of the type 1 insulin‐like growth factor receptor (IGF1R), a receptor tyrosine kinase that mediates tumour cell proliferation, motility and protection from apoptosis.

Drug-induced bladder and urinary disorders : Incidence, prevention and management

The bladder is vulnerable to the adverse effects of drugs because of its complex control and the frequent excretion of drug metabolites in the urine.Incontinence results when bladder pressure exceeds sphincter resistance. Stress incontinence because of sphincter weakness occurs with antipsychotics and α-blockers, especially in women. Urge incontinence and irritive symptoms may be caused by drugs. Anticholinergics, anaesthetics and analgesics cause urinary retention because of failure of bladder contraction. They are more likely to cause retention in men because of prostatic enlargement.Cyclophosphamide and tiaprofenic acid can cause chemical cystitis, and should be withdrawn if a patient develops irritative symptoms or haematuria. Cyclophosphamide may also induce bladder tumours. Adverse effects of cyclophosphamide can be reduced with prophylactic administration of mesna and adequate hydration. Mitomycin, doxorubicin or bacillus Calmette-Guerin (BCG) instilled locally to treat bladder tumours can cause cystitis, contracture and calcification. Their administration should be limited to 1 hour per week for a maximum of 8 weeks. Retroperitoneal fibrosis and urine discolouration may be caused by drugs. Ureteric calculi may result from any drug causing nephrolithiasis.

Vascular endothelial growth factor : An important angiogenic mediator in bladder cancer

Angiogenesis is the growth of new blood vessels from existing ones and is critical for tumour development, invasion and metastasis. In bladder cancer the prognostic significance of mean vascular density, a surrogate for angiogenesis, has lead to study of the factors determining the angiogenic phenotype. The motivation for these studies has been the search for non-invasive prognostic or diagnostic markers for the disease and for new therapeutic strategies against bladder cancer recurrence and progression. Whilst a large number of factors are involved in the mediation of tumour angiogenesis, vascular endothelial growth factor (VEGF) is widely considered to be central to the process. This review highlights the information presently available regarding the role of VEGF in bladder cancer through observational studies of its expression in bladder tumours and within the urine. In addition the value of VEGF in determining the prognosis in bladder cancer and the future possibilities for anti-VEGF therapy are discussed.

Accelerated Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (AMVAC) as Neoadjuvant Chemotherapy for Patients With Muscle-Invasive Transitional Cell Carcinoma of the Bladder

Meta‐analysis data demonstrate a 5% absolute survival benefit for neoadjuvant chemotherapy (NAC) using cisplatin‐based combination regimens in the radical treatment of muscle‐invasive bladder cancer (MIBC). However, there are no randomized, controlled trial data on the optimum regimen. Accelerated methotrexate, vinblastine, doxorubicin, and cisplatin (AMVAC) is a dose‐intense regimen that has the potential to minimize delays to definitive, potentially curative therapy. A retrospective analysis is presented of the efficacy and toxicity of AMVAC as NAC in patients with MIBC and its impact on the patient pathway.

Imaging bladder cancer.

Purpose of review To review recent developments in imaging for bladder cancer (BCa) diagnosis and staging. Recent findings Recent technical advances in multidetector computed tomography (CT) and, especially, CT urography make CT the preferred imaging modality for diagnosis and staging of BCa. CT urography combined with cystoscopy is emerging as the diagnostic imaging pathway of choice for investigating haematuria. CT provides information about local, lymph node and distant spread in a single examination. Summary Imaging for BCa should only be performed when it makes a difference to patient management. CT is the preferred imaging modality for diagnosing and staging urothelial cancer. Magnetic resonance (MR) imaging is superior for evaluation of the depth of tumour invasion into the bladder wall, but this knowledge may not ultimately affect treatment as feasibility for radical cystectomy depends on staging by a combination of clinical, histopathological and imaging findings. Radical cystectomy may include resection of adjacent organs and regional lymph nodes. The current purpose of CT or MR imaging is to detect T3b disease or higher and, especially, locoregional lymph node metastases. In the future, MR imaging with ultrasmall superparamagnetic iron oxide contrast agents may detect lymph nodes containing metastatic tumour, which may change treatment from surgery to chemotherapy with or without radiotherapy.

Recent advances in urinary bladder cancer detection

Urinary bladder cancer (BCa) is the most common malignancy of the urinary tract. In recent decades, the overall incidence of BCa appears to be on the increase. Despite the increase in incidence, mortality rates in North America and Europe appear to have declined in the last decade, probably due to improved detection and treatment. The mainstay of diagnosis is by cystoscopy, aided with imaging and urine tests (e.g., cytology). This article reviews the recent advances made in detection of primary and recurrent bladder cancer.