O. Alfthan

Preoperative Irradiation in the Treatment of Renal Adenocarcinoma

The effect of preoperative irradiation on the survival of patients with renal adenocarcinoma was studied in a clinical trial. 88 patients with verified renal carcinoma entered the trial during 1968-1972, of whom 38, selected in a randomized fashion, received preoperative irradiation to a total dose of 3 300 rads in 3 weeks, followed by extrafascial nephrectomy after a 3 week interval; in the remainder an extrafascial nephrectomy was performed immediately. Actuarial 5-year survival was 47% in the preoperative irradiation group and 63% in the nephrectomy-only group, i.e. preoperative irradiation did not improve the 5-year prognosis. Survival was also studied in P-categories of the U.I.C.C. as well as in high and low grade malignancies. In none of these groups could we find a clear tendency to a more favourable prognosis with preoperative irradiation; no statistically significant differences were found. Because no improvement in prognosis after preoperative irradiation was found in our series or any of the sub-groups, we consider preoperative irradiation not routinely indicated as an adjuvant therapy. It may be useful in some selected cases, but selecting these cases will be difficult.

A bioresorbable urethral stent

SummaryThe aim of the present study was to examine the suitability of biodegradable polymers as materials for a urethral stent. A new urethral stent made of biodegradable self-reinforced poly-l-lactide (SR-PLLA) was implanted in 16 male rabbits after urethrotomy. Seven stents of stainless steel served as controls. The dimensions of the two types of stents were identical: length 15 mm, diameter 8.2 mm. The mechanical construction was a helical spiral. The SR-PLLA spiral was sustained with three microspirals, and the whole device was coated withdl-lactide to achieve an active initial tissue reaction and better tissue penetration. The SR-PLLA stent showed more favourable implantation properties than the steel one. Within 6 months all PLLA stents had implanted, and the tissue reaction around the stent material was minimal. The helical spiral of stainless steel induced a remarkable inflammatory reaction due to poor implantation properties. We suggest that biodegradable SR-PLLA is a promising material for a urethral stent to prevent re-stenosis of urethral strictures.

Cyclosporine in Severe Interstitial Cystitis

PURPOSEnCyclosporine is a widely used immunosuppressive drug in organ transplantation and recently it has been used in several autoimmune disorders with good results. Because interstitial cystitis may have an autoimmune etiology, we wished to determine whether cyclosporine has any effect on symptoms in patients with severe interstitial cystitis.nnnMATERIALS AND METHODSnA total of 11 patients, who fulfilled the criteria for interstitial cystitis according to an international accrual form, received cyclosporine for 3 to 6 months at an initial dose of 2.5 to 5 mg./kg. daily and a maintenance dose of 1.5 to 3 mg./kg. daily. Blood pressure, serum creatinine and cyclosporine concentrations were monitored regularly. The patients completed frequency-volume charts at 2-week intervals.nnnRESULTSnThe frequency-volume charts showed favorable effects. Micturition frequency decreased (p<0.01), and mean and maximum voided volumes increased significantly (p<0.001 and p<0.01, respectively). Bladder pain decreased or disappeared in 10 patients, allowing for storage of large urine volumes. Serum creatinine did not change with the dosages used. Mild hypertension occurred in 2 patients and resolved after the cyclosporine dose was lowered. After cessation of treatment symptoms recurred in the majority of patients.nnnCONCLUSIONSnThe findings revive the concept of interstitial cystitis as an autoimmune disease.

Alternating Mitomycin C and Bacillus Calmette-Guerin Instillation Prophylaxis For Recurrent Papillary (Stages Ta to T1) Superficial Bladder Cancer

PURPOSEnWe attempted to prove if alternating chemoprophylactic and immunoprophylactic instillations improved efficacy and decreased toxicity in patients with recurrent superficial bladder cancer.nnnMATERIALS AND METHODSnA total of 188 patients with rapidly recurring stage Ta or T1 cancer was randomly treated with mitomycin C (group 1) or alternating mitomycin C and Pasteur strain bacillus Calmette-Guerin (BCG) instillations (group 2) for 2 years. Mean followup was 34 months.nnnRESULTSnMedian times to initial recurrence were 12 months in group 1 and 7 months in group 2 (p = 0.976), and treatment failed in 21.5% and 18.9%, respectively. Recurrence rates during the instillation period were 1.01 in group 1 and 0.86 in group 2 (p = 0.376). There was no difference in the disease-free interval between the 2 groups (p = 0.976). Instillations were discontinued because of adverse effects in 6 cases (6%) in both groups.nnnCONCLUSIONSnEfficacy of alternating mitomycin C and BCG was equal to mitomycin C monotherapy, and both methods were effective in prophylaxis of recurrent papillary bladder cancer. Less toxicity occurred in the alternating treatment group compared to earlier BCG monotherapy results.

Alternating mitomycin C and bacillus Calmette-Guerin instillation therapy for carcinoma in situ of the bladder

PURPOSEnOur aim was to prove if alternating chemotherapeutic and immunotherapeutic instillations improved efficacy and reduced toxicity in patients with carcinoma in situ of the bladder.nnnMATERIALS AND METHODSnOf 68 carcinoma in situ patients randomly treated with instillations 40 received mitomycin C and 28 received mitomycin C and Pasteur bacillus Calmette-Guerin (BCG) in alternating courses. Mean followup was 33 months.nnnRESULTSnThe complete response rates with mitomycin C and mitomycin C/BCG were 45% and 71% at 3 months, 59% and 82% at 12 months, and 47% and 74% at 24 months, respectively (p = 0.041). The disease-free interval showed the superiority of alternating therapy (p = 0.043). Recurrence rates during the instillation period were 1.834 with mitomycin C and 0.922 with mitomycin C/BCG (p = 0.013). No remarkable side effects developed in the alternating group.nnnCONCLUSIONSnTherapy of carcinoma in situ with alternating mitomycin C and BCG is more effective than mitomycin C alone. Compared to BCG monotherapy only few side effects occur.

Cytostatic effect of different strains of Bacillus Calmette-Guérin on human bladder cancer cells in vitro alone and in combination with mitomycin C and Interferon-α

SummaryThe cytostatic activity of five Bacillus Calmette-Guérin (BCG) strains (Pasteur, Evans, Tice, RIVM and Connaught) on human transitional cell cancer T24 cells was examined. A striking effect was noted even in 2-day cultures, and the effect was more pronounced when the cells were incubated for 5 days with different BCG strains alone. The concentrations needed were about the same as those used in clinical practice (109 colonyforming units of Pasteur strain in 100 ml buffered saline solution). Combination with mitomycin C or interferon-α-2b potentiated the cytostatic effect. A slight difference in cytostatic activity between different BCG strains was found.

Unexpected urethral strictures after short-term catheterization in open-heart surgery.

Urethral stricture was found in 59 of 478 male patients who had undergone open-heart surgery between June 79 and December 81. In 40/59 cases the stricture showed a string-of-pearls configuration or long narrowing of the penile urethra on the urethrogram. Burning pain and dysuria were the main symptoms, and the urinary stream started to weaken immediately after the removal of the siliconized latex catheter which had been routinely inserted at the time of the heart operation and usually kept indwelling for 3 days. The stricture epidemic stopped after change of the latex catheters to silicone-ones. The different catheters were investigated for cell toxicity. Eluates of catheters were added at different concentrations to cultures of various cell lines. The cell proliferation was measured by thymidine incorporation. The results were uniform and showed marked toxicity of the latex catheters against all investigated cell lines.

Treatment of Urethral Stricture by Urethroplasty or Direct Vision Urethrotomy

The outcome of treatment for urethral stricture is evaluated in two groups of patients in a retrospective study: 51 patients were treated with urethroplasty and 41 with direct vision urethrotomy. The groups did not differ greatly as regards primary success. It was 59% in the urethroplasty group and 61% in the urethrotomy group. This favours the view that the primary treatment of a urethral stricture should be direct vision urethrotomy whenever possible.

Current concepts in the role of intravesical instillations in the therapy and prophylaxis of superficial transitional-cell cancer of the bladder

SummaryA survey on superficial, local urinary bladder cancer, its prognostic factors, and instillation treatments is presented on the basis of experience with approximately 1,000 patients over a period of 20 years, experimental investigations, and the literature. Personal opinions and practical recommendations are presented in 11 conclusive theses.

Effect of Preoperative Radiotherapy on the Growth of Human Renal Carcinoma Tissue in Vitro

The growth of minced tumour tissue and normal kidney tissue in vitro was investigated in a material of 38 adenocarcinomas of the kidney, of which 17 had received preoperative radiotherapy in a total dose of 3 000–3 500 rads and the rest were unirradiated. The growth was estimated in degrees: no growth, primary attachment and cellular proliferation around the fragments and, thirdly, secondary growth allowing subculture. In the preoperatively non-irradiated group 71% of the tumour samples resulted in secondary or primary in vitro proliferation, whereas the comparable figure in the irradiated group was 18%. The difference was smaller as far as the normal kidney tissues in the same groups were concerned, being 86% and 71% respectively. The results of this study document, with in vitro methods, the marked loss in the proliferative capacity of tumour cells affected by preoperative irradiation.