P. Annese

Retinoblastoma protein expression predicts response to bacillus Calmette-Guérin immunotherapy in patients with T1G3 bladder cancer

OBJECTIVES Bacillus Calmette-Guérin (BCG) immunotherapy is regarded as the current treatment of choice for stage T1 grade 3 (T1G3) bladder cancer (BC), though its efficacy is limited by high recurrence and progression rate. Identification of molecular prognosticators that might be helpful in discriminating between responders and nonresponders to BCG treatment is therefore of major clinical importance; thus we focused on the cell-cycle related retinoblastoma protein (pRB), which had been already investigated in bladder cancer. The goal of our study was specifically to address whether its expression predicts the outcomes of BCG treatment for patients with T1G3 disease. MATERIALS AND METHODS To address this issue, paraffin-embedded specimens of 27 patients having undergone transurethral resection of T1G3 BC and intravesical instillations of BCG (induction + 1 year maintenance) were immunostained with pRB monoclonal antibody. Patients in whom the bladder muscle was not clearly visible, and healthy, as well as patients with TaG3 tumors or with concomitant carcinoma in situ were excluded. Mean follow-up was 60 months (range 15-135). RESULTS Thirteen tumors showed normal (1% to 50% labeling index) while 14 showed altered pRB expression, consisting of no expression (0% labeling index) in six and overexpression (>50% labeling index) in eight. Recurrence occurred in 10 (37%) patients and mean time to recurrence was 22.8 months (range 6-48). Recurrence rate was 57% in patients with altered and 15% in those with normal pRB expression, with a statistically significant difference in disease-free survival (P = 0.037). Progression occurred in five (18.5%) patients and mean time to progression was 24 months (range 6-48). Progression rate was 36% in patients with altered and 0% in patients with normal pRB expression, with a statistically significant difference in progression-free survival (P = 0.018). CONCLUSIONS In this homogeneous population of T1G3 bladder tumors, altered pRB expression predicted recurrence and progression after BCG treatment. These findings outline the potential role of pRB immunostaining in predicting T1G3 BC response to BCG immunotherapy.

Transurethral Distal Ureter Balloon Occlusion and Detachment: A Simple Means of Managing the Distal Ureter During Radical Nephroureterectomy

Distal ureter bladder cuff (DUBC) excision is an essential part of radical nephroureterectomy (RNU), but the technique to accomplish it remains controversial. We describe a novel technique of transurethral distal ureter balloon occlusion before detachment (TUDUBOD) whereby the affected ureter is occluded with a 5F Fogarty balloon catheter and circumferentially incised until the perivesical fat to detach it from the bladder. In the 13 patients who were treated between May 2005 and May 2010, mean surgical time for TUDUBOD was 21.3 minutes. Results for surgical margins were always negative; at mean follow-up of 39.8 months (range 16-74 mos), 4 (30.1%) patients had bladder recurrences but none occurred at the DUBC excision site or perivesical space. TUDUBOD seems to be a simple, cheap, and effective mean of managing the distal ureter during RNU that keeps with the oncologic principle of preventing tumor cell spillage outside the bladder.

Urethral Corpus Spongiosum Amyloidosis Presenting with Urethrorrhagia During Erection

INTRODUCTION Urethral amyloidosis is a rare, probably inflammatory condition usually presenting with hematuria and obstructive urinary symptoms, thus mimicking urethral malignancy. After histological confirmation of the diagnosis, treatment can be expectant or symptomatic. AIM. To report an unusual cause of urethrorrhagia occurring only during erection in an otherwise healthy man. METHODS. A 30-year-old man presented with a 5-month history of urethrorrhagia occurring only during erection, and with a painless palpable nodule in his penile urethra clearly visible on urethral US and magnetic resonance imaging, but not on urethroscopy. RESULTS. The patient underwent wide surgical excision of the urethral nodule and grafting of the urethral defect with a pedicled preputial flap. Histological examination revealed isolated amyloid of urethral corpus spongiosum. CONCLUSIONS. Isolated urethrorrhagia during erection and without urinary symptoms can be the presenting sign of urethral amyloidosis involving corpus spongiosum rather than the urethral lumen; in such cases, surgical exploration, wide urethral excision and grafting are mandatory.

EFFICACY OF ONE-YEAR MAINTENANCE IN EARLY ADJUVANT CHEMOTHERAPY FOR INTERMEDIATE RISK NON-MUSCLE- INVASIVE BLADDER CANCER. RESULTS AT 24 MONTHS OF A RANDOMIZED TRIAL

1704 EFFICACY OF ONE-YEAR MAINTENANCE IN EARLY ADJUVANT CHEMOTHERAPY FOR INTERMEDIATE RISK NON-MUSCLEINVASIVE BLADDER CANCER. RESULTS AT 24 MONTHS OF A RANDOMIZED TRIAL Vincenzo Serretta*, Vincenzo Altieri, Giuseppe Morgia, Darvinio Melloni, Maria Karidi, Pasquale Annese, Giuseppe Carrieri, Maurizio Cacciatore, Nino Dispensa, Alessandra Di Lallo, Giovanni Ruggiero, Federico Nicolosi, Mauro Iadevaia, Francesco Vacirca, Francesco Paolo Selvaggi, Rosalinda Allegro. Palermo, Italy, Napoli, Italy, Messina, Italy, Matera, Italy, Foggia, Italy, Partinico (PA), Italy, Campobasso, Italy, Telese Terme (BN), Italy, Catania, Italy, Maddaloni (CE), Italy, Caltanissetta, Italy, and Bari, Italy. INTRODUCTION AND OBJECTIVE: The clinical value of early intravesical adjuvant chemotherapy after TUR of intermediate risk nonmuscle-invasive bladder cancer (NMI TCCB) is well established. On the other hand, the optimal schedule regimen and the role of maintenance are still debated. The aim of the present study was to evaluate the effectiveness of one-year maintenance schedule in patients submitted to TUR plus adjuvant early intravesical chemotherapy for intermediate risk NMI TCCB. METHODS: Between May 2002 and August 2003, 577 patients, were recruited. All patients underwent TUR and early (within 6 hours) intravesical chemotherapy with epirubicin at the dose of 80 mg diluted in 60 ml of saline solution. When histology was available, 95 patients were excluded from the study since they were harbouring T1G3, Tis or single and primary Ta G1-G2 tumors. Four hundred eighty-two

Environmental Risk Factors in Superficial Bladder Cancer

As a preliminary approach to define the object of larger case-control studies, the distribution of potential risk factors coming from environmental pollution among patients affected by superficial bladder cancer (TCCB) has been analyzed. Material e Methods. The analysis included only patients affected by medium risk superficial TCCB. Forty Italian urological centres joined the study. Detailed information about age, sex, residency, employment, active and passive cigarette smoking, water resource, hair-dye use were centralized. All patients underwent TUR and early intravesical chemotherapy. The distribution of the above mentioned environmental factors was related to tumor characteristics such as multiplicity and previous natural history. Results. Until today 474 patients have been recruited, 182 (38.4%) with primary tumors and 293 (61.8%) with multiple lesions. Over 80% of the patients lived in urban areas, 20% were employed in industry at risk for bladder cancer and 8% used hair dye. Forty percent of the patients were smokers, with a median smoking period of 30 years. Bottled water was the only water resource in 42% of cases. At multivariate statistical analysis a significant correlation between tumor multiplicity and employment in industry (p<0.01) and between past natural history and period of cigarette smoking (p<0.05) was found. Preliminar/y, an interesting trend was detected for a correlation between water resource and bladder cancer in non-smoking patients. The municipal water system was the main water resource more frequently in non-smokers (75% vs 53%). This might imply a pathogenic role of water pollution and chlorination.