Takuji Shibahara

Papillary adenocarcinoma of the renal pelvis and ureter producing carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 125

Abstract  We report a case of advanced renal pelvis and ureter adenocarcinoma producing carcinoembryonic antigen (CEA), carbohydrate antigen 19‐9 (CA19‐9) and carbohydrate antigen 125 (CA125). A 72‐year‐old woman was diagnosed with right renal pelvic and ureter tumor with para‐aortic lymph node swelling. Biopsy of the ureteral mass revealed papillary adenocarcinoma. Serum levels of CEA, CA19‐9 and CA125 were extremely elevated. The patient was successfully treated with paclitaxel/carboplatin chemotherapy followed by surgery.

Paravesical granuloma after inguinal herniorrhaphy. Case report and review of the literature.

Paravesical granuloma after herniorrhaphy is an unusual complication due to infected suture material and often mimics bladder or urachal malignancy. We present 3 cases of this disease and reviewed 21 previously reported cases. Our patients underwent hernial repair 2–7 years before examination and presented urinary symptoms. They were treated with antibiotics and underwent exploration of the inguinal wound infection but the symptoms did not resolve. En bloc excision and partial cystectomy were performed and resulted in complete resolution of the symptoms. It is important to consider paravesical granuloma in patients who had undergone herniorrhaphy in the differential diagnosis of bladder or urachal tumors.

Randomized controlled study of the efficacy and safety of continuous saline bladder irrigation after transurethral resection for the treatment of non-muscle-invasive bladder cancer.

To evaluate the efficacy and safety of continuous saline bladder irrigation (CSBI) after transurethral resection of bladder tumour (TURBT) in patients with low‐ to intermediate‐risk non‐muscle invasive bladder cancer (NMIBC).

A Combination of Findings Obtained from Pre- and Postoperative Imaging Predict Recovery of Urinary Continence After Non-nerve-sparing Laparoscopic Radical Prostatectomy

Background/Aim: The aim of the study was to identify the reliable predictor for early recovery of urinary continence (UC) after non-nerve-sparing laparoscopic radical prostatectomy (NNS-LRP) according to the findings of pre- and postoperative imaging. Materials and Methods: A retrospective analysis of 215 patients who underwent NNS-LRP was carried out. Early recovery of UC was defined as using no pads or one security pad per day within 3 months. Preoperative membranous urethral length (MUL) measured on MRI and postoperative bladder neck angle (BNA) identified by cystography were analyzed to evaluate the relationship with recovery of UC. Patients were divided into three groups based on MUL and BNA (Group A: MUL ≥12.1 mm and BNA ≥103°, Group B: either MUL ≥12.1 mm or BNA ≥103°, Group C: MUL <12.1 mm and BNA <103°. Results: Early recovery rates were 80.3% in patients with MUL ≥12.1 mm, 37.5% in patients with MLU<12.1 (p<0.001), and 77.8% in patients with BNA ≥103°, 50% in patients with BNA <103°(p<0.001). In the combination of the two parameters, early recovery rates were 90.4%, 58%, and 36.1% in group A, B and C respectively (p<0.001). Kaplan–Meier curve of the time to recovery of UC showed significant differences among the three groups (log rank test: p<0.001). Conclusion: A combination of preoperative MUL and postoperative BNA was the reliable predictor of recovery of UC after NNS-LRP. Longer MUL with wider BNA is significantly and positively associated with an early recovery of UC.

PD19-05 THE BENEFIT OF CONTINUOUS SALINE BLADDER IRRIGATION AFTER TRANSURETHRAL RESECTION IN HIGH GRADE NON-MUSCULAR INVASIVE BLADDER CANCER - A SINGLE CENTER RANDOMIZED PROSPECTIVE STUDY

INTRODUCTION AND OBJECTIVES: The use of intravesical chemotherapy (IC) immediately following transurethral resection of bladder tumor (TURBT) for low grade (LG) non muscle invasive bladder cancer (NMIBC) has been well demonstrated to reduce local recurrence and is supported by current guidelines. We sought to demonstrate patterns of uptake for this practice as well as its impact on outcomes at a population level as an initial step in developing quality improvement initiates in NMIBC. METHODS: Incident cases of LG Ta or T1 NMIBC diagnosed between 2005 and 2012 were identified from the California Cancer Registry and linked to hospital records of the Office of Statewide Health Planning and Development. Tumor, patient, and hospital characteristics were included in the analysis. We determined rates of IC utilization following TURBT in patients with LG Ta or T1 NMIBC. Multivariable logistic regression models were utilized to determine predictors of IC utilization. Cumulative incidence functions and Cox Proportional Hazards (PH) models were used to determine predictors of recurrence-free survival (RFS), bladder cancer-specific survival (CSS), and overall survival (OS) with utilization of IC as the primary effector variable. RESULTS: The final cohort consisted of 10,031 patients with LG NMIBC diagnosed in California between 2005 and 2012, with initial TURBT 45 days from diagnosis. The overall rate of IC utilization was 5.1%, but demonstrated an increase from 1.7% (2005-2006) to 9.6% (2011-2012). On multivariable logistic regression analysis, variables associated with increased odds of immediate IC instillation included more recent year of diagnosis (OR 1.74, CI 1.60-1.90 for 2 year increments). Factors associated with lower odds of receiving IC included Hispanic race (OR 0.62, CI 0.43-0.88) and Asian/Pacific Islander race (OR 0.58, CI 0.37-0.91). The cumulative incidence of recurrence at 24 months for patients who received IC was 25.2% compared to 30.2% among those that did not receive IC. On multivariable Cox PH analysis, use of IC was significantly associated with an 18% improvement in RFS (HR 0.82, CI 0.70-0.97). CONCLUSIONS: Utilization of IC for LG NMIBC remains dismally low in routine practice, with less than 10% of patients receiving this standard of care even in more recent years. Poor utilization of this practice is associated with increased rates of recurrence. Strategies utilizing robust implementation of scientific methods should be studied as a means to overcome a major shortcoming in the quality of care provided to patients with LG NMIBC.