The indispensable role of urinalysis for patients undergoing treatment for nonmuscle invasive bladder cancer

Despite several efforts in the search for noninvasive biomarkers to provide prognostic information for noninvasive muscle bladder cancer,none have shown significant potential.In this context,standard urinalysis is still necessary to provide many data.This method is an inexpensive,simple,and easy-to-repeat tool to follow-up patients over time.Urinalysis does not fall within study protocols and allows evaluation of the immune activation/response(even if indirectly).As such,this method can certainly provide useful information for prognosis.

How to reduce bacillus Calmette-Guerin discontinuation in patients with severe functional impairment

Background:Severe functional impairment is often considered a contraindication to intravesical therapy for nonmuscle-invasive bladder cancer(NMIBC).A tailored intravesical bacillus Calmette-Guérin(BCG)procedure was evaluated in high-risk(HR)-NMIBC patients with severe functional impairment.Materials and methods:Patients with a Katz Index score of 2 or less and an initial diagnosis of HR-NMIBC with atraumatic insertion of a Foley-type indwelling catheter,bladder emptying,and BCG instillation were prospectively treated;after 2 hours,the bladder was emptied and the catheter was removed(group A).After propensity score matching,52 patients in group A were compared with that of 52 consecutive patients in group B using a retrospective database,with similar baseline/oncological characteristics and treated with standard intermittent catheterization.Moreover,groups A and B were compared with that of 130 consecutive patients(group C)retrospectively evaluated,with similar oncological characteristics but with a Katz Index score of 3 or greater and treated with standard intermittent catheterization.Results:The discontinuation rates were 11.5%,35%,and 9%in groups A,B,and C,respectively(A vs.B,log-rank score 42.52[po<0.05];B vs.C,107.6[p<0.05];A vs.C,3.45[p>0.05]).The overall adverse event rates were 38.5%,57.7%,and 39.2%,respectively(A vs.B,p=0.04;B vs.C,0.03;A vs.C,0.92).The rates of severe adverse events were 1.9%,1.9%,and 1.5%,respectively,without statistically significant differences.The cumulative HR disease-free survival rates were 63.4%,48%,and 69.2%,respectively(A vs.B,log-rank score 154.9[p<0.05];B vs.C,415[p<0.05];A vs.C,244[p<0.05]).Conclusions:A tailored intravesical instillation procedure may reduce BCG discontinuation and adverse effects.

Minimally invasive surgical therapies(MISTs)for lower urinary tract symptoms(LUTS):promise or panacea?

The increasing importance of treatment of lower urinary tract symptoms(LUTS),while avoiding side effects and maintaining sexual function,has allowed for the development of minimally invasive surgical therapies(MiSTs).Recently,the European Association of Urology guidelines reported a paradigm shift from the management of benign prostatic hyperplasia(BPH)to the management of nonneurogenic male LUTS.The aim of the present review was to evaluate the efficacy and safety of the most commonly used MisTs:ablative techniques such as aquablation,prostatic artery embolization,water vapor energy,and transperineal prostate laser ablation,and nonablative techniques such as prostatic urethral lift and temporarily implanted nitinol device(iTIND).MiSTs are becoming a new promise,even if clinical trials with longer follow-up are still lacking.Most of them are still under investigation and,to date,only a few options have been given as a recommendation for use.They cannot be considered as standard of care and are not suitable for all patients.Advantages and disadvantages should be underlined,without forgetting our objective:treatment of LUTS and re-treatment avoidance.

The association between postvoid residual and response to standard therapy in male and female patients with non-muscle-invasive bladder cancer

Background:The urinary retention is recognized as a promoting factor for bladder cancer,but its role as prognostic factor of therapeutic response has not yet been widely considered.To correlate bladder outlet characteristics with short-term response to treatment in non-muscle-invasive bladder cancer.Materials and methods:We carried out a case-control study on 600 consecutive patients with a first diagnosis of non-muscle-invasive bladder cancer,recruited at the first endoscopic follow-up visit after standard treatment:200 patients were not tumor-free(cases)and 400 were tumor-free(controls).Patients were compared based on baseline and bladder-outlet characteristics("functional param-eters":postvoid residual volume[PVR],International Prostatic Symptoms Score,perceived quality of bladder outlet).t Test,x^(2)test,receiver operating characteristic curves,logistic correlations,and multivariate analysis were applied.Results:The cases had higher statistically significant PVR values compared with controls.We reported a linear correlation of no-tumor-free status with PVR(R^(2)=0.087,p<0.005);the receiver operating characteristic curves revealed an area under the curve of 0.824(95%confidence interval,0.783-0.865;optimal PVR cutoff,50 mL).In the multivariate analysis,age,American Society of Anesthesiologists score≥2,risk category≥intermediate,and all functional parameters represented independent factors for no-tumor-free status.Conclusions:Urinary retention could represent a prognostic factor of treatment response,and its active treatment should be considered as an important therapeutic step into the clinical management of bladder cancer patients.