We present a case of a 60 years old female patient, with previous depressive disorders, an attempted suicide with pelvic injuries, who comes showing two years evolution of emergence incontinence. The was diagnosed with a giant fecal impaction occuping almost all the pelvic zone and leading to a bladder displacement and right ureteral ectasis.
long-term FU. The secondary objective is to report oncological outcomes of patients who failed.METHODS: This prospective observational study, currently ongoing, started in January 2013, including patients with pathologically confirmed Ta/T1 low grade NMIBC who experienced recurrence during follow-up (FU) and voluntary accepted AS monitoring. Inclusion criteria were: history of Low-Grade NMIBC (G1-G2) pTa/pT1; number of tumors between 1 and 5; size of larger tumor < 1 cm; absence of hematuria; negative urine cytology (UC). Failure was defined as reaching 1 or more of the exclusion criteria after enrolment. AS monitoring consisted in UC and flexible in-office cystoscopy every 3 months for the first year and then every 6 months.RESULTS: BIAS protocol included 229 patients (271 AS events). Median (IQR) age at AS entrance was 72 years (65-79). Median time from last TURB to AS enrolment was 11 months (6-21). At last Trans-urethral Resection of Bladder (TURB) before AS, population presented multifocal lesions in 73 cases, in 190 cases lesions were 5mm. Median time on AS was 16 months (6-28). Overall, we recorded 160 failure due to increase of lesion's number or dimension in 87 and 101 cases respectively, gross hematuria in 16, positive UC in 16, voluntary exit in 4. We also registered 5 cases of tumor regression during AS period. At failure TURB, in 19 cases there were an upstage to HG\CIS, in 1 case an upstage to T2, while 26 cases were negative. Actually, 86 patients are still on AS. We also evaluated the FU of patients who experienced AS failure and exit from protocol (median FU 38 months [24/52]): 102 of theme did not undergo any other TURB during FU. In those who underwent 1 or more TURB, most frequent histological finding was pTa in 52 patients, while we registered pT1 in only 8 cases and pT2 in 0 cases. Only 15 patients experienced an upstage to HG\CIS.CONCLUSIONS: This update confirms the safety in terms of oncological outcomes of AS in Low-grade NMIBC. Our findings are bolstered by data derived from the FU of patients who failed AS and exit our protocol.
INTRODUCTION: High grade, non-muscle invasive bladder cancer (NMIBC) is treated with intravesical Bacillus Calmette–Guérin. Chemohyperthermia therapy (CHT) may be a novel alternative therapy for the treatment of NMIBC. OBJECTIVE: To evaluate the recurrence-free survival (RFS) of patients treated with CHT using the Combat bladder recirculation system (BRS) for NMIBC. METHODS: This was a prospective multi-institutional study of 1,028 consecutive patients with NMIBC undergoing CHT between 2012 and 2020. A total of 835 patients were treated with CHT and Mitomycin C (MMC). Disease was confirmed on transurethral resection of bladder tumor (TURBT). Patients with NMIBC underwent CHT with MMC. Follow-up included cystoscopy and subsequent TURBT if recurrence/progression was suspected. The primary endpoint was RFS. Secondary endpoints were progression-free survival (PFS) and adverse events from CHT. RESULTS AND LIMITATIONS: Median follow up was 22.4 months (Interquartile range (IQR): 12.8 –35.8). Median age was 70.4 years (IQR: 62.1 –78.6). A total of 557 (66.7%), 172 (20.6) and 74 (8.9%) of patients were classified to BCG naïve, BCG unresponsive and BCG refractory/relapsing/intolerant, respectively. The RFS at 12 months and 24 months for BCG naïve was 87.6% (95% CI 85.0% - 90.4%) and 75.0% (95% CI 71.3% - 78.8%), respectively. The RFS at 12 months and 24 months for BCG unresponsive cohort was 78.1% (95% CI 72.0% - 84.7%) and 57.4% (95% CI 49.7% - 66.3%), respectively. The RFS at 24 months for the BCG unresponsive cohort for CIS positive and CIS negative patients were 43.6% (95% CI 31.4% –60.4%) and 64.5% (95% CI 55.4% - 75.1%), respectively. Minor events occurred in 216 (25.6%) of patients and severe events occurred in 17 (2.0%). CONCLUSIONS: CHT with MMC using the Combat BRS is effective in the medium term and has a favorable adverse event profile.
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