Title: Viral targeting of non-muscle invasive bladder cancer and priming of anti-tumour immunity following intravesical Coxsackievirus A21 Running Title: Viral targeting of non-muscle invasive bladder cancer.

Laparoscopic radical prostatectomy is similar to any other new surgical procedure and as with open surgery we learn and gain experience with each procedure; the learning curve is never completely finished.

OBJECTIVE To assess the use of sodium pentosan polysulphate (SPP) for haemorrhagic cystitis (HC), a potentially life‐threatening side‐effect in patients treated with pelvic radiotherapy or cyclophosphamide, and which can be difficult to manage as patients often have significant comorbidity. PATIENTS AND METHODS Between September 1991 and December 2000, 60 consecutive patients (24 women and 36 men) with haemorrhagic cystitis were primarily treated with SPP; 53 patients had had radical radiotherapy for pelvic malignancy and seven systemic cyclophosphamide. All patients were screened for blood dyscrasia and residual/primary urothelial malignancy with imaging, urine cytology and cystoscopy. RESULTS In all, 51 patients were available for follow‐up; the median (range) interval between completing treatment and developing haematuria was 4.5 (0.08–39.4) years, the duration of treatment 180 (21–1745) days and patients were followed for 450 (19–4526) days from the onset of haematuria. All patients were started on SPP at an initial dose of 100 mg three times daily. In 21 patients the dose was gradually reduced to a maintenance dose of 100 mg and in 10 further patients SPP was stopped because the haematuria stopped completely. Twenty patients died while on treatment from causes not directly related to their haematuria. CONCLUSION We recommend the use of SPP as the primary method of managing haemorrhagic cystitis associated with pelvic radiotherapy or systemic chemotherapy.

OBJECTIVE To present our results on managing loco‐regional recurrence of renal cell carcinoma (RCC) with surgical excision, as local recurrence at the site of a previous nephrectomy is resistant to both systemic therapy and radiotherapy. PATIENTS AND METHODS In all, 16 patients were operated on between 1994 and 2003 for local recurrence of RCC. The median (mean, range) age at the time of local recurrence was 57.9 (57.4, 28.9–71.7) years, and the median interval from primary surgery 2.22 (3.88, 0.27–14.46) years. Before surgery eight patients had been given systemic immunotherapy, with no response of their local recurrence. RESULTS Two patients were deemed inoperable because of direct invasion of the great vessels and the liver by tumour. The remaining 14 patients had recurrence in residual adrenal tissue (two), para‐aortic nodes (three), para‐caval nodes (two), retrocaval nodes (one), renal bed (six), liver, spleen and stomach (one each), and diaphragm (two). Although complete macroscopic en‐bloc clearance was achieved in these patients, only eight had tumour‐free margins on histological examination. The histology was consistent with RCC recurrence in all cases. All of the patients were followed with computed tomography at regular intervals. At a median follow‐up of 1.0 (1.65, 0.25–6.5) years, five patients remain disease‐free, four have local and distant relapse, and five developed distant metastasis only. The presence of tumour at the resection margin was a significant factor in predicting local and distant disease‐free survival (P < 0.05). CONCLUSIONS En bloc excision of isolated locally recurrent RCC is possible, and complete surgical extirpation can lead to prolonged disease‐free survival.