同期经尿道等离子电切治疗前列腺增生症合并浅表膀胱肿瘤

目的：探讨同期经尿道等离子电切治疗前列腺增生症(benign prostate hyperplasia，BPH) 合并浅表膀胱肿瘤(superficial bladder tumor，SBT)的安全性和有效性。方法：根据膀胱肿瘤的位置、大小、数目和前列腺大小、腺体与包膜粘连情况，采用等离子电切方法同期治疗86例BPH合并SBT，术后给予膀胱灌注化疗。结果：86例手术顺利。PKRBt手术时间(42.2±25.3)min，PKRP时间手术时间(72.3±23.2)min。术中闭孔神经反射9例，膀胱穿孔3例，无电切综合征、肠穿孔，未发生死亡病例。术后病检均为前列腺增生，膀胱尿路上皮癌，5例出现短期尿失禁，经盆底功能锻炼后好转。3例尿道狭窄，经定期尿道扩张后治愈。术后6个月国际前列腺症状评分(IPSS)为(7.4±4.3)分、最大尿流率(Q)为(18.2±4.5)ml/s，与术前(27.8±4.2)分、(5.4±3.3)ml/s相比明显改善(P＜0.01；P＜0.001)。86例随访1~6年，12例膀胱肿瘤复发，复发部位均无尿道及前列腺窝种植转移。结论：同期经尿道等离子电切治疗前列腺增生及浅表膀胱肿瘤，安全、可行、疗效可靠。具有手术时间短，创伤小、术后恢复快等优点。

EFFECTIVENESS OF SINGLE DOSE INTRAVESICAL MITOMYCIN C THERAPY AS PROPHYLAXIS TO PREVENT RECURRENCE AND PROGRESSION OF SUPERFICIAL NONMUSCLE INVASIVE BLADDER TUMOR.

Objectives: To determine the effectiveness of instillation of single dose of intravesical mitomycin C in patients with low grade non-muscle invasive bladder tumor (NMIBT). Study Design: Retrospective cross-sectional study. Setting: Tabba kidney institute Karachi. Period: 2016 to Jan-2018. Subject and Methods: A total of 76 patients with first time diagnosis of non-invasive bladder tumor were included. Data of patients of SNMIBT who underwent trans-uretheral resection of bladder tumor (TURBT) and received single dose instillation of mitomycin C (MMC, 40 mg) within 24 hours after resection from 2016 to Jan-2018 were included in this analysis. All these patients were followed for 6 months after TURBT, cystoscopy was performed at 3 and 6 monthly to check and record any recurrence or progression. Results: Out of 76 cases, 43 (56.57%) had one lesion, 27 (35.52%) had two lesion and 6 (7.89%) cases had three lesion. Single dose intravesical mitomycin C was effective in 81.57% (62/76) cases, recurrence occurred in 6 (7.89 %) cases and progression of disease in 8 (10.52%) cases. Conclusion: The results of present study confirmed the positive effect of instillation of single immediate dose of MMC in patients with low risk superficial bladder tumor. 81.57% patients will not require any further treatment if MMC-40 is given immediately following TURBT.

SUPERFICIAL BLADDER TUMOR;

Introduction: Bladder cancer is the second most common urologic cancer. Approximately 90% are transitional cellcarcinoma among which superficial bladder cancer constitutes about 50-70%. It is usually treated by transurethral resection withadjuvant intravesical instillations of chemotherapy or immunotherapy. Primary problems in superficial bladder cancers are its tendency torecur, about 50-80%, following surgical ablation alone, with progression to muscle invasive disease in 20-25% cases. Intravesicalchemotherapy appears to have major impact on decreasing chances of recurrence of superficial bladder cancer. Objective: To determinethe efficacy of single dose perioperative intravesical mitomycin C in reducing recurrence of superficial bladder tumor. Study Design:Comparative study. Settings: Department of Urology Shaikh Zayed Hospital Lahore. Duration of Study: One year.13-04-2009 to 13-04-2010. Methodology: Patients were divided into two groups randomly by using random numbers i.e. 40 patients in group A and 40 patientsin group B. Group A (40 patients) of bladder tumor received post TURBT single dose Mitomycin-C 40 mg/40ml N/Saline intravesically andGroup B (40 patients) was control group i.e. TURBT alone without Mitomycin-C. Results: The recurrence at first year follow up in bothgroups were showed a significant difference (p<0.05) as shown in Table No V: There were only 10% recurrence in Group A i.e. patientswho had intravesical Mitomycin –C as compared to 55% recurrence in Group B, who did not received postoperative intravesicalMitomycin–C. Conclusions: It is concluded that one perioperative (within 6 hours of TURBT) intravesical instillation of chemotherapysignificantly decreases the risk of recurrence after TURBT in patients with stage Ta T1, single and multiple papillary bladder cancer in lowrisk as well as high risk tumors. One immediate instillation after TUR reduces the recurrence.