RESUMO
OBJECTIVES: To demonstrate the importance of BCG as adjuvant treatment for superficial bladder tumors. To suggest the best dosage and treatment scheme for patients with this severe disease. To emphasize treatment-associated toxicity in our study with endovesical BCG. To evaluate relapse and progression rates of superficial bladder tumors. To describe histological grade and tumor location in our sample. To offer an economic and social benefit to both patient and our Country, improving the quality of life of our patients. METHODS: We performed a descriptive research in a series of cases, both retrospectively and prospectively, and a review of published advances in BCG adjuvant treatment for superficial bladder tumors. Between 1996 and 2000, 90 ambulatory patients were selected at the "Hospital Docente Clinico Quirurgico 10 de Octubre" to receive endovesical treatment with BCG in two different programs of treatment, 6 and 12 months long respectively, using statistical methods such as the homogeneicity test, chi-square test and the test for independence in selected tables and graphics. 45 controls were randomly selected from a group of patients to whom BCG was not administered between 1992 and 1996; their clinical records were retrospectively analyzed selecting the same variables of the 90 cases sample, being their results presented in tables and graphics. RESULTS: We evaluate and review a technology applied to patients with superficial bladder tumors. They were treated with Bacillus Calmette Guerin (BCG) after endoscopic resection (TUR) of bladder tumors and we observe that long-term treatment over 12 months is better than short-term over 6 months, improving quality of live with longer survivals. Using low doses of 50 mg/ml of a nationally produced BCG, economic savings were obtained for both patient and Country with fast patient's return to work, achieving the introduction and maintenance of the treatment in Cuba with relevant results during the "special period". Comparisons between both treatment groups and control group showed greater benefits with the first two. CONCLUSIONS: In patients with superficial bladder tumors stage I, the use of low dose (50 mg/ml) Bacillus Calmette Guerin is an effective treatment with minimal side effects (cystitis). Most tumors were located in the bladder trigone; histological grade 1 was predominant. Long-term treatment for 12 months was more effective than the short-term one, offering a social and economic benefit to patient and to our Country, by delaying or preventing tumor recurrences and progression, so that we recommend this modality of treatment should be part of the therapeutic armamentarium of the urologist in his fight against this severe health problem.
Assuntos
Adjuvantes Imunológicos/administração & dosagem , Vacina BCG/administração & dosagem , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias da Bexiga Urinária/tratamento farmacológico , Adjuvantes Imunológicos/efeitos adversos , Administração Intravesical , Adulto , Idoso , Vacina BCG/efeitos adversos , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium bovis/imunologia , Estadiamento de Neoplasias , Estudos Prospectivos , Estudos Retrospectivos , Análise de Sobrevida , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologiaRESUMO
OBJECTIVES: To report a new case of an intrauterine device causing bladder lithiasis, because of its rarity as a complication of the intrauterine device contraceptive method. METHODS/RESULTS: 27-year-old female patient admitted in the urology department of the "Hospital Medico-quirurgico 10 de Octubre" who having an intrauterine device was pregnant, underwent a caesarean section, and a new intrauterine device implant, and a few months later presented with lower urinary tract infectious syndrome, being diagnosed of double bladder lithiasis secondary to intrauterine device migration, for which cystolithotomy was performed. CONCLUSIONS: We performed a short review of the bladder foreign bodies reported in the literature, and present this case which is very infrequent because of the finding of 2 stones in the bladder and an intrauterine device inside one of them. The intrauterine device was detected after crushing one of the calculi, 2 cm in size. It seems that first intrauterine device had migrated through the uterine wall into the bladder, creating a calcareous concretion around.
Assuntos
Migração de Corpo Estranho/complicações , Dispositivos Intrauterinos/efeitos adversos , Cálculos da Bexiga Urinária/etiologia , Bexiga Urinária , Adulto , Feminino , HumanosRESUMO
Se informar los resultados del tratamiento en 74 casos de cáncer de la vejiga. Se incluyen en total, todas las categorías clínicas y grados histológicos, la superviviencia acturial a los 5 años es de 36%. Se señala que en los tumores superficiales T1-T2, esta superviviencia es de 42% a los 5 anos y en los profundos T3-T4 es de 13% a los 3 años. Se expresa que con el tratamiento endoscópico y la cistectomía parcial, se obtienen buenos resultados en los tumores superficiales de baja malignidad, pero en los de moderada o alta malignidad el resultado fue mejor si se combinan la cirugía con la radioterapia. Se indica que en los tumores profundos, los resultados fueron pobres con todos los métodos y combinaciones. Se señala que la cistectomía total y la radioterapia con cobalto 60 no ofrecieron ventaja alguna como tratamiento individual. Se informar que el mayor número de fallecidos y de recidiva se produce dentro del primer año del tratamiento
Assuntos
Humanos , Neoplasias da Bexiga Urinária/terapia , Análise Atuarial , Neoplasias da Bexiga Urinária/radioterapia , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
Se estudian 74 casos de carcinoma transicional de la vejiga. El mayor número se encontró en la séptima década de edad y aunque el examen físico fue negativo en la mayoría, la hematuria fue un síntoma constante. Los hallazgos radiológicos demonstraron poca repercusión en el tracto urinario superior y en los exámenes endoscópicos se observaron iguales características a las encontradas por otros autores. La mayoría de los tumores era de menos de 3 cm de diámetro, únicos, papilares y pediculados, aunque el grado histológico reveló una preponderancia de alta malignidad. El examen bimanual se correlacionó muy bien con el examen patológico de las piezas operatorias. Un mayor número de tumores se encontró en el estudio superficial de infiltración