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Overview of intravesical therapy: Current Controversies

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A part of the Virtual Edition on Intravesical therapy on www.bjui.org. Go to www.bjui.org to read the open access article.

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Miss Jo Cresswell Consultant Urologist James Cook University Hospital, Middlesbrough Overview of Intravesical Therapy: Current Controversies
Overview Intravesical, Oct 2010 Intravesical Therapy Single Immediate Instillation Maintenance Chemotherapy BCG Failure T1G3
Single instillation of MMC: Always appropriate? Single instillation of intravesical chemotherapy Intravesical , Oct 2010
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Single instillation of intravesical chemotherapy Intravesical, Oct 2010
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Single instillation of intravesical chemotherapy NMIBC, May 2010
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Single instillation of intravesical chemotherapy NMIBC, May 2010
A prospective study of the accuracy of flexible cystoscopy: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NMIBC, May 2010 Prediction of stage and grade
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NMIBC, May 2010 Single instillation of intravesical chemotherapy
[object Object],[object Object],[object Object],[object Object],NMIBC, May 2010 Single instillation of intravesical chemotherapy
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NMIBC, May 2010 Single instillation of intravesical chemotherapy
Re-resection of high-grade disease: a question of quality? ,[object Object],[object Object],Re-resection of high grade disease NMIBC, May 2010
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Re-resection of high grade disease NMIBC, May 2010
What is the evidence to support this recommendation? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NMIBC, May 2010 Re-resection of high grade disease ,[object Object],[object Object],[object Object]
Effect on prognosis ,[object Object],[object Object],[object Object],[object Object],[object Object],Re-resection of high grade disease NMIBC, May 2010
Most important risk factor for understaging was absence of muscle ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Re-resection of high grade disease NMIBC, May 2010 Even if muscle present, high-grade disease warrants re-resection
Decisions for re-resection ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Re-resection of high grade disease NMIBC, May 2010
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Quality of TURBT NMIBC, May 2010
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NMIBC, May 2010 Quality of TURBT
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Quality of TUR NMIBC, May 2010
[object Object],[object Object],[object Object],Failure of intravesical treatment NMIBC, May 2010
Definition of failure of BCG: Intolerance – patient intolerant of side-effects BCG resistance- recurrence/persistance of lesser disease, resolves with further BCG BCG Relapsing-recurrence after initial resolution BCG Refractory-not improving or worsening with BCG Failure of intravesical treatment NMIBC, May 2010
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NMIBC, 2010 Failure of intravesical treatment Tumour Charactistics: Size Multiplicity Cis Stage T1 vs Ta *Must be sure of staging
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NMIBC, May 2010 Failure of intravesical treatment
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Failure of intravesical treatment NMIBC, May 2010
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Failure of intravesical treatment NMIBC, May 2010
Thermotherapy: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Failure of intravesical treatment NMIBC, May 2010
Results of thermotherapy: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Failure of intravesical treatment NMIBC, May 2010 a) b)
Other options: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Failure of intravesical treatment NMIBC, May 2010
Thank you!

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Overview of intravesical therapy: Current Controversies

  • 1. Miss Jo Cresswell Consultant Urologist James Cook University Hospital, Middlesbrough Overview of Intravesical Therapy: Current Controversies
  • 2. Overview Intravesical, Oct 2010 Intravesical Therapy Single Immediate Instillation Maintenance Chemotherapy BCG Failure T1G3
  • 3. Single instillation of MMC: Always appropriate? Single instillation of intravesical chemotherapy Intravesical , Oct 2010
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  • 21. Definition of failure of BCG: Intolerance – patient intolerant of side-effects BCG resistance- recurrence/persistance of lesser disease, resolves with further BCG BCG Relapsing-recurrence after initial resolution BCG Refractory-not improving or worsening with BCG Failure of intravesical treatment NMIBC, May 2010
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Notes de l'éditeur

  1. Approx 500 new cases per year
  2. Approx 500 new cases per year
  3. Recurrence 31-78% at 5yrs, progression 1-15%
  4. Herr makes the point that if a recurrence is tiny and low grade can be ablated under LA, not every recurrence requires inpatent TURBT Basically according to Gudjonsson if tumour >3 on EORTC calculator – no benefit (size >3 cm, multiple, G2
  5. Herr makes the point that if a recurrence is tiny and low grade can be ablated under LA, not every recurrence requires inpatent TURBT
  6. Approx 500 new cases per year
  7. Herr et al. If residual T1 on re-TUR 82% progressed over 5 years, cp to 19% without residual disease
  8. Low grade – 3-22% Put in picture of bladderchek
  9. Low grade – 3-22% Put in picture of bladderchek
  10. Low grade – 3-22% Put in picture of bladderchek
  11. Low grade – 3-22% Put in picture of bladderchek
  12. Put in picture of ileal conduit and orthotopic neobladder
  13. Put in bladder staging diagram again
  14. Approx 500 new cases per year
  15. Put in pictures/movie of blue light cystoscopy
  16. Put in pictures/movie of blue light cystoscopy
  17. In other words get it right first time and the effect is lasting Put in picture from BJU international
  18. In other words get it right first time and the effect is lasting Put in picture from BJU international