Muscle-Invasive Bladder Cancer in Patients with Liver Cirrhosis: A Review of Pertinent Considerations


The incidence of liver cirrhosis is increasing worldwide. Patients with cirrhosis are generally at a higher risk of harboring hepatic and non-hepatic malignancies, including bladder cancer, likely due to the presence of related risk factors such as smoking. Cirrhosis can complicate both the operative and non-surgical management of bladder cancer. For example, cirrhotic patients undergoing abdominal surgery generally demonstrate worse postoperative outcomes, and chemotherapy in patients with cirrhosis often requires dose reduction due to its direct hepatotoxic effects and reduced hepatic clearance. Multiple other considerations in the peri-operative management for cirrhosis patients with muscle-invasive bladder cancer must be taken into

Differences in Quality of Life Between Men and Women who Undergo Bladder Preservation with Trimodality Therapy


PURPOSE: Sex-specific differences exist in muscle invasive bladder cancer (MIBC): men have a higher incidence; women present with more advanced disease; and surgical options differ between men and women. Health-related quality of life (HRQoL) for male versus female patients with MIBC is not well understood and limited data exist in patients who undergo bladder preservation with trimodality therapy (TMT). The purpose of this study was to compare long-term HRQoL between men and women who have undergone TMT.

METHODS AND MATERIALS: This was a secondary analysis of a prior study that reported long-term HRQoL differences for patients who 

A Randomized Feasibility Trial Comparing Surveillance Regimens for Patients with Low and Low-Intermediate Risk Non-Muscle Invasive Bladder Cancer


BACKGROUND: Surveillance regimens for non-muscle invasive bladder cancer (NMIBC) are disparate and controlled trials could inform guidelines. The feasibility of randomizing patients to variable frequency surveillance is unknown.

OBJECTIVES: To determine patient willingness to randomization to high frequency (HF) versus low frequency (LF) surveillance regimen for NMIBC and compare patient comfort and healthcare costs across regimens.

METHODS: A non-blinded, two-arm, randomized-controlled study of patients with low or low-intermediate risk NMIBC was conducted at two institutions where patients were offered randomization to HF vs. LF surveillance following initial tumor resection. The HF group underwent cystoscopy every three 

Quality of Life and Anxiety in Patients with First Diagnosed Non-Muscle Invasive Bladder Cancer Who Receive Adjuvant Bladder Therapy


BACKGROUND: Bladder cancer (BC) is one of the most common malignancies (4.5%of all newly diagnosed cases worldwide). Most of the new BC cases are diagnosed as non-muscle-invasive BC (NMIBC), needing continuous follow-up after primary endoscopic therapy. Adjuvant bladder therapy with chemo- or immuno- agents, apart from the initial diagnosis, the strict surveillance program, and the risk of recurrence, may have a major impact on the patients’ physical and mental health. OBJECTIVE: We evaluated anxiety and quality of life (QoL) in patients who underwent surgery for NMIBC and followed a bladder instillation program.


Alternating Cystoscopy with Bladder EpiCheck ® in the Surveillance of Low-Grade Intermediate-Risk NMIBC: A Cost Comparison Model


BACKGROUND: Bladder cancer surveillance is invasive, intensive, and costly. Patients with low-grade intermediate risk non-muscle invasive bladder cancer (NMIBC) are at high risk of recurrence.

OBJECTIVE: The objective of this model is to compare the cost of a strategy to alternate surveillance with cystoscopy and a urine marker, Bladder EpiCheck, to standard surveillance.

METHODS: A decision tree model was built using TreeAge Pro Healthcare to compare standard surveillance (Standard) with modified surveillance incorporating Bladder EpiCheck. The model was based on 2 years of surveillance. Outcomes were obtained from the literature. Costs were obtained from the US

Basal and Luminal Molecular Subtypes in Naturally-Occurring Canine Urothelial Carcinoma are Associated with Tumor Immune Signatures and Dog Breed


BACKGROUND: Improved therapies are needed for patients with invasive urothelial carcinoma (InvUC). Tailoring treatment to molecular subtypes holds promise but requires further study, including studies in pre-clinical animal models. Naturally-occurring canine InvUC harbors luminal and basal subtypes, mimicking those observed in humans, and could offer a relevant model for the disease in people.

OBJECTIVE: To further validate the canine InvUC model, clinical and tumor characteristics associated with luminal and basal subtypes in dogs were determined, with comparison to findings from humans.

METHODS: RNA sequencing (RNA-seq) analyses were performed on 56 canine InvUC tissues and bladder mucosa

Efficacy of EGFR Inhibitors and NSAIDs Against Basal Bladder Cancers in a Rat Model: Daily vs. Weekly Dosing, Combining EGFR Inhibitors with Naproxen, and Effects on RNA Expression


BACKGROUND: There are few effective treatments specifically aimed at basal bladder cancer.

OBJECTIVE: Female F344 rats administered N-butyl-N-(4-hydroxybutyl)-nitrosamine (OH-BBN) develop large invasive bladder cancers. We determined the efficacy of daily vs weekly dosing of EGFR inhibitors, determined the efficacy of naproxen combined with an EGFR inhibitor, and performed RNA analysis of bladder tumors treated for 5 days with EGFR inhibitors or NO-naproxen to identify pharmacodynamic biomarkers.

METHODS: Erlotinib (6 mg/Kg BW daily or 21 or 42 mg/Kg BW weekly), lapatinib (25 or 75 mg/Kg BW daily or 263 or 525 mg/Kg BW weekly), and/or naproxen (30 mg/Kg BW daily) were administered

Lung Metastases Versus Second Primary Lung Cancers in Patients with Primary Urothelial Carcinoma of the Bladder: A National Population-Based Assessment


BACKGROUND: The work-up and diagnosis of indeterminate lung nodules at the time of bladder cancer diagnosis may delay or change treatment.

OBJECTIVE: To quantify the incidence of synchronous and metachronous lung cancers in adults with bladder cancer and compare these rates to the incidence of bladder cancer metastases in the lung.

METHODS: We retrospectively analyzed all adults diagnosed with bladder cancer in the Surveillance, Epidemiology and End Results (SEER) registry (2010– 2015) and identified second primary lung cancers defined as being either synchronous (diagnosed within 6 months of bladder cancer diagnosis) or metachronous (more than 6 months

The Impact of Physical Activity on Risk and Health-Related Quality of Life in Bladder Cancer


BACKGROUND: Sedentarism is an important modifiable risk factor in the struggle against cancer. In the last decades, the relationship between physical activity and different types of cancer has been investigated in depth.

OBJECTIVE: To provide an overview of the literature on the effectiveness of physical activity in reducing the risk to develop bladder cancer and improving health-related quality of life in patients.

METHODS: A systematic review was conducted through a search of the Embase, Cochrane, PubMed, Scopus, and Web of Science (WOS) databases to seek information and PRISMA system to delimitate the research. Outcomes included in 

Impact of Intestinal Urinary Diversion on the Risk of Fracture and Loss of Bone Mass: A Systematic Review


BACKGROUND: Patients undergoing intestinal urinary diversion (IUD) may have a higher risk of osteoporosis and risk of fractures due to metabolic acidosis and a decrease of intestinal absorption surface.

OBJECTIVE: We performed a systematic review of the available literature on the impact of IUD on bone demineralization.

METHODS: We systematically searched PubMed® , for original articles published before April 2020. Primary endpoints were the risk of fracture and loss of bone density. Secondary outcomes were the metabolic changes in biochemical and urine parameters related to calcium metabolism and histological changes.

RESULTS: Our electronic search

Challenging Cases in Urothelial Cancer: Case 21

This is a 65-year-old current and longtime cigarette smoker who presented to me with an 8-month history of intermittent gross hematuria and a diagnosis of muscle-invasive urothelial cancer of the bladder. He has type 2 diabetes mellitus. He had symptomatic coronary artery disease and coronary artery stents were placed in 2015. He currently has a good performance status.

He was initially evaluated by another urologist who identified a papillary and sessile tumor on the right side of the bladder located above the right ureteral orifice. The tumor appeared to be arising from a bladder diverticulum.

Clinical Trials Corner Issue 7(3)

In this issue, we highlight several trials evaluating bladder preservation. While exciting, these trials do raise the question of comparability across studies given the use of different regimens of radiotherapy and different endpoints. 

Iatrogenic Causes of Urothelial Cancer of the Upper Urinary Tract and Bladder

The bladder and the upper urinary tract (UUT) are both lined by urothelium and have cancer characteristics that are histologically and molecularly similar. Aside from inherited (e.g. Lynch family tumor syndrome) [1] or unusual exposures (e.g. phenacetin or herbal remedies with Aristolochia fanchi) [2, 3], upper tract urothelial cancer (UTUC) represents 5–10%of all UCs [4] (Sountoulides) and presents with concomitant UC of the bladder (BC) in 20%of cases [5]. Moreover, about 30%of patients with UTUC have prior histories of BC [6, 7], and as many a 30% of patients with newly diagnosed UTUC without prior BCs will experience a recurrence in the bladder over the 12 months following radical nephron-ureterostomy (RNU) and bladder cuff excision [8]. Clearly, finding ways to prevent both UTUC and BC is worthwhile. Thus, it is of interest that two articles recently published in the Journal of Urology look at ways to reduce recurrences that are potentially iatrogenically induced.