Skip to main content

Intravesical Chemotherapy in the Treatment of Superficial Bladder Cancer

  • Chapter
Bladder Cancer

Abstract

Bladder cancer has proved to be a great challenge to urologists. This is so in that bladder cancer is a paradigm of malignancy. Some tumors are relatively benign, while others are highly aggressive, making early diagnosis and appropriate treatment critical. Transurethral resection is usually the primary mode of therapy for both diagnosis and treatment. Persistent high grade tumor confined to the urothelium may require further treatment to prevent recurrence or possible progression. Further treatment is usually in the form of intravesical chemotherapy or immunotherapy. This chapter concentrates on the role of intravesical chemotherapy. Its relation to transurethral resection will be discussed. Its use in relation to immunotherapy will also be discussed, but the various forms of immunotherapy will be the subject of another chapter. After review of their characteristics, mechanisms of action, toxicities, and indications for use, the intravesical chemotherapeutic agents will be reviewed in their relation to one another and to immunotherapy. Finally the future directions of intravesical chemotherapy will be discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Jones PA. Molecular basis for disease-transitional cell carcinoma. Presented at Society of Urologic Oncology Annual Meeting, San Francisco, CA, May 14. J Urol 1994; 151: 63A.

    Google Scholar 

  2. Messing EM, Catalona W. In: Urothelial Tumors of the Urinary Tract ( Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds.). WB Saunders Company, Philadelphia, PA, 1998, pp. 2327–2410.

    Google Scholar 

  3. Prout GR, Barton BA, Griffin PP, Friedell G. Treated history of noninvasive grade 1 transitional cell carcinoma. J Urol 1992; 148: 1413–1419.

    PubMed  Google Scholar 

  4. Thompson RA, Campbell EW Jr, Kramer HC, et al. Late invasive recurrence despite long term surveillance for superficial bladder cancer. J Urol 1993; 149: 1010–1011.

    PubMed  Google Scholar 

  5. Messing EM, Young TB, Hunt VB, et al. Hematuria home screening: repeat testing results. J Urol 19956; 154: 57–61.

    Google Scholar 

  6. Messing EM, Young TB, Hunt VB, et al. Comparison of bladder cancer outcome in men undergoing hematuria home screening versus those with standard clinical presentations. Urology 1995c; 45: 387–396.

    CAS  PubMed  Google Scholar 

  7. Althausen AF, Prout GR Jr, Daly JJ. Noninvasive papillary carcinoma of the bladder associated with carcinoma in situ. J Urol 1976; 116: 575–580.

    CAS  PubMed  Google Scholar 

  8. Gilbert HA, Logan JL, Lagan AR, et al. The natural history of papillary transitional cell carcinoma of the bladder and its treatment in an unselected population on the basis of histologic grading. J Urol 1978; 119: 486–492.

    Google Scholar 

  9. Fitzpatrick JM, West AB, Butler MR, et al. Superficial bladder tumors (stage pTa, grades 1 and 2): the importance of recurrence pattern following initial resection. J Urol 1986; 135: 920–922.

    CAS  PubMed  Google Scholar 

  10. Malmstrom PU, Busch C, Norlen BJ. Recurrence, progression, and survival in bladder cancer: a retrospective analysis of 232 patients with greater than or equal to 5-year follow-up. Scand J Urol Nephrol 1987; 21: 185–195.

    CAS  PubMed  Google Scholar 

  11. Klan R, Loy V, Huland H. Residual tumor discovered in routine second transurethral resection in patients with stage T1 transitional cell carcinoma of the bladder. J Urol 1991; 146: 316–318.

    CAS  PubMed  Google Scholar 

  12. Page BH, Levison VB, Curwen MP. The site of recurrence of noninfiltrating bladder tumors. Br J Urol 1978; 50: 237–242.

    CAS  PubMed  Google Scholar 

  13. Oosterlinck W, Kurth KH, Schroder F, et al. A prospective European Organization for Research and Treatment of Cancer Genitourinary Group randomized trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single Ta, T1 papillary carcinoma of the bladder. J Urol 1993; 149: 749–752.

    CAS  PubMed  Google Scholar 

  14. Cookson MS, Sarosdy MF. Management of stage T1 superficial bladder cancer with intravesical bacillus Calmette-Guerin therapy. J Urol 1992: 148: 797–801.

    CAS  PubMed  Google Scholar 

  15. Norming U, Tribukait B, Nyman CR, et al. Prognostic significance of mucosal aneuploidy in stage Ta,T1 grade 3 carcinoma of the bladder. J Urol 1992, 148: 1420–1426.

    CAS  PubMed  Google Scholar 

  16. Freeman JA, Esrig DE, Stein JP, et al. Radical Cystectomy for high risk patients with superficial bladder cancer in the era of orthotopic urinary reconstruction. Cancer 1995a; 76: 833–839.

    CAS  PubMed  Google Scholar 

  17. Wolf H, Melsen F, Pederson SE, Nielson KT. Natural history of carcinoma in situ of the urinary bladder. Scand J Urol Nephrol 1994; 157: 147–151.

    CAS  Google Scholar 

  18. Soloway MS. Rationale for intensive intravesical chemotherapy for superficial bladder cancer. J Urol 1980; 123: 461–466.

    CAS  PubMed  Google Scholar 

  19. Smith JA. Surgical management of superficial bladder cancer. Semin Surg Oncol 1997; 13: 328–334.

    PubMed  Google Scholar 

  20. Matzkin H, Soloway MS, Hardeman S. Transitional cell carcinoma of the prostate. J Urol 1991; 146: 1207–1212.

    CAS  PubMed  Google Scholar 

  21. Sakamoto N, Tsuneyoshi M, Naito S, Kumazawa J. An adequate sampling of the prostate to identify prostatic involvement by urothelial carcinoma in bladder cancer patients. J Urol 1993; 149: 318–321.

    CAS  PubMed  Google Scholar 

  22. Smith JA Jr. Endoscopic applications of laser energy. Urol Clin North Am 1986; 13: 405–419.

    PubMed  Google Scholar 

  23. Smith JA Jr, Landau S. Neodymium: YAG laser specifications for safe intravesical therapy. J Urol 1989; 141: 1238.

    PubMed  Google Scholar 

  24. Smith JA Jr, Dixon JA. Argon laser phototherapy of superficial transitional cell carcinoma of the bladder. J Urol 1984; 131: 655–666.

    PubMed  Google Scholar 

  25. Benson RC. Laser treatment. In: High Tech Urology: Technological Innovations and Their Clinical Applications ( Smith JA Jr, ed.). WB Saunders, Philadelphia, PA, 1992, pp. 47–49.

    Google Scholar 

  26. Johnson DE. Use of the holmium: YAG (ho: YAG) laser for treatment of superficial bladder carcinoma. Lasers Surg Med 1994; 14: 213–218.

    CAS  PubMed  Google Scholar 

  27. Milam DF. Surgical laser fibers and right angle laser techniques. In: Lasers in Urologic Surgery (Smith JA Jr, ed.), 3rd ed. Mosby-Year Book, St. Louis, MO, 1994, pp. 26–31.

    Google Scholar 

  28. Beisland HO, Seland P. A prospective randomized study on neodymium: YAG laser irradiation versus TUR in treatment of urinary bladder cancer. Scand J Urol Nephrol 1986; 20: 209–212.

    CAS  PubMed  Google Scholar 

  29. Sander S, Beisland HO. Superficial bladder cancer. In: Lasers in Urologie Surgery ( Smith JA Jr, ed.). Mosby Year Book, St. Louis, MO, 1994, pp. 126–134.

    Google Scholar 

  30. Badalament RA, Farah RN. Treatment of superficial bladder cancer with intravesical chemotherapy. Semin Surg Oncol 1997; 13: 335–341.

    CAS  PubMed  Google Scholar 

  31. Lamm DL, Griffith G, Pettit LL, Nseyo UO. Current perspectives on diagnosis and treatment of superficial bladder cancer. Urology 1992; 39 (4): 331–341.

    Google Scholar 

  32. Lamm DL. Long term results of intravesical therapy for superficial bladder cancer. (Review). Urol Clin North Am 1992; 19: 573–580.

    CAS  PubMed  Google Scholar 

  33. Schmittgen TD, Au JL, Wientjes MG, et al. Cultured human bladder tumors for pharmacodynamic studies. J Urol 1991; 145: 203–207.

    CAS  PubMed  Google Scholar 

  34. Wientjes MG, Dalton JT, Badalament RA, et al. A method to study drug concentration-depth profiles in tissues: mitomycin C in dog bladder wall. Pharmaceut Res 1991: 8: 168.

    CAS  Google Scholar 

  35. Schmittgen TD, Wientjes MG, Badalament RA, Au JL. Pharmacodynamics of mitomycin C in cultured human bladder tumors. Cancer Res 1991; 51: 3849–3856.

    CAS  PubMed  Google Scholar 

  36. Wientjes MG, Dalton JT, Badalment RA, et al. Bladder wall penetration of intravesical mitomycin C in dogs. Cancer Res 1991; 51: 4347–4354.

    CAS  PubMed  Google Scholar 

  37. Dalton JT, Wientjes MG, Badalament RA, et al. Pharmacokinetics of intravesical mitomycin C in superficial bladder cancer patients. Cancer Res 1991; 51: 51445152.

    Google Scholar 

  38. Wientjes MG, Badalament RA, Au JL. Use of pharmacologic data and computer simulations to design an efficacy trial of intravesical mitomycin C therapy for superficial bladder cancer. Cancer Chemother Pharmacol 1993: 32: 255–262.

    CAS  PubMed  Google Scholar 

  39. Wientjes MG, Badalament RA, Wang RC, et al. Penetration of mitomycin C in human bladder. Cancer Res 1993; 53: 3314–3320.

    CAS  PubMed  Google Scholar 

  40. Schmidbauer CP, Porpaczy P, Georgeopoulos A, et al. Absorption of doxorubicin-hydrochloride and mitomycin C after instillation into noninfected and infected bladders of dogs. J Urol 1984; 131 (4): 818–821.

    CAS  PubMed  Google Scholar 

  41. Dedrick RL, Flessner MF, Collins JM, Schultz JS. Is the peritoneum a membrane? ASAIO J 1982; 5: 1.

    Google Scholar 

  42. Flessner MF, Dedrick RL, Schultz JS. A distributive model of peritoneal-plasma transport: Analysis of experimental data in the rat. Am J Physiol 1985: 248: F413 - F424.

    CAS  PubMed  Google Scholar 

  43. Wientjes MG, Badalament RA, Au JL. Penetration of intravesical doxorubicin in human bladders. Cancer Chemother Pharmacol 1996; 37: 539–546.

    CAS  PubMed  Google Scholar 

  44. Groos E, Masters JR. Intravesical chemotherapy: studies on the relationship between osmolality and cytotoxicity. J Urol 1986; 136: 399–402.

    CAS  PubMed  Google Scholar 

  45. Walker MC, Masters JR, Parris CN, Hepburn PJ, English PJ. Intravesical chemotherapy: in vitro studies on the relationship between dose and cytotoxicity. Urol Res 1986; 14 (3): 137–140.

    CAS  PubMed  Google Scholar 

  46. Eksborg S, Nillson S, Edsmyr F. Intravesical instillation of adriamycin; a model for standardization of the chemotherapy. Eur Urol 1980; 6: 218–220.

    CAS  PubMed  Google Scholar 

  47. Masters JR, McDermott BJ, Harland S, Bibby MC, Loadman PM. ThioTEPA pharmacokinetics during intravesical chemotherapy: the influence of dose and volume of instillate on systemic uptake and dose rate to the tumour. Cancer Che-mother Pharmacol 1996; 38 (1): 59–64.

    CAS  Google Scholar 

  48. Tarkington M, Sommers, CL, Gelmann EP, Tefft MC, Lynch JH. The effect of pH on the in vitro colony-forming ability of transitional cell carcinoma cells treated with various chemotherapeutic agents: implications for in vivo therapy. J Urol 1992; 147: 511–513.

    CAS  PubMed  Google Scholar 

  49. Jauhiainen K, Kangas L, Nieminen AL, Kapyla H, Alfthan O. Optimising mitomycin C activity during intravesical instillation. Urol Res 1983; 11 (2): 59–62.

    CAS  PubMed  Google Scholar 

  50. Yen WC, Schmittgen T, Au JL. Different pH dependency of mitomycin C activity in monolayer and three-dimensional cultures. Pharm Res 1996; 13 (12): 1887–1891.

    CAS  PubMed  Google Scholar 

  51. De Bruijn EA, Sleeboom HP, van Helsdingen PJ, van Oosterom AT, Tjaden UR, Maes RA. Pharmacodynamics and pharmacokinetics of intravesical mitomycin C upon different dwelling times. Int J Cancer 1992; 513 ): 359–364.

    Google Scholar 

  52. Heney NM, Koontz WW, Barton B, et al. Intravesical thiotepa versus mitomycin C in patients with Ta, T l, and Tis transitional cell carcinoma of the bladder: a phase III prospective randomized study. J Urol 1988; 140: 1390–1393.

    CAS  PubMed  Google Scholar 

  53. Witjes JA, Oosterhof GON, Debruyne FMJ. In: Comprehensive Textbook of Genitourinary Oncology ( Vogelzang NJ, Scardino PT, Shipley WU, Coffey DS, eds.). Williams and Wilkins, Philadelphia, PA, 1996, pp. 416–427.

    Google Scholar 

  54. Hamdy FC, Hastic KJ, Kerry R, Williams JL. Mitomycin-C in superficial bladder cancer. Is long-term maintenance therapy worthwhile after initial treatment? Br J Urol 1993; 71: 183–186.

    CAS  PubMed  Google Scholar 

  55. Connolly JG. Chemotherapy of superficial bladder cancer. In: Carcinoma of the Bladder ( Connolly JG, ed.). Raven, New York, NY, 1981, pp. 165–175.

    Google Scholar 

  56. Sonneveld P, Kurth KH, Hagenmyer A, et al. Secondary hematologic neoplasm after intravesical chemotherapy for superficial bladder carcinoma. Cancer 1990; 65: 23–25.

    CAS  PubMed  Google Scholar 

  57. Parmar MK, Freedman LS, Hargreave TB, Tolly DA. Prognostic factors for recurrence and followup policies in the treatment of superficial bladder cancer: report from the British Medical Research Council Subgroup on Superficial Bladder Cancer (Urological Cancer Working Party). J Urol 1989; 142: 284–288.

    CAS  PubMed  Google Scholar 

  58. Rubben H, Lutzeyer W, Fischer N, et al. Natural history and treatment of low and high risk superficial bladder tumors. J Urol 1988; 139: 283–285.

    CAS  PubMed  Google Scholar 

  59. Bateman JC. The chemotherapy of solid tumors with triethylene thio phosphoraminde (Thiotepa). N Engl J Med 1955; 252: 879.

    CAS  PubMed  Google Scholar 

  60. Jones HC, Swinney J. Thiotepa in the treatment of tumors of the bladder. Lancet 1961; 2: 615.

    CAS  PubMed  Google Scholar 

  61. Weaver D, Khare N, Haigh J, et al. The effect of chemotherapeutic agents on the ultrastructure of transitional cell carcinoma in tissue culture. Invest Urol 1980; 17: 288–292.

    CAS  PubMed  Google Scholar 

  62. Koontz WW Jr, Prout GR, Smith W, et al. The use of intravesical thiotepa in the management of non-invasive carcinoma of the bladder. J Urol 1981; 125: 307312.

    Google Scholar 

  63. Hollister D, Coleman M. Hematological effects of intravesical thiotepa therapy for bladder carcinoma. JAMA 1980; 244: 2065–2067.

    PubMed  Google Scholar 

  64. Soloway MS, Ford KS. Thiotepa induced myelosupression: a review of 670 bladder instillations. J Urol 1983; 130: 889–891.

    CAS  PubMed  Google Scholar 

  65. Martinez-Pineiro JA, Jimenez Leon J, Martinez-Pineiro L Jr, et al. Bacillus Calmette-Guerin versus doxorubicin versus thiotepa: a randomized prospective study in 202 patients with superficial bladder cancer. J Urol 1990; 143: 502–506.

    CAS  PubMed  Google Scholar 

  66. Crooke ST. Mitomycin C: an overview. In: Mitomycin C Current Status and New Developments ( Carter SK, Crooke ST, eds.). Academic, New York, NY, 1979, pp. 1–4.

    Google Scholar 

  67. Phillips FS, Schwartz HS, Sternberg SS. Cancer Res 1960; 20: 1354.

    Google Scholar 

  68. Schwartz HS, Sternberg SS, Philips FS. Cancer Res 1963; 23: 1125.

    CAS  PubMed  Google Scholar 

  69. Iyer VN, Szybalski W. Proc Natl Acad Sci 1963; 50: 355.

    CAS  PubMed  Google Scholar 

  70. Iyer VN, Szybalski W. Science 1964; 145: 55.

    CAS  PubMed  Google Scholar 

  71. Lown SW, Weir G. Studies related to antitumor antibiotics. Part XIV. Reactions of mitomycin B with DNA. Can J Biochem 1978; 56: 296.

    CAS  Google Scholar 

  72. Thrasher JB, Crawford ED. Complications of intravesical chemotherapy. Urol Clin North Am 1992; 19: 529–539.

    CAS  PubMed  Google Scholar 

  73. Zein TA, Friedberg N, Kim H. Bone marrow suppression after intravesical mitomycin C treatment. J Urol 1986; 136: 459–460.

    CAS  PubMed  Google Scholar 

  74. de Groot AC, Meijden APM vd, Conemans JMH, Maibach HI. Frequency and nature of cutaneous reactions to intravesical instillation of mitomycin for superficial bladder cancer. Urology 1992; 40 (Suppl): 16.

    Google Scholar 

  75. Colver GB, Inglis JA, McVittle E, et al. Dermatitis due to intravesical Mitomycin C: a delayed type hypersensitivity reaction? Br J Dermatol 1990; 122: 217–224.

    CAS  PubMed  Google Scholar 

  76. Eijstein A, Knonagel H, Hotz E, et al. Reduced bladder capacity in patients receiving intravesical chemoprophylaxix with mitomycin C. Br J Urol 1990; 66: 386.

    Google Scholar 

  77. Drago PC, Badalament RA, Lucas J, Drago JR. Bladder wall calcifications after intravesical Mitomycin-C treatment of superficial bladder cancer. J Urol 1989; 142: 1071–1072.

    CAS  PubMed  Google Scholar 

  78. Tritton TR, Yee G, Wingard B Jr. Immobilized adriamycin: a tool for separating cell surface from intracellular mechanisms. Fed Proc 1983; 42: 284–287.

    CAS  PubMed  Google Scholar 

  79. Akaza H, Isaka S, Koiso K, et al. Comparative analysis of short-term and longterm prophylactic intravesical chemotherapy of superficial bladder cancer. Cancer Chemother Pharmacol 1987; 20: S91 - S96.

    PubMed  Google Scholar 

  80. Crawford ED, Mc Kenzie D, Mansson W, et al. Adverse reactions to the intravesical administration of doxorubicin hydrochloride: a report of six cases. J Urol 1986; 136: 668–669.

    CAS  PubMed  Google Scholar 

  81. Lundbeck F, Mogenson P, Jeppeson N. Intravesical therapy of noninvasive bladder tumors (stage Ta) with doxorubicin and urokinase. J Urol 1983; 130: 1087 1089.

    Google Scholar 

  82. Matsumura Y, Akaze H, Isaka S, et al. The 4th study of prophylactic intravesical chemotherapy with adriamycin in the treatment of superficial bladder cancer: the experience of the Japanese urological cancer research group for adriamycin. Cancer Chemother Pharmacol 1992; 30: S 10.

    Google Scholar 

  83. Lamm DL, Blumenstein BA, Crawford ED, et al. A randomized trial of intravesical doxorubicin and immunotherapy with bacillus Calmette-Guerin for transitional cell carcinoma of the bladder. N Engl J Med 1991; 325: 1205–1209.

    CAS  PubMed  Google Scholar 

  84. Khanna OP, Son DL, Mazer H, et al. Multicenter study of superficial bladder cancer treated with intravesical bacillus Calmette-Guerin or adriamycin. Urology 1991; 38 (3): 271–279.

    CAS  PubMed  Google Scholar 

  85. Burk K, Kurth KH, Newling D. Epirubicin in treatment and recurrence prophylaxis of patients with superficial bladder cancer. Prog Clin Biol Res 1989; 303: 423–434.

    CAS  PubMed  Google Scholar 

  86. Whelan P, Cumming JA, Garvie WHH, et al. Multicentre phase II study of low dose intravesical epirubicin in the treatment of superficial bladder cancer. Br J Urol 1991; 67: 600–602.

    CAS  PubMed  Google Scholar 

  87. Oosterlinck W, Kurth KH, Scroder F, et al. A prospective European Organisation for Research and Treatment of Cancer Genitourinary Group randomized trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single Ta, Tl papillary carcinoma of the bladder. J Urol 1993; 149: 749–752.

    CAS  PubMed  Google Scholar 

  88. Melekos MD, Dauaher II, Fokaefs E, et al. Intravesical instillations of 4-epidoxorubicin (epirubicin) in the prophylactic treatment of superficial bladder cancer: results of controlled prospective study. J Urol 1992; 147: 371–375.

    CAS  PubMed  Google Scholar 

  89. Ali-el-dein B, el-Baz M, Aly AN, et al. Intravesicall epirubicin versus doxorubicin for superficial bladder tumors (stages pTa and pTl): a randomized prospective study. J Urol 1997; 158 (1): 68–74.

    Google Scholar 

  90. Riddle PR. The management of superficial bladder tumors with intravesical epodyl. Br J Urol 1973; 45: 84–87.

    CAS  PubMed  Google Scholar 

  91. Robinson MRG, Shelty MB, Richards B, et al. Intravesical epodyl in the management of bladder tumors: combined experiences of the Yorkshire Urological Cancer Research Group. J Urol 1977; 118: 972–973.

    CAS  PubMed  Google Scholar 

  92. Flamm J, Bucher A. Adjuvant topical chemotherapy versus immunotherapy in primary superficial transitional cell carcinoma of the bladder. Br J Urol 1991; 67: 70–73.

    CAS  PubMed  Google Scholar 

  93. Hoetl W, Hasun R, Albrecht W. Prospective randomized trial to evaluate high-versus low-dose interferon-alpha 2b versus conventional chemotherapy in prevention of the recurrence of superficial transitional cell carcinoma of the urinary bladder. Anticancer Drugs 1992; 3 (Suppl 1): 29.

    Google Scholar 

  94. Bouffioux C, Denis L, Oosterlinck W, et al. Adjuvant chemotherapy of recurrent superficial transitional cell carcinoma: results of an European Organisation for Research on Treatment of Cancer randomized trial comparing intravesical instillations of thiotepa, doxorubicin, and cisplatin. J Urol 1992; 148: 297–301.

    CAS  PubMed  Google Scholar 

  95. Blumenreich MS, Needles B, Yagoda A, et al. Intravesical cisplatin for superficial bladder tumors. Cancer 1982; 50: 863–865.

    CAS  PubMed  Google Scholar 

  96. Stewart DJ, Green R, Futter N, et al. Phase I and pharmacology study of intravesical mitoxantrone for recurrent superficial bladder tumors. J Urol 1990; 143: 714716.

    Google Scholar 

  97. Ricos Torrent JV, Monros Lliso JL, Iborra Juan I, Casanova Ramon-Borja JA, Dumont Martinez R, Solsona Narbon E. (Mitoxantrone (MTX) versus mitomycin C (MMC) in the ablative treatment of Ta, Tl superficial bladder tumors. Phase III, randomized prospective study). (Article in Spanish) Arch Esp Urol 1992; 45 (7): 647–652.

    Google Scholar 

  98. Maffezzini M, Simonato A, Zanon M, Raber M, Carmignani G. Up-front intravesical chemotherapy for low stage, low grade recurrent bladder cancer. J Urol 1996; 155 (1): 91–93.

    CAS  PubMed  Google Scholar 

  99. Omoto T, Masaki Z, Kano M, et al. Postoperative prophylactic intravesical instillation of cytosine arabinoside and mitomycin c in superficial bladder tumor. A follow-up study. Urology 1982; 20: 510–514.

    CAS  PubMed  Google Scholar 

  100. Togashi M, Shinihara N, Toyota K, et al. Prophylactic chemotherapy for primary and recurrent superficial bladder cancer: preliminary results. Cancer Chemother Pharmacol 1992; 30: S21 - S25.

    PubMed  Google Scholar 

  101. Bono AV, Hall RR, Denis L, Lovisolo JA, Sylvester R. Chemoresection in Ta-T1 bladder cancer. Members of the EORTC Genito-Urinary Group. Eur Urol 1996; 29 (4): 385–390.

    CAS  PubMed  Google Scholar 

  102. Kurth K, Vijgh WJF, Fibo TK, et al. Phase study of intravesical epirubicin in patients with carcinoma in situ of the bladder. J Urol 1991; 146: 1508–1513.

    CAS  PubMed  Google Scholar 

  103. Richie JP. Intravesical chemotherapy. Treatment selection, techniques, and results. Urol Clin North Amer 1992; 19: 521.

    CAS  Google Scholar 

  104. Kurth KH, Debruyne FJ, Senge T, Carpentier PJ, Riedl H, Sylvester R, et al. Adjuvant chemotherapy of superficial transitional cell carcinoma: an E.O.R.T.C. randomized trail comparing doxorubicin hydrochloride, ethoglucid and TUR-alone. Prog Clin Biol Res 1985: 135–142.

    Google Scholar 

  105. Huland H, Otto U. Mitomycin instillation to prevent recurrence of superficial bladder carcinoma. Results of a controlled, prospective study in 58 patients. Eur Urol 1983; 9 (2): 84–86.

    CAS  PubMed  Google Scholar 

  106. Niijima T, Koiso K, Akaza H. Randomized clinical trial on chemoprophylaxis of recurrence in cases of superficial bladder cancer. Cancer Chemother Pharmacol 1983; 11 (Suppl): 79–82.

    Google Scholar 

  107. Akaza H, Isaka S, Koiso K, Kotake T, Machida T, Mani A, et al. Comparative analysis of short-term and long-term prophylactic intravesical chemotherapy of superficial bladder cancer. Prospective, randomized, controlled studies of the Japanese Urological Cancer Research Group. Cancer Chemother Pharmacol 1987; 20 (Suppl): 91–96.

    Google Scholar 

  108. Tolley DA, Hargreave TB, Smith PH, Williams JL, Grigor KM, Parmar MK, et al. Effect of intravesical mitomycin C on recurrence of newly diagnosed superficial bladder cancer: interim report from the Medical Research Council Subgroup on Superficial Bladder Cancer (Urological Cancer Working Party). Br Med J (Clin Res Ed) 1988; 296 (6639): 1759–1761.

    CAS  PubMed Central  Google Scholar 

  109. Kim HH, Lee C. Intravesical mitomycin C instillation as a prophylactic treatment of superficial bladder tumor. J Urol 1989; 141(6): 1337–9; discussion 1339–1340.

    Google Scholar 

  110. Rubben H, Graf-Dobberstein, Ostwald R, et al. Prospective randomized study of adjuvant therapy after complete resection of superficial bladder cancer; mitomycin C vs BCG Connaught vs TUR alone. In: Immunotherapy of Urological Tumors ( deKernion JB, Mazema E, eds.). Churchill Livingstone, New York, NY, 1990, pp. 27–36.

    Google Scholar 

  111. Minervini R, Felipetto R, Viganoa L, Pampaloni S, Fiorentini L. Recurrences and progressions of superficial bladder cancer following longterm intravesical prophylactic therapy with mitomycin C instillation: 48 month follow-up. Urol Int 1996; 56: 234–237.

    CAS  PubMed  Google Scholar 

  112. Burnand KG, Boyd PJ, Mayo ME, Shuttleworth KE, Lloyd-Davies RW. Single dose intravesical thiotepa as an adjuvant to cystodiathermy in the treatment of transitional cell bladder carcinoma. Br J Urol 1976; 48 (1): 55–59.

    CAS  PubMed  Google Scholar 

  113. Byar D, Blackard C. Comparisons of placebo, pyridoxine, and topical thiotepa in preventing recurrence of stage I bladder cancer. Urology 1977; 10 (6): 556–618.

    CAS  PubMed  Google Scholar 

  114. Nocks BN, Nieh PT, Prout GR Jr. A longitudinal study of patients with superficial bladder carcinoma successfully treated with weekly intravesical thio-tepa. J Urol 1979; 122 (1): 27–29.

    CAS  PubMed  Google Scholar 

  115. Asahi T, Matsumura Y, Tanahashi T, Yoshimoto J, Kaneshige T, Fujita Y, et al. The effects of intravesical instillation of Thio-Tepa on the recurrence rate of bladder tumors. Acta Med Okayama 1980; 34 (1): 43–49.

    CAS  PubMed  Google Scholar 

  116. Koontz WW Jr, Prout GR Jr, Smith W, Frable WJ, Minnis JE. The use of intravesical thio-tepa in the management of non-invasive carcinoma of the bladder. J Urol 1981; 125 (3): 307–312.

    PubMed  Google Scholar 

  117. Schulman CC, Robinson M, Denis L, Smith P, Viggano G, de Pauw M, et al. Prophylactic chemotherapy of superficial transitional bladder carcinoma. An EORTC randomized trial comparing thiotepa, an epipodophyllotoxin (VM26) and TUR alone. Eur Urol 1982; 8: 207–212.

    CAS  PubMed  Google Scholar 

  118. Zincke H, Utz DC, Taylor WF, Myers RP, Leary FJ. Influence of thiotepa and doxorubicin instillation at time of transurethral surgical treatment of bladder cancer on tumor recurrence: a prospective, randomized, double-blind, controlled trial. J Urol 1983; 129 (3): 505–509.

    CAS  PubMed  Google Scholar 

  119. Prout GR Jr, Koontz WW Jr, Coombs LJ, Hawkins IR, Friedell GH. Long-term fate of 90 patients with superficial bladder cancer randomly assigned to receive or not to receive thiotepa. J Urol 1983; 130 (4): 677–680.

    PubMed  Google Scholar 

  120. The effect of intravesical thiotepa on the recurrence rate of newly diagnosed superficial bladder cancer. An MRC Study. MRC Working Party on Urological Cancer. Br J Urol 1985; 57 (6): 680–685.

    Google Scholar 

  121. Zincke H, Utz DC, Taylor WF, Myers RP, Leary FJ. Influence of thiotepa and doxorubicin instillation at time of transurethral surgical treatment of bladder cancer on tumor recurrence: a prospective, randomized, double-blind, controlled trial. J Urol 1983; 129 (3): 505–509.

    CAS  PubMed  Google Scholar 

  122. Rubben H, Lutzeyer W, Fischer N, Deutz F, Lagrange W, Giani G. Natural history and treatment of low and high risk superficial bladder tumors. J Urol 1988; 139 (2): 283–285.

    CAS  PubMed  Google Scholar 

  123. Akaza H, Koiso K, Kotake T, Matsumura Y, Isaka S, Machida T, et al. Long-term results of intravesical chemoprophylaxis of superficial bladder cancer: experience of the Japanese Urological Cancer Research Group for Adriamycin. Cancer Che-mother Pharmacol 1992; 30 (Suppl): 15–20.

    Google Scholar 

  124. Oosterlinck W, Kurth KH, Schroder F, Bultinck J, Hammond B, Sylvester R. A prospective European Organization for Research and Treatment of Cancer Genitourinary Group randomized trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single stage Ta, T1 papillary carcinoma of the bladder. J Urol 1993; 149 (4): 749–752.

    Google Scholar 

  125. Pawinski A, Sylvester R, Kurth KH, et al. A combined analysis of European Organization for Research and Treatment of Cancer, and Medical Research Council randomized clinical trials for the prophylactic treatment of stage TaT1 bladder cancer. European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council Working Party on Superficial Bladder Cancer. J Urol 1996; 156: 1934–1940.

    CAS  PubMed  Google Scholar 

  126. Huland H, Kloppel G, Feddersen I, Otto U, Brachmann W, Hubmann H, et al. Comparison of different schedules of cytostatic intravesical instillations in patients with superficial bladder carcinoma: final evaluation of a prospective multicenter study with 419 patients. J Urol 1990; 144(1): 68–71; discussion 71–72.

    Google Scholar 

  127. Buffioux C, Kurth KH, Bono A, et al. Intravesical adjuvant chemotherapy for superficial transitional cell bladder carcinoma: results of two European Organization for Research and Treatment of Cancer randomized trials with mitomycin C and doxorubicin comparing early versus delayed instillations and short term versus long term treatment. European Organization for Research and Treatment of Cancer Genitourinary Group. J Urol 1995; 153: 934–941.

    Google Scholar 

  128. Zinke H, Benson RC Jr, Hilton JF, et al. Intravesical Thiotepa and Mitomycin C treatment immediately after transurethral resection and later for superficial (stages Ta and Tis) bladder cancer: a prospective, randomized, stratified study with crossover design. J Urol 1985; 134: 1110–1114.

    Google Scholar 

  129. Bonfante V, Villani F, Bonnadonna G. Toxic and therapeutic activity of 4’ epidoxorubicin. Tumori 1982; 68: 105–111.

    CAS  PubMed  Google Scholar 

  130. Abrams PH, Choa RG, Gaches CG, et al. A controlled trial of single dose intravesical adriamycin in superficial bladder tumors. Br J Urol 1981; 53 (6): 585–587.

    CAS  PubMed  Google Scholar 

  131. Burnand KG, Mayo ME, Shuttleworth KE, et al. Single dose intravesical thiotepa as an adjuvant to cystodiathermy in the treatment of transitional cell bladder carcinoma. Br J Urol 1976; 48 (1): 55–59.

    CAS  PubMed  Google Scholar 

  132. Tolley DA, Parmar MK, Grigor KM, et al. The effect of intravesical mitomycin C on recurrence of newly diagnosed superficial bladder cancer: a further report with 7 years of follow up. J Urol 1996; 155: 1233–1238.

    CAS  PubMed  Google Scholar 

  133. Ali-el-Dein B, Nabeeh A, el-Baz M, Shamaa S, Ashamallah A. Single-dose versus multiple instillations of epirubicin as prophylaxis for recurrence after transurethral resection of pTa and pTl transitional-cell bladder tumours: a prospective, randomized controlled study. Br J Urol 1997; 79 (5): 731–735.

    CAS  Google Scholar 

  134. Flamm J. Long-term versus short-term doxorubicin hydrochloride instillation after transurethral resection of superficial bladder cancer. Eur Urol 1990; 17 (2): 119–124.

    CAS  PubMed  Google Scholar 

  135. Okamura K, Kinukawa T, Tsumura Y, Otani T, Itoh H, Kobayashi H, et al. A randomized study of short-versus long-term intravesical epirubicin instillation for superficial bladder cancer. Nagoya University Urological Oncology Group. Eur Urol 1998; 33 (3): 285–288.

    CAS  PubMed  Google Scholar 

  136. Nseyo UO. Immunotherapy of bladder cancer. Semin Surg Oncol 1997; 13 (5): 342–349.

    CAS  PubMed  Google Scholar 

  137. Lamm DL, Riggs DR Traynelis CL, et al. Apparent failure of current intravesical chemotherapy prophylaxis to influence the long-term course of superficial transitional cell carcinoma of the bladder. J Urol 1995; 153 (50): 1444–1450.

    CAS  PubMed  Google Scholar 

  138. Krege S, Giani G, Meyer R, et al. A randomized multicenter trial of adjuvant therapy in superficial bladder cancer: transurethral resection only versus transurethral resection plus mitomycin C versus transurethral resection plus bacillus Calmette-Guerin. Participating Clinics [see comments]. J Urol 1996; 156: 962–966.

    CAS  PubMed  Google Scholar 

  139. Vegt PD, Witjes JA, Witjes WPJ, et al. A randomized study of intravesical Mitomycin C, Bacille Calmette-Guerin Tice and Bacille Calmette-Guerin RIVM treatment in pTa-pT1 papillary carcinoma and carcinoma in situ of the bladder. J Urol 1995; 153: 929–933.

    CAS  PubMed  Google Scholar 

  140. Rintala E, Jauhianien K, Alfthan O, et al. Intravesical chemotherapy (MMC) versus immunotherapy (BCG) in superficial bladder cancer. Eur Urol 1991; 20: 1925.

    Google Scholar 

  141. Malmstrom PU, Wijkstrom H, Lundholm C, Wester K, Busch C, Norlen BJ. 5-year followup of a randomized prospective study comparing mitomycin C and bacillus Calmette-Guerin in patients with superficial bladder carcinoma. Swedish-Norwegian Bladder Cancer Study Group. Br J Urol 1999; 161 (4): 1124–1127.

    Google Scholar 

  142. Witjes JA, van der Meijden AP, Sylvester LC, Debruyne FM, van Aubel A, Witjes WP. Long-term follow-up of an EORTC randomized prospective trial comparing intravesical bacille Calmette-Guerin-RIVM and mitomycin C in superficial bladder cancer. EORTC GU Group and the Dutch South East Cooperative Urological Group. European Organisation for Research and Treatment of Cancer GenitoUrinary Tract Cancer Collaborative Group. Urology 1998; 52 (3): 403–410.

    PubMed  Google Scholar 

  143. Lamm DL.BCG in perspective: advances in the treatment of superficial bladder cancer. Eur Urol 1995; 27(Suppl 1): 2–8.

    Google Scholar 

  144. Zhang S, Li H, Cheng H. The preventive recurrent results of postoperative intravesical instillation therapy in bladder cancer. Chung Hua Wai Ko Tsa Chih 1995; 33 (5): 304–306.

    CAS  PubMed  Google Scholar 

  145. Sekine H, Fukui I, Yamada T, et al. Intravesical mitomycin C and doxorubicin sequential therapy for carcinoma in situ of the bladder: a longer followup result. J Urol 1994; 151 (1): 27–30.

    CAS  PubMed  Google Scholar 

  146. Witjes JA, Caris CTM, Mungan NA, et al. Results of a randomized phase III trial of sequential intravesical therapy with mitomycin C and bacillus Calmette-Guerin versus mitomycin C alone in patients with superficial bladder cancer. J Urol 1998; 160: 1668–1671.

    CAS  PubMed  Google Scholar 

  147. Van der Meijden AP, Hall RR, Macaluso MP, et al. Marker tumour responses to the sequential combination of intravesical therapy with mitomycin-C and BCGRIVM in multiple superficial bladder tumours. Report from the European Organisation for Research and Treatment on Cancer-Genitourinary Group (EORTC 30897). Eur Urol 1996; 29 (2): 199–203.

    PubMed  Google Scholar 

  148. Raitanen MP, Lukkarinen O. A controlled study of intravesical epirubicin with or without alpha 2b-interferon as prophylaxis for recurrent superficial transitional cell carcinoma of the bladder. Finnish multicentre study group. Br J Urol 1995; 76 (6): 697–701.

    CAS  PubMed  Google Scholar 

  149. Obata K, Ohashi Y, Akaza H, et al. Prophylactic chemotherapy with intravesical instillation of adriamycin and oral administration of 5-flourouracil after surgery for superficial bladder cancer. The Japanese Urological Cancer Research Group for Adriamycin. Cancer Chemother Pharmacol 1994; 35 (Suppl): S88.

    PubMed  Google Scholar 

  150. Mukamel E, DeKernion JB. Conservative treatment of diffuse carcinoma in situ of the bladder with repeated courses of intravesical therapy. Br J Urol 1989; 64 (2): 143–146.

    CAS  PubMed  Google Scholar 

  151. Prout GR Jr, Griffin PP, Nocks BN, et al. Intravesical therapy of low stage bladder carcinoma with mitomycin C: comparison of results in untreated and previously treated patients. J Urol 1982; 127 (6): 1096–1098.

    PubMed  Google Scholar 

  152. Issel BF, Prout GR, Soloway MS, et al. Mitomycin C intravesical therapy in noninvasive bladder cancer after failure on thiotepa. Cancer 1984; 53 (5): 1025–1028.

    Google Scholar 

  153. Milani C, Bassi P, Meneghini A, et al. Mitomycin C in multiple superficial bladder tumors: short term therapy, long term results. Urol Int 1992; 48 (2): 154–156.

    CAS  PubMed  Google Scholar 

  154. deVere White RW, Ditch A, Tesluk H, et al. Prognostic significance of DNA ploidy in Ta,T1 bladder cancer: a southwest oncology group study. Uro Oncol 1996; 2: 27.

    Google Scholar 

  155. Lee E, Park I, Lee C. Prognostic markers of intravesical Bacillus Calmette-Guerin therapy for multiple, high-grade, stage Tl bladder cancers. Int J Urol 1997; 4: 55 2556.

    Google Scholar 

  156. Lebret T, Becette V, Barbagelatta M, et al. Correlation between p53 overexpression and response to Bacillus Calmette-Guerin therapy in a high risk select population of patients with T I G3 bladder cancer. J Urol 1998; 159: 788–791.

    CAS  PubMed  Google Scholar 

  157. Oveson H, Horn T, Steven K. Long term efficacy of intravesical Bacillus Calmette-Guerin for carcinoma in situ: relationship of progression to histological response and p53 nuclear accumulation. J Urol 1997; 157: 1655–1659.

    Google Scholar 

  158. Walther MM, Figg WD, Linehan WM. Intravesical Suramin: a novel agent for the treatment of superficial transitional-cell carcinoma of the bladder. World J Urol 1996; 14: 8–11.

    Google Scholar 

  159. Au JL, Kalns K, Gan Y, et al. Pharmacologic effects of paclitaxel in human bladder tumors. Cancer Chemother Pharmacol 1997; 41 (1): 69–74.

    CAS  PubMed  Google Scholar 

  160. Nativ O, Aronson M, Medalia O, et al. Antineoplastic activity of paclitaxel on experimental superficial bladder cancer; in vivo and in vitro studies. Int J Cancer 1997; 70 (3): 297–301.

    CAS  PubMed  Google Scholar 

  161. Song D, Wientejes MG, Au JL. Bladder tissue pharmacokinetics of intravesical taxol. Cancer Chemother Pharmacol 1997; 40 (40): 285–292.

    CAS  PubMed  Google Scholar 

  162. Pu YS, Hsieh TS, Cheng AL, et al. Combined cytotoxic effects of tamoxifen and chemotherapeutic agents on bladder cancer cells: a potential use in intravesical chemotherapy. Br J Urol 1996; 77 (1): 76–85.

    CAS  PubMed  Google Scholar 

  163. Erlichman C, Vidgen D, Wu A. Antineoplastic drug cytotoxicity in a human bladder cancer cell line: implications for intravesical chemotherapy. Urol Res 1987; 15 (1): 13–16.

    CAS  PubMed  Google Scholar 

  164. Nygren P, Csoka K, Larsson R, Busch C, Wester K, Malmstrom PU. Activity of standard and investigational cytotoxic drugs in primary cultures of tumor cells from patients with kidney and urinary bladder carcinomas. J Urol 1999; 162 (6): 2200–2204.

    CAS  PubMed  Google Scholar 

  165. Schmittgen TD, Weaver JM, Badalament RA, et al. Correlation of human bladder tumor histoculture proliferation and sensitivity to mitomycin C with tumor pathobiology. J Urol 1994; 152: 1632–1636.

    CAS  PubMed  Google Scholar 

  166. Nagawa M, Emoto A, Nasu N, et al. Clinical significance of multi-drug resistance associated protein and P-glycoprotein in patients with bladder cancer (see comments). J Urol 1997; 157 (4): 1260.

    Google Scholar 

  167. Nargund VH, Lowe J, Flannigan GM, et al. Role of P-glycoprotein in chemoresistant superficial bladder tumors. Eur Urol 1997; 31 (2): 160–162.

    CAS  PubMed  Google Scholar 

  168. Long JP Jr, Prout GR Jr, Wong YK, et al. The effect of verapamil on a multi-drug resistant bladder carcinoma cell line and its potential as an intravesical chemotherapeutic agent. J Urol 1990; 143 (5): 1053–1056.

    PubMed  Google Scholar 

  169. Duffy PM, Hayes MC, Gatrell SK, et al. Determination and reversal of resistance to epirubicin intravesical chemotherapy. Br J Urol 1996; 77 (6): 824–829.

    CAS  PubMed  Google Scholar 

  170. Naito S, Kotoh S, Omoto T, et al. Prophylactic intravesical instillation chemotherapy against recurrence after a transurethral resection of superficial bladder cancer: a randomized controlled trial of doxorubicin plus verapamil versus doxorubicin alone. The Kyushu University Urological Oncology Group. Cancer Che-mother Pharmacol 1998; 42 (5): 367–372.

    CAS  Google Scholar 

  171. Yu DS, Chu TM, Yeh MY, Chang SY, Ma CP, Han SH. Antitumor activity of doxorubicin-monoclonal antibody conjugate on human bladder cancer. J Urol 1988: 140 (2): 415–421.

    CAS  PubMed  Google Scholar 

  172. Tanaka J, Sato E, Saito Y, et al. Preparation of a conjugate of mitomycin C and anti-neural cell adhesion molecule monoclonal antibody for specific chemotherapy against biliary tract carcinoma. Surg Today 1998; 28 (11): 1217–1220.

    CAS  PubMed  Google Scholar 

  173. Hashimoto H, Tokunaka S, Sasaki M, et al. Dimethylsulfoxide enhances the absorption of chemotherapeutic drug instilled into the bladder. Urol Res 1992; 20 (3): 233–236.

    CAS  PubMed  Google Scholar 

  174. Walker L, Walker MC, Parris CN, Masters JR. Intravesical chemotherapy: combination with dimethyl sulfoxide does not enhance cytotoxicity in vitro. Urol Res 1988; 16: 329–331.

    CAS  PubMed  Google Scholar 

  175. Ohtani M, Miyanaga N, Naguchi R, et al. Promotive effects of intravesical instillation of dimethylsulfoxide on bladder carcinogenesis in mice. Nippon Hinyokika Gakkai Zasshi 1992: 83 (9): 1423.

    CAS  PubMed  Google Scholar 

  176. Parris CN, Masters JR, Walker MC, Newman B, Riddle P: Intravesical chemotherapy: combination with Tween 80 increases cytotoxicity in vitro. Urol Res 1987; 15: 17–20.

    CAS  PubMed  Google Scholar 

  177. Masters JR, McDermott BJ, Jenkins WE, et al. ThioTEPA pharmacokinetics during intravesical chemotherapy and the influence of Tween 80. Cancer Chemother Pharmacol 1990; 25 (4): 267–273.

    CAS  PubMed  Google Scholar 

  178. Maier U, Baumgartner G. Metaphylactic effect of mitomycin C with and without hyaluronidase after transurethral resection of bladder cancer: randomized trial. J Urol 1989; 141 (3): 529–530.

    CAS  PubMed  Google Scholar 

  179. Brausi M, Campo B, Pizzocaro G, et al. Intravesical electromotive administration of drugs for treatment of superficial bladder cancer: a comparative phase II study. Urology 1998; 51 (3): 506–509.

    CAS  PubMed  Google Scholar 

  180. Rigatti P, Lev A, Colombo R. Combined intravesical chemotherapy with mitomycin-C and local bladder microwave-induced hyperthermia as a preoperative therapy for superficial bladder tumors. A preliminary clinical study. Eur Urol 1991; 20: 204–210.

    CAS  PubMed  Google Scholar 

  181. Colombo R, Da Pozzo LF, Lev A, et al. Neoadjuvant combined microwave induced hyperthermia and topical chemotherapy alone for superficial bladder cancer. J Urol 1996; 155 (4): 1227–1232.

    CAS  PubMed  Google Scholar 

  182. Miyake H, Hara I, Gohji K, et al. Enhancement of chemosensitivity in human bladder cancer cells by adenoviral-mediated p53 gene transfer. Anticancer Res 1998; 18 (4C): 3087–3092.

    CAS  PubMed  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media New York

About this chapter

Cite this chapter

Bird, V.G., Soloway, M.S., Malmström, PU. (2001). Intravesical Chemotherapy in the Treatment of Superficial Bladder Cancer. In: Droller, M.J. (eds) Bladder Cancer. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-097-1_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-097-1_8

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-202-5

  • Online ISBN: 978-1-59259-097-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics