Cytomorphological and histological studies on the urothelium during and after chemoimmune prophylaxis

During and after chemoimmune prophylaxis with i.v. cyclophosphamide (CTX) and both intravesical and systemic BCG-treatment, the bladder mucosa is prone to morphological changes which might resemble tumor recurrences. Therefore, morphological parameters which can discriminate between treatment effects and tumor recurrences are of interest. In a prospective study, routine cytology, determination of granulocytes, lymphocytes, and macrophages in the urine sediment as well as flow-cytophotometry (FCM) for DNA analysis were performed before, during, and after chemoimmune prophylaxis. In addition, bladder biopsies and all recurrent tumors were histologically analysed. Our results show that FCM is the best method for monitoring the bladder mucosa for recurrent tumors during treatment. After termination of BCG, it takes at least 4 months for cytological normalization to take place. Urine excretion of granulocytes, lymphocytes, and macrophages does not correlate with this process. Histological alterations during treatment are demonstrated; their normalization requires at least 3 months. In 10% of the patients chronic inflammatory lesions ("pseudotumors") develop.