Transüretral mesane tümörü rezeksiyonu patoloji örneğinde detrusor kas dokusunun varlığını etkileyen faktörler

Year 2020, Volume: 12 Issue: 3, 204 - 209, 31.12.2020

Erhan Demirelli Ercan Öğreden Mefail Aksu Mehmet Karadayı Ural Oğuz

Abstract

Amaç: Mesane tümörü patolojik incelemesinde detrusor kas dokusunun (DKD) ortaya konulması doğru evreleme ve transüretral mesane tümörü rezeksiyonu (TUR-MT) sonrası tedavi planlanmasında oldukça önem arz eder. Bu çalışmada TUR-MT sonrası patoloji spesmeninde DKD örneklenmesine etki eden faktörleri belirlemeyi amaçladık.

Gereç ve Yöntemler: Kliniğimizde primer mesane tümörü nedeniyle TUR-MT yapılan ve ameliyat notunda tümörün lokalizasyonunun işaretlendiği mesane diyagramı kullanılan 59 hastanın dosyaları retrospektif olarak incelendi. Patoloji spesmeninde DKD izlenmeyen 26 hasta grup I, DKD izlenen 33 hasta grup II olarak isimlendirildi. Gruplar arasında yaş, cinsiyet, tümör sayısı, tümör boyutu ve tümör lokalizasyonu açısından fark olup olmadığı incelendi.

Bulgular: Çalışmamızda DKD izlenme oranı %56 olarak tespit edildi. Hastaların yaş ortalamaları grup I’ de 69.5±10.2 iken grup II’ de 68.7 ± 9.2 idi (p=0.755). İki grup arasında cinsiyet dağılımı açısından istatistiksel olarak anlamlı fark saptanmadı (p=0.646). Tümör lokalizasyonuna baktığımızda grup I de tümörlerin %11.5’i kubbede, %11.5’i karşı duvarda ve %77’ si yan duvarlarda; grup 2’ de ise %6.1’i kubbede, %27.2’ si karşı duvarda ve %66.7’ si de yan duvarlarda izlendi. Grup I ve grup II arasında tümör lokalizasyonu açısından anlamlı fark saptanmadı (p>0.05). Ortalama tümör sayısının ve tümör boyutlarının her iki grupta da istatistiksel olarak benzer olduğu saptandı (p>0,05).

Sonuç: Hastaların patolojik örneklerinde DKD görülmesine yaş, cinsiyet, tümör boyutu, tümör sayısı, tümörün mesane duvarındaki lokalizasyonu gibi değişkenlerin etkisinin olmadığı saptandı.

Keywords

Mesane tümörü, TUR-MT, Tümör lokalizasyonu, Detrusor kas tabakası

Factors affecting presence of detrusor muscle tissue in pathology specimen of transurethral bladder tumor resection

Abstract

Objective: Sampling of detrusor muscle tissue (DMT) in the pathological examination of the bladder tumor is very important in the planning of correct staging and treatment. In the present study, we aimed to determine the factors affecting the DMT sampling in the pathology specimen after TUR-BT.

Material and Mmethodsː The medical records of 59 patients who underwent TUR-BT were retrospectively analyzed. Twenty-six patients who had no DMT in the pathology specimen were classified as group I and 33 patients with DMT were classified as group II. Differences between groups in terms of age, gender, tumor number, tumor size, and tumor localization were examined.

Resultsː DMT was found in 56% of pathology specimens. There was no statistically significant difference in terms of gender distribution between the two groups (p=0.646). Tumor localizations were as follows; 11.5% is on the dome, 11.5% is on the opposite wall and 77% is on the side walls in group I; and In group 2, 6.1% were found on the dome, 27.2% on the opposite wall and 66.7% on the side walls. There was no statistically significant difference between group I and group II in terms of tumor localization (p>0.05). The mean number of tumors and mean tumor size was found to be statistically similar in both groups (p>0.05).

Conclusionsː It was concluded that variables such as age, gender, tumor size, number of tumors, and localization of the tumor did not affect the presence of DMT in the pathological specimen of the patients.

Keywords

Bladder cancer, TUR-BT, Tumor localization, Detrusor muscle tissue

References

• Aydın S, Boz MY. Rapid changes in the incidence of urinary system cancers in Turkey. Turk J Urol. 2015 Dec;41(4):215-20. PubMed PMID: 26623151. Pubmed Central PMCID: PMC4621150. Epub 2015/12/02.
• Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018 Jan;68(1):7-30. PubMed PMID: 29313949. Epub 2018/01/10.
• Vogeli T. Prospective study for quality control of TUR of bladder tumors by routine second TUR (re-TUR). J Urol. 1998.
• Herr HW. The value of a second transurethral resection in evaluating patients with bladder tumors. J Urol. 1999 Jul;162(1):74-6. PubMed PMID: 10379743. Epub 1999/06/24.
• Kamat AM, Bağcıoğlu M, Huri E. What is new in non-muscle-invasive bladder cancer in 2016? Turk J Urol. 2017 Mar;43(1):9-13. PubMed PMID: 28270945. Pubmed Central PMCID: PMC5330275. Epub 2017/03/09.
• Neuzillet Y, Methorst C, Schneider M, Lebret T, Rouanne M, Radulescu C, et al. Assessment of diagnostic gain with hexaminolevulinate (HAL) in the setting of newly diagnosed non-muscle-invasive bladder cancer with positive results on urine cytology. Urol Oncol. 2014 Nov;32(8):1135-40. PubMed PMID: 25023786. Epub 2014/07/16.
• Herr HW, Donat SM. Quality control in transurethral resection of bladder tumours. BJU Int. 2008 Nov;102(9 Pt B):1242-6. PubMed PMID: 19035888. Epub 2008/11/28.
• Mariappan P, Zachou A, Grigor KM. Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience. Eur Urol. 2010 May;57(5):843-9. PubMed PMID: 19524354. Epub 2009/06/16.
• Shindo T, Masumori N, Kitamura H, Tanaka T, Fukuta F, Hasegawa T, et al. Clinical significance of definite muscle layer in TUR specimen for evaluating progression rate in T1G3 bladder cancer: multicenter retrospective study by the Sapporo Medical University Urologic Oncology Consortium (SUOC). World J Urol. 2014 Oct;32(5):1281-5. PubMed PMID: 24190368. Epub 2013/11/06.
• Gendy R, Delprado W, Brenner P, Brooks A, Coombes G, Cozzi P, et al. Repeat transurethral resection for non-muscle-invasive bladder cancer: a contemporary series. BJU Int. 2016 Apr;117 Suppl 4:54-9. PubMed PMID: 26486968. Epub 2015/10/22.
• Capogrosso P, Capitanio U, Ventimiglia E, Boeri L, Briganti A, Colombo R, et al. Detrusor Muscle in TUR-Derived Bladder Tumor Specimens: Can We Actually Improve the Surgical Quality? J Endourol. 2016 Apr;30(4):400-5. PubMed PMID: 26597334. Epub 2015/11/26.
• Suarez-Ibarrola R, Soria F, Abufaraj M, D'Andrea D, Preto M, Gust KM, et al. Surgical checklist impact on recurrence-free survival of patients with non-muscle-invasive bladder cancer undergoing transurethral resection of bladder tumour. BJU Int. 2019 Apr;123(4):646-50. PubMed PMID: 30248235. Epub 2018/09/25.
• Dagli R, Dadali M, Emir L, Bagbanci S, Ates H. Comparison of Classic and Inguinal Obturator Nerve Blocks Applied for Preventing Adductor Muscle Contractions in Bladder Tumor Surgeries: A Prospective Randomized Trial. Urol J. 2019 Feb 21;16(1):62-6. PubMed PMID: 30345498. Epub 2018/10/23.
• Alavi CE, Asgari SA, Falahatkar S, Rimaz S, Naghipour M, Khoshrang H, et al. Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor. Turk J Urol. 2017 Dec;43(4):507-11. PubMed PMID: 29201516. Pubmed Central PMCID: PMC5687216. Epub 2017/12/05.
• Prentiss RJ, Harvey GW, Bethard WF, Boatwright DE, Pennington RD. MASSIVE ADDUCTOR MUSCLE CONTRACTION IN TRANSURETHRAL SURGERY: CAUSE AND PREVENTION; DEVELOPMENT OF ELECTRICAL CIRCUITRY. J Urol. 1965 Feb;93:263-71. PubMed PMID: 14260880. Epub 1965/02/01.
• Tekgül ZT, Divrik RT, Turan M, Konyalioğlu E, Şimşek E, Gönüllü M. Impact of obturator nerve block on the short-term recurrence of superficial bladder tumors on the lateral wall. Urol J. 2014 Mar 3;11(1):1248-52. PubMed PMID: 24595932. Epub 2014/03/07.
• Erbay G, Akyol F, Karabakan M, Celebi B, Keskin E, Hirik E. Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and recurrence of the disease. Kaohsiung J Med Sci. 2017 Feb;33(2):86-90. PubMed PMID: 28137416. Epub 2017/02/01.
• Teoh JY, Chan ES, Yip SY, Tam HM, Chiu PK, Yee CH, et al. Comparison of Detrusor Muscle Sampling Rate in Monopolar and Bipolar Transurethral Resection of Bladder Tumor: A Randomized Trial. Ann Surg Oncol. 2017 May;24(5):1428-34. PubMed PMID: 27882470. Epub 2016/11/25.
• Anderson C, Weber R, Patel D, Lowrance W, Mellis A, Cookson M, et al. A 10-Item Checklist Improves Reporting of Critical Procedural Elements during Transurethral Resection of Bladder Tumor. J Urol. 2016 Oct;196(4):1014-20. PubMed PMID: 27044571. Pubmed Central PMCID: PMC5460769. Epub 2016/04/06.