THE PRESENCE OF HYDRONEPHROSIS IN STAGING BLADDER CANCER: AN OMINOUS SIGN

Yıl 2000, Cilt: 13 Sayı: 1, 27 - 29, 03.12.2016

Türker Köksal İrfan Orhan Ahmet Tefekli Mustafa Usta Tibet Erdoğru Faruk Özcan

Öz

Objective: We investigated whether the presence of unilateral or bilateral upper tract obstruction could accurately predict advanced cancer stage.
Methods: Six hundred and ten patients with bladder cancer entered into the tumor registries of our institutions between January 1990 and December
1994. The median patient age was 64 years (range 35 to 80). A total 75 (12%) patients had unilateral or bilateral hydronephrosis on an IVP at the time of initial diagnosis of the bladder cancer. Preoperative screening included physical examination, chest radiograph, complete blood count, blood urea nitrogen, creatinin, electrolyte analysis and IVP. Furthermore, patients were usually evaluated by bone scan and computerized tomography (CT). The diagnosis of transitional cell carcinoma was made by cystoscopy and transurethral resection of the tumor. Staging transurethral resection was done in all cases.
Results: During a 5-year period 75 of 610 patients with carcinoma of the bladder had ureteral obstruction on excretory urography at the time of the initial diagnosis. Preoperative IVP revealed unilateral and bilateral hydronephrosis in 55 (73%) and 20 (27%) patients, respectively. Pathological staging revealed predominantly pT1 lesions for patients with unilateral obstruction. There were 30 (55%) patients with pT1, 10 (18%) with pT2, and 15 (27%) with pT3. Pathological staging revealed predominantly pT2 lesions for patients with bilateral obstruction. Pathological stage was pT2 in 10 (50%) cases, pT3 in 5 (25%), and pT4 in 5 (25%).
Conclusion: IVP can be used in staging because hydronephrosis may Indicate the presence of a
muscle-invasive bladder cancer, especially, bilateral hydronephrosis was strongly associated with advanced stage disease.
Key Words: Bladder cancer, excretory urography, clinical stage, pathological stage, transurethral resection.

Kaynakça

• /. Landis SH. Murray T, Bolden G, et at. Cancer statistics 1998. CA Can J Clin 1998:48:26-29.
• Herr HW. Transurethral resection in regionally advanced bladder cancer. Urol Clin north Am 1992;19:695-700.
• See WA. Fuller JR. Staging of advanced bladder cancer: current concepts and pitfalls. Urol Clin north Am 1992;19:663-685.
• Spissl B, Beahrs O, Hermanek P, et al. TnM Atlas. Illustrated Guide to the TnP/pTnM Classification of Malignant Tumors. Berlin: Springer Verlag by UtCC, 1992.
• Mostofi FK, Sobin LH, Torloni t1. Histologic typing of urinary bladder tumors. (International Histologic Classification of Tumors, no. 10). Geneva: World Health Organization, 1973.
• Messing EM, Catalona W. Urethelial tumors of urinary tract. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED, eds. Campbell s Urology. Philadelphia: WB Saunders Company. Sixth edition. Vol. 3, 1992:2327-2410.
• nichols JA, Marshall VF. The treatment of bladder carcinoma by local excising and fulguration. Cancer 1956:9:559-565.
• Lang EK. The roentgenographic assessment of bladder tumors. ,4 comparison of the diagnostic accuracy of roentgenographic techniques. Cancer 1969;23:717-724.
• Marshall VF. The relation of the preoperative estimate to the pathologic demonstration of the extent of vesical neoplasm. J Urol I952;68:714- 717.
• Haleblian GE, Skinner EC, Dickinson MG, et al: Hydronephrosis as a prognostic indicator in bladder cancer patients. J Urol 1998; 160:201 I -2014.
• Hatch TR, Barry JM. The value of excretory urography in staging bladder cancer. J Urol 1986,135:49.
• Kenny GM, Hardner GJ, Murphy GP: Clinical staging of bladder tumors. J Urol 1970; 104:720-723.
• Boileau MA, Johnson DE,Chan RC, et al. Bladder carcinoma: results with preoperative radiation therapy and radical cystectomy. Urology 1980,16:569-576.
• Hanash KA, Bissada HK, Abla A, et al. Predictive value of excretory urography, ultrasonography, computerized tomography, and liver and bone scan in the staging of bilharzial bladder cancer in Saudi Arabia. Cancer 1984;54:1 72-1 76.