A prospective observational study to evaluate the role of restaging transurethral resection of bladder tumour in patients with non-muscle invasive bladder cancer

Background: Transurethral resection of bladder tumour (TURBT) is the primary treatment modality for Non-muscle invasive bladder cancer (NMIBC). Restaging transurethral resection of bladder tumour (RETURBT) is indicated to reduce risk of residual disease and correct staging errors after primary TURBT. The aim of the study is to evaluate the risk of residual tumour and upstaging in NMIBC after TURBT and to investigate the risk factors for the same.Methods: A prospective observational study was carried out over 4 years and 87 patients were included in the study. Patients with NMIBC underwent RETURBT after 2-6 weeks of primary TURBT. The incidence of residual tumour and upstaging in RETUBRT was correlated with various histopathological and morphological parameters in primary TURBT.Results: Out of 87 patients, who underwent RETURBT, residual disease was present in 51 patients (58.6%) and upstaging occurred in 22 patients (25.2%).On univariate analysis, T1 stage (p=0.01), high grade (p=0.01), Carcinoma in situ(CIS) (p=0.01) and multifocality (p=0.05) were predictive for residual disease in RETURBT. High grade (p=0.01), CIS (p=0.01) and absence of detrusor muscle in specimen (p=0.03) were risk factors for upstaging in RETURBT.Conclusions: NMIBC have high incidence of residual disease and upstaging after primary TURBT. T1 stage, high tumour grade, CIS, and multifocality are risk factors for residual disease after primary TURBT. High tumour grade, CIS and absence of detrusor muscle are strongly associated with upstaging during RETURBT.

Second transurethral resection of bladder tumour for the treatment of muscle-invasive bladder tumours / Segunda resección transuretral del tumor de la vejiga en el tratamiento de los tumores de vejiga con invasión muscular

OBJECTIVE: This work aims to evaluate the effectiveness of a second transurethral resection for muscle-invasive bladder tumours. The clinical literature of 15 cases of patients with muscle-invasive bladder cancer treated by second transurethral resection of bladder tumours (TURBT) was analysed. METHODS: The operation was based on the principle of TURBT down to the fatty layer outside the bladder wall. A second transurethral resection was performed four to six weeks after the initial resection. All patients received intravesical chemotherapy postoperation. Fifteen cases were followed-up for three to 26 months, with a mean period of 14 months. RESULTS: After the second transurethral resection, residual tumours were found in two patients. All patients underwent computed tomography scan and biopsy. No patient had a recurrence of the tumour. Eighty per cent of the patients had normal bladder function and 20% had mild-to-moderate lower urinary tract symptoms. All patients had a high quality of life. CONCLUSIONS: A second TURBT is suitable for muscle-invasive bladder cancer when bladder preservation is planned as it prolongs the survival time and improves the patients' quality of life.

OBJETIVO: Este trabajo tiene como objetivo evaluar la eficacia de una segunda resección transuretral de los tumores vesicales con invasión de la capa muscular. Se analizó la literatura clínica de 15 casos de pacientes con cáncer de la vejiga con invasión muscular, tratados con segunda resección transuretral de los tumores de la vejiga (TURBT). MÉTODOS: La operación se basó en el principio de TURBT hasta la capa de grasa fuera de la pared de la vejiga. De cuatro a seis semanas después de la resección inicial, se realizó una segunda resección transuretral. Todos los pacientes recibieron quimioterapia intravesical postoperatoria. Quince casos tuvieron seguimiento de tres a 26 meses, con un período promedio de 14 meses. RESULTADOS: Después de la segunda resección transuretral, se hallaron tumores residuales en dos pacientes. A todos los pacientes se les hizo una biopsia y una tomografía computarizada. Ningún paciente tuvo una recidiva del tumor. Ochenta por ciento de los pacientes tenían una función vesical normal, en tanto que un 20% presentaban síntomas de las vías urinarias de leves a moderadamente bajos. Todos los pacientes tenían un alto nivel de vida. CONCLUSIONES: Es conveniente una segunda TURBT para el cáncer de vejiga con invasión muscular cuando se planea la preservación vesical, ya que prolonga el tiempo de supervivencia y mejora la calidad de vida de los pacientes.

Inflamatory Pseudotumor of the Bladder: A Histopathological Diagnostic Challenge from Its Malignant Variant

Inflammatory Pseudotumor (IP) of bladder is one of a variety of lesions which may arise from spindle cell lesions in the bladder. It is benign in nature compared to the other end of the spectrum of spindle cell lesions, such as sarcoma, sarcomatoid carcinoma and leiomyosarcoma. The diagnosis of IP and its differentiation from a malignant pathology is a diagnostic dilemma for Urologist and Pathologist as both entities share certain similar morphological and histo-pathological appearance as well as immuno-histo chemistry staining. It is however crucial to avoid misdiagnosis as the treatment option varies significantly between a radical or partial cystectomy with future surveillance cystoscopes. Hereby, we highlight a case of a benign variant of spindle cell tumour of bladder which needed second pathology review for confirmation and thus avoiding a radical cystectomy. We also review the literature on its presentation and emphasis characteristics differentiating a benign from a malignant pathology.

Expression of Pigment Epithelium-derived Factor in Bladder Tumour Is Correlated with Interleukin-8 yet Not with Interleukin-1α / 华中科技大学学报（医学）（英德文版）

Pigment epithelium-derived factor (PEDF) is an antiangiogenic factor which is effective in tumour inhibition in a variety of tumours and has not yet been studied in bladder tumour before.In this study the expression of PEDF,interleukin-1 α (IL-1α) and -8 (IL-8) in bladder tumours was investigated.Immunohistochemistry was performed on 64 bladder tumour and 23 normal uroepithelium samples.Expression change of the factors was compared with clinicopathological parameters.Correlations between PEDF,IL-1α and IL-8 were analyzed.None of the factors was in relation to gender,tumour occurrence,and size or onset pattem.PEDF (P=0.014) and IL-1α (P=0.049) expression was down-regulated with grade progression.PEDF expression was lower in normal uroepithelium than in papillary urothelial neoplasm of low malignant potential (PUNLMP) (P=0.000) and carcinoma (P=0.009) whilst IL-1α (P=0.000 and P=0.000 respectively) and IL-8 (P=0.000 and P=0.023 respectively) expression was higher in the same grouping.PEDF expression had a negative correlation with IL-8 in PUNLMP (P=0.049,r=-0.578) as well as in tumour grouping (P=0.033,r=-0.276).Deranged expressional change of PEDF,IL-1 α and IL-8 could be in relation to loss of differentiation from normal uroepithelium to papillary lesion and eventually to carcinoma.