RESUMO
PURPOSE: Currently, the initial treatments of muscle-invasive bladder cancer can be divided into bladder preservation strategies and radical cystectomy. We report our long-term clinical experience of multimodality therapy, using bladder preservation strategies, in patients with muscle-invasive bladder cancer. MATERIALS AND METHODS: Between 1991 and 1994, 23 patients, with a muscle-invasive transitional cell carcinoma of the bladder, underwent a rigorous transurethral resection of the bladder tumor, followed by concurrent cisplatin containing chemotherapy and radiotherapy. The patients' response to the treatment was evaluated with cystoscopy, urine cytology, chest radiography, abdominal-pelvic CT and whole body bone scans following completion of the treatment. Prognostic factors, such as T stage, tumor shape, tumor grade, and initial tumor resection status, were analyzed and the overall 5-year survival rate and disease-specific 5-year survival rate estimated. RESULTS: Of the 23 patients, 3 required a radical cystectomy due to a tumor recurrence. The T stage and initial tumor resection status seemed to be the most significant prognostic factors. The overall 5-year survival rate and disease-specific 5-year survival rate were 64 and 71% (stage T2, 62% and 83%; stage T3, 64% and 63%; stage T4: 0%), respectively, and the rate for retaining a functional bladder was 50%. CONCLUSIONS: Our actuarial 5-year overall and disease-specific survival rates were comparable with those reported for a contemporary radical cystectomy, and with other studies on multimodality bladder sparing treatments for patients at similar clinical and pathological stages. Multimodality treatment, with bladder preservation, can be regarded as an efficacious treatment, with most long-term survivors retaining functional bladders.
Assuntos
Humanos , Carcinoma de Células de Transição , Cisplatino , Cistectomia , Cistoscopia , Tratamento Farmacológico , Seguimentos , Radiografia , Radioterapia , Recidiva , Taxa de Sobrevida , Sobreviventes , Tórax , Neoplasias da Bexiga Urinária , Bexiga UrináriaRESUMO
PURPOSE: Although ultrasonography and diuretic renography are routinely performed for evaluation of ureteropelvic junction obstruction, no reported studies have systemically investigated the correlation of the two methods. We investigated the correlation and values of the two methods. MATERIALS AND METHODS: We studied 44 patients who presented with unilateral hydronephrosis due to ureteropelvic junction obstruction from 1994 to 1999. Patients were evaluated with ultrasound and nuclear renograms with furosemide. Hydronephrosis grade on ultrasonography and the severity of obstruction on diuretic renography were in accordance with the SFU (Society for Fetal Urology) system and "The Well Tempered Renogram", respectively. RESULTS: 27 patients showed grade III hydronephrosis and the remaining 17 patients showed grade IV hydronephrosis on ultrasonography. Kidneys of grade IV hydronephrosis had poorer washout patterns on diuretic renography than those of grade III hydronephrosis (p 0.05). In 37.0% (10/27) and 47.1% (8/17) of patients with grade III and grade IV hydronephrosis, hydronephrotic kidney had a differential function greater than 50%. CONCLUSIONS: Our study suggests that diuretic renography is not always indicated in the patients with grade IV hydronephrosis, but, must be performed to confirm the severity of obstruction in the patients with grade III hydronephrosis.