Superficial bladder tumours: recurrence and progression

To determine various presentations of superficial bladder cancer, its management, recurrence and progression rates. Case series. Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, From January 2002 to December 2009. Patients with pathologically proven superficial transitional cell carcinoma [TCC] with minimal 2 years of follow-up were included. Their clinical presentations and management was recorded. Complete transurethral resection of bladder tumour [TURBT] was attempted in all patients. Tumour grading and staging was performed. Intra-vesical single instillation of mityomycin-C was given postoperatively in selected patients. Cystoscopic surveillance was used to assess recurrence in all patients according to standard protocol. Metastatic work-up and biopsy record of follow-up TURBT was used to document progression in high risk patients. Results were described as simple descriptive statistics. A total of 92 patients were studied. The median age of patient was 62 years, with male preponderance [88%]. Hematuria with lower urinary tract symptoms [LUTS] was most common presentation [47.8%], followed by hematruia alone [25.7%], LUTS alone [9.2%] and upper tract symptom in 1.8% of patients. Complete TURBT in first attempt was possible in 72 patients [78.3%]. Multiple tumours were seen in 34 patients [39.6%]. Intravesical mitomycin was given in 70% patients. Over-all recurrence rate of 68.4% was noted. Patients with TaG2-3 showed recurrence rate of 58.8% which occurred late with good recurrence free interval. T1G2-3 patients have more and early recurrences [80.4%]. Progression seen in 13 patients [14%], 6 patients have up-grading, four showed stage progression, one developed pelvic lymphadenopathy and another one had bone metastasis. One female patient [TaG2] developed right renal pelvic recurrence and progression while her bladder disease was well controlled. The number of patients with T1 disease was 45% in this study which is comparatively higher than other studies. Early recurrences and progression were observed with T1G2-3, while late recurrence were seen with Ta disease, having tumour free interval between 6 months to 2 years. Early radical cystectomy was advised to T1G3 disease and with multiple recurrences, but patient's compliance was poor

Urethroplasty for traumatic posterior urethral strictures

Objective: To evaluate the results of delayed urethroplasty after initial cystostomy following posterior urethral injury

Design: Descriptive study

Place And Durationof Study: Department of Urology and Transplantation, Jinnah Postgraduate Medical Center Karachi, over the span of two years [2001-2002]

Subjects And Methods: Analysis of 15 patients undergoing delayed single stage perineal urethroplasty for posterior urethral distraction defect associated with pelvic fracture was performed. Preoperative evaluation of distraction defect included simultaneous retrograde urethrogram and voiding cystourethrogram. Postoperative pericatheter urethrogram was performed after three weeks and catheter removed in the absence of any leakage. Postoperative uroflowmetry and retrograde urethrogram was done after one month and three months respectively for average 12 months. Patients were evaluated specifically regarding stricture, impotence and incontinence postoperatively

Results: Mean age of the patients was 25 years. The estimated preoperative distraction defect was 3 cms. Mean follow up was six months, mean hospital stay was five days and duration of urethral stenting was average 3.6 weeks. Perineal urethroplasty was successful in 60% of cases. Ten patients underwent end to end anastomosis, seven [70%] proved to be successful while in 5 patients Badenoch pull-through urethroplasty was done. Successful results were obtained in 2 patients [40%].The criteria of success was no subsequent procedure required after urethroplasty. However, postoperative soft stricture, requiring optical urethrotomy less than twice, formed in 2 patients of end to end group and 2 patients of Badenoch pull through group. Rest of the patients from both groups, requiring salvage multiple endoscopic urethrotomies, were categorized as complete failure

Conclusion: Overall success of our one stage perineal urethroplasty was 60%. The most probable factor responsible for failure in our opinion was incomplete removal of dense fibrosis from distraction defect