ABSTRACT
According to clinical and pathological factors the prognosis of a patient with non-muscle invasive bladder tumors can be assessed. The prognosis is determined by the likelihood of recurrence (30-70%) and/or progression to muscle invasive bladder cancer (1-15%).Trans urethral resection of bladder tumors remains the initial therapy but adjuvant intravesical instillations are necessary. All patients benefit from a single immediate post operative instillation with a chemotherapeutic agent and for low risk tumors this is the optimal therapy. Patients with intermediate and high risk tumors need more intravesical chemo-or immunotherapy. Chemotherapy reduces recurrences but not progression. Intravesical immunotherapy(BCG) prevents or delays progression. Patients at high risk for progression may need upfront cystectomy.
Subject(s)
Medical Oncology/methods , Urinary Bladder Neoplasms/therapy , Antineoplastic Agents/therapeutic use , BCG Vaccine/metabolism , Biopsy , Cystectomy , Disease Progression , Humans , Prognosis , Recurrence , Risk , Treatment OutcomeABSTRACT
OBJECTIVE: The optimal treatment for solitary low grade, low stage papillary bladder tumours consists of transurethral resection (TUR) followed by one immediate postoperative instillation with a chemotherapeutic drug. However, when during TUR a bladder perforation or a near-perforation occurs, instillation of a chemotherapeutic drug may lead to leakage outside the bladder, possibly causing severe morbidity. So far, few case reports dealing with complications using mitomycin C have been published, but severe complications of leakage after an early adjuvant instillation with epirubicin have not been reported. METHODS: We describe 3 patients in whom we observed serious complications of one immediate postoperative instillation of epirubicin. RESULTS: Two of the patients recovered after conservative therapy, one patient died due to multi organ failure after explorative laparotomy. CONCLUSION: In order to prevent such complications, an immediate postoperative instillation has to be avoided when there is overt or even suspicion of bladder wall perforation.
Subject(s)
Antibiotics, Antineoplastic/administration & dosage , Carcinoma, Papillary/drug therapy , Cystectomy/methods , Epirubicin/administration & dosage , Urinary Bladder Neoplasms/drug therapy , Administration, Intravesical , Aged , Aged, 80 and over , Carcinoma, Papillary/pathology , Carcinoma, Papillary/surgery , Chemotherapy, Adjuvant , Cystoscopy , Fatal Outcome , Humans , Male , Neoplasm Staging , Postoperative Period , Treatment Outcome , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgeryABSTRACT
OBJECTIVES: On behalf of the European Association of Urology (EAU) guidelines for diagnosis, therapy and follow-up of upper urinary tract transitional cell carcinoma (UUTT) patients were established. Criteria for recommendations are based of level 2 only, as large randomised clinical trials have not been performed in this type of disease. METHOD: A systematic literature research using Medline Services was conducted. References were weighted by a panel of experts. RESULTS: TNM classification 2002 is recommended. Recommendations are developed for diagnosis, radical and conservative treatment and for local chemo-immunotherapy. Prognostic factors are defined. Recommendations for follow-up after different types of treatment are given.
