Risk factors for multiple intravesical recurrences of superficial bladder cancer.

OBJECTIVES: To elucidate the risk factors for a second or third intravesical recurrence in patients with superficial bladder cancer. METHODS: Of 84 consecutive patients newly diagnosed as having superficial bladder cancer in Sapporo Medical University Hospital, 30 patients who had at least one recurrent superficial bladder cancer and were followed up for more than 3 years were included in this study. Multivariate analysis by Cox's proportional hazards model was used to determine which clinical and pathologic variables significantly affected the second and third recurrences. Stepwise regression analysis was used to determine which clinical and pathologic variables significantly affected multiple recurrences of bladder cancer. RESULTS: The 1, 2, and 5-year recurrence-free rates as determined by the Kaplan-Meier method were 66.1%, 43.8%, and 29.8% for a second recurrence and 67.4%, 61.8%, and 39.2% for a third recurrence, respectively. Multivariate analysis revealed that only the interval between the initial transurethral resection of the bladder cancer and the first recurrence was a significant and independent factor affecting the second recurrence. In the study of the third recurrence, the interval between the first and second recurrences was the only definite risk factor for the third one. When multiple recurrences were considered, stepwise regression analysis revealed that a time of 6 months or less from the initial transurethral resection until the first recurrence was a significant factor that affected the total frequency of bladder cancer recurrence (R(2) = 0.220, P = 0.0078). CONCLUSIONS: The results of our study indicate that patients will have the potential for frequent recurrences if they have the disease with recurrence after a short interval. This result may contribute to the selection of patients with superficial bladder cancer to receive aggressive adjuvant treatments to prevent frequent recurrences.

Sarcomatoid transitional cell carcinoma originating from a duplicated renal pelvis.

A case of sarcomatoid transitional cell carcinoma of the renal pelvis is reported. It was distinguished from carcinosarcoma by immunohistochemical study. The tumor was difficult to distinguish from a renal parenchymal tumor in imaging studies because it originated from a duplicated renal pelvis.

Risk factors for the development of bladder cancer after upper tract urothelial cancer.

OBJECTIVES: To determine the clinical and pathologic risk factors for initial intravesical recurrence in patients with primary renal pelvic and/or ureteral cancer and to examine the progression in the bladder in patients having high risk factors for intravesical recurrence. METHODS: This study included 69 patients with renal pelvic and/or ureteral cancer. We excluded patients with distant metastases, those with a short period of follow-up, and those having a previous history or concomitance of bladder cancer. The exclusion criteria were chosen to avoid contamination by patients with a poor prognosis who might die of the primary cancer before bladder cancer development. Multivariate analysis by Cox's proportional hazards model was used to determine what clinical and pathologic variables significantly affected the initial intravesical recurrence of cancer. We also studied the stage progression of cancer that recurred in the bladder. RESULTS: Initial intravesical recurrence of the cancer was found in 22 patients during a median follow-up period of 53 months (range 12 to 225). The intravesical disease-free rate after upper tract urothelial cancer was 65% (rate of disease recurrence in bladder 35%) at 5 years by the Kaplan-Meier method. The extent (multifocality) of the upper urinary cancer (P = 0.0038) and pathologic stage (P = 0.0409) independently influenced intravesical recurrence. Age, sex, adjuvant chemotherapy, configuration of the primary tumor, primary cancer size, and pathologic grade did not affect recurrence. The rate of stage progression also was not influenced by the extent of the disease in the upper urinary tract. CONCLUSIONS: The extent and pathologic stage of cancer in the upper urinary tract were significant and independent factors for initial intravesical recurrence of cancer. However, no difference was found in clinical outcome in terms of stage progression between patients having high risk factors for intravesical recurrence and those without them.

Preselected biopsy for normal-appearing mucosa of superficial bladder carcinoma.

OBJECTIVES: We examined the incidence of positive findings (concomitant carcinoma in situ (CIS), frank carcinoma and dysplasia) for normal-appearing mucosal biopsies in superficial bladder carcinoma and the clinical outcome of patients with positive biopsy results. METHODS: Eighty-four cases of newly diagnosed superficial bladder carcinoma, from whom biopsies of preselected cystoscopically normal-appearing mucosal tissue were taken at the time of initial treatment, were studied. Multivariate analysis by Cox's proportional hazards model was applied. RESULTS: Twenty-seven percent of the patients with superficial bladder carcinoma showed positive biopsy results. Positive biopsy results independently influenced intravesical recurrence by Cox's proportional hazards model. CONCLUSIONS: Positive mucosal biopsy results are a significant indicator of intravesical recurrence in patients with superficial bladder carcinoma.

Lymph node metastasis in patients with carcinomas of the renal pelvis and ureter.

OBJECTIVES: We evaluated the clinical significance of lymph node metastasis in patients with carcinomas of the renal pelvis and ureter. METHODS: 68 patients without distant metastasis were included in this study. Multivariate analysis by Cox's proportional hazards model was applied to detect the prognostic factor(s). RESULTS: 12 patients (17.6%) had nodal involvement. More than 10% of the patients with pT1-2 showed nodal metastasis. Preoperatively determined clinical factors were not a predictive factor for nodal involvement. Nodal metastasis was the only significant negative prognostic factor for patient survival by multivariate analysis. CONCLUSIONS: Lymph node dissection is valuable to predict the clinical outcome of the patients with carcinoma of the renal pelvis and ureter. Attention should be paid to nodal status to select patients for conservative surgery.

[Endoscopic reconstruction after traumatic disruption of the urethra].

Endoscopic reconstruction was performed in 5 patients after complete traumatic disruption of the urethra. A prostatic urethra was disrupted in 1 patient, prostatic and membranous urethrae in 1 and bulbous urethra in 3. After endoscopic reconstruction, all patients required additional internal urethrotomy and urethral bougienage, but became able to void by themselves. Four patients had maximum flow rates between 13.8 and 41.9 ml/s. However, the other patient with an obliterated urethral segment of 4.6 cm had traumatic impotence preoperatively and a poor voiding status after reconstruction. None of the patients developed urinary incontinence or impotence associated with the operation. In conclusion, endoscopic reconstruction is recommended as the initial procedure for patients with obliterated segments smaller than 3 cm.