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- Title
Upper tract tumour after radical cystectomy for transitional cell carcinoma of the bladder: incidence and risk factors.
- Authors
Sved, Paul D.; Gomez, Pablo; Nieder, Alan M.; Manoharan, Murugesan; Kim, Sandy S.; Soloway, Mark S.
- Abstract
The considerable experience of the University of Miami in treating TCC is reviewed in the first article in this section. The authors found that the incidence of upper tract tumour after radical cystectomy for TCC is low, but that patients with prostatic urethral involvement at cystectomy have a greater risk of developing upper tract tumours.A questionnaire-based study in the UK attempted to assess how upper tract surveillance is carried out by British urologists in patients with urinary tract TCC. They found a wide variation in practice, which presumably is similar to that also found in other parts of the world. They recommend a follow-up strategy and suggest that this surveillance should continue for at least 15 years.There is an evaluation of the long-term results of salvage cystectomy after interstitial radiotherapy and external beam radiotherapy for TCC reported from Amsterdam. They found that salvage cystectomy gives acceptable morbidity and for any type of urinary diversion.To review the incidence, pattern and outcome of upper tract transitional cell carcinoma (TCC) after radical cystectomy for carcinoma of the bladder, and identify risk factors for its development.The records of 235 consecutive patients who had a radical cystectomy and urinary diversion for TCC at the authors’ institution by one surgeon between January 1992 and August 2003 were retrospectively reviewed.Five (2%) of 235 patients developed an upper tract urothelial tumour. The mean follow-up for all patients was 42 months, and was 52.2 months for those with an upper tract tumour. Four of the five patients presented with haematuria and one was diagnosed on routine follow-up intravenous urography. The mean time to the diagnosis of an upper tract tumour was 39.6 months. Of the potential risk factors, only the presence of TCC of the prostatic urethra had a statistically significant association with eventual upper tract tumour (P < 0.01). At the last follow-up, four patients died from urothelial cancer and one was disease-free.The incidence of upper tract tumour after cystectomy for TCC is low; most patients present with symptoms (haematuria) and have advanced disease at diagnosis. Patients with prostatic urethral involvement at cystectomy are at greater risk of developing upper tract tumour.
- Subjects
CANCER risk factors; URINARY organs; RADIOTHERAPY; UROLOGY; PROSTATE; DIAGNOSIS
- Publication
BJU International, 2004, Vol 94, Issue 6, p785
- ISSN
1464-4096
- Publication type
Article
- DOI
10.1111/j.1464-410X.2004.05032.x