EXPERIENCE WITH TRANSURETHRAL BIOPSY IN PATIENTS WITH SUPERFICIAL URINARY TRACT CARCINOMA IN THE EARLY POSTOPERATIVE PERIOD

Objective: to monitor the efficacy of transurethral resection (TUR) of a urinary bladder tumor, which has performed under the standard conditions and by using fluorescence cystoscopy (FCS), to diagnose early bladder cancer (BC), and to determine tumor aggression and prognosis of the disease.

Subjects and methods. 174 BC patients, who had undergone 4-6 weeks postoperatively re-endoscopy comprising routine cystoscopy (CS), FCS, and TUR biopsy of a postoperative scar area and fluorescent portions, were examined. Group 1 included 95 patients who had under- gone routine TUR; Group 2 consisted of 79 patients in whom TUR had performed under fluorescence guidance.  

Results. Re-endoscopy revealed fluorescence portions in 56 (58.9%) patients in Group 1 and in 28 (35.4%) in Group 2. Endothelial tumors were found in 45 (47.4%) patients from Group 1 and in 19 (24.1%) from Group 2. In the latter, residual tumors were less frequently observed than those in Group 1 (24.1 and 47.4%, respectively; p < 0.005). Control endoscopic study of Tis identified in 15 (15.8%) of the 95 examinees in Group 1 and only in 4 (5.1%) of 79 in Group 2 (p < 0.001). There was a significant difference in the frequency of residual tumors (Ta stage) in Groups 1 and 2 patients (16.8 and 8.9%; p < 0.005). The differences in the frequency of residual papillary tumors at T1 stage were also significant in the analyzed groups (10.5 and 6.3%, respectively; p < 0.05). At the same time, the difference was insignificant in the incidence of a recurrence at T2 stage. Amongst 27 Group 1 patients with multiple urinary bladder involvement, residual tumors were identified in 14 (51.9%); these were present only in 4 (18.2%) of 22 patients from Group 2 (p < 0.001).

 Conclusion. Early repeated CS and biopsy under fluorescence guidance should be recommended to patients with BC at stages Tis and Ta— T1 for the timely detection and removal of residual tumors and for the prevention of recurrences.

1. Аполихин О.А., Какорина Е.П., Сивков А.В. и др. Состояние урологической заболеваемости в Российской Федерации по данным официальной статистики. Урология 2008;(3):3, 5—7.

2. Лоран О. Б. Онкоурология сегодня: проблемы и достижения. Мед вестн 2007;13:7—8.

3. Горелов С.И., Карелин М.И., Каган О.Ф. и др. Флюоресцентная циcтоскопия в ранней диагностике и лечении рака мочевого пузыря. В кн.: Лучевая диагностика и лучевая терапия на пороге третьего тысячелетия: Тезисы докладов 1-го Российского науч. форума с международным участием. М., 2000. с. 157—9.

4. Горелов С.И., Хейфец В.Х., Каган О.Ф. Метод флуоресцентной цистоскопии и его применение в диагностике поверхностного рака мочевого пузыря. Пособие для врачей. СПб., 2004.

5. Матвеев Б.П., Фигурин К.М., Карякин О.Б. Новые тенденции и технологии в диагностике рака мочевого пузыря. В кн.: Рак мочевого пузыря. Мате- риалы 4-й Всероссийской научной конференции с участием стран СНГ. М., 2002. с. 26—7.

6. Brauers A. Second resection and prognosis of primary high risk superficial bladder cancer: Is cystectomy often too early? J Urol (Baltimore) 2001;165:791—808.

7. Kriegmair M., Stepp H., Baungartner R. et al. Fluorescence controlled transurethral resection of bladder cancer following intravesical application of 5-aminolevulinic acid. J Urol 1996;155:665A.

8. Oosterlinck W., Witres F., Sylvester R. Diagnostic and prognostic factors in non- muscle-invasive bladder cancer and their influence on treatment and outcomes. Eur Urol 2008;4:321—4.

9. Горелов С.И., Каган О.Ф., Хейфец В.Х., Хролович А.Б. Применение флуоресцентной цистоскопии в хирургическом лечении поверхностного рака мочевого пузыря. Отечественная урология: история и перспективы. Материалы научно-практической конференции, посвященной 300-летию основания Главного военного клинического госпиталя им. акад. Н.Н. Бурденко. М., 2006. с. 165.

10. Ghoneim M., El-McKresh M., El-Baz M. et al. Radical cystectomy for carcinoma of the bladder: critical evaluation of the results in 1,026 cases. J Urol (Baltimore) 1997;158:389—93.

11. Непеу N.М., Ahmec S., Flanagan М.J. et al. Superficial bladder cancer: progression and recurrence. J Urol (Baltimore) 1983;130:1083—96.

12. Herr H., Jakse G., Sheinfleld J. The Tl bladder tumour. Semin Urol 1990;8:254.

13. Медведев В.Л., Костюков С.И., Вакуленко И.Т. и др. Применение метода фотодинамической диагностики у пациентов с поверхностным раком мочевого пузыря. В кн.: Рак мочевого пузыря. Материалы 4-й Всероссийской научной конференции с участием стран СНГ. М., 2002. с. 38—9.

14. Heney N. Natural history of superficial bladder cancer. Prognostic features and long-term disease course. Urol Clin N Am 1992;19:373—429.

15. Kiemeney L., Witjes J.A., Debruyne F.M. et al. Dysplasia in normal-looking urotheli- um in creases the risk of tumour progression in primary superficial bladder cancer. Eur J Cancer 1994;11:157—62.

16. Klan R., Loy V., Huland H. et al. Residual tumor discovered in routine second transurethral resection in patients with stage Tl transitional cell carcinoma of the bladder. J Urol (Baltimore) 1991;146:324.

17. Fitzpatrick J.M., West A.B., Butler M.R. et al. Superficial bladder tumors (stage pTa, grades 1 and 2): the importance of recurrence pattern following initial resection. J Urol (Baltimore) 1986;135:920.

18. Mauritio В., Laurence C., Karlheinz K. et al. Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage Та Т1 transitional cell carcinoma of the bladder: A combined analysis of seven EORTC studies. Eur Urol 2002;41:523— 31. 1

19. Millan-Rodriguez F., Chechile-Toniolo R. Multivariate analysis of the prognostic factors of primary superficial bladder cancer. J Urol (Baltimore) 2000;163:68—73.

20. Лопаткин Н.А., Мартов А.Г., Крендель Б.М. и др. Современные подходы в лечении поверхностного рака мочевого пузыря. В кн.: Рак мочевого пузыря. Материалы 4-й Всероссийской научной конференции с участием стран СНГ. М., 2002. с. 50—1.

21. Лопаткин Н.А., Камалов А.А., Тока- рев Ф.В. и др. Возможности флюоресцентной диагностики рака мочевого пузыря. В кн.: Рак мочевого пузыря. Материалы 4-й Всероссийской научной конференции с участием стран СНГ. М., 2002. с. 17—8.

22. Holmang S., Johansson S. Stage Та— Т1 bladder cancer. The relationship between findings at first follow up cystoscopy and subsequent recurrence and progression. J Urol (Baltimore) 2002;167:1634—7.

23. Thomas K., O'Brien T. Improving transurethral resection of bladder tumour. The gold standard for diagnosis and treatment of bladder tumours. Eur Urol 2008;4:328—30.

24. Sylvester R., Kurth K., Denis L. et al. Predicting the short-term and long-term prognosis of patients with Та—Tl bladder cancer. Results of EORTC/MRC randomised clinical trials. Eur Urol 2001;39:471—80.

25. Stein J.P., Lieskovsky G., Cote R. et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in a large group of patients. J Urol (Baltimore) 1998;159:213—37.

26. Walsh P.C. Superficial bladder cancer. In: Campbell's urology. 7-th ed. Philadelphia: W. B. Saunders Company, 2000. p. 326—30.