Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press47810.17650/1726-9776-2015-11-4-102-106CLINICAL CASEКЛИНИЧЕСКИЙ СЛУЧАЙChoice of the optimal treatment strategy for patient with multifocal bladder cancer: clinical caseВыбор оптимальной тактики лечения у пациента с мультифокальным опухолевым поражением мочевого пузыря: клинический случайRevaI. А.РеваИ. А.
Russian Federation
igvar2005@rambler.ruBormotinА. V.БормотинА. В.
Russian Federation
bormotin@nm.ruPrilepskayaЕ. А.ПрилепскаяЕ. А.
Russian Federation
prilepskayae@mail.ruKovylinaМ. V.КовылинаМ. В.
Russian Federation
dr.kovylina@gmail.comBernikovА. N.БерниковА. Н.
Russian Federation
bernikov@mac.comTupikinaN. V.ТупикинаН. В.
Russian Federation
tupikina@mail.ruTsybulyaО. A.ЦыбуляО. А.
Russian Federation
oksadoc@yandex.ruPushkarD. Yu.ПушкарьД. Ю.
Russian Federation
pushkardm@mail.ruDepartment of Urology “Moscow State Medico-stomatological University named after A.I. Evdokimov”Кафедра урологии ГБОУ ВПО «Московский государственный медико-стоматологический университет им. А. И. Евдокимова»21/2 Vucheticha St., Moscow, 125206, RussiaРоссия,125206, Москва, ул. Вучетича, 21, корп. 2301220151141021062408201507102015https://oncourology.abvpress.ru/oncur/article/view/478

Transurethral resection of bladder is the standard surgical procedure for management of bladder cancer when it is suspected. Accurate clinical staging of the disease based on the histologic findings followed by further assessment of recurrence risks and risks of disease progression are vital for defining an optimal individualized treatment strategy. Early radical cystectomy (RC) is recommended for patients suffering from superficial bladder cancer at high risk for tumor recurrence.

Patients diagnosed with bladder tumors with multifocal lesions as well as with tumor size > 3 сm are related to a group of high risk for cancer progression. In this case in order to take a decision about the benefits of radical surgery, it’s essential to remember that RC is considered to be a major surgical procedure with a broad range of both intraoperative and postoperative complications. The vast majority of patients experience a lower quality of life based on the development of different types of metabolic alterations as well as the necessity for using urinals or inability to have adequate urination control. Organ-preserving therapy with active follow-up is thereby preferably to conduct on young patients with active life position.

In our clinical case we confirmed that such treatment strategy allows to establish adequate control over neoplastic process with less negative impact on patients’ quality of life.

При подозрении на опухоль мочевого пузыря стандартным методом установления окончательного диагноза является трансуретральная резекция мочевого пузыря. Точное определение по данным гистологического заключения стадии заболевания с последующей оценкой рисков рецидива и прогрессии опухоли позволяет выбрать оптимальную для каждого пациента тактику лечения. У пациентов с поверхностным раком мочевого пузыря, имеющих высокий риск прогрессии опухоли, рекомендуется выполнение ранней радикальной цистэктомии (РЦЭ).

При мультифокальном поражении мочевого пузыря, наличии опухолей размерами > 3 см еще на этапе установления диагноза пациент может быть отнесен к группе высокого риска прогрессии. В такой ситуации при принятии решения о выполнении радикального оперативного лечения следует помнить, что РЦЭ является масштабной операцией, сопряженной с широким спектром как интра-, так и послеоперацинных осложнений. У большинства пациентов отмечается выраженное ухудшение качества жизни, связанное как с развитием различного рода метаболических нарушений, так и с необходимостью ношения мочеприемников или с невозможностью осуществления адекватного контроля над актом мочеиспускания. В связи с этим у молодых пациентов с активной жизненной позицией следует отдавать предпочтение органосохраняющему лечению с активным динамическим наблюдением.

Описанный нами клинический случай подтверждает, что такая тактика позволяет осуществлять адекватный контроль над опухолевым процессом без выраженного негативного влияния на качество жизни пациента.

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