The significance of ureteral obstruction in lnvasive transitional cell carcinoma of the urinary bladder

Abstract

Ureteral obstruction is a frequent complication of transitional cell carcinoma (TCC), known as a poor prognostic sign and indicative of advanced disease. We investigated retrospectively the medical records of 122 consecutive patients who suffered from invasive TCC of the urinary bladder during a 6-year period. Unilateral or bilateral ureteral obstruction was found in 66 patients (54.1%). High stage (T3-T4) and grade (III-IV) tumors were correlated with ureteral obstruction in 89.4% and 83.3% respectively compared to 67.9% and 66.1%, respectively, among patients with normal upper tracts (P < 0.001); 10.6% of the patients with ureteral obstruction had low stage disease, and all of them proved to have involvement of the ureteral orifices on the affected side. The 5-year survival rate of patients with and without ureteral obstruction was 32.2% and 65.9%, respectively (P < 0.001). The presence of ureteral obstruction, particularly in the absence of intravesical involvement of the ureteral orifices, signified a high stage, muscle invasive, and often metastatic tumor in more than 90% of the patients. Ureteral obstruction was an accurate criterion for poor prognostic and was associated with significantly lower, overall and stage-specific, survival rates, despite of radical surgery. We conclude that evidence of ureteral obstruction is an important staging standard and significant prognostic indicator in transitional cell carcinoma of the urinary bladder.

Analysis of Prognostic Factors in Bladder Carcinoma Treated With Radical Cystectomy

“…The incidance of hydronephrosis associated with bladder carcinoma ranges from 7.2% to 54.1% (17,18). In our series, this rate was found to be 21.5%.…”

“…Therefore, hydronephrosis is a frequent complication of bladder carcinoma. However, its prognostic value in patients with bladder carcinoma is controversial (17)(18)(19)(20). In 1956, Nichols and Marshal first reported that seven of their ten patients with ureteral obstruction and transitional cell carcinoma of the bladder had high grade and high stage bladder carcinoma (20).…”

“…In 1956, Nichols and Marshal first reported that seven of their ten patients with ureteral obstruction and transitional cell carcinoma of the bladder had high grade and high stage bladder carcinoma (20). Since then, further studies have described the negative associations of hydronephrosis in bladder carcinoma including the presence of metastatic disease, poorer differentiation of tumours, poorer survival and treatment outcome (17,18,19,21 (22). More recently, in a large cystectomy series, Nielsen et al found that higher chronological age to be independently associated with pathologically advanced disease and bladder cancer-specific mortality after cystectomy (23).…”

Prognostic Significance of Hydronephrosis in Bladder Cancer Treated by Radical Cystectomy

“…The major prognostic factors in bladder carcinoma are tumor stage and grade [2,3,11] . The incidence of bladder tumor-related hydronephrosis ranges from 7.2 to 54.1% [4,5] . In our series, this rate was found to be 21.5%.…”

“…Nevertheless, Trasher et al [6] and Yang et al [7] reported, in a multivariate analysis, that hydronephrosis was an independent prog- nostic marker for cancer-specific survival. In one study, Leibovitch et al [5] analyzed 122 patients with invasive bladder cancer, of those 122 cases, 82% underwent radical cystectomy and only half of them had a pelvic lymph node dissection. In that series, 5-year cancer-specific survival rates were 32.2% and 65.9% for patients with and without hydronephrosis, respectively (p !…”