Bülent ALTUNOLUK, Erkan EFE, Tayfun ŞAHİNKANAT, Sefa RESİM, Ali İhsan TAŞÇI

Kliniğimizdeki mesane tümörlü hastaların geriye dönük analizi

Amaç: Bu geriye dönük çalışmada, Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Hastanesinde tanısı konulan, takip ve tedavileri yapılan mesane tümörlü olguların güncel literatür ve kılavuzlar doğrultusunda değerlendirilmesi amaçlandı.Gereç ve yöntem: Kliniğimizde transüretral mesane tümörü rezeksiyonu TUR-MT yapılarak mesane tümörü tanısı konulan 53 hasta bu çalışmaya alındı. Hastalara ait klinik ve patolojik bilgiler gözden geçirildi. Çalışma grubu kapsamına en az 3 aylık takibi olan hastalar alındı.Bulgular: Ortalama yaşları 60,94 ± 12,76 olan hastaların 36’sı %68 erkek, 17’si %32 kadındı. Hastaların 17’si hiçbir intravezikal tedavi almazken, 25 hasta BCG immünoterapisi, 3 hasta Mitomisin-C kemoterapisi aldı ve her iki grupta da takip sistoskopilerinde nüks izlenmedi. Kasa invaze 7, progresyon gösteren 2 ve leiomyosarkom bulunan 1 vaka; toplam 10 vakaya radikal sistektomi uygulandı. Lezyon 9 %17 hastada birçok odaklı iken, diğer 44 %83 hastada tek odaklı idi. Operasyon esnasında 2 hastada perforasyon, 1 hastada kanama meydana gelirdi.Operasyon sonrasında 3 hastada üretral darlık gelişti ve komplikasyonlar usulüne uygun olarak tedavi edildi.Sonuçlar: Kliniğimizde mesane tümörü tanısı, tedavisi ve takibi kılavuzlara uygun olarak yapılmaktadır. Vakalardan elde edilen bulgular, patoloji sonuçları, intravezikal tedavi endikasyonları ve sonuçları, rekürrens ve progresyon oranları ile komplikasyon oranları literatür ile uyumluluk göstermektedir

Anahtar Kelimeler:

Mesane tümörü, Transüretral rezeksiyon, Bacillus Calmette-Guerin

Retrospective analysis of patients with bladder tumour in our clinic

Objectives: In this retrospective study we aimed to evaluate the patients with bladder tumour according to recent literature and guidelines, who diagnosed and treated properly at Kahramanmaraş Sütçü Imam University Medical Faculty.Materials and Methods: 53 newly diagnosed bladder tumour patients undergoing transurethral resection TUR-BT in our clinic were enrolled into this retrospective study. Clinical and pathological data from the patients were reviewed. The patients who have at least 3 month follow-up enrolled in the study.Results: The mean patient age was 60,94 ± 12,76 years and 36 68% patients were men, 17 32% patients were women. Seventeen patients did not take any intravesical therapy, 25 patients took BCG immunotherapy and 3 patients Mitomycin-C chemotherapy; in each group no recurrence occurred at the follow-up cystoscopy. Ten patients underwent radical sistectomy, 7 of them were muscle-invasive, 2 were progressive and 1 patient was diagnosed as leiomyosarcom. While in 9 17% patients lesion was multiple, the other 44 83% were single lesion. At the operation, in 2 cases perforation and in 1 bleeding occured. After operation 3 urethral stenosis occured and the complications were appropriately treated.Conclusion: In our clinic the diagnosis, treatment and followup of the bladder tumour is performed according to the guidelines. The findings of the patients, pathology results, intravesical therapy indications and outcomes, recurrence and progression rates and complication rates are compatible with the literature

Keywords:

Bladder tumour, Transurethral resection, Bacillus Calmette-Guerin,

PDF

___

Bedük Y. Mesane Tümörleri. Anafarta K, Bedük Y, Arı- kan N (editörler), Temel Üroloji, Güneş Kitabevi, Anka- ra, 2007. p.725-740.
Tanagho EA, McAninch JW. Genel Üroloji. 17. Baskı. Me- sane tümörü. Nobel Tıp Kitabevleri, 2009. p. 308-327.
Ersoy H, İmamoğlu MA, Kiper A, Tuygun C, Esengen S, Burgu B: Yüzeyel mesane tümörlerinde tur sonrası intra- kaviter bcg uygulaması ve uzun süreli idamesinin rekür- rens ve progresyon üzerindeki etkisi. Ankara Üniv Tıp Fak Mecmuası 55(1): 63-72, 2002.
Pruthi RS, Baldwin N, Bhalani V, et al: Conservative ma- nagement of low risk superficial bladder tumours. J Urol, 179: 87-90, 2008.
Borhan A, Reeder JE, O’Connell MJ, et al: Grade progres- sion and regression in recurrent urothelial cancer. J Urol, 169: 2106-9, 2003.
Ataus S, Erozenci A: Kasa invaze olmayan mesane kanser- lerinde klinik prognostik faktorler, risk grupları ve intraka- viter kemoterapi. Uroloji Kitabı, Ozen H, Turkeri L (eds), Uroonkoloji Derneği yayını, Ankara 2007; 225-37.
Baltacı S: Kasa invazif olmayan mesane kanseri tedavisin- deki gelişmeler. Türk Üroloji Dergisi, 33 (3) : 257-65, 2007.
Shelley MD, Kynaston H, Court J, et al: A systematic re- view of intravesical bacillus Calmette-Guerin plus transu- rethral resection vs transurethral resection alone in Ta and T1 bladder cancer. BJU Int, 88(3): 209-16, 2001.
Herr HW, Pinsky CM, Whitmore WF: Experience with intravesical BCG therapy of superficial bladder tumors. Urology, 25:119, 1985.
Han RF, Pan JG. Can intravesical bacillus Calmette-Guerin reduce recurrence in patients with superficial bladder can- cer? A meta-analysis of randomized trials. Urology, 67(6): 1216-23, 2006.
Martinez M, Pieneiro JA, Leon JJ, et al: BCG versus Thite- pa. A randomize prospective study in 202 patients with su- perficial bladder cancer. J Urol, 143:502, 1990.
Shelley MD, Wilt TJ, Court J: Intravesical bacillus Calmette- Guerin is superior to mitomycin C in reducing tumour re- currence in high risk superficial bladder cancer: a meta- analysis of randomized trials. BJU Int, 93:485-490, 2004.
Morales A, Eidinger D, Bruce AW: Intracavitary bacillus Calmette- Guerin in the treatment of superficial bladder tumors. J Urol, 116:180–3, 1976.
Lamm DL, Blumenstein BA, Crissman JD: Maintenance bacillus Calmette-Guerin immunotherapy for recurrent Ta, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol, 163:1124-1129, 2000.
Van der Meijden AP, Sylvester RJ, Oosterlinck W, et al: Ma- intenance Bacillus Calmette-Guerin for Ta T1 bladder tu- mors is not associated with increased toxicity: Results from a European Organisation for Research and Treatment of Cancer Genito-Urinary Group Phase III Trial. Eur Urol, 44: 429-434, 2003.
Bohle A, Jocham D, Bock PR: Intravesical bacillus Calmet- te- Guerin versus mitomycin C for superficial bladder can- cer: A formal meta-analysis of comparative studies on re- currence and toxicity. J Urol, 169: 90-95, 2003.
Sylvester RJ, van der Meijden AP, Lamm DL: Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: A meta- analy- sis of the published results of randomized clinical trials. J Urol, 168: 1964-1970, 2002.
Sylvester RJ, van der Meijden AP, Witjes JA: Bacillus Calmette-Guerin versus chemotherapy for the intravesical treatment of patients with carcinoma in situ of the bladder: A meta-analysis of the published results of randomized cli- nical trials. J Urol, 174: 86-91, 2005.
Babjuk M, Oosterlinck W, Sylvester R: EAU Guidelines on Non-Muscle-Invasive Urothelial Carcinoma of the Blad- der. Eur Urol, 54: 303–314, 2008.