(Background) We studied the relationship between the recurrence rate of primary superficial bladder cancer and random biopsy.(Methods) We performed transurethral resection of primary superficial bladder cancer in 144 patients, and in 55 of those cases a random biopsy was also performed. The non-recurrence rate was examined in many recurrence facters.(Results) The non-recurrence rate in the group with random biopsy was not significantly different from that observed in the group (100 patients) without random biopsy (x2 test, Generalized Wilcoxon test and multivariate analysis). Because the intravesical instillation therapy is an important inhibition factor in the recurrence rate of the primary superficial bladder cancer, we further analysed the recurrence rate in two non treated groups with or without random biopsy (13 and 35 patients respectively). No significant difference in the rate of recurrence between the two groups was observed. However, we noted recurrence of bladder cancer at biopsy positions in 8/13 patients.(Conclusion) It appears that random biopsy may have an effect on the recurrence or the implantation of tumor cells. Further studies are needed to clarify whether random biopsy is a risk factor in the recurrence rate of primary superficial bladder cancer.
A clinico-pathological study was conducted on 69 patients with bladder cancer who underwent total cystectomy. The one, three and five-year actuarial survival rates for the 69 patients were 73.3%, 48.6% and 44.1%, respectively. Survival rate was not significantly associated with sex, the number of tumors or the size of tumors. The survival rate in those aged 70 years or more was slightly worse than in those who were much younger. Patients with papillary tumors had a more favorable survival rate than those with non-papillary tumors but we could find no significant difference between those with pedunculated tumors and those with sessile tumors. The actuarial 5-year survival rates by grade were 71.9% in G1+G2, 22.6% in G3 and 32% in non-transitional cell carcinoma; the rates by stage were 86.5% in pTa+pT1, 85.7% in pT2, 20.8% in pT3a, 18.2% in pT3b and 0% in pT4. When the stage reached pT3a, the survival rate fell remarkably. The rate of INFα (93.8%) was significantly better than that of INFβ (28.1%) and INFγ (15.2%). The rate of ly0 (76.2%) was also significantly better than that of ly1(25.5%) and ly2 (18.8%) . There was no significant difference in survival between v(-) (50.7) and v(+) (25.9%). We could find no significant difference between patients who underwent pelvic lymph nodes dissection and those who did not. The patients were divided into those who were alive and those dead within 2-years and 5-years after total cystectomy and the degree of involvement of clinico-pathological factors was assessed by multivariate analysis (Quantification II method), using 12 factors as predictor variables. The factor with the greatest influence on prognosis was pathological stage followed by mode of infiltration. Discrimination between the living and the dead was achieved at an 87.9% success rate (2 years) and an 88.5% success rate (5 years) by this analysis. These results suggest that systemic adjuvant treatment should be carried out to improve the prognosis of patients with bladder cancer after total cystectomy when the pathological stage is judged as pT3a-pT4 and when the mode of infiltration is INFβ or INFγ even if the stage is pT2.
Herein it is reported statistical studies on hematuria in outpatients who visited our department between 1971 and 1973. The total number of outpatients with hematuria was 589 cases (10.3%). The ratio of asymptomatic hematuria against symptomatic hematuria was two to three.The commonest disease with asymptomatic hematuria was essential renal bleeding and that of symptomatic hematuria was cystitis and urethritis. Tumors of urinary tract were found in 12.9% of outpatients with hematuria: 17.0% with asymptomatic hematuria and 10.3% with symptomatic hematuria. Malignant tumors were in 10.2% of outpatients with hematuria. Tumors of urinary tract were more frequent in older age group. Admission and suitable treatment were required in sixty cases (10.5%) of outpatients with hematuria.
An 80-year-old female had been taking phenacetin-containing analgesics due to severe pain in her legs and headache caused by SMON since 1957. The total accumulated dose of phenacetin that she had taken was about 2.3 kg. She visited the department of urology in our hospital complaining of gross hematuria in May, 1987. DIP showed that bilateral kidney were atrophic and her left pyelogram was non-visualized. A solid mass was located in her renal pelvis on the CT scan. Under the diagnosis of a left renal pelvic tumor, nephrectomy was performed on her left kidney in January, 1988. Histological diagnosis was interpreted as a transitional cell carcinoma, at a grade 1 greater than 2 and interstitial nephritis was detected. She died 8 months after the operation because of lung and bone metastasis. In autopsy, interstitial nephritis of the right kidney was also recognized. Our case is the fourth report of renal pelvic tumor due to phenacetin abuse in Japan.
A 40-year-old housewife was found to have a renal mass on her left side through an ultrasonogram at the hospital during a medical check up. The patient had a dull pain in her left flank intermittently for three years. She had no personal or family history of stigmas of tuberous sclerosis. The mass showed a high echogenicity on the ultrasonogram and a low density (-84HU) on the CT scan. Preoperative diagnosis was reported as renal angiomyolipoma and an enucleation of the tumor was performed with CUSA. A statistical study was done on data taken from 429 cases of renal angiomyolipoma in the Japanese literature, including our case. The male to female ratio was 1 to 2.9. Thirty three percent of the cases were associated with tuberous sclerosis. The ratio of bilateral cases to unilateral ones was 1:4. The main clinical signs were abdominal pain, abdominal mass and gross hematuria. Nephrectomy was done in 71.0% of the cases, partial nephrectomy and enucleation in 13.7% and embolization in 2.2%. Through the composition of the CT scan and the ultrasonogram, preoperative diagnosis has become possible in many cases, so recently the ratio of nephrectomy has been decreasing. We think partial nephrectomy and enucleation compose the most effective therapy for renal angiomyolipoma.
Statistical studies were made on 43 cases who died of urinary bladder cancer during the period of 10 years from 1961 to 1970. Special attention was paid to the causes of death and complications. A similar study was done on 690 cases recoreded in the Annual of the Pathological Autopsy Cases in Japan during the past 9 years from 1961 to 1969.1) Direct causes of death:i) 15 (34.9%) in our cases and 39.4% of the cases of Ann. Path. Aut. Cases Jap. died of urinary bladder cancer itself.ii) 8 (18.6%) in our cases and 18.8% of the cases of Ann. Path. Cases Jap. died of renal insufficiency.2) Complications:In our cases pyelonephritis was seen in 39.5%, hydronephrosis in 34.9% and, in the cases of Ann. Path. Cases Jap., the former in 44.6% and the latter in 27.1%.An autopsy survey of the bladder cancer was made on 8 of our autopsized cases. Pyelonephritis or hydronephrosis was seen in 6 of the 8 cases: 2 in cancerous death and 4 in noncancerous death, wherein all of the 4 noncancerous deaths were complicated with either or both of these complications.The high incidence of complications in the upper urinary tracts was verified in our autopsiy cases. This will alarm us for the sincere necessity of examination for and treatment of these complications, hydronephrosis and pyelonephritis, in the cases of bladder cancer.
