OUTCOME OF MULTIPLE SESSION TRANSURETHRAL RESECTION OF BLADDER TUMOUR WITH INTRAVESICAL THERAPY IN COMPARISON WITH RADICAL CYSTECTOMY AND URINARY DIVERSION FOR HIGH GRADE (G3), STAGE T1 TRANSITIONAL CELL CAECINOMA OF URINARY BLADDER

Akram Hossain Khan*, Md. Ashraful Islam, Md. Khalilur Rahman Khabir, Mohammad Tawfik Aziz Shaon, Md. Saidul Anwar and Tanveer Ahmed

ABSTRACT

Objectives: To observe the outcome between multiple session transurethral resection of bladder tumor with intravesical therapy vs radical cystectomy in case of high grade (G3) stage T1 transitional cell carcinoma of urinary bladder. Methods: Total 40 patients with T1G3 were selected by inclusion and exclusion criteria. Purposive sampling was done. Some patients (30) were treated with conservative approach and some patients (10) were treated with radical cystectomy and urinary diversion. This was a retrospective study. The study conducted in the department of urology of National Institute of Kidney Diseases and Urology, Dhaka from January 2015–dec 2015. All patients with TCC of urinary bladder. Results: Mean age and standard deviation of Group-A and Group-B patients were 61±10.33 and 58±6.74 respectively. There was no association between the patients treated by TURBT and intravesical therapy (Mitomycin-C or BCG) and radical cystectomy in case of male (36) and female (4). In relation to recurrence of disease the calculated value (i.e. 4.506) was greater than the tabulated value (i.e. 3.84). So the result was statistically significant. Percentage of recurrence was 100% and 20% in case of patients treated with conservative approach or radical cystectomy respectively. After radical cystectomy recurrence was occurred in the left lower ureter at the ureteroileal anastomotic site in one case and pelvic lymph nodes in another case. Disease progression was observed 4(30) and 2(10) patients in case of Group-A and Group-B. So the end point of my study to observe the recurrence and progression of disease in both groups. Conclusion: T1G3 transitional cell carcinoma of urinary bladder is an aggressive tumor. From my study it may be concluded that the recurrence rate of T1G3 TCC of urinary bladder is very high. In relation to recurrence of disease in high grade superficial bladder cancer TURBT and intravesical therapy is not a good treatment option. But early radical cystectomy and ileal conduit is the best treatment option to prevent recurrence. Certainly no definitive conclusions can be made regarding the impact of TURBT and intravesical therapy on progression from my study as the power of this study was limited by the small sample size. T1G3 is a deadly tumor, so proper follow-up protocol should be maintained.

Keywords: Transurethral resection, Bladder tumor, Urinary bladder.