Department of Urology, University of Iowa, Iowa City, Iowa, USA.
Int J Urol. 2012 Nov;19(11):988-93. doi: 10.1111/j.1442-2042.2012.03089.x. Epub 2012 Jul 4.
To investigate whether random bladder, and prostatic urethral biopsies and individual upper tract cytologies (restaging) provide useful clinical information in addition to cystoscopy and bladder cytology in assessing initial intravesical therapy response for high-grade non-muscle invasive bladder cancer.
We retrospectively reviewed records of all patients who underwent restaging at our institution after treatment for high-grade non-muscle invasive bladder cancer (Ta, T1 and Tis) between January 2000 and October 2009. A total of 78 patients undergoing 116 consecutive restagings were included. The presence of intravesical cancer at restaging was assessed by cystoscopy, bladder wash cytology and random bladder biopsies, whereas ureteral and prostatic urethral disease was determined using upper tract barbotage cytology and prostatic urethral biopsies.
Indication for intravesical treatment was carcinoma in situ in 86, high-grade T1 in 16 and high-grade Ta in 14 cases. A total of 48 patients had primary disease and 68 had recurrence. Overall, 59 of 116 (50.9%) restagings showed positive bladder or prostatic biopsy and/or a positive cytology localized to the upper tract. Of the total number of recurrences, 12.9% (15 of 116) showed a negative cystoscopy and negative bladder cytology, and would have been missed on routine surveillance. A total of 23 of 116 (19.8%) restagings showed evidence of prostatic urethral and or ureteral disease.
Roughly 25% of high-grade non-muscle invasive bladder cancer early recurrences after induction intravesical therapy would go unnoticed without the addition of random and directed prostate biopsies, and isolated upper tract cytologies to standard cystoscopy and bladder cytology.
探讨随机膀胱和前列腺尿道活检以及个体上尿路细胞学（再分期）除膀胱镜检查和膀胱细胞学外，在评估高级别非肌肉浸润性膀胱癌初始膀胱内治疗反应方面是否提供有用的临床信息。
我们回顾性分析了 2000 年 1 月至 2009 年 10 月期间在我院接受高级别非肌肉浸润性膀胱癌（Ta、T1 和Tis）治疗后进行再分期的所有患者的记录。共纳入 78 例患者，进行了 116 次连续再分期。再分期时通过膀胱镜检查、膀胱冲洗细胞学检查和随机膀胱活检评估膀胱内肿瘤的存在，而上尿路疾病则通过上尿路灌洗细胞学检查和前列腺尿道活检确定。
膀胱内治疗的指征为原位癌 86 例、高级别 T1 16 例和高级别 Ta 14 例。共有 48 例患者为初发病例，68 例为复发病例。总的来说，116 次再分期中有 59 次（50.9%）显示膀胱或前列腺活检和/或上尿路细胞学阳性。在所有复发病例中，12.9%（15/116）显示膀胱镜检查和膀胱细胞学阴性，常规监测可能会遗漏这些病例。116 次再分期中有 23 次（19.8%）显示前列腺尿道和/或输尿管疾病的证据。
在没有添加随机和定向前列腺活检以及孤立的上尿路细胞学检查的情况下，大约 25%的高级别非肌肉浸润性膀胱癌在诱导膀胱内治疗后早期复发可能会被忽视，而这些检查是标准膀胱镜检查和膀胱细胞学检查的补充。
