Background : Bladder cancer is one of the most common malignancies occurring worldwide. No published data exists on bladder cancer in Sri Lanka. The objective of the study was to determine the clinicopathological characteristics of histologically confirmed transitional cell carcinoma (TCC) of the bladder in Sri Lanka. Methods : Three hundred and one patients were diagnosed with primary bladder cancer during a 7.5-year period from 1993 to 2000. Two hundred and eighty-one patients (239 men and 42 women; mean age, 66 years; range, 26-88) with TCC of the bladder were evaluated with regard to clinical presentation, cystoscopic findings and histopathological data.Results : Transitional cell carcinoma accounted for 93.4% of primary bladder cancer. There was a male predominance with a sex ratio of 6 : 1. The majority of patients (63.7%) were in the 7th and 8th decades of life. Painless hematuria was the most common presenting symptom (52.7%), followed by painful hematuria (39.2%). The median duration of hematuria for all TCC patients, as well as for muscle-invasive TCC patients, was 3 months. Papillary configuration at cystoscopy, was found in 89.7% of non-invasive urothelial tumors. In contrast, 77.8% of invasive TCC patients had a solid/ mixed tumor configuration. One hundred and forty-five patients (51.6% of TCC) had non-invasive urothelial tumor and 136 patients (48.4%) had muscle-invasive disease. In the non-invasive urothelial tumor category, 61 patients (42.0%) had pTa tumors and 84 patients (58.0%) had pT1 tumors. Of newly diagnosed TCC cases, 5.3% were found to be T1G3 urothelial carcinomas. Fifty-six patients (38.6%) with non-invasive urothelial tumor had a tumor greater than 5 cm in size.Conclusions : More than 90% of primary bladder tumors in Sri Lanka are TCC, with nearly half the patients having muscle-invasive diseases on initial presentation. Even in non-invasive urothelial tumors, the majority (58.0%) have lamina propria invasion.

Key Clinical MessageHistory of large bladder stones suggests a long‐standing chronic irritation of the bladder, a known risk factor for squamous cell carcinoma. Therefore, in such patients, we suggest random biopsies to detect presence of dysplasia or malignancy and a follow‐up cystoscopy for early detection of a possible tumor.

BackgroundJackstone is a bladder stone that has a similar appearance to toy jacks. However review of the English language medical literature revealed only a few previous reports of jackstone calculus.Case presentationWe report a case in which a large jackstone calculus was incidentally detected during the evaluation of 67 year old male presenting with lower urinary tract symptoms. X-Ray kidney, ureter, bladder showed a large irregular shaped radio-opaque shadow in the pelvic region. He underwent cystolitholapaxy and transurethral resection of the prostate.ConclusionIt is important to recognize the characteristic shape of the urinary bladder calculi in the diagnosis of the jack stones and to treat the primary cause of calculi formation.

Key Clinical MessagePartial cystectomy with wide local excision may be considered a suitable option for selective cases of locally advanced bladder leiomyosarcoma without evidence of distant metastasis; thereby preserving the functional outcome and quality of life. A negative margin, complete tumor resection, and frequent follow‐up in such patients are mandatory.