Urological oncology

Abstract

Conclusions: Explanation of the etiology of the upper caliceal stone by the anatomic features is very difficult, and these caliceal anatomic variables (IPA, IL, IW) seem not to be a significant risk factor for stone formation in the upper calyx. Editorial CommentThe study is interesting and demonstrated that there is any statistically significant difference between the stonebearing and the normal kidneys of patients with upper caliceal stones and healthy individuals in terms of infundibulopelvic angle (IPA), infundibular length (IL) and width (IW) of upper caliceal system. Previous anatomical findings on pelvicaliceal features are well presented and discussed.The mean pelvicaliceal volume of 42 stone-bearing was 2455,2±1380,2 mm3 and contralateral kidneys was 2114±2081,5, with no statistical difference between stone-bearing and contralateral normal kidneys (p=0,34). When comparing to bilateral kidneys of healthy individuals not bearing stones the difference was significant. Nevertheless, as the authors stated, these finding must be viewed with caution. Purpose: We evaluated the potential benefit of a second transurethral resection in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder. Materials and Methods: Between January 2001 and May 2003, 80 patients with stage T1 bladder cancer were included in this protocol in which all patients prospectively received second TUR within 2 to 6 weeks following the initial resection. Patients with incomplete resections were excluded from study. The pathological findings of the second TUR were reviewed. Results: Of the 80 patients who underwent second resection, 18 (22.5%) had macroscopic tumors before resection. However, with the addition of microscopic tumors, overall residual disease was determined in 27 (33.8%) patients. Of the 27 patients 7 had pTa, 14 had pT1, 3 had pT1+pTis and 3 had pT2 disease. Residual cancers were detected in 5.8%, 38.2% and 62.5% in G1, G2 and G3 tumors, respectively. The risk of residual tumor directly correlated with the grade of the initial tumor (p = 0.009). Conclusions: Although second TUR dramatically changed the treatment strategy in a small percentage of cases, we strongly recommend performing second TUR in all cases of primary pT1 disease, especially in high-grade cases. Dr. Francisco Sampaio Editorial CommentThis paper highlights the usefulness of a second transurethral resection in superficial bladder cancer by providing own data and a review of the meanwhile large body of literature evidence.