Urothelial Tumors of the Urinary Bladder in Two Adolescent Patients: Emphasis on Follow-up Methods

Abstract

Here we describe two cases of papillary urothelial neoplasm of low malignant potential in adolescent boys. One case was a 16-year-old boy with a polypoid mass beside the right ureteral orifice and the other case was a 13-year-old boy with a papillary mass beside the left ureteral orifice. The initial presentation was hematuria in both cases and the bladder mass was detected by ultrasonography. Complete resection of the bladder tumor was performed by using an 11-Fr pediatric resectoscope. Follow-up has been performed with urine analysis, urine cytology, and bladder ultrasonography or cystoscopy every 3 months with no evidence of recurrence.

Urothelial neoplasm in a 19‐year‐old male patient with urine discoloration, negative lab, and imaging workup: Should we investigate the findings or the symptom?

“…The most prominent clinical sign is painless visible hematuria . Imaging modalities such as ultrasound (US) and unenhanced computed tomography (CT) have been advocated with reliable results . Urine cytology has low detection rates due to the preponderance of low‐grade tumors; thus, it is not a useful tool .…”

“…Delaying cystoscopy can be possibly explained by either lack of clinical awareness of bladder cancer in this particular age group or fear of causing penetrating urethral trauma . Endoscopic resection via transurethral radical excision of the urothelial lesion is the standard of care, regardless of age . Partial cystectomies have only been proposed for high‐grade tumors .…”

“…Owing to low recurrence rates, even in low‐grade bladder tumors, close follow‐up is recommended . Of note, there is lack of comprehensive guidelines for long‐term monitoring of these patients; thus, several follow‐up time intervals have been proposed so far and various screening modalities . Bujons et al demonstrated follow‐up intervals ranging from 8 to 27 years.…”

“…2,4,5 Imaging modalities such as ultrasound (US) and unenhanced computed tomography (CT) have been advocated with reliable results. 2,5,6 Urine cytology has low detection rates due to the preponderance of low-grade tumors; thus, it is not a useful tool. 4,6 On the contrary, cystoscopy remains the gold standard for diagnostic evaluation of hematuria and subsequent assessment of papillary intravesical masses.…”

“…2,5,6 Urine cytology has low detection rates due to the preponderance of low-grade tumors; thus, it is not a useful tool. 4,6 On the contrary, cystoscopy remains the gold standard for diagnostic evaluation of hematuria and subsequent assessment of papillary intravesical masses. 3,6 There are cases, indeed, where urologists hesitate to perform a diagnostic cystoscopy.…”