Partial Cystectomy Treatment & Management

  • Author: E Jason Abel, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: Apr 2, 2012
 

Medical Therapy

Bladder-sparing options other than partial cystectomy

In the United States, most young healthy patients with urothelial carcinoma are treated with radical cystectomy as the criterion standard treatment because of advantages in survival seen in large series.[21]

Several other studies have been published using treatment protocols involving systemic chemotherapy or external beam radiation (XRT). Multimodality bladder-sparing therapy usually includes complete transurethral resection followed by induction chemotherapy/radiation, repeat urological evaluation (biopsies or repeat transurethral resection), and, afterwards, consolidation chemotherapy/ radiation. Salvage cystectomy is offered to patients without response to induction therapy or if recurrence is detected.

Table 2. Options Other than Partial Cystectomy (Open Table in a new window)

Study Number of Patients Induction Therapy % Complete Response Consolidation Therapy % Overall Survival (years) % Overall Survival with Bladder Intact (years)
Housset et al120Bifractionated XRT + concurrent cisplatin + 5-fluorouracil77Bifractionated XRT + concurrent 5-fluorouracil + cisplatin63 (5)...
Sauer et al18445-54 Gy XRT + concurrent cisplatin or carboplatin80None56 (5)41 (5)
Fellin et al562 cycles MCVa, 40 Gy XRT + concurrent cisplatin5024 Gy XRT + concurrent cisplatin55 (5)41 (5)
Tester et al4940 Gy XRT + concurrent cisplatin6624 Gy XRT + concurrent cisplatin60 (4)42 (4)
Tester et al912 cycles MCV, 39.6 Gy XRT + concurrent cisplatin7525.2 Gy XRT + concurrent cisplatin62 (4)44 (4)
Shipley et al612 cycles MCVa, 39.6 Gy XRT + concurrent cisplatin6125.2 Gy XRT + concurrent cisplatin48 (5)36 (5)
Shipley et al6239.6 Gy XRT + concurrent cisplatin5525.2 Gy XRT + concurrent cisplatin49 (5)40 (5)
Kachnic et al1062 cycles MCV, 40 Gy XRT + concurrent cisplatin6624.8 Gy XRT + concurrent cisplatin52 (5)43 (5)
Zietman et al18Bifractionated XRT + concurrent cisplatin + 5-fluorouracil78Bifractionated XRT + concurrent cisplatin + 5-fluorouracil + 3 cycles MCV83 (3)78 (3)

a Methotrexate, cisplatin, and vinblastine[22]

Multimodality bladder-sparing approaches other than partial cystectomy yield 5-year overall survival rates of 48-56%, with 5-year bladder survival rates of 36-43%. Comparison between approaches is difficult because of the multiple variables which may affect survival differ significantly between study populations. To date, no prospective randomized studies among modalities have been performed, so data must be interpreted accordingly.

The most important factors for bladder-sparing therapies include appropriate patient selection and long-term surveillance. Patient factors that increase risk of failure in transurethral resection/chemoradiation protocols include clinical stage higher than T2, associated ureteral obstruction with hydroureteronephrosis, incomplete initial transurethral resection, multiple tumors, and lack of response to induction chemoradiation. Local recurrence rates for such protocols vary from 20-30%. A recent editorial estimated that the mortality risk of certain bladder sparing procedures was between 7-16%.[23]

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Preoperative Details

Initial TURBT should confirm that the patient is a good candidate for partial cystectomy (absence of multifocal tumors, no carcinoma in situ, good bladder capacity.) During TURBT, a thorough inspection is performed and necessary biopsy samples collected to ensure that no other portions of the lower urinary tract contain disease. Appropriate imaging staging studies are performed (see Imaging Studies) to ensure that no disease exists in the upper urinary tracts or outside the bladder. Preoperative history, physical examination, medical assessment, and necessary laboratory evaluation (see Lab Studies) are also performed.

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Intraoperative Details

The patient may be placed supine or low-lithotomy position with a slight amount of Trendelenburg positioning. Bimanual examination under anesthesia is performed to determine suitability for resection. A catheter is inserted through the urethra, and the bladder is instilled with Mitomycin C (1 mg/mL) to decrease local tumor spillage. The Foley catheter is clamped so that the intravesical chemotherapy remains inside the bladder and the bladder is allowed to partially expand, which facilitates dissection.

The surgical approach is either transperitoneal or extraperitoneal though a lower midline incision. The transperitoneal approach may be more suitable for tumors located posteriorly. Pelvic lymph node dissection can be performed before or after partial cystectomy. In urothelial carcinoma, it is known that improved survival can be achieved with extended pelvic lymph node dissection.[24]

After completing the pelvic lymph node dissection, the Mitomycin C is drained from the bladder into a contained Foley bag system and discarded according to biohazard principles. Next a combined endoscopic and open approach is utilized to ensure resection of the mass with adequate tumor margins. A flexible cystoscope is introduced via the urethra into the bladder. While the assistant surgeon displays the location of the mass on the video monitor with the cystoscope, the primary surgeon can now see exactly where to place 4 sutures (inferior, superior, medial, lateral) strategically into the detrusor muscle of the bladder, to outline the exact area to be resected.

Next, the bladder is mobilized while dividing the vas deferens and the obliterated hypogastric artery. A portion of the ipsilateral vascular pedicle including the superior vesical artery is divided and ligated. The superior vesical artery division is especially helpful in the lateral mobilization of the bladder to expose a posteriorly located lesion. The tumor is excised with a 1-cm to 2-cm margin. The perivesical fat and the overlying peritoneum are removed, if necessary, with care to protect both ureters and the rectum. Frozen sections of the specimen are sent for analysis to ensure negative surgical margins.

An alternative method of excision involves placement of a Satinsky clamp around the portion that contains the tumor, excision of the segment, and cauterization of the wound edges.

The bladder is closed in 2-layers, and drains are placed in the perivesical space. A suprapubic tube is avoided because of possible tumor spread. Bladder drainage is managed with a temporary Foley catheter. Tumor spillage is detrimental and can be prevented via instillation of intravesical chemotherapy into the bladder prior to making the lower midline incision, careful draping, isolation, and manipulation of the tumor. This wound edges should be protected and the wound copiously irrigated with sterile water prior to closure. Concurrent procedures, such as prostatic adenoma enucleation or transurethral incisions of the bladder neck for bladder outlet obstruction, should be avoided because of the risk of tumor implantation in the prostatic bed.

Partial cystectomy can also be performed laparoscopically or robotically with similar technique to open prodecures.[25, 26] The patient is placed in the extreme Trendelenburg position with his legs abducted in Allen stirrups. A 5-mm port may be used for a transperitoneal approach. The camera port is positioned at least 2-3 cm above the umbilicus to facilitate adequate mobilization of the urachal remnant. The peritoneum is incised lateral to each medial umbilical ligament, and the urachus and peritoneum along with the surrounding pre-peritoneal fat are widely mobilized en bloc.

Once the space of Retzius is fully developed and the bladder is completely mobilized, the tumor is typically identified. A circumferential cystotomy is made under simultaneous cystoscopic guidance at a distance of 2 cm from the tumor to provide an adequate margin. The surgical specimen is then immediately placed into an EndoCatch bag (USCC, Norwalk, CT).

Bladder margins are sent for frozen section analysis and the bladder is then closed in 2 layers. The retrieval bag is removed through an extension of the camera trocar site, and a Jackson Pratt drain is positioned in the prevesical space through one of the previous trocar sites. In selected patients, with skilled surgeons, laparoscopic or robotic approaches can afford the patient a shorter recovery time and hospital stay.[27, 28]

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Postoperative Details

Placement of a drain in the perivesical space and maintaining a large caliber urethral catheter helps facilitate healing of the suture line where the bladder has been repaired. Ideally, the bladder is kept decompressed and any initial urine leakage is drained to allow healing of the bladder suture line. A urethral catheter also allows monitoring of urine output and detection of hematuria. This catheter is usually left in place for 7-14 days postoperatively. A cystogram may be obtained prior to catheter removal to ensure that the bladder suture line has healed.

Rarely, intravesical bleeding may result in urinary clot retention and may require gentle bladder irrigation to evacuate clots. Postoperative wound infection or abscesses may require open or percutaneous drainage. Ureteral obstruction should be suspected if the patient reports flank pain. IVP or ultrasonography can be used to confirm this diagnosis, and percutaneous nephrostomy may be used to temporarily divert urine in the hope that the obstruction is temporary. Incontinence due to altered bladder compliance and uninhibited bladder contractions usually improves with time and anticholinergic medications.

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Follow-up

Careful monitoring of all patients with bladder cancer is mandatory as bladder cancer frequently recurs. Cystoscopy should be performed every 3 months initially with voided urine cytology and frequent imaging.

Upper urothelial tract imaging with IVP, CT urography, or retrograde pyelography is also necessary although recurrence in the upper tract is less common. A precise surveillance schedule should be determined on an individual basis and patients with high-grade tumors should be monitored for disease recurrence and progression for life.

For excellent patient education resources, see eMedicineHealth's patient education article Bladder Cancer.

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Surgery: partial cystectomy

Initial transurethral resection of bladder tumor (TURBT) is essential for adequate staging in order to make an informed decision about future therapy. In general, partial cystectomy involves removing the segment of diseased bladder and repairing the defect with or without performing pelvic lymph node dissection. Radical cystectomy involves removal of the bladder, prostate and seminal vesicles in men. In women, along with the bladder, the urethra, uterus, broad ligaments, and anterior third of the vaginal wall may be removed. Pelvic lymphadenectomy is performed and a urinary diversion is created which may include ileal conduit, neobladder or continent pouch. The remainder of this article discusses details for partial cystectomy only.

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Complications

Excluding recurrence of malignant disease, the overall complication rate of partial cystectomy is reported as 11-29%. Common complications of partial cystectomy include: bleeding, infection, reduction of bladder capacity, and urinary extravasation. Less commonly, some patients develop fistulas (vesicocutaneous, vesicovaginal, colovesical). Other complications include those that are possible in any major surgery: myocardial infarctions, pulmonary embolus, congestive heart failure, upper gastrointestinal hemorrhage, and death. Laparoscopic urologic surgery complications occur with a rate of 14.6%, although the rate of complications specific to laparoscopic partial cystectomy is not known.

Importantly, the recurrence rate of bladder cancer after partial cystectomy is reported to be 37-78%. Local recurrences in the wound or suprapubic tract are worrisome and have been reported in as many as 18% of patients. Peress et al noted that those with high-grade tumors were more likely to have local recurrences than low-grade tumors (54% to 0%).[29]

Perioperative mortality rates once approached 10%, although more recent studies have reported rates of 1-2%.

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Outcome and Prognosis

Recurrence

The major disadvantage of partial cystectomy compared with radical cystectomy is an increased bladder recurrence rate in addition to metastatic recurrence. Recurrence also implies a risk of disease progression, metastasis, and death from cancer. In many patients, salvage with radical cystectomy is not possible and some series report high death rates in patients who recur. Recurrence rates associated with partial cystectomy have been reported as 19-78%. Relapses seem to be influenced by tumor stage T3b, poorly differentiated (grade III) tumors, and tumor size (>4 cm). Various studies and their corresponding recurrence rates are as follows:

Table 3. Various Studies and Their Corresponding Recurrence Rates (Open Table in a new window)

Studies Recurrence rates
Resnick and O'Connor (1973)76%
Evans and Texter (1975)40%
Novick and Stewart (1976)50%
Peress et al (1977)54%
Cummings et al (1978)49%
Schoborg et al (1979)70%
Faysal and Freiha (1979)78%
Jardin and Vallencien (1984)78%
Lindahl et al (1984)58%
Kaneti (1986)38%
Dandekar et al (1995)43%
Holzbeierlein et al (2004)19%
Kassouf et al (2006)49%

Peress et al noted that preoperative grade is an important prognostic factor in determining the risk of recurrence after partial cystectomy.[29] They studied 61 patients with stage A transitional cell carcinoma and found that 54% of patients with high-grade lesions experienced recurrence after partial cystectomy and eventually died of their disease. Kassouf et al have shown that a higher pathological stage at time of partial cystectomy was associated with shorter recurrence-free survival. Smaldone et al found that only tumor size at time of partial cystectomy was associated with tumor recurrence.[30] Older studies by Resnick and O'Connor and by Faysal and Freiha have also confirmed these findings.[31, 32]

These high local recurrence rates reflect the natural history of bladder cancer. Urothelial carcinoma of the bladder may affect the urothelium globally in some patients. Recurrences and survival outcomes depend on tumor stage and grade. Conservative management of Ta-T2 disease with transurethral resection alone results in a 60% recurrence rate. Those patients with history of previous tumors have an 84% recurrence rate, with nearly half of all tumor recurrences being multifocal. At initial presentation, two thirds of urothelial cancer patients have superficial (Ta, T1) disease, and two thirds of these patients experience recurrence (with 20% of the recurrences being of a higher grade). Death from urothelial carcinoma occurs in 5% of patients with grade 1 disease, 16% of patients with grade II disease, 28-35% of patients with grade III/stage Ta disease, and 83% of patients with grade III/stage T2 disease.

Recurrent local disease may be treated with transurethral resection, intravesical chemotherapy, radiotherapy, repeat partial cystectomy, and radical cystectomy. Of all patients who undergo partial cystectomy as original therapy, 4-15% eventually undergo radical cystectomy.

Survival

Many studies have examined the survival of patients with bladder cancer after partial cystectomy. Survival is influenced by tumor stage, grade and histology. Accurately interpreting the impact of partial cystectomy on overall survival and comparing to results of radical cystectomy data is difficult. Most partial cystectomy series are small (usually < 50 patients) compared to radical cystectomy series of more than 1000 patients. Also, many partial cystectomy series are carefully selected for lower risk tumors before surgery and which may influence survival. Furthermore, pelvic lymph node dissection is frequently not performed in partial cystectomy series,[33] which has been shown to have a significant survival benefit.[24]

When comparing results for a given stage or grade of urothelial bladder cancer, the survival outcomes for partial cystectomy series have been worse compared to radical cystectomy series. Five-year survival rates vary from 35-70%; compared with the 50-88% survival rate of contemporary radical cystectomy series.

Data from Kassouf et al showed that patients undergoing partial cystectomy who had a prior history of superficial tumors had a decreased overall and advanced recurrence-free survival.[34] This finding is not surprising given that these patients have already demonstrated evidence of a global field effect within the urothelium

Neoadjuvant chemotherapy has been shown in randomized trials to improve overall survival in patients undergoing radical cystectomy[35] although it is unclear whether adjuvant therapy would be equally effective.[36] Adjuvant chemotherapy should be considered in patients with extravesical extension or pelvic lymph node metastases who undergo partial cystectomy.

Table 4. Survival Rates by Tumor Grade (Open Table in a new window)

Source Five-year Survival (%)Ten-year Survival (%)
Grade IGrade IIGrade III/IVGrade IGrade IIGrade III/IV
Magri (1962)883334---
Utz et al (1973)1004839---
Novick and Stewart (1976)10075400678
Brannan et al (1978)506255503330
Cummings et al (1978)1009632---
Schoborg et al (1979)75622650284
Faysal and Freiha (1979)100533025208
Merrell et al (1979)78562283320
Kaneti (1986)754646---
Dandekar et al (1995)10094.453.5---

Table 5. Survival Rates by Tumor Stage (Open Table in a new window)

Source Five-year Survival (%) Ten-year Survival (%)
T0T1T2T3T4OverallT0T1T2T3T4Overall
Magri (1962)-803826042------
Long et al (1962)80674390-------
Cox et al (1969)--2016--------
Resnick and O'Connor (1978)75717712.52035------
Utz et al (1973)-684729039------
Evans and Texter (1975)-69431400-----21
Novick and Stewart (1976)-675320-46-6744--36
Brannan et al (1978)100695433057-313611-32
Cummings et al (1978)-79806-60------
Schoborg et al (1979)6969291210043-3700012
Faysal and Freiha (1979)7558297040211513709
Merrell et al (1979)1001006725-48-100330032
Lindahl et al (1984)-5938--42-4825-038
Kaneti (1986)-684033048------
Smaldone et al (2008)-----70
a Stage T3a/T3b
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Future and Controversies

Partial cystectomy offers potential quality of life advantages over radical cystectomy and may be appropriate in selected patients with cancer or certain benign conditions.

In patients with urothelial cancer, partial cystectomy will probably continue to play a limited role in the absence of quality comparative studies demonstrating equivalent survival results to radical cystectomy. The improved quality of life and fewer complications seen in patients undergoing partial cystectomy must be carefully weighed against the increased risk of cancer death.

Patients should be appropriately counselled by experienced surgeons when considering partial cystectomy.

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Contributor Information and Disclosures
Author

E Jason Abel, MD  Assistant Professor of Urologic Oncology, Department of Urology, University of Wisconsin Hospital and Clinics, University of Wisconsin School of Medicine and Public Health; Attending Urologist, William S Middleton Memorial Veterans Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Aaron M Potretzke, MD  Resident Physician, Department of Urology, University of Wisconsin School of Medicine and Public Health

Aaron M Potretzke, MD is a member of the following medical societies: American Medical Association and Minnesota Medical Association

Disclosure: Nothing to disclose.

Kelvin Wong, MD  Resident Physician, Department of Urology, University of Wisconsin School of Medicine and Public Health

Kelvin Wong, MD is a member of the following medical societies: American College of Surgeons and American Medical Association

Disclosure: Nothing to disclose.

Tracy M Downs, MD  Associate Professor, Director of Bladder Cancer and Intravesical Therapy Programs, Department of Urology, University of Wisconsin School of Medicine and Public Health; Attending Urologist, Merriter Hospital and William S Middleton Memorial Veterans Affairs Hospital

Tracy M Downs, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Gamal Mostafa Ghoniem, MD, FACS  Professor of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urogynecologic Society, American Urological Association, International Continence Society, International Urogynaecology Association, and Society of Urodynamics and Female Urology

Disclosure: Astellas Honoraria Speaking and teaching; Coloplasty Consulting fee Board membership; Uroplasty Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Martin I Resnick, MD; Jason T Jankowski, MD; Edward E Cherullo, MD; Matthew L Steinway, MD; and Adrian H Feng, MD, to the development and writing of this article.

References

  1. Nieh PT and Marshall FF. Surgery of Bladder Cancer. In: Campbell-Walsh Urology. ninth. 2007:2503-2505.

  2. Lindahl F, Jørgensen D, Egvad K. Partial cystectomy for transitional cell carcinoma of the bladder. Scand J Urol Nephrol. 1984;18(2):125-9. [Medline].

  3. Given RW, Wajsman Z:. Bladder sparing treatments for muscle-invasive transitional cell carcinoma of the bladder. In: AUA Update Series. 1997:16:41-48.

  4. Chiou HY, Chiou ST, Hsu YH, Chou YL, Tseng CH, Wei ML, et al. Incidence of transitional cell carcinoma and arsenic in drinking water: a follow-up study of 8,102 residents in an arseniasis-endemic area in northeastern Taiwan. Am J Epidemiol. Mar 1 2001;153(5):411-8. [Medline].

  5. Smith AH, Goycolea M, Haque R, Biggs ML. Marked increase in bladder and lung cancer mortality in a region of Northern Chile due to arsenic in drinking water. Am J Epidemiol. Apr 1 1998;147(7):660-9. [Medline].

  6. Smith AH, Hopenhayn-Rich C, Bates MN, Goeden HM, Hertz-Picciotto I, Duggan HM, et al. Cancer risks from arsenic in drinking water. Environ Health Perspect. Jul 1992;97:259-67. [Medline].

  7. Sweeney P, Kursh ED, Resnick MI. Partial cystectomy. Urol Clin North Am. Nov 1992;19(4):701-11. [Medline].

  8. Golijanin D, Yossepowitch O, Beck SD, Sogani P, Dalbagni G. Carcinoma in a bladder diverticulum: presentation and treatment outcome. J Urol. Nov 2003;170(5):1761-4. [Medline].

  9. Serretta V, Pomara G, Piazza F, Gange E. Pure squamous cell carcinoma of the bladder in western countries. Report on 19 consecutive cases. Eur Urol. Jan 2000;37(1):85-9. [Medline].

  10. Dandekar NP, Dalal AV, Tongaonkar HB, Kamat MR. Adenocarcinoma of bladder. Eur J Surg Oncol. Apr 1997;23(2):157-60. [Medline].

  11. Herr HW. Urachal carcinoma: the case for extended partial cystectomy. J Urol. Feb 1994;151(2):365-6. [Medline].

  12. Balbay MD, Slaton JW, Trane N, Skibber J, Dinney CP. Rationale for bladder-sparing surgery in patients with locally advanced colorectal carcinoma. Cancer. Dec 1 1999;86(11):2212-6. [Medline].

  13. Nyam DC, Seow-Choen F, Ho MS, Goh HS. Bladder involvement in patients with colorectal carcinoma. Singapore Med J. Oct 1995;36(5):525-6. [Medline].

  14. Hays DM, Raney RB, Wharam MD, Wiener E, Lobe TE, Andrassy RJ, et al. Children with vesical rhabdomyosarcoma (RMS) treated by partial cystectomy with neoadjuvant or adjuvant chemotherapy, with or without radiotherapy. A report from the Intergroup Rhabdomyosarcoma Study (IRS) Committee. J Pediatr Hematol Oncol. Feb 1995;17(1):46-52. [Medline].

  15. Tai HC, Chung SD, Wang SM, Chueh SC, Yu HJ. Laparoscopic partial cystectomy for various bladder pathologies. BJU Int. Aug 2007;100(2):382-5. [Medline].

  16. Ikeda M, Endo F, Shiga Y, Oguchi T, Yashi M, Hattori K. [Cystoscopy-assisted partial cystectomy for paraganglioma of the urinary bladder]. Hinyokika Kiyo. Sep 2008;54(9):611-4. [Medline].

  17. Budman LI, Kassouf W, Steinberg JR. Biomarkers for detection and surveillance of bladder cancer. Can Urol Assoc J. Jun 2008;2(3):212-21. [Medline].

  18. Shirodkar SP, Lokeshwar VB. Bladder tumor markers: from hematuria to molecular diagnostics--where do we stand?. Expert Rev Anticancer Ther. Jul 2008;8(7):1111-23. [Medline].

  19. Wang LJ, Wong YC, Huang CC, Wu CH, Hung SC, Chen HW. Multidetector computerized tomography urography is more accurate than excretory urography for diagnosing transitional cell carcinoma of the upper urinary tract in adults with hematuria. J Urol. Jan 2010;183(1):48-55. [Medline].

  20. Epstein JI, Amin MB, Reuter VR, Mostofi FK. The World Health Organization/International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee. Am J Surg Pathol. Dec 1998;22(12):1435-48. [Medline].

  21. Fedeli U, Fedewa SA, Ward EM. Treatment of muscle invasive bladder cancer: evidence from the National Cancer Database, 2003 to 2007. J Urol. Jan 2011;185(1):72-8. [Medline].

  22. Kim HL, Steinberg GD. The current status of bladder preservation in the treatment of muscle invasive bladder cancer. J Urol. Sep 2000;164(3 Pt 1):627-32. [Medline].

  23. Herr HW. Editorial comment on: Bladder preservation in selected patients with muscle-invasive bladder cancer by complete transurethral resection of the bladder plus systemic chemotherapy: long-term follow-up of a phase 2 nonrandomized comparative trial with radical cystectomy. Eur Urol. Apr 2009;55(4):920-1. [Medline].

  24. Dorin RP, Skinner EC. Extended lymphadenectomy in bladder cancer. Curr Opin Urol. Sep 2010;20(5):414-20. [Medline].

  25. Colombo JR Jr, Desai M, Canes D, Frota R, Haber GP, Moinzadeh A, et al. Laparoscopic partial cystectomy for urachal and bladder cancer. Clinics. December 2008;63:731-4. [Medline].

  26. Tareen BU, Mufarrij PW, Godoy G, Stifelman MD. Robot-assisted laparoscopic partial cystectomy and diverticulectomy: initial experience of four cases. J Endourol. Jul 2008;22(7):1497-500. [Medline].

  27. Spiess PE, Correa JJ. Robotic assisted laparoscopic partial cystectomy and urachal resection for urachal adenocarcinoma. Int Braz J Urol. Sep-Oct 2009;35(5):609. [Medline].

  28. Allaparthi S, Ramanathan R, Balaji KC. Robotic partial cystectomy for bladder cancer: a single-institutional pilot study. J Endourol. Feb 2010;24(2):223-7. [Medline].

  29. Peress JA, Waterhouse K, Cole AT. Complications of partial cystectomy in patients with high grade bladder carcinoma. J Urol. Nov 1977;118(5):761. [Medline].

  30. Smaldone MC, Jacobs BL, Smaldone AM, Hrebinko RL Jr. Long-term results of selective partial cystectomy for invasive urothelial bladder carcinoma. Urology. September 2008;72:613-6. [Medline].

  31. Resnick MI, O'Conor VJ Jr. Segmental resection for carcinoma of the bladder: review of 102 patients. J Urol. Jun 1973;109(6):1007-10. [Medline].

  32. Faysal MH, Freiha FS. Evaluation of partial cystectomy for carcinoma of bladder. Urology. Oct 1979;14(4):352-6. [Medline].

  33. Fahmy N, Aprikian A, Tanguay S, Mahmud SM, Al-Otaibi M, Jeyaganth S. Practice patterns and recurrence after partial cystectomy for bladder cancer. World J Urol. Aug 2010;28(4):419-23. [Medline].

  34. Kassouf W, Swanson D, Kamat AM, Leibovici D, Siefker-Radtke A, Munsell MF, et al. Partial cystectomy for muscle invasive urothelial carcinoma of the bladder: a contemporary review of the M. D. Anderson Cancer Center experience. J Urol. Jun 2006;175(6):2058-62. [Medline].

  35. Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. Aug 28 2003;349(9):859-66. [Medline].

  36. Millikan R, Dinney C, Swanson D, Sweeney P, Ro JY, Smith TL. Integrated therapy for locally advanced bladder cancer: final report of a randomized trial of cystectomy plus adjuvant M-VAC versus cystectomy with both preoperative and postoperative M-VAC. J Clin Oncol. Oct 15 2001;19(20):4005-13. [Medline].

  37. Amiel J, Quintens H, Thyss A, Caldani C, Schneider M, Toubol J. [Combination transurethral resection and systematic chemotherapy as primary treatment of infiltrating bladder tumors (pT2-pT4 NxM0)]. J Urol (Paris). 1988;94(7):333-6. [Medline].

  38. Balbay MD, Slaton JW, Trane N, Skibber J, Dinney CP. Rationale for bladder-sparing surgery in patients with locally advanced colorectal carcinoma. Cancer. Dec 1 1999;86(11):2212-6. [Medline].

  39. Baniel J, Vishna T. Primary transitional cell carcinoma in vesical diverticula. Urology. Nov 1997;50(5):697-9. [Medline].

  40. Boring CC, Squires TS, Tong T, Montgomery S. Cancer statistics, 1994. CA Cancer J Clin. Jan-Feb 1994;44(1):7-26. [Medline].

  41. Brannan W, Ochsner MG, Fuselier HA Jr. Partial cystectomy in the treatment of transitional cell carcinoma of the bladder. J Urol. Feb 1978;119(2):213-5. [Medline].

  42. Brown LF, Berse B, Jackman RW, Tognazzi K, Manseau EJ, Dvorak HF. Increased expression of vascular permeability factor (vascular endothelial growth factor) and its receptors in kidney and bladder carcinomas. Am J Pathol. Nov 1993;143(5):1255-62. [Medline].

  43. Brush JP. Positron emission tomography in urological malignancy. Curr Opin Urol. Mar 2001;11(2):175-9. [Medline].

  44. Burch JD, Rohan TE, Howe GR, Risch HA, Hill GB, Steele R. Risk of bladder cancer by source and type of tobacco exposure: a case-control study. Int J Cancer. Oct 15 1989;44(4):622-8. [Medline].

  45. Carpinito GA, Stadler WM, Briggman JV, Chodak GW, Church PA, Lamm DL, et al. Urinary nuclear matrix protein as a marker for transitional cell carcinoma of the urinary tract. J Urol. Oct 1996;156(4):1280-5. [Medline].

  46. Chung SD, Tai HC, Chueh SC. Laparoscopic partial cystectomy for a vesical leiomyoma. Int Urogynecol J Pelvic Floor Dysfunct. May 2007;18:565-6. [Medline].

  47. Chung SD, Tai HC, Chueh SC. Laparoscopic partial cystectomy for a vesical leiomyoma. Int Urogynecol J Pelvic Floor Dysfunct. May 2007;18(5):565-6. [Medline].

  48. Clavel J, Cordier S, Boccon-Gibod L, Hemon D. Tobacco and bladder cancer in males: increased risk for inhalers and smokers of black tobacco. Int J Cancer. Oct 15 1989;44(4):605-10. [Medline].

  49. Collado A, Chechile GE, Salvador J, Vicente J. Early complications of endoscopic treatment for superficial bladder tumors. J Urol. Nov 2000;164(5):1529-32. [Medline].

  50. Cordon-Cardo C, Wartinger DD, Melamed MR, Fair W, Fradet Y. Immunopathologic analysis of human urinary bladder cancer. Characterization of two new antigens associated with low-grade superficial bladder tumors. Am J Pathol. Feb 1992;140(2):375-85. [Medline].

  51. Cox CE, Cass AS, Boyce WH. Bladder cancer: a 26-year review. J Urol. Apr 1969;101(4):550-8. [Medline].

  52. Cummings KB, Mason JT, Correa RJ Jr, Gibbons RP. Segmental resection in the management of bladder carcinoma. J Urol. Jan 1978;119(1):56-8. [Medline].

  53. Dandekar NP, Dalal AV, Tongaonkar HB, Kamat MR. Adenocarcinoma of bladder. Eur J Surg Oncol. Apr 1997;23(2):157-60. [Medline].

  54. Dandekar NP, Tongaonkar HB, Dalal AV, Kulkarni JN, Kamat MR. Partial cystectomy for invasive bladder cancer. J Surg Oncol. Sep 1995;60(1):24-9. [Medline].

  55. Deserno WM, Harisinghani MG, Taupitz M, Jager GJ, Witjes JA, Mulders PF, et al. Urinary bladder cancer: preoperative nodal staging with ferumoxtran-10-enhanced MR imaging. Radiology. Nov 2004;233(2):449-56. [Medline].

  56. Duncan RE, Bennett DW, Evans AT, Aron BS, Schellhas HF. Radiation-induced bladder tumors. J Urol. Jul 1977;118(1 Pt 1):43-5. [Medline].

  57. Esrig D, Spruck CH 3rd, Nichols PW, Chaiwun B, Steven K, Groshen S, et al. p53 nuclear protein accumulation correlates with mutations in the p53 gene, tumor grade, and stage in bladder cancer. Am J Pathol. Nov 1993;143(5):1389-97. [Medline].

  58. Evans RA, Texter JH Jr. Partial cystectomy in the treatment of bladder cancer. J Urol. Sep 1975;114(3):391-3. [Medline].

  59. Fellin G, Graffer U, Bolner A, Ambrosini G, Caffo O, Luciani L. Combined chemotherapy and radiation with selective organ preservation for muscle-invasive bladder carcinoma. A single-institution phase II study. Br J Urol. Jul 1997;80(1):44-9. [Medline].

  60. Gilbert HA, Logan JL, Kagan AR, Friedman HA, Cove JK, Fox M, et al. The natural history of papillary transitional cell carcinoma of the bladder and its treatment in an unselected population on the basis of histologic grading. J Urol. Apr 1978;119(4):488-92. [Medline].

  61. Golijanin D, Yossepowitch O, Beck SD, Sogani P, Dalbagni G. Carcinoma in a bladder diverticulum: presentation and treatment outcome. J Urol. Nov 2003;170(5):1761-4. [Medline].

  62. Greene FL. Urinary Bladder. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer; 2002:335-40.

  63. Gruis NA, Weaver-Feldhaus J, Liu Q, Frye C, Eeles R, Orlow I, et al. Genetic evidence in melanoma and bladder cancers that p16 and p53 function in separate pathways of tumor suppression. Am J Pathol. May 1995;146(5):1199-206. [Medline].

  64. Haddad FS. Partial cystectomy for bladder cancer. A new technique. Urology. Nov 1991;38(5):458-9. [Medline].

  65. Hall RR. Transurethral resection for transitional cell carcinoma. Urol. 1992;6:460-70.

  66. Halling KC, King W, Sokolova IA, Meyer RG, Burkhardt HM, Halling AC, et al. A comparison of cytology and fluorescence in situ hybridization for the detection of urothelial carcinoma. J Urol. Nov 2000;164(5):1768-75. [Medline].

  67. Hays DM, Raney RB, Wharam MD. Children with vesical rhabdomyosarcoma (RMS) treated by partial cystectomy with neoadjuvant or adjuvant chemotherapy, with or without radiotherapy. A report from the Intergroup Rhabdomyosarcoma Study (IRS) Committee [published erratum appears in J Ped. J Pediatr Hematol Oncol. Feb 1995;17(1):46-52. [Medline].

  68. Hayter CR, Paszat LF, Groome PA, Schulze K, Mackillop WJ, et al. The management and outcome of bladder carcinoma in Ontario, 1982-1994. Cancer. Jul 1 2000;89(1):142-51. [Medline].

  69. Herr HW. Editorial comment on: Bladder preservation in selected patients with muscle-invasive bladder cancer by complete transurethral resection of the bladder plus systemic chemotherapy: long-term follow-up of a phase 2 nonrandomized comparative trial with radical cystectomy. Eur Urol. Apr 2009;55(4):920-1. [Medline].

  70. Herr HW. Tumor progression and survival of patients with high grade, noninvasive papillary (TaG3) bladder tumors: 15-year outcome. J Urol. Jan 2000;163(1):60-1; discussion 61-2. [Medline].

  71. Herr HW. Urachal carcinoma: the case for extended partial cystectomy. J Urol. Feb 1994;151(2):365-6. [Medline].

  72. Herr HW, Bajorin DF, Scher HI. Neoadjuvant chemotherapy and bladder-sparing surgery for invasive bladder cancer: ten-year outcome. J Clin Oncol. Apr 1998;16(4):1298-301. [Medline].

  73. Hinman F. Atlas of Urologic Surgery. 2nd ed. Philadelphia, Pa: WB Saunders; 1998:500-4.

  74. Holzbeierlein JM, Lopez-Corona E, Bochner BH, Herr HW, Donat SM, Russo P, et al. Partial cystectomy: a contemporary review of the Memorial Sloan-Kettering Cancer Center experience and recommendations for patient selection. J Urol. Sep 2004;172(3):878-81. [Medline].

  75. Housset M, Maulard C, Chretien Y, Dufour B, Delanian S, Huart J, et al. Combined radiation and chemotherapy for invasive transitional-cell carcinoma of the bladder: a prospective study. J Clin Oncol. Nov 1993;11(11):2150-7. [Medline].

  76. Ikeda M, Endo F, Shiga Y, Oguchi T, Yashi M, Hattori K, et al. Cystoscopy-assisted partial cystectomy for paraganglioma of the urinary bladder. Hinyokika Kiyo. September 2008;54:611-4. [Medline].

  77. Inoue T, Kinoshita H, Satou M, Oguchi N, Kawa G, Muguruma K, et al. Complications of urologic laparoscopic surgery: a single institute experience of 1017 procedures. J Endourol. Feb 2010;24(2):253-60. [Medline].

  78. Jardin A, Vallencien G. Partial cystectomy for bladder tumors. In: Kuss R, Khoury S, Denis LJ, et al, eds. Bladder cancer, Part A: Pathology, Diagnosis and Surgery. New York, NY: AR Liss; 1984:375.

  79. Jayachandran S, Unni Mooppan MM, Wax SH, Kim H. The value of urinary fibrin/fibrinogen degradation products as tumor markers in urothelial carcinoma. J Urol. Jul 1984;132(1):21-3. [Medline].

  80. Kachnic LA, Kaufman DS, Heney NM, Althausen AF, Griffin PP, Zietman AL, et al. Bladder preservation by combined modality therapy for invasive bladder cancer. J Clin Oncol. Mar 1997;15(3):1022-9. [Medline].

  81. Kaneti J. Partial cystectomy in the management of bladder carcinoma. Eur Urol. 1986;12(4):249-52. [Medline].

  82. Kantor AF, Hartge P, Hoover RN, Fraumeni JF Jr. Familial and environmental interactions in bladder cancer risk. Int J Cancer. Jun 15 1985;35(6):703-6. [Medline].

  83. Keating J, Zincke H, Morgan WR. Extended experience with neoadjuvant (MVAC) chemotherapy for invasive transitional cell carcinoma of the urinary bladder. J Urol. 1989;141:244A.

  84. Kinders R, Jones T, Root R. Human bladder tumor antigen is a member of the RCA (Regulators of Complement Activation) gene family. J Urol. 1997;157:28, abstract 110.

  85. Konety BR, Nguyen TS, Brenes G, Sholder A, Lewis N, Bastacky S, et al. Clinical usefulness of the novel marker BLCA-4 for the detection of bladder cancer. J Urol. Sep 2000;164(3 Pt 1):634-9. [Medline].

  86. Koshikawa T, Leyh H, Schenck U. Difficulties in evaluating urinary specimens after local mitomycin therapy of bladder cancer. Diagn Cytopathol. 1989;5(2):117-21. [Medline].

  87. Lang EK, Thomas R, Davis R, Myers L, Sabel A, Macchia R, et al. Multiphasic helical computerized tomography for the assessment of microscopic hematuria: a prospective study. J Urol. Jan 2004;171(1):237-43. [Medline].

  88. Lantz EJ, Hattery RR. Diagnostic imaging of urothelial cancer. Urol Clin North Am. Nov 1984;11(4):567-83. [Medline].

  89. Lindahl F, Jørgensen D, Egvad K. Partial cystectomy for transitional cell carcinoma of the bladder. Scand J Urol Nephrol. 1984;18(2):125-9. [Medline].

  90. Locke JR, Hill DE, Walzer Y. Incidence of squamous cell carcinoma in patients with long-term catheter drainage. J Urol. Jun 1985;133(6):1034-5. [Medline].

  91. Long RT, Grummon RA, Spratt JS Jr, Perez-Mesa C. Carcinoma of the urinary bladder. (Comparison with radical, simple, and partial cystectomy and intravesical formalin. Cancer. Jan 1972;29(1):98-105. [Medline].

  92. Lutzeyer W, Rübben H, Dahm H. Prognostic parameters in superficial bladder cancer: an analysis of 315 cases. J Urol. Feb 1982;127(2):250-2. [Medline].

  93. MAGRI J. Partial cystectomy: a review of 104 cases. Br J Urol. Mar 1962;34:74-87. [Medline].

  94. Merrell RW, Brown HE, Rose JF. Bladder carcinoma treated by partial cystectomy: a review of 54 cases. J Urol. Oct 1979;122(4):471-2. [Medline].

  95. Messing EM, Catalona W. Urothelial tumors of the urinary tract. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders; 1998:2329-71.

  96. Micic S, Ilic V. Incidence of neoplasm in vesical diverticula. J Urol. Apr 1983;129(4):734-5. [Medline].

  97. Morrison AS. Advances in the etiology of urothelial cancer. Urol Clin North Am. Nov 1984;11(4):557-66. [Medline].

  98. Mydlo JH, Weinstein R, Shah S, Solliday M, Macchia RJ. Long-term consequences from bladder perforation and/or violation in the presence of transitional cell carcinoma: results of a small series and a review of the literature. J Urol. Apr 1999;161(4):1128-32. [Medline].

  99. Novick AC, Stewart BH. Partial cystectomy in the treatment of primary and secondary carcinoma of the bladder. J Urol. Nov 1976;116(5):570-4. [Medline].

  100. Nurmi M, Katevuo K, Puntala P. Reliability of CT in preoperative evaluation of bladder carcinoma. Scand J Urol Nephrol. 1988;22(2):125-8. [Medline].

  101. Nyam DC, Seow-Choen F, Ho MS, Goh HS. Bladder involvement in patients with colorectal carcinoma. Singapore Med J. Oct 1995;36(5):525-6. [Medline].

  102. O'Keane JC. Carcinoma of the urinary bladder after treatment with cyclophosphamide. N Engl J Med. Sep 29 1988;319(13):871. [Medline].

  103. Ojeda L, Johnson DE. Partial cystectomy: can it be incorporated into integrated therapy program?. Urology. Aug 1983;22(2):115-7. [Medline].

  104. Orlow I, Lacombe L, Hannon GJ, Serrano M, Pellicer I, Dalbagni G, et al. Deletion of the p16 and p15 genes in human bladder tumors. J Natl Cancer Inst. Oct 18 1995;87(20):1524-9. [Medline].

  105. Peress JA, Waterhouse K, Cole AT. Complications of partial cystectomy in patients with high grade bladder carcinoma. J Urol. Nov 1977;118(5):761. [Medline].

  106. Piper JM, Tonascia J, Matanoski GM. Heavy phenacetin use and bladder cancer in women aged 20 to 49 years. N Engl J Med. Aug 1 1985;313(5):292-5. [Medline].

  107. Ramakumar S, Bhuiyan J, Besse JA, Roberts SG, Wollan PC, Blute ML, et al. Comparison of screening methods in the detection of bladder cancer. J Urol. Feb 1999;161(2):388-94. [Medline].

  108. Ries LAG, Melbert D, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2005, National Cancer Institute. Bethesda, MD. Available at http://seer.cancer.gov/csr/1975_2005/.

  109. Santucci RA, True LD, Lange PH. Is partial cystectomy the treatment of choice for mucinous adenocarcinoma of the urachus?. Urology. Apr 1997;49(4):536-40. [Medline].

  110. Sarosdy MF, Schellhammer P, Bokinsky G, Kahn P, Chao R, Yore L, et al. Clinical evaluation of a multi-target fluorescent in situ hybridization assay for detection of bladder cancer. J Urol. Nov 2002;168(5):1950-4. [Medline].

  111. Sauer R, Birkenhake S, Kühn R, Wittekind C, Schrott KM, Martus P. Efficacy of radiochemotherapy with platin derivatives compared to radiotherapy alone in organ-sparing treatment of bladder cancer. Int J Radiat Oncol Biol Phys. Jan 1 1998;40(1):121-7. [Medline].

  112. Schoborg TW, Sapolsky JL, Lewis CW Jr. Carcinoma of the bladder treated by segmental resection. J Urol. Oct 1979;122(4):473-5. [Medline].

  113. Sella A, Dexeus FH, Chong C, Ro JY, Logothetis CJ. Radiation therapy-associated invasive bladder tumors. Urology. Mar 1989;33(3):185-8. [Medline].

  114. Shipley WU, Kaufman DS, Heney NM, Althausen AF, Zietman AL. An update of selective bladder preservation by combined modality therapy for invasive bladder cancer. Eur Urol. 1998;33 Suppl 4:32-4. [Medline].

  115. Shipley WU, Winter KA, Kaufman DS, Lee WR, Heney NM, Tester WR, et al. Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: initial results of Radiation Therapy Oncology Group 89-03. J Clin Oncol. Nov 1998;16(11):3576-83. [Medline].

  116. Silverberg E. Cancer statistics, 1985. CA Cancer J Clin. Jan-Feb 1985;35(1):19-35. [Medline].

  117. Slattery ML, West DW, Robison LM. Fluid intake and bladder cancer in Utah. Int J Cancer. Jul 15 1988;42(1):17-22. [Medline].

  118. Soloway MS. Commentary. In: Hinman F, ed. Atlas of Urologic Surgery. Atlas of Urologic Surgery. 2nd ed. Philadelphia: WB Saunders Co; 1998:504.

  119. Solsona E, Iborra I, Collado A, Rubio-Briones J, Casanova J, Calatrava A. Feasibility of radical transurethral resection as monotherapy for selected patients with muscle invasive bladder cancer. J Urol. Aug 2010;184(2):475-80. [Medline].

  120. Spruck CH 3rd, Ohneseit PF, Gonzalez-Zulueta M, Esrig D, Miyao N, Tsai YC, et al. Two molecular pathways to transitional cell carcinoma of the bladder. Cancer Res. Feb 1 1994;54(3):784-8. [Medline].

  121. Srougi M, Simon SD. Primary methotrexate, vinblastine, doxorubicin and cisplatin chemotherapy and bladder preservation in locally invasive bladder cancer: a 5-year followup. J Urol. Mar 1994;151(3):593-7. [Medline].

  122. Sternberg CN. Neo-adjuvant M-VAC (methotrexate, vinblastine, adriamycin, and cisplatin) for infiltrating bladder cancer: initial results in Italy. Prog Clin Biol Res. 1990;353:143-52. [Medline].

  123. Sternberg CN, Raghaven D, Ohi Y, Bajorin D, Herr H, Kato T, et al. Neoadjuvant and adjuvant chemotherapy in advanced disease--what are the effects on survival and prognosis?. Int J Urol. Jun 1995;2 Suppl 2:76-88. [Medline].

  124. Tai HC, Chung SD, Wang SM, Chueh SC, Yu HJ. Laparoscopic partial cystectomy for various bladder pathologies. BJU Int. December 2007;100:382-5. [Medline].

  125. Tester W, Caplan R, Heaney J, Venner P, Whittington R, Byhardt R, et al. Neoadjuvant combined modality program with selective organ preservation for invasive bladder cancer: results of Radiation Therapy Oncology Group phase II trial 8802. J Clin Oncol. Jan 1996;14(1):119-26. [Medline].

  126. Tester W, Porter A, Asbell S, Coughlin C, Heaney J, Krall J, et al. Combined modality program with possible organ preservation for invasive bladder carcinoma: results of RTOG protocol 85-12. Int J Radiat Oncol Biol Phys. Apr 2 1993;25(5):783-90. [Medline].

  127. Tsai YC, Nichols PW, Hiti AL, Williams Z, Skinner DG, Jones PA. Allelic losses of chromosomes 9, 11, and 17 in human bladder cancer. Cancer Res. Jan 1 1990;50(1):44-7. [Medline].

  128. Utz DC, Schmitz SE, Fugelso PD. Proceedings: A clinicopathologic evaluation of partial cystectomy for carcinoma of the urinary bladder. Cancer. Nov 1973;32(5):1075-7. [Medline].

  129. Wang TM, Chang PL, Huang ST, Hsieh ML, Tsui KH. Squamous cell carcinoma of the bladder: a ten-year retrospective study. Changgeng Yi Xue Za Zhi. Dec 1998;21(4):415-20. [Medline].

  130. Williams SG, Buscarini M, Stein JP. Molecular markers for diagnosis, staging, and prognosis of bladder cancer. Oncology (Williston Park). Nov 2001;15(11):1461-70, 1473-4, 1476; discussion 1476-84. [Medline].

  131. Wishnow KI, Johnson DE, Ro JY, Swanson DA, Babaian RJ, von Eschenbach AC. Incidence, extent and location of unsuspected pelvic lymph node metastasis in patients undergoing radical cystectomy for bladder cancer. J Urol. Mar 1987;137(3):408-10. [Medline].

  132. Zietman AL, Shipley WU, Kaufman DS, Zehr EM, Heney NM, Althausen AF, et al. A phase I/II trial of transurethral surgery combined with concurrent cisplatin, 5-fluorouracil and twice daily radiation followed by selective bladder preservation in operable patients with muscle invading bladder cancer. J Urol. Nov 1998;160(5):1673-7. [Medline].

 
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Papillary bladder tumors such as this one are typically of low stage and grade (Ta-G1). Courtesy of Abbott and Vysis Inc.
Gross anatomy of the bladder.
Table 1. Proportion of Patients With Bladder Cancer Treated With Partial Cystectomy
Source Total Patients With Bladder Cancer Patients Treated With Partial Cystectomy (%)
Utz et al (1973)3454199 (5.8)
Brannan et al (1978)55149 (7.1)
Faysal and Freiha (1979)859117 (13.6)
Merrell et al (1979)58554 (9.2)
Ojeda and Johnson (1983)39723 (5.8)
Jardin and Vallencien (1984)47590 (18.9)
Hayter et al (2000)20,822729 (3.5)
Holzbeierlein et al (2004)93558 (6.2)
Table 2. Options Other than Partial Cystectomy
Study Number of Patients Induction Therapy % Complete Response Consolidation Therapy % Overall Survival (years) % Overall Survival with Bladder Intact (years)
Housset et al120Bifractionated XRT + concurrent cisplatin + 5-fluorouracil77Bifractionated XRT + concurrent 5-fluorouracil + cisplatin63 (5)...
Sauer et al18445-54 Gy XRT + concurrent cisplatin or carboplatin80None56 (5)41 (5)
Fellin et al562 cycles MCVa, 40 Gy XRT + concurrent cisplatin5024 Gy XRT + concurrent cisplatin55 (5)41 (5)
Tester et al4940 Gy XRT + concurrent cisplatin6624 Gy XRT + concurrent cisplatin60 (4)42 (4)
Tester et al912 cycles MCV, 39.6 Gy XRT + concurrent cisplatin7525.2 Gy XRT + concurrent cisplatin62 (4)44 (4)
Shipley et al612 cycles MCVa, 39.6 Gy XRT + concurrent cisplatin6125.2 Gy XRT + concurrent cisplatin48 (5)36 (5)
Shipley et al6239.6 Gy XRT + concurrent cisplatin5525.2 Gy XRT + concurrent cisplatin49 (5)40 (5)
Kachnic et al1062 cycles MCV, 40 Gy XRT + concurrent cisplatin6624.8 Gy XRT + concurrent cisplatin52 (5)43 (5)
Zietman et al18Bifractionated XRT + concurrent cisplatin + 5-fluorouracil78Bifractionated XRT + concurrent cisplatin + 5-fluorouracil + 3 cycles MCV83 (3)78 (3)
Table 3. Various Studies and Their Corresponding Recurrence Rates
Studies Recurrence rates
Resnick and O'Connor (1973)76%
Evans and Texter (1975)40%
Novick and Stewart (1976)50%
Peress et al (1977)54%
Cummings et al (1978)49%
Schoborg et al (1979)70%
Faysal and Freiha (1979)78%
Jardin and Vallencien (1984)78%
Lindahl et al (1984)58%
Kaneti (1986)38%
Dandekar et al (1995)43%
Holzbeierlein et al (2004)19%
Kassouf et al (2006)49%
Table 4. Survival Rates by Tumor Grade
Source Five-year Survival (%)Ten-year Survival (%)
Grade IGrade IIGrade III/IVGrade IGrade IIGrade III/IV
Magri (1962)883334---
Utz et al (1973)1004839---
Novick and Stewart (1976)10075400678
Brannan et al (1978)506255503330
Cummings et al (1978)1009632---
Schoborg et al (1979)75622650284
Faysal and Freiha (1979)100533025208
Merrell et al (1979)78562283320
Kaneti (1986)754646---
Dandekar et al (1995)10094.453.5---
Table 5. Survival Rates by Tumor Stage
Source Five-year Survival (%) Ten-year Survival (%)
T0T1T2T3T4OverallT0T1T2T3T4Overall
Magri (1962)-803826042------
Long et al (1962)80674390-------
Cox et al (1969)--2016--------
Resnick and O'Connor (1978)75717712.52035------
Utz et al (1973)-684729039------
Evans and Texter (1975)-69431400-----21
Novick and Stewart (1976)-675320-46-6744--36
Brannan et al (1978)100695433057-313611-32
Cummings et al (1978)-79806-60------
Schoborg et al (1979)6969291210043-3700012
Faysal and Freiha (1979)7558297040211513709
Merrell et al (1979)1001006725-48-100330032
Lindahl et al (1984)-5938--42-4825-038
Kaneti (1986)-684033048------
Smaldone et al (2008)-----70
a Stage T3a/T3b
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