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Introduction: Urothelial carcinoma, especially localized bladder cancer, has a substantial prevalence in Brazil with 9,480 new cases each year and 3,903 deaths, therefore progress is required in its management in order to decrease its recurrence and progression, and improve survival. Material and Methods: Medical oncologists, radiation oncologists, and urologists from Brazil conducted a meeting to vote the best approaches available in this country in the diagnosis, staging, and treatment of localized and locally advanced urothelial bladder carcinoma. The panel drew up 73 questions and answers were chosen considering the feasibility according to the access to drugs and the procedures used in this country. Each answer reaching 75% of voters was considered a consensus. The results of this consensus were compared with evidence published in the medical literature and rated with a level of evidence and grade of recommendation using the Oxford classification. Results: Transurethral resection of bladder tumors confirms the diagnosis of and provides initial treatment for non-muscle-invasive bladder cancers. Repeated resection is necessary in selected cases and should not delay further treatment. The use of intravesical Bacillus Calmette-Guérin is performed according to risk stratification, showing a significant reduction in tumor recurrence and progression, and improved disease-specific survival in intermediate- and high-risk patients. Radical cystectomy should be considered for high-progression risk cases after Bacillus Calmette-Guérin treatment failure and for localized muscle-invasive bladder cancer. Conclusion: Management of urothelial carcinoma often requires a multidisciplinary team with surgical and clinical approaches, based on the expertise of professionals and evidence from the literature.

Urothelial carcinoma is a frequent worldwide malignancy. Poor survival rates in muscle-invasive and metastatic urothelial carcinoma impose major challenges for management. We conducted a consensus meeting to discuss the optimal treatment for urothelial carcinoma in Brazil, which was developed by a panel of multidisciplinary experts consisting of oncologists, urologists and radiation therapists. This paper provides recommendations for perioperative treatment, metastatic disease management, bone directed therapy and genetic counselling in urothelial carcinoma based on the specialists opinions and was classified according to the level of evidence found in the medical literature according to the Oxford classification. The recommendations were based on the available treatments in Brazil to guide health professionals in the management of urothelial carcinoma in low- and middle- income countries with limited access to therapy.

AbstractPurpose:To evaluate prospectively the actual bladder perforation incidence during transurethral resection of bladder tumor (TURB) performed by residents and to identify possible predisposing factors to such condition.Patients and Methods:Thirty-four patients with bladder tumor were submitted to TURB in our academic institution in April 2006, and were prospectively studied. Procedures were all done by senior residents under an attending direct supervision. All patients had a cystograms performed after the procedure by the injection of 400 mL of saline-diluted contrast solution with low-pressure infusion through the Foley catheter. The cystograms were evaluated blindly by a single radiologist. All patients were examined by cystoscopy and/or CT every 3 months for the first 2 years postoperatively.Results:The cystogram showed contrast leaking compatible with bladder perforation in 17 (50%) cases. None of the perforations were recognized intraoperatively by the surgeon. All perforations were extraperitoneal and managed conservatively. There was no significant correlation between the incidence of bladder perforation and the patient age (p= 0.508), the tumor stage (p= 0.998), the tumor grade (p= 0.833), the number of lesions (p= 0.394), and the tumor size (p= 0.651). The only factor that had impact on the development of bladder perforation was tumor localization at the bottom of the bladder (p= 0.035; OR, 6750; 95% CI, 1.14, 39.8).Conclusion:Asymptomatic perforations of the bladder wall occur very frequently after a TURB procedure performed by residents in training and, most of the time, are not noticed by the surgeon. Localization of the tumor at bladder dome was the only factor that negatively influenced perforation rates. [ABSTRACT FROM AUTHOR]