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手術後2年以上経過観察した初発原発性膀胱移行上皮癌110例(15～88歳)を対象に, 膀胱癌術後に発生した上部尿路上皮癌の発生起源, 危険因子について検討した.4例(3.6%)に上部尿路上皮癌が続発し, 先行した膀胱癌と続発した上部尿路上皮癌は病理組織学的にほぼ一致していた.続発性上部尿路上皮癌の危険因子としては, 高異型度, 多発性癌, 再発の繰り返し, 職業性膀胱癌, 上皮内癌(CIS)の存在, VURの存在, 膀胱壁内尿管への浸潤などが考えられた, A total of 110 patients were treated with primary transitional cell carcinoma (TCC) of the urinary bladder from 1990 to 2000. During the follow-up period, which was for at least two years, four patients (3.6 percent) had subsequent upper urothelial cancer at an average of 61.5 months after initial treatment of the bladder tumor. Two of the four patients received transurethral resection several times, and the remaining two patients underwent radical cystectomy for the initial bladder tumor. The histopathological findings of subsequent upper urothelial cancer were almost the same as those for the initial bladder tumor. One patient had accompanying carcinoma in situ (CIS) and the other had adenocarcinoma with TCC. Since 1) high grade, 2) multiple, 3) recurrent and 4) occupational bladder tumors, 5) concomitant CIS, 6) vesicoureteral reflux and 7) tumor invasion of the intravesical ureters have been reported to be risk factors for developing subsequent upper urothelial cancer, patients with bladder tumors who have these risk factors should be followed-up closely.

1)原発性膀胱腫瘍325例全体の2, 4, 6, 8, 10年生存率は77%, 68%, 62%, 58%, 51%であった.2)男女比と腫瘍数別で生存率に有意差は認められなかったが, 腫瘍が大きくなるにつれ, 発育形態が非乳頭状や広基性になるにつれ, 全摘群, 悪性度が高くなるにつれ, 浸潤度が進行するにつれ生存率が有意に低下した, To study the relationship between clinical features and prognosis of the bladder tumor, 325 patients who were treated in our hospital were analyzed. The overall 5-year and 10-year actual survival rates were 65% and 51%. There was no statistical significance in the actual survival rate between the single and multiple tumor group. Although, there was a significant difference in tumor size, tumor growing type and the mode of treatment. The ten-year survival rates for grades 1, 2 and 3 cases were 76%, 57% and 18%, respectively. There was a significant difference between grades 1 and 3 (p less than 0.001) and grades 2 and 3 (p less than 0.001). The ten-year survival rates for stages Ta, T1, T2, T3a, T3b and T2-4 M1 were 79%, 68%, 43%, 0%, 19% and 5%, respectively. There was a significant difference between the Ta, 1 and T2-4 group (p less than 0.001).

We analyzed 325 primary bladder tumor patients who were treated in our hospital during the past 15 years. There were 242 males and 83 females who were between 20 and 84 years old with an average age of 63 years old. The most frequent complaint was macroscopic hematuria in 76.9% of the patients (250/325). Cystoscopically, a single tumor was seen in 71%, the tumor was medium sized (1 to 3 cm) in 32%, and 56% were papillary tumors with a stalk. Histologically, 300 (92.3%) cases were transitional cell carcinoma. There were 42, 206 and 52 patients with grades 1, 2 and 3 transitional cell carcinoma and stage Tis, Ta, T1, T2, T3a, T3b, T2-4M1 and Tx were 2, 46, 151, 30, 15, 16, 37 and 3 cases each. Transurethral resection was performed in 231 (71.1%), partial cystectomy in 6 (1.8%) and total cystectomy in 44 (12.5%) cases each.

Two hundred and thirty one patients who underwent transurethral resection of a bladder tumor (TUR-Bt) at our hospital during the past 15 years were analyzed. There were 176 males and 55 females, and the average age at the initial TUR-Bt was 62 years old. Histopathologically, 225 cases were of transitional cell carcinoma, 4 cases of papilloma and 2 cases of squamous cell carcinoma. Grading and staging of 225 transitional cell carcinoma cases revealed grades 1, 2 and 3 in 32, 132 and 21 cases, and stages Ta, T1, T2, T3 and T2-4M1 in 48, 135, 20, 17 and 11 cases, respectively. The frequency of TUR-Bt varied from 1 to 10 times. Among the 231 cases TUR-Bt was done once, twice and three times in 149 (64.5%) and 41 (17.8%), and 22 (9.6%) cases, respectively and the total number of TUR-Bt was 400 times. The duration of the TUR-Bt operation was from 5 min. to 160 min. (mean: 32.4 min.) and the resected weight of tumor between 0.5 g and 85 g (mean: 5.4 g). As a complication of TUR-Bt, TUR-fulguration was necessary to control postoperative bleeding in 7 cases (1.7%), and blood transfusion was required in 13 cases (3.3%) during TUR-Bt. Postoperatively blood transfusion was required in 8 cases (2%), intraperitoneal perforation in 2 cases (0.5%), extraperitoneal perforation in 6 cases (1.5%) and hyponatremia in 1 case (0.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

1)膀胱腫瘍にてTUR-Btを施行した197例中72例に再発を認めた.2)再発例72例の悪性度についてみると, 悪性度の変化しなかったもの34例(47.2%), (再発経過中一度も悪性度の変化しなかった例28例, 再発経過中変化したが, 初回時および最近のTUR-Btにて変化した例6例), 増悪したもの16例(22.2%), 軽減したもの22例(30.6%)であった.3)悪性度の変化した44例を3群にわけ検討した.再発途中悪性度は変化したが, 初回TUR-Bt時と最近のTUR-Bt時に変化のなかった例あるいは悪性度の低下した例25例, 増悪例9例, 癌死例10例であった.4)第3群(癌死例)についてみると, 再発経過中grade 4に変化した例が7例認められた, Today, transurethral resection to superficial bladder tumors is an important method, although frequent recurrence is a problem. We examined whether the degree of progressiveness could be determined at the time of recurrence and therapeutic manner decided from only the grading. Forty four cases which had recurred over twice and in which grading was changed during recurrence were examined. Recurrence occurred twice in 19 cases, and 3 times in 13 cases. Two patients had the largest number of recurrences, i.e., seven. The patients were divided in 3 groups. The 1st group consisted of 25 cases not worsening in grade from initial and recent transurethral resection-bladder tumor (TUR-Bt). The 2nd group consisted of 9 cases who had progressing grading. The 3rd group consisted of 10 cases who died of carcinoma. In the first group, grading decreased in 17 cases. Eight cases in the 3rd group were grade 4. We found that recurrent cases of bladder tumor did not always progressive, grading, being rather decreased than progressing in group 1. However, most of the grade 4 cases died of carcinoma. In conclusion, recurrent TUR-Bt in low grade bladder tumor patients may not be progressive, but grade 4 cases at recurrence require radical operation.

Accurate clinical staging of bladder tumors is of utmost importance for selecting the most suitable treatment measure for each clinical case. We evaluated the diagnostic efficacy of pelvic angiography, transabdominal ultrasonography, transurethral ultrasonography and computed tomography for estimation of the extent of bladder tumor infiltration. During the past 12 years, we experienced 232 bladder tumor cases. Among them, 30 patients were evaluated with pelvic angiography, 52 with transabdominal ultrasonography, 14 with transurethral ultrasonography and 84 with computed tomography. Pelvic angiography enabled correct diagnosis in 24 of the 30 patients (80%), transabdominal ultrasonography in 8 of the 52 patients (15%), transurethral ultrasonography in 7 of the 14 patients (50%) and computed tomography in 62 of the 84 patients (74%). Combined examination with transurethral ultrasonography and computed tomography seems to be the most reliable method for estimation of the extent of bladder tumor infiltration.