Radical cystectomy for primary bladder malignancy: a 10 year review.

BACKGROUND: Radical cystectomy is universally accepted as the definitive treatment for muscle invasive bladder cancer and preventing stage progression in high-risk groups. There are few recent reviews outside of major international centres. We compared our institution's results with published literature. METHODS: Records of 50 consecutive patients treated with radical cystectomy for biopsy-proven bladder carcinoma between 1995 and 2005 were reviewed. RESULTS: The mean age was 70 years and 76% were male. Median follow up was 38 months (1-111 months). Twenty-three patients (46%) had known history of superficial transitional cell carcinoma and 12 patients (24%) had undergone previously intravesical therapy. Transitional cell carcinomas accounted for 94% of cases and most (76%) were poorly differentiated. Twenty-four (48%) had disease at pT3 stage or higher. Regional lymph nodes were involved in 35%. Twenty-three patients (46%) developed recurrence and over half (12 patients) recurred within 12 months. Both lymph node involvement and recurrence were associated with higher pT stage (P < 0.001). All patients with recurrent disease were dead within a year (median 103 days). Median hospital stay was 19 days and there was one postoperative death (2%). Five-year disease-free and overall survival were 42 and 34% respectively. CONCLUSION: Survival following curative resection for primary bladder malignancy is at best modest. Our overall proportion of higher stage disease contributed to earlier recurrence and lower survival rates. Our postoperative morbidity and mortality rates as well as length of stay are acceptable compared with major international units.

Improved assessment of renal lesions in pregnancy with magnetic resonance imaging.

OBJECTIVES: To ascertain the potential utility of magnetic resonance imaging in providing additional clarification of those solid renal mass lesions identified at routine antenatal ultrasonography in early pregnancy and influencing the management of such lesions. METHODS: We present 7 patients in whom magnetic resonance imaging was used to diagnose, stage, and monitor renal lesions detected during pregnancy. RESULTS: Magnetic resonance imaging provided for improved imaging of renal mass lesions identified at antenatal ultrasonography, without the use of ionizing radiation, and permitted management determined by optimal radiographic assessment of such lesions without fetal irradiation. CONCLUSIONS: Magnetic resonance imaging is the most appropriate method to further investigate renal masses identified at routine antenatal ultrasonography early in pregnancy.