Clinicopathological patterns and outcomes of urothelial bladder malignancies in Sri Lankan patients.

INTRODUCTION: Studies on bladder cancer in Sri Lanka have shown varying results in relation to clinicopathological characteristics and data on outcomes is limited. This study was aimed to describe the clinicopathological characteristics and outcomes of histologically confirmed urothelial bladder malignancies and to compare with previous studies. METHODS: A retrospective analysis of prospectively collected data of 314 newly diagnosed primary bladder malignancies between January-2007 and January-2017, was performed. After excluding the non-urothelial cancers, 289(92%) urothelial cancers (males=245, 84.8%, mean age = 65.4±SD10.9 years) were analysed. Data on clinical presentation, cystoscopic findings, histopathology and outcomes were studied. RESULTS: The majority (87.9%, n=254) presented with haematuria with a median duration of symptoms of 1 month. Non-muscle invasive cancers were seen among 64.4% (pTa:n=87(30.1%),pT1:n=99(34.3%)). The pT1 high grade (pT1-HG) tumours were seen in 17.5%. Muscle invasive bladder cancer (MIBC) were seen in 35.6%(n=103). The majority were high grade tumours (n=156,54%). Urothelial MIBC were significantly associated with solid tumours (p<0.001), high grade (p<0.001) and size>3cm (p<0.001). Comparison with previous studies showed a decline in the proportion of MIBC while the pT1-HG tumours are on the rise. Of those followed up, 52.5% developed recurrences with a median duration of 4 months (interquartile range (IQR): 3-12 months). Eighteen (9%) progressed to a higher stage with a median duration of 17 months (IQR:3.75-41.75). CONCLUSIONS: Urothelial cancer in the study population was 92%. Higher proportion of MIBC, high grade tumours and pT1-HG tumours were noted. The recurrence rate was high. Future studies should focus on the causative factors for this trend.

Bladder cancer in women: a Sri Lankan study

Introduction: Bladder cancer (BC) is the ninth commonest cancer globally, and ranks 19th among women. The literature on BC in women is sparse, and the knowledge on the variations of tumour characteristics in South Asian female BC is limited. The objective of this study was to describe the clinicopathological characteristics of BC in women and compare them with male BC. Methods: A retrospective analysis of all female patients with histopathologically proven newly diagnosed primary BC from January 2007 to January 2017 was done at the Urology Unit, National Hospital of Sri Lanka, and the findings were compared with men with BC during the same period. Results: There were 314 patients with primary BC, of which 55(17.5%) were women, with a male:female ratio of 4.7:1. Only 70.9% of women had haematuria at presentation. Forty-four women (80%) had urothelial bladder cancers(UBC). The mean age of women with UBC was 67±SD13.2 years, and for non-urothelial bladder cancers(NUBC) was 62.5±SD 12.7 years. NUBC in women accounted for a disproportionately higher percentage in comparison to men (20% vs.5.4%, p<0.001). Of the UBCs, muscle invasive BC accounted for 45.5% (20/44) in women as opposed to 33.5% (82/245) in men. Women had a significantly higher proportion of solid tumours (40%vs.22.8%,p=0.008) compared to men. Conclusion: Primary BC in women has a significantly higher proportion of NUBC and muscle invasive UBC, which are more aggressive cancers, compared to men. Furthermore, the lack of haematuria in >25%, and higher incidental diagnosis, with inherently thinner bladder wall, makes primary BC in women more likely to present late, in a more advanced state.

Jackstone in the Kidney: An Unusual Calculus.

Jackstones are stones in the urinary tract that have the characteristic appearance resembling six-pointed toy jacks. They are nearly always reported to occur in the urinary bladder, and the occurrence in less capacious renal pelvis is unusual. We report a solitary, typical jackstone in the renal pelvis without significant outflow obstruction that was successfully treated with retrograde intrarenal surgery followed by extracorporeal shockwave lithotripsy. This highlights the complex pathophysiological mechanisms in stone formation which needs to be further studied. It is important to recognize the characteristic shape of the renal calculi on the radiological investigation in the diagnosis of the jackstones.