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Sparing the Bladder: Studying Transurethral Resection By the time of diagnosis, one third of all bladder cancer cases have spread into the bladder’s muscle wall. In such cases the standard treatment is a radical cystectomy: the complete surgical removal of the bladder. The bladder is then replaced with an artificial bag to gather urine until the container can be emptied. Bladder removal greatly compromises quality of life. However, the procedure remains the gold standard for bladder cancer treatment, with the justification that it significantly improves survival rates. A report in the July 2002 issue of Urology suggests that an alternative to cystectomy exists. The article indicates that transurethral resection (TUR) of bladder tumors improves quality of life without lowering survival rates in a significant percentage of patients with locally advanced bladder cancer. During a transurethral resection, a slender instrument called a cystoscope is inserted through the urethra into the bladder. Surgical instruments are then threaded through the cystoscope to remove as much of the tumor as possible. The surgeon guides the surgical instruments using a small camera in the cystoscope that relays pictures back to a monitor. Dr. William U. Shipley, and other members of Massachusetts General Hospital in Boston, examined the survival times of 190 patients who underwent transurethral resection at the hospital between 1986 and 1997. All patients displayed locally advanced bladder cancer that had entered the muscle wall. Surgery was complemented by both chemotherapy and radiation therapy. Out of the 190 TUR patients, 121 went into complete remission. Of these, 72 experienced no relapse during the period studied. While relapse occurred in 22 cases, the cancer went back into remission without resorting to cystectomy. In this study, 66 patients did not have a complete response to the resection and eventually underwent cystectomies. Results from this TUR study showed that after five years 54 percent of the patients survived. After ten years, 36 percent survived. These results showed no significant deviation from survival rates of patients who received only a cystectomy. Dr. Shipley noted that “the ten-year overall survival and disease-specific survival rates are comparable to the results reported with contemporary radical cystectomy for patients of similar clinical and pathologic stage.” However, the retention of the bladder greatly improves the quality of life throughout the survival time. An independent study at the University of Erlangen, Germany, supports Dr. Shipley’s claims. The study, headed by Dr. Claus Rödel was published in the July 2002 issue of the Journal of Clinical Oncology. Dr. Rödel and his associates analyzed the results of 415 cases of transurethral resection. With radiation and chemotherapy, tumors disappeared completely in 288 patients and, of these, 186 experienced no disease recurrence. In this study, of the 102 patients who did relapse only 42 eventually required cystectomy. Resources American Cancer Society. (2002). Bladder cancer: Removal of the bladder may not be necessary. Retrieved July 3, 2003, from www.cancer.org/docroot/NWS/content/NWS_1_1x_Bladder_ Cancer_Removal_Of_The_Bladder_May_Not_Be_Necessary.asp. Cancerfacts.com. (2002). Cancer may not require bladder removal. Retrieved July 3, 2003, from www.cancerfacts.com/Home_News.asp?CancerTypeId=4&NewsId=1414.

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