Radikale Zystektomie - Oft zu spät?

Nichtinvasives und invasives Harnblasenkarzinom

Therapy of superficial bladder tumors is transurethral resection (TUR), and in cases of pT1 or high-grade tumors a re-TUR is indicated. Patients with carcinoma in situ receive intravesical chemotherapy or BCG for at least 3 months. Persistent carcinoma in situ may be treated by radical cystectomy. With the provision of a functionally adequate urinary diversion, cystectomy represents an effective treatment for patients with muscle-invasive bladder cancer without metastatic spread. Regional lymph node metastases can be found in up to 15% of stage T1 disease and are present in 33% of stage T3/4 lesions. Thus, lymphadenectomy gains diagnostic and possibly also therapeutic importance. For selected patients, who cannot be treated by radical cystectomy, multimodal concepts aiming to preserve the bladder are discussed. After or prior to cystectomy systemic chemotherapy may become necessary for some patients to positively affect the course of the disease in cases of locally advanced or metastatic lesions.

Current diagnostic and therapeutic methods in the treatment of vesical tumours

Reviewing the contemporary therapy of vesical tumour, the authors point to the basic principles that govern the daily practice, the precise application of which may go a long way to improving the results. Not ignorable is the experience that one part of these tumours defies discovery by multifocal and cystoscopic examination. The fundamental tenet of tumour surgery to remove the tumour by incision into sound tissue, must be respected. A brief review is given of the main lines that promise headway in dealing with the disease.