Recent advances in pediatric bladder malignancies

Bladder Leiomyoma in a 15-Year-Old Female Patient: A Case Report

Bladder leiomyoma is a rare condition in pediatric and adolescent age groups, accounting for less than 1% of all bladder tumors, presenting a diverse array of histologic types and prevalence. Furthermore, bladder leiomyoma's prevalence is even more seldom with only five reported cases till the present day. Common presentation depends on the localisation and the affected layer in the bladder, urinary outlet or ureteral obstruction, irritative voiding symptoms, pelvic pain, and hematuria are the most common presentations of this condition. Diagnostic, treatment, and follow-up protocols in this entity are not well-established due to their rare occurrence in this age group. After complete surgical excision, the prognosis is excellent and the risk of recurrence is reported to be very low. Up to the present day, no instances of malignant transformation or metastasis have been documented in the literature. This case report aims to enhance current knowledge of the radiological, pathological, and clinical features of bladder leiomyoma in a 15-year-old female patient. The main complaint was lower urinary tract symptoms. An incidental solid bladder mass was discovered during the evaluation with ultrasound and magnetic resonance imaging (MRI). Afterwards, cystoscopy confirmed a 5-centimeter solid mass at the right wall of the bladder, and transurethral piecemeal resection was performed. The bladder mass was found to be intramural, and complete endoscopic resection was considered safe and efficient during the surgery. No complications or recurrence occurred in the postoperative setting.

Recurrent Papillary Bladder Tumors in a Boy With Lynch Syndrome

Lynch syndrome (LS) is an autosomal dominant genetic disorder defined by germline mutations in one of four mismatch repair genes including PMS2, MLH2, MSH1, MSH2, or deletion in the EPCAM gene.1 The most common urologic manifestation of LS is upper tract urothelial carcinoma, which occurs in up to 20% of patients with LS.2 While data are scarce, there is growing evidence of an increased relative risk of bladder malignancy in patients with LS.3,4 Bladder tumors in children are a rare entity and the link between pediatric bladder tumors and LS has not been previously reported to our knowledge.

Long-term Follow-up of Detaenial Sigmoid Neobladder Reconstruction for Paediatric Patients with Bladder and Prostate Rhabdomyosarcoma: Technique and Results from a Single High-volume Centre

BACKGROUND

Rhabdomyosarcoma (RMS) is the most common paediatric soft-tissue sarcoma. Approximately 15-20% of RMS cases arise from the bladder and prostate (B/P). The optimal treatment strategy for B/P RMS remains unclear.

OBJECTIVE

To retrospectively evaluate the applicability of our procedure performed to treat paediatric patients with B/P RMS.

DESIGN, SETTING, AND PARTICIPANTS

This is a retrospective analysis from a single tertiary referral hospital. From August 2003 to March 2021, 62 children pathologically diagnosed with B/P RMS underwent radical cystectomy and orthotopic detaenial sigmoid neobladder reconstruction in our centre.

SURGICAL PROCEDURE

Surgical procedures included laparoscopic radical cystectomy and detaenial sigmoid neobladder reconstruction, which is demonstrated in the accompanying video.

MEASUREMENTS

Demographic, clinical, and follow-up data were collected. Perioperative and long-term oncological and functional outcomes were reported. A logistic regression analysis was also performed.

RESULTS AND LIMITATIONS

All surgeries, including three intracorporeal laparoscopic surgeries, were completed successfully. Of the 62 patients, 54 were alive without evidence of disease recurrence or metastasis at the last follow-up. Five of the 14 >12-yr-old boys reported that they experienced erections. Two female patients >12 yr old reported that they menstruated. However, this was a retrospective study conducted at a single centre with limited surgeon experience.

CONCLUSIONS

Our results confirmed the safety and feasibility of primary orthotopic sigmoid neobladder reconstruction after radical cystectomy for paediatric patients with B/P RMS. Good outcomes in terms of oncological control and functional recovery were achieved. The high histocompatibility and tissue adaptability of children are inspiring.

PATIENT SUMMARY

We describe our stepwise technique of radical cystectomy and detaenial sigmoid neobladder reconstruction for paediatric patients with bladder and prostate rhabdomyosarcoma. With this technique, we were able to achieve good functional recovery without compromising cancer control and significantly increasing complications.

Pediatric Bladder Tumors: A Ten-Year Retrospective Analysis

OBJECTIVE

To present our experience in a single pediatric urology practice over a ten-year period with bladder tumors in the pediatric population in an effort to add to the relatively small amount of existing data. We hope to expand the community's knowledge of presentations, management and natural history of pediatric bladder tumors.

METHODS

We retrospectively queried our electronic medical records for ICD-10 and CPT codes relevant for bladder tumors. Patients with underlying bladder pathology, such as neurogenic bladder, history of bladder exstrophy, and history of bladder augmentation, were excluded.

RESULTS

We identified 30 patients with bladder tumors from 2011 to 2021. There were 21 males and 9 females. Age at diagnosis ranged from 16 months to 19 years. Tumors identified were: 11 of various inflammatory subtypes; 4 papillomas; 4 rhabdomyosarcomas; 3 papillary urothelial neoplasms of low malignant potential (PUNLMP) and 8 of other types. Treatment included transurethral resection of bladder tumor (TURBT), chemoradiation and laparoscopic partial cystectomy. 29 patients had disease limited to the bladder and 1 had disease outside the bladder. Follow-up ranged from 2 weeks to 13 years (median 19 months). All patients had no evidence of disease at most recent follow-up.

CONCLUSION

Pediatric bladder tumors range from aggressive rhabdomyosarcomas to more benign urothelial lesions. Fortunately, the latter type of tumor is the more prevalent lesion. Knowledge of the treatment options and natural history of these tumors will hopefully be of benefit to clinicians and parents alike.