Organ conservation in invasive bladder cancer by transurethral resection, chemotherapy and radiation: results of a urodynamic and quality of life study on long-term survivors.
OBJECTIVE
Transurethral resection, chemotherapy and radiation with salvage cystectomy may be used as alternatives to immediate radical cystectomy in the management of invasive bladder cancer. Concern exists about the function of the retained bladder after such therapy.


METHODS
Of 221 patients with clinical T2-4a bladder cancer treated at Massachusetts General Hospital from 1986 to 2000 with trimodality therapy, 71 were alive with native bladders and disease-free in 2001. These patients were asked to undergo a urodynamic study and to complete a quality of life questionnaire. A total of 69% participated in some component of this study with a median time from trimodality therapy of 6.3 years (range 1.6 to 14.9).


RESULTS
Of 32 patients 24 had normally functioning bladders by urodynamic study. Decreased bladder compliance was seen in 7. Bladder hypersensitivity, involuntary detrusor contractions and incontinence were present in 2 women. The questionnaire showed that flow symptoms occurred in 6%, urgency in 15% and control problems in 19%. Of all women 11% wore pads. Distress from urinary symptoms was half as common as prevalence. Bowel symptoms occurred in 22% with 14% recording any level of distress. The majority of men retained sexual function. Global health related quality of life was high.


CONCLUSIONS
The majority of patients treated with trimodality therapy retain good bladder function. A fifth have evidence of bowel dysfunction.
Zietman
Anthony L
AL
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Cox 302, Boston, MA 02114, USA. azietman@partners.org
Sacco
Dianne
D
Skowronski
Uri
U
Gomery
Pablo
P
Kaufman
Donald S
DS
Clark
Jack A
JA
Talcott
James A
JA
Shipley
William U
WU
D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003558:Cystoscopy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007410:Intestinal Diseases / Q000503:physiopathology; D007422:Intestines / Q000503:physiopathology / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000503:physiopathology*; D011788:Quality of Life; D011832:Radiation Injuries / Q000503:physiopathology; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy; D017741:Survivors; D001745:Urinary Bladder Diseases / Q000503:physiopathology*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D014549:Urinary Incontinence / Q000503:physiopathology; D014563:Urodynamics / Q000502:physiology*