title: Does the less aggressive multimodal approach of treating bladder-prostate rhabdomyosarcoma preserve bladder function?
abstract: OBJECTIVE
  The treatment of bladder-prostate rhabdomyosarcoma has evolved into multimodal therapy, including chemotherapy, radiotherapy and organ sparing surgery with bladder preservation. We investigated bladder function in children who underwent multimodal therapy at our institution and retained the original bladder for at least 6 months after treatment ended.
  
  
  METHODS
  We evaluated 8 children with bladder-prostate rhabdomyosarcoma treated at our institution between 1999 and 2003 according to inclusion criteria. All patients underwent history, physical examination and urodynamic study at least 6 months after completion of treatment (range 6 to 39 months).
  
  
  RESULTS
  All patients were treated following the same chemotherapy and radiotherapy scheme. Three patients (37.5%) were asymptomatic and had normal urodynamic studies, and 1 had only dysuria (this patient later underwent continent urinary diversion with transverse colon). The 4 remaining patients had urological complaints, and the urodynamic findings were reduced bladder capacity in 4, overactivity plus sensory urgency in 2, sensory urgency only in 1 and suprapubic pain during filling in 1.
  
  
  CONCLUSIONS
  Among 8 patients 3 had normal urinary function and 4 had minor tolerable alterations. Cystectomy and urinary diversion were later necessary in only 1 patient due to disabling dysuria. The fact that the original functioning bladder was preserved in 7 of 8 patients suggests the feasibility of multimodal therapy. Long-term followup will still be necessary for definite conclusions, since we recognize that the deleterious effects, mainly of radiotherapy, may take longer to become evident.
authors.affiliation: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Soler
authors.forename: Antonio
authors.initials: A
authors.lastname: Macedo
authors.forename: Homero
authors.initials: H
authors.lastname: Bruschini
authors.forename: Fabíola
authors.initials: F
authors.lastname: Puty
authors.forename: Eliana
authors.initials: E
authors.lastname: Caran
authors.forename: Antonio
authors.initials: A
authors.lastname: Petrilli
authors.forename: Gilmar
authors.initials: G
authors.lastname: Garrone
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.forename: Valdemar
authors.initials: V
authors.lastname: Ortiz
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D015653:Cystectomy; D005260:Female; D006801:Humans; D007223:Infant; D007813:Laparotomy; D008297:Male; D011471:Prostatic Neoplasms / Q000503:physiopathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000628:therapy*; D014547:Urinary Diversion; D014554:Urination