Does the less aggressive multimodal approach of treating bladder-prostate rhabdomyosarcoma preserve bladder function?
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.
Soler
Roberto
R
Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
Macedo
Antonio
A
Bruschini
Homero
H
Puty
Fabíola
F
Caran
Eliana
E
Petrilli
Antonio
A
Garrone
Gilmar
G
Srougi
Miguel
M
Ortiz
Valdemar
V
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