title: The clinical presentation and outcome of urothelial atypia on biopsy of the bladder.
abstract: OBJECTIVE
  To examine the presentation and clinical outcome of patients diagnosed with reactive urothelial atypia (RUA) or urothelial atypia of unknown significance (AUS) on tissue biopsy of the bladder.
  
  
  METHODS
  We performed a retrospective cohort study of all patients who were diagnosed with either RUA or AUS on biopsy of the bladder at our institution from November 2000 to May 2008. Excluded from the analysis were patients with a history of or a concurrent diagnosis of urothelial carcinoma. A total of 66 patients were available for final analysis.
  
  
  RESULTS
  The mean patient age at diagnosis was 63 years (range: 18-89 years). There were 46 men (70%) and 20 women (30%). The indication for cystoscopic examination included lower urinary tract symptoms in 29 (44%), gross hematuria in 17 (26%), microscopic hematuria in 12 (18%), urolithiasis in 2 (3%), and hydronephrosis in 6 (9%) patients. On biopsy, 54 (82%) had RUA and 12 (18%) had AUS. The mean follow-up was 36 months (range: 0-271 months). During this period, 37 (56%) patients underwent at least 1 additional cystoscopy with negative result. None of the 66 (0%) patients developed biopsy-proven urothelial carcinoma.
  
  
  CONCLUSIONS
  Urothelial atypia is common in men older than 60 years and often presents with either hematuria or lower urinary tract symptoms. Both RUA and AUS have a similar benign clinical course. Therefore, after diagnosis, further intervention or surveillance is unnecessary.
authors.affiliation: Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: justin.ziemba@uphs.upenn.edu.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Ziemba
authors.affiliation: James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College, New York, NY.
authors.forename: Ron
authors.initials: R
authors.lastname: Golan
authors.affiliation: Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Skokan
authors.affiliation: Drexel University College of Medicine, Philadelphia, PA.
authors.forename: Darshan
authors.initials: D
authors.lastname: Patel
authors.affiliation: Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Feldman
authors.affiliation: Sanford Health, Fargo, ND.
authors.forename: Zhanyong
authors.initials: Z
authors.lastname: Bing
authors.affiliation: Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Guzzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology; D003558:Cystoscopy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology; D019459:Urothelium / Q000473:pathology*; D055815:Young Adult
keywords: Biopsy; Disease progression; Intraepithelial neoplasms; Neoplasms; Urinary bladder; Urothelium