An-Najah Staff

Intrauterine contraceptive devices have been in use for more than 30 years. Although perforation of the uterus by an intrauterine device is not uncommon, intravesical migration with secondary stone formation is a rare complication. A 46-year-old women is described in whom intravesical migration of the intrauterine device was complicated by bladder stone formation. Endoscopic management was applied with an excellent outcome. Copyright 2009 S. Karger AG, Basel.

Objective: This study was an evaluation of whether restaging transurethral resection of superficial bladder tumor(TURBT) may change the treatment modalities in patients with superficial bladder tumor.
Material and Methods: A total of 59 patients with mean age of 63.25 years; range 29-85, (53 male, 6 female) who underwent transurethral resection (TUR) and restaging TUR-BT were enrolled. All patients were diagnosed to have superficial bladder tumor; pTa 27 patients, pT1 32 patients. The grades of the tumors were; 15 patients had grade I, 23 patients had grade II and 21 patients had grade III. Restaging TUR (Re-TUR) was done after 4-6 weeks of the first resection. The tumoral lesions were evaluated in terms of stage, grade, tumor volume and tumor location. The repeat resection was done from the region of initial resection and suspicious lesions. The oncologic findings were evaluated in terms of presence of residual tumor and incidence of under staging.
Results: Residual tumor was found in 19 (32.20%) patients, including pT1 15(78.49%) patients and pTa 4 (21.50%) patients and all the tumor were detected at the regions of initial resection. Under staging was observed in 5 pT1 (26.31%) patients, and three patients changed diagnosis to carcinoma insitu (CIS). None of the patients with Ta grade 1 showed under staging or change in diagnosis at Re-TUR. No patient showed progression regards of grades.
Conclusion: The rate of detecting residual tumoral lesions at restaging transurethral resection is not low in all pathological subgroups. The alterations of pathological diagnosis at Re-TUR and the under staging at initial TUR mandated the change in the treatment options especially in pT1 grade III cases.

Urothelial cancer staged as T1G3 presents urologist with challenges, because it has poor outcome if treated as superficial bladder tumor. Transurethral resection is the standard treatment for the non-muscle-invasive bladder tumor. However, high-grade T1 bladder tumor has potentially bad prognosis and transurethral resection is not adequate treatment option. The recurrence rate after transurethral resection is 50-80% and progression rate to muscle-invasive disease is 27-63%. The treatment of choice for patients with high grade T1 bladder tumor is a matter of controversy. Herein, we reviewed the literature and guidelines regarding the management of patients diagnosed with high-grade T1 urothelial cancer.