[Diagnosis and therapy of superficial tumors of the urinary bladder]

Among patients with bladder carcinoma, 70-80% present with superficial bladder tumors. This group is composed of papillary tumors Ta, T1 and of flat nonpapillary high-grade carcinoma in situ (Tis). Typical features of superficial tumors are their multifocal origin and high recurrence-rate after initial therapy. The first and most important step in diagnosis and treatment of the bladder cancer is urethrocystoscopy under general or spinal anesthesia with resection of papillary lesions and biopsy of suspicious areas followed by pathologic examination of the surgical specimen. This approach enables total resection of all visible tumors, classification of the tumor and determination of prognostic factors. The aims of intravesical therapy are treatment of Tis and prevention of recurrence and progression after TUR. The most often used agents for intravesical chemotherapy are mitomycin C and adriamycin. This treatment modality prolongs tumor-free interval and reduces early recurrence-rate in about 14% of patients, but cannot reduce late recurrence-rate and progression-rate. BCG intravestical immunotherapy is with 73-87% response rate the most effective treatment modality in Tis. It is also more effective than chemotherapy in prevention of recurrence, but is connected with more frequent side effects. Radical cystectomy is considered in patients who do not respond to local therapy.