[Various methods of spread of bladder tumours (author's transl)]

The authors undertake a complete review of the literature concerning the various methods of spread of bladder tumours. They successively consider spread through the thickness of the bladder wall, surface extension, direct implantation of exfoliated cells, lymphatic spread, and venous dissemination both in the bladder wall as well as to the viscera by metastases. It is difficult to give a brief analysis of such an exhaustive review. However, a number of facts are worthy of emphasis: --the frequency of invasion of the seminal vesicles and the prostate; --the reliability of combined clinical, radiological and endoscopic findings, which may be used to differentiate deep tumours and superficial tumours in more than 80% of cases; --the importance of methods which await development, such as the scanner and, above all, ultrasound techniques; --the importance of study of the vesical mucosa at a distance from the tumour itself, both by fluorescent cystoscopic methods, as well as by distant biopsies (30 to 50% of premalignant cell changes found in cystoscopically normal zones); --the frequency if invasion of the terminal portions of the ureters (10% on average) and of the urethra (12 to 15%); --the prognostic gravity of tumour emboli in the intraparietal lymph vessels, the presence of which reduces the chances of cure at 5 years by two thirds; --the usual limitation of the first lymph node spread to the external iliac and hypogastric vessels with the exception of tumours of the bladder neck, where the first lymph node spread occurs to the aortic bifurcation; --the gravity of the presence of emboli in the parietal veins which reduces chances of survival at 5 years by half; --finally, the recently recognized frequency of secondary bone tumours; --and the supposed frequency of infraclinical metastases which would be a considerable argument in favour of complementary chemotherapy in therapeutic protocol for carcinomas of the bladder.