Treatment of Bladder Tumors* Acomparison of Results in Pedunculated and Infiltrating Types

Abstract

Introduction

Tumors of the urinary bladder have been, and still remain, one of the most difficult problems of urology, particularly in the selection of proper treatment. My purpose is to show the value of the cystoscopic interpretation of a tumor as a criterion for the selection of treatment.

At the Cleveland Clinic, bladder neoplasms constitute about 4 per cent of all malignancies, and 35 per cent of all cases of malignant diseases of the genito-urinary tract. Of 512 cases of bladder tumor treated over a twenty-year period, only forty-five patients (8.7 per cent) survived for more than five years.

The 130 cases in this review were selected at random from a total of 160 cases seen at the Cleveland Clinic from 1931 to 1939. Thirty cases are not included because of the meagerness of clinical data. Prior to this relatively short period of years, cystoscopic interpretation did not receive the present emphasis, and transurethral excision of bladder tumors with the resectoscope, used extensively in our series of cases, was unknown.

Sarcoma of the bladder, which occurs in less than 1 per cent of the cases, and other rare forms of bladder tumor are not discussed in this report.

Classification

The majority of bladder tumors are epithelial in origin and papillary in form. All papillary tumors are considered as potentially malignant.

For clinical interpretation, bladder tumors are classified as pedunculated or infiltrating. Pedunculated tumors which may be single or multiple are villous growths surmounted on a stalk growing out from the. . .