Carcinoma of Urinary Bladder in Young Patients

Introduction: Urothelial carcinoma of urinary bladder is rare before age of 40 years. The issue regarding age is critical because the behavior of tumor at different age group is a matter of great debate. Our study aimed to see the grade and stage of disease at the time of presentation and its recurrence as well as progression after 3 month at first check cystoscopy in young patients. Method: We prospectively analyzed our newly diagnosed twenty consecutive patients up to 40years of age (16 males – 04females) with urothelial carcinoma of urinary bladder, who were treated at our hospital. The data was reviewed regarding age of patients, stage and PGMI / Lahore General Hospital, Lahore grade of tumor at time of presentation. The recurrence and progression after 3 months at first check cystoscopy was noted. Results: Twenty consecutive patients of 21 to 40 years of age who were diagnosed as urothelial carcinoma of urinary bladder were analysed.The mean age at time of diagnosis was 32.2 years , male to female ratio was 4; 1. Painless hematuria was a predominant symptom in all cases, while 20% (n – 4) had irritative symptoms along with hematuria. The stage at first resection was as pTa (60%), pT1 (20%), pT2a (10%) and pT2b (10%). The grade of disease at initial diagnosis was low grade in 90% of cases (well differentiated in 60% of cases, moderately differentiated in 30%) while 10% had high grade disease. At first check cystoscopy after 3 month only 2 patients had recurrence out of 16 patients who had superficial disease. The remaining four patients who had muscle invasive disease were advised radiotherapy / radical cystectomy. They opted radiotherapy. Among these four patients two came on follow up and their cystoscopy reveal a very small recurrence which was resected. The remaining two did not turn up for follow up. No progression was noted. Conclusion: Biological behavior of urothelial bladder cancer depends upon stage and grade. The young patients have good prognosis as they are having low grade and stage.