H-grade bladder cancer kenneth g. Nepple, md and michael a. O’donnell, md from the university of iowa department of urology, iowa city, ia correspondence: dr. Michael a. O’donnell, university of iowa, department of urology, two hundred hawkins dr. , 3 rcp, iowa city, ia 52242-1089; fax: 319-356-3900; email: michael-odonnell/at/uiowa. Edu author information â–º copyright and license information â–º copyright : © 2009 canadian urological association or its licensors abstract stage t1hg bladder cancer should be considered an aggressive and potentially lethal disease. The importance of initial re-resection to identify unrecognized muscle-invasive disease is significant. Most patients with high-risk disease are candidates for initial bladder salvage with intravesical bacillus calmette-guerin vaccine for immunotherapy, a procedure with a high survival rate; however, failure of the procedure may result in a guarded prognosis. Even after apparent success, patients should be informed of the risks of the disease progressing to muscle-invasive or metastatic disease and the need for vigilant monitoring. Despite optimal management, a significant number of patients relapse or progress to invasive disease requiring cystectomy. This review provides insight into the optimal management of t1 high-grade bladder cancer. Introduction approximately 70% of all newly diagnosed bladder tumours are non-muscle invasive bladder cancers (nmibc), including stage ta, stage t1 and carcinoma in situ (cis). cheapviagraonlinebestprice.accountant http://buyviagraonlinedifferentdosage.accountant http://buycheapgenericviagrapillsonline.accountant http://viagraonlineforsalecanada.accountant genericviagraonlinecheappharmacy.accountant buygenericviagraonlinewithoutprescription.accountant Non-muscle invasive bladder cancers exist on a continuum of risk in patients with t1 high-grade (t1hg) bladder cancer at the aggressive end of the spectrum. Following transurethral resection alone, t1hg bladder cancer has a 69% to 80% recurrence rate and a 33% to 48% chance of progression to muscle-invasive disease. 1 – 4 this review provides insight into the optimal management of t1hg bladder cancer. Initial resection optimal management of t1hg bladder cancer begins with complete initial transurethral resection of the bladder tumour (turbt). A rectal or bimanual exam under anaesthesia is recommended on presentation of turbt to evaluate any local extension. Following initial turbt, attempts should be made to provide complete tumour resection including muscle in the specimen. To avoid perforation, you.
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