Re: preoperative hydronephrosis predicts extravesical and node positive disease in patients undergoing cystectomy for bladder cancer. C. J. Stimson, M. S. Cookson, D. A. Barocas, P. E. Clark, J. E. Humphrey, S. G. Patel, J. A. Smith, Jr. and S. S. Chang. J Urol 2010; 183: 1732-1737.

摘要

This article is an important addition to the English literature. The authors state that hydronephrosis has prognostic significance in patients with invasive bladder cancer undergoing radical cystectomy. As we know, accurate preoperative clinical and pathological staging is still a problem in patients with invasive bladder cancer, and thus the addition of other prognostic variables for treatment selection and analysis in such patients is still welcome.At present we have evidence that preemptive chemotherapy prolongs survival in patients with invasive bladder cancer undergoing cystectomy. Patients are selected for neoadjuvant chemotherapy based on pathological staging of the transurethral resection specimen, which frequently under stages invasiveness. Clinically bimanual examination with the patient under anesthesia is also an important adjunct in staging an invasive bladder tumor. Additional staging criteria such as hydronephrosis in the context of invasive bladder cancer could add to the accuracy of pre-cystectomy staging, and thus better characterize patients selected for neoadjuvant chemotherapy before cystectomy if correlation between hydronephrosis and survival could be consistently demonstrated.