膀胱灌注Mytomycin-C治療表淺膀胱癌引起之膀胱壁鈣化是否需手術切除?
沈敬棟1,2、李建達1、查岱龍2、孫光煥2、于大雄2、張聖原2、蒙恩2
國軍臺中總醫院外科部 泌尿外科1;三軍總醫院 外科部 泌尿外科2
Is the calcified lesion of bladder wall after intravesical mitomycin-c therapy for superficial bladder cancer should be resected?
Jing-Dung Shen1,2, Jane-Dar Lee1 , Tai-Lung Cha2, Guang-Haun Sun2, Dah-Shyong Yu2, Sun-Yran Chang3, En Meng2
1Divisions of Urology, Department of Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan 1 ,
 Division of Urology, Departments of Surgery, Tri-Service General Hospital,
National Defense Medical Center, Taipei, Taiwan2
 
Purpose: Intravesical therapy with Mitomycin-C and Bacillus Calmette-Guérin is a standard treatment for superficial bladder cancer. Owing to the worldwide shortage of Bacillus Calmette-Guérin, the use of Mitomycin-C for intravesical therapy is increasing. Sometimes, calcified lesion of bladder wall at previous resection site were found during scheduled cystoscopy. Are these lesions should be resected?
Materials and Methods: We retrospectively included 43 non-muscle invasive bladder cancer patients who were treated with transurethral resection of bladder tumor followed by adjuvant intravesical mitomycin C intravesical therapy between 2011 and 2014 at Tri-service General Hospital. These patients were classified into calcification and non-calcification groups. This study analyzes the characteristic of these two groups in order to find the predictive factor of bladder wall calcification and the meaning of bladder wall calcification in clinical practice.   
Results: Of the 43 patients, 7 had calcified lesion of bladder wall after intravesical mitomycin-C therapy and the other 36 didn’t. The urinary pH is lower in calcification group (5.43±0.071) than non-calcification group (5.94±0.150, p=0.002). The calcification group reveal the tendency of higher tumor recurrent rate than non-calcification group (28.6% V.S. 2.8%, p=0.014).
Conclusions: The patients with lower urinary pH during intravesical mitomycin-C therapy are prone to have bladder wall calcification and higher tumor recurrent rate. Our results revealed the calcified lesion might be the cover of tumor. Based on these results, we suggest resect the calcified lesion. 
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    2015-06-04 15:14:00
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