EPIDEMIOLOGICAL, CLINICAL, AND THERAPEUTIC ASPECTS OF BLADDER TUMORS IN THE UROLOGY DEPARTMENT OF FRIENDSHIP HOSPITAL: A STUDY OF 58 CASES.

Medicine

Currently, bladder tumor is the second most common cancer of the urogenital tract after prostate cancer. Objective : Our work aimed to study the epidemiological, clinical, and therapeutic aspects of bladder tumors in the urology department of Amitié Hospital in Nouakchott, Mauritania. Material and methods : This is a descriptive observational study with an analytical focus, conducted at a single center, based on bladder cancer cases recorded in the hospitalization registers of Amitié Hospital in Nouakchott. The study period was 5 years (2015 to 2020). Results : During our study period, 2700 patients were hospitalized in the Urology and Andrology Department at Amitié Hospital in Nouakchott, including 117 cases of bladder cancer, representing a hospital prevalence of 4.3%. However, only 58 patients had exploitable records. The incidence of bladder cancer in the urology department was 23 cases per year. The average age of patients was 64 years (ranging from 36 to 80 years). The age group of 40 to 60 years was the most represented, observed in 40% of patients. The sex ratio was 1.41. The most common risk factor was smoking at 38%, followed by residence in a schistosomiasis-endemic area at 34%. The most frequent reason for consultation was lower urinary tract symptoms in 30% of patients, followed by isolated macroscopic hematuria in 29% of patients. The most common consultation delay was 3 to 6 months. Physical examination was normal in 84% of patients, and a hypogastric mass was found in 9% of patients. The hemoglobin level was above 12 g/dl in 48% of the patients, 36% of the patients had anemia with a hemoglobin level between 7 g/dl and 12 g/dl, and 16% had a hemoglobin level below 7 g/dl. Creatinine levels were normal in 90% of patients. Ultrasound was performed on 57 patients and showed the presence of a budding tumor in 84% of cases. A CT urogram was performed on 46 patients and revealed the presence of a budding mass in 87% of cases. Cystoscopy was performed in all patients in our series and showed a papillary appearance of the tumor in 40% of cases and a solid appearance in 60% of cases. The tumor was located posteriorly in 47%, anteriorly in 38%, and in the trigone in 34%. The tumor was solitary in 28% of cases and multiple in 60% of cases. The size of the tumor was 3-6 cm in 53% of cases and less than 3 cm in 43% of cases. Endoscopic resection was performed on 40 patients. The most common histological type was urothelial carcinoma in 86.2% of cases, of which 21% were non-invasive and 64% were invasive. Epirdemoid carcinoma was observed in 13.8% of patients. Endoscopic resection plus BCG was performed on 14 patients. Iterative resection was performed on 10 patients. Curative surgical treatment was performed on 22 patients: total cystoprostatectomy in 59% and anterior pelvicectomy in 41%. Among the 13 patients who underwent total cystoprostatectomy, urinary diversion was of the Bricker type in 11 patients and ureterostomy in 2 patients. Among the 9 patients who underwent anterior pelvicectomy, 6 had Bricker-type urinary diversion and 3 had ureterostomy. Radio-chemotherapy was administered to 8 patients. Palliative treatment was given to 8 patients. In our series, 41 patients, or 71%, had a favorable outcome, while 10 patients, or 17%, died after 6 months of follow-up, and 7 patients were lost to follow-up after treatment. Conclusion : Bladder tumors pose a public health problem. Our study reveals that these tumors are among the most common tumor pathologies in urology, but patient follow-up is complicated, which explains why only 58 out of 117 patient records could be analyzed. These tumors affect relatively young individuals and are more common in men than in women. The main identified risk factors are smoking and schistosomiasis.

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