Fractionated Cystogram in Bladder Tumors

Shin, Keum Dong

Abstract

Temeliescu first demonstrated that bladder expansion could be evaluated by serial instillations of contrast medium. If bladder capacity is not exceeded, each instillation results in a symmetrical expansion of the normal bladder. When the muscular wall of the bladder is infiltrated by tumor, its capacity to expand is lost at the site of invasion. There are several methods of staging bladder tumors. To standardize the nomenclature and to facilitate the exchange of information, the I.U.C.C. had adopted a clinical stage classification. The value of a standardized classification is obvious. From a prognostic point of view one of the most important features is to determine if the tumor has invaded muscle. Careful bimanual examination under anesthesia will properly stage the tumor in about 80 per cent of cases. However, this degree of accuracy is only achieved by those seeing large numbers of bladder tumors. In certain instances, accurate staging of this disease is still a problem, which has led to the development of additional X-ray technique and non-operative means of more precisely staging the tumors. Angiography, double contrast barium cystography and perivesical gas insufflation have been used to visualized bladder tumors. However, these various techniques are of little assistance in determine the degree of invasion and, consequently, little additional information may be obtained, furthermore, certain techniques are distressing to the patient and are not without serious morbidity. Complications of angiography include hemorrhage, aneurysm formation, impaired vascular supply to the lower limbs and embolism. In addition these techniques require highly skilled personnel and elaborate equipment, thereby restriction their use. Fractionated cystography is a simple method of evaluating muscle invasion by a bladder tumor. It requires no complicated equipment and carries little or no morbidity. The time required for doing the procedure is little more than that for conventional cystograms. 10 cases of bladder tumors done fractionated cystography, which were admitted to our Urologic Department during Jan., 1970 to present, were reported. Utilizing a modification of Temeliescu's technique, we have been studying bladder tumors since Jan. 1970. They were investigated by comparing with previous papers.