Bladder Tumors 2006 Edition
Introduction
The title of this text makes a statement. All bladder tumors are not malignant and thus, the title is bladder tumors and not bladder cancer. This is appropriate. Tumors of the urinary bladder are heterogeneous. Not all neoplastic growths in the bladder are a threat to the host. Papilloma, papillary urothelial neoplasms of low malignant potential and even most low-grade, non-invasive papillary tumors sometimes termed low grade transitional cell carcinoma do not behave as a malignancy with the potential for invasion or metastasis. Yet, almost 50% of our patients with bladder tumors have one of these benign neoplasms and much of our attention is directed at treating them.
Bladder tumors are indeed a major health problem. The prevalence of bladder tumors is high due in part to their propensity to “recur” once resected and the many etiologic factors related to their development. Some of the causative agents are known such as cigarette smoking and hair dyes while others have yet to be determined. It is likely that many of the chemicals in our environment are concentrated in the urine and capable of causing mutations in the bladder urothelium thus leading to a bladder neoplasm. It has been stated that the cost of taking care of patients with bladder tumors is among the highest of all neoplasms.
This text details the final report of the consultation on bladder tumors and provides an extensive resource for all those interested in this disease. It has been an honor and privilege to chair this International Consultation on Bladder Tumors. I was confident that the many experts throughout the world would agree to share their expertise and participate in this major effort. I subdivided the subject of bladder tumors into eleven areas. Each committee had the task of collecting information on their subject area and, after an extensive review, arrive at a consensus or guidelines. Although there are relatively few randomized trials dealing with bladder tumors, we have produced many guidelines whose foundation largely rests on the experience of those who have studied this disease for many years. Guidelines may change as new techniques, knowledge and treatments evolve. Most of these, however, are based on an understanding of the biology of bladder tumors
and will likely remain for many years.
I particularly want to express my deep appreciation to all of the chairs, vice-chairs and committee members who unselfishly provided us with their time and energy to accomplish this goal. This was a labor of love. Each of the chairs had the task of synthesizing the often diverse opinions of their committee members and reaching a consensus when possible.
I am particularly grateful to two individuals that guided the project from its inception to completion. Saad Khoury formulated the concept of an international consultation. I believe this is a worthy goal and although some may challenge individual guidelines, most would agree that a periodic review of the literature with the discussion on appropriate management is a productive endeavor. Working with Mustafa Elhillali and the SIU, Saad provided the challenge and the mechanism to carry out the task. The second individual is Adrienne Carmack. While only a mid-level urology trainee, Adrienne is an accomplished editor, skilled communicator and most importantly, has superb time management skills. She was able to attend three international meetings, communicate regularly with the committees, and helped me edit the manuscripts while still taking part in a demanding residency program. Without email even Adrienne could not have accomplished this task.
Many of you will not have the opportunity to read the entire text but will use this volume as a resource
and select topics of interest. I will take the chairman’s prerogative of highlighting some of the guidelines and recommendations from the 11 committees.
The Editors
Mark Soloway, Adrienne Carmack, Saad Khoury
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