Management of transitional cell carcinoma of the urinary bladder at Kenyatta National Hospital, Nairobi.

Objectives: To highlight the management of patients with transitional cell carcinoma of the urinary bladder with regards to clinical presentation, treatment and outcome.

Design: A retrospective study.

Setting: Kenyatta National Hospital, Nairobi, Kenya.

Subjects: Fifty two patients who presented at Kenyatta National Hospital over a ten year period with histologically proven transitional cell carcinoma of the urinary bladder. There were 41 males and 11 females aged 27 to 84 years. The mean age was 57 years.

Results: An average of 5.2 patients per year were seen. The male to female ratio was 3.7:1. Most common clinical presentations were haematuria 98%, Lower abdominal pains 71%. The main investigative procedures done in these patients included cystoscopy in 71.2%, ultrasound 46.2%, IVU 32.7% among others. The treatment modalities were based on the stage of the disease and included surgery 48.1%, combination therapy in 23.1%, chemotherapy in 5.8% and radiotherapy in 3.8%. Surgery was the mainstay of treatment, cystectomy was done in 26.9% and cystostomy and resection of tumour 26.9%. Other surgical methods carried out were transurethral resection of bladder tumour(TURBT), cystectomy and bladder augumentation, channel transurethral resection, cystectomy and ileocondult. Nine patients (17.3%) were not given any treatment because either the disease was too advanced and died before any treatment was instituted or were lost to follow up. Mortality and outcome of the disease was difficult to assess due to poor follow up, however 65.4% of the patients were still alive, 17.3% had died and 17.3% were lost to follow up by the end of the study period.

Conclusion: Haematuria was the most important presenting clinical feature. Poor record keeping may have contributed to the low number of patients enrolled into the study. The TCC in this study was not thoroughly managed. It is suggested that early diagnosis, early surgery and combination of other treatment modalities should improve the outcome. This can only be possible with further training of health personnel, the education of the public and availability of improved diagnostic as well as treatment facilities especially cystoscopes and resectoscopes. There is need for developing proper management protocols for bladder tumours.