The significance of ureteral obstruction in lnvasive transitional cell carcinoma of the urinary bladder

Ureteral obstruction is a frequent complication of transitional cell carcinoma (TCC), known as a poor prognostic sign and indicative of advanced disease. We investigated retrospectively the medical records of 122 consecutive patients who suffered from invasive TCC of the urinary bladder during a 6‐year period. Unilateral or bilateral ureteral obstruction was found in 66 patients (54.1%). High stage (T3‐T4) and grade (III‐IV) tumors were correlated with ureteral obstruction in 89.4% and 83.3% respectively compared to 67.9% and 66.1%, respectively, among patients with normal upper tracts (P < 0.001); 10.6% of the patients with ureteral obstruction had low stage disease, and all of them proved to have involvement of the ureteral orifices on the affected side. The 5‐year survival rate of patients with and without ureteral obstruction was 32.2% and 65.9%, respectively (P < 0.001). The presence of ureteral obstruction, particularly in the absence of intravesical involvement of the ureteral orifices, signified a high stage, muscle invasive, and often metastatic tumor in more than 90% of the patients. Ureteral obstruction was an accurate criterion for poor prognostic and was associated with significantly lower, overall and stage‐specific, survival rates, despite of radical surgery. We conclude that evidence of ureteral obstruction is an important staging standard and significant prognostic indicator in transitional cell carcinoma of the urinary bladder. © 1993 Wiley‐Liss, Inc.