Natural history of urothelial dysplasia of the bladder

Urothelial dysplasia is the putative precursor of urothelial carcinoma in s itu (CIS) and invasive urothelial carcinoma of the urinary tract. Utothelia l dysplasia is frequently identified in patients with urothelial CIS and ca ncer. However, very little is known about the clinical presentation and nat ural history of urothelial dysplasia in the absence of urothelial CIS or in vasive cancer. The authors studied 36 patients with isolated urothelial dys plasia at the Mayo Clinic between 1969 and 1984. None of these patients had previous or concurrent urothelial CIS or invasive cancer, and none receive d treatment for dysplasia. The histopathologic features of urothelial dyspl asia were examined, and long-term clinical follow-up was obtained. Progress ion was defined as the development of urothelial CIS or carcinoma. The male -to-female ratio was 2.6:1, acid the mean patient age at the time of diagno sis was 60 years (range 25-79). Urothelial dysplasia has a predilection for the posterior wall. Eleven patients had urinary irritative symptoms, 10 ha d hematuria, 3 had both irritative symptoms and hematuria, and 12 were foun d to have dysplasia incidentally. The mean follow-up was 8.2 years (range 0 .1-25.5). Seven (19%) of 36 patients developed biopsy-proven progression, i ncluding 4 with CIS and 3 with invasive cancer, and 1 of them died of bladd er cancer. The intervals from diagnosis to progression ranged from 6 months to 8 years (mean 2.5 years). One of the remaining 29 patients had positive cytologic results 2.5 years after the initial diagnosis of dysplasia. The authors conclude that urothelial dysplasia is a significant risk for the de velopment of CIS and invasive urothelial carcinoma, and patients with uroth elial dysplasia should be followed up closely.