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Urology (Expert Forum)
Pathology report incomplete, another TURP?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Pathology report incomplete, another TURP?
by z24dkl, Jul 22, 2004 12:00AM
I am a 53 year old male, 35-year pack-a-day smoker. Have just undergone TURP for transitional cell carcinoma. I
initially presented with no hematuria but I was passing clots of tissue (neoplasm?). My doctor called today with the
pathology report. Stage was Ta (great!) but grade was IV/IV (worst possible). I had one large tumor attached by a
stalk located 12 o’clock high in bladder. Other random biopsy sites all proved negative. Now for the problem. The
tumor was pretty large and had to be chopped up significantly to be removed from the bladder. The pathologist
could not locate a portion of the specimen that had part of the bladder muscle layer attached to it. They could only
find portions with the Urothelium and Lamina propria layers attached. My doctor said the pathology report showed
the tumor had not penetrated through the Urothelium layer. My doctor says he will ask pathology to look again for a
specimen that has muscle layer attached. He says he is sure he cut deep enough to include muscle layer in the
specimen. However, he wants to go back in and do the TURP again. He wants to resection the same area and I
guess he wants to make sure he gets a muscle layered specimen. He is meeting with other doctors in the Urology
clinc to discuss when is the better time to redo the TURP. Some are saying immediately and some are saying three
months from now. I am very confused as what to do. This does not sound normal to me. Is my doctor second
guessing himself or is there more I should know about the situation. I really need an objective opinion as to what is
going on. Please reply as soon as possible.
initially presented with no hematuria but I was passing clots of tissue (neoplasm?). My doctor called today with the
pathology report. Stage was Ta (great!) but grade was IV/IV (worst possible). I had one large tumor attached by a
stalk located 12 o’clock high in bladder. Other random biopsy sites all proved negative. Now for the problem. The
tumor was pretty large and had to be chopped up significantly to be removed from the bladder. The pathologist
could not locate a portion of the specimen that had part of the bladder muscle layer attached to it. They could only
find portions with the Urothelium and Lamina propria layers attached. My doctor said the pathology report showed
the tumor had not penetrated through the Urothelium layer. My doctor says he will ask pathology to look again for a
specimen that has muscle layer attached. He says he is sure he cut deep enough to include muscle layer in the
specimen. However, he wants to go back in and do the TURP again. He wants to resection the same area and I
guess he wants to make sure he gets a muscle layered specimen. He is meeting with other doctors in the Urology
clinc to discuss when is the better time to redo the TURP. Some are saying immediately and some are saying three
months from now. I am very confused as what to do. This does not sound normal to me. Is my doctor second
guessing himself or is there more I should know about the situation. I really need an objective opinion as to what is
going on. Please reply as soon as possible.
Doctor's Answer
by Kevin Pho, MD, Jul 25, 2004 12:00AM
, Jul 25, 2004 12:00AM
Tough to give a completely objective opinion since I am not involved in your case.
In cases like these, there is no "right" approach. That is likely why there is so much discussion. It seems like there are some who advocate repeating the TURP and some saying delaying it in a few months.
I think that the decision rests on the definitive interpretation of the pathology report. If there is confusion as to how deep the biopsy was, another pathology interpretation would be suggested.
In cases like these where there are several options, it may be wise to obtain further urological opinions, and then to go with the consensus.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
In cases like these, there is no "right" approach. That is likely why there is so much discussion. It seems like there are some who advocate repeating the TURP and some saying delaying it in a few months.
I think that the decision rests on the definitive interpretation of the pathology report. If there is confusion as to how deep the biopsy was, another pathology interpretation would be suggested.
In cases like these where there are several options, it may be wise to obtain further urological opinions, and then to go with the consensus.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
