Urothelial bladder neoplasms are rare in children, occurring in 0.1-0.4% of the population before the age of 20. There are no current paediatric guidelines to their management. This study retrospectively reviews the files of patients from three tertiary centres between 1999-2013, classifying all lesions according to the 2004 World Health Organisation / International Society of Urological Pathology (WHO/ISUP) criteria. Eighteen children (nine male, nine female) with a mean age of 11 years (3-17) presented with gross painless haematuria in 16 of them and as an incidental finding in two. An initial ultrasound scan (USS) identified the lesion in 17 (mean diameter 17mm, range 5-50mm) with cystoscopy performed for treatment of reflux identifying one case. All were treated with transurethral resection of bladder tumour (TURBT). Tumour location was on the lateral wall in four, posterior wall in six, near the UO’s in eight. There was complete macroscopic resection in all and no postoperative complications. Histologically eight were urothelial papillomas (UP), eight papillary urothelial neoplasm of low malignant potential (PUNLMP), one low grade urothelial carcinoma (LGUC) and one high grade urothelial carcinoma (HGUC). Three patients underwent CT staging with no other lesions found. One patient had one dose of intravesical Mit-C, none of the others had initial adjuvant therapy. Follow-up (median five years, range nine months – 14.5 years) showed varying levels of surveillance with USS and no recurrence in any of the individuals. The authors conclude that in children bladder tumours are generally less aggressive and low grade, and that long-term follow-up in terms of USS surveillance is all that is necessary after treatment.
Bladder urothelial neoplasms in children
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