Abstract:

Background: Urological malignancies global incidence has been increasing at an alarming rate despite improved primary prevention, detection and treatment. In Tanzania, they contribute a major burden in cancer morbidities and mortalities. At Bugando Medical Centre (BMC), urological malignancies are a single most common cause of urological and oncological admissions. The aim of this study was to determine the clinico–pathological profile of urological malignancies at BMC.

Methods: This was a hospital–based, prospective and retrospective descriptive study involving patients with histopathologically confirmed urological malignancies at BMC. The retrospective part was for 3 years taking patients from March 2016 to February 2019 whereas the prospective part was for 3 months enrolling patients from March 2019 to May 2019. In each patient data including; demographic profile, clinical presentation, anatomical site and histopathology results were collected and analyzed using STATA.

Results: A total of 662 patients (M: F ratio = 3.8:1) were studied. The median age at presentation was 67 (IQR, 54 to 76 years), the duration of symptoms ranged from 2 months to 4 years with a median duration of 12 months. The commonest clinical presentations were lower urinary tract symptoms (LUTS) 71.1% (470/662), hematuria 33.8% (224/662), bone pain 31.0% (205/662), abdominal pain (loin/suprapubic) 28.7% (190/662), abdominal mass (loin/suprapubic) 19.3% (128/662) and weight loss 12.4% (82/662). The majority of patients presented late with an advanced stage of cancer. Prostate was the commonest anatomical site affected 58.0% (384/662) followed by the urinary bladder 28.1% (186/662). Bladder cancer was the commonest among females 78.1% (107/137) followed by the kidney 21.2% (29/137) and the female gender was commonly affected for the bladder and kidney cancers (M:F = 1:1.4 and 1:1.3 respectively). Adenocarcinoma was the leading histopathological type for prostate cancer 99.7% (383/384) while squamous cell carcinoma (SCC) was the commonest histopathology for bladder cancer 62.4% (116/186). The leading kidney histology was nephroblastoma (Wilm‘s tumor) in children 57.7% (30/52) and renal cell carcinoma (RCC) in adults 30.8% (16/52).

Conclusion: The most common clinical presentation of urological malignancies in our patients were found to be lower urinary tract symptoms (LUTS), hematuria, bone pain, abdominal pain (loin/suprapubic), abdominal mass (loin/suprapubic) and weight loss. Furthermore, the majority of patients presented late with an advanced stage of cancer. The most common anatomical site affected was the prostate. Bladder cancer was the commonest among female. Adenocarcinoma was the most frequent histological type for the prostate cancer whereas squamous cell carcinoma was the leading for bladder cancer. The commonest histological type for kidney cancer was nephroblastoma in children and renal cell carcinoma in adults. Resources should be allocated based on the commonest urological malignancies in our setting.