The natural history of patients less than 40 years old with bladder tumors.

We treated 19 men and 6 women less than 40 years old with bladder tumors. The average patient age at diagnosis was 30.6 years and the mean followup was 65 months. Gross hematuria was present in 84 per cent and excretory urography showed a mass in the bladder in 44 per cent of the patients. Of 8 patients less than 30 years old 6 had papilloma and 2 had grade II to III, stage O transitional cell carcinoma. All patients with papillomas were free of disease. The pathological reports of the patients more than 30 years old revealed papilloma or grade I, stage O transitional cell carcinoma in 9, grade II to III, stage O to A papillary transitional cell carcinoma in 6 and invasive disease in 2, 1 of whom died. Of the 9 patients with papilloma or grade I, stage O disease 77 per cent are currently free of disease. Of those with grade II to III, stage O to B papillary transitional cell carcinoma only 1 is free of disease, while 6 have had resectable recurrences. One patient with grade II to III disease was lost to followup. Accordingly, all patients, regardless of age, should be treated as aggressively as necessary on the basis of the stage and grade of the tumor.