Tumours of urinary bladder and ureter associated with abuse of phenacetin-containing analgesics

Forty-two patients with a bladder tumor and 4 patients with a ureteral tumor and a history of abuse of phenacetin-containing analgesics were studied. The sex ration was 1:1, and the mean age 63 yr. The estimated amount of ingested phenacetin was 7.1 kg, the estimated mean exposure time 21 yr, and the estimated mean induction time 30 yr. Renal papillary necrosis and impaired renal function were found in 34 patients. A history of recurrent urinary tract infection was found in 80 % of the patients, suggesting that the combination of phenacetin-abuse and chronic inflammation might be responsible for the localization of the tumors to the bladder. The majority of the bladder tumors were of low grade (1 and 2); muscular invasion was seldom found and metastases were rare. The patients were followed for 1.5-13 years; 26 of them died; the mean survival time was 46 mth. Uremia due to analgesic nephropathy was the main cause of death in 14 patients and contributed to death in another 7 patients. Three of the patients with ureteral tumors had received radiological treatment against the pelvic region, 15-20 yr prior to the diagnosis of the ureteral tumor.