Urothelial cancer of the upper urinary tract after radical cystectomy: primary focus, recurrence of bladder cancer or de novo tumor. Surgical treatment

Recurrence of urothelial carcinoma in the upper urinary tract after radical cystectomy is observed in 0.9–9.8 % of patients. Due to the relatively low incidence of cancer, there are no clear recommendations for the prevention, diagnosis, and treatment of recurrence of urothelial cancer in the upper urinary tract after radical cystectomy.

The aim of the work is to present the original experience of surgical treatment of relapsed bladder cancer after radical cystectomy in the upper urinary tract.

Patient, 69 years 24 months after laparoscopic radical cystprostatectomy with urethrectomy, developed hydronephrosis of the left kidney, computed tomography revealed a formation in the pelvis. Nephroscopy revealed a tumor of the pelvis and calyxes, histologically - transitional cell carcinoma G₂.

Nephrureterectomy was performed completely extraperitoneally. Histological examination of the removed specimen confirmed transitional cell carcinoma in the pelvis: pT2N0M0. 36 months after surgery, serum creatinine was 132 μmmol/L, and there were no signs of disease recurrence.

The efficacy of radical nephrureterectomy with excision of the adjacent fragment of the intestinal segment in recurrences of urothelial carcinoma in the upper urinary tract after radical cystectomy has been shown. Separate ureteral anastomoses with intestinal conduit during radical cystectomy are facilitates treatment in cases of complications from the upper urinary tract. The need to develop protocol for the detection of primary urothelial tumors of the upper urinary tract during preoperative examination before radical cystectomy is shown. Further research is needed to determine an algorithm for the early detection and treatment of this kind of relatively rare complications.