肾移植术后并发尿路上皮肿瘤(附25例报告)

目的 探讨肾移植术后并发尿路上皮肿瘤的临床特点及其诊治方法.方法 回顾性分析1998年～2006年间肾移植术后发生尿路上皮肿瘤的临床资料25例.就患者性别、移植时年龄、导致肾功能不全的原发病、移植后肿瘤发生的时间、临床症状、肿瘤发生部位及转归等项目进行临床分析.所有病例移植前均排除肿瘤.肿瘤均经影像学和膀胱镜等检查方法诊断.22例患者行手术治疗,术后所有患者免疫抑制剂用量减少1/3并辅以局部灌注化疗.结果 本组25例患者中男4例,女21例;移植时患者平均年龄55.1岁;原发病为慢性间质性肾炎的患者19例;术后发生肿瘤的时间距肾移植时间平均26个月;临床表现为肉眼血尿或镜下血尿25例,反复泌尿系感染10例,肾盂输尿管积水者12例;肿瘤为多发者22例;移植肾同侧有上尿路肿瘤者16例;3例行姑息性治疗的晚期肿瘤患者分别于发现肿瘤5个月、6个月及8个月后死亡,22例手术治疗患者已随访2～7年,18例肿瘤复发,再行手术治疗;所有患者在免疫抑制剂减量期间均未出现急性排斥,肾功能正常.结论 本组显示慢性间质性肾炎导致肾功能衰竭的肾移植患者和女性肾移植患者易发生移植后尿路上皮肿瘤;血尿、泌尿系感染和肾盂积水是常见的症状,多发性和易复发性是另一临床特点;移植肾同侧上尿路较对侧好发肿瘤.     

马兜铃酸肾病并发尿路上皮癌的诊断治疗

目的 探讨马兜铃酸肾病并发尿路上皮癌的特点及诊治方法。方法 回顾性分析8例慢性马兜铃酸肾病合并尿路上皮癌患者的临床资料。8例患者均有长期（2～20年）间断小剂量服用含马兜铃酸药物史，其中肾功能不全代偿期1例，肾功能衰竭期7例。8例均合并尿路上皮癌。7例行单侧肾、输尿管全长加膀胱袖套状切除，1例行膀胱全切加双侧输尿管皮肤造口术。结果 5例术后12～48（平均31）个月再发对侧肾盂肿瘤，1例术后再发膀胱肿瘤，1例膀胱全切术后60个月再发双侧肾盂肿瘤。7例均接受了二次手术，仅1例单侧肾盂肿瘤患者术后62个月无肿瘤复发。7例患者二次术后随访10～56个月，平均36个月，存活6例，1例死于癌转移。结论 慢性马兜铃酸肾病出现血尿、尿道出血或膀胱刺激症状时，应警惕合并尿路上皮肿瘤的可能。由于肿瘤常常表现为复发和双侧多发，治疗以双侧上尿路或同时行膀胱全切为宜。     

肾移植术后并发自体尿路上皮多器官癌六例的临床分析

目的 探讨6例肾移植术后并发自体尿路上皮多器官癌的病因、临床诊断及治疗结果.方法 回顾性分析6例肾移植术后并发自体尿路上皮多器官癌患者的临床资料,对肿瘤的发生原因、临床诊断和治疗结果进行了总结.结果 6例患者肾移植术后均采用环孢素A(CsA)或他克莫司(Tac)+霉酚酸酯(MMF)+泼尼松(Pred)的三联免疫抑制方案;并以抗CD3单克隆抗体(OKT3)或达利珠单抗进行免疫诱导.6例患者发生肿瘤的时间在肾移植术后2～48个月,平均为26个月.除1例是在使用B型超声波复查时发现膀胱肿瘤外,其余患者均以间歇性血尿为首发症状,临床症状发生后通过B型超声波、尿找脱落瘤细胞、膀胱镜、输尿管镜、静脉尿路造影(IVU)、逆行肾盂造影及CT明确诊断,并经内窥镜下取材活检证实.6例患者均为非同时发生的尿路上皮多器官癌,非同时发生肿瘤的间隔期为1.5～15个月.每例患者均因肿瘤复发或新发而接受了2～5次肿瘤切除术,其中1例行全膀胱切除术及移植肾输尿管皮肤造瘘术,1例行全膀胱切除术、移植肾输尿管皮肤造瘘术及全尿道切除术.术后均通过膀胱灌注给予丝裂霉素、吡柔比星和表柔比星等进行化疗.治疗效果满意,但复发率高.结论 肾移植术后并发的尿路上皮多器官癌与免疫抑制剂的使用密切相关;并发自体尿路上皮多器官癌往往进展快,易扩散和转移,因此,应注重患者移植后的筛查,做到早期诊断,积极治疗,慎重对待移植肾切除.     

上尿路上皮肿瘤的腔内治疗

一、概述 肾盂输尿管尿路上皮肿瘤相对少见，占泌尿系上皮肿瘤的5％～6%。尿路上皮肿瘤标准手术方法为患侧肾输尿管全切术和膀胱袖套状切除。由于尿路上皮肿瘤发病呈多灶性的特点，双侧上尿路可同时或相继出现多个病灶，因此部分学者提出对部分早期肾盂输尿管上皮肿瘤行保留患侧肾脏和输尿管的肿瘤腔内切除术，尤其对于孤立肾、双侧上尿路肿瘤及部分肾功能不全的患者，内镜下行肿瘤切除术往往是较好的选择。     

肾移植术后并发自体尿路上皮多器官癌6例诊治研究

目的：探讨肾移植后并发自体尿路上皮多器官癌的诊治方法。方法：回顾性分析6例肾移植术后自体尿路上皮多器官癌的临床资料。结果：发现6例中1例为亲属肾移植。5例临床表现为肾移植术后2～48个月出现间歇性血尿,1例B超发现膀胱占位病变。6例均为非同时发生的移行细胞癌,非同时发生肿瘤的时间为1．5～16个月。6例患者因肿瘤复发或新发而接受2～5次肿瘤切除术,1例行全膀胱切除术及移植肾输尿管皮肤造瘘术,1例行全膀胱切除术、移植肾输尿管皮肤造瘘术及全尿道切除术。术后通过膀胱灌注给予丝裂霉素、吡柔比星、表阿霉素等进行化疔。治疗效果比较满意。结论：肾移植术后的尿路上皮多器官癌往往进展快,易扩散和转移,预后较差。对肾移植后并发自体尿路上皮多器官癌应高度重视,严把受体关,密切随访,早期诊断,积极治疗,慎重对待移植肾切除。     

双侧上尿路同时发生移行细胞癌6例报告

目的:探讨双侧上尿路同时发生移行细胞癌患者的处理方法。方法:报告6例双侧上尿路同时发生移行细胞癌患者的临床资料,均有慢性肾功能不全、无痛性肉眼血尿,经影像学和输尿管镜等检查确诊。3例行保肾手术,2例行肾输尿管切除术,1例仅行活检术。结果:术后病理检查均为移行细胞癌。随访3~33个月,平均14.2个月。随访期间2例死亡,2例术后发生膀胱肿瘤,1例输尿管肿瘤复发,2例未见肿瘤复发。结论:双侧上尿路同时发生移行细胞癌,根据肾功能情况可选择行保肾手术或双侧肾输尿管切除术;保肾手术后应加强监测,以利早期发现复发和治疗。     

肾细胞癌并发尿路移行细胞癌的诊断与治疗

目的 探讨肾细胞癌并发尿路移行细胞癌的临床特点和诊治方法。方法 回顾性分析5例肾细胞癌并发尿路移行细胞癌患者的临床资料。男4例，女1例。年龄42～75岁，平均62岁。间歇无痛全程肉眼血尿4例，间歇全程肉眼血尿伴右侧腰痛1例。B超、IVU及CT提示肾肿瘤并发尿路肿瘤4例，肾癌不除外合并同侧肾盂占位1例。结果 5例均行根治性手术，4例同时行不同部位肿瘤根治术，1例行分次手术。病理为肾癌并发膀胱癌3例，肾癌并发同侧输尿管癌1例，肾癌并发同侧肾盂癌1例。随访6～18个月，平均11个月。1例术后10个月膀胱肿瘤局部复发，再行经尿道膀胱肿瘤切除术；4例无瘤生存。结论 肾细胞癌并发尿路移行细胞癌临床少见，对肾癌患者行泌尿系超声、IVU和术中肾脏剖开检查有助于正确诊断。根治性手术宜同时切除肾癌侧输尿管，以避免残余输尿管发生肿瘤。     

输尿管镜结合钬激光技术治疗孤立肾上尿路尿路上皮癌3例报告

目的总结输尿管镜结合钬激光技术治疗孤立肾上尿路尿路上皮癌的诊治体会。方法回顾性分析3例孤立肾上尿路尿路上皮癌患者的临床资料和随访结果。3例均为女性,1例输尿管癌,其对侧肾萎缩无功能;1例肾盂癌,曾因对侧输尿管癌接受肾输尿管全长切除术;1例为移植肾肾盂癌。3例患者均接受输尿管镜钬激光治疗。结果术后平均随访2年,3例患者均存活,其中1例无复发,1例因对侧萎缩肾一侧发生输尿管癌而再次接受输尿管镜钬激光治疗,术后无复发,1例因移植肾肾盂癌伴膀胱癌复发接受肾输尿管及膀胱切除术。结论对于解剖性或功能性孤立肾上尿路尿路上皮癌,输尿管镜结合钬激光技术是一种可选择方法,但术后应密切随访。     

腹腔镜及开放根治性肾输尿管膀胱切除术治疗上尿路肿瘤合并膀胱癌8例报告

目的探讨腹腔镜和开放根治性肾输尿管膀胱切除术治疗上尿路肿瘤合并膀胱癌患者的可行性和安全性。方法收集我院2004年6月至2009年3月期间收治的8例单侧上尿路肿瘤并浸润性膀胱癌行根治性肾输尿管膀胱切除术及尿流改道手术患者的临床资料并进行随访分析。结果本组8例。男7例,女1例,平均年龄56岁。术前经膀胱镜、输尿管镜、B超和CT等检查证实为单侧上尿路肿瘤并浸润性膀胱癌,其中4例左肾盂癌和2例右肾盂癌合并膀胱癌,2例为左输尿管癌合并膀胱癌。2例行腹腔镜肾输尿管膀胱切除术及回肠膀胱术,平均手术时间470min,术中平均出血量275ml,均无输血,术后肠功能恢复时间为2d,下床活动时间为4d。6例患者行开放肾输尿管膀胱全切除术,其中4例行回肠膀胱术,另2例行输尿管造口术,平均手术时间366min,平均出血量767ml,平均输血量485ml,术后肠功能恢复时间为3.3d,下床活动时间平均为6.7d。8例患者术后均未出现并发症。术后病理结果 7例为尿路上皮癌,上尿路肿瘤分期分级为T2～4N0～1M0G2,膀胱癌为T2～3N0M0G3,另1例为左肾盂鳞癌T4N1M0合并膀胱鳞癌T3N0M0。术后平均随访24.6个月,鳞癌患者术后18个月因肿瘤广泛转移死亡,余7例患者无瘤生存至今。结论单侧上尿路肿瘤合并膀胱癌可行Ⅰ期根治性肾输尿管膀胱切除术,腹腔镜下行该手术是可行及安全的,较开放手术创伤小,出血少,恢复快。     

慢性马兜铃酸肾病伴发尿路上皮恶性肿瘤16例报告

目的提高对慢性马兜铃酸肾病伴发尿路上皮恶性肿瘤的认识。方法回顾性分析16例慢性马兜铃酸肾病伴发尿路上皮恶性肿瘤患者的临床资料。16例均有长期间断小剂量服用含马兜铃酸成分药物病史,根据病史及相关检查均可诊断为慢性马兜铃酸肾病、慢性肾功能不全。患者临床表现均为间歇性无痛肉眼血尿,术前经B超、逆行造影、CT或MRU、输尿管镜等检查明确诊断。膀胱肿瘤6例;上尿路肿瘤10例,其中双侧同时发生肿瘤者6例、伴膀胱肿瘤1例。结果6例膀胱肿瘤行经尿道膀胱肿瘤电切术(TURBt);10例上尿路肿瘤者中6例8侧行保肾手术;4例5侧行根治性切除术,其中1例双侧肾盂肿瘤者另一侧术中探查发现肾周肿瘤明显外浸,粘连明显,手术困难,仅行活检术;1例双侧肾盂及双侧输尿管肿瘤者仅行活检术。术后病理均为移行细胞癌,WHO标准病理分级:Ⅰ级1例、Ⅰ～Ⅱ级4例、Ⅱ级6例、Ⅲ级5例。14例获随访3～37个月,平均14个月。死亡4例,其中1例为未手术的双侧肾盂及双侧输尿管肿瘤患者,术后5个月因瘤死亡;输尿管肿瘤、膀胱肿瘤及双肾盂肿瘤者各1例分别于术后17、19、26个月死于多发转移。4例膀胱肿瘤术后4～9个月复发6次,其中2例为2次复发者;上尿路肿瘤2例术后9～10个月膀胱肿瘤3次复发;3例输尿管肿瘤术后3～32个月复发,其中1例原位复发,2例异位复发;5例未见肿瘤复发。结论慢性马兜铃酸肾病伴发的尿路上皮恶性肿瘤以上尿路肿瘤为主,双侧发病率较高,肿瘤具有多发、易复发及恶性程度高等特点。     

肾移植术后并发双侧自体肾盂和输尿管移行细胞癌16例

目的 总结肾移植术后发生双侧自体肾盂、输尿管移行细胞癌的诊治经验.方法 回顾性分析16例肾移植术后发生双侧自体肾盂、输尿管移行细胞癌患者的资料.首次发现上尿路肿瘤的时间为移植后(56.2±33.0)个月.2例同时发现双侧上尿路肿瘤,其余14例双侧上尿路肿瘤先后发现的时间间隔为(8.6±6.7)个月.临床症状和检查阳性结果以血尿和自体肾积水为主.均行自体上尿路根治性切除术,术后行膀胱灌注化疗.结果 16例手术均成功.32次自体肾、输尿管的病理检查结果均为移行细胞癌,包括单纯肾盂肿瘤4次,单纯输尿管肿瘤9次,合并肾盂、输尿管肿瘤19次.23次肾盂肿瘤的分级为1级8例,2级11例,3级4例;28次输尿管肿瘤的分级为1级6例,2级10例,3级12例.术后随访(26.8±25.1)个月,1例出现肺部转移后死亡;1例发生腰背部软组织转移性移行细胞癌,局部切除;其他患者未发现肿瘤复发及转移.结论 肾移植后自体上尿路移行细胞癌的常见表现为血尿合并自体肾积水,该肿瘤侵袭性较强,对于膀胱及一侧自体上尿路同时存在移行细胞癌者,应行对侧自体肾上尿路预防性切除术.

Abstract：

Objective To investigate the clinical features of bilateral native pelvic and ureteral transitional cell carcinoma (TCC) in renal transplant patients. Methods A retrospective analysis was carried out on 16 patients with bilateral native pelvic and ureteral TCC after kidney transplantation.The mean time between transplantation and diagnosis of upper urinary TCC was 56. 2 ± 33. 0 months.Two patients were suffered from bilateral upper urinary TCC at the same time. The mean interval between 2 upper urinary tract operations of the remaining 14 cases was 8. 6 ± 6. 7 months. Hematuria and hydronephrosis of native kidneys were the main symptoms and targets in checkup. Intravesical chemotherapy was postoperatively given. Results All operations were performed successfully. All specimens obtained from the operations were pathologically diagnosed as TCC. The TCC location involved pure native pelvis (n = 4), pure native ureter (n = 9), and pelvis combined with ureter (n = 19). Pelvic TCC pathological grades included grade 1 in 8 cases, grade 2 in 11 cases, and grade 3 in 4 cases; Ureteral TCC grades included grade 1 in 6 cases, grade 2 in 10 cases, and grade 3 in 12 cases.Patients were followed up for 26. 8 ± 25. 1 months. One patient died of lung metastasis. (One case of lumbar soft tissue transfer was given local excision. The remaining patients had no recurrence and metastasis. Conclusion Renal transplant patients with hematuria and native renal hydronephrosis should be highly vigilant of the occurrence of upper urinary tract TCC. TCC after renal transplantation is invasive. Prophylactic contralateral nephroureterectomy should be performed on the recipients having TCC at the bladder and one side of native upper urinary tract.     

177例尿路移行细胞癌的临床分析

目的：探讨尿路移行细胞癌(TCC)的发病特点及与预后的关系，提高尿路TCC的治愈率。方法：分析177例TCC患者的诊断措施、手术方法和术后处理资料。结果：肾盂癌17例，输尿管癌8例，膀胱癌152例。发现14例为多中心性和异时性TCC，其中下行性异时性膀胱癌10例。结论：TCC是尿路上皮肿瘤发病率最高的恶性肿瘤，异时性膀胱肿瘤的发生率明显高于上尿路肿瘤，发生肿瘤的异时性对患者预后有一定影响，加强肿瘤术后监测是提高患者生存率的重要手段之一。     

肾移植术后并发泌尿系统恶性肿瘤22例

目的 分析肾移植受者泌尿系统恶性肿瘤的发病情况,并探讨其发病机理及治疗方法.方法 回顾性分析1978年至2010年12月间肾移植受者发生泌尿系统恶性肿瘤22例的资料.结果 22例的病理检查结果分别为膀胱移行上皮细胞癌9例(其中1例第3次手术后发现转化为腺癌),膀胱鳞状细胞癌1例,膀胱腺癌1例,肾透明细胞癌3例(其中2例为双侧肾癌),肾低分化癌1例,肾盂移行细胞癌1例,肾盂+膀胱移行细胞癌1例,输尿管移行细胞癌2例,输尿管+膀胱移行细胞癌2例,输尿管移行细胞癌+膀胱腺癌1例.肾癌及输尿管癌均发生在患者原肾及输尿管.11例膀胱癌患者中9例存活,均保有全部或部分肾功能;4例肾癌患者均在发病后半年内死亡;肾盂癌、输尿管癌除2例术后早期死亡外,其余5例存活.22例发现肿瘤后1年存活率为73.7%.结论 肾移植后泌尿系统恶性肿瘤可见少见的病理类型.治疗中应注意免疫抑制剂的使用和移植肾功能保护的问题.肾实质性恶性肿瘤预后很差.

Abstract：

Objective To investigate the incidence of urological malignancy in renal allograft recipients and explore the mechanism of increased incidence in China and the management. Methods A retrospective study was performed on 22 patients with urological malignancy in renal allograft recipients between 1978 and 2010. Results Twenty-two cases of urological malignancy were diagnosed by pathologic evidence, including 9 cases of transitional cell carcinoma (TCC) of bladder, 1 case of squamous cell carcinoma of bladder, 1 case of adenocarcinoma of bladder, 1 case of TCC of pelvis, 1 case of TCC of bladder and pelvis, 1 case of TCC of ureter complicated with adenocarcinoma of bladder, 2 cases of TCC of ureter, 2 cases of TCC of ureter and bladder, 3 cases of clear cell carcinoma of kidney, and 1 case of undifferentiated carcinoma of kidney. All the malignancies belonged to native organs. All the patients suffering bladder cancer had normal function of allograft. Five patients with TCC of pelvis or ureter survived and 2 cases died early after operation. All the patients suffering renal carcinoma deceased within 6 months after diagnosis. One-year survival rate was 73. 7 % after the diagnosis of urological malignancy. Conclusion Urological malignancy ranked highest in malignancy in renal allograft recipients, and rare pathological types of urological malignancy in non-renal allograft recipients are often demonstrated. The strategy of treatment should take consideration of the relationship between the usage of immunosupressive agents and the preservation of allograft function. It is critical for the therapy of malignancies to possess satisfactory allograft function. The prognosis of renal cell carcinoma is poor.     

肾移植术后并发自体泌尿系统恶性肿瘤22例的临床分析

目的 分析肾移植受者并发自体泌尿系统恶性肿瘤的临床特征.方法 回顾性分析单中心1945例肾移植受者的临床资料,其中发生自体泌尿系统恶性肿瘤22例(发生率为1.13％),占所有恶性肿瘤的56.4 ％(22/39).22例中肾乳头状腺癌、肾乳头状细胞癌、肾血管肉瘤各1例;肾盂移行细胞癌1例,肾盂输尿管移行细胞癌6例,输尿管移行细胞癌7例,肾盂输尿管膀胱移行细胞癌1例;膀胱恶性肿瘤4例(包括膀胱移行细胞癌3例、膀胱交界恶性肿瘤1例).22例中,以肉眼血尿为主要症状者17例,2例反复出现镜下血尿,只有3例无明显临床症状.患者的发病年龄为(54.3±12.3)岁,诊断肿瘤的中位时间为移植术后53个月.10例采用环孢素A+硫唑嘌呤+泼尼松预防排斥反应,12例采用环孢素A+吗替麦考酚酯+泼尼松.所有患者均接受手术治疗,其中3例肾脏恶性肿瘤患者接受了根治性肾切除手术,15例肾孟、输尿管肿瘤患者接受患侧肾、输尿管切除并膀胱袖状切除,4例膀胱恶性肿瘤患者中,3例接受经尿道膀胱肿瘤电切术,1例行膀胱部分切除术.结果 随访2～97个月,死亡9例,死亡时间为肿瘤手术后6～97个月,死亡原因为骨转移1例,肺转移1例,脑转移2例,肝转移2例,全身广泛转移3例.随访截止时存活13例,存活时间最长者为单纯膀胱肿瘤患者,存活92个月,存活超过4年者4例,存活超过1年者5例.结论 自体泌尿系统恶性肿瘤是肾移植术后的一个重要并发症;无痛性肉眼血尿是最常见的症状;根治性手术切除是最主要的治 疗手段.     

Prognostic variables in patients with transitional cell carcinoma of the renal pelvis and proximal ureter

Recent technological advances in urological endoscopic surgery of the renal pelvis and proximal ureter via ureteroscopy or percutaneous nephroscopy have made it possible to consider parenchymal-sparing procedures in patients with transitional cell carcinoma. To define the role of these procedures in the management of renal pelvic or proximal ureteral transitional cell carcinoma we analyzed retrospectively 31 patients who underwent nephroureterectomy for transitional cell carcinoma of the renal pelvis and/or proximal ureter. High grade upper urinary tract transitional cell carcinoma and a history of metachronous or synchronous bladder transitional cell carcinoma were independent adverse prognostic factors. However, patients with low grade upper urinary tract transitional cell carcinoma and no evidence of a urothelial field change had a 100 per cent 5-year survival rate. It would appear that parenchymal-sparing endoscopic techniques should be regarded with caution in patients with either high grade transitional cell carcinoma of the renal pelvis and proximal ureter or a history of bladder cancer.     

Urothelial cancer after renal transplantation: an update

According to the Australian and New Zealand Dialysis and Transplantation (ANZDATA) 2010 Annual Report, cancer is surpassing cardiovascular diseases as the leading cause of posttransplantation death. Skin cancer and posttransplantation lymphoproliferative disorder (PTLD) are 2 cancers in Western countries. However, urothelial cancer happens much more frequently among Chinese people. We reviewed our experience in Congress of the Asian Society of Transplantation (CAST) 2005, including 10 urothelial cancers, among 620 renal transplant recipients. In this report, we have presented our updated data. From July 1981 to May 2011, we performed 770 renal transplantations followed by graft and native kidney sonography annually even among asymptomatic cases using the protocol described in CAST 2005. During this period, 35 urothelial tumors were detected, ie, 25 new cases were identified in 6 years. These 35 cases included 7 cases with bilateral upper tract involvement and 5 of them with bladder tumors. Seven patients had bladder cancer alone. In 19 patients, 22 ureteral cancers included 1 that grew from the graft ureter, 17 (77.3%) patients showed hydronephrosis by sonography. We performed 13 bilateral nephroureterectomies; 2 were known to have bilateral upper tract cancer. Four of the other 11 were found to have insidious tumors. In contrast, 2 of the 15 initial unilateral nephroureterectomy patients underwent a subsequent contralateral nephroureterectomy due to a tumor. The pattern of urethral cancer in renal transplant recipients is thoroughly different, including female predominance, and a higher incidence of upper tract involvement. We emphasize the necessity of routine periodic sonographic survey even among asymptomatic patients for early detection of a urothelial tumor.     

Epidemiology of urothelial carcinoma

The epithelium lining is defined as the mucosal surfaces of the renal collecting tubules, calyces and pelvis, as well as the ureter, bladder and urethra. The term “urothelium” is used to refer to these surfaces. Upper tract urothelial carcinoma is a rare subset of urothelial cancers with a poor prognosis. Urinary bladder cancer is the most common malignancy involving the urinary system. Upper tract urothelial carcinoma is more common in men than in women, with a male‐to‐female ratio of 2:1. The incidence of urinary bladder cancer is also higher in men. Cigarette smoking and occupational exposure are the main upper tract urothelial carcinoma and urinary bladder cancer risk factors, while other factors are more specific to the carcinogenesis of upper tract urothelial carcinoma (i.e. Balkan endemic nephropathy, Chinese herb nephropathy). In Egypt until recent years, urinary bladder cancer was the most frequently diagnosed cancer due to Schistosoma haematobium. Substantial knowledge exists regarding the causes of upper tract urothelial carcinoma and urinary bladder cancer, and epidemiological studies have identified various chemical carcinogens that are believed to be responsible for most cases of urothelial carcinoma. In the era of precision medicine, genetic effects might play a direct role in the initiation and progression of urothelial carcinoma.     

Transitional cell carcinoma in renal transplant recipients

We describe our experience in managing transitional cell carcinoma (TCC) in renal transplant (RTx) recipients. Nineteen RTx recipients (7 men; 12 women) presented with hematuria or hydronephrosis of native kidneys and were suspected with TCC were reviewed retrospectively; 17 of them proved to have TCC. The mean interval of the occurrence of TCC was 58.7 months (range, 3-144 months) after RTx. The patients with suspected upper tract lesions received bilateral nephroureterectomies (BNU) and bladder cuff resection. Transurethral resection of the bladder tumor (TUR-BT) was performed in patients with concomitant or solitary superficial bladder lesions. Of the 15 patients with upper tract TCC, 8 had bilateral lesions pathologically, but only 2 of them were suspected preoperatively on image study. With a mean follow-up of 28 months (range, 1-57 months) both the overall graft and patient survival rates were 76%; 4 patients with advanced diseases at presentation died. Bladder recurrence was noted in 6 patients (35%). Transplant patients with hematuria warrant detailed study of the whole urinary system and periodic ultrasonography of the native kidneys is recommended in all RTx recipients. Simultaneous BNU for the native kidneys is mandatory if there is any evidence of TCC in either renal/ureteral unit.