Muscle-invasive bladder cancer developing after nephroureterectomy for upper urinary tract urothelial carcinoma

ObjectivesTo evaluate the risk factors and prognosis of muscle-invasive bladder cancer (MIBC) developing after nephroureterectomy for upper urinary tract urothelial cell carcinoma (UUT-UC).Materials and methodsWe reviewed the medical records of 422 patients who underwent nephroureterectomy for UUT-UC between 1990 and 2010, and identified 173 (40.9%) with intravesical recurrence and 28 (6.6%) with MIBC. We evaluated the clinicopathologic features, risk factors, and cancer-specific survival (CSS) using the Kaplan-Meier method and the Cox proportional hazards regression models.ResultsThe median intervals from nephroureterectomy to intravesical recurrence and the development of MIBC were 8 and 17 months, respectively. On multivariate analysis, the pathologic stage (≥pT3 vs. Ta/T1, HR 5.03, P = 0.001) and ureteral tumor location (HR 2.79, P = 0.011) were independent risk factors for the development of MIBC, whereas a history of previous or concomitant bladder tumor was the only significant risk factor for intravesical recurrence. The probability of developing MIBC 5 years after nephroureterectomy was 12.6% in patients with 1 risk factor and 20.6% in patients with both risk factors. Patients with MIBC had significantly worse CSS than those without MIBC (P = 0.004), whereas CSS rates were similar in patients with and without intravesical recurrence (P = 0.593). However, stratification analysis for matching pathology revealed that CSS rates were not significantly different in patients with pT2 or higher stage of UUT-UC.ConclusionsApproximately 5% of the patients developed MIBC after nephroureterectomy with a median interval of 17 months. Patients with advanced pathologic stage (≥pT3) and a ureteral tumor location are at increased risk of developing MIBC after nephroureterectomy.     

Upper urinary tract transitional cell carcinoma after total cystectomy for bladder cancer

During a 17-year-period from 1967 to 1983, 110 total cystectomies for transitional cell bladder cancer have been performed in our clinic. During the postcystectomy period, upper urinary tract urothelial cancer developed in seven patients (6.4%). In every case a multifocal, low stage transitional cell cancer had been found in the bladder. The time between the cystectomy and discovery of the upper tract tumour varied from less than three months to almost 13 years. In five cases the first sign of occurrence of the tumour was malignant conduit urine cytology, in two macroscopic haematuria with subsequent malignant cells in urine. In one patient bilateral renal pelvic tumours were found. Five patients could be surgically treated. The need for regular conduit urine cytological studies at short intervals in patients with multifocal low stage and high grade transitional cell carcinoma in the cystectomy specimen is emphasised.     

Transitional cell carcinoma of the upper urinary tract following total cystectomy for bladder cancer]

From 1975 to 1990, we treated 118 patients with urinary epithelial cancer, including 100 with primary bladder cancer, 13 with primary upper urinary tract cancer, and 5 with both diseases. Thirty-five patients with primary bladder cancer underwent total cystectomy. Upper urinary tract urothelial cancer developed in 4 patients (4.0%) and was detected only after cystectomy. Three patients had multiple bladder tumors before cystectomy and recurrent tumors under long-term bladder-preserving treatment. The other patient had had cystectomy for the primary bladder lesion. Our present policy is to perform urinary cytology once a month and intravenous urography once a year in patients with bladder cancer for early detection of secondary upper urinary tract cancer.     

A case report of urinary reconstruction by ileal neobladder performed 16 years after total cystectomy for bladder cancer

We report a 59-year old male patient who successfully underwent urinary reconstruction by ileal neobladder that was performed 16 years after total cystectomy and ureterocutaneostomy for bladder cancer. He had been suffering from refractory contact dermatitis around the ureterocutaneostomy stoma and was referred to our hospital. In 2003, bilateral percutaneous nephrostomy was performed together with ureteral ligation at the most distal part. However recurrent pyelonephritis developed afterward because of nephrostomy catheter troubles and the patient's quality of life was markedly impaired. Then urinary reconstruction was planned in 2005. Because the urethra had not been resected and remained intact, ileal neobladder (Hautmann's method) was successfully created and he was free from nephrostomy catheter. Postoperatively there has been no recurrence of pyelonephritis. Long time insertion of nephrostomy catheter causes several complications, such as urinary tract infection and formation of urinary stones. To preserve renal function and improve quality of life, every chance for urinary reconstruction should be sought in those patients who suffer from upper urinary tract catheter troubles.     

Brain metastasis of bladder carcinoma after total cystectomy: a case report

A 74-year-old woman underwent total cystectomy with ureterostomy on March 1993 on a diagnosis of advanced bladder cancer. The pathological diagnosis was transitional carcinoma grade 3, pT3a pN0 pV1, pL2. Two courses of adjuvant chemotherapy with CDDP and MTX were added. Three years and 3 months later, she began to suffer from amnesia and hemiparalysis on her left side. Brain MRI examination revealed a solid tumor, 4 x 4 x 3 cm in size, in the right frontal lobe of the cerebrum. No other metastatic lesions were found. She underwent surgical resection of the tumor and subsequent irradiation to right frontal lobe in the cerebrum. Pathological examination confirmed its origin of bladder cancer. She has been enjoying a disease-free life for 3 years with minimal neurological symptoms.     

Development of upper tract carcinoma after cystectomy for bladder carcinoma

Two hundred twenty patients who underwent a radical cystectomy and en bloc pelvic lymph node dissection with urinary diversion were reviewed to define the incidence of upper tract carcinoma developing after cystectomy. Each patient was followed for at least five years or until death. In 5 of 220 (2.4%) upper tract lesions developed, with a disease-free interval from cystectomy of twenty-two to fifty-four months. All patients died within two to twenty-seven months of diagnosis. Common pathologic features included the presence of high-grade multifocal lesions or carcinoma in situ (CIS) in the cystectomy specimen, tumor invasion of the intramural ureter, and positive findings on urethrectomy specimens. Although the incidence of this disease process is low, heightened surveillance of the upper urinary tracts would seem appropriate in patients displaying these pathologic features.     

Recurrence of bladder cancer in fossa navicularis 12 years after total cystectomy: a case report

We report a case of urothelial cancer recurrence in fossa navicularis of urethra 12 years after total cystourethrectomy for bladder cancer. A 73-year-old man had undergone total cystourethrectomy and ureterocutancostomy for multiple bladder cancer on June 13, 1986. Histopathological findings showed transitional cell carcinoma, G3, pT4 with carcinoma in situ. Twelve years after the cystectomy, he was admitted to our hospital complaining of the induration of the glans penis. Magnetic resonance imaging showed a high intensity tumor in T1-WI and low intensity tumor in T2-WI, which had invaded fossa navicularis of urethra to glans penis. Aspiration biopsy of the penile tumor revealed transitional cell carcinoma. Therefore, we performed partial penectomy on July 16, 1998, since computed tomography showed no lymph node swelling in the inguinal region. Five months after the second operation, he was diagnosed with bilateral inguinal lymph node metastasis. Then we performed 2-course M-VAC (methotrexate, vinblastine, doxorubicin cisplatin) therapy, which showed partial response. Thereafter, bilateral inguinal lymphadenectomy with one-course postoperative M-VAC therapy was performed.     

Clinical course of plasmacytoid urothelial carcinoma of the upper urinary tract: a case report

Plasmacytoid urothelial carcinoma of the bladder represents a rare and aggressive variant of urothelial carcinoma, which is usually diagnosed at an advanced pathologic stage. Until now, no reports exist on this rare tumor type in the upper urinary tract. Herein, we present the first report on the clinical course of a metastatic plasmacytoid urothelial carcinoma of the renal pelvis and show its unfavorable outcome despite multimodal therapy.     

预防肾盂输尿管癌术后再发膀胱癌的手术方法研究

目的探讨预防。肾盂输尿管癌术后再发膀胱癌的手术方法。方法对156例单纯。肾盂癌、单纯输尿管癌中获随访的139例患者资料进行同顾性总结。肾盂癌78例。输尿管癌61例。肿瘤细胞分级：G1 19例，G2 88例，G3 32例。肿瘤分期：Ta—T1 38例，T2 80例，T3～T4 21例。肿瘤直径0．8—6．0cm。结果139例均行根治性。肾、输尿管及管口周围部分膀胱壁（1．5—2．0cm）切除术。术后随访1～10年。再发膀胱癌55例，占39．6％。肾盂癌术中先用纱条结扎输尿管后游离切除患肾输尿管及管口周围部分膀胱者术后膀胱癌再发率18．5％（5／27），未先结扎输尿管者再发率27．5％（14／51）。术后当日膀胱灌注化疗者膀胱癌再发率32．3％（10／31）。术后3周开始膀胱灌注化疗者膀胱癌再发率34．9％（30／86）。术后当日及术后序贯膀胱灌注化疗者术后膀胱癌再发率20．0％（4／20），单纯术后序贯膀胱灌注化疗者膀胱癌再发率39．3％（26／66）。2者比较差异有统计学意义（P〈0．01）。结论术后当日及术后序贯膀胱灌注化疗可有效降低。肾盂输尿管癌术后膀胱癌的再发率，游离切除。肾输尿管前先结扎输尿管对预防肾盂癌术后再发膀胱癌可能有益。     

Secondary bladder cancer after upper tract urothelial carcinoma in the US population

Study Type – Prognosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? It is known that a certain percentage of patients treated for upper tract urothelial carcinoma (UTUC) will go on to develop a secondary bladder cancer; however, the risk factors for developing a secondary bladder tumour have not been studied in a population‐based setting. Given the large changes in how UTUC has been diagnosed and managed in recent years, this study aimed to evaluate the natural history of UTUC in the US population over a 30‐year period, with a particular emphasis on the development of secondary bladder cancer.

OBJECTIVE

• ? To assess the natural history of upper tract urothelial carcinoma (UTUC) and the development of lower tract secondary cancer.

PATIENTS AND METHODS

• ? Patients diagnosed with UTUC between 1975 and 2005 were identified within nine Surveillance, Epidemiology and End Results registries.
• ? Baseline characteristics of patients with and without secondary bladder cancer were compared.
• ? A multivariate logistic regression model was fitted to test if the year of diagnosis predicted the likelihood of developing a secondary bladder cancer.

RESULTS

• ? Of the 5212 patients with UTUC, 242 (4.6%) had a secondary bladder cancer (range: 1.7–8.2%).
• ? There was a mean interval of 26.5 (95% CI: 22.2–30.8) months between cancer diagnoses.
• ? Compared with those without secondary tumours, patients with secondary bladder malignancy were more likely to present with larger tumours (4.2 vs 3.1 cm, P < 0.001) and with tumours located in the ureter (P < 0.001).
• ? Year of diagnosis was not a predictor of the likelihood of having a secondary bladder malignancy in a multivariate analysis controlling for demographic and tumour characteristics (odds ratio: 0.99; 95% CI: 0.95–1.03)

CONCLUSIONS

• ? Patients with larger urothelial tumours located in the ureter were those most likely to develop a secondary lower tract tumour.
• ? No longitudinal changes in the rate of secondary bladder cancer were noted among patients with UTUC over the 30‐year study period.

     

Distressful symptoms after radical cystectomy with urinary diversion for urinary bladder cancer: a Swedish population-based study

OBJECTIVE: To study the excess prevalence of distressful symptoms after radical surgery for urinary bladder cancer. METHODS: We included all patients who underwent cystectomy due to bladder cancer before 1996 in Stockholm County. A control group was randomly selected from the general population. Information was collected by means of an anonymous postal questionnaire. RESULTS: Completed questionnaires were returned by 310 (71%) controls and 251 (85%) cystectomized individuals. A 5-fold (reservoir) and 9-fold (conduit) increase in defecation urgency and a 4-fold (reservoir) and 6-fold (conduit) increase in faecal leakage were reported in individuals operated on. Urinary tract infection was increased 3-fold in cystectomized individuals compared with controls, during the previous year 26% of the patients reported a symptomatic infection. The perception of a reduced physical attractiveness due to disease was more than 5-fold increased in the men operated on compared to the controls. The majority, 135 out of 201 (67%), reported that they would have refused alternative bladder-sparing procedures if they decreased the prospects of survival by even as little as 1%. CONCLUSIONS: The patient's situation after cystectomy is considerably impaired due to changed bowel and sexual function, urinary tract infections and a sense of decreased attractiveness. However, most patients are in spite of this unwilling to compromise survival.     

Continent cutaneous urinary diversion is still a valid alternative after cystectomy for bladder carcinoma

OBJECTIVE: We compared patient opinions concerning reservoir/bladder function as well as quality of life (QOL) after cystectomy for bladder carcinoma and continent cutaneous urinary diversion or orthotopic bladder reconstruction. MATERIAL AND METHODS: Fifteen patients with Kock reservoirs (11 females, 4 males) and 11 men with orthotopic bladders answered the European Organization for Research and Treatment of Cancer quality-of-life questionnaire-C30 as well as specially constructed questions concerning reservoir/bladder function. The glomerular filtration rate (GFR) was determined using Cr-EDTA or iohexol clearance. RESULTS: Functioning and global health/QOL scales did not differ between the two groups of operated patients or between diverted patients and gender- and age-matched groups from the general population. The majority of the patients were satisfied/very satisfied with their diversion but more patients were troubled by leakage in the orthotopic bladder group than in the Kock reservoir group. The GFR was similar in the two groups. CONCLUSION: Continent cutaneous urinary diversion is associated with fewer leakage problems than orthotopic bladder reconstruction after cystectomy for bladder carcinoma.     

单次与多次膀胱灌注化疗对上尿路尿路上皮癌术后复发膀胱癌的影响

目的研究单次与多次膀胱灌注化疗对上尿路尿路上皮癌术后复发膀胱癌的影响。方法研究对象为2017年1月至2019年1月入院的46例上尿路尿路上皮癌术后患者,按照化疗方案划分为对照组(23例)与研究组(23例)两组,对照组选用单次膀胱灌注化疗,研究组选用多次膀胱灌注化疗,比较两组术后不良反应发生率、腹膜后肿瘤复发率及膀胱癌发生率。结果对照组术后出现1例膀胱刺激征,不良反应发生率为4.35%;研究组术后出现1例少量血尿,1例下尿路刺激征,不良反应发生率为8.70%,两组术后不良反应发生率差异无统计学意义(P>0.05)。对照组术后1例患者复发腹膜后肿瘤,发生率为4.35%;研究组术后无1例患者复发腹膜后肿瘤,两组术后腹膜后肿瘤复发率差异无统计学意义(P>0.05)。对照组术后发生9例膀胱癌,发生率为39.13%;研究组术后发生2例膀胱癌,发生率为8.70%,研究组术后膀胱癌发生率明显低于对照组(P<0.05)。结论多次膀胱灌注化疗可有效降低上尿路尿路上皮癌术后患者的膀胱癌发生率,对于预防膀胱癌具有积极作用,值得推广应用。     

Beta-hCG producing urothelial carcinoma of the urinary bladder: a case report

A 74-year-old man visited our hospital presenting with pollakisuria. Cystoscopy revealed a bladder cancer with necrotic tissue. The patient was initially treated by transurethral resection of bladder tumor (TUR-Bt). Pathologically, the tumor was shown to be a carcinoma of bladder with human chorionic gonadotropin (hCG) positivity. After TUR-Bt, chemotherapy with M-VAC (methotrexate, vinblastine, adriamycine and cisplatin) was performed. This patient is still alive eight months after resection. To our knowledge, there are 37 cases of beta-hCG-producing urothelial carcinoma of the urinary bladder reported in the Japanese literature.