A case of bilateral ureteral triplication

Ureteral triplication is a rare congenital anomaly of the urinary tract, although ureteral duplication is rather common. Bilateral ureteral triplications are even rare anomalies. A five-year-old girl with a history of urinary tract infection and episodes of fever and lower abdominal pain was admitted to our hospital for further examination of microscopic hematuria. An excretory urogram (IVP) revealed bilateral 3 pelves and ureters, and cystoscopic examination showed 2 ureteral orifices on each side. Both sides of bilateral ureteral triplications in our case belonged to type B of Smith's classification. Ureteral triplication was first reported by Wrany in 1870. Since then 84 cases have been reported and among them 3 cases had bilateral ureteral triplications. In this article, the classification and the development of ureteral triplication are reviewed briefly.     

A case of quadruple carcinoma with special reference to ureteral cancer

A case of quadruple carcinoma involving the ureter, stomach, transverse colon and rectum is described. All tumours have been removed and the patient is healthy without evidence of disease.     

A case of bilateral multiple ureteral diverticula

The patient was a 73-year-old man who was referred to our hospital for examination of asymptomatic gross hematuria. Urine cytology was negative. Drip infusion pyelography and retrograde pyelography revealed bilateral multiple out-patchings of both ureters. Multiple ureteral diverticula is generally considered to be rare. There have been 20 reported cases in the Japanese literature. We present the 21st case of multiple ureteral diverticula.     

A case of ureterocele with ureteral stone and bladder tumor

A case of ureterocele with ureteral stone and bladder tumor is reported. The patient, a 35-year-old man, presented with the complaint of terminal miction pain. IVP revealed the cobra-head appearances of a left-sided ureterocele, ureteral stone and hydroureter. The stone in the ureterocele and the tumor arising from the ureterocele were confirmed by cystoscopic examination. Transurethral biopsy was carried out and followed cystolithotomy, partial cystectomy, partial ureterectomy and ureteroneocystostomy. Histopathological examination of surgical specimens revealed the same feature of transitional cell carcinoma developed from the ureterocele.     

Significance of carcinoma in situ and dysplasia in association with bladder cancer

Cystectomy specimens of 118 transitional cell carcinomas of the bladder were analyzed by step-sectioning. The carcinoma in situ and dysplasia adjacent to and remote from the visible bladder cancer were correlated with the tumor configuration on cystoscopy, and grade and stage of the disease. Results showed that a combination of papillary and nodular carcinomas in a single bladder was associated with a high incidence of mucosal involvement. Moreover, more than 50 per cent of all grade 3 carcinomas were associated with carcinoma in situ and dysplasia adjacent to and remote from the visible tumors. Carcinoma in situ and dysplasia were not related to the stage of disease. For management of bladder cancer, it appears important to assess the gross configuration of tumors by cystophotography and to determine the grade of tumors by biopsy, because mucosal involvement was found to be correlated closely with the tumor configuration and grade 3 disease.     

Sintilimab treatment for ureteral carcinoma following bladder cancer leads to leukopenia: a case report

Herein, we present a case report of sintilimab treatment for a patient with ureteral cancer reoccurring after bladder cancer, and exploration of the mechanism of adverse reactions from the aspects of intestinal flora and immunity. We have reported a case of leukopenia in a patient with recurrent ureteral cancer after bladder cancer who was treated with sintilimab. A 52-year-old Chinese man with a history of hypertension and diabetes presented with lower urinary tract symptoms, including painless hematuria, frequent and urgent urination, and micturition without pain. Computed tomography (CT) and 3-dimensional (3D) reconstruction suggested bladder space occupation, bladder cancer was pathologically confirmed after laser resection of the bladder tumor, which then recurred and was subject to reoperation. After 8 months, B-mode ultrasonography indicated left ureter occupation, and the patient began sintilimab immunotherapy according to the outcome of immunohistochemistry (IHC) and immune checkpoint inhibitor (ICI) evaluation. The patient was treated with sintilimab a total of 6 times. After the first treatment, the patient was in stable condition. The second treatment was discontinued due to renal insufficiency. The patient was then treated with renal and liver protection for 1.5 months, followed by 5 rounds of immunotherapy. After the sixth round of immunotherapy, the patient presented with leukopenia. In order to determine the causes of adverse reactions, we analyzed the changes of intestinal flora of patients before and after immunotherapy, and summarized the immune function indicators of patients during immunotherapy. The leucopenia induced by sintilimab may be related to intestinal flora and immunity.     

A case report: occurrence of bladder carcinoma in the defunctionalised bladder in a patient after operation of left ureteral carcinoma]

An eighty year-old woman was diagnosed as left ureteral carcinoma and right dysfunctional kidney in 1984. Left partial ureterectomy, partial cystectomy, and left ureterocutaneostomy were performed and her bladder was left behind after the operation. In 1990 (72 months after the operation), she was aware of bleeding from the urethra. A bladder wash was performed, demonstrating malignant cells on cytological examination, and cystoscopy revealed a papillary tumor in the defunctionalized bladder. Total cystectomy was performed and the histological findings of the surgical specimen showed transitional cell carcinoma, grade 2, pTaNoMo. This case shows the need for periodic examinations of the defunctionalized bladder, because renal pelvic and ureteral carcinoma tends to recur in the bladder within two years after operation and because tumors rarely developed in the defunctionalized bladder.     

A case of ureteral cancer with sarcomatous proliferation

The patient was a 70-year-old man who had complained of a terminal miction pain and gross hematuria. A left total nephroureterectomy and partial cystectomy were carried out under the diagnosis of ureteral tumor and bladder tumor. Histopathological examination revealed a spindle cell carcinoma consisting of transitional cell carcinoma grade 3 with sarcomatous proliferation. There were histologically direct transformation of the transitional cell carcinoma into squamous cells, and transformation of the squamous cells into sarcomatous spindle cells. Five months after operation, the patient died from recurrence.     

Metachronous bilateral ureteral cancer in patient with hereditaly nonpolyposis colorectal cancer

Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant disorder characterized by an excess of extracolonic malignancies including those of the urinary tract. We report a case of metachronous bilateral ureteral cancer associated with HNPCC. A 51-year-old man was referred to Nara National Hospital for further examination of left hydronephrosis on excretory urography performed on the periodical follow-up for colon cancer. Computed tomography showed a mass in the left lower ureter and urine cytology was demonstrated class V. The operation was performed under the diagnosis of left ureteral cancer. The histopathological diagnosis was transitional cell carcinoma, grade 2, pT1. After 4 months of the operation, he presented with gross hematuria. Retrograde pyelography demonstrated tumors in the right side (ureter and renal pelvis) and the histopathological diagnosis of the biopsy specimens revealed transitional cell carcinoma, grade 2. We performed 4 times of BCG instillation followed by laser ablation of the tumor. The reported case was compatible for Japanese clinical criteria, group B for HNPCC.     

Breast carcinoma metastasizing to the urinary bladder presenting as bilateral hydronephrosis treated with ureteral stenting and chemotherapy

We describe a case of metastatic breast carcinoma involving the urinary bladder and causing bilateral hydronephrosis. Treatment consisted of bilateral renal decompression followed by chemoradiotherapy. The pertinent literature is reviewed.     

Obstructive uropathy caused by bilateral synchronous ureteral carcinoma: report of a case

We report on a 67-year-old man with bilateral, synchronous, ureteral transitional cell carcinoma. He presented with bilateral flank pain accompanied by nausea, vomiting and oliguria. Bilateral hydronephrosis with upper ureteral filling defects was found on antegrade pyelogram. After urinary diversion with bilateral percutaneous antegrade drainages for 6 days, serum creatinine fell from 10.1 to 4.7 mg/dl. Exploration revealed bilateral upper ureteral tumors. Right nephroureterectomy and left ureterectomy with left nephrostomy were done.     

A case study with bladder metastasis of renal cell carcinoma and stomach cancer

A 64-year-old woman received nephrectomy and lymph expurgation surgery for renal cell carcinoma on Jury 1, 1981. The pathologic diagnosis was adenocarcinoma of the clear cell type at Robson's stage 2. She next visited the Department of Gastroenterology complaining of stomach discomfort on November 5, 1981. Stomach cancer of Borrmann's type IV was identified in the lesser gastric curvature, but only biopsy was performed because it was inoperable. The pathologic diagnosis was undifferentiated adenocarcinoma. On January 23, 1982, there was microscopic hematuria. A cystoscopic examination revealed one soy bean-sized, smooth, pedicle tumor to which coagula were partially adhered in the center of the triangular region. After TUR-Bt performed on March 3 the pathologic diagnosis was adenocarcinoma of the clear cell type with no submucosal infiltration. Based on these findings, the patient was diagnosed as having suffered metastasis of renal cell carcinoma to the bladder. She died of bleeding from stomach cancer on June 15. Based on the fact that the tumor was localized in the bladder mucosa, implantation through the urinary tract was strongly suspected as the metastatic route of the renal cell carcinoma to the bladder.     

A clinical study of associated bladder cancer in patients with renal pelvic and ureteral cancer

We reviewed 76 cases of renal pelvic and ureteral cancer, admitted to our hospital between January, 1975 and December, 1988, with special reference to the occurrence of bladder cancer. Bladder cancer was associated with an upper urinary tract neoplasm in 35 of the 76 cases (46.1%), 7 with a preceding bladder cancer, 17 with a coexistent one and 11 with a subsequent one. In case of renal pelvic and upper ureteral cancer the incidence of coexistent or subsequent tumors of the bladder was 28.7% (16 of 56 patients). However, in the cases of lower ureteral cancer the incidence of these tumors was 82.4% (14 of 17 patients). This incidence was significantly higher than that in renal pelvic and upper ureteral cancer. The subsequent bladder cancer was observed in 19 patients including 8 patients who had a recurrence of the bladder cancer after the treatment for a preceding and coexistent bladder cancer. The cancer in most cases occurred within 2 years after the treatment of the upper urinary tract neoplasm. Of 19 patients who had subsequent bladder cancer 11 had primary sites in the renal pelvis and upper ureter. Another 8 patient had primary sites in the lower ureter. Four of the 8 subsequent bladder cancers in patients with lower ureteral cancer occurred just on and around the affected ureteral orifice. All these 4 tumors were high grade and high stage tumors. On the other hand, another 15 patients developed subsequent bladder cancer in a place other than the affected ureteral orifice. Of these 15 patients, 13 cases showed a low grade and low stage tumor.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ureteroneocystostomy for bilateral ureteral obstruction in carcinoma of prostate

“Fish-mouth” ureteroneocystostomy was successful in a patient with bilateral ureteral obstruction secondary to locally invasive adenocarcinoma of the prostate. The complications of permanent intubation are avoided and renal function is restored.     

膀胱灌注化疗预防输尿管尿路上皮细胞癌术后再发膀胱癌

目的 探讨膀胱灌注化疗对不同级别输尿管尿路上皮细胞癌患者行肾、输尿管及膀胱袖状切除术后再发膀胱癌的影响.方法 对194例原发性输尿管尿路上皮癌患者的临床资料进行回顾性研究,比较术后2年内各级别肿瘤患者中吡柔比星灌注组与未灌注组的膀胱癌复发率.结果 行根治性肾、输尿管及膀胱袖状切除术2年后,灌注组复发率23.9%(28/117)明显低于未灌注组的39.0%(30/77),差异有统计学意义(P＜0.05).其中G1肿瘤灌注患者复发率为5.0%(1/20),未灌注患者复发率14.3%(3/21),差异无统计学意义(P＞0.05);G2肿瘤灌注患者复发率21.4%(12/56)明显低于未灌注组的43.9%(18/41)(P＜0.05);G3肿瘤灌注患者复发率36.6%(15/41),未灌注患者复发率60.0%(9/15),差异无统计学意义(P＞0.05).结论 对于原发性输尿管尿路上皮癌患者,术后膀胱灌注化疗可预防输尿管尿路上皮癌患者术后膀胱癌的发生.尤其对G2肿瘤患者,术后膀胱灌注化疗可有效预防肿瘤的膀胱内复发;但其对G1及G3肿瘤患者无明显预防作用.     

A case of ureteral carcinoma at 11 years after radical cystectomy and rectal bladder reconstruction: a case report

We report a 74-year-old male who developed ureteral carcinoma after 11 years of radical cystectomy and rectal bladder reconstruction. The patient had right lumbago and high grade fever and right hydronephrosis. He was suspected to have right ureter tumor under the antegrade pyelography at the time of right nephrostomy, and ureter tumor was diagnosed by the combination of computed tomography and antegrade pyelography. Under this preoperative diagnosis, right nephroureterectomy was performed. The histopathological diagnosis was transitional cell carcinoma. Since the recurrence of urothelial cancer at 10 years after radical cystectomy is rare, we believe our case is useful for the establishment of long-term follow up of bladder cancer.     

Urinary diversion in a case of bilateral ureteral endometriosis

Endometriosis of the urinary tract is uncommon. We report a case of bilateral ureteral endometriosis. A 46-years-old woman was presented with facial edema. The level of blood urea nitrogen and creatinine were 52 and 4.83 mg/dl respectively at the first examination. Retrograde urography demonstrated bilateral hydronephrosis with distal ureteral obstruction and MRI (magnetic resonance imaging) showed left ovarian cyst. CA125 level was 93 U/ml. We diagnosed the case as ureteral endometriosis by exploratory laparotomy. After 16 month of gonadotropin-releasing hormone analogue therapy and ureteral dilation with catheter, she underwent end-to-side uretero-ureterostomy with ureteral reimplantation (psoas hitch). Bilateral hydronephrosis and renal function were improved after the operation. The case was suspected of extrinsic type ureteral endometriosis.