Management of upper urinary tract problems after radical cystectomy for urothelial carcinoma: tips and tricks

Abstract

Purpose of reviewAfter radical cystectomy (RC) patients are at risk for both benign and malignant problems regarding the upper urinary tract (UUT). This review summarizes the recent literature and provides tips on how to manage problems of the UUT after RC. Recent findingsDisease recurrence, kidney stones and ureteroenteric strictures (UES) are common after RC. Endourological techniques can be used to treat low-grade disease recurrence, either with a retrograde or antegrade approach. Treatment success depends on getting access to the UUT and on tumor characteristics; selecting the right approach is key. Kidney stones can be treated endourologically with good results. With use of minimal invasive techniques such as robot cystectomy, a higher incidence of UES is observed. The use of indocyanine green could help to prevent this complication. In case of a stricture, primary reconstruction should be the treatment strategy of choice. SummaryAfter RC, recurrence of the UUT remains a complicated problem. Choice of treatment method should be tailored to the patient and tumor characteristics. Kidney stones after cystectomy can be successfully managed endourological. Robot assisted RC introduced a higher rate of UES, which should be managed by primary revision.

Robot-Assisted Totally Intracorporeal Resection of Cutaneous Ureterostomy Tumor and Ileal Conduit Surgery: A Rare Case Report

“…Nathan et al ( 7 ) analyzed 574 patients who received RC and discovered 3.7% probability of upper urinary tract (UUT) recurrence. The treatment method was reported in the patients with UUT recurrence, including nephroureterectomy, laparoscopic resection and segmental ureterectomy ( 8 ). We were the first to describe the detailed operation plan for a patient who developed ureteral cutaneous recurrence following RC.…”