Simultaneous Cystectomy and Nephroureterectomy due to Synchronous Upper Urinary Tract Tumors and Invasive Bladder Cancer: Open and Laparoscopic Approaches

Abstract

Introduction: It is not unusual for bladder tumors to appear following transitional cell carcinoma of the upper urinary tract (UUT), with involvement of the UUT, following invasive bladder cancer, being less common. The synchronous presence of transitional cell carcinoma of the bladder and of the UTT is exceptional. Methods: Fifteen simultaneous cystectomies with nephroureterectomies were performed due to synchronous UUT and invasive bladder cancers (1997–2009). Surgery was performed using an open approach in 10 patients, while the last 5 procedures were performed laparoscopically. Results: The mean age was 68.7 years. Mean surgery time was 348.6 minutes. Mean blood loss was 816 ml. Acute renal failure was the most frequent postoperative complication being present in 5 patients (33%). There was 1 case of a leak in the ureter-intestinal anastomosis (open approach), which required placement of a left-sided percutaneous nephrostomy. There were 2 cases of postoperative mortality, both in the open approach series and with intestinal neobladder. Mean follow-up time for the whole series was 21.25 months. Eight cases experienced metastatic progression of the disease (mean follow-up 17 months). Conclusion: Though multi-site studies with longer follow-up and a greater numbers of patients are needed, the moment at which urothelial tumors appear seems to influence their prognosis, with lower survival rates for tumors that synchronically appear.

Simultaneous en-bloc robot-assisted radical cystectomy and nephro-ureterectomy: technique description, outcomes, and literature summary

“…Post-operative complications occurred in three patients: one patient died from sepsis arising from an enterocutaneous fistula, one patient suffered a prolonged ileus, and one patient experienced a wound infection. Perez and coworkers [22] reported on ten open and five laparoscopic simultaneous cystectomies and nephro-ureterectomies. The open procedures lasted a mean of 314 min, whereas the laparoscopic approach required 418 min.…”

Predictive role of preoperative hydronephrosis on poor pathological outcomes and prognosis in upper tract urothelial carcinoma patients: Experience from a nationwide high-volume center in China

“…A distinguishing feature of urothelial carcinomas is their multiple foci, which cause the tumors to appear synchronously or sequentially throughout the urinary tract, including the upper urinary tracts (renal pelvis or ureter), bladder and urethra (2). Upper tract urothelial carcinomas (UTUC) are uncommon and account for only 5-10% of urothelial carcinomas (3).…”

Characteristics and treatment outcomes of pan-urothelial cell carcinoma: a descriptive analysis of 45 patients

“…Urothelial carcinomas are distinguished by their ability to develop multiple foci in a synchronous or sequential fashion throughout the urinary tract 1 . Upper tract urothelial carcinoma (UTUC) and bladder tumor (BT) often co-exist 2 3 , and 1.6% to 6.9% of UTUC patients have been reported to suffer from synchronous or metachronous bilateral disease 4 5 6 .…”