Upper Urinary Tract Transitional Cell Carcinoma in Patients with Bladder Carcinoma and Associated Vesicoureteral Reflux

Abstract

Of 269 patients with bladder neoplasms treated during a 20-year period 47 had associated vesicoureteral reflux. All 47 patients were followed for 3 years or more, or until death. Upper urinary tract transitional cell cancer developed in 3, each of whom had recurrent bladder cancer. Among the 222 patients who had vesical cancer without reflux transitional cell carcinoma of the ureter developed in only 1, 11 years after transurethral resection for a bladder tumor. The incidences of upper tract transitional cell cancer in patients with and without vesicoureteral reflux were 6.4 and 0.44 per cent, respectively, which support the suggested role of reflux in disseminating or seeding of cancer cells from the bladder into the upper urinary tract. Patients with bladder cancer and associated vesicoureteral reflux have an approximately 15-fold greater risk of upper tract cancer developing compared with those without reflux. We recommend vigilant scrutiny of patients with recurrent bladder cancer and associated vesicoureteral reflux for early detection of upper urinary tract transitional cell carcinoma.

Bacillus Calmette-Guérin Treatment and Vesicorenal Reflux

“…In the case of BCG treatment in the presence of a double-J stent, any urinary infection should be ruled out or treated vigorously before onset of therapy and good diuresis should be sustained. The incidence of ureteral and renal pelvic tumors in patients with reflux is increased [3], the possible cause being primary multifocality or secondary tumor cell im plantation [1,3,15]. As BCG exerts its tumor-protective effect only on the urothelium with which it is in close contact [7,9], treatment in the presence of refluxive ure ters seems to be reasonable and even desirable.…”

Concurrent Urothelial Carcinoma in the Renal Pelvis of an Allograft Kidney and Native Recipient Bladder: Evidence of Donor Origin

“…Patients with primary bladder carcinomas also have only a 0.5 -2% risk of subsequent upper urinary tract tumors. However, the risk of subsequent upper urinary tract tumor is reported to rise to 6 -20% if the patient has vesicoureteral reflex (15,16). These observations suggest the importance of urinary flow in heterotopic recurrence, thus underscoring the role of implantation or seeding of a transformed cell in the process of multifocality.…”

Endoscopic Treatment of Vesicoureteral Reflux following Transurethral Resection of a Vesical Carcinoma by Teflon Injection

“…Amar and Das [9] reported 5 patients with bladder cancer and VUR in whom transvesical ure- It was suggested that some endovesical chemothera pies used in bladder cancer prophylaxis can produce reflux by themselves by causing inflammation and fibro sis of the muscular and mucosal layers of the bladder and terminal ureter [6][7][8][9][10][11][12].…”

“…The number of refluxing ureteral units successfully treated with the first injection is then only 14 (43.8%). Among the remaining 18 ureters, in which the reflux did not disappear, we performed a second injection, obtaining a reflux cure in 4 (22.2%) and an improvement 1 % of the cases [9,11], Nevertheless these rates increase from 6 to 20% in those patients that present with VUR [6,9,11,15], being 15-20 times greater.…”