Upper urinary tract recurrence following radical cystectomy for bladder cancer

Abstract

Aim:The objective of this study was to analyze the clinicopathological features of upper urinary tract recurrence following radical cystectomy for bladder cancer. Methods: Between 1995 and 2003, 583 patients underwent radical cystectomy and urinary diversion for bladder cancer at the authors' institution and the related hospitals. A retrospective review of patient records was carried out to evaluate characteristics of patients who underwent upper urinary tract recurrence after radical cystectomy. Results: During the observation period (median, 41.5 months), 12 (2.1%) of the 583 patients had upper urinary tract recurrence. Of the 12 patients with upper urinary tract recurrence, there were multiple tumors in eight at the initial diagnosis of bladder cancer, and eight received transurethral resections two or more times before radical cystectomy. The median time to diagnosis of an upper urinary tract cancer after radical cystectomy was 29.5 months. When upper urinary tract recurrence was detected , five patients had metastatic diseases simultaneously, and two had bilateral upper urinary tract cancers. The cancer-specific survival in patients with upper urinary tract recurrence was significantly poorer than that in those without upper urinary tract recurrence. In addition, eight of the 12 patients (66.7%) died of disease progression within 3 years after the diagnosis of upper urinary tract cancer. Conclusions: These findings suggest that despite the low incidence of upper urinary tract recurrence following radical cystectomy, the prognosis of such patients was markedly poorer compared with that of those without upper urinary tract recurrence. Accordingly, intensive therapies should be considered when upper urinary tract recurrence is detected after radical cystectomy.

A Retrospective Analysis of Incidence and Its Associated Risk Factors of Upper Urinary Tract Recurrence following Radical Cystectomy for Bladder Cancer with Transitional Cell Carcinoma: The Significance of Local Pelvic Recurrence and Positive Lymph Node

“…In this study, the median follow-up period was 53 months (13–207 months), which was not quite a long enough period of time for follow-up of UUTR in reference to 10–15 years. However, it might be cautiously said that this study may be representative for RC with an acceptable time of follow-up of UUT, because most of our RC patients (approximately 80%) had completed their follow-up with more than postoperative 36–44 months, and most previous reports also showed a median time of follow-up period of between 30–50 months [3], [6], [8], [23]. Therefore, with our median follow-up period, it was worth discussing the natural histories of 11 UUTRs, although conduct of further studies with large numbers of subjects with further long-term follow-ups would be necessary in order to obtain more clinical significance for comparison with other studies.…”

“…For decades, the schedule and methods for surveillance of UUT after RC have been discussed because of its characteristics of low prevalence (0.7–7.4%) [3], [7], [8], [12], [20]–[22], late diagnosis after postoperative 25–40 months [6], [7], [23], poor prognosis with a median survival of 10–20 months from diagnosis [6], [23], difficulty in detection of abnormal UUT findings in the changed abdomino-pelvic anatomy with diverted intestinal urinary tract of urinary diversions, and contaminated urine specimen from UUT with many degenerating desquamated intestinal epithelial cells to decrease the sensitivity of urine cytology. Many previous studies have attempted to identify several predictive risk factors of UUTR, however, their predictive values varied from those reported in other studies to remain controversial due to different characteristics of the enrolled patients [3], [24].…”

“…The two different types of urinary diversion were compared in this study under the assumption that incidence of UUTR might be higher with Neo, with poorer prognosis than for IC because Neo has a longer time of mucosal contact from malignant cells in urine and a higher rate of reflux to the upper urinary tract than IC [6], [8], [12], [13], [23]. A study by Yang et al reported a long-term effect of UUT change in both functional deterioration and anatomical distortion because of the refluxing and infection related problem [47].…”

Endourologic Management of Upper Tract Transitional Cell Carcinoma following Cystectomy and Urinary Diversion

“…The incidence of upper tract recurrence following radical cystectomy for urothelial cancer ranges from 2% to 6% [3, 6–11], with the majority of recurrence in the first 3 years [3]. Additionally, Tran et al [3] demonstrated that the risk of upper tract recurrence does not change with time, emphasizing the critical importance of continued surveillance for UTTCC following cystectomy.…”

Clinical benefits of tubeless umbilical cutaneous ureterostomy

“…14 The recurrence of UUT is associated with poor survival because metastases are often detected at the time of diagnosis. 15 After cystectomy, the patients are usually monitored by computed tomography (CT) and urine cytology, but the efficacy of this approach Tubeless umbilical cutaneous ureterostomy remains debatable. Urine cytology is considered an inadequate screening tool after radical cystectomy and ileal conduit because the test does not distinguish the cancer cells from degenerated intestinal epithelial cells.…”