Recurrence of urothelial bladder cancer in the upper urinary tract after radical cystectomy: is there prevention and what are the treatment options?

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Abstract

Radical cystectomy is recognized as the gold standard in the management of muscle-invasive bladder cancer. However, despite its definitive nature, recurrences of urothelial carcinoma in the upper urinary tract remain an important cause of morbidity and mortality during long-term follow-up. The prognosis of such recurrences is generally poor, largely due to delayed diagnosis.

This article presents three clinical cases of upper urinary tract recurrence detected 16–24 months after radical cystectomy. Successful treatment was achieved with radical nephroureterectomy including excision of the adjacent intestinal segment. These cases highlight the effectiveness of this surgical approach for upper tract recurrences following radical cystectomy and emphasize the need to establish criteria to determine whether urothelial tumors in the upper urinary tract represent true recurrences of bladder cancer or previously undiagnosed primary lesions. Further studies are required to develop algorithms for the early detection and management of this relatively rare pattern of disease progression.

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About the authors

Dmitry V. Perlin

Volgograd Regional Center of Urology and Nephrology; Volgograd State Medical University

Author for correspondence.
Email: dvperlin@mail.ru
ORCID iD: 0000-0002-4415-0903

Dr. Sc. (Med.), Professor, Chief Physician; Head of the Department of Urology

Russian Federation, 86, Karbyshev St., Volzhsky, Volgograd Region, 404120; 1, Pavshykh Bortsov Sqr., Volgograd, 400131

Artyom O. Shmanev

Volgograd Regional Center of Urology and Nephrology; Volgograd State Medical University

Email: sparta238@yandex.ru
ORCID iD: 0000-0002-8807-8819

Urologist; Assistant at the Department of Urology

Russian Federation, 86, Karbyshev St., Volzhsky, Volgograd Region, 404120; 1, Pavshykh Bortsov Sqr., Volgograd, 400131

Shamil N. Shamkhalov

Volgograd Regional Center of Urology and Nephrology

Email: samhalov@yandex.ru
ORCID iD: 0000-0002-5302-2217

Urologist

Russian Federation, 86, Karbyshev St., Volzhsky, Volgograd Region, 404120

Vasily P. Zipunnikov

Volgograd Regional Center of Urology and Nephrology; Volgograd State Medical University

Email: vzipunnikov@yandex.ru
ORCID iD: 0000-0003-0980-4534

Cand. Sc. (Med.), Head of the Urology Department; Associate Professor at the Urology Department

Russian Federation, 86, Karbyshev St., Volzhsky, Volgograd Region, 404120; 1, Pavshykh Bortsov Sqr., Volgograd, 400131

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Supplementary files

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2. Fig. 1. Intraoperative view – retroperitoneoscopic nephroureterectomy: clipping and transection of the renal vein

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3. Fig. 2. Intraoperative view – clipping of the ureter in the proximal section

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4. Fig. 3. Intraoperative view – mobilisation of the ureter under the mesentery of the sigmoid colon

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5. Fig. 4. Intraoperative view – resection of the ureter with the adjacent intestinal conduit bed

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