Method for surgical treatment of bladder cancer in patients with end-stage renal disease on renal replacement therapy with program hemodialysis simultaneously with treatment and prevention of purulent pyelonephritis. Review of clinical cases

Background. Bladder cancer (BC) is one of the most common malignancies in the world and ranks 7th in the structure of oncopathology in men and 17th in women. Patients on renal replacement therapy (RRT) have been shown to have a more aggressive tumor and often a more advanced stage of the disease. In most cases, the disease is asymptomatic at an early stage and difficult to screen. As a rule, clinical manifestations and diagnosis occur at the muscle-invasive stage, where organ-preserving treatment is not possible.

Description of the clinical cases. From 2021 to 2023, 2 patients with muscle-invasive bladder cancer with end-stage renal disease (ESRD), who were on RRT with program hemodialysis, underwent surgery at the City Clinical Hospital № 52. All patients underwent laparoscopic bilateral nephroureterectomy, cystoprostatvesiculectomy, ad bloc ureterectomy.

Results. All patients underwent minimally invasive surgical treatment. There were no complications in the early and late operative periods, and there were no lethal cases. According to the results of histological examination in all patients, the kidney tissue has sclerotic changes and thinned urothelium without signs of tumor growth, mono- or bilateral apostematous pyelonephritis. The first patient had muscle-invasive urothelial bladder cancer pT2b N0. The second patient has metastases in the lymph nodes of the small pelvis. Also as an accidental finding, prostate cancer pT2N0 Gleason 6 (3+3) was detected. During the follow-up period at the outpatient settings, no data on the progression of the oncological process were received.

Conclusion. On the example of these clinical cases, it can be convinced that the radical treatment of muscle-invasive bladder cancer in patients with ESRD is possible in combination with the removal of a purulent-septic focus, and in some cases it can be a prevention of purulent-septic complications. However, in the treatment of these diseases, it is necessary to apply a multimodal approach to develop optimal methods for diagnosis and treatment.