Upper urinary tract tumour after radical cystectomy for transitional cell carcinoma of the bladder: an update on the risk factors, surveillance regimens and treatments
Article first published online: 8 APR 2007
Volume 100, Issue 1, pages 11–16, July 2007
How to Cite
Sanderson, K. M. and Rouprêt, M. (2007), Upper urinary tract tumour after radical cystectomy for transitional cell carcinoma of the bladder: an update on the risk factors, surveillance regimens and treatments. BJU International, 100: 11–16. doi: 10.1111/j.1464-410X.2007.06841.x
- Issue published online: 8 APR 2007
- Article first published online: 8 APR 2007
- Accepted for publication 21 December 2006
- urinary tract cancer;
- bladder cancer;
- transitional cell;
The mini reviews this month cover two somewhat unusual topics, but I feel certain that they will be of interest to the readership. Metachronous TCC in the upper urinary tract after radical cystectomy has been an important topic in relation to the follow-up, and this paper throws considerable light on the subject. The second paper is an excellent review of the literature on emphysematous cystitis.
Urothelial carcinoma is characterized by multiple, multifocal recurrences throughout the genitourinary tract; ≈ 3% of patients treated by radical cystectomy (RC) for invasive transitional cell carcinoma (TCC) of the bladder will subsequently develop a subsequent TCC in the upper urinary tract (UUT) urothelium. Metachronous upper UUT tumours (mUUT-TCC) typically occur as a late oncological event (>3 years after RC). The vast majority of mUUT-TCCs are detected only after the progression to tumour-related symptoms, e.g. haematuria, flank pain or pyelonephritis, despite strict adherence to surveillance protocols. Failure of imaging and cytology to detect most asymptomatic tumours has led to questions about the need for routine UUT surveillance. Some authors have advocated a more tailored approach to surveillance after RC, targeting high-risk patients and with limiting imaging in those patients at lowest risk of developing a subsequent UUT-TCC. mUUT-TCCs are most common in patients with TCC in the ureter or urethra, and with organ-confined bladder cancer. Although the prognosis is generally poor, long-term survival can be achieved in a subset of patients after radical nephroureterectomy (NU). Minimally invasive techniques, e.g. ureteroscopic and percutaneous resection, have been proposed as renal-sparing alternatives to radical surgery for patients with low-stage and -grade de novo UUT-TCC. However, oncological control of renal-sparing therapies in those with high-risk mUUT-TCC remains largely unconfirmed. Until oncological outcomes equivalent to the standard, radical NU, are reported in patients after RC, conservative treatment strategies should be avoided.