Letter to the Editor
Panurothelial recurrence in a patient after nephroureterectomy for transitional cell carcinoma. A therapeutic dilema
Recidiva panurotelial en paciente con nefroureterectomía por tumor de células transicionales. Dilema terapéutico
G.H. Mutsinzi Mukarukaka
, A. Arruza Echevarría
Corresponding author
Servicio de Urología, Hospital Universitario de Cruces, Barakaldo, Spain
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A therapeutic dilema" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "513" "paginaFinal" => "514" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G.H. Mutsinzi Mukarukaka, A. Arruza Echevarría" "autores" => array:2 [ 0 => array:4 [ "nombre" => "G.H." "apellidos" => "Mutsinzi Mukarukaka" "email" => array:1 [ 0 => "hirwa93@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Arruza Echevarría" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Urología, Hospital Universitario de Cruces, Barakaldo, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recidiva panurotelial en paciente con nefroureterectomía por tumor de células transicionales. Dilema terapéutico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 969 "Ancho" => 1508 "Tamanyo" => 152875 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominopelvic computed tomography: half empty bladder with irregular walls. Distal ureter thickening (marked with an arrow) with double J stent tip inside.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 61-year-old man diagnosed with a recurrent panurothelial tumor. The scarcity of information about synchronous presentation at the level of the urethra, bladder, and ureter, as in our case, makes treatment a challenge.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient went to the emergency room where an ultrasound was requested due to creatinine level of 7<span class="elsevierStyleHsp" style=""></span>mg/dL. The ultrasound revealed the absence of the right kidney and obstruction of the left due to a calcified double-J stent. Although we knew that he had undergone surgery at another center for urothelial neoplasia, the patient had to be questioned again to clarify that he had undergone a right nephroureterectomy, several transurethral resections of the bladder (TUR), a distal left ureterectomy with reimplantation, and chemotherapy. For unknown reasons, he had lost all follow-up at his referral center, without any contact with urology until then. After placing a nephrostomy and improving creatinine to 2.5<span class="elsevierStyleHsp" style=""></span>mg/dL, a computed tomography urogram (CTU) was requested, which showed parietal thickening of the distal ureter up to the trigone, the distal end of the double-J ascended to the ureter and absence of metastatic spread (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Cystoscopy reveals papillary lesions in the urethra and bladder. We proposed an initial endoscopic approach, resecting the urethral and bladder lesions, compatible with a low-grade non-muscle invasive tumor, but it was impossible to perform a ureteroscopy due to the stenosis produced by the tumor.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">It seems obvious that treatment of the residual tumor implies at least the exeresis of the affected ureteral section. The dilemma arises from the decision to try to preserve the residual kidney, and the suitability of preserving the urethra and bladder having assumed the need for permanent nephrostomy or cutaneous ureterostomy. Although complete excision of the urothelium would have been the safest oncologically, when making such decisions we include factors such as loss of quality of life and significant increase in morbidity when starting dialysis after nephroureterectomy, the eventual need for chemotherapy for which the patient would not be a good candidate without residual renal function, the patient's interest in trying the most conservative surgery, and the history of lack of adherence to follow-up and treatment. After some discussion, we finally offered the patient radical cystoprostatectomy and ureterectomy, trying to preserve the kidney, but explaining the risk of recurrence. The patient understood and accepted the intervention, but at the last moment he rejected surgery and requested follow-up at a center in another region.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Reviewing the literature on panurothelial involvement, we found that the most frequent presentation is metachronous recurrence in the upper urinary tract after cystectomy.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We share this case because of its rarity, and therefore, the difficulty of proposing clinical management that considers the patient's wish to try a conservative approach. Various texts consulted defend complete exenteration of the urinary tract as a safer alternative, and the first option in selected patients,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> since recurrence is generally associated with greater aggressiveness than the initial tumor. The possible complications of cystectomy and the dependency on hemodialysis after double nephroureterectomy are what cause patients to opt for conservative management with TUR when possible. In addition, cancer-specific prognosis and survival seem to be more related to tumor stage than to surgical radicality.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest, nor have they benefited from any grant or financial support for the development of this project.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Mutsinzi Mukarukaka GH, Arruza Echevarría A. Recidiva panurotelial en paciente con nefroureterectomía por tumor de células transicionales. Dilema terapéutico, Actas Urol Esp. 2022;46:513–514.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 969 "Ancho" => 1508 "Tamanyo" => 152875 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominopelvic computed tomography: half empty bladder with irregular walls. Distal ureter thickening (marked with an arrow) with double J stent tip inside.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical outcomes in patients with panurothelial carcinoma treated with radical nephroureterectomy following cystectomy for metachronous recurrence" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Q. Li" 1 => "M. Assel" 2 => "N. Benfante" 3 => "E. Pietzak" 4 => "A. Bagrodia" 5 => "E. Cha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2017.03.120" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2017" "volumen" => "198" "paginaInicial" => "546" "paginaFinal" => "551" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28342936" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cistectomía radical, histerectomía con doble anexectomía y nefroureterectomía bilateral con extracción por vía transvaginal. Descripción y consideraciones específicas de la técnica quirúrgica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Juarez-Soto" 1 => "J.M. Arroyo-Mestre" 2 => "M. Soto-Delgado" 3 => "M. de Paz-Suarez" 4 => "P. Beardo-Villar" 5 => "M.A. Arrabal-Polo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2014.02.019" "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2014" "volumen" => "38" "paginaInicial" => "694" "paginaFinal" => "697" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24703256" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and treatment outcomes of pan-urothelial cell carcinoma: a descriptive analysis of 45 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Fang" 1 => "P. Liu" 2 => "G. Xiong" 3 => "L. Zhang" 4 => "N. Singla" 5 => "G. Zhao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/srep18014" "Revista" => array:5 [ "tituloSerie" => "Sci Rep" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "18014" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26657777" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000004600000008/v1_202210061534/S2173578622000683/v1_202210061534/en/main.assets" "Apartado" => array:4 [ "identificador" => "6296" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000004600000008/v1_202210061534/S2173578622000683/v1_202210061534/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578622000683?idApp=UINPBA00004N" ]
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