Panurothelial recurrence in a patient after nephroureterectomy for transitional cell carcinoma. A therapeutic dilema

Mutsinzi Mukarukaka, G.H.; Arruza Echevarría, A.

doi:10.1016/j.acuroe.2022.02.008

array:23 ["pii" => "S2173578622000683" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2022.02.008" "estado" => "S300" "fechaPublicacion" => "2022-10-01" "aid" => "1449" "copyright" => "AEU" "copyrightAnyo" => "2022" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Urol Esp. 2022;46:513-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210480622000389" "issn" => "02104806" "doi" => "10.1016/j.acuro.2022.02.001" "estado" => "S300" "fechaPublicacion" => "2022-10-01" "aid" => "1449" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Urol Esp. 2022;46:513-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "CARTA AL DIRECTOR" "titulo" => "Recidiva panurotelial en paciente con nefroureterectomía por tumor de células transicionales. Dilema terapéutico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "513" "paginaFinal" => "514" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Panurothelial recurrence in a patient after nephroureterectomy for transitional cell carcinoma. A therapeutic dilemma" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 969 "Ancho" => 1508 "Tamanyo" => 152931 ] ] "descripcion" => array:1 [ "es" => "Tomografía computarizada abdominopélvica: vejiga semivacía con paredes irregulares. Engrosamiento de uréter distal (señalado con una flecha) con extremo de catéter doble J en su interior." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G.H. Mutsinzi Mukarukaka, A. Arruza Echevarría" "autores" => array:2 [ 0 => array:2 [ "nombre" => "G.H." "apellidos" => "Mutsinzi Mukarukaka" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Arruza Echevarría" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173578622000683" "doi" => "10.1016/j.acuroe.2022.02.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578622000683?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480622000389?idApp=UINPBA00004N" "url" => "/02104806/0000004600000008/v1_202210061428/S0210480622000389/v1_202210061428/es/main.assets" ] ] "itemAnterior" => array:18 [ "pii" => "S2173578622000506" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2022.06.002" "estado" => "S300" "fechaPublicacion" => "2022-10-01" "aid" => "1458" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2022;46:504-12" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Can ureteral stents with a different format reduce patients’ symptomatology? A single-blinded, randomized, controlled study comparing smooth-walled and grooved ureteral stents" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "504" "paginaFinal" => "512" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Puede el diseño del catéter ureteral reducir la sintomatología de los pacientes? Estudio controlado, aleatorizado y simple ciego, que compara el catéter ureteral de superficie lisa con el catéter ureteral de diseño acanalado" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2630 "Ancho" => 2508 "Tamanyo" => 264483 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "The algorithm used in this study." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.A. Villares da Costa, L.G.V. da Costa, A.C. Lopes Neto, B.M. Casulli, L.R.R. Arnoni, S. Glina" "autores" => array:6 [ 0 => array:2 [ "nombre" => "L.A." "apellidos" => "Villares da Costa" ] 1 => array:2 [ "nombre" => "L.G.V." "apellidos" => "da Costa" ] 2 => array:2 [ "nombre" => "A.C." "apellidos" => "Lopes Neto" ] 3 => array:2 [ "nombre" => "B.M." "apellidos" => "Casulli" ] 4 => array:2 [ "nombre" => "L.R.R." "apellidos" => "Arnoni" ] 5 => array:2 [ "nombre" => "S." "apellidos" => "Glina" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578622000506?idApp=UINPBA00004N" "url" => "/21735786/0000004600000008/v1_202210061534/S2173578622000506/v1_202210061534/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Panurothelial recurrence in a patient after nephroureterectomy for transitional cell carcinoma. 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" => "*" "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" => "Abdominopelvic computed tomography: half empty bladder with irregular walls. Distal ureter thickening (marked with an arrow) with double J stent tip inside." ] ] ] "textoCompleto" => "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.The patient went to the emergency room where an ultrasound was requested due to creatinine level of 7mg/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 2.5mg/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.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>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.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">1</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">1,2</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">3</a>Conflicts of interestThe 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." "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" => "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." ] ] "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" => "Abdominopelvic computed tomography: half empty bladder with irregular walls. Distal ureter thickening (marked with an arrow) with double J stent tip inside." ] ] ] "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"]

ISSN: 2173-5786

Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided. It has high visibility and accessibility and is found in the most important data bases, Medline/Pubmed, Emabase, JCR, Ïndice Médico Español, Índice bibliográfico Español en Ciencias de la Salud (IBECS), Cuiden, Dialnet, Hinari, Scopus, Google Scholar.

See more Open Access Option

Indexed in:

Science Citation Index Expanded, Journal of Citation Reports, Index Medicus/MEDLINE, Scopus, EMBASE/Excerpta Medica, IBECS

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

1.2

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

1.9

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.332

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.557

View more metrics

Journal Information

Previous article | Next article

Vol. 46. Issue 8.

Pages 513-514 (October 2022)

Lee este artículo en Español

Export reference

Download PDF

Article

These are the options to access the full texts of the publication Actas Urológicas Españolas (English Edition)

Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”

Subscribe to

Actas Urológicas Españolas (English Edition)

More information

Purchase

Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now

Contact

Phone for subscriptions and reporting of errors

From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.

Calls from Spain

932 415 960

Calls from outside Spain

+34 932 415 960

E-mail

atencionalcliente@elsevier.com

Publish in

Actas Urológicas Españolas

Tools

Actas Urológicas Españolas (English Edition) is a member and subscribes the principles of, the Committee on Publication Ethics (COPE)
www.publicationethics.org.

Free access articles

Recommendations on the treatment of metastatic...

Actas Urol Esp. 2024;48:623-31

Changes in benign prostatic hyperplasia management in...

Actas Urol Esp. 2024;48:461-9

Long-term functional success and patient-reported outcomes...

10.1016/j.acuroe.2024.05.014

Indexed in:

Follow us:

Subscribe:

Article

Subscribe to our newsletter