Hungarian Society of Urology

Late recurrence of urothelial carcinoma after radical cystectomy and its surgical solution

DOI: 10.22591/magyurol.2021.2.torkolyt.71

Törköly Tamás Máté dr.1, Farkas Antal dr.2, Somogyi Tamás dr.2, Flaskó Tibor dr.2
1Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktatókórház, Urológiai osztály Miskolc (osztályvezető: Máté Zsolt dr.)
2 Debreceni Egyetem KK Urológiai Klinika Debrecen, (igazgató: Flaskó Tibor dr.)


Introduction: In Hungary the uretero-ileo-cutaneostomy (Bricker conduit) is a popular and widely used procedure to achieve proper urinary diversion after radical cystectomy. Among the different types of urinary diversions, those patients with ileum conduits and those with orthotopic neobladders have similar oncological outcomes. The upper urinary tract represents the most common site where late recurrence of urothelial carcinomas occurs. In these cases, radical nephroureterectomy is the most accepted method that may prolong survival.
Case report: We present the case of a late urothelial tumour recurrence at the distal ureter and ileum conduit after radical cystectomy (2015) in a 63-year-old male patient. The patient attended regular follow-up visits and had no complications after surgery. In the fall of 2020 the patient presented with massive haematuria from the ileal conduit. CT scan detected an exophytic tumour at the left uretero-ileal anastomosis as the source of bleeding. After quick evaluation of options and proper preparations, left side uretero-nephrectomy and the exploration of the Bricker conduit were done. During the procedure the tumour and proximal end of the conduit turned out to be resecable.
The right side anastomosis remained unaffected. Histology showed recurrent pT3 urothelial tumour.
Conclusions: Long term, probably lifelong follow-up is recommended in all cases after radical cystectomy. In the upper urinary tract, tumour recurrence can occur even after many years. Recurrence may also develop in the lumen of the conduit. Organ sparing techniques can be possible even in cases with recurrent urothelial carcinomas at the site of the uretero-enteral anastomosis.


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