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. 2018 Dec 21;45(5):393-397.
doi: 10.5152/tud.2018.55453. Print 2019 Sep.

Aggressive treatment for urothelial cancer-complete urinary tract extirpation: Operative feasibility in two cases

Murat Akand  1 , Özcan Kılıç  1 , İsmail Harmankaya  2 , Pınar Karabağlı  2 , Çağdaş Yavaş  3 , Özlem Ata  4
Affiliations

Aggressive treatment for urothelial cancer-complete urinary tract extirpation: Operative feasibility in two cases

Murat Akand et al. Turk J Urol. .

Abstract

Bladder cancer (BC), the most common malignancy of the urinary tract, accounts for 90-95% of all urothelial carcinomas (UCs), while upper urinary tract UC (UUTUC) accounts for only 5-10%. Radical nephroureterectomy with excision of bladder cuff, and radical cystectomy with pelvic lymph node dissection and a urinary diversion (UD) are the gold standard treatments for UUTUC and muscle-invasive bladder cancer (MIBC), respectively. These two treatments can be performed simultaneously when a bilateral or unilateral UUTUC is present with a MIBC, and are called complete urinary tract extirpation (CUTE) and hemi-CUTE, respectively. This complex surgery can help the patient by avoiding multi-staged surgeries, repeated anesthesia, and delay in completion of treatment. Herein, we report the first cases of a hemi-CUTE and CUTE in our department and share our experience with this aggressive and complex surgical treatment.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
a, b. Magnetic resonance imaging scan showing the UUTUC in left kidney. (a) Axial section, (b) Coronal section
Figure 2
Figure 2
Image of the hemi-CUTE specimen
Figure 3
Figure 3
a–c. Histopathological evaluation of the hemi-CUTE specimen. (a) Infiltrating urothelial carcinoma of the kidney. The tumor is composed of invasive malignant urothelial cell groups (hematoxylin & eosin, 100X). (b) Infiltrating urothelial carcinoma of the kidney. In immunohistochemistry, the tumor cells were positive for CK7 (CK7, ×50). (c) Infiltrating urothelial carcinoma of the urinary bladder. The tumor is composed of high-grade urothelial cell groups arranged in a papillary pattern, which infiltrated the muscular layer of the bladder (hematoxylin & eosin, 100X)
Figure 4
Figure 4
a, b. Computed tomography image showing the tumor in bladder dome. (a) Axial section. (b) Coronal section; bilateral atrophic kidneys with numerous cysts suggestive of end-stage renal disease are shown
Figure 5
Figure 5
Image of the CUTE specimen
Figure 6
Figure 6
a–f. Histopathological evaluation of the CUTE specimen. (a) Glomerulosclerosis, right kidney (hematoxylin & eosin 100X). (b) Glomerulosclerosis, left kidney (hematoxylin & eosin, 100X). (c) Infiltrating urothelial carcinoma of the urinary bladder (hematoxylin & eosin, 50X). (d) Tumor-muscle interaction (desmin, 100X). (e) Tumor-muscle interaction (hematoxylin & eosin, 100X). (f) Tumor-muscle interaction (pancytokeratin, 100X)
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