He has a history of left side pelvis tumor for which he had radical surgery in 2011. The bladder recurrence was noticed in 2013 for which he was treated with TURBT followed by BCG x 6 and again in January 2014. Now he has extensive disease involving the renal pelvis, ureter and bladder.
An extensive TCC mass , in solitary renal unit with such multifocality and recurrence might be of high grade, what about metastasis work up and renal function ?
This patient have a very bad TCC outcome with multifocal recurrences.Now if the tumor involves all rigth urinary tract radical surgery is mandatori.Start with dyalisis and blader control.A renal transplantation my be possible after years
If no metastasis,I agree with Dott. Pere Borrat. If bladder is interested also cystectomy.
the safest procedure would be nefro-ureterectomy.
In case of low grade tumor we performed in 1 case bench-surgery
We explanted the kidney, cooled and perfused the kidney with eurocolllins solution and resected all the tumor out of the renal pelvis. Then we closed the pelvis and autotransplanted the kidney in the iliac fossa,
Safest would be Radical nephrouretrectomy with cystectomy if bladder is involved. He will need a renal transplant subsequently.
Many thanks to all of you for valuable opinions and comments.
The case was reffered to me by the urolgist and initial information was disease localized to renal calyx, ureter and bladder. After reviewing in detail we discussed the case in detail and suggested complete staging.
If after staging there is no distant disease then radical surgery followed by hemodialysis for some time followed by renal transplant. In case distant disease is visible then palliative chemotherapy.
Many thanks once again for showing interest and contribution.
Cystectomy (T1G3- invasive) and nephroureterectomy> dyalisis> 5 years survival> renal transplantation.
If there is no evidence of distant metastasis I suggest Nephroureterectomy and Cystectomy with extensive lymphadenectomy. After the pathohistological examination decision about chemotherapy. Hemo or peritonel dyalisis and after 5 years determination of renal transplantation.
I agree with nephroureterectomy and cystectomy if no distant spread.
I wish to ask why wait for 5 years on dialysis before transplantation. Is 3 years not adequate?
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