In the case of a fit patient (ECOG 0/1), having a distal ureteric tumor, with a proven TCC high grade pT1- of the bladder, what would be the most apt management strategy?
Would the choice of management vary, depending on-
A) Age of the patient
B) Status of the Opposite kidney
C) Role of reimplantation of the ureter in a diseased bladder.
D) Need for surveillance of the upper tract.
For sure it depends on other factors as well, like the stage and grade, the condition of the higher ureter, renal function, and comorbid condition.
I agree with Mr. Hadi. In a fit patient and according to AUA guidelines, I would suggest neoadjuvant chemotherapy because of the UTUC. Based on the UTUC + high-risk NMIBC, radical cystectomy and either nephroureterectomy or distal ureterectomy should be discussed with the patient. Based on the need for postoperative surveillance, I would suggest nephroureterctomy rather than ureterectomy.
Yes, the management of UTUC and bladder Ca depends on many patient-related factors, including age, grade, stage, multifocality, bilaterality or status of contralateral kidney function….
For high grade, high stage, AND unilateral UTUC, radical Nephroureterectomy is recommended.
For low grade, superficial and single tumor, solitary kidney or bilateral involvement,…nephron sparing approach including ureteric resection and reimplantation is preferable.
But in this index case, we know the status bladder Ca (high grade pT1) and that of ureteric tumor was not mentioned.
If high grade or stage tumor, Radical cystectomy with Nephroureterectomy can be an option. But we need to consider the mentioned factors to decide.
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