The Risk of Upper Tract Recurrence Following Cystectomy in Patients with Transitional Cell Carcinoma Involving the Distal Ureter

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Abstract
Risk factors for the development of an upper urinary tract transitional cell carcinoma following radical cystectomy are identified.The records of 430 patients who underwent cystectomy for transitional cell carcinoma of the bladder between 1981 and 1988 were retrospectively reviewed.Upper tract tumors developed in 11 patients (2.6%) at a median of 40 months after radical cystectomy. Of the potential risk factors evaluated only the presence of transitional cell carcinoma within the distal ureter showed a statistically significant correlation with upper tract recurrence (p = 0.001). Six of the 11 recurrent neoplasms were asymptomatic. Among the patients with upper urinary tract recurrence 5 died of disease, 4 had no evidence of disease and 2 were alive with cancer.Patients with distal ureteral involvement at cystectomy are at a high risk for upper tract recurrence. These patients should be monitored with routine upper tract cytology and imaging studies.