Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2023; 11(13): 3062-3069
Published online May 6, 2023. doi: 10.12998/wjcc.v11.i13.3062
Metachronous urothelial carcinoma in the renal pelvis, bladder, and urethra: A case report
Jian-Qing Zhang, Yu Duan, Kun Wang, Xiao-Li Zhang, Ke-Hua Jiang
Jian-Qing Zhang, Yu Duan, Kun Wang, Ke-Hua Jiang, Department of Urology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
Xiao-Li Zhang, Department of Biomedicine, Guizhou University, Guiyang 550025, Guizhou Province, China
Author contributions: Zhang JQ, Duan Y and Wang K contributed to this work; Jiang KH designed the study; Zhang JQ and Duan Y drafted the manuscript; Wang K and Zhang XL collected the clinical data; All authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82060462; The Science and Technology Plan Project of Guizhou Province, No. [2019]5405; Foundation of Health and Family Planning Commission of Guizhou Province, No. gzwjkj2019-1-127
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ke-Hua Jiang, MD, Professor, Department of Urology, Guizhou Provincial People’s Hospital, No. 52 Zhongshan East Road, Nanming District, Guiyang 550002, Guizhou Province, China. tjjkh@sina.com
Received: November 28, 2022
Peer-review started: November 28, 2022
First decision: December 19, 2022
Revised: February 6, 2023
Accepted: March 31, 2023
Article in press: March 31, 2023
Published online: May 6, 2023
Processing time: 148 Days and 2.2 Hours
Abstract
BACKGROUND

Urothelial carcinoma (UC) is a common malignancy of the urinary system that can occur anywhere from the renal pelvis to the proximal urethra. Most UCs are in the bladder and have multifocal growth. Upper urinary tract UC (UTUC), which occurs in the renal pelvis or ureter, accounts for only 5% to 10% of UCs.

CASE SUMMARY

In March 2015, a 70-year-old male who initially presented to a local hospital with a complaint of painless hematuria was diagnosed with UTUC of the right renal pelvis. The doctors administered radical nephroureterectomy and bladder cuff excision. Although the doctors recommended intravesical chemotherapy and regular follow-up, he rejected this advice. In December 2016, the patient presented at our hospital with dysuria. We identified UC in the residual bladder and administered radical cystectomy and left cutaneous ureterostomy. In November 2021, he presented again with urethral bleeding. We detected urethral UC as the cause of urethral orifice bleeding and administered radical urethrectomy. Since then, he has visited regularly for 6-mo follow-ups, and was in stable condition as of December 2022.

CONCLUSION

UTUC is prone to seeding and recurrence. Adjuvant instillation therapy and intense surveillance are crucial for these patients.

Keywords: Upper urinary tract urothelial carcinoma; Bladder urothelial carcinoma; Urethral urothelial carcinoma; Treatment; Case report

Core Tip: Urothelial carcinoma (UC) is a common malignancy in the urinary system, and typically grows from multiple foci. UC is most common in the bladder, and upper urinary tract UC (UTUC) is rare. We describe a male who initially presented at a local hospital in 2015 at the age of 70 years with a complaint of painless hematuria. The doctors diagnosed UTUC of the right renal pelvis. After radical nephroureterectomy and bladder cuff excision, the doctors recommended intravesical chemotherapy and regular follow-up, but he rejected this advice. He presented at our hospital again with dysuria in 2016. We identified UC in the residual bladder and performed radical cystectomy and left cutaneous ureterostomy. Unfortunately, he presented again with urethral orifice bleeding in 2021, and we identified urethral UC as the cause. We thus administered radical urethrectomy. Since this last surgery, he has received regular 6-mo follow-ups and has remained in a stable condition. Treatment for upper UTUC should include adjuvant instillation as immunotherapy and intense surveillance.