Outcomes of patients undergoing concurrent radical cystectomy and nephroureterectomy: A single-institution series

Authors

  • Gianpaolo P. Carpinito Department of Urology, University of Texas Southwestern Medical Center
  • Grayden S. Cook University of Texas Southwestern School of Medicine
  • Aaron N. Tverye University of Texas Southwestern School of Medicine
  • Samuel A. Gold Department of Urology, University of Texas Southwestern Medical Center
  • Yair Lotan Department of Urology, University of Texas Southwestern Medical Center
  • Vitaly Margulis Department of Urology, University of Texas Southwestern Medical Center
  • Jeffrey M. Howard UT Southwestern Medical Center

DOI:

https://doi.org/10.5489/cuaj.7612

Keywords:

bladder cancer, upper tract urothelial carcinoma, urothelial carcinoma, radical cystectomy, nephroureterectomy

Abstract

Introduction: Radical cystectomy (RC) and radical nephroureterectomy (RNU) are commonly performed in urological oncology. Concurrent disease in the upper tract and bladder is rare, so performing both procedures in the same setting is uncommon. Here, we report the perioperative and oncological outcomes of a single-institution series of concurrent RC+RNU.

Methods: We retrospectively reviewed the charts of patients who underwent concurrent RC+RNU for bladder and/or upper tract urothelial carcinoma between 2006 and 2020. Patient demographic and clinical factors, perioperative parameters, and oncological outcomes were obtained.

Results: Twenty-seven patients underwent RC+RNU during the study period; 22 (81%) were male. Median (interquartile range) patient age was 71 (67–75) years. All had a diagnosis of bladder cancer. Concurrent upper tract urothelial carcinoma (UTUC) was the indication for RNU in 12 cases (44%) and non-functional renal unit in the remainder. Two patients (7%) experienced early postoperative mortality. Eight patients (30%) experienced major complications (Clavien-Dindo >3). Complications did not vary significantly between those rendered anephric (5/16, 31%) and those who were not (3/11, 27%) (p=0.82, Chi-squared test). Median (95% confidence interval) and five-year overall survival were 47 (41–52) months and 42%, respectively. Six of 22 male patients (27%) experienced a urethral recurrence and three of 14 patients (21%) with non-functional kidneys had occult UTUC discovered on final pathology.

Conclusions: Combined RC+RNU carries an elevated perioperative risk, primarily in highly comorbid patients. Striking rates of occult UTUC in non-functional kidneys and of urethral recurrence after cystectomy were noted. RC+RNU is an appropriate option in select patients.

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Published

2022-02-28

How to Cite

Carpinito, G. P., Cook, G. S. ., Tverye, A. N., Gold, S. A., Lotan, Y., Margulis, V., & Howard, J. M. (2022). Outcomes of patients undergoing concurrent radical cystectomy and nephroureterectomy: A single-institution series. Canadian Urological Association Journal, 16(7), E363–9. https://doi.org/10.5489/cuaj.7612

Issue

Vol. 16 No. 7 (2022): CUAJ July

Section

Original Research

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