Management of panurothelial disease in superficial bladder cancer.

BACKGROUND

A 59-year-old female presented with a history of recurrent superficial bladder cancer. Since the initial diagnosis 12 years earlier, she had had 12 recurrences, all treated with transurethral resection with adjuvant bacillus Calmette-Guérin and mitomycin C. Pathology samples had always shown Ta grade 1 transitional-cell carcinoma. At the last recurrence, she presented with several papillary lesions throughout the bladder, discovered on control cystoscopy. Transurethral resection revealed a papillary grade 3 transitional-cell carcinoma of the bladder.

INVESTIGATIONS: Intravenous urography and ureteroscopy.

DIAGNOSIS: Panurothelial superficial transitional-cell carcinoma.

MANAGEMENT: Radical cystectomy with total right ureterectomy and distal left ureterectomy. Reconstruction of the urinary tract was performed with the distal ileum detubulized and rearranged in a U shape. A pyeloileal anastomosis and a proximal ureteroileal anastomosis were performed at the right and left sides respectively.