Approaches to Upper Urinary Tract Recurrences Following Radical Cystectomy

The incidence of recurrences in upper urinary tract following radical cystectomy has is 4-6%. Recurrences are usually observed at an advanced stage and survival rates are low. In this review, literature related to risk factors for the development of upper urinary tract recurrences, diagnostic tools and approaches to these patients will be evaluated. The progression rate in patients with recurrences in the upper urinary tract following radical cystectomy is high. Risk factors for the development of recurrence are previous history of non-muscle invasive bladder cancer, multiple tumors, co-incidence of in-situ carcinoma, tumor in the distal ureteral margins, and tumor in the prostatic urethra as well as tumor grade and lymph node involvement. Computed tomography and cytology can be used as diagnostic tools, however, routine use of diagnostic tools in asymptomatic patients is under debate. Nephroureterectomy is the gold standard treatment for these patients In this procedure, the entire ureter, including the ureterointestinal anastomosis should be extracted. General health status of the patient, stage of the disease and previous radical cystectomy as well as urinary diversion techniques should be evaluated while planning the treatment. Special care must be taken during the follow-up after radical cystectomy for the development of recurrences in upper urinary tract. Routine follow-up should be applied to patients with certain risk factors and while planning the treatment, stage of the disease, previous radical cystectomy and urinary diversion techniques should be kept in mind.