[Extension to the upper urinary tract of excreto-urinary carcinoma of the bladder. Apropos of 6 cases].

Of a total of 261 patients with carcinoma of bladder, 6 (2.3%) presented secondary lesions in upper urinary tract 3 to 13 years after initial diagnosis, including one only after total cysto-prostatectomy. These 6 patients represent 12 renal units, including 5 with iatrogenic reflux, and all had secondary urethral localizations. Urine cytology was particularly reliable since results were positive after treatment of bladder lesion and before detection of upper urinary tract foci. The latter developed whatever the stage or grade of the bladder tumor, from carcinoma in situ, through grade I stage O (3 cases), to undifferentiated and infiltrating tumor. Treatment included surgical excision, endoscopic resection including upper urinary tract (2 cases) and radio-chemo and immuno-therapy (BCG). Results were only fair with 2 deaths and 4 survivors, all with recurrence, although one has not had surgery and is in comfort without dialysis after 18 years. Two hypotheses have been invoked for the origin of these secondary upper tract tumoral localizations: grafting of tumoral cells propulsed upwards by vesicorenal reflux, almost always iatrogenic and a mysterious carcinogenic factor in urine responsible for the multicentric origin of lesions. Both are probable in part, the former appearing well established statistically. These widespread lesions require the application of all urologic resources but treatment is deceiving: since no test exists to determine evolutive potential with accuracy, treatment of bladder cancer lies between the risk of doing too much or too little.