Yedulla Reddy Roshan, Ravichandran Rajan, Singh Rubina, T Chandru, Kumaresan Natarajan
Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
Cureus. 2025 Jul 26;17(7):e88821. doi: 10.7759/cureus.88821. eCollection 2025 Jul.
Recurrent upper-tract urothelial carcinoma (UTUC) following radical cystectomy is an uncommon but clinically significant occurrence. We present the case of a 48-year-old man with a history of muscle-invasive bladder cancer (pT2N0M0) treated with radical cystectomy and Bricker ileal conduit diversion. He remained recurrence-free on structured surveillance for 42 months before developing isolated, painless stomal bleeding without associated systemic symptoms. Cross-sectional imaging revealed a 1.6 cm enhancing mass at the left uretero-enteric anastomosis with mild proximal hydroureteronephrosis, and PET-CT confirmed localized hypermetabolic activity without nodal or distant spread. The patient underwent laparoscopic radical nephroureterectomy with en-bloc excision of the distal ureter and limited conduit revision. Histopathology confirmed high-grade invasive UTUC (pT2) with lympho-vascular invasion, negative surgical margins, and a negative hilar node. He subsequently received four cycles of adjuvant gemcitabine-cisplatin (GC) chemotherapy. 18 months postoperatively, the patient remains asymptomatic with preserved renal function and no evidence of radiological recurrence. This case highlights the importance of considering upper-tract recurrence in the differential diagnosis of conduit bleeding. It supports timely cross-sectional imaging and oncologic resection as key steps in achieving long-term disease control.
根治性膀胱切除术后复发性上尿路尿路上皮癌（UTUC）虽不常见，但具有临床意义。我们报告一例48岁男性病例，该患者有肌肉浸润性膀胱癌（pT2N0M0）病史，接受了根治性膀胱切除术及Bricker回肠导管改道术。在进行了42个月的结构化监测且无复发后，他出现了孤立的、无痛的造口出血，无相关全身症状。横断面成像显示左输尿管肠吻合处有一个1.6 cm的强化肿块，近端轻度输尿管肾盂积水，PET-CT证实为局限性高代谢活性，无淋巴结或远处转移。患者接受了腹腔镜根治性肾输尿管切除术，同时整块切除远端输尿管并对导管进行有限修复。组织病理学证实为高级别浸润性UTUC（pT2），伴有淋巴血管浸润，手术切缘阴性，肾门淋巴结阴性。随后，他接受了四个周期的吉西他滨-顺铂（GC）辅助化疗。术后18个月，患者无症状，肾功能保留，无影像学复发证据。该病例强调了在导管出血的鉴别诊断中考虑上尿路复发的重要性。它支持及时进行横断面成像和肿瘤切除，作为实现长期疾病控制的关键步骤。
