V1862: Endoscopic evaluation of the recurrence of transitional cell carcinoma in the ureteroileal diversion.
VideoIntroduction and Objectives
Tumor recurrence in the ileal conduit is extremely rare, especially in the absence of urothelial tumor in the upper urinary tract. It usually presents as episodes of hematuria or pyelonephritis secondary to obstruction by the neoformation.
Thanks to advances in the field of endourology and as the urothelial tumor can affect the entire urinary tract, the role of endoscopic examination of both the ileal conduit and the upper urinary tract of the two sides, becomes more important.
The aim is to show the endoscopic management of tumor recurrence in the bowel diversions in a case of a patient with transitional cell carcinoma unresponsive to Bacillus Calmette- Guerin (BCG) who underwent a cystectomy in the absence of evidence of tumor in the upper urinary tract.
We explore the intestinal loop using a cystoscope. We reach theureteroileal anastomosis area (Wallace type) and catheterize both ureters and selective cytologies are obtained. Then we introduced a 26Fr resectoscope and performed resection of the recurrence in the ureteroileal anastomosis.
Subsequently retrograde ureteroscopy is performed using an Olympus flexible ureteroscope and the Porges sheath Multiple and randomized urothelial biopsies are taken, including injuries that went unnoticed in the imaging, suggestive of neoplastic recurrence.
Endoscopy of the ileal loop as well as the upper urinary tract allowed us to make a histological mapping in order to decide further treatment.
Tumor recurrence of multicentric transitional cell carcinoma associated with carcinoma in situ is common and in patients who underwent cystectomy is difficult to assess whether there is evidence of papillary formations.
The endoscopic management of patients with suspected recurrence is a safe and effective option that allows taking biopsies under direct vision and mapping the upper urinary tract, reaching inadvertent injury to the common imaging tests.