異時性多発性尿路上皮癌に対して最終的に尿路全摘除を施行した1例

Abstract

48歳男.頻回に再発する尿路移行上皮癌で最終的に尿路全摘除術, 血液透析となった症例

A 48-year-old male patient underwent transurethral resection (TUR) for solitary bladder tumor in January 1985. Pathological finding of the specimen was non-invasive transitional cell carcinoma (TCC) G2 > G1. Following the operation, prophylactic intravesical instillation of antitumor agents, intrapelvic irradiation, and hyperthermia were done for the recurrences. In June 1987, left renal pelvic tumor revealed, and nephroureterectomy was performed. Histological examination of renal pelvic tumor showed TCC G1. Five months later, multiple bladder tumors and right renal pelvic tumor were detected. A total cystectomy, partial nephrectomy and nephrostomy were performed in February and March 1988. Pathology of the bladder and right kidney were TCC G3. One month after these operations, tumors recurred in the rest of the right kidney. Complete remission was achieved after systemic chemotherapy with methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC). In January 1992, right renal pelvic tumor recurred again. After two cycles of M-VAC therapy, the rest of the right kidney was extirpated. Postoperative hemodialysis has been uneventful. He has lived without tumor recurrence for three years after the introduction of hemodialysis.