The Management of Urothelial Bladder Carcinoma with Synchronous and Bilateral Urothelial Carcinoma of the Upper Tractus at Saint Clair Hospital, South of France.

Introduction and Objectives. Urothelial carcinomas can arise throughout the entire urinary tract, the urinary bladder being the predominant point of origin. Synchronous multifocal non-muscle invasive urothelial carcinomas of the bladder (UCB) are not a rare finding. Although rare, the incidence of concomitant bladder and upper urothelial tract tumors (UTUC) is 8-17% and mostly found in recurrences after initial treatment. The aim of this article is to share our individual experience regarding the case management of a patient with synchronous bilateral UTUC and UCB, at presentation, for a better understanding and optimization of future patient care. Materials and Methods. A late November 2022 evening, Mr. V.J.M, an 81-year-old male patient, is brought into our emergency room at the request of his general practitioner for suspicion of acute ischemic stroke. A kidney and bladder ultrasound (US) scan was performed, finding bilateral hydronephrosis and the presence of a tumor mass measuring almost 3 centimeters on the right lateral wall of the bladder. A non-contrast CT scan confirmed the bilateral hydronephrosis as well as the presence of an endo-ureteral tissue density mass at L4 level on the right side and another an endo-ureteral tissue density mass in regard to the iliac vessels on the left side, highly in favor of urothelial lesions Results. An urgent urine drainage was granted, the patient undergoing surgery for a bilateral retrograde stent insertion. A second intervention consisting in a transurethral resection of the bladder and bilateral rigid and flexible diagnostic ureteroscopy (URS) was performed. The histopathological examination reported a non-muscle invasive low-grade papillary urothelial carcinoma (NMIBC) for all the lesions of the upper tractus as well as the bladder lesion. The patient then underwent surgery allowing the laser vaporization of all urothelial masses and bilateral double J stents were left in place as to ensure good kidney drainage. Conclusions. Although the incidence of concomitant bladder and upper urothelial tract tumors is very rare, it is something that we may stumble upon in everyday clinical practice. The management of multifocal and synchronous locations is difficult, requiring a multidisciplinary approach with a meticulous preoperative and postoperative planning as to offer the most adapted treatment plan, where minimal invasive treatment might be offered in highly selected cases as this one. If radical invasive treatment cannot be proposed, a more rigorous follow-up may be useful as not to compromise the oncological results. [ABSTRACT FROM AUTHOR]