Case Study - August 2009
This is a CT scan in an 80-year-old man with invasive bladder cancer (treated by chemotherapy alone) and a previous right nephroureterectomy for an ureteric tumour. He has been experiencing haematuria despite a recent normal check cystoscopy.
- What does the CT show?
- What other investigations should be performed?
- What treatment is needed?
Reveal Answer
Open answer There is no fixed answer to this question, however your response should be similar to the one below:
- The CT shows an "apple-core" lesion in the remaining (left) lower ureter, consistent with a solid intra-ureteric tumour
- Urine cytology (or ureteric washings) may help in diagnosis. Retrograde ureterography with rigid ureteroscopy & biopsy confirmed a tumour of the ureter which was a G3 pT1 transitional cell carcinoma
- Ideally, he should have a nephroureterectomy but this would render him anephric. He declined an attempt at open reconstruction with re-anastomosis and was managed by permanent ureteric stenting