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.

  1. What does the CT show?
  2. What other investigations should be performed?
  3. 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:

  1. The CT shows an "apple-core" lesion in the remaining (left) lower ureter, consistent with a solid intra-ureteric tumour
  2. 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
  3. 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

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