The risk of upper tract recurrence following cystectomy in patients with transitional cell carcinoma involving the distal ureter

Purpose: Risk factors for the development of an upper urinary tract transitional cell carcinoma following radical cystectomy are identified. Materials and Methods: The records of 430 patients who underwent cystectomy for transitional cell carcinoma of the bladder between 1981 and 1988 were retrospectively reviewed. Results: Upper tract tumors developed in 11 patients (2.6%) at a median of 40 months after radical cystectomy. Of the potential risk factors evaluated only the presence of transitional cell carcinoma within the distal ureter showed a statistically significant correlation with upper tract recurrence (p = 0.001). Six of the 11 recurrent neoplasms were asymptomatic. Among the patients with upper urinary tract recurrence 5 died of disease, 4 had no evidence of disease and 2 were alive with cancer. Conclusions: Patients with distal ureteral involvement at cystectomy are at a high risk for upper tract recurrence. These patients should be monitored with routine upper tract cytology and imaging studies.