Synchronous Urothelial Tumors In Multiple Urinary Organs

1. Objective:To investigate the clinical features, diagnosis and treatment of synchronous urothelial tumors in multiple urinary organs.2. Methods:45 newly diagnosed patients with synchronous urothelial tumors in multiple urinary organs from January 1996 to December 2006 were analyzed retrospectively for the clinical states, involved sites, clinical stage, grade, laboratory/imaging examinations, operations, recurrence and prognosis.3. Results:A total of 45 patients (18 men and 27 women; age range, 44 - 83 years; mean age, 62.1 years) with synchronous urothelial tumors in multiple urinary organs who had undergone follow-up were reviewed. Of them, 18 cases had carcinomas of renal pelvis and ureter; 7 cases had carcinomas of renal pelvis and bladder;8 cases had carcinomas of ureter and bladder; 6 cases had concurrent carcinomas of renal pelvis, ureter and bladder; 5 cases had carcinomas of bilateral ureters; 1 cases had carcinomas of bilateral renal pelvises. By tumor staging, 9 cases had stage Ta tumor ; 12 cases had stage T1 tumor; 9 cases, T2 ; 12 cases, T3 ; and 3 cases, T4. By tumor grading, 5 cases had G1 tumor; 22 cases, G2 ; and 18 cases, G3. Follow-up ranged from 4 months to 11 years. Among the 45 patients, 32 (71.1%) were preoperatively diagnosed with urothelial tumors in multiple organs. The preoperative accuracy rate was 20.0% (9/45) by B-ultrasound, 10.7% (3/28) by IVU, 51.5% (17/33) by retrograde pyelography, 32.6% ( 14/43) by CT,28.6% (4/14) by MRI, 81.8% (9/11) by ureteropyeloscopy, respectively. After operation 14 patients (31.1%) had urothelial tumors recurrence(11 cases with bladder tumors and 3 cases with contralateral renal pelvis tumors); and 10 of them had recurrence within 2 years. The recurrence rates of G1, G2and G3 bladder carcinoma were 0% , 50% and 16.7% , respectively. The recurrence rate of G2 - G3 cases was significantly higher than that of G1 cases (P < 0. 01). 2 cases had higher grade than before. 11 cases died during the follow-up ,The 3-, 5-year survival rates were 62.1% and 42.1% , respectively.4. Conclusions:Ureteropyeloscopy is a good means for detection of synchronous urothelial tumors in multiple urinary organs.Bladder tumor recurrence is common in synchronous urothelial tumors in multiple urinary organs and it is correlated with tumor grade. Most of them had recurrence within 2 years. Close follow-up, including regular cystoscopy and urography, is required.The majority of recurrence tumors has the same or lower grade than the original tumors, the recurrence has no significantly effect to prognosis.