The Clinical Diagnosis And Treatment Strategy Of Autologous Upper Urinary Tract Tumor After Kidney Transplantation

Objective:Through the analysis and discussion of the clinical manifestation,laboratory examination,imaging,pathological features,treatment and operation time of autologous upper urinary tract tumor after renal transplantation,we should pay more attention to this disease,reduce misdiagnosis and missed diagnosis,and improve the level of diagnosis and treatment.Methods:The clinical data of 33 patients who underwent operation after autologous upper urinary tract tumor in our hospital during the past five years were retrospectively analyzed.The characteristics of autologous upper urinary tract malignant tumor after renal transplantation were analyzed and discussed by combining the related literature at home and abroad,and using chi square test and bilateral Fisher exact probability method.Results:A total of 33 patients,8 men and 25 women,were divided into clinical diagnosis group and clinical suspicious group.The two groups were treated with autologous upper urinary tract tumor,and 28 cases were malignant,including 13 cases in the diagnosis group and 15 cases in suspicious group.The long-term stable use of triple immunosuppressive therapy for all patients after renal transplantation: calcineurin inhibitor(CNI)+ malcophenol ester(MMF)+ prednisone(Pred).The average age of 28 patients with upper urinary tract cancer was 57.9 ± 8.9 years.The average time after transplantation was 99.4 ±44.4 months.Postoperative pathology included 27 cases of urothelial carcinoma and one case of villous adenocarcinoma.Follow up time was 2~60 months after operation,and two cases of contralateral upper urinary tract tumors were found.Three cases of postoperative recurrence of bladder cancer were treated with surgical treatment.One case of recurrent and multiple bladder cancer underwent transabdominal laparoscopic radical cystectomy,right nephrectomy,right ureterectomy and ileal cystectomy.One case of lymph nodes metastases to the left iliac vessel is treated with radiotherapy.One case of recurrent left posterior peritoneal tumor is treated with radiotherapy.There were two cases of death,one case of cardiopulmonary failure and the other one of liver metastases.The remaining patients are alive with no tumor recurrence.Conclusion:1.Ureteral CT scan revealed that abnormal changes in the form of hydronephrosis and ureteral dilatation for the first time after renal transplantation are important hints of autologous upper urinary tract tumors.2.In line with preoperative suspicious clinical standard cases,if patients and their families have the intention to treat and exclude surgical contraindications,active surgical treatment is recommended.