Congress of the Société Internationale d'Urologie edition:30th location:Shanghai date:1-5 November 2009
Introduction and Objective
Complete urinary tract extirpation (CUTE) involves bilateral nephroureterectomy and cystectomy or cystoprostatectomy. We retrospectively analysed the cases performed at our institution.
Materials and Methods
We identified all patients who underwent CUTE at our institution between 1999 and 2008. We retrospectively analysed the patient data including pre- and postoperative status, perioperative morbidity and mortality, pathology and final outcome.
CUTE was performed in 17 patients. In 12 patients this was done as a one stage CUTE, whereas 5 patients underwent 2 separate procedures over time. The median patient age was 66 and 13 patients were male. Two patients had cardiac and 3 patients had renal allografts in the past medical history. Transitional cell carcinoma was identified in all patients except one diagnosis of urachal carcinoma and bilateral reflux nephropathy. Incidental prostate cancer was found in 1 patient. During the first 90 days after surgery, 3 patients died of complications, including 1 patient after CUTE combined with resection of a chronically rejected kidney transplant and 1 patient with a cardiac transplant. Major non mortal early complications were identified in 4 other patients, including prolonged ileus, sepsis, pneumonia and reintubation after over dosage of opioids for pain management. The mean follow up was 39 months. A transplantectomy due to TCC in the transplant ureter was performed in 1 patient 1 year after CUTE, he developed metastatic disease 20 months after CUTE and died after 22 months. A second tumour recurrence occurred in another renal transplant patient 12 months after CUTE but disease has stabilised after systemic therapy after a follow up of 16 months. There was no tumour recurrence in any other patients. During follow up, kidney transplantation was performed on an ileal conduit in 4 patients.
To our knowledge, this is the largest case series of patients undergoing CUTE. CUTE is a procedure that can be performed for complex urogenital conditions. Good cancer control can be obtained. Nevertheless, it has significant perioperative mortality and morbidity.