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Diagnosis and Management of Upper Urinary Tract Recurrences After Radical Cystectomy

  • Mark Ferretti
  • Jonathan Bloom
  • John L. Phillips
Chapter

Abstract

Upper Urinary Tract Urothelial Carcinoma (UUT-UC) can be a deadly disease in patients who present with an otherwise normal genitourinary system. For patients who have undergone radical cystectomy for bladder cancer, however, the diagnosis and management of UUT-UC may be complex and elusive. Advances in non-contrast-based magnetic resonance imaging (MRI), cytology and FISH analysis, and molecular studies such as the identification of mismatch repair (MMR) mutations may help predict the risk of UUT-UC in cystectomy patients. We review the epidemiology of UUT-UC occurring de novo and in patients with a prior history of bladder UC, advances in imaging sciences that are relevant to the diagnosis of UUT-UC, and novel biomarkers that are in use and under consideration in the detection and prognosis of UUT-UC. We will review endoscopic techniques unique to those patients who have undergone urinary diversion. Surgical options for UUT-UC will be discussed which may include conservative approaches for elderly bladder cancer patients after urinary diversion and renal insufficiency who may tolerate neoadjuvant chemotherapy or radical nephroureterectomy.

Keywords

Upper urinary tract urothelial carcinoma (UUT-UC) Urinary diversion Fluorescent in situ hybridization (FISH) Mismatch repair mutations MRI urography Looposcopy Neoadjuvant chemotherapy Segmental ureterectomy 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mark Ferretti
    • 1
  • Jonathan Bloom
    • 1
    • 2
  • John L. Phillips
    • 1
  1. 1.Department of UrologyWestchester Medical Health Network/New York Medical CollegeValhallaUSA
  2. 2.Urologic Oncology BranchNational Institute of HealthBethesdaUSA

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