Treatment of Ureteral Tumors

Today's patient is a 63-year-old male patient who first presented to us with bleeding in the urine and pain on the right side. In the examinations of the patient, we performed the first surgery on the patient with the prediction of a ureteral tumor that grew into the ureteral lumen in the lower end of the right ureter, in the last third of the ureter, in urinalysis, urine culture and ultrasound. 

The surgery was performed with trans ureterorenoscopy laser. After the surgery, the pathology result came back as a transitional cell tumor. This is our third follow-up and we are following the patient in three-month periods. 

He is currently being followed up with ultrasound, urinalysis and urine cytology from time to time. Since the first ureteral biopsies, i.e. tumor biopsies, did not show high grade but low grade, our current follow-up continues in this way. 

Today, we will perform a urethraronoscopy procedure that we call diagnostic urethraronoscope for both diagnostic and therapeutic purposes. Again, we do it under general anesthesia. If something tumoral is found, we will apply biopsy and laser fulguration again. 

We performed cystoscopy plus diagnostic urethraronoscopy on our patient. When we checked the right ureter, no pathology was seen inside. The previous operation area was also seen as normal, but during cystoscopy, we saw that there were small recurrences of 4-5 mm in size in 7-8 foci in the bladder. Thereupon, trans urethral bladder tumor resection was started and after the procedure I performed, bladder tumor resection was performed and these were sent to pathology again. 

Of course, recurrence here and the emergence of a new recurrence in the bladder, especially after upper ureteral system tumors, can often be encountered in the bladder at a rate of up to 20-25%. In such cases, depending on the number of recurrences, the location of the recurrence and the size of the recurrent tumor, we also start intracavitary intra-bladder treatments if necessary. In this patient, we will probably start BCG treatment into the bladder after pathology.