Distal ureteral regeneration after radical transurethral bladder tumor resection

Radical, full-thickness resection of the bladder wall and overlying bladder tumor is a management option in highly selected patients with muscle invasive bladder cancer. The consequences of iatrogenic ureteral injury in patients whose tumor involves the ureteral orifice and intramural ureter have not been reported. This report details an experience with 4 patients who underwent full-thickness resection of the hemi-trigone and distal ureter as treatment for muscle-invasive bladder tumors.

Between August 1995 and February 1999, 4 patients with T2 transitional cell cancer involving the bladder base and hemi-trigone underwent radical transurethral resection of bladder tumor (TURBT), defined as resection of the tumor and bladder wall into the perivesical fat as primary tumor management. Six weeks later, the patients underwent a restaging TURBT to assess the pathologic response and status of the distal ureter. Patients were then followed up at regular intervals for the development of hydronephrosis and/or upper tract complications.

Regeneration of the distal ureter was noted at 6 weeks in all patients. At a mean follow-up of 24 months, no patient had developed evidence of upper tract deterioration. All patients remained without evidence of tumor recurrence.

This experience suggests that iatrogenic injury to the distal ureter during radical transurethral resection of tumor involving the hemi-trigone does not result in long-term distal ureteral damage. Involvement of the hemi-trigone by tumor does not appear to be a contraindication to radical TURBT.