Lymphangitic ureteral metastases from prostatic carcinoma

Apart from an occasional focal lesion, ureteral metastases diagnosed during life are rare. We have encountered, on intravenous urography and retrograde pyelography, a rather characteristic appearance of multiple undulating areas of narrowing produced by diffuse lymphatic involvement of the periureteral fat in occult prostatic carcinoma with normal regional lymph nodes. Over a 10-year period, six such patients were reviewed. Four patients presented with colicky pain and three proceeded rapidly to either azotemia or acute anuria. A fifth patient with vague symptoms were into acute anuria. In three patients the prostate gland felt benign, but four-corner biopsies of the prostate disclosed the occult malignancy. The serum acid phosphatase was normal in two patients and only slightly elevated in four. In addition to ureteral lymphangitic involvement, five of the six patients had bone or lung involvement. All areas responded well to orchidectomy and estrogen therapy. The survival time was surprisingly good with two patients alive and well after 5 years.