Simultaneous Open Radical Bilateral Nephroureterectomy and Cystoprostatectomy

Background:  Synchronous bilateral urothelial tumours of the upper urinary tract are extremely rare. However, their treatment is a real challenge for urologists. Patient with low grade superficial urinary bladder tumour can be treated by endoscopic procedures. But they need to be put onto a surveillance programme for superficial bladder cancer.  In the case of high grade, invasive or large volume or multifocal tumours, radical bilateral nephroureterectomy with cystoprostatectomy is considered the standard of care. Here, We present a case of multifoci high grade tumour of bilateral renal pelvis and ureters in a patient with history of high grade superficial bladder cancer who was treated endoscopically for thirteen years. Most recently, bladder growth recurred aggressively and widely over the last six months and this was treated by single-stage Simultaneous Open Radical Bilateral Nephroureterectomy and Cystoprostatectomy. Our aim was not only to present the operative technique but also to show that the procedure is safe and effective modality of treatment. The open approach was preferred due to its advantage of shorter operative time. In addition, the decision was based on team consultation [Patients, Surgeon and Anesthetist]. The outcome was satisfactory and safe. Thus, the one setting [simultaneous] open approach is considered safe and effective. However, we do not against laparoscopic approach, but we encourage individualization [case by case] of the procedure for each patient according his clinical situation and after counselling of all members of the team.