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Abstract: The patient in this case, Mr. Wang, was admitted to the hospital because of “hematuria with right-sided lumbar pain”, and ultrasound and CT examination suggested right renal pelvis occupancy with severe hydronephrosis. After completing relevant examinations, laparoscopic radical surgery for right renal pelvis cancer was performed, and the pathology suggested malignant tumor of renal pelvis: infiltrative uroepithelial carcinoma of right renal pelvis (high grade). After the operation, adjuvant chemotherapy and immunotherapy were administered. Now the tumor was removed, and the patient is recovering well and in stable condition.
Basic information】Male, 74 years old
Disease Type】Infiltrating uroepithelial carcinoma of the right renal pelvis (high-grade)
Hospital】Fujian Medical University Union Hospital
Date of consultation】March 2022
Treatment plan】Laparoscopic radical surgery for renal pelvis cancer + GC regimen chemotherapy (injectable gemcitabine hydrochloride + cisplatin injection) + bladder perfusion chemotherapy (injectable piroplatin hydrochloride)
Treatment period】Hospitalization for 13 days, regular review
Treatment effect】Tumor removal, stable disease control
I. Initial consultation
The patient came to our hospital in March 2022. He reported that hematuria with right-sided lumbar pain was diagnosed at the local hospital, and the diagnosis suggested that there was an occupied renal pelvis. The patient’s general condition was good, and ultrasound and CT examinations were performed, suggesting an occupied right renal pelvis with severe hydronephrosis, and no obvious distant metastases were seen. The patient and his family were informed that right renal pelvis occupancy could not exclude right renal pelvis cancer, and that severe hydronephrosis in the right kidney also needed urgent treatment to avoid damage to renal function. After communication between the patient and family, the decision was made to admit to the hospital.
(CT)
II. Treatment history
Radical treatment of renal pelvis cancer requires complete resection of the right kidney, the entire length of the right ureter and part of the bladder, which is a major and risky operation, but at the same time, surgical resection is also the most effective treatment. After communicating with the patient, the patient decided to undergo surgery. However, because of the inability to obtain effective pathology to confirm pelvic cancer before surgery, the patient and family members were informed that if ureteroscopy was performed to obtain pathology, the diagnosis might not be confirmed due to the small amount of tissues captured, and the patient’s right renal pelvis was severely hydrated, and it was considered that there was stenosis or obstruction in the ureteral lumen, so the ureteroscope might not be able to go up to the pelvis, and if ureteroscopy was performed, it might cause the tumor to spread and metastasize.
After communicating with the patient, we finally decided to perform laparoscopic radical surgery for renal pelvis cancer. The postoperative pathology confirmed that the cancer was infiltrative uroepithelial carcinoma of the right renal pelvis (high-grade).
III. Treatment results
Intraoperative complete resection of the right kidney + right ureter + right ureter-bladder junction was performed to remove the lesion. The incision healed well, the drainage tube and urinary catheter were removed, the patient recovered well, and he was discharged from the hospital 13 days after admission. After discharge, the patient received regular postoperative adjuvant GC regimen chemotherapy (injectable gemcitabine hydrochloride + cisplatin injection) and bladder instillation chemotherapy (injectable piroplatin hydrochloride). Regular review showed stable disease control and no recurrence.
IV. Notes
We are glad that the patient’s disease control is stable after surgical treatment and chemotherapy. Patients need to pay attention to the high malignancy and recurrence rate of renal pelvic uroepithelial carcinoma and the difficulty of surgery. After surgery, they need to pay attention to rest, increase the intake of high-quality protein appropriately, and avoid spicy and stimulating, greasy, high-fat and high-salt diet to promote the healing of incision. After discharge from the hospital, it is necessary to avoid strenuous activities, pay attention to the healing of the incision and removal of stitches, and avoid premature bathing. Pay attention to regular follow-up examinations (including abdominal CT and regular cystoscopy) to be alert for tumors in the bladder. You can do soothing activities such as walking more often.
V. Personal insight
The common pathological type of renal pelvis malignancy is uroepithelial carcinoma, which often has symptoms of hematuria or is detected by physical examination. If the patient is in good health and has no distant metastases, surgery is preferred, as in this case. During surgery, attention should be paid to the separation to avoid damage to the collecting system, and postoperative high-risk patients need adjuvant chemotherapy or immunotherapy, and some patients can be treated in combination. Since uroepithelial carcinoma is a highly recurrent tumor, close follow-up is needed, and patients need to come to the hospital immediately for review if pain and other abnormalities occur.