Simultaneous Open Radical Bilateral Nephroureterectomy and Cystoprostatectomy

Synchronous bilateral urothelial tumors of the upper urinary tract are extremely rare and when occurring at the same time their treatment constitutes a real challenge for urologists. Patient who has low grade superficial urinary bladder tumor can be treated using endoscopic procedures, these patients would reasonably be put onto a surveillance programme for superficial bladder cancer, which include a cystoscopy every three months for a year, then every six months for another year and then annually for life, unless there is evidence of subsequent cystoscopies of recurrent bladder tumour or unless there is evidence of subsequent biopsies that there is muscle invasive bladder cancer, (progression in grade and stage). In the case of high grade, invasive or large volume or multifocal tumors, radical bilateral nephroureterectomy with cystoprostatectomy is considered the standard of care. We present the case of multiple foci of high grade tumors of the renal pelvises, ureters in a patient with a history of high grade superficial bladder cancer whom was treated endoscopically for thirteen years but most recently, bladder growth was recurred aggressively and widely over few months period and this was treated by single-stage Simultaneous Open Radical Bilateral Nephroureterectomy and Cystoprostatectomy. Our aim is not only to present the operative technique but also to show that the procedure is safe, effective modality of treatment.