Bilateral metachronous ureteral and renal pelvic carcinomas: incidence, clinical presentation, histopathology, treatment and outcome.

PURPOSE: Metachronous bilateral UUTTs are rare. The authors reported baseline and long-term followup data for all patients diagnosed in Western Sweden during a 28-year period.
MATERIALS AND METHODS: We performed a clinical and histopathological analysis of all patients in Western Sweden surgically treated for ureteral and renal pelvic tumors from 1971 to 1998.
RESULTS: Of 768 patients a contralateral UUTT developed in 24 (3.1%) after a median of 46 months (range 2 to 232). The projected incidence after initial UUTT diagnosis was 2.7%, 5.8% and 6.5% at 5, 10 and 15 years, respectively. Median age of the 24 patients at initial UUTT diagnosis was 67 years and the median age at death was 77 years. Bladder cancer was significantly more common among patients with bilateral UUTT compared to those with unilateral UUTT (83% vs 31%, p <0.0001). Routine followup urography was normal in 9 patients 2 to 11 months before the diagnosis of the contralateral UUTT. Nine patients died of UUTT and 5 patients died of bladder cancer.
CONCLUSIONS: Bilateral subsequent upper tract tumors are rare, in general diagnosed at an older age and associated with short survival. Many patients die of bladder cancer and it may be possible to improve survival if the bladder cancer is treated early and aggressively. Routine followup urography is not indicated among patients with a tumor-free bladder and a history of UUTT.