Urinary tract involvement by colorectal cancer.
OBJECTIVE
Involvement of the urinary tract by colorectal cancer is sufficiently rare to be encountered by an individual surgeon on an infrequent basis. The aim of this review is to highlight technical and oncologic issues that should be considered when dealing with complex colorectal cancer that involves the urinary tract.


METHODS
The relevant literature from 1975 to 2001 was identified using the MEDLINE database of the U.S. National Library of Medicine and reviewed. Because of the diversity of forms of presentation of urologic involvement, few randomized, controlled trials are available, with most evidence derived from retrospective studies.


RESULTS
Three distinct clinical situations in which the urinary tract may be affected by colorectal cancer were identified: involvement by primary colorectal cancer, involvement by recurrent cancer, and unexpected intraoperative findings of urinary tract involvement. Management strategies to identify and treat locally advanced primary or recurrent colorectal cancer involving the urinary tract improve survival with acceptable morbidity and mortality. Careful preoperative assessment of all patients with colorectal cancer will reduce unexpected identification of urinary tract invasion at the time of surgery. In patients in whom cure is not possible, endourologic techniques combined with judicious surgical resection can provide high-quality palliation. Optimal care of many of these conditions is facilitated by specialist urologic advice.


CONCLUSIONS
The wide spectrum of possible urinary tract involvement by colorectal cancer requires individual patient-specific and disease-specific consideration. The literature offers important guidelines that aid decision making and improve management of these challenging problems.
McNamara
Deborah A
DA
Department of Surgery, University College Dublin, Mater Misericordiae Hospital, Dublin, Ireland.
Fitzpatrick
John M
JM
O'Connell
P Ronan
PR
D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis; D007431:Intraoperative Complications; D007674:Kidney Diseases / Q000628:therapy; D008297:Male; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D010166:Palliative Care; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery; D012669:Seminal Vesicles / Q000473:pathology / Q000601:surgery; D014571:Urologic Neoplasms / Q000473:pathology* / Q000628:therapy