Synchronous bilateral ureteral and renal pelvic carcinomas: incidence, etiology, treatment and outcome.
BACKGROUND
Synchronous bilateral urothelial tumors of the upper urinary tract are very rare. The authors reported baseline and long-term follow-up data for all patients in western Sweden during a 28-year period.


METHODS
The authors performed a clinical and histopathologic study of all patients in western Sweden who were diagnosed with a malignant neoplasm in the renal pelvis or ureter between 1971 and 1998.


RESULTS
Of 936 patients, 15 (1.6%) had synchronous bilateral tumors. The incidence of such tumors decreased in each successive decade. Abuse of phenacetin-containing analgesics by patients also decreased during the study period, as did the incidence of renal papillary necrosis. The median age at diagnosis of bilateral tumors was 68 years, and 80% of the patients were male. Eleven patients had bilateral tumors of the renal pelvis, two had bilateral ureteral tumors, and two had tumors of the renal pelvis and contralateral ureter. Partial renal pelvic, ureteral, or kidney resection on at least one side was possible in eight patients, and four patients were left untreated on at least one side. Only three patients underwent bilateral nephroureterectomy. Twelve patients (80%) had bladder carcinoma diagnosed either before or after diagnosis of the upper tract tumors. The median survival period for the 11 patients who received surgery for their bilateral tumors was 84 months.


CONCLUSIONS
The decreasing incidence of synchronous bilateral upper tract tumors may be related to the prohibition of phenacetin-containing analgesics in the 1960s. Partial resection with preservation of the renal parenchyma was possible in the majority of patients. Survival for patients with bilateral tumors did not differ from that of patients with unilateral tumors.
Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden. sten.holmang@telia.com
Sten
S
Holmäng
Sonny L
SL
Johansson
D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000209:etiology / Q000601:surgery / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology / Q000209:etiology / Q000601:surgery / Q000628:therapy; D011379:Prognosis; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D014516:Ureteral Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000601:surgery / Q000628:therapy