title: Transitional cell carcinoma of the upper urinary tract after cystectomy.
abstract: OBJECTIVE
  To assess the incidence, characteristics and outcome of upper urinary tract tumors (UUTTs) that developed in patients who underwent radical cystectomy for  urothelial carcinoma.
  
  
  METHODS
  We performed an analysis of original and review articles that were related to post-cystectomy UUTTs. The articles were published from 1984 through 2011 and  were identified by searching the Pub Med database.
  
  
  RESULTS
  The incidence of post-cystectomy UUTT ranges from 2-6% and is stable over time. The primary risk factors include a tumor in the distal  ureter in the cystectomy  specimen and signs of multifocal disease (e.g., multiplicity, a history of non-muscle-invasive bladder tumor, diffuse carcinoma in situ and the presence of a tumor in the prostatic urethra). The median time between cystectomy and UUTT exceeded three years in 70% of the reviewed cases. Even with regular radiological follow-up visits, over  50% of  cases were  diagnosed after clinical onset, and over 70% were in an advanced stage. Currently, a multidetector computed tomography urography is the standard technique  for studying  the upper urinary tract. In patients with urinary diversion, the maximum yield of cytology can be obtained when this technique is used to confirm a clinical or radiological  suspicion of UUTT. Nephroureterectomy is the treatment of choice for these tumors. The high prevalence of high-grade and stage UUTT results in endourological treatment being  restricted to only selected cases. Despite surgery, fewer than 30% of post-cystectomy UUTT patients experience prolonged survival.
  
  
  CONCLUSIONS
  Post-cystectomy UUTT is rare and usually has a late onset. A distal ureteral tumor and the presence of multifocal disease are its primary risk factors.  Most cases of post-cystectomy UUTT are diagnosed clinically and in advanced stages.
authors.affiliation: Urology Department, Clinic Hospital of Barcelona, Barcelona, Spain. jhuguet@clinic.ub.es
authors.forename: Jorge
authors.initials: J
authors.lastname: Huguet
mesh_terms: D002278:Carcinoma in Situ / Q000209:etiology / Q000473:pathology / Q000601:surgery; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D012307:Risk Factors; D013534:Survival; D014057:Tomography, X-Ray Computed; D014516:Ureteral Neoplasms / Q000209:etiology / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D014571:Urologic Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*