title: Simultaneous Cystectomy and Nephroureterectomy due to Synchronous Upper Urinary Tract Tumors and Invasive Bladder Cancer: Open and Laparoscopic Approaches.
abstract: BACKGROUND
  It is not unusual for bladder tumors to appear following transitional cell carcinoma of the upper urinary tract (UUT), with involvement of the UUT, following invasive bladder cancer, being less common. The synchronous presence of transitional cell carcinoma of the bladder and of the UTT is exceptional.
  
  
  METHODS
  Fifteen simultaneous cystectomies with nephroureterectomies were performed due to synchronous UUT and invasive bladder cancers (1997-2009). Surgery was performed using an open approach in 10 patients, while the last 5 procedures were performed laparoscopically.
  
  
  RESULTS
  The mean age was 68.7 years. Mean surgery time was 348.6 minutes. Mean blood loss was 816 ml. Acute renal failure was the most frequent postoperative complication being present in 5 patients (33%). There was 1 case of a leak in the ureter-intestinal anastomosis (open approach), which required placement of a left-sided percutaneous nephrostomy. There were 2 cases of postoperative mortality, both in the open approach series and with intestinal neobladder. Mean follow-up time for the whole series was 21.25 months. Eight cases experienced metastatic progression of the disease (mean follow-up 17 months).
  
  
  CONCLUSIONS
  Though multi-site studies with longer follow-up and a greater numbers of patients are needed, the moment at which urothelial tumors appear seems to influence their prognosis, with lower survival rates for tumors that synchronically appear.
authors.affiliation: Hospital General Universitario Ciudad Real, Servicio de Urología, Ciudad Real, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pérez-Utrilla Pérez
authors.affiliation: Hospital Universitario La Paz, Servicio de Urología, Ciudad Real, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Aguilera Bazán
authors.affiliation: Hospital Universitario La Paz, Servicio de Urología, Ciudad Real, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Alonso Dorrego
authors.affiliation: Hospital General Universitario Ciudad Real, Servicio de Cirugía General, Ciudad Real, Spain.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Vitón Herrero
authors.affiliation: Hospital Universitario La Paz, Servicio de Urología, Ciudad Real, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Cisneros Ledo
authors.affiliation: Hospital Universitario La Paz, Servicio de Urología, Ciudad Real, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: de la Peña Barthel
keywords: Cystectomy; Nephroureterectomy; Transitional cell carcinoma; Upper urinary tract tumor