PMC9366000_01
(A) CTU revealed that orthotopic neobladder was in good shape and there was no hydronephrosis in both renal pelvis. (B) The red arrows indicate the morphological changes in the left renal pelvis. (C) The pathological result identified high-grade urothelial papillary carcinoma of the left renal pelvis. (D) CT revealed recurrence of the right ureteral carcinoma with obstructive hydronephrosis. (E) CT revealed that the maximum diameter of the tumor shrank from 25 to 15 mm.
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Patient follow-up was performed from 2012 to 2018 with abdominal-pelvis computed tomography (CT) (Figure 1A). CT showed morphological changes in the left renal pelvis without a ureteral lesion present (Figure 1B), and cancer cells were found in urine cytology. The lesion was indicated as locally advanced urothelial carcinoma with a stage of T3N0M0 (Figure 1C). After 1 year of regular follow-up, CT revealed recurrence of the right ureteral carcinoma with obstructive hydronephrosis, cT3N0M0 (Figure 1D). Nine weeks later, CT revealed that the maximum diameter of the tumor shrank from 25 to 15 mm, suggesting a partial response (PR) to tislelizumab (Figure 1E).
(A) The intestinal substitute is derived from the ileum. (B) Intestinal sections isolated with their mesenteric branch. The continuity of the small intestine is restored. (C) Each ring is then incised along its longitudinal axis; the incisions of the most proximal and distal segments are not at the antimesenteric border but close to the mesenteric attachments. (D) Intestinal strips joined end to end. (E) The tissue plate tubularized around a single "J" stent to form the neoureter. (F) The postoperative pathology was invasive high-grade urothelial carcinoma. (G) CTU revealed that the neoureter was in good shape and that there was no hydronephrosis in the right renal pelvis.
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These three strips are joined at the ends, to make a rectangular piece of 18 cm in length, which is then tubularized around a single "J" stent to form a tube of suitable length (Figures 2A-E). The operation went well, and the postoperative pathology was invasive high-grade urothelial carcinoma, with infiltration into the muscular layer of the canal wall and negative margins on both sides (Figure 2F). He is still on tislelizumab immunotherapy at 18 months of follow-up, and no recurrence or distant metastases were observed (Figure 2G).
Treatment Timeline.
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The treatment flowchart is shown in Figure 3.