Abstract
A 59-year-old man, who had been undergoing hemodialysis for three months, developed recurrent bladder cancer soon thereafter. The patient had undergone left nephroureterectomy for left renal pelvic carcinoma four months before the initiation of hemodialysis. He underwent transurethral resection of the bladder tumor (TURBT) and received intravesical instillations of mitomycin C (MMC) to prevent tumor recurrence. However, he developed severe chronic inflammation and hemorrhagic cystitis following MMC instillations. Thereafter, bladder cancer recurred repeatedly, and the tumor T stage and grade worsened with each recurrence. Total cystectomy was finally carried out in order to control the bladder tumor. One year after total cystectomy, CT scan demonstrated an enhanced tumor in the right lower ureter, which necessitated right nephroureterectomy. However, prior to surgery, the patient developed acute pancreatitis and died from sepsis. Since patients with chronic renal failure trend to have a variety of physiological disorders, such as oliguria, acidosis and immune deficiency, a specific bladder instillation protocol is urgently needed to inhibit recurrence without inducing complications, such as symptomatic hematuria. Early cystectomy combined with total resection of the upper urinary tract might be one of the treatment options for such hemodialysis patients with repeated recurrence of urothelial cancer.
