Abstract
The patient was a 67-year-old man who had begun hemodialysis in January 1997 due to diabetic nephropathy. In February of the same year, he presented with gross hematuria, and was diagnosed with bladder cancer within a vesical diverticulum which treated by partial cystectomy. However, invasive bladder tumors quickly recurred and we performed radical cystectomy without urinary diversion. Subsequently a deficit was detected in the right renal pelvis on MR urography and right nephroureterectomy was performed. Two months later, urethral bleeding appeared and urethral washing cytodiagnosis showed class V disease. Although urethrectomy was performed, paraaortic lymph node metastases and left renal pelvic deficit were detected thereafter. The patient died despite radiation therapy. Bladder cancer in many dialysis patients seems to exhibit an advanced stage and high grade, so that radical cystectomy without urinary diversion is needed in most cases. Although multiple urothelial carcinomas along the whole urinary tract including the urethra are rarely observed, close post-operative observation is required along with salvage therapy on recurrence.
