Abstract

Upper tract urothelial carcinomas account for 5% of urothelial tumors. Urothelialtumors of pelvis are more common than that of the ureter, of which 24% occur in mid ureter. Bilateral synchronous Upper Tract TCC (transitional cell carcinoma) is rare with few reports in literature. This is a  case report of a 43 year old male who presented with oliguria & abdominal pain for 3 days. On examination patients vitals were stable. Abdominal examination was unremarkable and bladder was not palpable. On investigation Ultrasound showed bilateral Hydronephrosis with hydro ureter till mid ureter, distal ureters obscured, and bladder was   normal. Plain CT abdomen confirmed ultrasound findings. No was calculus seen. Blood investigations revealed a raised Sr.creatinine of 9.5mg/dl. With a provisional diagnosis of retroperitoneal fibrosis, patient was taken up for Bilateral RGP & DJ stenting.  RGP revealed Bilateral mid Ureteric stricture, stenting was not possible and procedure abandoned.  Patient was planned for left sided exploration. OT finding revealed left Pyelonephritic kidney, upper ureteric mass with dilation of ureter till mid ureter (Stricture site).Patient underwent Segmental ureterectomy with uretero-ureterostomy with DJ stenting. Histopathological examination revealed High grade solid urothetial carcinoma of ureter. Standard management of UTTCC is nephroureterectomy with cuff of bladder; however endoscopic management is being considered a good option in select patients.

Keywords: Bilateral, synchronous, ureteric, transitional cell carcinoma.