Outcomes of patients undergoing concurrent radical cystectomy and nephroureterectomy: A single-institution series

Introduction: Radical cystectomy (RC) and radical nephroureter-ectomy (RNU) are commonly performed in urological oncology. Concurrent disease in the upper tract and bladder is rare, so per-forming both procedures in the same setting is uncommon. Here, we report the perioperative and oncological outcomes of a single -institution series of concurrent RC+RNU. Methods: We retrospectively reviewed the charts of patients who underwent concurrent RC+RNU for bladder and/or upper tract urothelial carcinoma between 2006 and 2020. Patient demographic and clinical factors, perioperative parameters, and oncological out-comes were obtained. Results: Twenty-seven patients underwent RC+RNU during the study period; 22 (81%) were male. Median (interquartile range) patient age was 71 (67-75) years. All had a diagnosis of bladder cancer. Concurrent upper tract urothelial carcinoma (UTUC) was the indi-cation for RNU in 12 cases (44%) and non-functional renal unit in the remainder. Two patients (7%) experienced early postopera-tive mortality. Eight patients (30%) experienced major complica-tions (Clavien-Dindo >3). Complications did not vary significantly between those rendered anephric (5/16, 31%) and those who were not (3/11, 27%) (p=0.82, Chi-squared test). Median (95% confidence interval) and five-year overall survival were 47 (41-52) months and 42%, respectively. Six of 22 male patients (27%) experienced a ure-thral recurrence and three of 14 patients (21%) with non-functional kidneys had occult UTUC discovered on final pathology. Conclusions: Combined RC+RNU carries an elevated periopera-tive risk, primarily in highly comorbid patients. Striking rates of occult UTUC in non-functional kidneys and of urethral recurrence after cystectomy were noted. RC+RNU is an appropriate option in select patients.