The Presentation
A man in his 70s was found to have two separate cancers of the urinary tract. A tumour in the bladder had grown into the bladder's muscle wall, and a second, high-grade tumour lay in the lower part of the ureter, the tube that carries urine down from the kidney. He had only one functioning kidney, and its function was already below normal.
Why This Case Was Complex
- Two cancers had to be removed together. The bladder cancer was muscle-invasive, and the ureteric tumour was high grade; leaving either would have risked spread.
- There was no spare kidney. Any damage to his only working kidney, or any obstruction to its drainage, could have meant lifelong dialysis.
- Reduced kidney function narrowed the options. Choices of urinary diversion and treatment had to be made with the kidney's safety as a priority.
The Approach
Dr. Anshuman Singh performed a robotic radical cystectomy (removal of the bladder) together with a robotic distal ureterectomy, removing the lower ureter containing the second tumour in the same operation. An extended pelvic lymph node dissection was carried out to check for spread.
To keep the remaining kidney draining reliably with the least extra surgery, the ureter was brought out to a small opening on the abdomen (cutaneous ureterostomy), where urine drains into a bag.
The Outcome
- Early discharge: he went home on the second day after surgery.
- Kidney protected: his only kidney continued to work after the operation.
- Complete removal: on microscopic examination, the surgical margins and the lymph nodes were free of cancer.
- He continues regular follow-up for both the cancer and his kidney function.
Key Takeaways for Patients
- Cancers of the bladder and the ureter are related and can occur together, so the whole urinary tract is checked when one is found.
- Having a single kidney does not rule out major cancer surgery, but every step is planned to protect that kidney.
- Robotic Surgery allows complex operations with a short hospital stay, even in older patients.
- Visible blood in the urine should always be investigated, at any age.
Read more about Bladder Cancer, Kidney and upper tract cancers and Robotic Surgery.
Every patient is different. This case describes one patient's treatment and is not a guarantee of similar results. It is shared for education, with the patient's consent and without identifying details.