Upper tract transitional cell carcinoma following or related to bladder cancer: Controversies

— The incidence of upper urinary tract transitional cell carcinoma (UTTCC) following a bladder cancer has been studied in 1731 urothelial tumours from 1984 to 1995. The UTTCC were 88: 59 primitive, 6 synchronous and 23 metachronous after a bladder cancer (1672). Of the 23 metachronous UTTCC, 17 followed TURBT (17/1310 = 1.3%): the latency period was very long (64.8 months); grading and staging were mostly similar to the foregoing bladder tumours. A vesicoureteral reflux raised the metachronous UTTCC rate to 17.6%. A neoplastic distal ureter was found during radical cystectomy in 2.24%. During the follow-up of 362 radical cystectomies 6 (1.65%) metachronous UTTCC were recorded. A metachronous UTTCC is always a poor prognostic sign. There are some controversies concerning this topic such as: the role of IVP and urine cytology in the follow-up of bladder cancer, the management of a vesicoureteral reflux in bladder cancer and the choice of a urinary diversion in the event of an upper urinary tract at high risk for UTTCC.