Metastasis to the ureter

R.A.S HEMAT, MB;BCh, FRCSI, DUL.

The ureter is unusual site for metastases from any cancer.
Ureters are frequently compromised by extraluminal metastatic disease.
The majority of ureteric metastases are of nonurologic origin, e.g., breast, cervical, stomach...etc.
Bladder and prostate account for 15% of the ureteric metastases.
There are (341) cases of metastases to the ureter reported.
The ureter was the sole site of metastases in 10% of the cases, and in 46% of these cases both ureter were involved.

RCC & Ureteral metastasis

Ureteral metastasis of RCC is rare and is usually confined to the ipsilateral ureter.

Only (47) cases of RCC metastasising to the ureter had been reported:

  • (31) cases are asynchronous metastases in the remnant distal ureter after radical nephrectomy.
  • (9) cases of synchronous ipsilateral ureteral metastasis
  • (6) cases of contralateral ureteral metastases.
  • (1) case of RCC metastasising to the contralateral renal pelvis.

Possible routes for ipsilateral metastases

  • hematogenous.
  • direct mucosal and submucosal spread.
  • retrograde venous spread from the renal vein to the ureteral venous system.
  • implantation of dislodged tumour cells on the normal or diseased urothelium.

Contralateral ureteral metastasis

  1. RCC metastasising to the contralateral ureter is a rare lesion with an uncertain mechanism of dissemination.
  2. Only 8 cases of contralateral ureteral metastasis has been reported so far.
  3. Contralateral metastasis may develop by mucosal implantation caused by reflux of tumour cells up the contralateral ureter.
  4. Ureteric metastasis can result in obstruction that can affect the function of the remaining kidney in the post-nephrectomy patient. The lesion is polypoid connected by a thin stalk to the mucosa.

Intervention

  1. Obstruction must be decompressed to preserve renal function.
  2. Ureteroscopic resection.
  3. Total ureterectomy and ileal ureteral replacement, combined by psoas hitch to prevent obstruction on bladder filling and the small amount of ileum reduces the likelihood of metabolic acidosis.
  4. Adjuvant therapy is disappointing (0-16%).
  5. 5 years survival rate is 29-34% following excision of solitary metastatic lesions.


Mar, 2001

Note: The information in this article has been excerpted from the following books: urotext-ebook simplifying urology, Principles of modern urology, by Dr. R.A.S HEMAT. Permission is granted to copy and redistribute this document electronically as long as it is unmodified. This article may not be sold in any medium, including electronic, CD-ROM, or database, or published in print, without the explicit, written permission of Dr. R. A. S. Hemat.

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