We report the case of a 60-year-old man with a history of prostate cancer treated with external beam radiotherapy at the age of 47, who subsequently developed recurrent multifocal urothelial carcinoma involving the bladder, ureter, and left kidney, with later recurrence in the bulbar urethra. The patient had pre-existing chronic kidney disease prior to undergoing bilateral nephroureterectomy and subtotal cystectomy as salvage procedures for radiation-induced cystitis with refractory hematuria. He later presented with urethrorrhagia, and urethroscopy revealed papillary lesions at the bulbo-membranous junction. Perineal urethrectomy failed to control bleeding, necessitating salvage prostatectomy for definitive management. This case highlights the clinical and surgical challenges associated with recurrent multifocal urothelial carcinoma and emphasizes the importance of a multidisciplinary approach in complex urological oncology cases.
Serrano et al. (Wed,) studied this question.