Ureterovesical Malignancy Following Renal Transplantation: A Case Report H. Bakirtas, N. Guvence, H.U. Ozok, M. Ure, and M. Eroglu ABSTRACT We present a case of ureterovesical stenosis that developed in 2 of 203 renal transplant patients operated between 1997 and 2005 in our department. In the current case, an ureterovesical region tumor was identified 1.5 years after renal transplantation, while being operated for the correction of ureterovesical stenosis. This report sought to remind physicians about the possibility of a malignancy in patients with ureterovesical stenosis following renal transplantation. F OLLOWING RENAL TRANSPLANTATION, the frequency of complications pertaining to the urinary system has been reported to be between 2% and 10%. 1 Ureterovesical stenosis is one of the most common among such complications. 2 Despite the fact that malignancies of the genitourinary system are not that common among renal transplant recipients, the situation has been reported to be increasing during recent years. 3,4 Having a tumor only in the ureterovesical region without any tumor in another part of the urinary system is a rare condition. In the present patient, a ureterovesical region tumor was identified 1.5 years after the initial operation. CASE REPORT A 34-year-old nonsmoking male patient underwent renal trans- plantation from a live donor in July 2003. In the postoperative period, he received tacrolimus (0.1 mg/kg/d), immuran (1.5 mg/kg/d), and prednisolone (5 mg/d). In January 2005, we detected a rise in creatinine level. Upon ultrasonography, the transplanted kidney was found to have grade III hydronephrosis; a nephrostomy catheter was placed percutaneously. Antegrade pyelography re- vealed stenosis at the lower end of the ureter. During this procedure, it was observed that the tip of the percutaneous nephrostomy catheter was outside the renal pelvis, therefore it was replaced to the appropriate position (Fig 1). Thereafter, balloon dilatation was performed to the stenotic region with an antegrade approach. The nephrostomy catheter was retrieved after placement of a double-J stent. When the double-J stent was extracted 3 weeks thereafter, the patient developed anuria. Ultrasonography revealed hydronephrosis again and the percutaneous nephrostomy was repeated. Computerized tomography and cystourethroscopy did not reveal any pathological finding. The patient was reoperated in April 2005 for correction of the ureterovesical stenosis. A firm mass lesion of 13 mm was observed in the ureterovesical region. The region was resected and an ureteroneocystostomy performed in another region. Pathological examination revealed an epithelial tumor of the ureter. The patient underwent another cystoscopy during which a biopsy was obtained around the orifice. Pathological examination of the biopsy specimen revealed findings of moderate uroepithelial dysplasia. Magnetic resonance urography demon- strated a localized nodular mass lesion of 28 mm diameter in the upper half of the kidney graft (Fig 2). Therefore, graft nephroure- terectomy plus partial cystectomy were performed in July 2005. The patient was diagnosed to display transitional cell carcinoma (TCC) upon immunohistochemical examination. Invasion to the perirenal adipose tissue was positive but the surgical margin of the ureter was free of tumor. The patient underwent continuous ambula- tory peritoneal dialysis treatments and received gemcitabine plus cisplatin. The follow-up of the donor did not reveal any malignancy. DISCUSSION The incidence of ureterovesical stenosis following renal transplantation has been reported to be around 2% to 4%. 2 Between 1997 and 2005, 203 patients have been operated in our department for renal transplantation. Ureterovesical stenosis developed in 2 patients. One underwent balloon dilatation, and the other patient who we currently present, had the ureterovesical region tumor identified at 1.5 years after the initial operation. The possibility of developing a tumor is increased 2- to 5-fold in the native urinary system of a recipient as well as in the grafted kidney on its ureter compared with the normal population. 5–7 Among the solid organ tumors ob- served following renal transplantation, 45% developed in the genitourinary system. 4 Tumor-related mortality may From the Department of Urology, S.B. Ankara Etlik Ihtisas Hospital, Ankara, Turkey. Address reprint requests to Hasan Bakirtas, MD, S.B. Ankara Etlik Ihtisas Hospital, 38, Cadde No. 9/30, Cukuranbar 06520 Ankara, Turkey. E-mail: hasanbakirtas@hotmail.com 0041-1345/07/$–see front matter © 2007 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2007.03.110 360 Park Avenue South, New York, NY 10010-1710 3474 Transplantation Proceedings, 39, 3474 –3476 (2007)