Urothelial metastasis in prostate adenocarcinoma.

Case 1 A 70-year-old man presenting with an initial episode of urinary retention was subsequently diagnosed to have prostate adenocarcinoma (Gleason’s grade 4+4) upon transrectal ultrasound guided biopsy of the prostate. His initial prostate-specific antigen (PSA) level was 30 ug/mL. Staging computed tomography (CT) scan revealed a locally advanced prostatic tumour with bilateral hydronephrosis. A radioisotope bone scan showed metastases at T5 and T6 vertebrae. Serum creatinine was 160 umoL/L. A channel transurethral resection of the prostate (TURP) was offered to relieve the bladder outlet obstruction with a simultaneous bilateral orchidectomy. At cystoscopy, there were 2 isolated tumour masses, approximately 2 cm in size each, obstructing the ureteric orifices (Fig. 1a). Interestingly, the intervening bladder mucosa was normal and free from tumour deposits. These masses were resected, exposing the ureteric orifices. In view of the ureteric obstruction, insertion of bilateral double J stents was attempted. A double J stent was successfully inserted on the right side. However, it was impossible to stent the left ureter. Postoperatively, the patient was able to pass urine with no significant residual urine. In addition, the hydronephrosis resolved on the right Urothelial Metastasis in Prostate Adenocarcinoma