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Reply to Forster et al
Urologic Oncology: Seminars and Original Investigations 25 (2007) 269
Letter to Editor Reply to Forster et al. To the Editor: It was with great interest that we read the article by Forster et al. [1]. We recently encountered a 56-year-old lady who presented with acute renal failure (serum creatinine 6.6 mg/dl). She had previously undergone a left mastectomy for lobular carcinoma of the breast 10 years ago and was being followed up with regular mammograms of the right breast. An urgent renal ultrasound showed marked bilateral hydronephrosis and a subsequent computerized tomogram confirmed retroperitoneal lymphadenopathy compressing both ureters. A computed tomography-guided biopsy of the retroperitoneum confirmed metastatic adenocarcinoma of breast origin. She initially underwent bilateral ureteric stenting that, unfortunately, blocked within a few weeks, requiring bilateral nephrostomy insertion. She then went on to have bilateral antegrade stents inserted followed by a course of chemotherapy (docetaxel). In a review of 57 patients with metastatic lobular carcinoma of the breast by Winston et al. [2], 16% (9 patients) had retroperitoneal disease, and 11% (6 patients) had hydronephrosis. It is essential to note that the time interval between initial malignancy and presentation of metastatic disease can be more than 5–10 years. In addition, if possible, nephrostomy drainage should always be the first modality of choice to relieve hydronephrosis in cases of ex-
1078-1439/07/$ – see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.urolonc.2006.10.004
trinsically caused ureteric obstruction. This is because although ureteric stents have long been used to bypass extrinsic ureteral obstruction, they are more likely to succeed in cases of intrinsic compression, as reported by Docimo and Dewolf in 1989 [3]. Finally, any patient with a past history of malignancy who presents with unilateral or bilateral hydronephrosis, local recurrence, or metastatic disease should always be excluded. Thiru Gunendran, M.B.Ch.B., M.R.C.S. Department of Urology Royal Preston Hospital Manchester, United Kingdom Andrew M. Sinclair, M.B.Ch.B., M.R.C.S. Department of Urology Stepping Hill Hospital Cheshire, United Kingdom References [1] Forster J, Agrawal V, Anathhanam AJ, et al. Breast carcinoma metastasizing to the urinary bladder presenting as bilateral hydronephrosis treated with ureteral stenting and chemotherapy. Urol Oncol 2006;24: 33–5. [2] Winston CB, Hadar O, Teitcher JB, et al. Metastatic lobular carcinoma of the breast: Patterns of spread in the chest, abdomen, and pelvis on CT. AJR Am J Roentgenol 2000;175:795– 800. [3] Docimo SG, Dewolf WC. High failure rate of indwelling ureteral stents in patients with extrinsic obstruction: Experience at 2 institutions. J Urol 1989;142:277–9.
Letter to Editor Reply to Forster et al. To the Editor: It was with great interest that we read the article by Forster et al. [1]. We recently encountered a 56-year-old lady who presented with acute renal failure (serum creatinine 6.6 mg/dl). She had previously undergone a left mastectomy for lobular carcinoma of the breast 10 years ago and was being followed up with regular mammograms of the right breast. An urgent renal ultrasound showed marked bilateral hydronephrosis and a subsequent computerized tomogram confirmed retroperitoneal lymphadenopathy compressing both ureters. A computed tomography-guided biopsy of the retroperitoneum confirmed metastatic adenocarcinoma of breast origin. She initially underwent bilateral ureteric stenting that, unfortunately, blocked within a few weeks, requiring bilateral nephrostomy insertion. She then went on to have bilateral antegrade stents inserted followed by a course of chemotherapy (docetaxel). In a review of 57 patients with metastatic lobular carcinoma of the breast by Winston et al. [2], 16% (9 patients) had retroperitoneal disease, and 11% (6 patients) had hydronephrosis. It is essential to note that the time interval between initial malignancy and presentation of metastatic disease can be more than 5–10 years. In addition, if possible, nephrostomy drainage should always be the first modality of choice to relieve hydronephrosis in cases of ex-
1078-1439/07/$ – see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.urolonc.2006.10.004
trinsically caused ureteric obstruction. This is because although ureteric stents have long been used to bypass extrinsic ureteral obstruction, they are more likely to succeed in cases of intrinsic compression, as reported by Docimo and Dewolf in 1989 [3]. Finally, any patient with a past history of malignancy who presents with unilateral or bilateral hydronephrosis, local recurrence, or metastatic disease should always be excluded. Thiru Gunendran, M.B.Ch.B., M.R.C.S. Department of Urology Royal Preston Hospital Manchester, United Kingdom Andrew M. Sinclair, M.B.Ch.B., M.R.C.S. Department of Urology Stepping Hill Hospital Cheshire, United Kingdom References [1] Forster J, Agrawal V, Anathhanam AJ, et al. Breast carcinoma metastasizing to the urinary bladder presenting as bilateral hydronephrosis treated with ureteral stenting and chemotherapy. Urol Oncol 2006;24: 33–5. [2] Winston CB, Hadar O, Teitcher JB, et al. Metastatic lobular carcinoma of the breast: Patterns of spread in the chest, abdomen, and pelvis on CT. AJR Am J Roentgenol 2000;175:795– 800. [3] Docimo SG, Dewolf WC. High failure rate of indwelling ureteral stents in patients with extrinsic obstruction: Experience at 2 institutions. J Urol 1989;142:277–9.