Recurrent Papillary Transitional Cell Carcinoma of the Urinary Bladder, Ureter, and Prostate: Diagnosis Delayed by COVID-19 Pandemic: A Case Report

Introduction Papillary transitional cell carcinoma (TCC) is the most common type of bladder cancer, accounting for 84.32% of cases. The presence of tumors in various parts of the urinary tract is a known feature of TCC, often due to intraluminal seeding. This report discusses a rare case of non-invasive TCC affecting three distinct sites in the urinary system due to COVID-19 crisis [1,2]. Case Presentation A 62-year-old man presented with hematuria. Cystoscopy revealed urinary bladder carcinoma staged as pT2G3, confirmed by transurethral resection. During follow-up, ureterocystoscopy showed altered mucosal appearance; a biopsy confirmed pT1G2 TCC. Bacillus Calmette-Guérin therapy was initiated. Follow-up revealed bladder neck elevation and prostate enlargement, preventing ureterocystoscopy. The patient developed a severe COVID-19 infection, causing missed treatment appointments. Resection of the prostatic urethra and bladder neck was performed, with histology confirming pT4aG2 TCC. A CT scan showed no metastasis, and neoadjuvant chemotherapy began. Further treatment included radical cystoprostatectomy, lymph node dissection, and appendectomy. A Wallace ureteroenteric anastomosis and urostomy were performed. Later, CT revealed right hydronephrosis due to a ureteral stricture. Further evaluation showed ureteral obstruction by a tumor with a cystic abscess and pyelonephritis. Antibiotics and nephrostomy were administered. Right ureter resection with Bricker anastomosis was performed. The patient continues treatment and follow-up. Discussion Papillary transitional cell carcinoma (TCC) presents a significant challenge due to its multifocality and recurrence. Surgery remains the primary treatment, with radiotherapy and chemotherapy for high-grade cases. In March 2020, Lithuania’s COVID-19 emergency led to outpatient closures, reducing cancer care by 16.8% that year [4–6]. Conclusions COVID-19-related disruptions contributed to TCC in the bladder, ureter, and prostate, complicating treatment. Further research into multifocal TCC’s genetic and molecular characteristics may improve targeted therapies. Globally, recurrences increased as patients delayed seeking care due to widespread facility closures.