Anterior pelvic exenteration and synchronous bilateral nephroureterectomy for BK polyoma virus induced urothelial carcinoma of the bladder: A case report

Abstract

BK polyoma virus (BKV) is a known risk factor for the development of urothelial carcinoma. There is currently limited data on the management of BKV-induced urothelial carcinoma (BUC) of the bladder, with available data limited to case reports. It remains debatable whether radical cystectomy (RC) with removal of the native urinary tract or RC alone is the most optimal management for BUC of the bladder. BKV-induced urothelial carcinoma is rare, and its management is challenging in immunocompromised patients such as that of post-transplant patients. This case report provides additional insight into a rare disease, the management of which still lacks established guidelines and remains debatable. We present a unique case of BKV-induced muscle-invasive urothelial carcinoma of the bladder in an immunosuppressed renal transplant patient who underwent open radical cystectomy, anterior pelvic exenteration, bilateral native nephroureterectomy and ileal conduit formation to transplant kidney. The patient remains recurrence-free with preserved graft function 2 years since surgery. An aggressive management approach which involves anterior pelvic exenteration with removal of the native urinary tract may be favoured in young patients with BUC of the bladder with minimal comorbidities. However, treatment should be individualised for each individual patient.