BK virus (BKV) is a polyoma virus which remains latent within the urinary tract after initial infection and can reactivate in immunosuppressed patients to re-establish infection with a subsequent risk for development of urothelial carcinoma. Malignancies in transplant patients have been theorised to be more aggressive, and this is compounded by the required state of immunosuppression which makes BKV-induced urothelial cancers challenging to manage, given the absolute contraindication to intravesical immunotherapy and relative contraindication to systemic chemotherapy in this patient group. This poses the question of whether radical cystectomy alone is adequate for muscle-invasive bladder cancer (MIBC) when considering surgical management, or whether a more aggressive approach with complete urinary tract extirpation (CUTE) should be performed in this patient population, as opposed to conservative approaches. We present a review of three cases of CUTE for BKV-induced muscle-invasive urothelial carcinoma of the bladder in the setting of immunosuppression following renal transplantation at a single institution.

Patients who underwent CUTE at our institution were identified and retrospectively followed on their perioperative journey using electronic medical records.

Of four patients who underwent CUTE at our institution, three were identified to have BKV-induced urothelial cancer in the setting of immunosuppression following renal transplantation. One was excluded from discussion due to not meeting inclusion criteria of having a diagnosis of BK-viraemia.

BKV-induced urothelial carcinoma is a rare phenomenon and management of this disease is contentious with no established guidelines. Literature regarding CUTE is equally scarce, and it is yet to be determined whether CUTE should be the standard of care in the immunosuppressed post-transplantation patient with urothelial cancer, or if more conservative approaches should be recommended.