Introduction: Bladder cancer is one of the most common urological malignancies, with painless macroscopic hematuria being the primary symptom leading to diagnosis. For muscle-invasive urothelial carcinoma, the standard treatment includes radical cystectomy with subsequent urinary diversion. The orthotopic neobladder is one of the possible continent reconstructive options. Urethral recurrence is a rare but possible complication.
Case presentation: We present the case of a 43-year-old male with a history of radical cystoprostatectomy and orthotopic neobladder reconstruction (2012), hospitalized with macroscopic hematuria and lower abdominal pain. CT scan and cystoscopy revealed a lesion suspicious for recurrence at the anastomosis between the urethra and the neobladder. Histology confirmed a poorly differentiated papillary urothelial carcinoma. Four months later, the patient underwent neocystectomy and urethral resection with the creation of an incontinent ureterocutaneostomy.
Conclusion: The presence of macroscopic hematuria in patients with a history of urothelial carcinoma and continent urinary diversion requires thorough evaluation. Although rare, local recurrence after radical cystectomy with neobladder reconstruction must be considered and diagnosed early.
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