Abstract: Objective This study aims to synthesize the principal  diagnostic and therapeutic considerations and short⁃term follow⁃up outcomes of complete urinary tract exenteration (CUTE) in end⁃stage renal disease (ESRD) patients undergoing long⁃term dialysis complicated by urothelial carcinoma (UC), and to provide references for surgical decision⁃making and perioperative management in this high⁃risk cohort. Methods The clinical data of two patients with ESRD receiving long⁃term maintenance hemodialysis and concomitant UC treated at Beijing Anzhen Hospital, Capital Medical University were analyzed retrospectively, including preoperative assessment, imaging findings, surgical procedures, postoperative pathology, and follow⁃up. Both patients underwent a CUTE⁃based strategy mainly composed of radical cystectomy combined with unilateral or bilateral nephroureterectomy. Follow⁃up was performed through clinical assessment along with chest and abdominopelvic imaging. Results The surgery was successfully completed for both patients, with operative durations of 65 and 83 minutes, respectively. Postoperative recovery was uneventful for both individuals, with hospital stay of 5 and 4 days, respectively. Postoperative pathology indicated high⁃grade urothelial carcinoma with multifocal involvement of the urinary tract in both cases. In case 1, there was invasive high⁃grade papillary urothelial carcinoma affecting the right kidney, ureter, and bladder, with vascular invasion. In case 2, the tumor involvement of the bladder muscularis propria (less than half the thickness), the muscular layer of the upper and middle segments of the right ureter (less than half the thickness), and the lamina propria of the right renal pelvis, without evidence of lymphovascular tumor thrombus or perineural invasion. Follow⁃up durations were 10 and 11 months, respectively; at the last follow⁃up, chest and abdominopelvic imaging showed no definite evidence of recurrence or metastasis. Conclusions With rigorous preoperative evaluation and standardized perioperative management, CUTE appears feasible for patients with ESRD on long⁃term dialysis complicated by UC and may enable radical resection of multifocal and occult urothelial involvement. No radiographic recurrence or metastasis was observed during short⁃term follow⁃up. Larger cohorts and longer follow⁃up are warranted to further clarify its safety and oncologic benefit.

Key words: End?stage renal disease, Urothelial carcinoma, Complete urinary tract exenteration, Perioperative management, Prognosis