Xenograft Bone-Guided Regeneration of the Foot in Case of Metastatic Bladder Carcinoma causing Pathological Fracture

Background: Bladder carcinoma with distal bone metastasis is rare. Treatment should be multidisciplinary, including pain relief, treatment of threatening (or) pathological fractures, and oncologic therapy for bladder cancer. Case report: A 52-year-old male patient with bladder cancer reported having pain in the right foot and ankle. Xray and CT revealed multiple bone metastases of bladder cancer to the right foot and ankle, causing pathological fractures. The patient refused proposed below-knee amputation, therefore, preservative surgery with metastasectomy of larger metastases in the foot and ankle, and distal fibulaectomy were performed. To fulfill the defects in the foot, bone guided regeneration with equine xenograft bone block and collagen membrane was performed and additionally stabilized with osteosynthetic material. Two months after surgery, the bone graft was incorporated into the bone and the patient was capable of weight bearing, pain-free, and able to continue with chemotherapy and radiation therapy. Despite the therapy, the patient died of embolism due to metastasis 6 months following the foot operation. Discussion: The aim of our case report is to show that amputation is not the only method of treatment for patients with multiple metastases of the foot and ankle. Alternatively, bone-guided regeneration with xenograft can be successfully performed also in such patients. Rehabilitation following bone-guided regeneration is shorter compared to amputation, and also enables a better quality of life.