TOPICAL ADJUVANT THERAPY AFTER ENDOSCOPIC ABLATION OF UPPER URINARY TRACT TRANSITIONAL CELL CARCINOMA (UUT-TCC)
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Upper urinary tract
Adjuvant Therapy
Primary transitional cell carcinoma (TCC) of the upper urinary tract represents 6-8% of all TCC cases. Nephroureterectomy with removal of a bladder cuff is the treatment of choice. The rates of TCC recurrence in the bladder after primary upper urinary tract surgery described in the literature range between 12.5 and 37.5%. In a retrospective analysis we examined the occurrence of TCC after nephroureterectomy for upper tract TCC in patients without a previous history of bladder TCC at the time of surgery.Between 1990 and 2002, 29 patients underwent primary nephroureterectomy for upper tract TCC. The mean age of the patients was 69.5 years. In 5 cases upper urinary tract tumors were multilocular, in the remaining cases unilocular in the renal pelvis (n=12) or the ureter (n=12). The follow-up was available for 29 patients with a mean follow-up of 3.37 (0.1-11.2) years.11/29 (37.9%) patients had TCC recurrence with 9/11 patients having bladder TCC diagnosed within 2.5 years (0.9-6.0) after nephroureterectomy. 13/29 patients are alive without TCC recurrence, 3/29 patients died due to systemic TCC progression and 5/29 died of unrelated causes without evidence of TCC recurrence.Our data indicate a high incidence of bladder TCC after nephroureterectomy for primary upper tract TCC of up to 6 years after primary surgery. Because of the high incidence of bladder TCC within the first 3 years of surgery, careful follow-up is needed over at least this period.
Upper urinary tract
Cuff
Renal pelvis
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Upper urinary tract
Conservative Treatment
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Six hundred forty-five cases of transitional cell carcinoma (TCC) of the bladder, ureter, and/or kidney were reviewed retrospectively to determine the frequency of synchronous and metachronous lesions elsewhere in the urinary tract. Among 597 patients with TCC of the bladder, 23 (3.9%) developed an upper-tract lesion, after an average delay of 61 months. Metachronous upper-tract tumors developed in 13% of 38 patients with primary ureteral TCC and in 11% of 63 with renal TCC, after average delays of 28 and 22 months, respectively. Synchronous TCC was found in 2.3% of patients with bladder TCC, 39% of those with ureteral TCC, and 24% of those with renal TCC. Seventeen percent of the subsequent upper-tract lesions would have been demonstrated by intravenous or retrograde urography performed 1 year after the initial onset of primary bladder cancer, and 61% would have been demonstrated by studies performed within 2 years. Therefore, the authors recommend annual radiologic evaluation of the upper urinary tract for 2 years after initial diagnosis and treatment of an upper-tract or bladder TCC.
Upper urinary tract
Pyelogram
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Since Pérez-Castro and Martínez-Piñeiro initiated diagnostic and therapeutic ureteroscopy this technique has gained a place in the management of upper urinary tract tumors. Improvement of the equipment (rigid and flexible), better diagnosis and knowledge of outcomes and allows to treat a group of patients with transitional cell carcinoma of the ureter and pelvis by the conservative retrograde technique. In this article, we present an overview of indications and management of the upper urinary tract tumor by ureteroscopy.
Ureteroscopy
Upper urinary tract
Renal pelvis
Ureteral neoplasm
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Disagreement exists about the necessity and frequency of contrast medium imaging of the upper urinary tract in patients with transitional cell carcinoma. During a 10-year period 39 patients were treated for upper urinary tract transitional cell carcinoma. There were 3 contralateral recurrences in 33 patients treated by nephroureterectomy for the initial lesion. Of 4 patients treated initially by segmental ureterectomy or partial renal pelvectomy 1 had an ipsilateral recurrence 3 years later. Two patients with bilateral upper tract transitional cell carcinoma were treated by simple nephrectomy combined with simultaneous contralateral segmental ureterectomy or renal pelvectomy. Both patients had no evidence of recurrent tumor after 4 years of followup. Of the 39 patients with upper tract transitional cell carcinoma 6 had multiple bladder tumors or carcinoma in situ documented on biopsy before the development of an upper tract tumor. The interval between the treatment for the last bladder tumor or carcinoma in situ was 1 year in 4 patients, 2 1/2 years in 1 and 5 years in 1. Of these 6 patients 2 had bilateral upper tract tumor occurring at different times. Both patients had multiple bladder tumors diagnosed between the development of each upper tract lesion. Annual contrast medium imaging of the upper urinary tract is recommended in patients who have had multiple bladder tumors and in those who have undergone treatment for upper urinary tract transitional cell carcinoma.
Upper urinary tract
Carcinoma in situ
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Upper urinary tract
Intravenous Pyelogram
Renal pelvis
Pyelogram
Ureteral neoplasm
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The standard treatment of an upper urinary tract transitional cell carcinoma is neph-roureterectomy with removal of the bladder cuff. Recently, conservative approaches have been suggested for selected patients. With technological advances in instrumentation and techniques the endoscopic approach to upper tract transitional cell carcinoma becomes an alternative to the open surgery.
We report our initial experience in the treatment of two patients with upper urinary tract transitional cell carcinoma with intracavitary bacillus Calmette-Guerin (GCG). Both of them had smooth outcome and were free of tumor recurrence. We conclude that endoscopic techniques may provide satisfactory treatment for selected for selected individuals with upper urinary tract transitional cell carcinoma when preservation of functioning kidney is necessary. (J Urol R.O.C., 8:148-151,1997)
Upper urinary tract
Cuff
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To discuss the necessity of prophylactic contralateral nephroureterectomy in renal transplantation patients with upper urinary tract transitional cell carcinoma (TCC).In our study 15 renal transplantation patients with upper urinary tract TCC were involved from Dec.2006 to May 2013. All the patients received prophylactic contralateral nephroureterectomy 3 months after their last nephroureterectomy. A retrospective analysis was performed.TCC of upper urinary tract was confirmed by postoperative pathology in all the 15 cases .Similarly, TCC of contralateral upper urinary tract was detected in 7 of these cases (46.7%), and 13 survived after 36 months' follow-up (86.7%).In the renal transplantation patient with unilateral upper urinary tract TCC, the possibility of contralateral upper urinary tract TCC is high, thus the necessity of prophylactic contratateral nephroureterectomy is certain.
Upper urinary tract
Ureteral neoplasm
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A retrospective analysis of 74 cases of transitional cell carcinoma of the renal pelvis and ureter treated at this institution over the past 30 years is presented. When nephrectomy alone or incomplete nephroureterectomy was performed, subsequent transitional cell carcinoma developed in 30% of the ureteral stumps. Subsequent bladder carcinoma occurred in 25% of the patients with primary upper urinary tract carcinoma. The type of initial surgery performed did not appear to influence this incidence of subsequent bladder tumors. Contralateral upper urinary tract carcinoma developed in only one patient. When nephroureterectomy is performed for carcinoma of the renal pelvis and ureter, a cuff of bladder that includes the ureteral orifice should be removed to obviate recurrent disease in the ureteral stump. Since single-incision nephroureterectomy did not include the intramural ureter in 50% of the cases in which it was performed, a second incision may be required for adequate exposure.
Upper urinary tract
Renal pelvis
Cuff
Ureteral neoplasm
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