Ureteroscopic Treatment and Surveillance of Upper Urinary Tract Transitional Cell Carcinoma
Keely F, Bibbo M, Bagley D

PURPOSE: We determine the efficacy of ureteroscopic treatment of upper urinary tract transitional cell carcinoma.

MATERIALS AND METHODS: Of 92 patients diagnosed with upper urinary tract transitional cell carcinoma at our institution from 1985 to 1995, 38 (41 kidneys) underwent ureteroscopic treatment and follow up. Semirigid and flexible ureteroscopes were used to examine the collecting system. Tumors were biopsied and treated with fulguration, the neodymium:YAG laser and/or the holmium:YAG laser. Patients were treated every 6 to 12 weeks until tumor-free and then followed on a strict endoscopic protocol.

RESULTS: Mean and median follow up was 35.1 and 26 months, respectively (range 3 to 116). Grading of ureteroscopic biopsies was possible in 40 of 41 cases. Initial grading of tumors was low (grade 1 or 1 to 2) in 21 kidneys, grade 2 in 14 and grade 3 in 5. Of 41 kidneys, 28 (86%) with no evidence of disease at the most recent follow up. No patient to date has had progression of disease during endoscopic follow up. High tumor grade, size and multifocality were significantly associated with tumor persistence and recurrence. Location in the kidney versus ureter was not a significant prognastic factor. Of the recurrent tumors, 75% were not identified radiographically but were only discovered endoscopically. Two of 8 kidneys removed after endoscopic treatment had no tumor stage (pT0).

CONCLUSIONS: Endoscopic treatment of upper urinary tract transitional cell carcinoma is a reasonable method to treat carefully selected patients based on strict indications. Complete endoscopic follow up at regular intervals is essential to rule out recurrences.

Journal of Urology, Vol. 157, Number 5, 1560-1565, May 1997

Search

| Advanced Search | Site Map | Home