title: Endoscopic management of upper tract urothelial tumors.
abstract: We evaluated renal-preserving endourology in the diagnosis and management of upper tract urothelial tumors. Referral patients were identified for the endourologic management of upper urinary tract tumors between January 1990 and May 1996 at two tertiary care referral centers. Chart reviews, indications for intervention, and treatment outcomes were assessed. Twenty patients (mean age 66 years; range 32-89; males 14; females 6) underwent endourologic diagnosis and/or management of upper tract urothelial neoplasms. Mean follow-up was 25 months. The diagnosis of transitional cell carcinoma (TCC) was endoscopically confirmed in all cases. Twenty-one biopsies were performed for pathological diagnoses; one identified pathological muscle that assisted in clinical staging. Percutaneous approaches were required in four patients (six kidneys) as a result of inadequate retrograde access or excessive tumor burden. Four (44%) renal pelvic tumors recurred after long-term follow-up; ureteral recurrences occurred in 4 (80%) of 5 patients. Open surgery was required in six patients for excessive tumor burden/concurrent muscle invasive bladder tumors. No endoscopically managed patient developed metastatic disease. No patient died as a result of TCC. Endourologic biopsies are small, yet sufficient for pathological diagnoses of upper tract tumors; most biopsies lack muscle to evaluate staging. Recurrent upper tract tumors are common and may require multiple staged endoscopic interventions. Successful endoscopic management of upper urinary tract neoplasms is primarily related to tumor burden and pathological grade. Minimally invasive endourologic management of upper tract tumors should be considered in select patients. Open surgical management does not equate with failure.
authors.affiliation: The Department of Urology, University of California School of Medicine, San Francisco 94143-0738, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Stoller
authors.forename: D L
authors.initials: DL
authors.lastname: Gentle
authors.forename: M W
authors.initials: MW
authors.lastname: McDonald
authors.forename: J H
authors.initials: JH
authors.lastname: Reese
authors.forename: J R
authors.initials: JR
authors.lastname: Tacker
authors.forename: P R
authors.initials: PR
authors.lastname: Carroll
authors.forename: C
authors.initials: C
authors.lastname: Best
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000628:therapy; D004724:Endoscopy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D014516:Ureteral Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D018666:Ureteroscopy