Conservative management of upper urinary tract tumors.
OBJECTIVE
We determined the immediate and long-term results of endoscopic management of upper tract transitional cell in regard to rates of tumor recurrence and preservation of renal function.


METHODS
From January 1990 to July 1999, 61 patients (mean age 66.2 years) underwent endoscopic management of upper tract cell carcinoma. Of the patients 20 (32%) had a solitary kidney. Tumors were resected in a one time procedure by ureteroscopy only in 31.5%, by percutaneous nephroscopy in 29% or both in 8%; multiple treatment was necessary in 31.5% of cases using percutaneous nephroscopy only.


RESULTS
Immediate nephrectomy was done in six cases for high grade (three patients), insufficient local control (two cases) or patient's choices (one case). There were six cases of benign tumors excluded from survival Kaplan Meier analysis. With a mean follow-up of 39.9 months, the rate of kidney preservation, recurrence free rate, global survival and specific survival rates were, respectively, 81%, 68%, 77%, and 84%.


CONCLUSIONS
Nephron sparing percutaneous management of upper tract cell carcinoma is applicable in a significant number of patients with a filling defect of upper urinary tract TCC. In carefully selected patients the results are at least comparable to other forms of management of tumor control and preservation of renal function.
Service d'Urologie et Chirurgie de la Transplantation, Hôpital E. Herriot, Lyon, France.
Emmanuel
E
Deligne
Marc
M
Colombel
Lionel
L
Badet
Philippe
P
Taniere
Olivier
O
Rouviere
Jean Michel
JM
Dubernard
Mohamed
M
Lezrek
Albert
A
Gelet
Xavier
X
Martin
D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D018450:Disease Progression; D004724:Endoscopy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D015996:Survival Rate; D016896:Treatment Outcome