Percutaneous nephroscopic management of upper urinary tract transitional cell carcinoma: recurrence and long-term followup.
OBJECTIVE
We present long-term results of the percutaneous approach and resection of upper urinary tract transitional cell carcinoma, and we evaluate the prognostic factors related to recurrence.


METHODS
A total of 34 patients underwent primary percutaneous resection of an upper urothelial tumor. We treated the patients with a superficial tumor that was completely resected macroscopically. Adjuvant topical chemotherapy or immunotherapy was administered. Patients were followed with excretory urography. Ureteroscopy and computerized tomography were obtained when clinically indicated.


RESULTS
With a mean followup of 51 months ipsilateral recurrence developed in 41.2%. Median time to recurrence was 24 months. The rate of kidney preservation was 73.5%. Two patients died of the disease. There was a trend of recurrence in patients with multifocal tumors (OR 2.66, 95% CI 0.07-1.92), history of bladder carcinoma in situ (OR 2.4, 95% CI 1.61-3.74), tumor in renal pelvis (OR 6.45, 95% CI 0.01-1.46) and multiple tumor locations (OR 6.53, 95% CI 0.01-1.54).


CONCLUSIONS
The percutaneous approach to renal urothelial tumor should be considered a valid option with a good long-term outcome. Recurrence is not uncommon and, as transitional cell carcinoma superficial bladder cancer it may be treated with endourological maneuvers or radical surgery, but with the obligation to a long lasting, strict surveillance.
Palou
Juan
J
Department of Urology, Fundació Puigvert, Barcelona, Spain. jpalou@fundacio-puigvert.es
Piovesan
Luís Felipe
LF
Huguet
Jorge
J
Salvador
José
J
Vicente
José
J
Villavicencio
Humberto
H
D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018666:Ureteroscopy; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014571:Urologic Neoplasms / Q000601:surgery*
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin