title: Partial nephrectomy and autotransplantation with pyelovesicostomy for renal urothelial carcinoma in solitary kidneys: a clinical update.
abstract: OBJECTIVE
  To evaluate the indications and outcomes after partial nephrectomy and renal autotransplantation for urothelial cancer in solitary kidneys, with special attention to the ease of endoscopic tumour control after pyelovesicostomy.
  
  
  METHODS
  In all, 978 records of three institutions were reviewed for patients undergoing partial nephrectomy between January 1990 and December 2000. Ex vivo organ-preserving surgery was used in selected patients with a solitary kidney and localized pelvic or calyceal tumour. Autotransplantation was established using a pyelovesicostomy. The follow-up included ultrasonography, pelvi-cystoscopy, urine cytology, computed tomography, renal functional evaluation and video-urodynamics. The study included four patients aged 52-56 years, with a follow-up of 6-14 years.
  
  
  RESULTS
  The histopathological status was pT1G2R0 in two and pT1G1R0 in the other two patients. One of them had an additional papilloma in the upper ureter. All patients entered a protocol of mitomycin/bacille Calmette-Guérin instillation therapy after surgery. The patients are currently alive with no recurrences. There is stable kidney function despite vesico-renal reflux, and normal bladder function with no subvesical obstruction.
  
  
  CONCLUSIONS
  Partial nephrectomy and renal autotransplantation for renal urothelial cancer in solitary kidneys is feasible, but should only be used in the rarest cases, and for the most selective indications. Dialysis and renal replacement can be avoided. Pyelovesicostomy allows effective chemotherapy instillation therapy, and easy and secure urothelial cancer control of the upper urinary tract.
authors.affiliation: Department of Urology, St Antonius Hospital, Eschweiler, and University of Saarland, Hombérg/Saar, Germany. joachim.steffens@sah-eschweiler.de
authors.forename: Joachim
authors.initials: J
authors.lastname: Steffens
authors.forename: Ulrich
authors.initials: U
authors.lastname: Humke
authors.forename: Schahnaz
authors.initials: S
authors.lastname: Alloussi
authors.forename: Manfred
authors.initials: M
authors.lastname: Ziegler
authors.forename: Stefan
authors.initials: S
authors.lastname: Siemer
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D003559:Cystostomy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000592:standards; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery*