Retrograde laser-ablation with flexible ureterorenoscope of an upper urinary tract tumor in an orthotopic urinary diversion.
We report a case of a right upper urinary tract tumor (UUTT) in a patient submitted two years before to a radical cystectomy with an orthotopic urinary diversion. Excretory urography (IVP) showed a filling defect in the right renal pelvis, confirmed by contrast enhanced multislice spiral computerized tomography and virtual ureteroscopy. A flexible uretero-renoscopy showed a papillary tumor in the renal pelvis. Multiple biopsies, by a 3 Fr forceps, with frozen sections allowed us to establish the diagnosis of low-grade (G2) urothelial neoplasm. In the same session, we performed a laser-ablation of the tumor by an Holmium-laser fiber. During the endoscopic follow-up every three months, at the sixth month we had an high grade (G3) recurrence in the renal pelvis and ureteropelvic junction. The patient subsequently underwent to a radical right nephroureterectomy. When the urothelial tumors are small and low-grade, the retrograde conservative treatment is feasible. We try to avoid the percutaneous access because of higher morbidity and the possible seeding of nephrostomic tract, even if this complication is uncommon. However a careful endoscopic surveillance is mandatory, because of high frequency of local recurrences. In our case the main difficulty was caused by the ileal orthotopic neobladder, that made hard to visualize the ureteral orifice and to go up into the kidney.
Defidio
Lorenzo
L
Division of Urology, Cristo Re Hospital, Roma. defidio@tin.it
Di Pinto
Antonio
A
D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D053685:Laser Therapy / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000175:diagnosis / Q000601:surgery*; D018666:Ureteroscopy; D014547:Urinary Diversion