title: Imperative indications for conservative management of upper tract transitional cell carcinoma.
abstract: OBJECTIVE
  We report our experience with patients with imperative indications for endoscopic treatment for upper tract transitional cell carcinoma.
  
  
  METHODS
  Between 1983 and 2004 we identified 37 patients with a solitary kidney, bilateral disease or preoperative creatinine greater than 2.0 mg/dl who underwent endoscopic treatment for localized upper tract transitional cell carcinoma. A retrospective chart review was performed.
  
  
  RESULTS
  Of the 37 patients 32 had a solitary kidney, 3 had bilateral disease and 2 had preoperative creatinine greater than 2.0 mg/dl. Median age at diagnosis was 75 years (range 56 to 88). Bladder cytology was positive or atypical in 15 of 31 patients (48%). Tumors were grade 1 to 3 in 2, 13 and 7 patients, respectively, and diagnosed visually in 15. At a median followup of 2.7 years for survivors 23 patients (62%) had a total of 56 upper tract transitional cell carcinoma recurrences. Grade and stage progression occurred in 3 and 3 patients, respectively. Ten of the 23 patients who experienced upper tract recurrence died of transitional cell carcinoma. Overall kidney preservation was achieved in 24 of the 32 patients (75%) with a solitary kidney. At last followup 24 patients had died, including 11 (29.7%) of transitional cell carcinoma, at a median of 2.9 years. Cancer specific survival at 5 years for this cohort was 49.3%.
  
  
  CONCLUSIONS
  Our results indicate that upper tract tumor recurrence occurs in a majority of patients with imperative indications for endoscopic treatment, underscoring the need for frequent surveillance. While most kidneys can be preserved, cancer specific death is common.
authors.affiliation: Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA. krambeck.amy@mayo.edu
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
authors.forename: R Houston
authors.initials: RH
authors.lastname: Thompson
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.forename: David E
authors.initials: DE
authors.lastname: Patterson
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Elliott
authors.forename: Michael L
authors.initials: ML
authors.lastname: Blute
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000401:mortality / Q000601:surgery*; D018666:Ureteroscopy; D001749:Urinary Bladder Neoplasms