Case report: percutaneous management of transitional-cell carcinoma of the upper urinary tract using the bipolar resectoscope.
BACKGROUND
The traditional management of upper-tract urothelial tumors is radical nephroureterectomy. However, in recent years, minimally invasive nephron-sparing endoscopic approaches have been utilized. We present our initial experience using the bipolar resectoscope with saline irrigation in the management of renal transitional-cell carcinoma (TCC).


METHODS
A 74-year-old woman presented with a 3.5-cm filling defect in the collecting system on CT. Cystoscopy and retrograde ureterography demonstrated normal bladder mucosa and a normal contralateral ureter. Ureteroscopy revealed a papillary TCC in the renal pelvis. Ureteroscopic treatment was declined because of the lesion's size. We elected to proceed with percutaneous resection. Using the bipolar resectoscope, the lesion was removed completely. The procedure was accomplished in 90 minutes. The estimated blood loss was 50 mL. The hospital stay was 23 hours. Pathology examination revealed a low-grade TCC. Follow-up for 9 months has shown no recurrence.


CONCLUSIONS
In our initial experience, percutaneous treatment of upper-tract urothelial tumors may be accomplished using the bipolar resectoscope with favorable results.
Storm
Douglas W
DW
Department of Urology, Geisinger Clinic and Medical Center, Danville, Pennsylvania 17822, USA. dwstorm@geisinger.edu
Fulmer
Brant R
BR
D000368:Aged; D002291:Carcinoma, Papillary / Q000628:therapy; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000601:surgery*; D004564:Electrocoagulation / Q000379:methods; D005260:Female; D006801:Humans; D007668:Kidney / Q000378:metabolism; D009399:Nephrons / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020709:Ureteroscopes; D014551:Urinary Tract / Q000473:pathology*; D014571:Urologic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D019459:Urothelium / Q000473:pathology