Endourologic management of patients with upper-tract transitional-cell carcinoma: long-term follow-up in a single center.
OBJECTIVE
To evaluate the outcome of endoscopic management of upper-tract transitional-cell carcinoma (TCC).


METHODS
From March 1991 to March 2006, 40 patients with upper-tract TCC were treated by an endoscopic approach as the primary management: 37 (90.2%) by ureteroscopy and by percutaneous techniques or both approaches in 2 cases each (5%). Follow-up was between 5 and 115 months (mean 41.6 months). Most of the patients, 26 (65%), had a normal contralateral kidney, and the indication for conservative management was low tumor grade or tumor size (<2 cm) and patient commitment to a rigorous follow-up protocol. Absolute and relative indications for conservative management such as solitary kidney were met in 14 patients (35%).


RESULTS
Treatment consisted of electrocautery only in 15 cases (36.6%), neodymium:YAG or holmium:YAG laser only in 11 (26.8%), and combinations in 15 (36.6%). Most of the patients (74.3%) had an upper-tract recurrence. The renal-preservation rate was 70.7%, and the survival rate was 80%.


CONCLUSIONS
Conservative treatment is preferred in patients with bilateral disease, a solitary kidney, or co-morbidities that contraindicate major surgery. Patients with low-grade, low-stage disease and normal contralateral kidneys also benefit from this approach provided adequate endoscopic follow-up can be achieved and the surgeon has a low threshold for carrying out ablative surgery.
Sowter
Steven J
SJ
Department of Urology, Western General Hospital, Edinburgh, UK. sjs@bigpond.com
Ilie
Cristian P
CP
Efthimiou
Ioannis
I
Tolley
David A
DA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D003558:Cystoscopy / Q000379:methods; D004564:Electrocoagulation / Q000379:methods; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015907:Hysteroscopy / Q000379:methods; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D018666:Ureteroscopy / Q000379:methods*; D014572:Urology / Q000379:methods*