Oncologic control obtained after exclusive flexible ureteroscopic management of upper urinary tract urothelial cell carcinoma.
OBJECTIVE
To assess oncological outcome after first-line management of upper urinary tract urothelial cell carcinomas (UUT-UCCs) by exclusive flexible ureteroscopy.


METHODS
A retrospective review was performed for 35 patients treated between 2003 and 2007. All patients underwent retrograde flexible ureteroscopy for diagnosis, treatment (i.e., holmium:YAG vaporisation), and follow-up. The following data were reviewed: sex, age, ASA score, presence of a solitary kidney, unifocal or multifocal tumour, history of bladder cancer, tumour localisation, tumour size, stage and grade, outcome, recurrence, and progression.


RESULTS
The mean age was 67 + or - 13.1 years (range: 38-88). The tumour involved the renal pelvis and the caliceal system in 19 cases (54%), the ureter in 8 cases (23%), and both in 8 cases (23%). Twelve patients (34%) had a history of bladder carcinoma. Tumour stage was superficial in 63% (57% were pTa and 6% were pT1) and not available in 37%. Tumour grade was low, high, and unavailable in 49, 14, and 37%, respectively. The median follow-up was 30 months (range: 12-66), and 21 patients had a recurrence (60%). The median survival rate without recurrence was 10 months (95% CI [5-22]). Four patients underwent nephroureterectomy during follow-up. No patient died of disease progression. The main limitation was the limited length of follow-up.


CONCLUSIONS
Flexible endoscopic management can be advocated in selected cases of non-muscle invasive UUT-UCCs as an alternative to nephroureterectomy. Because of a high recurrence rate, long-term and stringent surveillance is needed, including iterative ureteroscopies at least every 3 months for 2 years.
Cornu
Jean-Nicolas
JN
The Academic Department of Urology of Tenon and of Pitié-Salpétrière, Groupe Hospitalo-Universitaire EST, Assistance-Publique Hôpitaux de Paris.
Rouprêt
Morgan
M
Carpentier
Xavier
X
Geavlete
Bogdan
B
de Medina
Sixtina Gil Diez
SG
Cussenot
Olivier
O
Traxer
Olivier
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009392:Nephrectomy; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*; D019459:Urothelium / Q000473:pathology / Q000601:surgery*