title: Transitional cell carcinoma of the ureteric stump: a systematic review of the literature.
abstract: OBJECTIVE
  To present a review of the literature using evidence-based criteria for diagnosis and treatment of malignant growths in the ureteric remnant following nephrectomy for non-malignant disease.
  
  
  METHODS
  A database search using the key search words was performed, producing a total of 16 articles published between 1952 and 2009. The Oxford Centre for Evidence-Based Medicine classification was used. Statistical significance was tested by Pearson correlation. Demographic data, reason for nephrectomy, symptoms, time to diagnosis since initial nephrectomy, imaging modality and treatment option chosen, as well as histology and overall survival were reviewed.
  
  
  RESULTS
  Analysis was possible for 33 out of 63 cases reported in the literature. There was a male predominance (82%). Visible, painless haematuria was the presenting symptom in 72% of cases. Open ureterectomy was performed in the majority of patients (85%), while none had laparoscopic surgery. Transitional cell carcinoma was found in 66% of cases. Mean follow-up was 2.7 years. Metastases were detected in 36% and correlated significantly with cancer-specific mortality (95% CI: p < 0.001). Tumour stage, grade and cell type did not correlate significantly with mortality.
  
  
  CONCLUSIONS
  Gross, painless haematuria is a feature highly suggestive of neoplastic change. Diagnosis often involves multimodality imaging and endoscopy. Complete ureterectomy with removal of bladder cuff, previously resected endoscopically, is the treatment of choice. Metastases at diagnosis and follow-up carry a worse prognosis.
authors.affiliation: Urology Department, King George Hospital, Barking, Havering and Redbridge University Teaching (BHRUT) Hospitals NHS Trust, London, UK. bourdoua@hotmail.com
authors.forename: Andreas
authors.initials: A
authors.lastname: Bourdoumis
authors.forename: Imran
authors.initials: I
authors.lastname: Syed
authors.forename: Geraldine
authors.initials: G
authors.lastname: Soosay
authors.forename: Ahmed
authors.initials: A
authors.lastname: Manzoor
authors.forename: Jayanta
authors.initials: J
authors.lastname: Barua
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000628:therapy*; D004724:Endoscopy; D019317:Evidence-Based Medicine; D005260:Female; D006417:Hematuria; D006801:Humans; D007249:Inflammation; D008279:Magnetic Resonance Imaging; D008297:Male; D009362:Neoplasm Metastasis; D011379:Prognosis; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000473:pathology*; D014516:Ureteral Neoplasms / Q000175:diagnosis* / Q000628:therapy*