Premium
Partial nephrectomy and autotransplantation with pyelovesicostomy for renal urothelial carcinoma in solitary kidneys: a clinical update
Author(s) -
Steffens Joachim,
Humke Ulrich,
Alloussi Schahnaz,
Ziegler Manfred,
Siemer Stefan
Publication year - 2007
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2007.06753.x
Subject(s) - medicine , nephrectomy , urology , urine cytology , renal function , autotransplantation , ureter , bladder cancer , kidney , urinary system , surgery , cystoscopy , cancer , transplantation
OBJECTIVE To evaluate the indications and outcomes after partial nephrectomy and renal autotransplantation for urothelial cancer in solitary kidneys, with special attention to the ease of endoscopic tumour control after pyelovesicostomy. PATIENTS AND METHODS In all, 978 records of three institutions were reviewed for patients undergoing partial nephrectomy between January 1990 and December 2000. Ex vivo organ‐preserving surgery was used in selected patients with a solitary kidney and localized pelvic or calyceal tumour. Autotransplantation was established using a pyelovesicostomy. The follow‐up included ultrasonography, pelvi‐cystoscopy, urine cytology, computed tomography, renal functional evaluation and video‐urodynamics. The study included four patients aged 52–56 years, with a follow‐up of 6–14 years. RESULTS The histopathological status was pT1G2R0 in two and pT1G1R0 in the other two patients. One of them had an additional papilloma in the upper ureter. All patients entered a protocol of mitomycin/bacille Calmette‐Guérin instillation therapy after surgery. The patients are currently alive with no recurrences. There is stable kidney function despite vesico‐renal reflux, and normal bladder function with no subvesical obstruction. CONCLUSIONS Partial nephrectomy and renal autotransplantation for renal urothelial cancer in solitary kidneys is feasible, but should only be used in the rarest cases, and for the most selective indications. Dialysis and renal replacement can be avoided. Pyelovesicostomy allows effective chemotherapy instillation therapy, and easy and secure urothelial cancer control of the upper urinary tract.