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Elective endoscopic management of transitional cell carcinoma first diagnosed in the upper urinary tract
Author(s) -
Thompson R. Houston,
Krambeck Amy E.,
Lohse Christine M.,
Elliott Daniel S.,
Patterson David E.,
Blute Michael L.
Publication year - 2008
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.2008.07766.x
Subject(s) - medicine , transitional cell carcinoma , upper urinary tract , stage (stratigraphy) , pathological , surgery , urinary system , endoscopy , urology , bladder cancer , cancer , paleontology , biology
OBJECTIVE To report our experience using ureteroscopic or percutaneous management of upper urinary tract (UUT) transitional cell carcinoma (TCC) in patients with no history of bladder TCC. PATIENTS AND METHODS Between 1983 and 2004 we identified 22 patients who underwent endoscopic management of TCC first diagnosed in the UUT and in the setting of a normal contralateral kidney. We performed a retrospective chart review and conducted outcome analyses. RESULTS The median (range) age at diagnosis was 64 (37–86) years and the median tumour size was 0.8 (0.3–2.6) cm. The tumour grade was 1, 2, or diagnosed as visual low grade in two (9%), seven (32%), and 13 (59%) patients, respectively; no patient had grade 3 TCC at diagnosis. Tumour stage was Ta or visual Ta in all patients. The median follow‐up was 4.9 (0.4–17) years during which 11 (50%) patients developed 21 UUT recurrences and 10 (45%) patients developed bladder TCC. At last follow‐up, seven (32%) patients required a nephroureterectomy for recurrent TCC and two (9%) patients died from TCC. Among 13 patients with a diagnosis based on visual inspection only, three recurred with grade 3 invasive TCC during follow‐up. No patient with pathological confirmation of low‐grade/stage TCC recurred with high‐grade or invasive TCC. CONCLUSIONS Recurrence is common after endoscopic management of UUT‐TCC, underscoring the need for strict surveillance. Patients diagnosed visually, without adequate tissue for pathological examination, can recur with high‐grade invasive TCC. No patient with pathological confirmation of low‐grade TCC developed progressive disease during follow‐up.