Abstract
Traditionally, nephroureterectomy is the gold standard therapy for upper tract recurrence of transitional cell carcinoma (TCC) following cystectomy and urinary diversion. With advances in endoscopic equipment and improvements in technique, conservative endourologic management via a retrograde or antegrade approach is technically feasible with acceptable outcomes in patients with bilateral disease, solitary renal units, chronic renal insufficiency, or significant medical comorbidities. Contemporary studies have expanded the utility of these techniques to include low-grade, low-volume disease in patients with a normal contralateral kidney. The aim of this report is to review the current outcomes of conservative management for upper tract disease and discuss its application and relevance in patients following cystectomy with lower urinary tract reconstruction.
Highlights
Upper tract transitional cell carcinoma (UTTCC) represents 5% of all urothelial cancers [1]
We review the literature in order to summarize and define the advantages and disadvantages of ureteroscopic and percutaneous management of upper tract TCC following urinary diversion
The incidence of upper tract recurrence following radical cystectomy for urothelial cancer ranges from 2% to 6% [3, 6,7,8,9,10,11], with the majority of recurrence in the first 3 years [3]
Summary
Upper tract transitional cell carcinoma (UTTCC) represents 5% of all urothelial cancers [1]. Due to the proposed field defect associated with these lesions, removal of the entire urothelium on the ipsilateral side offers the best chance of surgical cure. For this reason, the traditional and gold standard treatment for UTTCC has been radical nephroureterectomy [2]. Treatment of upper tract recurrence following lower urinary tract reconstruction is challenging, but with recent technological advances, both ureteroscopic and percutaneous techniques have been utilized for surveillance and management in these complex patients. We review the literature in order to summarize and define the advantages and disadvantages of ureteroscopic and percutaneous management of upper tract TCC following urinary diversion
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