Office-Based Surveillance Ureteroscopy After Endoscopic Treatment of Transitional Cell Carcinoma: Technique and Clinical Outcome

Abstract

The reference standard treatment for transitional cell carcinoma (TCC) of the upper tract remains nephroureterectomy. However, with improvements in endoscopic technology and techniques, endoscopic ablation of upper tract TCC has become a reality for highly selected patients. We report our present technique and 16-year experience of office-based ureteroscopy for surveillance of TCC after initial endoscopic ablation. The office and hospital records of all patients undergoing office-based anesthesia-free ureteroscopy were retrospectively reviewed. The patient characteristics, tumor characteristics, ureteroscopic technique and findings, and complications were documented. Ten patients with a mean age of 68.8 years were treated with endoscopic ablation of upper tract TCC. A total of 67 (range 1 to 19 per patient) surveillance ureteroscopies in the office setting were performed. Office ureteroscopy revealed seven upper tract TCC recurrences in 5 patients. A thorough ureteroscopic examination in the operating room of these patients revealed that only 1 patient had more extensive disease than was recognized during the office-based ureteroscopy. All patients tolerated office-based ureteroscopy well, and each procedure was successfully completed with minimal patient discomfort. No acute complications were noted. One patient who experienced multiple recurrences and underwent ablation of extensive ureteral TCC developed a benign ureteral stricture. The results of our study have shown that for the rare patient undergoing endoscopic management of upper tract TCC, office-based anesthesia-free ureteroscopic surveillance is a reasonable management strategy. The technique has been free of complications and appears to be as accurate as surveillance ureteroscopy performed in the operating room.