Transitional Cell Carcinoma Of Renal Pelvis Research Articles

A web-based prognostic nomogram for the cancer specific survival of elderly patients with T1-T3N0M0 renal pelvic transitional cell carcinoma based on the surveillance, epidemiology, and end results database

BackgroundAt present, there are few studies on renal pelvic transitional cell carcinoma (RPTCC) in elderly patients in the literature. The study aims to establish a new nomogram of cancer-specific survival (CSS) in elderly patients with T1-T3N0M0 RPTCC and validate its reliability.MethodsThis study downloaded the data of 1375 elderly patients with T1-T3N0M0 RPTCC in the Surveillance, Epidemiology, and Final Results (SEER) database from 2004 to 2018. Patients were randomly divided into training cohort (n = 977) and validation cohort (n = 398). Proportional subdistribution hazard analyse was applied to determine independent prognostic factors. Based on these factors, we constructed a compting risk model nomogram. We use the calibration plots, the area under the receiver operating characteristics curve (AUC), concordance index (C-index), and decision curve analysis (DCA) to validate predictive performance and clinical applicability. Patients were divided into low-risk group and high-risk group based on nomogram risk score. Kaplan–Meier curve was applied to analyze the difference in survival curve between the two groups of patients.ResultsWe found that the risk factors affecting CSS in elderly patients with T1-T3N0M0 RPTCC are surgery, AJCC stage, laterality, tumor size, histological grade, and tumour laterality. Based on these factors, we established a nomogram to predict the CSS of RPTCC patients at 1-, 3-, and 5-year. The calibration plots showed that the predicted value was highly consistent with the observed value. In the training cohort and validation cohort, the C-index of the nomogram were 0.671(95% CI 0.622–0.72) and 0.679(95% CI 0.608–0.750), respectively, the AUC showed similar results. The DCA suggests that namogram performs better than the AJCC stage system. The Kaplan–Meier curve showed that CSS of patients was significantly higher in the low-risk group.ConclusionsIn this study, the SEER database was used for the first time to create and validate a new nomogram prediction model for elderly patients with T1-T3N0M0 RPTCC. Compared with the traditional AJCC stage system, our new nomogram can more accurately predict the CSS of elderly patients with T1-T3N0M0 RPTCC, which is helpful for patient prognosis assessment and treatment strategies selection.

Incidence, management and treatment outcomes of renal malignancy in a post-transplant recipient at a tertiary care centre: A 16-year experience

Introduction and Objective: Although the incidence of malignancy in renal transplant recipients is on the rise owing to boom in the post-transplant immunosuppressive therapy, there is paucity of literature regarding their reporting and management. In this study, we report the incidence of de novo renal malignancies, post-renal transplantation at our centre over a 16-year period and discuss their management. Methods: All patients who underwent renal transplantation at our department between March 2004 and February 2020 were included and retrospectively reviewed. We analysed the incidence of renal malignancy both in the native kidney and the graft, histological subtype, time to and type of treatment. Results: A total of 376 patients underwent renal transplantation. Mean age of recipients was 48.2 and 52.15 years among those who developed cancer. 13 (2.93%) of 376 recipients developed urogenital malignancy, of whom 8 had renal cell carcinoma (RCC) in their native kidneys and 1 in the allograft. Transitional cell carcinoma (TCC) of renal pelvis was noted in three patients with one concomitant TCC of bladder. No treatment-related graft losses occurred in the native kidney malignancy. Patients with RCC underwent nephrectomy while TCC of renal pelvis underwent nephroureterectomy with bladder cuff excision. Transurethral resection was done for bladder tumour. All patients were followed up as per standard protocol. Conclusion: A rise in urological post-transplant malignancies mandates regular surveillance after renal transplantation to ensure early detection of de novo malignancies and early initiation of treatment. Goal should be to minimise adverse graft outcomes with no compromise on oncological outcomes. Level of evidence: Not applicable

Overall and Cancer-Specific Survival in Patients With Renal Pelvic Transitional Cell Carcinoma: A Population-Based Study.

Background: Renal pelvic transitional cell carcinoma (TCC) is a relatively rare tumor. This study aimed to develop two prognostic nomograms to predict overall survival (OS) and cancer-specific survival (CSS) in renal pelvic TCC patients.Methods: Clinicopathological and follow-up data of renal pelvic TCC patients diagnosed between 2010 and 2015 were retrieved from the Surveillance, Epidemiology, and End Result (SEER) database. Univariate and multivariate Cox regression analyses were used to screen the independently prognostic factors. These independently prognostic factors were then utilized to build nomograms for predicting 3-, 4-, and 5- years OS and CSS of patients with renal pelvic TCC. The nomograms were assessed by calibration curve, receiver operating characteristic (ROC) curve and decision curve analysis (DCA).Results: A total of 1,979 renal pelvic TCC patients were enrolled. Age, tumor size, histological type, American Joint Committee on Cancer (AJCC) stage, surgery, chemotherapy, bone metastasis and liver metastasis were confirmed as independently prognostic factors for both OS and CSS. The areas under the ROC curves (AUCs) of OS nomogram at 3-, 4- and 5-years in the training cohort were 0.797, 0.781, and 0.772, respectively, and the corresponding AUCs in the validation cohort were 0.813, 0.797, and 0.759, respectively. The corresponding AUCs of CSS nomogram were all higher than 0.800. The calibration curves and DCA indicated that both nomograms had favorable performance. Subgroup analyses showed that both nomograms perform in well and poorly differentiated patients.Conclusion: In conclusion, we successfully developed and validated two valuable nomograms to predict the OS and CSS for renal pelvic TCC patients. The nomograms incorporating various clinicopathological indicators can provide accurate prognostic assessment for patients and help clinicians to select appropriate treatment strategies.

Pattern of Failure in Patients with Non-Metastatic Renal Pelvis Transitional Cell Carcinoma: A Single Center Experience in Alexandria, Egypt Shaaban Elassal,Maher Soliman, Naomi Nyambura Clinical Oncology Department,Alexandria University, Egypt.

PURPOSE:Globally, renal pelvis transitional cell carcinoma (RPTCC) is rare. There is a scarcity of information on the pattern of failure from the low and middle-income countries' patients, posing an unmet need. The aim of this study was to identify the patterns of failure and prognostic factors of survival outcomes in non-metastatic RPTCC.PATIENTS AND METHODS:The medical files of all patients with non-metastatic RPTCC who were treated in Alexandria Main University Hospital between January 2007 and December 2017 were reviewed. The clinicopathologic characteristics and treatment outcome data was collected and analyzed using univariate and multivariate analyses. RESULTS:Thirty-six patients were included. The mean age at diagnosis was 60 years (SD ± 9.79). The median tumor size was 7cm (6.0-8.75 cm). High tumor grade and lymphovascular invasion (LVI) were observed in 63.9% and 61.1% of tumors, respectively. About half of patients (47.2%) of the patients developed treatment failures including (13.9%) local recurrence and (33.3%) distant recurrence. Lungs (22.2%) was the most common site of distant failure.The 5-year local failure-free survival (LFFS) was 71%, while the distant failure-free survival (DFFS) was 60.3%. The 5-years overall survival (OS) was 82.5%. In multivariate analysis, the tumor size was an independent predictive factor for LFFS, DFFS and OS. The tumor size (p = 0.03) and LVI (p= 0.01) were significant prognostic factors for DFFS in multivariate analysis. CONCLUSION:RPTCC is very aggressive rare tumor which should be further explored in future research. The tumor size and grade are independent factors for survival outcomes.

PS1 - 159 A Case of Intracranial Metastases from Renal Pelvic Carcinoma and Review of Literature

Transitional cell carcinoma (TCC) of the renal pelvis is a rare urological malignancy, with only a handful of cases of metastases to the brain reported in literature. We aim to present a case of intracranial metastasis in a female patient with history of renal pelvic carcinoma, and review existing literature of brain metastases from renal pelvic TCC. Methods: We searched PubMed, EMBASE, and MEDLINE from 1966 to January 2016 for published case reports written in English. Results: Five published case reports describe intracranial metastases from renal pelvic TCC. Our case is a 56-year-old woman with known high grade renal pelvic carcinoma and pulmonary metastases, who presented nine years after her initial diagnosis with mild left side weakness and headaches. She was found to have two lesions in the right cerebral hemisphere and underwent surgical resection of the larger right frontal lobe mass. Her neurologic symptoms improved postoperatively. She declined whole brain radiotherapy and remains stable at 6 months’ follow-up. This is the first published case of presentation of brain metastases from pelvic TCC more than 12 months after diagnosis of the primary cancer. Conclusion: There is minimal literature of renal pelvic TCC metastasizing to the brain. However, as systemic chemotherapy leads to improved survival from the primary cancer, it is possible for more cases to appear, necessitating increased awareness from the healthcare team.

Pure Retroperitoneal Laparoscopic Radical Nephrectomy for Right Renal Masses with Renal Vein and Inferior Vena Cava Thrombus

To describe our pure retroperitoneal laparoscopic radical nephrectomy (LRN) with thrombectomy for right renal masses with renal vein (RV) and inferior vena cava (IVC) thrombus. Five patients with right renal masses with RV and IVC thrombus underwent pure retroperitoneal LRN. Three patients had a history of abdominal surgery. In one patient with a RV thrombus, the RV was ligated and dissected with Hem-o-lok clips; in four patients with IVC thrombus, the IVC was partially occluded with a laparoscopic vascular clamp and incised distal to its junction with the right RV, and the thrombus was delivered intact. The IVC was closed with a running 3-0 polypropylene suture. Pure retroperitoneal LRN with thrombectomy was successfully performed for all the patients without hand-assisted or open conversion. The mean tumor size was 6.2 cm, and mean thrombus length was 2.8 cm; four thrombi extended 0.6-1.0 cm into the IVC, and the mean operative time was 127 minutes with the average estimated blood loss at 148 mL. The mean hospital stay was 5 days. Histology revealed two renal-cell carcinomas, one angiomyolipoma, one renal pelvic transitional-cell carcinoma, and one renal infarction. All the surgical margins were negative. With a mean follow-up of 35 months, metastatic diseases did not develop in any patient. Despite the technical challenges, pure retroperitoneal LRN for right renal masses with a RV and IVC thrombus is safe and feasible in appropriately selected patients using a retroperitoneal approach. In patients with minimal caval involvement, our surgical approach provided an alternative treatment option, especially when the patients had a history of abdominal surgery.

Trends of adult primary malignant renal tumors over six years

To assess the demographic and clinico-pathological trends, as well as the management options of adult patients with primary malignant renal tumors over 6 years. From July 2003 - July 2009, 55 adult patients with primary malignant renal tumors were treated in two teaching hospitals (Jordan University Hospital in Amman - Jordan and Al-Jumhory Teaching Hospital in Mosul - Iraq). Their data were reviewed retrospectively. Of the 55 patients, 44 had renal cell carcinoma (RCC), eight patients had Transitional cell carcinoma (TCC) of the renal pelvis, two had Sarcoma and one Patient had primary renal lymphoma. Among patients with RCC: the mean age was 56 years, male to female ratio was 3:1. The most common presenting symptom was hematuria. Most of the patients were treated with radical nephrectomy, the clear cell subtype was predominant and most of the patients were diagnosed at stage T2. Regarding patients with TCC: mean age was 57 years, all were treated with radical nephro-ureterectomy and removal of bladder cuff, however (50%) of them developed TCC of urinary bladder within 12 months of radical nephro-ureterectomy. In our series of patients with RCC: there is a trend toward younger age at Diagnosis. We still encountered locally advanced and metastatic disease with a lower rate of incidentally Diagnosed tumors.With regard to patients with renal pelvis TCC: there are trends toward younger age affection, localized disease and early development of bladder TCC which indicate the importance of strict surveillance protocol.

Spontaneously Arising Concurrent Ileocaecal Adenocarcinoma and Renal Pelvis Transitional Cell Carcinoma in a Rhesus Macaque (Macaca mulatta)

A 25-year-old, female rhesus macaque (Macaca mulatta) presented with a history of weight loss despite a normal appetite and supportive care. The animal was humanely destroyed due to poor prognosis. Post-mortem examination revealed a focally extensive, firm, white annular constriction at the ileocaecal junction and an incidental finding of a pale white nodule approximately 0.8 cm in diameter in the left renal pelvis. Based on the microscopical findings, ileocaecal adenocarcinoma and renal pelvis transitional cell carcinoma (TCC) were diagnosed. The use of cytokeratin (CK)-7 and -20 and uroplakin III as potential renal TCC markers was evaluated. The neoplastic cells were labelled intensely with antibodies to uroplakin III, but not to CK-7 or -20. Spontaneous intestinal adenocarcinoma has been documented in the rhesus macaque, but concurrent renal pelvis TCC is highly unusual.

Surgical Treatment of Inferior Vena Cava Invasion in Patients with Renal Pelvis Transitional Cell Carcinoma by Use of Human Cadaveric Aorta

We herein report a case of radical nephroureterectomy and replacement of the inferior vena cava (IVC) with ahuman cadaveric aortic graft for a patient with renal pelvis transitional cell carcinoma associated with IVC infiltration. In advanced disease, radical surgery is essential to achieve long-term survival. This case entails the use of another treatment option among the numerous options currently available for the management of patients with advanced renal cancer associated with IVC invasion.

V501 LAPARO-ENDOSCOPIC SINGLE SITE TRANSVESICAL BLADDER CUFF EXCISION

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2011V501 LAPARO-ENDOSCOPIC SINGLE SITE TRANSVESICAL BLADDER CUFF EXCISION Rene Javier Sotelo, Juan Arriaga, Oswaldo Carmona, Robert De Andrade, Camilo Giedelman, Zehnder Pascal, Brian Irwin, Aron Monish, Mihir Desai, Inderbir Gill, and Jose Saavedra Rene Javier SoteloRene Javier Sotelo Caracas, Venezuela More articles by this author , Juan ArriagaJuan Arriaga Caracas, Venezuela More articles by this author , Oswaldo CarmonaOswaldo Carmona Caracas, Venezuela More articles by this author , Robert De AndradeRobert De Andrade Caracas, Venezuela More articles by this author , Camilo GiedelmanCamilo Giedelman Caracas, Venezuela More articles by this author , Zehnder PascalZehnder Pascal Los Angeles, CA More articles by this author , Brian IrwinBrian Irwin Burlington, VT More articles by this author , Aron MonishAron Monish Los Angeles, CA More articles by this author , Mihir DesaiMihir Desai Los Angeles, CA More articles by this author , Inderbir GillInderbir Gill Los Angeles, CA More articles by this author , and Jose SaavedraJose Saavedra Caracas, Venezuela More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.597AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To present a novel technique for the management of the bladder cuff during distal ureterectomy under pneumovesicum using a single port device inserted transvesically. BACKGROUND A variety of techniques have been used to manage the distal ureter during minimally invasive nephroureterectomy for benign and malignant diseases. Each technique has distinct advantages and disadvantages that may impact intra-operative and post-operative outcomes. A general concensus has not been established. METHODS We present two cases. The first case demonstrates the technique in a patient with malignant disease in an 80 year old man with a 5cm left renal pelvic tumor. The second case shows the techniques application in a benign disease in a 25 year old woman with history of recurrent urinary tract infections in whom a CT scan showed complete duplication of the left collecting system with upper pole hydroureteronephrosis. RESULTS The first patient underwent left laparoendoscopic single site (LESS) radical nephroureterectomy with retroperitoneal lymph node dissection and bladder cuff excision under pneumovesicum for a left renal pelvic transitional cell carcinoma; final histopathology revealed pathologic G3 T3 N0 with 7 negative nodes. The operative time was 375 minutes including 45 minutes for bladder cuff excision, and estimated blood loss was 250cc. Length of stay was one day. No post-operative complications or evidence of recurrence were noted after one year of follow up. The second patient underwent LESS upper pole heminephroureterectomy for treatment of a duplicated left collecting system and upper pole hydronephrosis. Final pathology revealed chronic pyelonephritis. The operative time was 210 minutes including 30 minutes for bladder cuff excision and estimated blood loss was 400cc. The patients length of stay was three days. Postoperatively the patient was found to have lower pole renal vein thrombosis at her first postoperative visit. CONCLUSIONS LESS transvesical bladder cuff excision may offer many advantages including the ability to allow precise marking of the bladder cuff, avoiding potential injury to the contralateral ureteral orifice, and allowing water-tight closure of the bladder. It can be performed trough a small suprapubic skin incision with a small cystotomy pubic incision it can be also then used to assist the laparoscopic dissection. Additional studies are needed to identify the best approach for managing the distal ureter at the time of laparoscopic nephroureterectomy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e203-e204 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rene Javier Sotelo Caracas, Venezuela More articles by this author Juan Arriaga Caracas, Venezuela More articles by this author Oswaldo Carmona Caracas, Venezuela More articles by this author Robert De Andrade Caracas, Venezuela More articles by this author Camilo Giedelman Caracas, Venezuela More articles by this author Zehnder Pascal Los Angeles, CA More articles by this author Brian Irwin Burlington, VT More articles by this author Aron Monish Los Angeles, CA More articles by this author Mihir Desai Los Angeles, CA More articles by this author Inderbir Gill Los Angeles, CA More articles by this author Jose Saavedra Caracas, Venezuela More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high‐risk upper tract transitional cell carcinoma

The authors evaluated the incidence of pathologic downstaging and complete remission (CR) in patients with high-grade ureteral and renal pelvic transitional cell carcinoma (TCC) (upper tract TCC) who received neoadjuvant chemotherapy followed by surgery. The study group comprised patients with biopsy-demonstrated, high-grade disease who received neoadjuvant chemotherapy followed by nephrouterectomy from 2004 to 2008, during which time patients uniformly were considered for neoadjuvant chemotherapy. The control group comprised patients with biopsy-demonstrated, high-grade disease who underwent initial nephroureterectomy from 1993 to 2004, when patients uniformly underwent initial surgery. Multiple clinical and pathologic features were evaluated, and the primary endpoint was pathologic tumor classification. One hundred seven patients in the control group underwent initial surgery, and 43 patients in the study group received neoadjuvant chemotherapy. Baseline demographics were similar between the groups except for a higher rate of sessile tumor architecture in the study group (72.1% vs 49.5%; P = .018). There was significant downstaging in study group patients compared with the historic control group (P = .004). The incidence of tumors classified as pathologic T2 (pT2) or as pT3 or higher was significantly lower in the study group (pT2, 65.4% vs 48.8%; P = .043; pT3 or higher, 47.7% vs 27.9%; P = .029). Fourteen percent of patients who received neoadjuvant chemotherapy had a pathologic CR. Neoadjuvant chemotherapy was associated with a 14% CR rate and a significant rate of downstaging. While longer follow-up is awaited for survival data to mature, the current data provide justification for the sustained support of trials using this strategy.

1284 A COMPARATIVE STUDY OF THE REQUIREMENT OF INTRODUCER SHEATHS FOR URETERIC ACCESS BETWEEN AN OLD GENERATION FIBRE-OPTIC FLEXIBLE URETEROSCOPE AND A NEW “CHIP ON THE TIP” DIGITAL FLEXIBLE URETEROSCOPE

You have accessJournal of UrologyTechnology & Instruments: Ureteroscopy1 Apr 20101284 A COMPARATIVE STUDY OF THE REQUIREMENT OF INTRODUCER SHEATHS FOR URETERIC ACCESS BETWEEN AN OLD GENERATION FIBRE-OPTIC FLEXIBLE URETEROSCOPE AND A NEW “CHIP ON THE TIP” DIGITAL FLEXIBLE URETEROSCOPE Zafar Maan, Tamer El-Husseiny, Konstantinos Moraitis, Junaid Masood, and Noor Buchholz Zafar MaanZafar Maan More articles by this author , Tamer El-HusseinyTamer El-Husseiny More articles by this author , Konstantinos MoraitisKonstantinos Moraitis More articles by this author , Junaid MasoodJunaid Masood More articles by this author , and Noor BuchholzNoor Buchholz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.855AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although the new generation “chip on the tip” digital flexible ureteroscopes provide significantly superior views and are likely to be more durable than the old generation fibre-optic flexible ureteroscopes, one area of concern might be their larger distal tip diameter as it houses the digital chip. This might necessitate more frequent use of an introducer sheath to gain entry into the ureter. This of course may increase the risk of ureteric injury, the need for placing a JJ stent and has cost implications. METHODS We only looked at the need for a sheath in order to gain access to the ureter in all patients undergoing flexible uretero-renoscopy over a period between June 2006 and January 2009. Patients were scoped with either an old generation fibre optic flexible ureteroscope (DUR-8, Elite, ACMI; Working Length= 65cm; Distal Tip Diameter=8.5F) or a new generation “chip on the tip” digital LCD flexible ureteroscope (Invisio D-URD flexible ureteroscope; Working Length=65cm; Distal Tip Diameter= 8.7F). The age and sex of the patients and indications for f-URS were noted and compared between the two groups. Any patients who had a pre-operative JJ stent in place were excluded from the study. RESULTS FO and LCD flexible ureteroscopies were performed in 157 cases over the time frame. Sheaths were used for access more frequently in LCD f-URS cases; 19 out of 77 LCD f-URS cases required a sheath for access (25%), compared to 6 out of 80 FO f-URS cases (7.5%). Student's t-test produced a significant difference between the two groups (p value 0.00174). The two groups were well matched in terms of age and sex as well as indications for f-URS (85% for upper ureteric and renal calculi, 10% diagnostic and 5% for renal pelvic transitional cell carcinoma fulgaration). The vast majority of f-URS were carried out for stone disease and the groups were well matched in terms of stone location and stone burden. Post-operative JJ stenting was required in 35 of the 77 patients in the digital f-URS group and in 31 out of 80 in the fibre-optic f-URS group. This was not significantly different and may due to reduced operating time as a result of the superior image quality. CONCLUSIONS A statistically significant increase in sheath use was observed in the new generation digital f-URS group despite an increase in the tip diameter of only 0.2F (8.7F VS 8.5F). Despite the obvious improvement in the images obtained and the likely better durability, the increased use of ureteric access sheaths may increase morbidity and expense. London, United Kingdom© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e497 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zafar Maan More articles by this author Tamer El-Husseiny More articles by this author Konstantinos Moraitis More articles by this author Junaid Masood More articles by this author Noor Buchholz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Percutaneous Endourologic Procedures in High-Risk Patients in the Lateral Decubitus Position Under Regional Anesthesia

The prone position is the most commonly used position for percutaneous endourologic procedures. It is usually combined with a general anesthesia. In high-risk patients, this approach can lead to circulatory and respiratory compromises. Operating on such patients in a full lateral position will minimize the hemodynamic and respiratory risks and-if combined with spinal anesthesia-will allow for increased patient comfort and safety. After rigorous preoperative assessment, 27 medical high-risk patients (12 men) with a mean age of 62 years and an American Society of Anesthesiologists score of 3+ were included in this study. The majority (78%) had regional anesthesia and were fully awake and alert during the operation. The procedures consisted of an initial retrograde renal study/filling with contrast medium with the patient in the lithotomy position to aid kidney puncture. The percutaneous procedure was then performed with the patient in the lateral decubitus position, and access was performed under fluoroscopic and/or ultrasonographic guidance. Twenty-two percutaneous nephrolithotomies (PCNL), 3 anterograde endopyelotomies (AEP), 1 percutaneous resection of renal pelvic transitional-cell carcinoma, and 1 percutaneous renal cyst sclerotization were performed. After PCNL, 11 patients were stone free postoperatively, and a further 8 were stone free after adjuvant shockwave lithotripsy. Two patients needed temporary Double-J stents. One renal access failed. Two procedures were aborted because of hemorrhage. One patient died in the recovery room from uncontrollable renal bleeding. A renal scan after 3 months showed relief of obstruction in the three patients who had undergone AEP. Ultrasonography confirmed complete resolution of the sclerotized renal cyst. Neither of the patients with regional anesthesia needed conversion to general anesthesia. In two patients who experienced moderate pain, a "top-up" with local anesthesia solved the problem. The full lateral position-while necessitating expertise and some learning for renal puncture from an unusual angle-is safe in medical high-risk patients. It can be safely performed using regional anesthesia, avoiding the risks of general anesthesia and allowing for patient-anesthetist communication throughout the procedure. Cardiac and respiratory parameters are improved, stable, and easily controlled. As opposed to the supine position, the awake patient is more comfortable, and morbid obesity is not a problem.

The Protective Role of Renal Parenchyma as a Barrier to Local Tumor Spread of Upper Tract Transitional Cell Carcinoma and its Impact on Patient Survival

We investigated whether tumor location has independent prognostic significance in upper tract transitional cell carcinoma cases and which factor determines it. We reviewed data on 122 renal pelvis and 102 ureteral tumor cases, including the recurrence pattern. Tumor location and other clinicopathological variables were evaluated regarding cancer specific and recurrence-free survival. Stage pT3 tumors were stratified into those invading renal parenchyma or peripelvic/periureteral fat. Overall 5-year cancer specific survival and recurrence-free survival rates were 77.0% and 71.6%, respectively, at a mean followup of 60.7 months. Of the clinicopathological parameters T stage was the most significant prognosticator of the survival rate, while nodal involvement, high grade and ureteral tumor location were also significant for lower survival rates. Stratification analysis for matching pathological stage revealed that, while survival rates were similar in the renal pelvis and ureteral tumor groups at stage pT2 or less, renal pelvic tumors were associated with significantly higher survival rates than ureteral tumors for stage pT3. Specifically renal pelvic tumors invading the renal parenchyma were associated with a lower local failure rate, and higher cancer specific and recurrence-free survival rates than tumors invading peripelvic or periureteral fat, ie 77.5% vs 49.7% 5-year cancer specific survival and 75.6% vs 32.0% 5-year recurrence-free survival (p = 0.014 and 0.003, respectively). Tumor location is an independent prognostic factor for pT3 upper tract transitional cell carcinoma. The overall better prognosis of renal pelvic tumors was mainly attributable to pT3 tumor outcomes, specifically lesions invading the renal parenchyma. These findings may be due to the protective role of thick renal parenchyma against local tumor spread.

Prognostic Impact of Peripelvic Fat Invasion in pT3 Renal Pelvic Transitional Cell Carcinoma

Renal pelvic transitional cell carcinoma (TCC), which invades beyond muscularis into peripelvic fat or the renal parenchyma, is diagnosed as stage pT3 despite its structural complexity. We evaluated the prognostic impact of peripelvic fat invasion in pT3 renal pelvic TCC. Between 1986 and 2004, the medical records on 128 patients who were surgically treated for renal pelvic TCC were retrospectively reviewed. Sixty patients with pT3 disease were eligible for the main analysis. The prognostic impact of various clinicopathological factors was analyzed using univariate and multivariate analyses. On univariate analysis, sex, age, concomitant bladder tumors, concomitant ureter tumors, lymphadenectomy, adjuvant chemotherapy, tumor grade, multiplicity, renal parenchymal invasion, and carcinoma in situ did not influence the disease-specific survival (p>0.05). By contrast, peripelvic fat invasion, lymph node invasion, and lymphovascular invasion were each significantly associated with disease-specific survival (p<0.05). Multivariate analysis showed that peripelvic fat invasion (p=0.012) and lymph node invasion (p=0.004) were independent prognostic factors. In conclusion, peripelvic fat invasion is a strong prognostic factor in pT3 renal pelvic TCC. Thus, systemic adjuvant therapy should be considered in the presence of peripelvic fat invasion, even if the lymph nodes are not involved.

The Impact Factors on Prognosis of Patients With pT3 Upper Urinary Tract Transitional Cell Carcinoma

Stage 3 upper urinary tract transitional cell carcinoma is a heterogeneous disease including different tumor locations (pelvis vs ureter) and invasion patterns (renal parenchyma, peripelvic fat and periureteral fat). Unfortunately the outcomes of patients with pT3 disease with different invasion pattern are largely unknown. This study presents the clinical outcome of patients with pT3 disease with upper urinary tract transitional cell carcinoma. We retrospectively reviewed the medical records of all patients with pT3 disease with upper urinary tract transitional cell carcinoma. Four patient groups were classified according to tumor location and tumor invasion pattern. Prognostic factors including age, gender, tumor grade, tumor size, tumor number, tumor location and microscopic finding of vascular invasion were analyzed with respect to disease recurrence and survival. A total of 72 patients were included in this study. The most common complaint and tumor relapse pattern were painless gross hematuria and distant metastasis, respectively. Patients with pT3 disease with superficial parenchymal invasion had better disease-free and recurrence-free survival than the other 3 groups. Initial tumor location (p = 0.02) and vascular invasion (p = 0.02) were independent factors for disease-free survival, and vascular invasion (p = 0.001) was the only predictive factor for recurrence-free survival. The present study demonstrated that patients with pT3 disease with superficial parenchymal invasion should be considered to have lower stage disease, and that vascular involvement is the only independent prognostic factor for patients with pT3 disease for disease-free and recurrence-free survival. Systemic adjuvant therapy should be recommended for patients with pT3 disease with vascular involvement.

Tumor lysis syndrome after treatment with gemcitabine for metastatic transitional cell carcinoma

Tumor lysis syndrome is a set of life threatening complication that can arise from treatment of high tumor burden, drug sensitive, and rapidly proliferating neoplasm particularly of hematological origin. It is rarely described in patients with solid tumors. We report the first case of tumor lysis syndrome in a man with metastatic renal pelvic transitional cell carcinoma after gemcitabine treatment. Despite aggressive therapy, he died 2 weeks after TLS was diagnosed. Our experience demonstrates that administration of gemcitabine for metastatic renal pelvic transitional cell carcinoma may induce acute tumor lysis syndrome, which necessitates frequent laboratory monitoring and prompt initiation of appropriate therapeutic measures.

Krukenberg Tumor of Renal Pelvic Origin: Report of a Case With Selected Comments on Ovarian Tumors Metastatic From the Urinary Tract

Metastatic tumors to the ovary are infrequently of urinary tract origin. In approximate descending order of frequency, this subset of secondary ovarian neoplasms includes renal cell carcinoma, transitional cell carcinoma of the urinary bladder, and urachal adenocarcinomas. These tumors usually raise a differential in turn of primary ovarian clear cell, transitional cell, or mucinous carcinomas. Only rare metastatic signet-ring adenocarcinomas of the bladder have shown the features of a Krukenberg tumor. We report the case of a 74-year old woman with bilateral Krukenberg tumors metastatic from a primary renal pelvic transitional cell carcinoma with glandular and signet-ring cell differentiation. This unique case reinforces that tumors with signet-ring cell morphology have a propensity to metastasize to the ovary, and indicates that renal pelvic carcinoma rarely may be the source of Krukenberg tumors.

Pseudo-Meigs' syndrome associated to renal pelvis tumor

Pseudo-Meigs' syndrome is associated with tumors different from the benign ovary tumor, but it has never been described in association to transitional cell carcinoma. A female 73 year-old patient presenting pleural effusion nonmetastatic associated with renal pelvis transitional cell carcinoma that resolved and did not recur after radical nephroureterectomy. Renal pelvis transitional cell carcinoma can result in the Pseudo-Meigs' syndrome. Although being a rare clinical entity, the identification of such syndrome can result in an accurate diagnosis, leading to an efficient surgical treatment, without comorbidity for the patient.

187Endourologic treatment of renal pelvic and ureteral transitional cell carcinoma

187Endourologic treatment of renal pelvic and ureteral transitional cell carcinoma