Subsequent Ureteroscopy Research Articles

Comparison of the results of active surgical treatment and serial stenting for urolithiasis in pregnant women

Introduction. Renal colic during pregnancy is a common cause of pain in the lower back. Currently, with a diagnosed kidney or ureter stone, the standard treatment is serial drainage of the urine tract using an internal ureter stent, with replacement of the drainage before delivery, followed by surgery to remove the stone after delivery.Objective. To study the effectiveness and safety of ureteroscopic interventions in the treatment of urolithiasis in pregnant women in comparison with the method of serial drainage of the upper urinary tract during gestation followed by surgical treatment of urolithiasis 4 weeks after delivery.Materials & methods. The study group consisted of 119 patients with a confirmed diagnosis of urolothiasis using instrumental diagnostic methods and a gestational age up to and including the 27th week. Two groups were formed based on treatment approaches for urolithiasis: group 1 included 59 patients (49.6%) who underwent surgical removal of the stone; group 2 included 60 patients (50.4%) who underwent internal ureteral stent replacement every 4 – 6 weeks prior to delivery and subsequent ureteroscopy There were no significant differences in age, body mass index, or number of pregnancies between the two groups.Results. The frequency of complete stone removal in groups 1 and 2 was 96.6 and 96.7%, respectively. The median amount of time spent on urolithiasis treatment in groups 1 and 2 was 60 [45; 72] and 97 [54; 105] minutes, respectively (p = 0.002). Migration of the ureteral stent in group 2 was observed in 13.3% of cases (p = 0.05). Among group 1 patients who underwent ureteroscopic intervention aimed at stone removal, the incidence of internal drainage dislocation was 3.4%. Encrustation of the ureteral stent in groups 1 and 2 was observed among 2 (3.4%) and 17 (28.3%) patients, respectively (p < 0.001). The bed-day (median time in days spent in hospital for drainage replacement and time of surgical treatment of urolithiasis) in groups 1 and 2 was four and eight days, respectively (p < 0.05). The frequency of natural childbirth in groups 1 and 2 was 81.35% and 55.0%, respectively (p = 0.002).Conclusion. Urolithiasis among pregnant women is a complex multifactorial disease that affects not only the health of the mother, but also the condition of the developing foetus. It is possible to perform surgical treatment with high efficiency and low complication rate, which improves the quality of life.

Transurethral guidewire loop for manipulation and extraction of stent: A novel, innovative, video-endoscopic technique in ureteral stent removal

Background Ureteral stent removal is one of the most common procedures performed in urology. Herein, we describe a novel technique for stent removal using TransUrethral Guidewire loop for Manipulation and Extraction of stents (TUG-ME) method. We aimed to evaluate the role, feasibility, cost, operative time, and complications of the method. A review of the literature outlining the innovations in ureteral stent removal was also performed. Materials and methods Cystoscopic stent removal was performed using TUG-ME in all sequential cases. Variables including sex, age, stent type, duration, reason for stent insertion, type of anesthesia (general/local), cystoscopic stent removal time, and documentation of postprocedural complications were tabulated. In addition, using the search term “novel innovation in ureteral stent removal,” various databases (PubMed, EMBASE, Cochrane Library, SCOPUS, and Web of Science) were searched. Results TUG-ME was successfully performed in all patients assessed on the first attempt. The patients comprised both sexes. The procedure was well tolerated under local anesthesia (4 of 5 cases), whereas general anesthesia was used in 1 case as the patient was booked for subsequent ureteroscopy under the same anesthetic. The procedure time was <27 seconds in all the cases assessed. No significant complications were noted. Fifteen studies involving novel innovations were included in the critical appraisal. Conclusions TUG-ME is a simple, cost-effective, and innovative alternative for removing ureteral stents. It may be easily applied instead of a conventional ureteral stent grasper. Published innovative trends in ureteral stent removal have evolved over time, including advancements in stent design, retrieval devices, and the use of fluoroscope-free and cystoscope-free techniques.

Percutaneous nephrostomy versus JJ ureteric stent as the initial drainage method in kidney stone patients presenting with acute kidney injury: A prospective randomized study.

To compare percutaneous nephrostomy tube versus JJ stent as an initial urinary drainage procedure in kidney stone patients presenting with acute kidney injury. Between January 2017 and January 2019, 143 patients with acute kidney injury secondary to obstructive kidney stone were prospectively randomized into the percutaneous nephrostomy tube group (71 patients) and JJ stent group (72 patients) at Beni-Suef University Hospital, Beni-Suef, Egypt. Exclusion criteria included candidates for acute dialysis, fever (>38°C), pyonephrosis, pregnancy and uncontrolled coagulopathy. The period required for serum creatinine normalization, failure of insertion, operative and fluoroscopy time were recorded. Definitive stone management for proximal ureteral stones >1.5cm consisted of percutaneous nephrolithotomy for the percutaneous nephrostomy group and ureteroscopic laser lithotripsy for the JJ stent group. For stone size <1.5cm, ureteroscopy or shockwave lithotripsy was carried out for both groups. Percutaneous nephrolithotomy was carried out for renal stones >2cm, and shockwave lithotripsy for stones <2cm. Distal and mid ureteral stones were treated by ureteroscopy. The percutaneous nephrostomy group had shorter operative time (P=0.001). There was no significant difference in the recovery period for normalization of serum creatinine between both groups (P=0.120). Procedural failure, ureteric mucosal injury and perforations increased in the case of male sex, stone size >1.5cm and upper ureteric stones in the JJ stent group. Procedural failure, pelvic perforations and intraoperative bleeding increased in case of male sex, mild hydronephrosis and stone size >2.5cm in the percutaneous nephrostomy group. Suprapubic pain, urethral pain and lower urinary tract symptoms were significant in the JJ stent group. The presence of a JJ stent directed us toward ureteroscopy (P=0.002) and the presence of a percutaneous nephrostomy directed us toward percutaneous nephrolithotomy (P=0.001). Percutaneous nephrostomy facilitates subsequent percutaneous nephrolithotomy, especially when carried out by a urologist, and it has a higher insertion success rate, a shorter operative time and a lesser incidence of postoperative urinary tract infection than a JJ stent. A JJ stent facilitates subsequent ureteroscopy, but operative complications can increase in the case of proximal ureteral stones >1.5cm.

Shockwave Lithotripsy Use in the State of Michigan: American Urological Association Guideline Adherence and Clinical Implications

To understand how treatment of patients with urinary stones by shockwave lithotripsy (SWL) aligns with current published practice guidelines. We used the Michigan Urologic Surgery Improvement Collaborative Reducing Operative Complications for Kidney Stones registry to understand SWL use in the state of Michigan. This prospectively maintained clinical registry includes data from community and academic urology practices and contains clinical and operative data for patients undergoing SWL and ureteroscopy (URS). We identified patients undergoing SWL from 2016 to 2019. In accordance with AUA guidelines, we evaluated practice patterns in relation to recommendations for treatment selection for SWL as well as clinical implications of guideline nonadherence. Four thousand, two hundred and nine SWL procedures performed across 34 practices were analyzed. Perioperative antibiotics were administered to 61.3% of patients undergoing SWL. A ureteral stent was placed at the time of SWL in 2.7% of patients. For lower pole renal stones >1 cm or large (>2 cm) renal stones in the registry, 32.2% and 58.9% of patients, respectively, underwent SWL, while the remainder were treated with URS. In these instances, SWL was associated with inferior stone-free rate (SFR) relative to URS. In patients with residual stones after SWL, 34.6% were treated with repeat SWL with lower SFR than those treated with subsequent URS. Postoperatively, 42.1% of patients were prescribed alpha-blockers with no benefit seen in terms of SFR. Substantial variation exists among urology practices with regard to SWL use. These data serve to inform quality improvement efforts regarding appropriateness criteria for SWL in Michigan.

Predictors of spontaneous ureteral stone passage in the presence of an indwelling ureteral stent.

Patients presenting acutely with obstructing stones often have a ureteral stent placed as a temporizing solution. Ureteroscopy is then commonly performed in a staged fashion, but occasionally the stone is found to have passed. We aimed to identify the frequency and predictors of ureteral stone passage with a stent in place. Records were reviewed to identify patients who had a stent placed for a single ureteral stone. Subsequent ureteroscopy or CT scan was used to ascertain stone passage. Effect of age, gender, BMI, stone diameter, alpha blocker use, urinary tract infection, hydronephrosis, and stent duration on stone passage was assessed. Inclusion and exclusion criteria were met in 209 patients. Mean maximum stone diameter was 6.5 ± 2.5mm. Passage rates for stones < 3mm, 3-4.9mm, 5-6.9mm, and ≥ 7mm were 50%, 13%, 10%, and 0%, respectively. The overall rate of passage was 8%. Stone passage was associated with smaller maximum stone diameter, more distal stone location, and longer duration of stent before ureteroscopy/CT on univariate analysis (p < 0.01). Stone diameter and stent duration remained significantly associated on multivariable analysis (p = 0.001 and p = 0.05, respectively). Our findings suggest ureteral stone passage with a concurrent ureteral stent is not a rare event as it occurred in 14% of stones less then 7mm in maximum diameter. Stone size and duration of stent before ureteroscopy or CT were found to be independent predictors of passage. Select patients with small ureteral stones who have been stented should be considered for a trial of urine straining or repeat imaging before subsequent ureteroscopy.

Urothelial Carcinoma of the Renal Pelvis and Ureter Associated with Hydronephrosis in a Patient with Horseshoe Kidney: a Case Report

A 73-year-old woman visited our clinic for right abdominal fullness and dull pain. She had been treated rheumatoid arthritis and CT scan had shown hydronephrosis with a renal stone in the right kidney of horseshoe kidney 2 and a half years ago, although no treatment had been sought because of the lack of symptoms. Although retrograde pyelography showed no filling defect in the upper urinary tract, urine cytology was positive. Subsequent ureteroscopy of the right renal pelvis showed multiple papillary tumors. Right nephroureterectomy and isthmusectomy were performed. The pathological diagnoses were urothelial carcinoma in the renal pelvis and squamous cell carcinoma, accompanied by urothelial carcinoma in the ureter. The present report describes the 35th case of renal pelvic carcinoma occurred in a horseshoe kidney in Japan.

1540 PREDICTORS FOR NOT FINDING A STONE DURING URETEROSCOPY AFTER EMERGENCY DRAINAGE OF THE UPPER TRACT BY DOUBLE J URETERAL STENT

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (I)1 Apr 20131540 PREDICTORS FOR NOT FINDING A STONE DURING URETEROSCOPY AFTER EMERGENCY DRAINAGE OF THE UPPER TRACT BY DOUBLE J URETERAL STENT Shmuel Roizman, Ilia Beberashvili, Yaniv Shilo, Yoram Siegel, Erez Lung, Kobi Stav, Amnon Zisman, Arie Lindner, and Dan Leibovici Shmuel RoizmanShmuel Roizman rishon lezion, Israel More articles by this author , Ilia BeberashviliIlia Beberashvili rishon lezion, Israel More articles by this author , Yaniv ShiloYaniv Shilo rishon lezion, Israel More articles by this author , Yoram SiegelYoram Siegel rishon lezion, Israel More articles by this author , Erez LungErez Lung rishon lezion, Israel More articles by this author , Kobi StavKobi Stav rishon lezion, Israel More articles by this author , Amnon ZismanAmnon Zisman rishon lezion, Israel More articles by this author , Arie LindnerArie Lindner rishon lezion, Israel More articles by this author , and Dan LeiboviciDan Leibovici rishon lezion, Israel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3030AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients who undergo emergency drainage for an obstructed upper urinary tract by stones often undergo subsequent uerteroscopy as a definitive procedure. However, in some, the obstructing stone will not be found at ureteroscopy. Our purpose was to identify predictors of not finding ureteral stones in patients who had undergone previous drainage by stents. METHODS 102 consecutive patients in whom a double J stent was inserted underwent subsequent ureteroscopy. Demographical, clinical, laboratory and imaging data were collected retrospectively. Stone presence was determined by endoscopy and retrograde fluoroscopy during ureteroscopy. Univariate and multivariate logistic regression analysis were performed to identify predictors for the presence of stone in the urinary tract. Receiver operator curve was used to identify the stone diameter cutoff that best predicts stone presence. RESULTS in 35 patients (34.3%) the stone was not found in the urinary tract during ureteroscopy. Univariate analysis showed that male gender and stone diameter were related to finding the stone in the urinary tract. Multivariate analysis found that stone diameter was the only predictor for stone presence in the urinary tract with a cutoff of 5.5 mm. Smaller stones had a higher probability not to be found in ureteroscopy (p= 0.033). Of all the ureteroscopies with stones smaller than 5.5 mm (43) there were 22 in which no stone was found (51.2%). For stones larger then 5.5 mm the proportion was 13 out of 59 (22%). thus the likelihood of not finding the stone is twice higher for smaller versus larger stones. CONCLUSIONS in 34% of the patients who underwent ureteroscopy after previous ureteral stent insertion the stone was not found. Stone diameter is an independent predictor of stone presence. Stones smaller than 5.5mm are less likely to be found at ureteroscopy, The probability to find a stone larger then 5.5 mm is twice as higher. Table 1. Stone finding probability: (OR=odds ratio; CI=confidence interval) univariate multivariate variable OR(95%-CI) P OR(95%-CI) P Age (↑ 1y) 1.014 (0.985-1043) 0.350 1.026 (0.992-1.061) 0.134 Gender (m) 5.000 (1.074-23.274) 0.040 4.657 (0.883-24.556) 0.070 Previous ureteroscopy 0.241 (0.028-2.040) 0.192 0.238 (0.025-2.230) 0.209 Stone size(↑ 1mm') 0.682 (0.552-0.843) 0.0001 0.750 (0.599-0.940) 0.012 Side (right) 0.554 (0.244-1.258) 0.158 1.823 (0.721-4.610) 0.204 Stone location (distal ureter) 1.458 (0.643-3.306) 0.732 0.553 (0.189-1.620) 0.280 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e631-e632 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shmuel Roizman rishon lezion, Israel More articles by this author Ilia Beberashvili rishon lezion, Israel More articles by this author Yaniv Shilo rishon lezion, Israel More articles by this author Yoram Siegel rishon lezion, Israel More articles by this author Erez Lung rishon lezion, Israel More articles by this author Kobi Stav rishon lezion, Israel More articles by this author Amnon Zisman rishon lezion, Israel More articles by this author Arie Lindner rishon lezion, Israel More articles by this author Dan Leibovici rishon lezion, Israel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ureteral Stents for Impassable Ureteroscopy

For the narrow ureter that will not accommodate a ureteroscope, it is common practice to place a ureteral stent, to allow subsequent ureteroscopy in the passively dilated ureter. Surprisingly, there are limited data on the effectiveness or safety of these maneuvers. We retrospectively analyzed patients managed with ureteral stent placement followed by another attempt at ureteroscopy after an initial attempt of flexible ureteroscopy failed because the ureteroscope would not pass up an otherwise normal ureter. Of 41 patients with follow-up who underwent ureteral stenting for this reason, the ureteroscope passed with ease poststenting in 29 (71%) and there was continued resistance in 12. Of these 12 patients, the ureteroscopy was continued despite resistance in 9, while another stent was placed in the remaining 3. Of these three patients, the third attempt at ureteroscopy was successful in two, and further attempts at ureteroscopy were not made after the third attempt failed in one. With a mean overall follow-up of 32 months, two patients (5%) developed ureteral strictures. Both were among nine patients in whom repeat ureteroscopy was performed despite resistance, with a rate of obstruction of 22% in this subgroup. Overall, ureteral stenting allowed successful ureteroscopy in 98% of patients. Ureteral stenting with subsequent ureteroscopy is a successful and safe method of addressing a narrow ureter that initially does not allow passage of a flexible ureteroscope, as long as persistent subsequent attempts to insert the ureteroscope are made only if it passes easily.

The double wire technique: an alternative method for difficult ureteroscopic access

We read with great interest the study report by Ji et al. (Urol Res, doi: 10.1007/s00240-012-0476-0 , 2012) about the impact of the intentional ureteral stenting on the success rate of calculus extraction by second ureteroscopy, when the initial ureteroscopy failed. Actually, sometimes ureteral stone treatment pose challenging problems for the urologists. This study has filled an important gap on this field. If flexible ureteroscopy and laser lithotripter are not available pre-existing stent may improve the success rate of a subsequent ureteroscopy for impacted ureteral stones. Because, post-stent ureteroscopy has the advantage of working through a dilated ureter. We would like to add some additional comments and suggestions in addition to the authors' discussion, which is noteworthy in several respects.

V1719 FLEXIBLE URETEROSCOPY-ASSISTED RETROGRADE NEPHROSTOMY FOR PCNL

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2012V1719 FLEXIBLE URETEROSCOPY-ASSISTED RETROGRADE NEPHROSTOMY FOR PCNL Jason B. Wynberg, Joshua Z. Vicena, Scott A. Salmon, and Vince N. Hannosh Jason B. WynbergJason B. Wynberg Detroit, MI More articles by this author , Joshua Z. VicenaJoshua Z. Vicena Detroit, MI More articles by this author , Scott A. SalmonScott A. Salmon Detroit, MI More articles by this author , and Vince N. HannoshVince N. Hannosh Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1678AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We adapted the COOK® Lawson retrograde nephrostomy puncture wire for deployment through the operating channel of a flexible ureteroscope. We present our initial experience with this technique. METHODS Patients were placed under general anesthesia and positioned in Galdakao-Modified Supine Valdivia position. Previously placed ureteric stent was removed and flexible ureteroscopy was performed with ureteral access sheath and safety wire in place. Flexible ureteroscope was advanced into selected calyx and trajectory for puncture wire deployment was evaluated with 2-plane fluoroscopy. Laser was applied to stone if needed to enter selected calyx. Surgeon held ureteroscope position while assistant passed puncture wire into working channel until tip emerged from scope. Assistant then released pin-vise lock and advanced puncture wire in 1 cm increments under fluoroscopic guidance until wire emerged from flank. A 5F, 30 cm coaxial transitional dilating catheter (Vascular Solutions, Inc.) was used as an exchange catheter at the flank and advanced over puncture wire into ureter. Puncture wire, inner catheter from coaxial set and ureteroscope were removed. A 0.038” wire was advanced antegrade through outer catheter of coaxial set until wire emerged out of ureteric access sheath. Outer coaxial was then removed from flank, 0.038” wire was secured at flank and urethra. 5F catheter was advanced into ureter for retrograde imaging during PCNL prior to removing access sheath. Foley catheter was placed in the bladder. PCNL was then performed in same position. RESULTS Procedure was successful in 8/9 patients – in one patient, puncture wire tract was not dilated due to high kidney, nearby pleura. Mean BMI - 31.5; mean stone diameter 2.5 x 1.7 cm, and mean 1.3 stones per kidney. Only one access was performed in all patients with mean 2.3 wire passages to achieve acceptable wire passage. Laser lithotripsy was required in one case to grant access to selected calyx. All dilated punctures were behind the posterior axillary line. For nephrostomy + PCNL: procedure - mean 153 min., fluoro - mean 2 min. 48 s. Five patients were stone free; two required subsequent ureteroscopy. No complications were noted in this series. CONCLUSIONS This technique is safe, intuitive, and builds on modern urologists' endoscopy skills. We found it easy to teach to residents. Careful pre-op review of adjacent organs on CT scan to establish a safe course for wire passage is critical for establishing patient eligibility. We found this procedure more difficult in obese patients. We contemplate a complementary role for this technique alongside antegrade methods. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e693 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason B. Wynberg Detroit, MI More articles by this author Joshua Z. Vicena Detroit, MI More articles by this author Scott A. Salmon Detroit, MI More articles by this author Vince N. Hannosh Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

E27 Is SWL-failure a predictor for poor outcome in subsequent ureteroscopy. A matched pair analysis

E27 Is SWL-failure a predictor for poor outcome in subsequent ureteroscopy. A matched pair analysis

First case of a primary osteosarcoma of the ureter: diagnostic findings, course of disease and treatment

In October 2005, a 61-year-old patient was admitted with symptomatic right sided hydronephrosis. She was treated for breast cancer in 2003 with radical mastectomy and chemotherapy and for cervical carcinoma in 1983, which was cured by a Wertheim-Meigs operation and radiotherapy. An intravenous pyelogram was performed, which demonstrated occlusion of the right distal ureter (Figure 1). A subsequent ureteroscopy revealed a hard, round mass in the distal ureter that was not removable and occluded the lumen. Biopsies were taken and histopathology revealed a highly pleomorphic neoplasm composed of myxoid spindle cell sarcomatous elements and more closely packed spindle cells with malignant osteoid production. Distal ureteric resection with bladder-cuff and ureterocystoneostomy were performed (R0-resection). The patient made a good recovery from surgery and was discharged. Adjuvant chemotherapy was recommended but rejected by …

Efficiency and cost of treating proximal ureteral stones: Shock wave lithotripsy versus ureteroscopy plus holmium:yttrium-aluminum-garnet laser

Objectives To compare the success rates, cost effectiveness, and efficiency of ureteroscopy (URS) and extracorporeal shock wave lithotripsy (ESWL) for proximal ureteral stones. Methods In a retrospective manner, 220 patients who underwent treatment for proximal ureteral stones were included in the study. The patient records, radiographs, and billing statements of all patients treated for upper ureteral stones between January 1997 and June 2001 at Scott and White Memorial Hospital were reviewed. The patients were placed into two treatment groups according to the method of their stone’s initial treatment. The stones were categorized as less than 1 cm and 1 cm or greater. Results A total of 111 patients were in the ESWL group, 73 of whom had stones less than 1 cm, and 109 patients in the URS group, 81 of whom had stones less than 1 cm. In the URS group, 91% were successfully treated with one treatment intervention, and 55% of the ESWL group were successfully treated with their initial intervention ( P <0.0001). Of the patients with URS failure, all but one was treated successfully with a second URS. Of the patients with ESWL failure, 52% were treated successfully by subsequent URS. The remaining patients with ESWL failure were treated with repeat ESWL, with a 62% success rate. The efficiency quotient for stones less than 1 cm for URS and ESWL was 0.79 and 0.51, respectively. For stones 1 cm or greater, URS had an efficiency quotient of 0.72 and ESWL of 0.46. The URS group required fewer days to be stone free (8 versus 25.5 days, P <0.0001). No statistically significant difference was found in the overall complication rates ( P = 0.43). URS had significantly lower charges for the initial procedure ($7575 versus $9507, P <0.0001). The total charges were also lower for URS ($9378 versus $15,583, P <0.0001). Complications were similar in the two groups. The URS group had two ureteral strictures. Conclusions The results of this study indicate that URS is more efficient and cost-effective for stones up to and larger than 1 cm with similar complication rates compared with ESWL.

LYMPHOEPITHELIOMA-LIKE CARCINOMA OF THE URETER

Lymphoepithelioma is a malignant epithelial tumor of the nasopharynx that has also been reported to occur in other organs. To our knowledge we report the first case of lymphoepithelioma-like carcinoma of the ureter. CASE REPORT A 75-year-old man presented with total gross painless hematuria and intermittent right flank pain. Ultrasound showed mild right hydronephrosis in an otherwise normal kidney and cystoscopy revealed blood coming from the right ureteral orifice. Creatinine was 1.9 mg./dl. (normal 0.6 to 1.4). Urine cytology showed some atypical cells. Retrograde ureteropyelography and subsequent ureteroscopy defined a solitary 1.0 cm. lesion in the lower third of the ureter. Computerized tomography suggested a localized ureteral process. Distal ureterectomy and psoas hitch ureteroneocystotomy were performed. A 1.0 x 1.0 x 0.8 cm. white nonpapillary intraluminal nodule was noted in the lower third of the right ureter (fig. 1). At the site of excision the tumor was noted to ' have infiltrated the entire ureteral wall. A total of 27 pelvic lymph nodes proved negative for metastatic disease. Microscopic examination of the resected tumor revealed , syncytium-like sheets of large tumor cells with indistinct , cytoplasmic membranes, vesicular nuclei and prominent nucleoli. Rare mitotic figures were present. Individual cell necrosis was also evident. Between the syncytium was a prominent lymphoid infiltrate composed of small lymphocytes, immunoblasts, histiocytes and plasma cells. Occasional germinal center formation was noted (fig. 2). Adjacent to the tumor was an area of severe urothelial atypia with numerous small lymphocytes interspersed between epithelial cells. NO classical urothelial carcinoma was noted on the specimen. Immunostains revealed the large tumor cells to express cytokeratins 7 and 20, a keratin profile compatible with urothelial cells. The lymphocytic infiltrate was composed of predominantly CD20 positive B cells and CD3 positive T cells (ratio 2:l). CD68 positive histiocytes were scattered in the lymphoid infiltrate. The plasma cells were polyclonal with respect to K and A expression. Deoxyribonucleic acid in situ hybridization with the Epstein-Barn virus, deoxyribonucleic acid NotWstI repeat region probe? and Epstein-Barr virus early Eber ribonucleic acid oligoprobest proved negative in the tumor cells and lymphocytic infiltrate. Because the morphological picture was indistinguishable from that of lymphoepithelioma of the nasopharynx and the immunohistochemistry confirmed an epithelial differentiation, diagnosis was lymphoepithelioma-like carcinoma of the ureter. DISCUSSION