Tract Tract Transitional Cell Carcinoma Research Articles

Resection of Solitary Lung Metastasis of Urinary Tract Transitional Cell Cancer Can Prolong Survival in Selected Patients

There are only a few small published studies on pulmonary metastasectomy for urinary tract transitional cell carcinoma (TCC). In this study, we examined the long-term outcome and the prognostic survival factors associated with pulmonary metastasectomy of urinary tract TCC, as based on our centre's 20-year experience. Between 2000 and 2020, curative pulmonary metastasectomy was performed in 18 patients (14 males and 4 females). Clinical, demographical and surgical data were retrospectively analysed. The disease-free interval between treatment of the primary tumour and pulmonary metastasectomy ranged from one to 48 months. Survival analysis was conducted with the Kaplan-Meier method and log-rank test. The 3- and 5-year survival rates were 84.7% and 52.9%, respectively. Resection of solitary metastases was a positive and independent factor for survival (p=0.04). Pulmonary metastasectomy of urinary tract TCC is associated with a favourable outcome and solitary metastasis is associated with long-term survival. Surgical resection of solitary pulmonary metastasis and repeated lung metastasectomy by pulmonary recurrence from a urinary tract TCC is feasible in selected patients.

Clinical and pathological factors predictıve of bladder cancer recurrence in patients with upper tract prımary TCC.

To evaluate predictive clinical and histopathological risk factors for bladder cancer recurrence in patients who underwent nephroureterectomy for primary upper urinary tract transitional cell carcinoma (TCC). Data of 111 patients, who were diagnosed with upper urinary tract TCC and underwent nephroureterectomy were reviewed A total of 65 patients were included in the study, after excluding 34 patients. Results: Bladder cancer recurrence developed in 20 (30.7%) of the 65 patients under evaluation. The recurrence-free survival rates in the 1st, 3rd, and 5th years were 78.4%, 70.7% and 69.2%, respectively. Lymphovascular invasion and a positive surgical margin were defined as risk factors for bladder cancer recurrence. In addition, patients with multiple tumors and low stage and grade pathology had a high rate of bladder cancer recurrence, although this was not statistically significant. After nephroureterectomy, a careful follow-up is required in terms of bladder tumor recurrence especially in patients with a positive surgical margin, lymphovascular invasion, low-grade tumors, or multifocal tumors.

MP63-15 CAN RENAL TRACT ULTRASOUND REPLACE CT UROGRAPHY FOR THE EVALUATION OF MICROSCOPIC HEMATURIA? RESULTS OF A PROSPECTIVE OBSERVATIONAL STUDY

You have accessJournal of UrologyImaging/Radiology: Uroradiology IV1 Apr 2018MP63-15 CAN RENAL TRACT ULTRASOUND REPLACE CT UROGRAPHY FOR THE EVALUATION OF MICROSCOPIC HEMATURIA? RESULTS OF A PROSPECTIVE OBSERVATIONAL STUDY Wei Shen Tan, Andrew Feber, Liqin Dong, Rachael Sarpong, Simon Rodney, Pramit Khetrapal, Patricia de Winter, Rumana Jalil, Norman Williams, Chris Brew-Graves, John Kelly, and DETECT I trial group Wei Shen TanWei Shen Tan More articles by this author , Andrew FeberAndrew Feber More articles by this author , Liqin DongLiqin Dong More articles by this author , Rachael SarpongRachael Sarpong More articles by this author , Simon RodneySimon Rodney More articles by this author , Pramit KhetrapalPramit Khetrapal More articles by this author , Patricia de WinterPatricia de Winter More articles by this author , Rumana JalilRumana Jalil More articles by this author , Norman WilliamsNorman Williams More articles by this author , Chris Brew-GravesChris Brew-Graves More articles by this author , John KellyJohn Kelly More articles by this author , and DETECT I trial groupDETECT I trial group More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2038AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The American Urology Association recommends that CT urography should be the upper tract imaging of choice for the evaluation of both gross and microscopic hematuria patients. In a prospective observational study (clinicaltrials.gov NCT02676180), we determine and compare the diagnostic accuracy of both CT urography and renal tract ultrasound (RTU) at identifying urinary tract cancer (UTC). METHODS The DETECT I study prospectively recruited patients investigated for hematuria at 40 hospitals. All patients had cystoscopy and CT urography and/ or RTU as part of haematuria evaluation. Bladder cancer was defined as histologically confirmed cancer following transurethral resection of bladder cancer or bladder biopsy. Upper tract tumours (renal parenchymal cancers or upper tract transitional cell carcinoma (TCC)) were determined following review of scans at tumour board meeting. RESULTS 3561 patients with a median age of 68 years (IQR: 57, 76) were recruited between March 2016 to June 2017. The overall incidence of UTC was 10% (bladder cancer: 8.0%, renal parenchymal cancer 1.1%, upper tract TCC: 0.7%). Of the 448 patients (13%) who had both RTU and CT urography, 64 bladder cancers, 9 renal parenchymal cancer and 6 upper tract TCC were diagnosed. RTU had a sensitivity of 89% (n=8) of identifying renal parenchymal cancers with a positive predictive value (PPV) of 53%. The negative predictive value (NPV) of RTU of ruling out renal parenchymal tumours was >99.5%. Of the 6 upper tract TCC identified on CT urography, RTU missed 3 cases. No upper tract TCC was identified following a presentation of microscopic hematuria. 2104 patients (59%) had RTU while 1608 patients (45%) had a CT urography. The diagnostic accuracy for RTU to detect bladder cancer was: sensitivity: 66%, specificity 99%, PPV 82% and NPV 98%. CT urography identified bladder cancer with a sensitivity of 87%, specificity of 97%, PPV of 79% and NPV of 99%. CONCLUSIONS CT urography can safely replace URT when evaluating patients presenting with microscopic hematuria due to the low risk of upper tract TCC. In patients with gross hematuria, the incidence of upper tract TCC is 1% and CT urography is indicated because of its superiority at identifying upper tract TCC compared to RTU. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e846-e847 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Wei Shen Tan More articles by this author Andrew Feber More articles by this author Liqin Dong More articles by this author Rachael Sarpong More articles by this author Simon Rodney More articles by this author Pramit Khetrapal More articles by this author Patricia de Winter More articles by this author Rumana Jalil More articles by this author Norman Williams More articles by this author Chris Brew-Graves More articles by this author John Kelly More articles by this author DETECT I trial group More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP06-08 WHO SHOULD BE EVALUATED FOR HEMATURIA? A COMPARISON OF INTERNATIONAL GUIDELINES

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I1 Apr 2018MP06-08 WHO SHOULD BE EVALUATED FOR HEMATURIA? A COMPARISON OF INTERNATIONAL GUIDELINES Wei Shen Tan, Andrew Feber, Liqin Dong, Rachael Sarpong, Simon Rodney, Pramit Khetrapal, Patricia de Winter, Rumana Jalil, Norman Williams, Chris Brew-Graves, John Kelly, and DETECT I trial group Wei Shen TanWei Shen Tan More articles by this author , Andrew FeberAndrew Feber More articles by this author , Liqin DongLiqin Dong More articles by this author , Rachael SarpongRachael Sarpong More articles by this author , Simon RodneySimon Rodney More articles by this author , Pramit KhetrapalPramit Khetrapal More articles by this author , Patricia de WinterPatricia de Winter More articles by this author , Rumana JalilRumana Jalil More articles by this author , Norman WilliamsNorman Williams More articles by this author , Chris Brew-GravesChris Brew-Graves More articles by this author , John KellyJohn Kelly More articles by this author , and DETECT I trial groupDETECT I trial group More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.200AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES ematuria is associated with an increased risk for urinary tract cancer (UTC). The American Urology Association (AUA) recommendation is that any patient presenting with gross haematuria (GH) and patients aged ≥ 35 years with asymptomatic microscopic hematuria (MH) should be investigated. The UK National Institute for Health and Care Excellence (NICE) recommended that patients aged ≥ 45 years with GH and ≥ 60 years with unexplained MH with either dysuria or a raised white cell count on blood test should be investigated. In this multicentre study, we compared hematuria guidelines to determine the appropriate age-dependent threshold for investigations. W also determined the incidence of bladder cancer, upper tract tumours and clinical-pathological characteristics according to type of hematuria. METHODS DETECT I (clinicaltrials.gov NCT02676180) is a multicentre observational study to determine the diagnostic accuracy of a urinary biomarker test for the detection of bladder. The study recruited patients refereed from primary care to any of 40 hospitals following a presentation of hematuria. All patients had a cystoscopy and upper tract imaging. Patients with a suspicion of bladder cancer had transurethral resection of bladder cancer or bladder biopsy for histological confirmation of cancer. RESULTS 3561 patients with a median age of 68 years were recruited over a 14-month period. GH represents 65% of patients referred for investigations. GH, increasing age, male patients and smoking history were independently associated with a diagnosis of UTC (all ≤0.05) on multiple logistic regression. The overall incidence of UTC was 10% (bladder cancer: 8.0%, renal parenchymal cancer 1.1%, Upper tract transitional cell carcinoma (TCC): 0.7%). The AUA guidance would identify all patients diagnosed with UTC in this patient cohort. Adopting the NICE guidance would miss 11 UTC (10 bladder cancers, 1 upper tract TCC). This represents 3.5% of bladder cancers and 3.8% of upper tract TCC. 70% of bladder cancers missed are intermediate to high risk disease including one ≥pT2 cancer. Of the 11 UTC missed, 4 missed bladder cancers presented with MH. 61% of patients presenting with MH have high risk bladder cancer with 32% of them ≥pT2. CONCLUSIONS Applying the NICE criteria to select patients for hematuria investigation will miss a significant number of cancers including those with clinically significant disease. The AUA guidance will identify all UTC in this study. Hematuria investigations cannot be safely avoided in patients with GH regardless of age and those ≥ 35 years with MH. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e54-e55 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Wei Shen Tan More articles by this author Andrew Feber More articles by this author Liqin Dong More articles by this author Rachael Sarpong More articles by this author Simon Rodney More articles by this author Pramit Khetrapal More articles by this author Patricia de Winter More articles by this author Rumana Jalil More articles by this author Norman Williams More articles by this author Chris Brew-Graves More articles by this author John Kelly More articles by this author DETECT I trial group More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP50-08 LIMITATIONS OF THE LITHOVUE SINGLE USE DIGITAL FLEXIBLE URETEROSCOPE

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2017MP50-08 LIMITATIONS OF THE LITHOVUE SINGLE USE DIGITAL FLEXIBLE URETEROSCOPE Saum Ghodoussipour, Eli Thompson, Adit Shah, Anirban Mitra, Sameer Deshmukh, and Matthew Dunn Saum GhodoussipourSaum Ghodoussipour More articles by this author , Eli ThompsonEli Thompson More articles by this author , Adit ShahAdit Shah More articles by this author , Anirban MitraAnirban Mitra More articles by this author , Sameer DeshmukhSameer Deshmukh More articles by this author , and Matthew DunnMatthew Dunn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1596AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A new disposable flexible digital ureteroscope (Lithovue, Boston Scientific, Marlborough, Mass) was recently released as an alternative to nondisposable digital scopes. This series reviews our initial experience with this new device with a focus on identifying its limitations. METHODS We retrospectively reviewed our first 75 cases with the 7.7Fr disposable flexible digital ureteroscope and identified any problems, difficulties, or complications related to the scope itself. RESULTS Of the 75 patients, 47 were female 28 were male; 39 cases were left sided, 30 were right sided, and 6 were bilateral. The reasons for ureteroscopy include stone disease in 60 pts, ureteral stricture disease in 5 patients, and upper tract transitional cell carcinoma (TCC) in 10 patients. There was difficulty in getting up the ureter (ureterovesical junction) in 3 patients; one due to distal ureteral narrowing requiring balloon dilation, the other 2 due to proximal ureter narrowing requiring stenting. Passage of the scope was relatively effortless in the remaining retrograde URS patients. Two patients underwent antegrade ureteroscopy through an established nephrostomy tract to treat ureteroenteric anastomotic strictures. There was mild interference in the video system during laser lithotripsy of hard stones (calcium oxalate monohydrate but did not prevent treatment. But the system was incompatible with the use of electrocautery. During fulguration of upper tract TCC, the system continually shut down during the use of a 3Fr electrode. Another difficulty with visualization occurred during antegrade ureteroscopy for 2 ureteroileal anastomotic strictures. Due to problems with distant focusing, there was difficulty identifying the true lumen past the stricture, which lead to inaccurate incision of the soft tissue resulting in extravasation in both cases. CONCLUSIONS This new disposable ureteroscope works well for routine ureteroscopy with laserlithotripsy but should not be used with electrocautery and avoided for antegrade incision of ureteroenteric anastomotic strictures. Its strength is in near focusing rather than distant focusing which is fine for stones but not for the latter situation. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e686-e687 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Saum Ghodoussipour More articles by this author Eli Thompson More articles by this author Adit Shah More articles by this author Anirban Mitra More articles by this author Sameer Deshmukh More articles by this author Matthew Dunn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract 305: Ultra-low coverage exome sequencing of FFPE tumor specimens identifies exposure to carcinogenic aristolochic acid

Abstract Dietary intake of Aristolochia plants containing aristolochic acid (AA, IARC Group 1 carcinogen), leads to renal disease and to recurrent urinary tract transitional cell carcinomas (TCC). Mutation screens identified frequent A>T transversions, alterations underrepresented in other cancer types, as the signature of AA exposure. AA-associated TCC is a preventable cancer yet millions are estimated at risk due to unregulated medicinal use of Aristolochia. Here we present an ultra-low coverage modification of whole-exome sequencing (ULC-WES) as a novel molecular epidemiology method that reliably detects the AA mutation signature in small amounts of DNA from FFPE tumor tissues and can identify new exposed populations. DNA was isolated from paraffin sections of 18 TCC tumors from endemic nephropathy (EN) patients from regions in Croatia and Bosnia linked to exposure to AA. Four non-EN upper tract TCCs were used as controls. 250 ng of DNA was used for sequencing libraries and exome enrichment (Nimblegen, Roche). Libraries were sequenced on Illumina HiSeq2500 at 10-12x coverage. After data processing, GATK was used to call single nucleotide variants (SNV). To assess platform independence, 7 samples were run on SOLID 5500XL (Life), using proprietary chemistry and pipeline for data processing and variant calling. Normal genetic variants were filtered out after SNV annotation. ULC-WES at 10x identified the A>T predominance in 17 of 18 EN tumors (94%), and at <10x coverage (3-9 reads per SNV) still detected the major A>T pattern in 14 (78%) samples. In contrast, the A>T presence was <8% in the control TCCs. We observed stochastic distribution of the A>T mutations in the genome (R^2=0.83 for mutation count correlated with the chromosome length) but also identified recurrent non-synonymous A>T mutations in tumor suppressors and oncogenes including TP53, ARID1A, BRCA1/2, AXIN1, GATA3 and NRAS, DNMT1, FLT3, CSF1R and PIK3CA. We next detected recurrent A>T mutations in a number of histone and DNA modifiers suggesting epigenetic deregulation of genome activity in the AA-associated TCCs. In 2 patients, pairs of distinct TCCs from the same surgery had markedly overlapping mutation patterns (624 SNVs shared between same-side pelvic and ureteric tumors in one case, and 191 shared between renal pelvic and bladder tumors in the other). Thus, ULC-WES provided evidence supporting the concept of tumor cell seeding along the urinary tract as a mechanism of TCC spread and recurrence. We conclude that ULC-WES is a sensitive and specific method to identify AA exposure in tumor tissue and is directly applicable to identification of new populations at risk. The method can ultimately facilitate evidence-based preventive measures in the affected regions. Acknowledgments: Genetic Services Platform, IARC; Genome Technology Center, NYU Langone Medical Center; NIH P01 ES04068, NIH Fogarty International Center 1R03TW007042, Croatian Ministry of Science. Citation Format: Xavier Castells, Sandra Karanovic, Magali Olivier, Maude Ardin, Florence Le Calvez-Kelm, Catherine Voegele, James McKay, Damir Dittrich, Karla Medak Tomic, Kathleen Dickman, Arthur P. Grollman, Bojan Jelakovic, Jiri Zavadil. Ultra-low coverage exome sequencing of FFPE tumor specimens identifies exposure to carcinogenic aristolochic acid. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 305. doi:10.1158/1538-7445.AM2014-305

Application of narrow‐band imaging in upper urinary urothelial carcinoma: A preliminary report

AimIn the present study, the performance of narrow‐band imaging (NBI) ureteroscopy in the detection of upper urinary tract transitional cell carcinoma (TCC) was evaluated.Patients and MethodsUreteroscopies were carried out using both white‐light imaging (WLI) and NBI in patients with known upper urinary tract TCC before definitive treatment. Biopsies were performed when abnormal lesions were detected. The number of lesions found in WLI and NBI ureteroscopies, and histological findings, were compared with final pathological reports on nephroureterectomy or segmental resection specimens.ResultsSeven patients with eight upper urinary tract TCC were examined using WLI/NBI ureteroscopy between 2010 and 2011. Complete examinations failed in two patients, due to ureteric strictures. After ureteroscopy, five nephroureterectomies and two segmental resections were performed in this series. Endoscopic laser resection of the ureteric tumour was performed successfully under WLI/NBI in one patient. NBI ureteroscopy detected two more lesions than WLI, both of which were found to be benign in the final histological analysis. No other lesions in the nephroureterectomy specimens escaped detection during the ureteroscopic examination.ConclusionNBI ureteroscopy is technically feasible for upper urinary tract examination. It did not improve TCC detection rate compared with conventional WLI. Further studies might be necessary for the evaluation of its use and efficacy.

Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China

Objective: We compared long-term clinical outcomes of upperurinary tract transitional cell carcinoma (TCC) patients treated byretroperitoneoscopic nephroureterectomy (RNU) or open radicalnephroureterectomy (ONU).Methods: Upper urinary tract TCC patients were treated with RNU(n = 86) or ONU (n = 72) and followed-up for more than threeyears. Demographic and clinical data, including preoperativeindexes, intraoperative indexes and long-term clinical outcomes,were retrospectively compared to determine long-term efficacy ofthe two procedures.Results: The RNU and ONU groups were statistically similar inage, gender, previous bladder cancer history, tumour location,pathologic tumour stage, pathologic node metastasis or tumourpathologic grade. The original surgery time required for both RNUand ONU was statistically similar, but RNU was associated witha significantly smaller volume of intraoperative estimated bloodloss and shorter length of postoperative hospital stay. Follow-up(average: 42.4 months, range: 3-57) revealed that the RNU 3-yearrecurrence-free survival rate was 62.8% and the 3-year cancerspecific survival rate was 80.7%. In the ONU group, the 3-yearrecurrence-free survival and the three-year cancer-specific survivalrates were 59.2% and 80.3%, respectively. Neither of the survivalrates were statistically different between the two groups. T stage,grade, lymph node metastasis and bladder tumour history wererisk factors for tumour recurrence; the operation mode and thebladder cuff incision mode had no correlation with the recurrencefreesurvival.Conclusion: The open surgery strategy and the retroperitoneoscopicnephroureterectomy strategy are equally effective for treating upperurinary tract TCC. However, the RNU procedure is less invasive,and requires a shorter duration of postoperative hospitalized care;thus, RNU is recommended as the preferred strategy.

Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China

We compared long-term clinical outcomes of upper urinary tract transitional cell carcinoma (TCC) patients treated by retroperitoneoscopic nephroureterectomy (RNU) or open radical nephroureterectomy (ONU). Upper urinary tract TCC patients were treated with RNU (n = 86) or ONU (n = 72) and followed-up for more than three years. Demographic and clinical data, including preoperative indexes, intraoperative indexes and long-term clinical outcomes, were retrospectively compared to determine long-term efficacy of the two procedures. The RNU and ONU groups were statistically similar in age, gender, previous bladder cancer history, tumour location, pathologic tumour stage, pathologic node metastasis or tumour pathologic grade. The original surgery time required for both RNU and ONU was statistically similar, but RNU was associated with a significantly smaller volume of intraoperative estimated blood loss and shorter length of postoperative hospital stay. Follow-up (average: 42.4 months, range: 3-57) revealed that the RNU 3-year recurrence-free survival rate was 62.8% and the 3-year cancer specific survival rate was 80.7%. In the ONU group, the 3-year recurrence-free survival and the three-year cancer-specific survival rates were 59.2% and 80.3%, respectively. Neither of the survival rates were statistically different between the two groups. T stage, grade, lymph node metastasis and bladder tumour history were risk factors for tumour recurrence; the operation mode and the bladder cuff incision mode had no correlation with the recurrence-free survival. The open surgery strategy and the retroperitoneoscopic nephroureterectomy strategy are equally effective for treating upper urinary tract TCC. However, the RNU procedure is less invasive, and requires a shorter duration of postoperative hospitalized care; thus, RNU is recommended as the preferred strategy.

Clinicopathological spectrum and the outcome of treatment of upper tract transitional cell carcinoma

Introduction:Disease spectrum of upper tract transitional cell carcinoma (TCC) in Indian patients is not known. Herein, we present data on clinical presentation, pathological characteristics, and the outcome of treatment of upper tract TCC.Materials and Methods:Clinicopathological data of patients who were diagnosed for upper tract TCC between January 2000 and January 2010 were collected from the hospital information system and case records. Preoperative diagnosis was based on contrast-enhanced computerized tomography of the whole abdomen and urine cytology. Cross tab and logistic regression analysis was done on the effect of various clinicopathological characteristics on the outcome and cancer-specific and recurrence survival were derived.Results:There were total 40 patients, 35 (87.5%) of them were male. The mean age was 62.7 ± 7.9 years. The most common symptom was gross hematuria present in 30 (75%). Mean tumor size was 2.8 ± 1.2 cm. Median duration of follow up was 36 (12 to 100) months. Laparoscopic nephroureterectomy was done in 27 patients along with bladder cuff excision and seven patients underwent open surgery. Thirty two (88.8%) patients had invasive T stage and high-grade lesions were seen in 24 (66.6%). Lymphovascular invasion was found only in one case and necrosis in 30 (83.3%). Necrosis was found to be the poor prognostic factor. Five-year recurrence-free and cancer-specific survivals were 36.33% and 26%, respectively.Conclusion:Patients with upper tract TCC present very late with a high-stage disease and a very low 5-year cancer-specific and recurrence-free survivals.

Surgical management for upper urinary tract transitional cell carcinoma

Upper tract transitional cell carcinomas (TCC) are uncommon and aggressive tumours. There are a number of surgical approaches tomanage this condition including open radical nephroureterectomy and laparoscopic procedures. To determine the best surgical management option for upper tract transitional cell carcinoma. A sensitive search strategy was developed to identify relevant studies for inclusion in this review. The following databases were searched for randomised trials evaluating surgical approaches to the management of upper tract TCC: Medline EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, British Nursing Index, AMED, LILACS, Web of Science®, Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, and ISI Proceedings. The following criteria that were considered for this review.Types of studies - All randomised or quasi-randomised controlled trials comparing the various surgical methods and approaches for the management of localised upper tract transitional cell carcinoma. Types of participants - All adult patients with localised transitional cell carcinoma. Localised disease was defined as limited to the kidney or ureter with no gross regional lymph nodal enlargement on imaging. Types of interventions - Any surgical method or approach for managing localised upper tract transitional cell carcinoma. Types of outcome measures - Overall and cancer-specific survival were primary outcomes. Surgery-related morbidity. Quality of life and health economics outcomes were secondary outcomes. Two review authors examined the search results independently to identify trials for inclusion. We identified one randomised controlled trial that met our inclusion criteria. The trial showed that the laparoscopic approach had superior peri-operative outcomes compared to open approach. Laparoscopic was superior and statistically significant for blood loss (104 mL (millilitres) versus 430 mL, P < 0.001) and mean time to discharge (2.3 days versus 3.7, P < 0.001). Oncological outcomes (bladder tumour-free survival, metastasis-free survival, cancer-specific survival curves), at a median follow up of 44 months and in organ-confined disease, were comparable for both groups. There is no high quality evidence available from adequately controlled trials to determine the best surgical management of upper tract transitional cell carcinoma. However, one small randomised trial and observational data suggests that laparoscopic approach is associated with less blood loss and early recovery from surgery with similar cancer outcomes when compared to open approach.

A one-port pneumovesicum method in en bloc laparoscopic nephroureterectomy with bladder cuff resection is feasible and safe for upper tract transitional cell carcinoma

• To introduce a modified method for managing the distal ureter in laparoscopic nephroureterectomy (LNU) for upper tract transitional cell carcinoma (TCC) and to evaluate the feasibility and safety of this method. • Six consecutive patients underwent LNU using a one-port pneumovesicum method for pathologically confirmed upper tract TCC. • Each patient was placed on the operating table in the lithotomy position and the pneumovesicum method was applied with CO(2) insufflation. Dissection was performed circumferentially through the entire detrusor muscle to disconnect the ureter from the bladder wall. A 10-mm trocar was placed into the bladder above the pubic bone. The distal ureter was occluded using a Hem-o-lok clip and pushed out of the bladder. Laparoscopic nephroureterectomy was then performed with the patient in the lateral position. • After surgery, all six patients received systemic chemotherapy and follow-up. • All procedures were performed successfully. • The median (range) operating time for the complete procedure was 105 (85-140) min, and the median (range) estimated blood loss was 125 (60-230) mL. • Seven days after surgery, each patient underwent cystography, which confirmed no extravasation of urine. • None of the patients developed bladder tumour recurrence or metastatic disease during follow-up. • The one-port pneumovesicum method in LNU, which is applied to manage the distal ureter and bladder cuff, is technically feasible and safe. • The method simplifies management of the distal ureter, reduces the invasiveness of the procedure and improves cosmesis.

V863 SINGLE INCISION SURGERY FOR UPPER TRACT TRANSITIONAL CELL CARCINOMA (TCC): FEASIBILITY STUDY OF LAPAROENDOSCOPIC SINGLE SITE (LESS) RADICAL NEPHROURETERECTOMY COMBINED WITH RETROGRADE INTRAVESICAL RECONSTRUCTIVE SURGERY (RIVRS)

You have accessJournal of UrologyReconstruction, Transitional Cell Carcinoma & Adrenal1 Apr 2011V863 SINGLE INCISION SURGERY FOR UPPER TRACT TRANSITIONAL CELL CARCINOMA (TCC): FEASIBILITY STUDY OF LAPAROENDOSCOPIC SINGLE SITE (LESS) RADICAL NEPHROURETERECTOMY COMBINED WITH RETROGRADE INTRAVESICAL RECONSTRUCTIVE SURGERY (RIVRS) Rajan Sharma, Shashikant Mishra, Abraham Kurien, Arvind Ganpule, Veeramani Muthu, Ravindra Sabnis, and Mahesh Desai Rajan SharmaRajan Sharma Nadiad, India More articles by this author , Shashikant MishraShashikant Mishra Nadiad, India More articles by this author , Abraham KurienAbraham Kurien Nadiad, India More articles by this author , Arvind GanpuleArvind Ganpule Nadiad, India More articles by this author , Veeramani MuthuVeeramani Muthu Nadiad, India More articles by this author , Ravindra SabnisRavindra Sabnis Nadiad, India More articles by this author , and Mahesh DesaiMahesh Desai Nadiad, India More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.685AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single site surgery (LESS) has been demonstrated to be feasible in various oncological ablative procedures. TCC upper tract traditionally required long and multiple incisions to manage the upper tract and the bladder cuff. With the introduction of laparoscopy, the upper tract incision could be avoided. We extended the LESS principal to radical nephroureterectomy and novel technique of transurethral retrograde intravesical reconstructive surgery (RIVRS) to complete a single incision procedure for TCC upper tract and assessed the feasibility of technique. METHODS 60 year old gentleman on evaluation of one episode of painless gross hematuria was detected to have a 2.9 cm right sided upper pole TCC. He was prepared for LESS radical nephroureterectomy with RIVRS. Patient was placed in lateral position for LESS Radical Nephroureterectomy which was performed using quadport variant of R-port TM (Advanced Surgical Concepts, Ireland) and Olympus endoeyeTM camera with coaxial light cable was used. Ureter was dissected till the bladder, then the patient was placed in supine oblique lithotomy position and bladder resection was done using a combination of hook cautery, and endoscissors. Bladder closure was done by endosutures (extracorporeal knotting) using 3-0 vicryl which were taken endoscopically using Sew right SR-5TM endosuturing instrument. The entire resection and suturing was also monitored laparoscopically through the R-port TM and the specimen was retrieved from the umbilical incision. RESULTS Procedure was completed successfully in a single umbilical incision of 5.5 cm length. The operative time was 210 minutes, estimated blood loss was 110 ml, and post operative hospital stay was 5 days with no complications. The urethral catheter was removed on 10th day after doing a cystogram which showed no leak. Post operative histopathology report revealed Stage T3a TCC (invading the renal parenchyma) and all margins were negative. CONCLUSIONS LESS radical nephroureterectomy combined with RIVRS is an efficient, feasible and minimally invasive technique for endoscopic management of upper and lower ureter in upper tract TCC and allows for primary endoscopic bladder closure and completion of entire surgery in a single umbilical incision preserving good oncological efficacy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e346 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajan Sharma Nadiad, India More articles by this author Shashikant Mishra Nadiad, India More articles by this author Abraham Kurien Nadiad, India More articles by this author Arvind Ganpule Nadiad, India More articles by this author Veeramani Muthu Nadiad, India More articles by this author Ravindra Sabnis Nadiad, India More articles by this author Mahesh Desai Nadiad, India More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcome of surgical resection of pulmonary metastasis from urinary tract transitional cell carcinoma

There is little information on pulmonary metastasectomy of urinary tract transitional cell carcinoma (TCC). In this study, we examined the long-term outcome and the factors associated with long-term survival after pulmonary metastasectomy of urinary tract TCC based on a 20-year single center experience. Between 1984 and 2005, 18 patients (12 men, six women) underwent pulmonary metastasectomy of the urinary tract TCC in our hospital. The clinicopathological and surgical data of these patients obtained from the medical records were analyzed in this retrospective study. The time interval between lung resection and death, or latest follow-up ranged from two to 200 months (median 52). Survival analysis was conducted by the Kaplan-Meier method and log-rank test. The cumulative three- and five-year survival rates were 59.8% and 46.5%, respectively. The number of resected metastatic tumors (solitary vs. multiple) was associated with long-term survival (P<0.05). The five-year survival rate of patients with solitary metastasis was 85.7% while that of patients with multiple metastases was 20.0%. Pulmonary metastasectomy of urinary tract TCC is associated with a favorable outcome, and solitary metastasis is associated with long-term survival. Aggressive management of solitary pulmonary metastasis from a urinary tract TCC is feasible in selected patients.

Concomitant carcinoma in situ and tumour size are prognostic factors for bladder recurrence after nephroureterectomy for upper tract transitional cell carcinoma

To identify prognostic risk factors for the development of subsequent bladder recurrence in patients undergoing nephroureterectomy (NU) for upper tract transitional cell carcinoma (TCC). The data of 79 patients who underwent NU for localized upper tract TCC were collected retrospectively, and analysed for clinical and pathological variables. Patients with previous invasive bladder tumours were excluded. Age, sex, tumour location, previous/synchronic bladder tumours, stage, grade, concomitant upper tract carcinoma in situ (CIS), and size were all analysed. Univariate and multivariate analyses were done using the Kaplan-Meier Method, with the log-rank test, and the Cox proportional hazards regression model, respectively. The median follow-up was 71 months, during which bladder tumours were detected in 42 patients (54%). On univariate analyses, tumour stage ≥ pT2 (P = 0.015), concomitant upper tract CIS (P = 0.001), high-grade tumour G3 (P = 0.027) and tumour size > 4 cm (P = 0.011) were statistically significant predictors of intravesical recurrence. After multivariate analyses, concomitant CIS (P = 0.005, hazard ratio 2.9, 95% confidence interval 1.4-5.8) and tumour size > 4 cm (P = 0.042; 1.9, 1-3.7) were significantly related to bladder tumour recurrence. There is a high bladder recurrence rate after NU for upper tract TCC. Patients with tumours of > 4 cm and concomitant upper tract CIS have a major risk of developing subsequent bladder recurrence. Therefore, closer surveillance of the bladder is needed in these patients and they may potentially benefit from prophylactic intravesical instillation therapy.

Laparoendoscopic Single-Site Nephroureterectomy with Bladder Cuff Excision for Upper Urinary Tract Transitional-Cell Carcinoma: Technical Details Based on Oncologic Principles

To describe our technical details of laparoendoscopic single-site (LESS) nephroureterectomy with bladder cuff excision for the management of upper urinary tract transitional-cell carcinoma (TCC) based on oncologic principles. Two patients underwent LESS nephroureterectomy for upper urinary tract TCC. In both cases, we used a homemade single-port device that consisted of a wound retractor and a surgical glove. Using the flexible laparoscopic instruments, nephrectomy was performed using procedures similar to those of conventional laparoscopic nephrectomy. Bladder cuff excision was performed laparoscopically using the same procedure with open technique. All procedures were completed successfully without conversion to conventional laparoscopic or open surgery and without additional extraumbilical trocars or incisions. LESS nephreoureterectomy with bladder cuff excision was performed in 385 and 285 minutes with estimated blood loss of 100 and 350 mL, respectively. Both patients were discharged on postoperative day 3 without perioperative complications. LESS nephroureterectomy with bladder cuff excision for upper urinary tract TCC is a minimally invasive technique that may reproduce the open surgical technique and adhere to oncologic principles.

Endoscopic management of upper tract transitional cell carcinoma

Upper urinary tract transitional cell carcinoma (TCC) accounts for up to 10% of cases of neoplasm of the upper urinary tract. The “gold standard” management of upper tract TCC is nephroureterectomy. Technological innovations, miniaturisations and increased availability of energy sources such as Holmium laser fibers have improved the armamentarium of endoscopic management of upper tract TCC. Endoscopic management of upper tract TCC includes the percutaneous (antegrade) and retrograde approaches. Modern flexible ureterorenoscopy allows retrograde approach to small (<1.5cm), low grade and noninvasive tumors, which is inaccessible to standard rigid ureteroscopes without breaching the urothelial barrier. In patients with large tumors or in whom retrograde access is difficult, the percutaneous approach to the renal pelvis, although more invasive, provides an alternative access and control. Both retrograde and percutaneous approaches allow instillation of various chemotherapeutic agents. Careful selection of patients is the key point in the successful endoscopic management of upper tract TCC. Patient selection is based on tumor size, grade and multifocality and other patient factors such as comorbidities, single kidney, post kidney transplant and patient choice. Both motivation and compliance of patients are needed for long-term successes. However, until large randomized trials with long term follow-up are available, endoscopic management of upper tract TCC should be reserved for only selected group of patients. This review summarizes the current techniques, indications, contraindications and outcomes of endoscopic management of UTTCC and the key published data.

Initial experience of robotic nephroureterectomy: a hybrid‐port technique

To report a new technique of robot-assisted laparoscopic nephroureterectomy (RANU) using a hybrid port, as RANU has recently become a minimally invasive treatment option for upper tract transitional cell carcinoma (TCC). Eleven consecutive patients underwent RANU by one surgeon. The first six patients were repositioned after the nephrectomy, from flank to lithotomy position, and the robot was re-docked for excision of the distal ureter and bladder cuff. The last five patients were treated by a new RANU technique that did not require a change of position or movement of the patient cart. We analysed data obtained before, during and after RANU. The total operative duration was reduced by approximately 50 min in last five patients. There was no improvement in hospital stay or estimated blood loss. There were no transfusions and positive surgical margins in any patient. Maintaining the patient in a flank position allows gravity to displace the bowel away from the distal ureter, not only shortening the surgery but also improving exposure of the distal ureterectomy and closure of the bladder cuff. The new RANU technique is a safe and feasible treatment option for upper tract TCC.

Patterns of failure and influence of potential prognostic factors after surgery in transitional cell carcinoma of the upper urinary tract

We investigated the long-term outcome of upper urinary tract transitional cell carcinoma (TCC) after surgery. The study population comprised 114 surgically treated patients with upper urinary tract TCC treated at Jikei University Hospital between March 1990 and December 2004. All these patients underwent radical surgery without any type of neoadjuvant therapy. Patterns of failure and patient survival were compared with clinicopathological parameters. The 5- and 10-year overall survival (OAS) rates for the patients were 85% (95% confidence interval [CI], 81%-89%) and 76% (95% CI, 69%-83%). To date, 19 patients (16.7%) have experienced distant or lymph node metastasis at a mean of 13.3 months following surgery (range, 1 to 50 months). The site of the primary tumor did not affect patient survival (P > 0.05). Both lymphovascular involvement (LVI) and positive lymph nodes were found to have poor prognosis in univariate analysis (P = 0.004 and P < 0.0001). Multivariate analysis indicated pathological stage and bladder recurrence (bladder recurrence being a better prognostic factor) to be independent predictors of metastasis-free survival, but not of OAS or cause-specific survival (CSS). Pathological stage and bladder recurrence were found to be the predictors of metastasis-free survival in this study. Further searching for reliable biomarkers is needed to accurately predict the prognosis of this malignancy.

Laparoscopic Nephroureterectomy: Oncologic Outcomes and Management of Distal Ureter; Review of the Literature

Introduction. Laparoscopic radical nephroureterectomy (LNU) is being increasingly performed at several centers across the world. We review oncologic outcomes after LNU procedure and the techniques for the management of distal ureter. Materials and Methods. A comprehensive review of the literature was performed on the oncological outcomes and management of distal ureter associated with LNU for upper tract transitional cell carcinoma (TCC). Results and Discussion. LNU for upper tract TCC is performed pure laparoscopically (LNU) or hand-assisted (HALNU). The management of the distal ureter is still debated. LNU appears to have superior perioperative outcomes when compared to open surgery. Intermediate term oncologic outcomes after LNU are comparable to open nephroureterectomy (ONU). Conclusions. Excision of the distal ureter and bladder cuff during nephroureterectomy remains controversial. Intermediate term oncologic outcomes for LNU compare well with ONU. Initial long-term oncologic outcomes are encouraging. Prospective randomized comparison between LNU and open surgery is needed to define the role of these modalities in the current context.