Tract Transitional Cell Carcinoma Research Articles

P230 NBI-assisted versus standard white light flexible ureteroscopy in non-invasive upper urinary tract transitional cell carcinoma – an evidence-based, prospective, singlecenter diagnostic accuracy comparison

P230 NBI-assisted versus standard white light flexible ureteroscopy in non-invasive upper urinary tract transitional cell carcinoma – an evidence-based, prospective, singlecenter diagnostic accuracy comparison

EP230 - A Closed Loop Audit for Peri-Operative Outcomes Comparing Laparoscopic and Robotic-Assisted Nephroureterectomy for Upper Tract Transitional Cell Carcinoma

Abstract Introduction Transitional cell carcinoma (TCC) of the upper urinary tract (localised high-risk disease) is treated with a radical nephroureterectomy (RNU). Evidence shows laparoscopic and robotic-assisted RNU have similar oncological outcomes to open RNU, but improved peri-operative outcomes, namely length of stay (LOS) and time to mitomycin C (MMC) – given to reduce bladder recurrence. Standard The European Association of Urology (EAU) Guidelines suggest MMC instillation should occur 2-10 days after RNU. Aim To determine if this standard was being met in a single tertiary centre following laparoscopic RNU, and if the expansion of the robotics service has improved this and other peri-operative outcomes. Methods Retrospective data was collected from patient notes and collated in an excel spreadsheet for descriptive statistical analysis. Results The first loop analysed laparoscopic procedures (n = 36). The average LOS was 5 days (SD = 3.7±) and the average time to MMC was 14 days (SD = 6.7±). Bladder recurrence occurred in 41% (n = 14) of this cohort, over an average follow up time of 30.6 months. The second loop analysed robotic-assisted procedures (n = 33). The average LOS was 4 days (SD = 2.23±) and the average time to MMC was 2 days (SD = 0.57±). Bladder recurrence occurred in 30% (n = 8) of this cohort, over an average follow up time of 13 months. Conclusion Both procedures are safe and effective with satisfactory oncological outcomes. By expanding the robotics service, the average LOS and time to MMC decreased. Disease recurrence was higher in the laparoscopic cohort, but the follow-up period was longer.

Bladder Cancer: Upper Tract Transitional Cell Carcinoma III (PD41)

Bladder Cancer: Upper Tract Transitional Cell Carcinoma III (PD41)

Bladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD20)

Bladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD20)

Bladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)

Bladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)

Surgery for pulmonary lesions in patients with a history of urinary tract transitional cell carcinoma

BackgroundThere has been little information on the actual diagnosis of pulmonary lesions in patients with a history of urinary tract transitional cell carcinoma (TCC) and short- and long- outcomes of pulmonary resection for these patients.MethodsIn the present study, the data of 37 consecutive patients with a history of TCC who underwent pulmonary resection for solitary pulmonary lesions were reviewed, and the clinical factors and short- and long-term outcomes were analyzed.ResultsThe study population included 35 male patients, and 2 female patients. The mean age was 72.5 years. Twenty patients (80%) were smokers and showed a high incidence of chronic obstructive pulmonary disease. Pulmonary lesions and primary TCC were detected simultaneously in 5 patients and metachronously in 32 patients. The median interval between treatment for primary TCC and the detection of pulmonary lesion was 43 months. The mean tumor diameter was 23 mm. The types of resection included lobectomy (n = 19), segmentectomy (n = 8), and partial resection (n = 10). Twelve of 37 patients (32%) developed postoperative complications. The pathological diagnoses included primary lung cancer (n = 28), pulmonary metastasis from TCC (n = 7), and others (n = 2). The 5-year overall survival rate for all patients was 72%. The 5-year overall survival rate of patients with primary lung cancer was 74%, while that of patients with pulmonary metastasis from TCC was 57%.ConclusionsSurgery can be proactively considered for treating pulmonary lesions in patients with a previous history of TCC, as it provides favorable long-term outcomes.

Upper tract transitional cell carcinoma: An array of imaging conundrum

We report a 38-year-old gentleman who presented with painless haematuria for 6-months duration. Contrast-enhanced CT renal revealed a large, calcified intrapelvic mass with calyceal extension confined within the right kidney with moderate pelvicalyceal dilatation but no evidence of synchronous lesion elsewhere. Histopathological analysis showed high grade urothelial carcinoma of the renal pelvis with invasion of renal parenchyma. Upper tract urothelial carcinoma (UTUC) which was once thought similar to urothelial carcinoma of the bladder (UCB), is increasingly being recognized as a different entity. However, heterogenous array of imaging manifestations of UTUC is also increasingly being encountered and pose diagnostic challenges though UTUC is not as prevalent as UCB which is easier to diagnose. Despite distinctive features against renal cell carcinoma (RCC), UTUC may mimic numerous other renal pathologies especially the benign ones hence imaging plays a pivotal role in ascertaining the diagnosis. This disease is usually treated with radical nephroureterectomy with superadded neoadjuvant chemotherapy for high-risk cases. Less invasive endoscopic resection is also offered in certain cases but stringent surveillance of the whole urinary tract as well as post-operative follow-up are mandatory.

Is the presence of upper tract transitional cell carcinoma in a calyceal diverticulum a risk factor for early metastasis? A case report and review of the literature

Upper tract transitional cell carcinoma poses diagnostic challenges due to its prevalence and diverse clinical presentations. This case report describes the incidental discovery of high-grade transitional cell carcinoma during the management of a 48-year-old male with ischemic heart disease and an asymptomatic right renal stone. During flexible ureteroscopy for stone removal, papillary lesions were identified within a calyceal diverticulum and confirmed as high-grade transitional cell carcinoma. The unique anatomy of the calyceal diverticulum, characterized by its restricted wall thickness, may predispose the tumor to early metastasis. Additionally, there is a concern about potential iatrogenic dissemination of tumor cells to the bladder during the ureteroscopic procedure. This case highlights the diagnostic complexities associated with upper tract transitional cell carcinoma in rare anatomical locations and emphasizes the need for careful consideration of both procedural factors and anatomical features to manage the risk of metastasis and tumor dissemination effectively.

Genç Yaşta Görülen Transizyonel Hücreli Mesane Karsinomunda Genetik Yatkınlık Var Mıdır?

Objective: The aim of this study is to determine whether there is a genetic predisposition in young patients with transitional cell carcinoma (TCC) of the bladder. Material And Methods: Data were collected from a total of 652 patients who underwent transurethral resection of bladder tumor (TUR-BT) between January 2010 and January 2021. Seven patients under the age of 40, non-smokers, and without occupational predisposing factors to urinary tract TCC were included in the study. Age, body mass index (BMI), sex, occupation, and five-year follow-up were collected retrospectively. A total of 403 cancer-related genes were analyzed from the patients’ blood samples. The Clinical Exome Sequencing test was used to identify genetic mutations. Results: Six of the patients were male and one patient was female. The mean age and BMI were 31.42 ± 2.12 (22-39) years and 21.72 ± 33.14 (22-27.7) kg/m2, respectively. None of the patients had a first-degree relative with urinary tract TCC. Of all the patients, only one patient had a deletion of exons 1 to 17 in the breakpoint cluster region gene. Conclusion: Genetic predisposing factors in young bladder TCC have not been clearly identified. Although our study included a limited number of patients, our results showed no genetic predisposition in young patients with bladder TCC without family history of bladder cancer. To evaluate the exact relationship, prospective randomised controlled trials with larger numbers of patients are needed.

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.

69 Is CT Urogram Screening Necessary in All Patients with Visible Haematuria in Both the Immediate and Short-Term Follow-Up Period?

Abstract Introduction A standardised specific investigation protocol for visible haematuria (VH) screening remains a debate. A recent regional audit highlighted our department as an outlier for the high useage of CT urogram (CTU). We sought to determine the incidence of upper tract cancer (UTC) in a VH cohort, exploring the benefit of routine CTU versus the possibility of developing a selective patient-centred approach. Method Retrospective case-note review of all 2-week-wait patients referred for VH from May-October 2018. Data was analysed to describe the incidence of bladder transitional cell carcinoma (TCC), upper tract transitional cell carcinoma (UTTCC) and renal cell carcinoma (RCC); the detection rate of CTU and the missed rate of UTC over the following four years. Results 437 patients (334 men, 103 women; age range 21-95 years, median age 71 years; 35% smokers, 45% non-smokers, 18% smoking status unknown) underwent VH screening with a cancer detection rate comparable to previous literature (18% TCC, 1.4% RCC, 1% UTTCC). 73% (n = 321) underwent CTU, 52% (n = 229) underwent CTU and ultrasound (USS). USS missed one RCC subsequently detected by CTU. 72.7% and 63.6% of those diagnosed with UTC (age range 57- 86, mean age 71 years) were male or smokers, respectively. 43% (n = 189) received further upper tract imaging during the subsequent four years, with one further RCC detected. Conclusions The additional detection rate of CTU and subsequent development of UTC was minimal within our cohort suggesting the use of CTU in VH screening could be selective rather than routine.

Fluoranthene-terminated terpyridine ensemble for fluorescence light up and ratiometric chemical sensor for multi toxic metals

A novel π-electron rich fluoranthene embellished with a phenyl spacer and coupled with terpyridine (TS1) was developed through Diels-Alder reaction. Single crystal X-ray structure evidences the variations in dihedral angles between the fluoranthene and the phenyl unit responsible for development of non-coplanar interactions and stabilized by a wave-like molecular packing in the crystal lattice with weak π-π interaction of 4.125 Å. The peripheral terpyridine of TS1 endows an efficient binding with multiple metal ions by colorimetric and fluorometric methods. TS1 exhibits a ratiometric fluorescence response from sky blue to yellow colour upon the addition of Zn2+ ions with a limit of detection (LOD) of 0.05 ppm. The other metal ions such as Cu2+, Co2+ and Fe2+ demonstrate fluorescence quenching behaviour with LODs of 0.1, 0.3 and 0.7 ppm, respectively. The intramolecular charge transfer (ICT) shows the variation in TS1 emission behaviour upon metal ions interaction and quantitatively discriminates the metal ion concentrations. TS1 conferred a visual colorimetric change from colourless to magenta, enabling naked-eye detection of Fe2+ and showing clear discrimination between Fe2+ and Fe3+ ions for the real-time water samples. Furthermore, we have investigated the effect of TS1 in Zebrafish larvae/embryos and cytotoxicity in human urinary tract transitional cell carcinoma cells (UM-UC-3).

Bladder Cancer: Upper Tract Transitional Cell Carcinoma II (PD46)

You have accessJournal of UrologyCME1 Apr 2023Bladder Cancer: Upper Tract Transitional Cell Carcinoma II (PD46) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003359AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

Bladder Cancer: Upper Tract Transitional Cell Carcinoma I (MP69)

You have accessJournal of UrologyCME1 Apr 2023Bladder Cancer: Upper Tract Transitional Cell Carcinoma I (MP69) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

Bilateral nephrolithiasis and upper tract transitional cell carcinoma in horseshoe kidney.

Nephroureterectomy is currently the criterion-standard treatment for high-grade upper tract urothelial carcinoma (UTUC). Current guidelines and expert opinions propose some exceptions to this approach based on patient characteristics, disease status, and function of the contralateral kidney. We present a rare case of a patient with horseshoe kidney, bilateral large nephrolithiasis, high-grade UTUC in one moiety, and relative parenchymal thinning of the contralateral side. The patient was treated with a percutaneous, minimally invasive, nephron sparing approach. The patient also had intracollecting system instillations of gemcitabine and docetaxel. Minimally invasive percutaneous resection of high-grade UTUC is a safe procedure in select cases. Current guidelines may not apply to all patients; unique scenarios with UTUC may require personalized decision-making and treatment at specialized centers.

Bladder Cancer: Upper Tract Transitional Cell Carcinoma I (MP40)

Bladder Cancer: Upper Tract Transitional Cell Carcinoma I (MP40)

Retrocaval ureter coexisting with renal cell carcinoma: A case report and review of literature

Background: Retrocaval Ureter (RCU) is a rare congenital anomaly that often presents with obstructive changes in the upper urinary tract which may or may not symptomatic. It arises as a result of an aberration in embryologic development of Inferior Vena Cava (IVC). Commonly occurs in isolation but can occur in association with other anomalies. Few studies have reported RCU co-existing with upper tract Transitional Cell Carcinoma (TCC) but there is no literature report so far of its co-existence with Renal Cell Carcinoma (RCC). Case summary: Hence, we report a case of a 65 year old man with right sided RCC coexisting with RCU. The anomaly was discovered intra-operatively and the patient was offered open right radical nephrectomy with a good post-operative recovery and uneventful follow-up. Conclusion: Retrocaval ureter is a rare congenital anomaly that may occur in isolation or with other associated conditions. To the best of our knowledge, we report the first case of RCU coexisting with renal cell carcinoma. Proper pre-operative evaluation will help to identify these associated anomalies so as to adopt a holistic approach to patient care in order to ensure good treatment outcome. Keywords: radical nephrectomy; renal cell carcinoma; retrocaval ureter; nephroureterectomy.

Comparison of Tumor Seeding and Recurrence Rate After Laparoscopic vs. Open Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma

Introduction: Laparoscopic surgery for Upper Urinary Tract Urothelial Cell Carcinoma (UTUC) is still debated for its possible seeding risk and thus consequent oncological recurrences, especially for atypical ones. The aim of the study is to compare recurrence and survival after Laparoscopic vs. Open Radical Nephroureterectomy (RNU) for Upper Urinary Tract Urothelial Cancer (UTUC).Method: A retrospective evaluation of UTUC consecutive surgeries from 2008 to 2019 was conducted, including pT ≥ 2, High Grade UTUC who underwent RNU with bladder cuff excision without concomitant lymphadenectomy in three urological tertiary centers. Statistical analyses compared recurrence and cancer specific survival, based on surgical approach, while logistic multivariate analyses and Kaplan Meyer survival curve analyzed possible risk factors for recurrence and survival.Results: One hundred seven cases of RNU, 47 (43.9%) laparoscopic and 60 (56.1%) open, were included in this report. Preoperative characteristics were comparable between groups. However, tumor stage was higher in the Open arm [T3–T4 in 44 (73.3%) vs. 20 (43.4%) in Laparoscopic]. Mean follow-up was 91.6 months in laparoscopy RNU vs. 93.5 months in open RNU. Recurrence rate (RR) was comparable between groups (p = 0.594), and so was the site, although 3 (6.3%) peritoneal recurrences were found only in laparoscopic group (p = 0.057). At multivariate logistic regression, tumor stage and surgical approach were independent predictors of recurrence (p < 0.05), while only tumor stage was predictor of cancer specific death (p = 0.029).Conclusion: Surgical approach has no impact on recurrence site, overall survival, and RR. Still, according to our data peritoneal carcinomatosis was present only in laparoscopic arm, despite how it didn't reach statistical significance.

PD43-12 WHAT PART DOES URETEROSCOPY PLAY IN THE DIAGNOSTIC PATHWAY OF UPPER TRACT TRANSITIONAL CARCINOMA? A TWO-YEAR REVIEW IN A HIGH-VOLUME INSTITUTION

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD43)1 Sep 2021PD43-12 WHAT PART DOES URETEROSCOPY PLAY IN THE DIAGNOSTIC PATHWAY OF UPPER TRACT TRANSITIONAL CARCINOMA? A TWO-YEAR REVIEW IN A HIGH-VOLUME INSTITUTION Radha Sehgal, Shifa Wong, Yasmin Abu-Ghanem, Theodore Birks, Rajesh Kucheria, Darrell Allen, Anuj Goyal, Paras Singh, Leye Ajayi, and Gidon Ellis Radha SehgalRadha Sehgal More articles by this author , Shifa WongShifa Wong More articles by this author , Yasmin Abu-GhanemYasmin Abu-Ghanem More articles by this author , Theodore BirksTheodore Birks More articles by this author , Rajesh KucheriaRajesh Kucheria More articles by this author , Darrell AllenDarrell Allen More articles by this author , Anuj GoyalAnuj Goyal More articles by this author , Paras SinghParas Singh More articles by this author , Leye AjayiLeye Ajayi More articles by this author , and Gidon EllisGidon Ellis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002057.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy (URS) is an established diagnostic tool in the diagnosis of upper tract urothelial carcinoma (UTUC); it enables exclusion of UTUC in cases of diagnostic uncertainty and facilitates endoscopic kidney-sparing management in selected cases. However, its use is controversial due to the potential risk of tumour seeding into the bladder and delays incurred in the diagnostic pathway. We aim to review the diagnostic value of URS a large cohort of patients investigated for UTUC. METHODS: We performed retrospective review of diagnostic URS at our institution for suspected UTUC between January 2018 to December 2019. Demographics, CT urogram (CTU) findings, cytology and intra-operative appearances were obtained from electronic records. Histology was recorded from ureteroscopic biopsy and where applicable, final radical nephroureterectomy (RNU). RESULTS: A total of 161 diagnostic URS were performed for suspected UTUC. Patients presented predominantly with haematuria (42%). Pre-operative CTU w demonstrated a filling defect/lesion (48%), hydronephrosis (25%), urothelial thickening (21%) or no abnormality (6%), where URS was performed due to persistent haematuria or blood from the ureteric orifice at cystoscopy. Selective cytology was positive in 34 cases (27%). Urothelium was visually suspicious in 71 cases (44%) and biopsy results were malignant in 41 cases (25%). A diagnosis of UTUC was confirmed based on cytology and histology in 47 cases (29%). Of these, 31 patients (66%) underwent RNU, 14 patients (30%) underwent kidney-sparing management and 2 patients (4%) were unfit for further surgery. Two patients underwent RNU where the final histology was not UTUC (renal cell carcinoma and renomedullary interstital tumour). Following a negative URS, 68 patients (54%) were discharged or reassured and 8 patients (6%) were referred to other specialties for non-urothelial tumours. CONCLUSIONS: Diagnostic URS is crucial in accurately diagnosing and staging UTUC. Of the 47 confirmed cases of UTUC, 30% of patients underwent kidney-sparing management. RNU was avoided in 61% of patients who were subsequently discharged following negative URS or diagnosed with non-urothelial tumours. We conclude that in cases of diagnostic uncertainty and where kidney-sparing management is feasible, URS should remain in the diagnostic pathway of UTUC. Further research into diagnostic pathway delays and intravesical recurrence in this cohort is ongoing. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e735-e735 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Radha Sehgal More articles by this author Shifa Wong More articles by this author Yasmin Abu-Ghanem More articles by this author Theodore Birks More articles by this author Rajesh Kucheria More articles by this author Darrell Allen More articles by this author Anuj Goyal More articles by this author Paras Singh More articles by this author Leye Ajayi More articles by this author Gidon Ellis More articles by this author Expand All Advertisement Loading ...

Bladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD43)

Bladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD43)