Ureteral Tumors Research Articles

The evolving role of simulators and training in robotic urological surgery: Which assessment tool to use?

The evolving role of simulators and training in robotic urological surgery: Which assessment tool to use?

Management of noninvasive, low-grade ureteral cancer：Intravesical perfusion of pirarubicin with ureteral stent placement post trans-urethral resection of ureteral tumor：3 cases we encountered

Management of noninvasive, low-grade ureteral cancer：Intravesical perfusion of pirarubicin with ureteral stent placement post trans-urethral resection of ureteral tumor：3 cases we encountered

Clinical application of laparoscopy-assisted small incision surgery in treatment of urological diseases

Objective To apply laparoscopy-assisted small incision surgery in complicated urological operation,and to summarize our experience.Methods We retrospectively analyzed the clinical data of 9 patients with renal tumors(3 with solitary kidney tumors,2 with unilateral multiple tumors,1 with bilateral tumors,and 3 with contralateral renal insufficiency),3 patients with renal pelvic ureteropelvic junction obstruction(UPJO) and multiple stones,and 1 patient with distal ureteral tumor.All patients underwent laparoscopy-assisted small incision surgery in our department from Aug.2007 to Jun.2011.The key steps of the surgery were discussed and the clinical experience was summarized.Results (1) For 9 patients with renal tumors,the incision was 4-6 cm in length,the cold ischemia time was(15±4) min,and the operation time ranged from 90 to 180 min.Drainage tubes were removed within 48 h after operation.No patient had bleeding,urinary fistula or other serious complications.(2) For the 3 patients with UPJO,the incision was 4-5 cm in length and the operation time was 110 to 190 min.Drainage tubes were removed within 3-5 d after operation.No patient had bleeding,urinary fistula or other serious complications.No patient had fever or back pain after removal of double-J stents.Intravenous pyelography showed no hydronephrosis and the renal structure was normal.(3) For the patient with ureteral tumor,the drainage tube was removed 3 d after operation and there was no complication.No patients in the present study used analgesic pump or analgesic medications after surgery.Conclusion Laparoscopy-assisted small incision surgery can reduce the length of incision,minimize injury,and protect renal function.Besides,the method is safe and capable of handling complicated situations,especially suitable for patients who are difficult to receive total laparoscopic surgery.

Impact of tumour location versus multifocality in patients with upper tract urothelial carcinoma treated with nephroureterectomy and bladder cuff excision: a homogeneous series without perioperative chemotherapy

It is well established that upper tract urothelial carcinoma is a rare cancer with an aggressive course. Currently, radical nephroureterectomy with bladder cuff excision remains the standard of care in the treatment of these tumours. Previous studies demonstrate that stage, grade and lymphovascular invasion have prognostic significance on recurrence and outcome whereas the prognostic impact of tumour location remains unclear. This study provides an accurate analysis of the impact of tumour location and multifocality on prognosis in patients with upper tract urothelial carcinoma following nephroureterectomy with bladder cuff excision. Ureteral tumour location, particularly when associated with multifocal disease in the renal pelvis, is significantly associated with an increased risk of disease recurrence and cancer-specific death after surgery. To examine the significance of ureteral and renal pelvic location of upper tract urothelial carcinoma in a large multi-institutional study. We collected and pooled a database of 637 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy and bladder cuff excision in nine international academic centres. Univariate and multivariate models examined the effect of tumour location on recurrence-free survival (RFS) and cancer-specific survival (CSS) rates. Collected variables included age, gender, race, presence of lymphovascular invasion, concomitant carcinoma in situ, pathological stage, lymph node dissection and type of surgery (open vs laparoscopic). Anatomically, 34% of tumours were ureteral, 59% were renal pelvic and 7% were multifocal. Median follow-up for patients alive was 42 months (interquartile range: 19-76). Race, type of surgery, pathological stage and presence of lymphovascular invasion were significantly different across the three subgroups of patients (all P values <0.05). Age, gender, grade, presence of concomitant carcinoma in situ and follow-up duration were similar among the three subgroups. On multivariable Cox regression analyses, ureteral tumour location was an independent predictor of worse RFS (hazard ratio 2.1, P = 0.006) and CSS (hazard ratio 2.0, P = 0.027). When associated with renal pelvic disease, ureteral location was an even stronger independent predictor of worse RFS (hazard ratio 4.6, P < 0.001) and CSS (hazard ratio 4.0, P < 0.001). Ureteral tumour location, particularly in association with multifocal disease in the renal pelvis, is an independent prognostic factor for higher disease recurrence and cancer-specific mortality.

Should Follow-up Cystoscopy in Bacillus Calmette-Guérin–Treated Patients Continue After Five Tumour-Free Years?

BackgroundIt is not known how long follow-up cystoscopy in tumour-free bacillus Calmette-Guérin (BCG)–treated patients should continue. ObjectiveDetermine the incidence of late recurrences and progression after a tumour-free period of >5 yr after BCG treatment. Design, setting, and participantsData on 542 patients with non–muscle-invasive bladder cancer treated with BCG between 1986 and 2003 were analysed. Of 542 patients, 204 patients (37.6%) were tumour-free for ≥5 yr. The median tumour-free period was 105.5 mo (range: 60–252 mo). MeasurementsTo compare the tumour-free group with patients who were not tumour-free for 5 yr, traditional variables (tumour grade, tumour stage, age, gender, tumour number and size, primary or recurrent tumour, BCG strain, previous chemotherapy, previous upper tract tumour, number of earlier resections, and European Organisation for Research and Treatment of Cancer recurrence and progression risk groups) were analysed using the Fisher exact test for dichotomous variables, the Mantel-Haenszel chi-square test for ordered categorical variables, and the Mann-Whitney U-test for continuous variables. Kaplan-Meier curves for time to recurrence were constructed using Statistica software (StatSoft, Tulsa, Oklahoma, USA). Differences between groups were tested with the log-rank test. For continuous variables, Cox proportional hazard regression was performed to find significant effect on the time to recurrence. Results and limitationsTwenty-two of 204 patients (10.8%) had a recurrence after being tumour-free for ≥5 yr. The Kaplan-Meier estimated risk for recurrence was 12.5% at 10 yr and 20.5% at 15 yr. Among patients with TaG1–TaG2 before BCG, 11 of 79 patients (13.9%) had recurrences, including three patients with invasive extravesical tumours. Among the bladder recurrences were seven TaG1s and one carcinoma in situ (CIS). Among the 125 patients with TaG3/CIS/T1 before BCG, 11 patients (8.8%) had recurrences, including 2 patients with invasive ureter tumours. The bladder recurrences were one T2, four CIS, and four TaG1. Late recurrences were 8.5 times more common among patients with recurrent tumours before BCG compared with patients treated after their first tumour episode. The study was retrospective and nonrandomised but unselected and population-based. ConclusionsA tumour-free period of 5 yr after BCG treatment is a good prognostic sign, but recurrences after >10 yr are not unusual. Literature data and the present report support cystoscopy follow-up for ≥10–15 tumour-free years, at least among patients with recurrent tumours and/or high-grade lesions before BCG treatment.

Robot-Assisted Excision of Ureteral Tumor and Reconstruction in Patients with Unifocal Urothelial Cancers

Introduction and Objective: There are different surgical options for management of upper tract urothelial tumors, ranging from nephroureterectomy to segmental ureteral excision and reconstruction. Ureteral sparing techniques are particularly useful for unifocal, low-grade cancers in select patients. We have performed robot-assisted segmental excision of ureteral tumor with reconstruction in seven patients. Methods: An Institutional Review Board (IRB)-approved retrospective review of our robotic surgery database was performed to identify all consecutive patients who underwent robot-assisted segmental ureterectomy between 2009 and 2010 for biopsy-confirmed, low-grade urothelial carcinoma. We have performed robot-assisted excision of ureteral tumor and reconstruction in seven patients (two for mid ureter; five for lower ureter). In three of the five lower ureteral tumors, we have performed ipsilateral pelvic lymphadenectomy. In this video, we describe our technique for excision of a midureteral transitional cell carcinoma followed by an end-to-end ureteral anastomosis. In addition, our technique of ureteral stenting is demonstrated for midureteral lesions. The steps of the procedure demonstrated in our video include (1) port placement, (2) reflection of colon and exposure of the retroperitoneum, (3) ureteral mobilization, (4) application of Hem-o-lock clips proximally and distally, (5) excision of ureteral tumor, (6) intracorporeal Double-J stent placement, and (7) ureteral–ureteral anastomosis. Results: Final pathology revealed low-grade carcinoma in five patients, whereas two patients demonstrated high-grade urothelial malignancy without any carcinoma in situ (CIS) or positive surgical margins. Mean estimated blood loss was 75 mL, and mean length of hospital stay was 1.5 days. Stents were removed at 4 weeks postoperatively. At follow-up, ranging from 3 to 20 months, cystoscopy and upper tract imaging were normal in all but two patients. One patient developed ipsilateral iliac lymphadenopathy. Lymph node biopsy revealed transitional cell carcinoma and this patient underwent chemotherapy. The second patient developed disease recurrence in the bladder, which was managed with endoscopic resection, and to date has not recurred again. Both these patients who recurred had distal ureteral tumors. Conclusions: In selected cases, segmental ureterectomy and primary ureteroureteral anastomosis are feasible for ureteral carcinomas. Long-term and regular follow-up are necessary, as in any patient with urothelial malignancy. The authors have nothing to disclose. Runtime of video: 7 mins 21 secs

UP-03.152 Prognosis and Prognostic Factors in Renal Pelvis and Ureter Tumors

UP-03.152 Prognosis and Prognostic Factors in Renal Pelvis and Ureter Tumors

VID-05.05 Endoscopic Treatment of Multiple Ureteral Tumors in an Eighty-Year-Old Patient

We present the case of an 80-year old lady with multiple small superficial tumors in the left ureter, treated endoscopically. The patient had 15 year-long history of multiple bladder tumors, treated by transurethral resection (TUR) and fulguration.

UP-03.145 T2 Ureteral Tumor and Severe Hydronephrosis: Poor Prognostic Factors in Upper Urinary Tract Transitional Cell Carcinoma

UP-03.145 T2 Ureteral Tumor and Severe Hydronephrosis: Poor Prognostic Factors in Upper Urinary Tract Transitional Cell Carcinoma

Upper urinary tract transitional cell carcinoma: location is not correlated with prognosis

To identify the impact of tumour location on the disease recurrence and survival of patients who were treated surgically for upper urinary tract transitional cell carcinoma (UUT-TCC). A single-centre series of 189 consecutive patients who were treated surgically for UUT-TCC between January 1999 and December 2009 was evaluated. Patients who had previously undergone radical cystectomy, preoperative chemotherapy or contralateral UUT-TCC were excluded. In all, 133 patients were available for evaluation. Tumour location was categorized as renal pelvis or ureter based on the location of the dominant tumour. Recurrence-free probabilities and cancer-specific survival were estimated using the Kaplan-Meier method and Cox regression analyses. The 5-year recurrence-free and cancer-specific survival estimates for the cohort in the present study were 66% and 62%, respectively. The 5-year bladder-only recurrence-free probability was 76%. Using multivariate analysis, only pT classification (hazard ratio, HR, 2.46; P = 0.04) and demographic characteristics (HR, 2.86 for areas of Balkan endemic nephropathy, vs non-Balkan endemic nephropathy areas; 95% confidence interval, 1.37-5.98; P = 0.005) were associated with disease recurrence. Tumour location was not associated with disease recurrence in any of the analyses. There was no difference in cancer-specific survival between renal pelvis and ureteral tumours (P = 0.476). Using multivariate analysis, pT classification (HR, 8.04; P = 0.001) and lymph node status (HR, 4.73; P = 0.01) were the only independent predictors associated with a worse cancer-specific survival. Tumour location is unable to predict outcomes in a single-centre series of consecutive patients who were treated with radical nephroureterectomy for UUT-TCC.

Is Hand-Assisted Retroperitoneoscopic Nephroureterectomy Better Than Transurethral Bladder Cuff Incision-Assisted Nephroureterectomy?

To compare the perioperative and oncologic outcome between hand-assisted nephroureterectomy (HARNU) and transurethral bladder cuff incision-assisted nephroureterectomy (TUINU), which manage the bladder cuff with different methods. From January 2005 to December 2008, 325 patients with upper urinary tract urothelial carcinoma (UUT-UC) underwent nephroureterectomy at our institution. A total of 208 patients were enrolled in this retrospective study. A total of 208 patients, including 102 men and 106 women, were analyzed in this retrospective study. Ninety-eight patients underwent HARNU for UUT-UC, and110 patients underwent TUINU. The HARNU group has less operative time and hospital stay, and fewer postoperative ileus episodes. There were trends of less blood loss in the HARNU group. There were no statistical differences in the total bladder tumor recurrence, local recurrence, contralateral recurrence, distant metastasis, and cancer-specific survival between HARNU and TUINU. There was a significantly higher incidence of bladder tumor recurrence in TUINU group, however, than in the HARNU group (P=0.008) if the tumor was located at the low third of the ureter. There were more oncologic concerns about bladder tumor recurrence for the low third ureteral tumor in the TUINU group. In addition, the perioperative outcomes such as operative time, blood loss, hospital stay, and ileus rate were better in the HARNU group. Therefore, surgeons can manage UUT tumor with less oncologic concern and better perioperative results with HARNU.

Robotic-assisted Nephroureterectomy and Bladder Cuff Excision Without Intraoperative Repositioning

To present surgical tips and describe a novel technique for successful performance of robotic nephroureterectomy with bladder cuff excision (RNUBCE). We report a technique of RNUBCE without intraoperative patient repositioning or redocking of the robot. Nephroureterectomy with bladder cuff excision is the standard management of high-grade or bulky upper tract transitional cell carcinoma. Lymphadenectomy is performed when clinically indicated. Fifteen patients underwent RNUBCE between January 2009 and May 2010. Several key points to this operation contribute to its success. Ports are strategically placed to allow access to the kidney, ureter, and bladder. The ureter is clipped, though not divided, immediately after ligating the renal hilum to minimize the risk of tumor seeding resulting from manipulation of the kidney. In cases of ureteric tumors, wide dissection of the ureter is carried out to avoid a positive margin or entry into the ureter. Bladder stay sutures are placed lateral to the ureterovesical junction to prevent retraction of the bladder once the bladder cuff is excised. If desired, a partial excision of the cuff can be performed with the ureter acting as a bucket handle. All procedures were performed successfully without complications. Mean total operative time was 184 minutes, estimated blood loss was 103 mL, and mean hospital stay was 2.7 days. Short-term oncological outcomes have revealed no recurrences. RNUBCE, with lymphadenectomy when clinically indicated, provides a viable treatment option for patients with upper tract transitional cell carcinoma.

Ureteral and Multifocal Tumours Have Worse Prognosis than Renal Pelvic Tumours in Urothelial Carcinoma of the Upper Urinary Tract Treated by Nephroureterectomy

BackgroundIt is not known whether the primary tumour location of upper urinary tract urothelial carcinoma (UUT-UC) is associated with prognosis. ObjectiveTo evaluate the impact of initial primary tumour location on survival in patients who had undergone radical nephroureterectomy (RNU). Design, setting, and participantsUsing a multi-institutional, retrospective database, we identified 609 patients with UUT-UC who had undergone RNU between 1995 and 2010. Tumour location was categorised as renal pelvis, ureter, or multifocal. InterventionAll patients had undergone RNU. MeasurementsTumour location was tested as a prognostic factor for survival through univariate and multivariable Cox regression analysis. Results and limitationsTumour location was renal pelvis in 317 cases (52%), ureter in 185 cases (30%), and multifocal in 107 cases (18%). Compared to renal pelvic and ureteral tumours, multifocal tumours were more likely to be associated with advanced stages (pT3/pT4; 39%, 30%, and 54%, respectively; p<0.001) and high-grade disease (53%, 56%, and 76%, respectively; p<0.001). On multivariable analysis, tumour location was an independent prognostic factor for cancer-specific death, disease recurrence, and metastasis (p<0.05). The 5-yr cancer-specific death–free survival probability was 86.8% for renal pelvic tumours, 68.9% for ureteral tumours, and 56.8% for multifocal tumours (p<0.001). The retrospective design of this study was its main limitation. ConclusionsUreteral and multifocal tumours had a worse prognosis than renal pelvic tumours. These findings are not in line with recently published data and should be investigated in a prospective assessment to obtain a definitive statement regarding this matter.

Contrast-enhanced ultrasonography in ureteral lesions: a preliminary study

Objective To explore the diagnostic value of contrast-enhanced ultrasonography (CEUS) in ureteral lesions.Methods The ultrasonogram of conventional ultrasound and CEUS were retrospectively analyzed in 19 confirmed ureteral lesions cases by operation and pathology.The size,inner echoes,boundary and color blood signal of ureteral lesions were observed by conventional ultrasound.The modality and phases of enhancement,including arrival time,peak time,washout time and appearance of internal structure,were observed by CEUS.Results The 19 ureteral tumors were of maximum widths between 2.1 to 7.7 cm.Conventional ultrasound showed 7 hypoechoic masses,10 isoechoic masses,1 hyperechoic mass and 1 unclear mass.Color Doppler flow imaging showed fairly rich blood signal in 8 tumors,a small amount of blood signal around tumor in 6 tumors and no blood signal in the rest.In early phase,CEUS showed enhancement in all 19 ureteral lesions,including synchronously enhancement in 8 tumors and delayed enhancement in 11 tumors.In peak time,hypoechogenicity compared to the normal renal cortex was shown in 3 tumors,hyperechogenicity in 11 tumors and isoechogenicity in 5 tumors.In late phase,fast wash-out was displayed in 16 tumors,isochronously wash-out in 1 tumor,delayed wash-out in 1 tumor and unclear in 1 tumor.The detection rates of blood supply and clear boundary in ureteral lesions and the diagnostic sensitivity for ureteral cancer were 74% (14/19),16% (3/19),50% (8/16) by conventional ultrasound respectively.The detection rates of blood supply and clear boundary in ureteral lesions and the diagnostic sensitivity for ureteral cancer were 100% (19/19) ,58% (11/19) ,94% (15/16) by CEUS respectively.The change of these performances was statistically significant between conventional ultrasound and CEUS.Conclusions CEUS can improve blood supply,boundary and the diagnostic sensitivity of ureteral lesions. Key words: Ultrasonongraphy; Microbubbles; Ureteral neoplasms

Preoperative Hydronephrosis Grade Independently Predicts Worse Pathological Outcomes in Patients Undergoing Nephroureterectomy for Upper Tract Urothelial Carcinoma

We analyzed the prognostic impact of hydronephrosis grade on disease specific survival and evaluated whether hydronephrosis grade could preoperatively predict worse pathological outcomes in cases of upper tract urothelial carcinoma treated surgically. We identified and retrospectively reviewed the records of 91 patients who were evaluated by multidetector computerized tomography and/or magnetic resonance imaging preoperatively, and treated with nephroureterectomy at our institution from 2000 to 2009. Ipsilateral hydronephrosis was graded 0 to 4 by 2 urological radiologists blinded to clinical outcomes. We analyzed the associations between hydronephrosis grade, and pathological findings and patient outcomes. Preoperatively 67 patients (73.6%) had ipsilateral hydronephrosis. Grade was 1 to 4 in 3 (3.3%), 17 (18.7%), 23 (25.3%) and 24 cases (26.4%), respectively. Higher hydronephrosis grade was significantly associated with a ureteral tumor (p = 0.0307), higher pT stage (p = 0.0002) and lymphovascular invasion (p = 0.0014). Higher hydronephrosis grade was not associated with disease specific or metastasis-free survival. On preoperative multivariate analysis high hydronephrosis grade predicted pathological T stage (T3 or greater) (HR 4.98, p = 0.0228), positive lymphovascular invasion (HR 6.37, p = 0.0022) and grade 3 (HR 2.98, p = 0.0311). On image analysis preoperative hydronephrosis grade was associated with features of aggressive disease and predicted an advanced pathological outcome in patients with upper tract urothelial carcinoma. This information could prove useful to select candidates for neoadjuvant chemotherapy and make decisions concerning surgical options.

365 ROLE OF THE SELECTIVE UPPER URINARY TRACT CYTOLOGY IN PATIENTS WITH SUSPICIOUS TRANSITIONAL LESIONS

365 ROLE OF THE SELECTIVE UPPER URINARY TRACT CYTOLOGY IN PATIENTS WITH SUSPICIOUS TRANSITIONAL LESIONS

363 PROSPECTIVE EVALUATION OF BIOMARKERS IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOAMA: PROGNOSTIC ROLE OF CELL CYCLE REGULATORS

You have accessJournal of UrologyUrothelial Cancer: Markers + Natural History & Pathophysiology1 Apr 2011363 PROSPECTIVE EVALUATION OF BIOMARKERS IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOAMA: PROGNOSTIC ROLE OF CELL CYCLE REGULATORS Ramy Youssef, Tyler Arendt, Nicholas Cost, Arthur Sagalowsky, Yair Lotan, and Vitaly Margulis Ramy YoussefRamy Youssef Dallas, TX More articles by this author , Tyler ArendtTyler Arendt Dallas, TX More articles by this author , Nicholas CostNicholas Cost Dallas, TX More articles by this author , Arthur SagalowskyArthur Sagalowsky Dallas, TX More articles by this author , Yair LotanYair Lotan Dallas, TX More articles by this author , and Vitaly MargulisVitaly Margulis Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.449AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study was to prospectively evaluate the prognostic role of a panel of tissue biomarkers in patients with upper tract urothelial carcinoma (UTUC). METHODS Since 2007, primary tumors of patients treated with radical nephroureterctomy (RNU) for high grade UTUC were prospectively evaluated for expression of p53, p21, p27, Cyclin E, and pRB/Ki−67. Standardized, automated immunohistochemical staining and scoring were utilized in conjunction with bright field microscopy imaging and advanced color detection software. The relationship between tumor markers and pathological parameters as well as oncologic outcomes was assessed. RESULTS The study included 28 patients with 16 (57%) renal pelvis and 12 (43%) ureteral tumors. At a median follow up of 20 months, 8 (29%) patients experienced systemic disease progression and 7 (25%) died from UTUC. Expression of p53, p21, p27, Cyclin E, and pRB/Ki−67 was altered in 12 (46%), 5 (18%), 10 (36%), 1 (4%) and 25 (89%) tumors, respectively. Unfavorable prognostic bio−score (>2 altered markers) was associated with non−organ confined UTUC at RNU (>pT2 and/or pN1−2). Specifically, 9 (50%) of 18 patients with non organ confined UTUC demonstrated unfavorable prognostic bio−score, compared to 1 (10%) patient with organ confined UTUC (p=0.048). Median cancer−specific survival of patients with >2 altered biomarkers was 14.0 months, and it was not reached in patients with < 2 altered markers (HR 3.766, p=0.052). CONCLUSIONS The preliminary analysis of this ongoing prospective study demonstrates that tissue biomarkers can be utilized for prediction of non−organ confined disease and overall oncologic outcomes after RNU for UTUC. Further study will determine if tissue biomarkers can be employed for patient risk−stratification and integration of peri−operative systemic chemotherapy into management paradigm of UTUC. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e148 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ramy Youssef Dallas, TX More articles by this author Tyler Arendt Dallas, TX More articles by this author Nicholas Cost Dallas, TX More articles by this author Arthur Sagalowsky Dallas, TX More articles by this author Yair Lotan Dallas, TX More articles by this author Vitaly Margulis Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1150 SIGNIFICANCE OF CANCER INVOLVEMENT OF THE URETER AND ITS MEANING FOR UPPER URINARY TRACT RECURRENCE IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20111150 SIGNIFICANCE OF CANCER INVOLVEMENT OF THE URETER AND ITS MEANING FOR UPPER URINARY TRACT RECURRENCE IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER Andreas Loeser, Timo Katzenberger, Arkadius Kocot, Daniel C. Vergho, Martin Spahn, and Hubertus Riedmiller Andreas LoeserAndreas Loeser Wuerzburg, Germany More articles by this author , Timo KatzenbergerTimo Katzenberger Wuerzburg, Germany More articles by this author , Arkadius KocotArkadius Kocot Wuerzburg, Germany More articles by this author , Daniel C. VerghoDaniel C. Vergho Wuerzburg, Germany More articles by this author , Martin SpahnMartin Spahn Wuerzburg, Germany More articles by this author , and Hubertus RiedmillerHubertus Riedmiller Wuerzburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.749AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate: (1) The incidence of ureteral tumour involvement in patients undergoing radical cystectomy (RC) for transitional cell carcinoma (TCC) or carcinoma in situ (CIS) of the bladder. (2) Furthermore the usefulness and accuracy of intraoperative frozen section analysis (FSA) of the ureter and (3) the significance of ureteral tumour involvement regarding the incidence of tumour recurrence in the upper urinary tract. METHODS Between 2003 and 2007 a total number of 176 patients underwent RC for transitional cell carcinoma (group I) or solitary or concomitant CIS (group II) of the bladder. Intraoperativly the ureters were stepwise analysed by FSA until a tumourfree margin could be established. FSA results were compared to the corresponding results of final histology. Tumour involvement was evaluated and correlated to upper urinary tract recurrence (UUTR). RESULTS In group I (117/176 patients) one infiltrated ureter could be seen (0.85%). On the contrary out of the 59/176 patients of group II 21 had a tumour involvement of the ureter (35.8%). This difference was significant (p<0.0001). In both groups a total of 403 ureteral edges were analyzed (group I: 232, group II: 171). Among patients with TCC of the bladder (group I) FSA in 1/232 (0.4%) was false negative. In group II (CIS of the bladder) 5/171 FSA results in five different patients were false-negative (2.9%). Overall 2/176 patients (1.1%) had upper urinary tract recurrence during follow-up. Both patients had CIS of the bladder (group II). Of these two patients one had a dysplasia in the remnant ureter the other a CIS. CONCLUSIONS (1) Patients who undergo RC because of a solitary or concomitant CIS of the bladder are at a significant increased risk of tumour involvement of the ureter. (2) FSA as intraoperative analysis can be regarded as accurat. (3) Patients with tumour-involved ureters and espically left positive margins are at a higher risk of upper urinary tract recurrence. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e461-e462 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreas Loeser Wuerzburg, Germany More articles by this author Timo Katzenberger Wuerzburg, Germany More articles by this author Arkadius Kocot Wuerzburg, Germany More articles by this author Daniel C. Vergho Wuerzburg, Germany More articles by this author Martin Spahn Wuerzburg, Germany More articles by this author Hubertus Riedmiller Wuerzburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V2091 THE USE OF THE URETHRA AS A NOTS (NATURAL ORIFICE TRANS-ENDOSCOPIC SURGERY) FOR URETHERAL CLOSURE AND URINARY BLADDER SUTURE IN PATIENT WHO WAS TAKEN TO LAPAROSCOPIC NEPHREOURETERECTOMY

You have accessJournal of UrologySingle Port Surgery1 Apr 2011V2091 THE USE OF THE URETHRA AS A NOTS (NATURAL ORIFICE TRANS-ENDOSCOPIC SURGERY) FOR URETHERAL CLOSURE AND URINARY BLADDER SUTURE IN PATIENT WHO WAS TAKEN TO LAPAROSCOPIC NEPHREOURETERECTOMY Manuel Duque and Natalia Victoria Manuel DuqueManuel Duque Cali, Colombia More articles by this author and Natalia VictoriaNatalia Victoria Cali, Colombia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2388AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There's always been doubts concerning that in the nephroureterectomy procedures by the time of the release of the urether, tumoral cells could fall into the retroperitoneum, therefore causing potentially carcinogenic spreads in that area. NOTES, is a state of the art procedure that could successfully avoid this complication. METHODS Female Patient. 56 years old. The patient complains from blood in her urine. Smoker for 35 years. Female patient with gross haematuria. No symptoms for abdominal pain other than occasional cramping. CAT Scan shows tumoral lesion between the distal portion of the urether and dispaired function. RESULTS The ureteroscopy shows an ureteral tumor. A PDS 3 0 stitch is passed through the nephroscope sheet; the sheet is then removed and a laparoscopic needle handler is placed as well as the nephroscope. The needle is secured, then a stitching point is placed in the uretheral meatus. The needle is then removed. External knot maid in the suture. The uretheral meatus is released. The electroscalpel and the sheet are pushed into the retroperitoneum for latter closure of the urinary bladder defect in a similar way. Urinary catether is placed and then nephroureterectomy is performed. The distal portion of the urether is observed along with the PDS 3 0 stitching points. Total Surgical Time 2 hours and 30 minutes. Total Blood Loss: 100 cc. Inpatient Care: 1 day. Non opioid pain relief medication required. CONCLUSIONS NOTES could be the answer to the concern that's been around the procedure in terms of the risk of tumoral cells in the retroperitoneum. At the present time five procedures have been performed: Two males; three females, so far in a safe way and with no major complications. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e836 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manuel Duque Cali, Colombia More articles by this author Natalia Victoria Cali, Colombia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical value of color doppler ultrasonography in the diagnosis of primary ureteral carcinoma

Objective To study the clinical valne of color Doppler ultrasound for the diagnosis of primary ureteral carcinoma. Methods 15 patients with pathologically confirmed primary ureteral carcinoma by color Doppler ultrasound were retrospectively analyzed. Results 15 patients with lesions above the ureter and renal pelvis and varying degrees of expansion,water, of which 11 cases of solid mass within the probe and ureter. Color Doppler showed lesions could be detected, and dot, stripe and dendritic arterial blood flow signal, resistance index (RI) 0. 58 ～ 0. 67.Conclusion Color Doppler ultrasound screening of primary ureteral carcinoma has important diagnostic value, can increase the rate of preoperative diagnosis,and can provide reference for clinical staging. Key words: Ureteral neoplasms; Ultrasonography, doppler, color