%0 Journal Article
%T Ureteroscopic Laser Treatment of Upper Urinary Tract Urothelial Cell Carcinomas: Can a Tumour Free Status Be Achieved?
%A Christos Kalaitzis
%A Athanasios Zisimopoulos
%A Stilianos Giannakopoulos
%A Stavros Touloupidis
%J Advances in Urology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/429585
%X Introduction. In cases of anatomic or functional single kidney with urothelial tumours of the upper urinary tract, the endoscopic laser ablation has proven efficacious. Based on the knowledge that low-grade, low-stage upper tract transitional cell carcinomas rarely progress to invasive lesions, indications for endoscopic laser ablation have expanded to include patients with bilateral functioning kidneys and low-grade tumours. The question that remains to be answered is whether endoscopic laser ablation has the ability to completely eradicate upper urinary tract tumours. Methods. We performed in 25 patients in a period of 11 years 288 ureteroscopies and, if needed, laser ablation of upper urinary tract tumours in imperative indication. Results. In 32% of the patients the cancer remained even after several laser sessions. 64% of patients were tumour free after one or more laser sessions but remained clear only for the next 3 months. Only 1 patient was tumour free for a period of 68 months after 1 session of laser treatment. The procedure had low complication rates. Conclusion. The laser technology and the introduction of small diameter semirigid and flexible ureteroscopes made ablation of upper urinary tract tumours possible and safe. Nevertheless a complete resection of the carcinomas is rarely possible. 1. Introduction Upper urinary tract urothelial carcinomas (UTUCs) occur with an incidence of 1-2/100.000 in Western countries and comprise up to 5¨C10% of all urothelial carcinomas [1]. Radical nephroureterectomy (RNU) with bladder cuff excision is considered the gold standard treatment. However this procedure requires an intact contralateral kidney. In cases of a solitary kidney, bilateral kidney involvement by tumour or in cases of chronic renal insufficiency, organ preservation is crucial, and kidney sparing approaches are indicated (imperative indication). The demonstrated lack of aggressiveness of low-grade UTUCs together with the advent of improved ureterorenoscopes and advanced lasers technology has pushed the elective indications of endoscopic ablation of UTUC to include patients with upper urinary tract urothelial tumours and normal contralateral kidney function [1, 2] (nonimperative or elective indication). The European Urology Guidelines recommend the endoscopic treatment only for patients with low-grade and low-stage urothelial tumours [1]. The success rate of ureteroscopic therapy for grade 1 and grade 2 UTUCs is similar to that of bladder lesions managed by transurethral resection [3]. Endoscopic treatment of UTUCs can be performed
%U http://www.hindawi.com/journals/au/2013/429585/