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 5–10% 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
References
[1]
M. Rouprêt, R. Zigeuner, J. Palou et al., “European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update,” European Urology, vol. 59, no. 4, pp. 584–594, 2011.
[2]
G. B. Johnson and M. Grasso, “Ureteroscopic management of upper urinary tract transitional cell carcinoma,” Current Opinion in Urology, vol. 15, no. 2, pp. 89–93, 2005.
[3]
M. J. Bader, R. Sroka, C. Gratzke et al., “Laser therapy for upper urinary tract transitional cell carcinoma: indications and management,” European Urology, vol. 56, no. 1, pp. 65–71, 2009.
[4]
A. R. Rastinehad, M. C. Ost, B. A. VanderBrink et al., “A 20-year experience with percutaneous resection of upper tract transitional carcinoma: is there an oncologic benefit with adjuvant bacillus Calmette Guérin therapy?” Urology, vol. 73, no. 1, pp. 27–31, 2009.
[5]
M. L. Cutress, G. D. Stewart, S. Wells-Cole, S. Phipps, B. G. Thomas, and D. A. Tolley, “Long-term endoscopic management of upper tract urothelial carcinoma: 20-year single-centre experience,” British Journal of Urology International, vol. 110, no. 11, pp. 1608–1617, 2012.
[6]
R. H. Thompson, A. E. Krambeck, C. M. Lohse, D. S. Elliott, D. E. Patterson, and M. L. Blute, “Endoscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys,” Urology, vol. 71, no. 4, pp. 713–717, 2008.
[7]
R. H. Thompson, A. E. Krambeck, C. M. Lohse, D. S. Elliott, D. E. Patterson, and M. L. Blute, “Elective endoscopic management of transitional cell carcinoma first diagnosed in the upper urinary tract,” British Journal of Urology International, vol. 102, no. 9, pp. 1107–1110, 2008.
[8]
A. E. Krambeck, R. H. Thompson, C. M. Lohse et al., “Endoscopic management of upper tract urothelial carcinoma in patients with a history of bladder urothelial carcinoma,” Journal of Urology, vol. 177, no. 5, pp. 1721–1726, 2007.
[9]
M. Rouprêt, V. Hupertan, O. Traxer et al., “Comparison of open nephroureterectomy and ureteroscopic and percutaneous management of upper urinary tract transitional cell carcinoma,” Urology, vol. 67, no. 6, pp. 1181–1187, 2006.
[10]
S. M. Lucas, R. S. Svatek, G. Olgin et al., “Conservative management in selected patients with upper tract urothelial carcinoma compares favourably with early radical surgery,” British Journal of Urology International, vol. 102, no. 2, pp. 172–176, 2008.
[11]
A. J. Gadzinski, W. W. Roberts, G. J. Faerber, and J. S. Wolf Jr., “Long-term outcomes of immediate versus delayed nephroureterectomy for upper tract urothelial carcinoma,” Journal of Endourology, vol. 26, no. 5, pp. 566–573, 2012.
[12]
S. Razdan, J. Johannes, M. Cox, and D. H. Bagley, “Current practice patterns in urologic management of upper-tract transitional-cell carcinoma,” Journal of Endourology, vol. 19, no. 3, pp. 366–371, 2005.
[13]
F. X. Keeley Jr., M. Bibbo, and D. H. Bagley, “Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma,” Journal of Urology, vol. 157, no. 5, pp. 1560–1565, 1997.
[14]
B. N. Hendin, S. B. Streem, H. S. Levin, E. A. Klein, and A. C. Novick, “Impact of diagnostic ureteroscopy on long-term survival in patients with upper tract transitional cell carcinoma,” Journal of Urology, vol. 161, no. 3, pp. 783–785, 1999.
[15]
A. J. Gadzinski, W. W. Roberts, G. J. Faerber, and J. S. Wolf Jr., “Long-term outcomes of nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma,” Journal of Urology, vol. 183, no. 6, pp. 2148–2153, 2010.
[16]
M. L. Cutress, G. D. Stewart, E. C. Tudor et al., “Endoscopic versus laparoscopic management of noninvasive upper tract urothelial carcinoma: 20-year single center experience,” The Journal of Urology, vol. 189, no. 6, pp. 2054–2061, 2013.
[17]
J. K. Wang, M. K. Tollefson, A. E. Krambeck, L. W. Trost, and R. H. Thompson, “High rate of pathologic upgrading at nephroureterectomy for upper tract urothelial carcinoma,” Urology, vol. 79, no. 3, pp. 615–619, 2012.
[18]
J. A. Martínez-Pi？eiro, M. J. García Matres, and L. Martínez-Pi？eiro, “Endourological treatment of upper tract urothelial carcinomas: analysis of a series of 59 tumours,” The Journal of Urology, vol. 156, no. 2, Part 1, pp. 377–385, 1996.
[19]
R. S. Suh, G. J. Faerber, and J. S. Wolf Jr., “Predictive factors for applicability and success with endoscopic treatment of upper tract urothelial carcinoma,” Journal of Urology, vol. 170, no. 6, part 1, pp. 2209–2216, 2003.
[20]
E. R. Tawfiek and D. H. Bagley, “Upper-tract transitional cell carcinoma,” Urology, vol. 50, no. 3, pp. 321–329, 1997.
[21]
D. S. Elliott, J. W. Segura, D. Lightner, D. E. Patterson, and M. L. Blute, “Is nephroureterectomy necessary in all cases of upper tract transitional cell carcinoma? Long-term results of conservative endourologic management of upper tract transitional cell carcinoma in individuals with a normal contralateral kidney,” Urology, vol. 58, no. 2, pp. 174–178, 2001.
[22]
G. L. Chen and D. H. Bagley, “Ureteroscopic surgery for upper tract transitional-cell carcinoma: complications and management,” Journal of Endourology, vol. 15, no. 4, pp. 399–404, 2001.
[23]
S. Daneshmand, M. L. Quek, and J. L. Huffman, “Endoscopic management of upper urinary tract transitional cell carcinoma: long-term experience,” Cancer, vol. 98, no. 1, pp. 55–60, 2003.
