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27.05.2016 | Topic Paper

Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma

verfasst von: Rao S. Mandalapu, Mesut Remzi, Theo M. de Reijke, Vitaly Margulis, J. Palou, A. Kapoor, Ofer Yossepowitch, Jonathan Coleman, Olivier Traxer, J. Kyle Anderson, James Catto, Jean de la Rosette, Timothy O’Brien, Anthony Zlotta, Surena F. Matin

Erschienen in: World Journal of Urology | Ausgabe 3/2017

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Abstract

Introduction

The conservative management of upper tract urothelial carcinoma (UTUC) has historically been offered to patients with imperative indications. The recent International Consultation on Urologic Diseases (ICUD) publication on UTUC stratified treatment allocations based on high- and low-risk groups. This report updates the conservative management of the low-risk group.

Methods

The ICUD for low-risk UTUC working group performed a thorough review of the literature with an assessment of the level of evidence and grade of recommendation for a variety of published studies in this disease space. We update these publications and provide a summary of that original report.

Results

There are no prospective randomized controlled studies to support surgical management guidelines. A risk-stratified approach based on clinical, endoscopic, and biopsy assessment allows selection of patients who could benefit from kidney-preserving procedures with oncological outcomes potentially similar to radical nephroureterectomy with bladder cuff excision, with the added benefit of renal function preservation. These treatments are aided by the development of high-definition flexible digital URS, multi-biopsies with the aid of access sheaths and other tools, and promising developments in the use of adjuvant topical therapy.

Conclusions

Recent developments in imaging, minimally invasive techniques, multimodality approaches, and adjuvant topical regimens and bladder cancer prevention raise the hope for improved risk stratification and may greatly improve the endoscopic treatment for low-risk UTUC.

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Titel: Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma
verfasst von: Rao S. Mandalapu
Mesut Remzi
Theo M. de Reijke
Vitaly Margulis
J. Palou
A. Kapoor
Ofer Yossepowitch
Jonathan Coleman
Olivier Traxer
J. Kyle Anderson
James Catto
Jean de la Rosette
Timothy O’Brien
Anthony Zlotta
Surena F. Matin
Publikationsdatum: 27.05.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 3/2017
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1859-6

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