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Current Urology Reports

Erschienen in:

01.04.2017 | Minimally Invasive Surgery (T Guzzo, Section Editor)

Endoscopic Treatment of Upper Tract Urothelial Carcinoma

verfasst von: Daniel P. Verges, Costas D. Lallas, Scott G. Hubosky, Demetrius H. Bagley Jr.

Erschienen in: Current Urology Reports | Ausgabe 4/2017

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Abstract

Purpose of Review

This study aims to make the reader be aware of recent trends regarding the endoscopic management of upper tract urothelial carcinoma (UTUC) via review of the urologic literature over the past 5 years. Given the rare incidence of this disease, and the lack of level 1 evidence, systematic reviews and meta-analyses were also evaluated. Studies of importance are also considered and outlined in the annotated reference section.

Recent Findings

The PubMed database was queried using the following medical subject headings (MeSH terms): “carcinoma, transitional cell,” “ureter,” “ureteral neoplasms,” “kidney pelvis,” “endoscopy,” “laser therapy,” “ureteroscopy,” “urologic surgical procedures,” and “ureteroscopes.” MeSH terms were linked together in varying combinations and limited to human studies in English. Given the relatively rare nature of upper tract urothelial carcinoma (UTUC), level 1 evidence regarding the efficacy of endoscopic treatment does not exist, even after 30+ years of experience. Rather, the literature available mostly is in the form of single institutional retrospective series consisting of relatively small numbers of patients with short to intermediate follow-up. Only within the last 3 years have published series with larger numbers of patients and mean follow-up over 5 years been made available. Even with these more robust experiences, comparisons among series are difficult given variable treatment and follow-up approaches.

Summary

Most endoscopically managed UTUC will locally recur, especially with longer follow-up. Renal preservation rate is high, however, approaching 80% with follow-up well over 3 years. Patients with high-grade disease often fare poorly regardless of treatment modality. As such, endoscopic management for high-grade urothelial carcinoma should only be used in exceptional circumstances (i.e., in those patients medically unfit for NU or those with solitary kidneys wishing to avoid the morbidity of dialysis). No level 1 evidence exists for the routine use of intraluminal adjuvant therapy for UTUC (i.e., BCG and Mitomycin C) and multiple retrospective observational series claim there is no overt benefit. The recent formation of multiple international groups with interest in UTUC may eventually lead to the production of level 1 studies regarding optimal treatment; however, uniformity in treatment approach will likely still offer challenges.

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• Azemar MD, Comperat E, Richard F, Cussenot O, Roupret M. Bladder recurrence after surgery for upper urinary tract urothelial carcinoma: frequency, risk factors and surveillance. Urol Oncol. 2011;29:130–6. doi:10.1016/j.urolonc.2009.06.003. In this review article, Azemar and Roupret examine bladder cancer after surgery for UTUC. The downstream tumor seeding and pan-urothelial defect theories for bladder recurrence are discussed. The authors remind the reader that the bladder is the most common site of recurrence after treatment for UTUC and that synchronous bladder tumors are present in 8-13% of patients with UTUC. This review found that 15-50% of patients with UTUC will subsequently develop a metachronous bladder lesion and that upper tract tumor multifocality and previous history of bladder cancer are the most significant risk factors for bladder recurrence after surgery for UTUC. Most bladder recurrences occur within 2 years of initial surgery for UTUC.

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Titel: Endoscopic Treatment of Upper Tract Urothelial Carcinoma
verfasst von: Daniel P. Verges
Costas D. Lallas
Scott G. Hubosky
Demetrius H. Bagley Jr.
Publikationsdatum: 01.04.2017
Verlag: Springer US
Erschienen in: Current Urology Reports / Ausgabe 4/2017
Print ISSN: 1527-2737
Elektronische ISSN: 1534-6285
DOI: https://doi.org/10.1007/s11934-017-0675-x

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