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01.02.2013 | Topic paper

Results and outcomes after endoscopic treatment of upper urinary tract carcinoma: the Austrian experience

verfasst von: Harun Fajkovic, Tobias Klatte, Udo Nagele, Michael Dunzinger, Richard Zigeuner, Wilhelm Hübner, Mesut Remzi

Erschienen in: World Journal of Urology | Ausgabe 1/2013

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Abstract

Introduction

Through evolution in technology, endoscopic treatment has gained popularity for the treatment of upper tract urothelial carcinoma (ENDO-UTUC).

Methods

A total of 20 patients with ENDO-UTUC were compared to 178 treated by radical nephroureterectomy (RNU) for a pTa-1 UTUC, and a systematic review was performed.

Results

Mean age for ENDO-UTUC was 71.9 ± 16.0 years, and tumor features were favorable (90 % papillary, 14 low grade, 11 pTa). All ENDO-UTUC were performed ureteroscopically. Mean follow-up was 20.4 ± 30 months. The 5-year overall survival (OS) rate was 45 %. Local (LR) and bladder recurrence (BR) was 25 and 15 %. Time to definitive treatment was longer, ASA higher, LR rates higher, OS lower for ENDO-UTUC (all p < 0.001), but no difference was recorded for BR (p = 0.056) and cancer-specific survival (CSS) (p = 0.364). Postoperative kidney function (KF) was better in the ENDO-UTUC (p = 0.048), though preoperative KF showed no difference. The maximal level of evidence was 3b, patients were highly selected, numbers of patients were low, and ASA scores high. OS was rather low and CSS high. LR rate was high (61 %) and BR rate moderate (39 %) for ureteroscopic and 36 and 28 %, respectively, for percutaneous approach.

Conclusions

LR for ENDO-UTUC is high. In high-grade UTUC, oncological outcome is worse. RNU is associated with a significant loss of KF, but LR is rare. ENDO-UTUC is reserved for selected cases if elective. In imperative cases, it has to be balanced between KF, morbidity of the procedure, risk of operation and tumor control. ENDO-UTUC is not necessarily underused in Austria, because of lack in evidence, but 41 % of all RNU were performed in pTa/pTis/pT1 lesions.

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Titel: Results and outcomes after endoscopic treatment of upper urinary tract carcinoma: the Austrian experience
verfasst von: Harun Fajkovic
Tobias Klatte
Udo Nagele
Michael Dunzinger
Richard Zigeuner
Wilhelm Hübner
Mesut Remzi
Publikationsdatum: 01.02.2013
Verlag: Springer-Verlag
Erschienen in: World Journal of Urology / Ausgabe 1/2013
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-012-0948-4

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Introduction

Methods

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Conclusions

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