Endourological Treatment of Upper Tract Urothelial Carcinomas

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Abstract
We analyzed a series of 59 reno-ureteral units with upper tract urothelial carcinoma treated endourologically at our institution. Between January 1980 and January 1995, 54 of 185 patients with a clinically diagnosed upper tract tumor were considered candidates for endourological treatment. Of the patients 14 had either bilateral disease or a solitary kidney. The primary approach was ureteroscopy in 39 reno-ureteral units and percutaneous nephroscopy in 20. Superficial stage pTa, T1 or Tis disease was noted in 48 cases, infiltrating stage pT2 cancer in 4 and inverted papilloma in 4, while the tumor was impossible to classify in 3. A total of 32 patients received adjuvant supplemental therapy. Ureteroscopy failed in 11 cases (28.2%), with salvage by nephroureterectomy in 6 and percutaneous nephroscopy in 5. Primary nephroscopy failed in 3 cases (15%) that were salvaged by open surgery. Two patients died of unrelated causes postoperatively and 14 (26%) had intraoperative or late complications that were treated conservatively in 12. After a mean followup of 30.6 months (range 2 to 119), 2 patients died of progressive upper tract tumor, 2 died of concurrent bladder cancer and 2 died of a second cancer. Of 42 upper tracts treated solely by endourological means 10 (23.8%) had recurrences, which were treated endourologically in 6. Bacillus Calmette-Guerin and mitomycin C seemed to be effective at preventing recurrences, with recurrence rates of 12.5 and 14.2%, respectively, compared to 60% for thiotepa, and 40% for oral combination 5-fluorouracil and uracil. Endourological treatment of low grade, small, noninvasive tumors of the upper urinary tract is a feasible and safe alternative even in patients with a normal contralateral kidney.