Elective endoscopic management of transitional cell carcinoma first diagnosed in the upper urinary tract

R. Houston Thompson, Amy Krambeck, Christine M. Lohse, Daniel S. Elliott, David E. Patterson, Michael L. Blute

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

OBJECTIVE: To report our experience using ureteroscopic or percutaneous management of upper urinary tract (UUT) transitional cell carcinoma (TCC) in patients with no history of bladder TCC. PATIENTS AND METHODS: Between 1983 and 2004 we identified 22 patients who underwent endoscopic management of TCC first diagnosed in the UUT and in the setting of a normal contralateral kidney. We performed a retrospective chart review and conducted outcome analyses. RESULTS: The median (range) age at diagnosis was 64 (37-86) years and the median tumour size was 0.8 (0.3-2.6) cm. The tumour grade was 1, 2, or diagnosed as visual low grade in two (9%), seven (32%), and 13 (59%) patients, respectively; no patient had grade 3 TCC at diagnosis. Tumour stage was Ta or visual Ta in all patients. The median follow-up was 4.9 (0.4-17) years during which 11 (50%) patients developed 21 UUT recurrences and 10 (45%) patients developed bladder TCC. At last follow-up, seven (32%) patients required a nephroureterectomy for recurrent TCC and two (9%) patients died from TCC. Among 13 patients with a diagnosis based on visual inspection only, three recurred with grade 3 invasive TCC during follow-up. No patient with pathological confirmation of low-grade/stage TCC recurred with high-grade or invasive TCC. CONCLUSIONS: Recurrence is common after endoscopic management of UUT-TCC, underscoring the need for strict surveillance. Patients diagnosed visually, without adequate tissue for pathological examination, can recur with high-grade invasive TCC. No patient with pathological confirmation of low-grade TCC developed progressive disease during follow-up.

Original languageEnglish (US)
Pages (from-to)1107-1110
Number of pages4
JournalBJU International
Volume102
Issue number9
DOIs
StatePublished - Nov 2008
Externally publishedYes

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Transitional Cell Carcinoma
Urinary Tract
Urinary Bladder
Recurrence
Neoplasms

Keywords

  • Carcinoma
  • Endoscopy
  • Transitional cell
  • Ureteric neoplasms
  • Ureteroscopy

ASJC Scopus subject areas

  • Urology

Cite this

Elective endoscopic management of transitional cell carcinoma first diagnosed in the upper urinary tract. / Thompson, R. Houston; Krambeck, Amy; Lohse, Christine M.; Elliott, Daniel S.; Patterson, David E.; Blute, Michael L.

In: BJU International, Vol. 102, No. 9, 11.2008, p. 1107-1110.

Research output: Contribution to journalArticle

Thompson, R. Houston ; Krambeck, Amy ; Lohse, Christine M. ; Elliott, Daniel S. ; Patterson, David E. ; Blute, Michael L. / Elective endoscopic management of transitional cell carcinoma first diagnosed in the upper urinary tract. In: BJU International. 2008 ; Vol. 102, No. 9. pp. 1107-1110.
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abstract = "OBJECTIVE: To report our experience using ureteroscopic or percutaneous management of upper urinary tract (UUT) transitional cell carcinoma (TCC) in patients with no history of bladder TCC. PATIENTS AND METHODS: Between 1983 and 2004 we identified 22 patients who underwent endoscopic management of TCC first diagnosed in the UUT and in the setting of a normal contralateral kidney. We performed a retrospective chart review and conducted outcome analyses. RESULTS: The median (range) age at diagnosis was 64 (37-86) years and the median tumour size was 0.8 (0.3-2.6) cm. The tumour grade was 1, 2, or diagnosed as visual low grade in two (9{\%}), seven (32{\%}), and 13 (59{\%}) patients, respectively; no patient had grade 3 TCC at diagnosis. Tumour stage was Ta or visual Ta in all patients. The median follow-up was 4.9 (0.4-17) years during which 11 (50{\%}) patients developed 21 UUT recurrences and 10 (45{\%}) patients developed bladder TCC. At last follow-up, seven (32{\%}) patients required a nephroureterectomy for recurrent TCC and two (9{\%}) patients died from TCC. Among 13 patients with a diagnosis based on visual inspection only, three recurred with grade 3 invasive TCC during follow-up. No patient with pathological confirmation of low-grade/stage TCC recurred with high-grade or invasive TCC. CONCLUSIONS: Recurrence is common after endoscopic management of UUT-TCC, underscoring the need for strict surveillance. Patients diagnosed visually, without adequate tissue for pathological examination, can recur with high-grade invasive TCC. No patient with pathological confirmation of low-grade TCC developed progressive disease during follow-up.",
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N2 - OBJECTIVE: To report our experience using ureteroscopic or percutaneous management of upper urinary tract (UUT) transitional cell carcinoma (TCC) in patients with no history of bladder TCC. PATIENTS AND METHODS: Between 1983 and 2004 we identified 22 patients who underwent endoscopic management of TCC first diagnosed in the UUT and in the setting of a normal contralateral kidney. We performed a retrospective chart review and conducted outcome analyses. RESULTS: The median (range) age at diagnosis was 64 (37-86) years and the median tumour size was 0.8 (0.3-2.6) cm. The tumour grade was 1, 2, or diagnosed as visual low grade in two (9%), seven (32%), and 13 (59%) patients, respectively; no patient had grade 3 TCC at diagnosis. Tumour stage was Ta or visual Ta in all patients. The median follow-up was 4.9 (0.4-17) years during which 11 (50%) patients developed 21 UUT recurrences and 10 (45%) patients developed bladder TCC. At last follow-up, seven (32%) patients required a nephroureterectomy for recurrent TCC and two (9%) patients died from TCC. Among 13 patients with a diagnosis based on visual inspection only, three recurred with grade 3 invasive TCC during follow-up. No patient with pathological confirmation of low-grade/stage TCC recurred with high-grade or invasive TCC. CONCLUSIONS: Recurrence is common after endoscopic management of UUT-TCC, underscoring the need for strict surveillance. Patients diagnosed visually, without adequate tissue for pathological examination, can recur with high-grade invasive TCC. No patient with pathological confirmation of low-grade TCC developed progressive disease during follow-up.

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