Advances in the management of upper tract urothelial carcinoma: improved endoscopic management through better diagnostics

Knoedler, John J.; Raman, Jay D.

doi:10.1177/1756287218805334

Cited by 11 publications

(6 citation statements)

References 55 publications

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“…In addition, the excision of the bladder cuff is important in UTUC surgery. (24) Even though the meta-analysis findings reveal inconsistent outcomes for endoscopic distal ureter excision, it demonstrates that the extravesical method is a predictor of IVR. (8) In our patients, we performed an open bladder cuff excision with Gibson incision with an extravesical technique in distal ureter treatment management.…”

Section: Discussionmentioning

confidence: 95%

Risk factors for intravesical recurrence after radical nephrourethrectomy in upper urinary tract urothelial tumors: retrospective single-center study

Kargı

Ekşi

2022

New J Urol.

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Objective: We examined factors predicting metachronous recurrence of bladder cancer in our series of patients who underwent radical nephroureterectomy (RNU) for upper system urothelial carcinoma (UTUC). Material and Methods: Patients with UTUC-induced RNU in our center from September 2009 to March 2020 were included in the study. Patients were classified as having and not having an intravesical recurrence (IVR), and the factors predicting recurrence were evaluated. Results: A total of 50 patients were included in the study. IVR was developed in 19 (38%) of 50 patients, with a mean follow-up of 39.5 ± 25.3 months. There was no significant difference between the two groups in demographic characteristics, admission hemoglobin, glomerular filtration rate, and degree of hydronephrosis in preoperative ureterorenoscopy and cytology positivity history (p>0.05). The IVR (+) group had significantly more previous history of bladder cancer (35.5% vs. 52.6%, p=0.019, respectively). While the number of patients with ureteral tumors was 10 (32.3%) in the IVR (-) group, it was 9 (47.4%) in the IVR (+) group, and it was significantly higher. There are 28 (56%) patients with T2-T4 pathology in the entire patient group, and the rate is significantly greater in the IVR (+) group (63.2% vs. 51.6%, p=0.038, respectively). Conclusion: Caution should be exercised for metachronous bladder cancer recurrence in patients with a previous history of bladder cancer, especially in ureteral and high pathological T-stage UTUCs. Keywords: upper urinary tract urothelial carcinoma, intravesical recurrence, risk factor, nephroureterectomy

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Section: Discussionmentioning

confidence: 95%

Risk factors for intravesical recurrence after radical nephrourethrectomy in upper urinary tract urothelial tumors: retrospective single-center study

Kargı

Ekşi

2022

New J Urol.

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“…2,3 To address the high rate of ipsilateral recurrence, adjuvant topical therapies have been investigated after endoscopic tumor ablation including bacillus Calmette-Guérin (BCG) and mitomycin C using a variety of delivery methods. 4 To date, the literature investigating the utility of adjuvant topical therapies has been limited to single-center experiences with small sample sizes. The most studied adjuvant therapy is BCG.…”

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confidence: 99%

Efficacy and Safety of Mitomycin Gel (UGN-101) as an Adjuvant Therapy After Complete Endoscopic Management of Upper Tract Urothelial Carcinoma

et al. 2023

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Purpose:We describe a novel application of the reverse thermal polymer gel of mitomycin C (UGN-101) as adjuvant therapy after complete endoscopic ablation of upper tract urothelial carcinoma.Materials and Methods:We retrospectively reviewed patients treated with UGN-101 from 15 high-volume centers. Adjuvant therapy was defined as treatment administered following visually complete endoscopic ablation. Response at primary endoscopic evaluation was defined as no visual tumor or negative biopsy. Ipsilateral disease-free and progression-free survival were estimated by the Kaplan-Meier method. Ureteral stenosis and other adverse events were abstracted from the medical records. Ureteral stenosis was defined as a condition requiring ureteral stent or nephrostomy, or that would typically warrant stent or nephrostomy.Results:Adjuvant UGN-101 after complete endoscopic ablation was used in 52 of 115 (45%) renal units in the oncologic analysis. At first endoscopic evaluation, 36/52 (69%) were without visible disease. At 6.8 months’ median follow-up, the ipsilateral disease-free rate was 63%. Recurrence after adjuvant UGN-101 therapy was more likely in multifocal tumors compared to unifocal (HR 3.3, 95% CI 1.07-9.91). Compared with UGN-101 treatment for chemoablation of measurable disease, there were significantly fewer disease detections with adjuvant therapy (P < .001). Ureteral stenosis after UGN-101 was diagnosed in 10 patients (19%) undergoing adjuvant therapy compared to 17 (29%) undergoing chemoablative therapy (P = .28).Conclusions:In patients being considered for UGN-101, maximal endoscopic ablation prior to UGN-101 treatment may result in fewer patients with disease at first endoscopy and possibly fewer adverse events than primary chemoablative therapy. Longer follow-up is needed to determine if UGN-101 after complete endoscopic ablation will lead to durable disease-free interval.

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“…There are several diagnostic tools for UTUC, and narrow-band imaging (NBI) and PDD may be possible during URS [21] . However, when considering the mechanism of NBI in terms of the specific light absorption of hemoglobin and the mucosa, this method cannot be used for ablated or ischemic tumor tissues.…”

Section: Discussionmentioning

confidence: 99%

Photodynamic Diagnosis–guided Dual Laser Ablation for Upper Urinary Tract Carcinoma: Preoperative Preparation, Surgical Technique, and Clinical Outcomes

Yoshida

Mizutani

Matsuzaki

et al. 2021

European Urology Open Science

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Background Although ureteroscopic surgery (URS) is beneficial for low-risk upper urinary tract carcinoma (UTUC), there is no standardized URS technique or navigation system for challenging cases. Objective To present a URS technique for UTUC using thulium (Tm):YAG and holmium (Ho):YAG lasers under photodynamic diagnosis (PDD) guidance, named PDD-guided dual laser ablation (PDD-DLA) and compare its efficacy with that of conventional Ho:YAG laser ablation (HLA; historical control). Design, setting, and participants The study included ten consecutive UTUC patients who underwent PDD-DLA between 2017 and 2019. The control group comprised 16 consecutive patients who underwent HLA between 2006 and 2016. Surgical procedure After oral administration of 5-aminolevulinic acid (20 mg/kg), UTUC tumors were endoscopically resected via PDD-DLA. Measurements Clinical data were prospectively collected for our institutional UTUC data set. Disease progression, UTUC recurrence, and clinical outcomes were assessed. Results and limitations PDD-DLA was successfully performed in all patients. The median tumor size was 23.5 mm (interquartile range [IQR] 12.8–30.0) and there were four cases (40.0%) of high-grade tumor. The median operative time was 120 min (IQR 98.5–142.5). No Clavien-Dindo grade ≥3 complications were observed. There were no differences in most clinical characteristics between the PDD-DLA and HLA groups. The 2-yr progression-free survival rate was 100% in the PDD-DLA group and 58.7% in the HLA group ( p = 0.0197), and the 2-yr recurrence-free survival rate was 57.1% and 41.3%, respectively ( p = 0.072). The PDD-DLA group had a lower incidence rate of salvage RNU compared with the HLA group (0.0% vs 50%; p = 0.009). The small sample size might affect the reproducibility of these results. Conclusions PDD-DLA seems to be an effective and feasible endoscopic technique for UTUC treatment with favorable oncological outcomes. Patient summary We investigated a new laser technique for treating cancer of the upper urinary tract called photodynamic diagnosis–guided dual laser ablation. Our strategy was effective in removing tumors and stopping bleeding. Further studies in larger groups of patients are needed to confirm whether this technique improves cancer outcomes.

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Advances in the management of upper tract urothelial carcinoma: improved endoscopic management through better diagnostics

Cited by 11 publications

References 55 publications

Risk factors for intravesical recurrence after radical nephrourethrectomy in upper urinary tract urothelial tumors: retrospective single-center study

Risk factors for intravesical recurrence after radical nephrourethrectomy in upper urinary tract urothelial tumors: retrospective single-center study

Efficacy and Safety of Mitomycin Gel (UGN-101) as an Adjuvant Therapy After Complete Endoscopic Management of Upper Tract Urothelial Carcinoma

Photodynamic Diagnosis–guided Dual Laser Ablation for Upper Urinary Tract Carcinoma: Preoperative Preparation, Surgical Technique, and Clinical Outcomes

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