Complications Associated With Ureteroscopic Management of Upper Tract Urothelial Carcinoma

Linehan, Jennifer; Schoenberg, Mark; Seltzer, Elyse; Thacker, Kim; Smith, Angela

doi:10.1016/j.urology.2020.09.036

Cited by 18 publications

(22 citation statements)

References 49 publications

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“…Ureteral obstruction can be caused by extrinsic or intrinsic factors, such as a retroperitoneal tumor, ureteral endometriosis, ureteral polyps, or ureteral carcinoma (2,(13)(14)(15). Although rare, multiple ureteral polyps are the most common intrinsic causes of ureteral obstruction.…”

Section: Discussionmentioning

confidence: 99%

Transabdominal Laparoscopic Ureteroureterostomy With the Intraoperative Retrograde Ureteroscopy-Assisted Technique for Multiple Ureteral Polyps: A Single-Center 10 Years Experiences

Xia

Chen

et al. 2022

Front. Surg.

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BackgroundThe purpose of this study was to report our experience in treating multiple ureteral polyps with transabdominal laparoscopic ureteroureterostomy (LAP-UU) with intraoperative retrograde ureteroscopy (RU)-assisted technique.MethodsThe data of 32 patients who underwent transabdominal LAP-UU with the intraoperative RU-assisted technique due to multiple ureteral polyps between January 2011 and March 2021 were reviewed at our institute. After administration of anesthesia, patients were placed in a passive position and underwent a three-port transabdominal laparoscopy with RU. Detailed data were reviewed, such as demographic characteristics, intraoperative outcomes, postoperative data, complications, and pathology reports.ResultsThirty-two patients were diagnosed with multiple ureteral polyps underwent this surgery method at our institution. The mean duration of symptoms at the time of diagnosis was approximately 7.1 months. The mean age of patients was 42.4 years, with men accounting for 68.8% (22/32), lesion of left for 56.3% (18/32), and the upper ureter for 62.5% (20/32). Furthermore, the median length of the polyps was 3.6 cm, the mean operative time was 174.6 min, and the estimated blood loss (EBL) was about 86.8 ml. The mean time to begin a liquid diet and to be out of bed were 1.7 and 2.3 days, respectively. The average length of hospital stay was 6.3 days. The ureteral stent was removed by cystoscope 2–3 months after surgery. Follow-up duration ranged from 3 to 112 months and none of the patients required another surgery for recurrence.ConclusionTransabdominal LAP-UU combined with the intraoperative RU-assisted technique is an effective, safe, and reliable surgical option for patients with multiple ureteral polyps. Further long-term follow-up is recommended.

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Section: Discussionmentioning

confidence: 99%

Transabdominal Laparoscopic Ureteroureterostomy With the Intraoperative Retrograde Ureteroscopy-Assisted Technique for Multiple Ureteral Polyps: A Single-Center 10 Years Experiences

Xia

Chen

et al. 2022

Front. Surg.

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“…При удалении опухолей мочеточника важен вопрос о сохранности просвета мочеточника в дальнейшем. После использования гольмиевого лазера частота фор мирования стриктур мочеточника варьирует в пределах от 7 до 15 %, что снижает результаты лечения [8]. Для профилактики формирования стриктур мочеточника авторы предлагают минимизировать термическое воз действие на стенку мочеточника, для чего рекоменду ется не использовать энергию более 10 Вт [2].…”

Section: Discussionunclassified

Upper tract urothelial carcinoma: can the tumor be removed en bloc?

2022

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Diagnosis and treatment of upper tract urothelial carcinoma (UTUC) remain important problems of clinical urology. UTUC en bloc i.e. in one-piece removal during organ-sparing surgery is still hardly possible. The most typical endourological operations are either electrosurgery, holmium or thulium YAG laser tumor vaporization.We present a clinical case of ureteroscopic en bloc UTUC removal using a new super pulse thulium fiber laser (SPTFL, FiberLase U3). Recent innovations and trends in this field are also discussed. The technical steps of en bloc ureteroscopic tumor removal allowing for diagnosis verification, identification of pT stage and surgical margin are described. The further innovations in laser UTUC removal include modulation of laser pulse length and development of the correlation between preoperative tumor characteristics and possibility of en bloc removal.

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“…Adverse events included fatigue (27%), flank pain (19%), UTI (12%), sepsis (8%) and haematuria (8%). Ureteric stenosis occurred in three patients (9%) at a median (IQR) 17 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) weeks after the last dose of therapy. None of these patients had a history of UTUC or prior ureteroscopies before the index diagnostic endoscopy.…”

Section: Safety Analysismentioning

confidence: 99%

Antegrade administration of mitomycin gel for upper tract urothelial carcinoma via percutaneous nephrostomy tube: a multi‐institutional retrospective cohort study

et al. 2022

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To assess the safety profile of antegrade mitomycin gel instillation through a percutaneous nephrostomy tube (PCNT) for upper tract urothelial carcinoma (UTUC) with the aim of decreasing morbidity associated with therapy. Patients and MethodsPatients undergoing antegrade administration of mitomycin gel via PCNT were retrospectively included for analysis from four tertiary referral centres between 2020 and 2022. The primary outcome was safety profile, as graded by Common Terminology Criteria for Adverse Events (v5.0). Post-therapy disease burden was assessed by primary disease evaluation (PDE) via ureteroscopy. ResultsThirty-two patients received at least one dose of mitomycin gel via PCNT for UTUC, 29 of whom completed induction and underwent PDE. Thirteen patients (41%) had residual tumour present prior to induction therapy. At a median of 15.0 months following first dose of induction therapy, ureteric stenosis occurred in three patients (9%), all of whom were treated without later recurrence or chronic stenosis. Other adverse events included fatigue (27%), flank pain (19%), urinary tract infection (12%), sepsis (8%) and haematuria (8%). No patients had impaired renal function during follow-up and there were no treatment-related deaths. Seventeen patients (59%) had no evidence of disease at PDE and have not experienced recurrence at a median follow-up of 13.0 months post induction. ConclusionsAdministration of mitomycin gel via a PCNT offers a low rate of ureteric stenosis, demonstrates a favourable safety profile, and is administered without general anaesthesia.

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Complications Associated With Ureteroscopic Management of Upper Tract Urothelial Carcinoma

Cited by 18 publications

References 49 publications

Transabdominal Laparoscopic Ureteroureterostomy With the Intraoperative Retrograde Ureteroscopy-Assisted Technique for Multiple Ureteral Polyps: A Single-Center 10 Years Experiences

Transabdominal Laparoscopic Ureteroureterostomy With the Intraoperative Retrograde Ureteroscopy-Assisted Technique for Multiple Ureteral Polyps: A Single-Center 10 Years Experiences

Upper tract urothelial carcinoma: can the tumor be removed en bloc?

Antegrade administration of mitomycin gel for upper tract urothelial carcinoma via percutaneous nephrostomy tube: a multi‐institutional retrospective cohort study

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