Does Flexible Ureteropyeloscopy Promote Local Recurrence of Transitional Cell Carcinoma?

Abstract

Ureteropyeloscopy has gained increasing acceptance as an initial method of diagnosis, treatment, and surveillance of upper tract hematuria and radiographically demonstrated filling defects. With its more frequent use, concern for the possibility of migration of malignant cells during endoscopy secondary to increased intrarenal pressure must be addressed. We report on 13 patients, all of whom underwent ureteropyeloscopy with biopsy and treatment one to four times prior to nephroureterectomy for transitional cell carcinoma of the renal pelvis. Only one patients had vascular/lymphatic extension, and because of the tumor growth characteristics, extension was suspected prior to endoscopy. This patient had no free cells or clumps noted. There have been no local recurrences in the follow-up of 3 months to 6 years. We believe uretero pyeloscopy to be safe and effective for endoscopic diagnosis and treatment of upper tract neoplasm.

Can We Improve the Biopsy Quality of Upper Urinary Tract Urothelial Tumors? Single-Center Preliminary Results of a New Biopsy Forceps

“…These tumors can present a significant diagnostic and treatment challenge to urologists. However, the role of renal preservation surgery has been clearly established, particularly in patients with renal insufficiency, bilateral lesions and solitary kidney or those with low-grade lesions that are amenable to endoscopic treatment [4,5]. The development of sophisticated endourologic techniques for the treatment of benign urologic disease has translated to the treatment of malignant neoplasms, with the use of ureteroscopy and laser ablation becoming commonplace in urologic practice.…”

“…The development of sophisticated endourologic techniques for the treatment of benign urologic disease has translated to the treatment of malignant neoplasms, with the use of ureteroscopy and laser ablation becoming commonplace in urologic practice. Further, the cancer control efficacy of this management approach has been established [5,6]. Cytopathological analysis of upper tract barbotage specimens or brush biopsies has poor sensitivity in cases of low-grade TCC [7,8].…”

Nephroureterectomy for Transitional Cell Carcinoma – The Value of Pre-Operative Histology

“…22 There has been no demonstrable added risk of local recurrence due to tumour seeding attributable to this procedure. 23 There has, however, been a report of a single case of pyelovenous/lymphatic migration of renal TCC following flexible URS 24 and a case report of renal pelvic explosion during ureteroscopic fulguration of upper tract TCC. 25 Diagnostic ureterorenoscopy has no clinically apparent adverse effect on long-term or disease-specific survival of these patients with upper tract TCC.…”

Diagnostics clinique, urétéroscopique et photodynamique des tumeurs de la voie excrétrice urinaire supérieures : état-de-l’art pour le rapport scientifique annuel de l’Association française d’urologie

“…On recense notamment : perforations, stripping, sténoses de l'uretère ou infections parenchymateuses. L'hypothèse d'un possible essaimage tumoral induit par l'hyperpression dans les cavités rénales au décours de l'urétéroscopie n'a finalement jamais été confirmée [27]. L'impact sur la récidive vésicale par contact avec le liquide d'irrigation reste débattu [28][29][30].…”