Early repeated ureteroscopy within 6–8 weeks after a primary endoscopic treatment in patients with upper tract urothelial cell carcinoma: preliminary findings

Villa, Luca; Cloutier, Jonathan; Letendre, Julien; Ploumidis, Achilles; Salonia, Andrea; Cornu, Jean Nicolas; Montorsi, Francesco; Traxer, Olivier

doi:10.1007/s00345-015-1753-7

Cited by 67 publications

(38 citation statements)

References 31 publications

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“…15 Addressing this issue, Villa and colleagues, in a novel study, examined the role of early repeat URS at 6 weeks and the association of tumor present at second look with outcomes. 16 They found that the presence of tumor 6 weeks later predicted poor subsequent recurrence-free rates. One wonders if this truly represents early recurrence, or instead an incomplete identification and resection of tumor at the initial endoscopy, and therefore incomplete treatment.…”

Section: Indications and Outcomes Endoscopic Managementmentioning

confidence: 99%

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

Knoedler

Raman

2018

Therapeutic Advances in Urology

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As a rare disease, the management of upper tract urothelial carcinoma (UTUC) continues to evolve. While radical nephroureterectomy remains the gold standard, there is a growing desire to pursue nephron-sparing approaches through endoscopic management, particularly for low-risk disease or in the setting of imperative indications. A particular challenge for those undertaking endoscopic management is appropriate grading and staging of tumors, and thereby appropriate patient selection. In this review we will cover the current state of diagnostics for UTUC as well as highlight the challenges in accurate diagnosis. Additionally, we will focus on emerging technologies to aid in optimizing diagnostic accuracy in UTUC. This will include discussion of narrow band imaging, photodynamic diagnosis, optical coherence tomography, and confocal laser endomicroscopy.

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Section: Indications and Outcomes Endoscopic Managementmentioning

confidence: 99%

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

Knoedler

Raman

2018

Therapeutic Advances in Urology

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“…In a retrospective study of 41 UTUC patients, Villa et al [14] evaluated the cancer detection rate of a second-look URS performed within 60 days of the first URS with laser ablation. The cancer detection rate at second-look URS was 51.2%, which emphasizes the necessity of a second look at 6–8 weeks and a stringent follow-up.…”

Section: Treatment Selectionmentioning

confidence: 99%

Consultation on UTUC, Stockholm 2018: aspects of treatment

et al. 2019

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PurposeTo provide an overview of treatment modalities for management of upper tract urothelial carcinoma (UTUC).MethodsIn accordance with the standards for a scoping review, data presentation and discussion at the Consultation on UTUC in Stockholm, 6–7 September 2018, consensus was reached on the latest and most important treatment recommendations for UTUC. Using Pubmed, Web of Science, and Embase, publications were selected based on quality, clinical relevance, and level of evidence.ResultsKidney-sparing surgery should be attempted for low-grade UTUC. Radical nephroureterectomy with bladder cuff excision is first option for high-grade disease. Post-operative bladder instillation of chemotherapy should be offered after RNU to reduce intravesical recurrence rate. Identification of tumor grade and stage is crucial when selecting treatment. Ureteroscopic management of low-grade and non-invasive UTUC achieves disease-free survival similar to that offered by radical nephroureterectomy but seems to be a risk factor for intravesical recurrence. Lymphadenectomy appears important for high-risk disease, although the therapeutic benefit needs further validation. There is little evidence supporting use of Bacillus Calmette–Guérin (BCG) and mitomycin C as monotherapy and adjuvant treatment in UTUC. A randomized clinical trial has indicated that platin-based chemotherapy for invasive UTUC improves disease-free survival, suggesting that adjuvant chemotherapy should be considered standard care for ≥ T2 N0–3M0 disease.ConclusionsRisk stratification assessment is feasible and mandatory in UTUC. Identification of tumor grade and stage is essential for optimal treatment selection. Kidney-sparing surgery should be offered in low-risk disease, whereas radical nephroureterectomy and adjuvant chemotherapy should be considered in high-risk disease.

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“…Nevertheless, biopsy grading may be used to improve tumor staging: 68–100% of grade 1 tumors on biopsies are non-muscle invasive tumors while 62–100% of grade 3 are ≥ pT2 tumors ( 20 ). Recently, the impact of cancer detection rate during early repeated flexible ureteroscopy (2nd-look-ureteroscopy within 60 days of the first ureteroscopy) has been recently reported in patients initially treated with endoscopic laser ablation ( 22 ). At a median follow-up of 27.6 months, massive tumour (defined as a tumour not completely removable with a kidney sparing approach) RFS rates were 88% and 48% in patients with negative and positive 2nd-look-ureteroscopy, respectively.…”

Section: Preoperative Predictive/prognostic Factors For Utucmentioning

confidence: 99%

Risk stratification for kidney sparing procedure in upper tract urothelial carcinoma

Khene¹,

Mathiéu²,

Kammerer‐Jacquet³

et al. 2016

Transl. Androl. Urol.

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Risk stratification for kidney sparing procedures (KSP) to treat upper tract urothelial carcinoma (UTUC) is a major issue. A non-systematic Medline/PubMed literature search was performed using the terms “upper tract urothelial carcinoma” with different combinations of keywords to review the current knowledge on this topic. Original articles, reviews and editorials in English language were selected based on their clinical relevance. Available techniques for KSP include segmental ureterectomy and endoscopic resection through a percutaneous or flexible ureteroscopic access. These approaches were traditionally restricted to patients with imperative indications. Current recommendations suggest that selected patients with normal contralateral kidney should also be candidates for such treatments. Modern imaging and endoscopy have improved to accurately stage and grade the tumor while various prognostic clinical factors and biomarkers have been proposed to identify tumor with aggressive features and worse outcomes. Several predictive models using different combinations of such baseline characteristics may help clinicians in clinical decision making. However, risk-adapted based approach that has been proposed in recent guidelines to identify patients who are more likely to benefit from KSP only relies on few clinical and pathological factors. Despite growing understanding of the disease, treatment of UTUC remains challenging. Further efforts and collaborative multicenter studies are mandatory to improve risk stratification to decide and promote optimal KSP in UTUC. These efforts should focus on the integration of promising biomarkers and predictive tools in clinical decision making.

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Early repeated ureteroscopy within 6–8 weeks after a primary endoscopic treatment in patients with upper tract urothelial cell carcinoma: preliminary findings

Abstract: 2nd-look-URS-related CDR in conservatively treated UTUC patients was 51.2 %. 2nd-look-URS outcomes affected the findings of both subsequent endoscopic evaluation and mRFS. Further studies are needed to confirm the benefits of this approach in terms of patient outcomes.

Cited by 67 publications

References 31 publications

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

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

Consultation on UTUC, Stockholm 2018: aspects of treatment

Risk stratification for kidney sparing procedure in upper tract urothelial carcinoma

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