Percutaneous Management of Renal Pelvic Tumors: A Treatment Option in Selected Cases

Abstract

Nine patients with renal pelvic transitional cell carcinomas were selected for treatment with percutaneous resection because of a solitary kidney (3), bilateral synchronous disease (1), renal insufficiency (1), poor surgical risk (2) or preoperative evidence of a single, low grade, superficial tumor (2). Eight patients underwent second-look procedures 2 to 28 days postoperatively, at which time 6 received neodymium: YAG laser irradiation. Supplemental intracavitary therapy through the nephrostomy tube was given in 6 patients (mitomycin C in 1 and bacillus Calmette-Guerin in 5). Of those patients 2 had third-look procedures. Five patients remain free of recurrence with a followup of 3 to 28 months (mean 9.5 months). In the other 4 patients there was recurrent disease in the renal pelvis (3) or reappearance of positive cytology studies (1) 4 to 5 months postoperatively. Extrarenal tumor recurrence was not observed. Percutaneous surgery provided adequate information to assess tumor architecture, grade, invasiveness and multifocality, and the presence of contiguous mucosal abnormalities, which, along with positive cytology and a history of or concurrent tumors in other segments of the urinary tract, increased the likelihood of tumor recurrence. Second-look procedures appeared to be useful to assess the effectiveness of the initial procedure and to remove any residual disease. Our results suggest that percutaneous surgery can provide results similar to those of an open conservative operation, although further investigation is needed to determine the ultimate place of this technique.

Bacillus Calmette–Guérin Perfusion Therapy for the Treatment of Transitional Cell Carcinoma in situ of the Upper Urinary Tract

“…Because ureteroscopy usually needs epidural or lumbar anesthesia, it is not considered to be noninvasive. Moreover, even by ureteroscopy we cannot detect CIS lesion every time [15, 16, 17, 18, 19]. For these reasons, most of the reports adopt the criteria of upper urinary tract CIS as we have used in this study (see Patients and Methods).…”

Cáncer de pelvis renal: Cuadro clínico-patológico y sobrevida.

“…Sin embargo, la distribución según el sexo en nuestra serie (H:M. 1:1) fue diferente a la indicada en otros estudios en que la proporción oscila entre 1.7-4.2:1 (3,21,22).…”

Percutaneous Resection of Renal Transitional Carcinoma: Venous Injury and Its Conservative Management

“…Orihuella et al [1] and Smith et al [2] first described the technique but the initial experience with percutaneous management of upper tract transitional cell carcinoma was summarized by Gerber and Lyon [3] who reviewed an early experience from six different institutions. Initially this approach was advocated for patients with a solitary kidney in renal failure and for patients with low-volume and low-grade disease.…”

“…We have been using this technique since its advent and until now we have managed 26 upper urinary track tumours percutaneously [4]. The technique has certain limitations that include incomplete removal of tumour [1], biopsy not representing the exact stage and grade [2], retroperitoneal seeding [4] and a risk of track seeding [5], pyelolymphatic or pyelovenous flow [6] and aggressive resection may injure adjacent organs [7]. Despite these factors in the light of the age of this patient and associated comorbid factors a percutaneous resection was considered reasonable.…”