Primary Carcinoma of the Ureter: A Report of 102 New Cases

Bloom, Norman A.; Vidone, Romeo A.; Lytton, Bernard

doi:10.1016/s0022-5347(17)62008-1

Cited by 174 publications

(39 citation statements)

References 13 publications

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“…In comparison with the bladder, the anatomical char acteristics of the ureter and renal pelvis are a thin wall and abundant lymphatic drainage system [1], Even if no sig nificant difference in malignant potential between urcteropelvic and bladder TCCs is evident, ureteropelvic TCC is more likely to invade and metastasize, as compared with bladder TCC, owing to the characteristic anatomical feature of the ureter and renal pelvis described above. Thus, our results document that the elevated C-AgNOR as well as P-AgNOR in invasive ureteropelvic TCC might be attributed to the secondary effect rather than causa tion.…”

Section: Discussionmentioning

confidence: 98%

“…The reason for the unfavor able clinical outcome in ureteropelvic TCC has been implied by the difficulty of early diagnosis and the early occurrence of invasion and/or metastasis owing to its thin wall and enormous lymphatic drainage around the ureter and renal pelvis [1], However, it is possible that there is a difference between ureteropelvic and bladder TCCs in the malignant potential of individual tumor cells, but this remains to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Ureteropelvic Transitional Cell Carcinoma with Bladder Transitional Cell Carcinoma Using an Image Analyzer

Shiina

Igawa²,

Urakami³

et al. 1996

Urol Int

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To elucidate whether a significant difference in malignant potential between ureteropelvic transitional cell carcinoma (TCC) and bladder TCC is present, the argyrophilic nucleolar organizer region (AgNOR), nuclear DNA content and mean nuclear area (MNA) were evaluated in 32 ureteropelvic TCCs and 60 bladder TCCs, and were also compared with histological grade and stage. The parameters used were the mean AgNOR count (C-AgNOR), the percentage of cells exhibiting more than 3 AgNOR dots within nuclei (P-AgNOR), 2c deviation index (2cDI), 5c exceeding rate (5cER) and MNA. No significant difference in these 5 parameters was found between ureteropelvic and bladder TCCs. In addition, within each histological grade of tumor, no significant difference in each parameter between ureteropelvic and bladder TCCs was noted. Similarly, within pTa or pT1 TCCs, there was no significant difference in the parameters between ureteropelvic and bladder TCCs. On the other hand, invasive TCCs (pT2 and higher), the C-AgNOR and P-AgNOR were significantly higher in ureteropelvic than in bladder TCC (p < 0.05), while no significant difference in 2cDI, 5cER and MNA was noted. These findings suggest that: (i) as a whole, the difference in malignant potential between ureteropelvic and bladder TCCs appears to be less significant, and (ii) factors other than the malignant potential of a tumor might contribute to the unfavorable clinical outcome in patients with ureteropelvic TCC.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Comparison of Ureteropelvic Transitional Cell Carcinoma with Bladder Transitional Cell Carcinoma Using an Image Analyzer

Shiina

Igawa²,

Urakami³

et al. 1996

Urol Int

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“…This has been ascribed to the thinness of ureteral wall and its rich lymphatic drainage that allows early local invasion and metastasis. The delay between the onset of symptoms and treatment due to procrastination by the patient and also due to the difficulties in diagnosis because of inconclusive investigations has also been implicated [3].…”

Section: Discussionmentioning

confidence: 99%

Primary Squamous Carcinomatous Ureteric Stricture of a Solitary Kidney with Spontaneous Intraperitoneal Urinary Extravasation

Pandey¹,

Kumar²,

Dorairajan³

et al. 2003

Urol Int

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We report a very rare case of a carcinoma of the ureter occurring in association with contralateral renal agenesis. Owing to this association, the patient had a unique presentation with urinary ascites and anuria. He was initially managed by retrograde ureteral stenting and supportive measures for renal failure. Thereafter, once the renal parameters became normal, distal ureterectomy and Boari flap reconstruction were performed. Although most patients with ureteral tumours present with advanced disease, the disease was localized in our patient, as the absence of the contralateral kidney resulted in an early presentation.

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“…5 The importance of appropriate distal ureter management is demonstrated in classic series where the bladder cuff and distal ureter were not removed during radical nephroureterectomy, resulting in recurrence rates of 33% to 75% in the ureteric remnant. [7][8][9][10][11][12] This likely occurs due to either antegrade seeding of the ureteric stump or panurothelial susceptibility within the entire upper urinary tract. 13 These high recurrence rates in the distal ureteric stump mirror the rates of metachronous intravesical recurrence after UTUC-presumably by similar mechanisms.…”

Section: E845mentioning

confidence: 99%

The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

Kapoor

Dason

Allard

et al. 2014

CUAJ

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Introduction: Radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) must include some form of distal ureter management to avoid high rates of tumour recurrence. It is uncertain which distal ureter management technique has the best oncologic outcomes. To determine which distal ureter management technique resulted in the lowest tumour recurrence rate, we analyzed a multiinstitutional Canadian radical nephroureterectomy database. Methods: We retrospectively analyzed patients who underwent radical nephroureterectomy with distal ureter management for UTUC between January 1990 and June 2010 at 10 Canadian tertiary hospitals. Distal ureter management approaches were divided into 3 categories: (1) extravesical tenting for ureteric excision without cystotomy (EXTRAVESICAL); (2) open cystotomy with intravesical bladder cuff excision (INTRAVESICAL); and (3) extravesical excision with endoscopic management of ureteric orifice (ENDOSCOPIC). Data available for each patient included demographic details, distal ureter management approach, pathology and operative details, as well as the presence and location of local or distant recurrence. Clinical outcomes included overall recurrence-free survival and intravesical recurrence-free survival. Survival analysis was performed with the Kaplan-Meier method. Multivariable Cox regression analysis was also performed. Results: A total of 820 patients underwent radical nephroureterectomy with a specified distal ureter management approach at 10 Canadian academic institutions. The mean patient age was 69.6 years and the median follow-up was 24.6 months. Of the 820 patients, 406 (49.5%) underwent INTRAVESICAL, 316 (38.5%) underwent EXTRAVESICAL, and 98 (11.9%) underwent ENDOSOPIC distal ureter management. Groups differed significantly in their proportion of females, proportion of laparoscopic cases, presence of carcinoma in situ and pathological tumour stage (p < 0.05). Recurrence-free survival at 5 years was 46.3%, 35.6%, and 30.1% for INTRAVESICAL, EXTRAVESICAL and ENDOSCOPIC, respectively (p < 0.05). Multivariable Cox regression analysis confirmed that INTRAVESICAL resulted in a lower hazard of recurrence compared to EXTRAVESICAL and ENDOSCOPIC. When looking only at intravesical recurrence-free survival (iRFS), a similar trend held up with INTRAVESICAL having the highest iRFS, followed by ENDOSCOPIC and then EXTRAVESICAL management (p < 0.05). At last follow-up, 406 (49.5%) patients were alive and free of disease. Conclusion: Open intravesical excision of the distal ureter (INTRAVESICAL) during radical nephroureterectomy was associated with improved overall and intravesical recurrence-free survival compared with extravesical and endoscopic approaches. These findings suggest that INTRAVESICAL should be considered the gold standard oncologic approach to distal ureter management during radical nephroureterectomy. Limitations of this study include its retrospective design, heterogeneous cohort, and limited follow-up.

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Primary Carcinoma of the Ureter: A Report of 102 New Cases

Cited by 174 publications

References 13 publications

Comparison of Ureteropelvic Transitional Cell Carcinoma with Bladder Transitional Cell Carcinoma Using an Image Analyzer

Comparison of Ureteropelvic Transitional Cell Carcinoma with Bladder Transitional Cell Carcinoma Using an Image Analyzer

Primary Squamous Carcinomatous Ureteric Stricture of a Solitary Kidney with Spontaneous Intraperitoneal Urinary Extravasation

The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

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