Treatment of urothelial tumors of the upper urinary tract by nephroureterectomy, renal autotransplantation, and pyelocystostomy

Abstract

Nephroureterectomy, renal autotransplantation, and pyelocystostomy have been performed in eight patients with urothelial tumors of the upper urinary tract. One patient had tumors in a solitary kidney, two patients had bilateral tumors, and five patients had unilateral tumors. Three patients have had recurrent calyceal tumors which were successively managed by the transurethral route. In one patient the kidney had to be removed after 4.5 years because of infiltrating tumor recurrence. Two patients died; the renal pelvis of the graft was tumor free at autopsy in both cases. The other five patients are alive and free from tumor recurrence. The procedure implies increased radicality compared with conventional conservative treatment and simplified follow‐up. It may be considered in patients with bilateral tumors or tumors of a solarity kidney, and in selected patients with unilateral low‐grade, low‐stage tumors.

Kidney Auto Transplantation: A Long Forgotten Technique?

“…But these indications are also seen controversially from an oncological point of view and the indication should be rigorously evaluated [3,12].…”

“…Since this time, cases and studies which report good long term results with a selected group of patients have been published regularly. These patients usually suffer from long ureteral lesions, metabolic stone disorders, complex vascular and Reno vascular disorders and diverse malignoma [2][3][4][5][6]12,14,26,27]. In the care of experienced transplantation surgeons, kidney auto transplantation is a safe and efficient procedure to treat the above mentioned disorders.…”

“…In this field, kidney auto transplantation has a fixed standing. In regards to renal tumor surgery, or also tumor surgery of the renal pelvis and the upper and middle third of the ureter, there are good results [3,[12][13][14], but the indication is to be carefully regarded with these indications and must be rated as the ultima ratio to retain the kidney's function.…”

“…In publications, there are repeated reports of good long-term results after auto transplantation regarding the kidney's function and the interval without tumors with patients with bilateral kidney carcinoma or a kidney cell carcinoma in individual kidneys [3,[12][13][14]. The largest publication in this scope is by Mickisch [14].…”

“…This counts both for extrinsic lesions, such as with Mb. Ormond, or retroperitoneal tumors [22][23][24], as well as for intrinsic lesions, such as with urothel carcinoma, or long ureteral stenosis [1,12,[25][26][27][28][29]. This means that kidney auto transplantation is, besides the Ileuminterponate, a potent solution for restructuring after complex ureteral injuries with individual kidneys, or limited kidney function combined with a significant loss of the upper and middle third of the ureter [26,30,31].…”