Transitional Cell Carcinoma of the Ureteric Stump: A Systematic Review of the Literature

Abstract

Objective: To present a review of the literature using evidence-based criteria for diagnosis and treatment of malignant growths in the ureteric remnant following nephrectomy for non-malignant disease. Methods: A database search using the key search words was performed, producing a total of 16 articles published between 1952 and 2009. The Oxford Centre for Evidence-Based Medicine classification was used. Statistical significance was tested by Pearson correlation. Demographic data, reason for nephrectomy, symptoms, time to diagnosis since initial nephrectomy, imaging modality and treatment option chosen, as well as histology and overall survival were reviewed. Results: Analysis was possible for 33 out of 63 cases reported in the literature. There was a male predominance (82%). Visible, painless haematuria was the presenting symptom in 72% of cases. Open ureterectomy was performed in the majority of patients (85%), while none had laparoscopic surgery. Transitional cell carcinoma was found in 66% of cases. Mean follow-up was 2.7 years. Metastases were detected in 36% and correlated significantly with cancer-specific mortality (95% CI: p < 0.001). Tumour stage, grade and cell type did not correlate significantly with mortality. Conclusion: Gross, painless haematuria is a feature highly suggestive of neoplastic change. Diagnosis often involves multimodality imaging and endoscopy. Complete ureterectomy with removal of bladder cuff, previously resected endoscopically, is the treatment of choice. Metastases at diagnosis and follow-up carry a worse prognosis.

Three rare etiologies of urinary retention in pediatrics: A case series and review of the literature

“…Nevertheless, the remaining ureteral stump in partial ureterectomy can cause complications. The most common complications related to the ureteral stump are UTI, empyema with or without calculi, pain, hematuria, malignant transformation, and fungal peritonitis 6,7,63–68 …”

“…The most common complications related to the ureteral stump are UTI, empyema with or without calculi, pain, hematuria, malignant transformation, and fungal peritonitis. 6,7,[63][64][65][66][67][68] Different approaches for the management of symptomatic ureteral stumps have been introduced. While open and laparoscopic surgeries for stump removal are widely practiced, 6,64,65,69 some authors have also reported less invasive approaches.…”

“…6,7,[63][64][65][66][67][68] Different approaches for the management of symptomatic ureteral stumps have been introduced. While open and laparoscopic surgeries for stump removal are widely practiced, 6,64,65,69 some authors have also reported less invasive approaches. Endoscopic sub-ureteric injection of bulking agents, percutaneous irrigation and drainage with ureteral orifice closure, transurethral fulguration and a combination of endoscopic mucosal fulguration and bulking agent injection are the less invasive options.…”

Delayed Ureterectomy after Incomplete Nephroureterectomy for Upper Tract Urothelial Carcinoma: Pathologic Findings and Outcomes

“…Multiple techniques are described for the minimally invasive excision of the distal ureter and a bladder cuff (2-6). Unfortunately, many techniques ligate the ureter extravesically and several centimeters of intravesical ureter may remain, which may develop into malignancy (18). A study by Matin and Gill (19) demonstrated the higher positive surgical margin rate, reduced bladder cancer recurrence free survival, and reduced overall survival when using extravesical laparoscopic stapling.…”