Transitional-Cell Carcinoma of the Renal Pelvis: Ureteroscopic and Percutaneous Approach

Abstract

There are a variety of publications advocating the ureteroscopic or the percutaneous approach for the treatment of transitional cell carcinoma of the renal pelvis. The diagnostic tool of choice for the upper urinary tract and collecting system is the flexible ureteroscope. One of the major concerns about ureteroscopic management of renal disease initially was the lack of flexibility of the instruments and therefore the inability to deal with demanding sites. The advent of new ureteroscopic techniques, as well as the continuous evolution of the technology, have paved the way for safe and effective access to the upper urinary tract. In the hands of an experienced urologist, such procedures can provide reliable treatment options for small upper urinary tract lesions. Coupling minimal morbidity with ever-improving optics and flexibility, the ureteroscope of today leaves no area of the urinary tract unseen. In patients with bulky tumors or in whom easy access and resection is not possible ureteroscopically, the percutaneous approach to the renal pelvis, although more invasive, provides a better working environment. Clearly, the most difficult aspect of ureteroscopic access to the lower pole is not just visibility but the loss of deflection caused by passage of various instruments through the working channel. Direct access via percutaneous approach with a large resectoscope avoids these problems.

Minimally Invasive Management of Upper Tract Malignancies: Renal Cell and Transitional Cell Carcinoma

“…Often, repeated and frequent endoscopic surveillance is appropriate in this population. Endoscopic therapy offers the advantages of minimally invasive surgery, and in highly selected patients, it may provide results equivalent to radical extirpative surgery [60,61].…”

The Application of Endoscopic Techniques in the Management of Upper Tract Recurrence After Cystectomy and Urinary Diversion

“…21,[47][48][49] In review of several large series, recurrence rates for grade 1 (5-20%) 24,47-50 and grade 2 disease (6-33%) 24,47-51 have been reported as significantly lower than recurrence rates for grade 3 disease (31-60%). 24,[47][48][49] In a large series of 62 patients with low-grade disease undergoing percutaneous resection followed by immediate Mitomycin C therapy and adjuvant Bacillus Calmette-Guérin (BCG) therapy, Montanari et al 52 observed no upper tract recurrences and only one bladder recurrence with a mean follow-up of 71 months. Jabbour et al 51 reviewed their experience in 24 patients with grade 2 disease and observed a 25% tumor recurrence rate with only one patient progressing to invasive disease with a mean follow-up of 48 months.…”

“…55 The incidence of blood loss varies among investigators and depends greatly on the size and extent of the treated lesion as well as ease of access, but transfusion rates up to 37% have been reported. 49 …”

Descriptive analysis of a series of 32 upper urinary tract tumors in a second level hospital

“…La ablación endoscópica puede ser considerada en casos altamente seleccionados, como sería tumores unifocales, menores de 1-1.5 cm, de bajo grado y sin evidencia de lesión infiltrante en la urografía por tomografía computerizada multidetector, sin embargo, existe el riesgo de infraestadiaje de la enfermedad con este tipo de tratamiento (1,3). Es preferible el uso de ureteroscopio flexible frente al rígido, quedando el acceso percutáneo como una opción para los tumores localizados a nivel calicial a los cuales no se puede acceder mediante ureterorrenoscopia (21,22).…”