Primary tumors of the ureter

Urothelial tumours of the upper urinary tract

We present a retrospective 10 year analysis of 76 patients with urothelial tumours of the upper urinary tract. Patients older than 65 years, and female patients, presented with more advanced stages and had a worse prognosis. The grade and stage of the tumour has the greatest impact on survival. No conclusions can be drawn on the efficacy of various types of surgery, but simple nephrectomy gave a 5-year survival of 68%, with a stump recurrence rate of 15%. We observed that patients with urothelial tumours had 4 fold increased chance of developing gastrointestinal cancer.

Carcinoma of the renal pelvis and ureter following bladder carcinoma: frequency, risk factors and clinicopathological findings

We followed 657 primary bladder carcinoma patients for at least 10 years or until death. Subsequent carcinomas of the renal pelvis or ureter were found in 11 patients (1.7 per cent) 10 months to 13 years after the primary bladder tumor. In 3 patients the tumors were diagnosed or suspected by excretory urography, while in 5 the tumors were not found until autopsy. Four patients had undergone cystectomy and 9 had multiple bladder tumors at the initial assessment or during followup. The initial or recurrent bladder tumor involved the ipsilateral ureteral orifice in 6 patients. We conclude that in bladder cancer patients routine excretory urography is not indicated in the absence of upper urinary tract symptoms but it should be performed in selected patients, that is those with multiple and recurrent bladder tumors or tumors involving the ureteral orifices, or those with a previous cystectomy.

Prognostic factors in carcinoma of the ureter

The records and pathological slides of 60 patients with ureteral cancer were reviewed with particular attention being paid to the tumor-adjacent mucosa. Mucosal abnormalities increased as grade and stage increased but their presence did not correlate with survival nor with the presence of urothelial tumors elsewhere, that is previous, concomitant and subsequent tumors. Patients with papillary and solid tumors survived equally well. Survival among patients with stage B tumors was better than that reported previously (82 per cent survived 5 years).

Primary neoplasms of the ureter

The role of tobacco as a carcinogenic agent should be considered in ureteral carcinoma. In our study 77 per cent of the patients had a history of smoking, with an average of 50 packs a year consumption. Various studies have shown that the prognosis for ureteral carcinoma is related primarily to the grade and stage of the disease at the time of treatment. Therefore, it is imperative that the clinician maintain a high index of suspicion. This index of suspicion should be heightened in any patient with lower tract urothelial tumors. In addition to endoscopic followup excretory urography should be done on an annual basis, with retrograde studies when necessary. Ureteral brush biopsies or tissue obtained with the Dormia basket may be diagnostic. A Dormia stone basket was used in 3 patients in our study and sufficient tissue for diagnosis was obtained in each case. No complications were encountered. The results obtained in treating a primary leiomyosarcoma of the ureter are noteworthy in that complete remission of pulmonary metastases was obtained after the patient received a course of doxorubicin hydrochloride and dimethyl-triazeno imidazole carboxamide.

Recurrent urothelial tumors following surgery for transitional cell carcinoma of the upper urinary tract

A retrospective analysis of 74 cases of transitional cell carcinoma of the renal pelvis and ureter treated at this institution over the past 30 years is presented. When nephrectomy alone or incomplete nephroureterectomy was performed, subsequent transitional cell carcinoma developed in 30% of the ureteral stumps. Subsequent bladder carcinoma occurred in 25% of the patients with primary upper urinary tract carcinoma. The type of initial surgery performed did not appear to influence this incidence of subsequent bladder tumors. Contralateral upper urinary tract carcinoma developed in only one patient. When nephroureterectomy is performed for carcinoma of the renal pelvis and ureter, a cuff of bladder that includes the ureteral orifice should be removed to obviate recurrent disease in the ureteral stump. Since single-incision nephroureterectomy did not include the intramural ureter in 50% of the cases in which it was performed, a second incision may be required for adequate exposure.

The ureteral stump after nephroureterectomy

Herein we review 70 cases of transitional cell carcinoma of the upper urinary tract. When complete nephroureterectomy was not performed transitional cell carcinoma developed in 30 per cent of the remaining ureteral stumps. Single incision nephroureterectomy did not include the intramural ureter in 50 per cent of the cases in which it was performed. When nephroureterectomy is selected as treatment for carcinoma of the renal pelvis or ureter a cuff of bladder, which includes the ureteral orifice, should be removed. A second incision may be required for adequate exposure.

Primary carcinoma of the ureter: a prognostic study

Fourty-one patients with primary invasive carcinomas of the ureter were seen at Memorial Hospital from 1947 to 1972. Overall survuval patterns were similiar in 19 patients with and 22 patients without prior or concomitant urothelial cancers elsewhere in the urinary tract, with 5-year survival rates, as estimated by the product-limit methos, of41% for both groups. Prognosis was determined primarily by anatomical stage of ureteral cancer. In 11 Stage A (submucosal) patients, 7 Stage B (muscular), 12 Stage C (periureteric fat), and 9Stage D (extraureteral), the similarly estimated 5-year survival rates were 91%, 43%, 23%, and nil, respectively. None of Stage A cases had metastases for periods ranging from 5 to 11 years after surgery alone. Seventy-eight percent of patients with more advanced stages died within 3 years of treatment, withmetastases mainly in pelvic and para-aortic lymph nodes.