Long-term outcome of endoscopic biopsy and subsequent nephroureterectomy for upper urinary tract tumor

The usefulness of ureterorenoscopic examination in evaluation of upper tract disease

AIM

The objective of the present study was to clarify the indications, usefulness and limitations of ureterorenoscopy.

MATERIAL AND METHODS

From January 1998 to June 2004, 72 consecutive patients (48 men and 24 women) with a mean age of 66 years (range, 27-83 years) underwent ureterorenoscopy to diagnose upper urinary tract tumors (UUT). Median follow-up was 24 months (range, 1-73 months). Patients were divided into four subgroups by voided urine cytology and preoperative radiographic findings. Group A (n=11, 15.3%), positive voided urine cytology and positive preoperative radiographic findings; group B (n=5, 6.9%), positive cytology and negative radiographic findings; group C (n=48, 66.7%), negative cytology and positive radiographic findings and group D (n=8, 11.1%), frank hematuria originating from the UUT but negative cytology and negative radiographic findings. We compared the findings of ureterorenoscopic examination and biopsy with the results of retrograde pyelography and cytology of upper tract urine. For each examination, the following diagnostic indices were assessed: sensitivity, specificity, positive-predictive-value (PPV) and negative-predictive-value (NPV) and accuracy. Statistical analysis was performed using McNemar's test.

RESULTS

For ureterorenoscopy, sensitivity was 94%, specificity 59%, PPV 72%, NPV 92% and accuracy 76%. For biopsy, sensitivity was 77%, specificity 100%, PPV 100%, NPV 80% and accuracy 88%. Accuracy of ureterorenoscopy tended to be superior to that of retrograde pyelography. Ureterorenoscopy was most useful in the group which consisted of 48 patients (66.7%) with negative voided urine cytology and positive preoperative radiographic findings. This group was the only group in which accuracy of ureterorenoscopic biopsy was superior to that of urine cytology, significantly (P=0.03).

CONCLUSION

Results indicated that ureterorenoscopy is most suitable and gives superior accuracy in patients with positive radiographic findings and negative voiding cytology. Ureterorenoscopic biopsy of the upper urinary tract would provide useful information when considering therapeutic strategies, such as nephron-sparing management.

Upper Urinary Tract Cancer: Location is Correlated with Prognosis

OBJECTIVES

Evaluate prognostic information of anatomical location in patients with upper tract transitional cell carcinoma (UTTCC).

METHODS

Retrospective analysis of 149 upper tract transitional cell carcinoma (UTTCC) patients from a single institute treated surgically between 1988 and 2003.

RESULTS

Transmural tumor growth (pT3 or pT4) was less common in distally located tumors (33%) compared to mid (44%), proximal ureter (75%) or pyelum tumors (41%). Tumor stage was the best predictor of disease specific survival. Distally located tumors had a significantly better survival than proximally located cancers (median survival 53 months versus 16 months for tumors in the proximal ureter). Bladder cancer was found in 73 (49%) patients. Invasive UTTCC were less likely to be associated bladder cancer (RR 0.66, 95%CI 0.43-0.98). In a multivariate analysis both tumor stage and location in the upper tract were predictive of disease specific survival after UTTCC diagnosis.

CONCLUSION

Tumor location in the proximal upper tract predicts stage-independent poor prognosis in patients with UTTCC.

Hands-free hook for endourological procedures

We present here a hook that can be used to free both hands from holding the endoscope during endourological procedures. We made the hook from a wire hanger, and thus, it is a convenient, cheap and easy tool to make using this everyday item. As this hook makes the insertion of the endoscope into the urethra easier, it allows urologists to perform endourological procedures, which require the handling of biopsy forceps, a basket wire and lithotripsy probes, unassisted.