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Xie Z, Liu M, Chen S, Tang W, Liang G, Xu J, Zhao Z. Long segment ureterectomy with tapered demucosalized ileum replacement of ureter for ureteral cancer: a case report and literature review. Front Oncol 2024; 14:1426003. [PMID: 39184042 PMCID: PMC11341426 DOI: 10.3389/fonc.2024.1426003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/22/2024] [Indexed: 08/27/2024] Open
Abstract
Radical nephroureterectomy (RNU) with bladder sleeve resection is currently the gold standard for the treatment of high-risk ureteral cancer. However, in certain special cases, such as bilateral upper tract urothelial carcinoma(UTUC), isolated and chronic kidney disease, and low-risk UTUC, kidney sparing surgery(KSS) may represent a viable alternative, though it remains highly challenging. The current KSS options for ureteral cancer include endoscopic treatment, segmental ureterectomy, total ureterectomy combined with kidney autotransplantation and nephrostomy. These methods are associated with significant disadvantages, such as a high risk of recurrence and vascular-related complications. On the basis of previous studies, we creatively proposed a surgical method of long segment ureterectomy with tapered demucosalized ileum(TDI) replacement of the ureter for ureteral cancer, and successfully performed this operation on a patient with ureteral cancer. The follow-up results showed that this surgical method provides good tumor control while preserving the patient's renal function and improves the inherent defect of the ileal replacement of the ureter, which is a feasible choice for patients with ureteral cancer and kidney preservation.
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Affiliation(s)
- Zhifei Xie
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Mingwen Liu
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Shulian Chen
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen Tang
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Guobiao Liang
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jingyu Xu
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zeju Zhao
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Herout R, Baunacke M, Flegar L, Borkowetz A, Reicherz A, Koch R, Kraywinkel K, Thomas C, Groeben C, Huber J. Upper tract urothelial carcinoma in Germany: epidemiological data and surgical treatment trends in a total population analysis from 2006 to 2019. World J Urol 2023; 41:127-133. [PMID: 36445373 PMCID: PMC9849285 DOI: 10.1007/s00345-022-04219-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/06/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To report contemporary epidemiological data and treatment trends for upper tract urothelial carcinoma (UTUC) in Germany over a 14-year period. METHODS We analyzed data from the nationwide German hospital billing database and the German cancer registry from 2006 to 2018/2019. The significance of changes over time was evaluated via regression analysis. Survival outcomes were calculated using the Kaplan-Meier method. RESULTS There was a non-significant increase in the age-standardized incidence rate from 2.5/100,000 in 2006 to 2.9/100.000 in 2018. 13% of patients presented with lymph node metastasis and 7.6% of patients presented with distant metastasis at primary diagnosis. The 5-year overall survival was estimated at 45% and the 10-year overall survival at 32%. Endoscopic biopsies of the renal pelvis and ureter as well as ureteroscopies with excision/destruction of UTUC all increased significantly over the study period. The number of radical nephroureterectomies (RNU) for UTUC steadily increased from 1643 cases in 2006 to 2238 cases in 2019 (p < 0.005) with a shift from open surgery towards minimally invasive surgery. Complex reconstructive procedures like ileal ureter replacement or autotransplantation are rarely performed for urothelial carcinoma of the ureter. CONCLUSION Diagnostic and therapeutic procedures for UTUC have increased and minimally invasive nephroureterectomy is the predominant approach concerning radical surgery in 2019.
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Affiliation(s)
- Roman Herout
- Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
| | - Martin Baunacke
- grid.4488.00000 0001 2111 7257Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Luka Flegar
- grid.10253.350000 0004 1936 9756Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Angelika Borkowetz
- grid.4488.00000 0001 2111 7257Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Alina Reicherz
- grid.459734.80000 0000 9602 8737Department of Urology, Ruhr-University of Bochum, Marien Hospital Herne, Herne, Germany
| | - Rainer Koch
- grid.10253.350000 0004 1936 9756Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Klaus Kraywinkel
- grid.13652.330000 0001 0940 3744National Center for Cancer Registry Data, Robert Koch Institute, Berlin, Germany
| | - Christian Thomas
- grid.4488.00000 0001 2111 7257Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Christer Groeben
- grid.10253.350000 0004 1936 9756Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Johannes Huber
- grid.10253.350000 0004 1936 9756Department of Urology, Philipps-University Marburg, Marburg, Germany
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Matsuda Y, Inoue T, Maeno A, Koizumi A, Yamamoto R, Nara T, Kanda S, Numakura K, Saito M, Narita S, Satoh S, Habuchi T. A patient with synchronous bilateral low-grade upper tract urothelial carcinoma who underwent nephroureterectomy and total ureterectomy with ileal ureteric replacement. Int Cancer Conf J 2020; 9:82-87. [PMID: 32257759 DOI: 10.1007/s13691-020-00402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/17/2020] [Indexed: 11/29/2022] Open
Abstract
We present the case of a synchronous bilateral low-grade upper-tract urothelial carcinoma patient who underwent left nephroureterectomy and right total ureterectomy with ileal ureteric replacement resulting in a favorable prognosis. A 66-year-old male presented with bilateral hydronephrosis. Computed tomography revealed left pelvic and right upper-middle ureteral tumors with no lymph node swelling or distant metastasis. The patient underwent a left nephroureterectomy with a bladder cuff, and histopathology revealed a low-grade urothelial carcinoma. Considering the contralateral low-grade nature as revealed in histopathology and the right retrograde ureterography being noninvasive, he underwent a right total ureterectomy with ileal ureteric replacement. Histopathology of the right ureter revealed a low-grade urothelial carcinoma. The patient successfully avoided an anephric status without renal function deterioration for 4 years with a transurethral resection for a recurrent small papillary bladder tumor on 18 months after the total ureterectomy.
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Affiliation(s)
- Yoshinori Matsuda
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan.,Department of Urology, Akita City Hospital, Akita, Japan
| | - Takamitsu Inoue
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Atsushi Maeno
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan.,Department of Urology, Akita City Hospital, Akita, Japan
| | - Atsushi Koizumi
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Ryohei Yamamoto
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Taketoshi Nara
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Sohei Kanda
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Kazuyuki Numakura
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Mitsuru Saito
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Shintaro Narita
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Shigeru Satoh
- 2Center for Kidney Disease and Transplantation, Akita University Hospital, Akita, Japan
| | - Tomonori Habuchi
- 1Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
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Ou YC, Hu CY, Cheng HL, Yang WH. Long-term outcomes of total ureterectomy with ileal-ureteral substitution treatment for ureteral cancer: a single-center experience. BMC Urol 2018; 18:73. [PMID: 30170590 PMCID: PMC6119331 DOI: 10.1186/s12894-018-0389-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background To explore the feasibility and long-term outcomes of renal preservation in a retrospective cohort of patients with ureteral urothelial carcinoma undergoing total ureterectomy with ileal-ureteral substitution. Methods A retrospective review of the data from patients treated with total ureterectomy with ileal-ureteral substitution from 1988 to 2016 was performed. The pre-operative oncological status, long-term oncological outcome, long-term renal functional outcome, early and late complications were analyzed. Results A total of eight patients with a median age of 70 years were included. The median follow-up time was 109 months. Six patients had multi-focal tumor involvement over the target ureter, and six patients had bilateral upper tract involvement. Only one patient encountered the upper-tract recurrence. The 2 and 5-year cancer-specific survival rates were 87.5 and 75.0%, respectively. The renal function was well-preserved in most patients, with only one patient needed life-long postoperative hemodialysis. Five patients experienced early complications and four patients experienced late complications. No perioperative mortality happened. Conclusions A total ureterectomy with an ileal-ureteral substitution is feasible for treating ureteral urothelial carcinoma when a renal-sparing procedure is indicated. It provides good long-term oncological outcomes over the upper tract, and it also preserves the renal function.
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Affiliation(s)
- Yin-Chien Ou
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Che-Yuan Hu
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Hong-Lin Cheng
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China
| | - Wen-Horng Yang
- Department of Urology, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, 704, Taiwan, Republic of China.
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