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Jakus D, Šolić I, Borovac JA, Šitum M. The influence of the initial clinical presentation of upper tract urothelial carcinoma on histopathological tumor features. Int Urol Nephrol 2024; 56:1335-1341. [PMID: 38015383 DOI: 10.1007/s11255-023-03883-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE To investigate the influence of the initial clinical presentation (symptomatic vs. asymptomatic) on histopathological tumor features in patients with upper tract urothelial carcinoma (UTUC). METHODS We conducted a single-center, cross-sectional, and retrospective study that enrolled 72 adults with primary UTUC who underwent radical nephroureterectomy at our institution over a period of 4 years (April 2019-April 2023). RESULTS Symptomatic patients exhibited significantly higher frequencies of high-grade UTUC (73.6% vs. 36.8%, p = 0.006), ≥ T2 stage UTUC (60.4% vs. 26.3%, p = 0.007), and larger tumor sizes (median 5 vs. 4 cm, p = 0.015) compared to asymptomatic patients. Multiple regression analyses demonstrated significant associations between symptomatic presentation and the presence of high-grade UTUC (OR 6.35, 95% CI 1.81-22.27, p = 0.004), ≥ T2 stage UTUC (OR 5.98, 95% CI 1.62-22.08, p = 0.007), and larger tumor size (B 3.14, 95% CI 0.62-5.66, p = 0.015). A subset of patients with hematuria was separately analyzed to assess the influence of hematuria severity (gross vs. microscopic) on UTUC characteristics. Patients with gross hematuria exhibited significantly higher frequencies of high-grade UTUC (72.9% vs. 33.3%, p = 0.048) and ≥ T2 stage UTUC (58.3% vs. 22.2%, p = 0.001). Multiple regression analyses showed significant associations between gross hematuria and the presence of high-grade UTUC (OR 6.34, 95% CI 1.15-34.95, p = 0.034) and ≥ T2 stage UTUC (OR 6.54, 95% CI 1.11-38.93, p = 0.039). CONCLUSION Initial symptomatic presentation was independently associated with adverse histopathological UTUC characteristics, potentially attributed to earlier detection of UTUC in asymptomatic patients, before the onset of symptoms.
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Affiliation(s)
- Dora Jakus
- Department of Urology, University Hospital of Split, Šoltanska 1, Split, Croatia.
| | - Ivana Šolić
- Department of Urology, University Hospital of Split, Šoltanska 1, Split, Croatia
| | - Josip Anđelo Borovac
- Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia
| | - Marijan Šitum
- Department of Urology, University Hospital of Split, Šoltanska 1, Split, Croatia
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2
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Tao CP, Cao YS, Mao CK, Peng B. Laparoscopic treatment of pediatric duplicated kidney with ureteral fibroepithelial polyps: A case report. Asian J Surg 2024; 47:1499-1500. [PMID: 38065739 DOI: 10.1016/j.asjsur.2023.11.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/24/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Cheng-Pin Tao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Yong-Sheng Cao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.
| | - Chang-Kun Mao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Bo Peng
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
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3
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Tao C, Cao Y, Mao C. Analysis of the Therapeutic Efficacy of Laparoscopic Treatment for Fibroepithelial Polyps of the Ureter in Children. J Endourol 2024; 38:219-227. [PMID: 38185850 DOI: 10.1089/end.2023.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Objective: The aim of this study is to assess the efficacy and safety of laparoscopic surgery in the treatment of pediatric ureteral fibroepithelial polyp (FEP) patients. Our hypothesis is that laparoscopic surgery can effectively treat FEPs while minimizing patient discomfort and complications. Our research aims to evaluate the clinical outcomes of the surgery, including postoperative symptom relief, improvement in kidney function, and risk of postoperative complications. Methods: The clinical records of 34 patients who underwent ureteral polyp surgery at the Department of Urology at Anhui Provincial Children's Hospital between May 2014 and February 2023 were retrospectively analyzed. All patients underwent laparoscopic surgery. Among the 34 pediatric patients, there were 31 males and 3 females, with 2 on the right side and 32 on the left side. Of these cases, 24 polyps were located at the ureteropelvic junction, while seven were found in the upper segment of the ureter and three in its middle segment. Patients' ages ranged from 4 years and 3 months to 15 years, with a median age of 8 years and 6 months. All children presented with varying degrees of hydronephrosis, and preoperative clinical symptoms included ipsilateral flank or abdominal pain, hematuria, and other discomfort. Preoperative examinations mainly comprised ultrasound, intravenous pyelography, CT, or magnetic resonance urography imaging studies, as well as diuretic renography. All pediatric patients underwent laparoscopic excision of the polyp segment of the ureter, followed by renal pelvis ureteroplasty or ureter-to-ureter anastomosis. Results: All patients underwent surgery without conversion to open surgery. The surgical duration ranged from 72 to 313 minutes, with an average of 179.5 minutes. The average intraoperative blood loss was 14 mL. Postoperatively, one patient experienced leakage at the anastomotic site; however, no other significant complications occurred during or after the procedure. Postoperative histopathology confirmed the presence of FEPs in the ureter for all cases. All patients experienced a favorable postoperative recovery, with hospitalization periods ranging from 3 to 16 days and an average stay of 8.6 days. A Double-J stent was inserted in all patients for a duration of 1 to 2 months after surgery, and upon removal, follow-up color Doppler ultrasound revealed reduced hydronephrosis within 1 to 3 months. Follow-up examinations were conducted at intervals ranging from 3 to 108 months postsurgery, with an average follow-up time of 42.2 months, during which no recurrence of ureteral polyps or symptoms such as pain and hematuria was observed. Conclusions: The findings of this study demonstrate that laparoscopic excision of the polyp segment of the ureter, renal pelvis ureteroplasty, and ureter-to-ureter anastomosis represent safe and effective treatment modalities for pediatric FEPs in the ureters. This technique offers several advantages, including minimal invasiveness, rapid recovery, and definitive therapeutic efficacy, which effectively alleviate clinical symptoms and improve hydronephrosis.
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Affiliation(s)
- Chengpin Tao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Yongsheng Cao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Changkun Mao
- Department of Urology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
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4
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Pan SY, Lai CZ, Chen WC, Chen YH, Lin CH, Chang H, Huang CP, Yeh CC. Chondrosarcoma of Ureter in an Elderly Patient: A Case Report. Medicina (B Aires) 2023; 59:medicina59030454. [PMID: 36984455 PMCID: PMC10051176 DOI: 10.3390/medicina59030454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
Chondrosarcoma is a rare type of cancer that can affect the upper urinary tract. Because of its rarity, the clinical presentation of chondrosarcoma can be similar to other urinary tract conditions, such as renal colic, hematuria, and urothelial carcinoma. The primary treatment for chondrosarcoma is the surgical removal of the tumor, and radiation or chemotherapy may be used for advanced cases. However, because of the limited number of patients with this condition, there are no established guidelines for chemotherapy, and the outcomes are unclear. In this case, we present a 71-year-old female patient who was diagnosed with ureteral chondrosarcoma. She presented with abdominal pain and hydronephrosis, and a tumor was found beneath a small stone. The patient underwent nephroureterectomy and received oral fluorouracil chemotherapy due to the advanced stage of the disease. Fortunately, the patient survived, and at the 7 months post-operative follow-up there was no evidence of recurrence. In conclusion, the chondrosarcoma of the upper urinary tract is a rare condition that can be difficult to diagnose due to its similarity to other urinary tract conditions. Treatment typically involves the surgical removal of the tumor, with radiation or chemotherapy reserved for advanced cases. However, because of the limited number of patients, there are no established guidelines for chemotherapy, and the outcomes of treatment are unclear.
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Affiliation(s)
- Szu-Ying Pan
- Department of Urology, China Medical University Hospital, Taichung 404332, Taiwan
| | - Chien-Zhi Lai
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Wen-Chi Chen
- Department of Urology, China Medical University Hospital, Taichung 404332, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
| | - Che-Hung Lin
- Division of Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung 404332, Taiwan
| | - Han Chang
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Pathology, China Medical University Hospital, Taichung 404332, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung 404332, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Ching-Chung Yeh
- Department of Urology, China Medical University Hospital, Taichung 404332, Taiwan
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5
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Sandozi A, Jivanji D, Huang Y, Azar O, Schulman A. Robotic distal ureterectomy and re-implant for obstructing metastatic melanoma - surgical considerations in the palliative setting. Can J Urol 2022; 29:11323-11325. [PMID: 36245204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Non-urothelial malignant ureteral obstruction (MUO) causes hydronephrosis, renal damage and infectious sequelae. The overall condition, symptoms, and plans for systemic therapy inform urologic intervention. In well-selected cases, there is a role for definitive reconstruction. We describe a robotic-assisted distal ureterectomy and reimplant for definitive repair of obstructive metastatic melanoma.
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Affiliation(s)
- Arshia Sandozi
- Division of Urology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Dhaval Jivanji
- Division of Urology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Yiwu Huang
- Division of Urology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Omar Azar
- Division of Urology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Ariel Schulman
- Division of Urology, Maimonides Medical Center, Brooklyn, New York, USA
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6
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Maresca G, Royle J, Donaldson JF. Tranexamic acid-induced ureteric clot obstruction in a patient with urothelial cell carcinoma resulting in upper urinary tract perforation. BMJ Case Rep 2022; 15:e247334. [PMID: 35039376 PMCID: PMC8768920 DOI: 10.1136/bcr-2021-247334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/03/2022] Open
Abstract
This is the first report of upper urinary tract (UUT) perforation secondary to tranexamic acid (TXA) induced ureteric clot obstruction. A 77-year-old woman was referred to the urology department with intermittent, painless visible haematuria from a lesion in the right upper calyx, suspicious of urothelial cell carcinoma. She did not have any flank pain or blood clots in her urine. Preoperatively, her haemoglobin level dropped from 113 g/L to 95 g/L and was prescribed oral TXA by her general practitioner, which led to extensive clot formation within the right kidney and ureter resulting in pain and ureteric obstruction. At ureteroscopy, a large ureteric blood clot was extracted and perforation close to the tumour with resultant urinary extravasation was noted. The patient subsequently underwent a successful nephroureterectomy, but risk of potential perforation-related complications such as tumour seeding, sepsis and urinoma formation could have been avoided. TXA in haematuria from the UUT should be strongly discouraged due to the risk of ureteric clot obstruction and UUT perforation.
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Affiliation(s)
| | - Justine Royle
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
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7
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Weng HY, Ou CH. Retroperitoneoscopic nephroureterectomy and ipsilateral bladder cuff resection in peritoneal dialysis-dependent patients: tips for immediate reinstitution. Int Urol Nephrol 2020; 52:2275-2279. [PMID: 32749553 DOI: 10.1007/s11255-020-02556-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To maximize the chance of maintaining peritoneal dialysis (PD) after retroperitoneoscopic nephroureterectomy without interruption in PD-dependent patients who were suspected as having upper tract urothelial carcinoma (UTUC). METHODS During 2005-2018 at our hospital, 10 PD-dependent patients who were suspected as having UTUC underwent hand-assisted retroperitoneoscopic nephroureterectomy (HARN) and bladder cuff resection by a single surgeon. The medical record and post-operative outcomes were retrospectively analyzed. Our surgical tips aiming at staying on PD including keeping adequate but relatively lower insufflation pressure during the operation, reducing the negative pressure of the drain tube post-operatively and initiating PD at a low volume with gradual titration, were also presented in the article. RESULTS A total of ten patients were enrolled in our study. The first five patients failed to resume PD and need interim hemodialysis due to various reasons. After some technique modifications, all the following five patients have PD reinstitution immediately after the operation without increasing the incidence of post-operative complications. CONCLUSION Staying on PD wound be beneficial for those ESRD patients who underwent retroperitoneoscopic nephroureterectomy due to UTUC, mainly to avoid hemodynamic interference and possible complications related to hemodialysis during the peri-operative period. However, it remains challenging for surgeons. We concluded the key points to minimize peritoneal violation. By adherence to our tips, retroperitoneoscopic nephroureterectomy should be strongly considered in PD patients with suspicious UTUC if feasible.
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Affiliation(s)
- Han-Yu Weng
- Department of Urology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 704, Taiwan
| | - Chien-Hui Ou
- Department of Urology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 704, Taiwan.
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8
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Muñoz Reyes MC, Romero Requena JM, Piña Alcántara YG, Bueno Álvarez-Arenas J, Ortiz Cansado A. Masquerade syndrome: An eye problem as a manifestation of a more sinister disease. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:50-52. [PMID: 30104072 DOI: 10.1016/j.oftal.2018.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
A middle-aged man with cardiovascular risk factors, who suffered from a slight loss of unilateral vision for 6 months. After obtaining a diagnosis of diffuse choroiditis+papillitis within a probable masquerade syndrome, the patient was referred to outpatient Internal Medicine where this diagnosis was confirmed as an extended neoplastic disease.
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Affiliation(s)
- M C Muñoz Reyes
- Servicio de Medicina Interna, Hospital Perpetuo Socorro, Badajoz, España.
| | - J M Romero Requena
- Servicio de Medicina Interna, Hospital Perpetuo Socorro, Badajoz, España
| | - Y G Piña Alcántara
- Servicio de Radiodiagnóstico, Hospital Perpetuo Socorro, Badajoz, España
| | | | - A Ortiz Cansado
- Servicio de Medicina Interna, Hospital Perpetuo Socorro, Badajoz, España
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9
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Tan WS, Sarpong R, Khetrapal P, Rodney S, Mostafid H, Cresswell J, Watson D, Rane A, Hicks J, Hellawell G, Davies M, Srirangam SJ, Dawson L, Payne D, Williams N, Brew‐Graves C, Feber A, Kelly JD. Does urinary cytology have a role in haematuria investigations? BJU Int 2019; 123:74-81. [PMID: 30003675 PMCID: PMC6334509 DOI: 10.1111/bju.14459] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy of urinary cytology to diagnose bladder cancer and upper tract urothelial cancer (UTUC) as well as the outcome of patients with a positive urine cytology and normal haematuria investigations in patients in a multicentre prospective observational study of patients investigated for haematuria. PATIENT AND METHODS The DETECT I study (clinicaltrials.gov NCT02676180) recruited patients presenting with haematuria following referral to secondary case at 40 hospitals. All patients had a cystoscopy and upper tract imaging (renal bladder ultrasound [RBUS] and/ or CT urogram [CTU]). Patients, where urine cytology were performed, were sub-analysed. The reference standard for the diagnosis of bladder cancer and UTUC was histological confirmation of cancer. A positive urine cytology was defined as a urine cytology suspicious for neoplastic cells or atypical cells. RESULTS Of the 3 556 patients recruited, urine cytology was performed in 567 (15.9%) patients from nine hospitals. Median time between positive urine cytology and endoscopic tumour resection was 27 (IQR: 21.3-33.8) days. Bladder cancer was diagnosed in 39 (6.9%) patients and UTUC in 8 (1.4%) patients. The accuracy of urinary cytology for the diagnosis of bladder cancer and UTUC was: sensitivity 43.5%, specificity 95.7%, positive predictive value (PPV) 47.6% and negative predictive value (NPV) 94.9%. A total of 21 bladder cancers and 5 UTUC were missed. Bladder cancers missed according to grade and stage were as follows: 4 (19%) were ≥ pT2, 2 (9.5%) were G3 pT1, 10 (47.6%) were G3/2 pTa and 5 (23.8%) were G1 pTa. High-risk cancer was confirmed in 8 (38%) patients. There was a marginal improvement in sensitivity (57.7%) for high-risk cancers. When urine cytology was combined with imaging, the diagnostic performance improved with CTU (sensitivity 90.2%, specificity 94.9%) superior to RBUS (sensitivity 66.7%, specificity 96.7%). False positive cytology results were confirmed in 22 patients, of which 12 (54.5%) had further invasive tests and 5 (22.7%) had a repeat cytology. No cancer was identified in these patients during follow-up. CONCLUSIONS Urine cytology will miss a significant number of muscle-invasive bladder cancer and high-risk disease. Our results suggest that urine cytology should not be routinely performed as part of haematuria investigations. The role of urine cytology in select cases should be considered in the context of the impact of a false positive result leading to further potentially invasive tests conducted under general anaesthesia.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
| | - Rachael Sarpong
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Pramit Khetrapal
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
| | - Simon Rodney
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- UCL Cancer InstituteLondonUK
| | - Hugh Mostafid
- Department of UrologyRoyal Surrey County HospitalGuildfordUK
| | - Joanne Cresswell
- Department of UrologyJames Cook University HospitalMiddlesbroughUK
| | - Dawn Watson
- Department of UrologyJames Cook University HospitalMiddlesbroughUK
| | - Abhay Rane
- Department of UrologyEast Surrey HospitalRedhillUK
| | - James Hicks
- Department of UrologyWorthing HospitalWorthingUK
| | | | - Melissa Davies
- Department of UrologySalisbury District HospitalSalisburyUK
| | | | | | - David Payne
- Department of UrologyKettering General HospitalKetteringUK
| | - Norman Williams
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Chris Brew‐Graves
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Andrew Feber
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- UCL Cancer InstituteLondonUK
| | - John D. Kelly
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
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Abstract
The aim of this study was to investigate the effect of preoperative anemia on the prognosis of patients who underwent radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).A total of 620 patients with UTUC were retrospectively analyzed. Anemia was decided by preoperatively measured hemoglobin values based on the World Health Organization (WHO) classification. Kaplan-Meier method and Cox proportional hazards regression models were used to analyze the relationship between anemia and survival outcomes. The meta-analysis part was performed according to PRISMA guidelines.The median follow-up was 51 (range: 1-168) months. A total of 246 patients had preoperative anemia in our cohort. Anemia was found to be related to high-grade (P < .001), sessile architecture (P = .001), advanced T stage (P < .001), lymphovascular invasion (LVI) (P = .006), and worse chronic kidney disease (CKD) stage (P = .012). Kaplan-Meier curves revealed that patients with preoperative anemia had worse overall survival (OS), cancer-specific survival (CSS), and disease recurrence-free survival (RFS) (all P < .001). Multivariable Cox analyses found that anemia was an independent predictor of CSS [hazard ratio (HR) 1.719, 95% confidence interval (95% CI): 1.285-2.300], RFS (HR 1.427, 95% CI: 1.114-1.829) and OS (HR 1.756, 95% CI: 1.353-2.279). Among patients without end-stage renal disease (ESRD, n = 614), the anemia was also proved to be associated with worse outcomes in multivariable Cox analysis (OS, HR 1.759, 95% CI: 1.353-2.287; CSS, HR 1.726, 95% CI: 1.289-2.311, and RFS, HR 1.431, 95% CI: 1.117-1.837). Seven studies were included in the meta-analysis, and the pooled results showed that anemia was also related to worse CSS (HR 2.05, 95% CI: 1.73-2.44), RFS (HR 1.57, 95% CI: 1.30-1.90), and OS (HR 1.53, 95% CI: 1.10-2.13), but not related to intravesical recurrence (HR 1.17, 95% CI: 0.75-1.82).Preoperative anemia was proved to be significantly associated with worse oncologic outcomes in patients with UTUC following RNU.
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Affiliation(s)
- Ping Tan
- Department of Urology, Institute of Urology
| | | | - Haotian Liao
- Department of Liver Surgery, Liver Transplantation Division
| | | | - Huan Xu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Yang
- Department of Urology, Institute of Urology
| | | | - Qiang Wei
- Department of Urology, Institute of Urology
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11
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Khoo CC, Abboudi H, Cartwright R, El-Husseiny T, Dasgupta R. Metallic Ureteric Stents in Malignant Ureteric Obstruction: A Systematic Review. Urology 2018; 118:12-20. [PMID: 29408390 DOI: 10.1016/j.urology.2018.01.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/08/2018] [Accepted: 01/18/2018] [Indexed: 10/16/2022]
Abstract
The effectiveness of metallic stents in the management of malignant ureteric obstruction is unclear. This systematic review evaluates the use of 4 commercially available metallic stents (Resonance, Memokath 051, Uventa, and Allium URS). Twenty-one studies met eligibility criteria. Overall success rates ranged from 88% for the Allium stent to 65% for Memokath 051. Resonance demonstrated the lowest migration rate (1%). Uventa had the lowest obstruction rate (6%). Metallic ureteric stents offer a viable alternative in the management of malignant ureteric obstruction. Further high quality studies are required to assess cost effectiveness and refine specific indications based on etiology and level of the ureteric obstruction.
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Affiliation(s)
- Christopher C Khoo
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Hamid Abboudi
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Rufus Cartwright
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Tamer El-Husseiny
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Ranan Dasgupta
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom.
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12
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Abstract
Malignancies of the urinary tract (kidney, ureter, and bladder) are distinct clinical entities. Hematuria is a unifying common presenting symptom for these malignancies. Surgical management of localized disease continues to be the mainstay of treatment, and early detection is important in the prognosis of disease. Patients often require life-long follow-up and assessment for recurrence.
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Affiliation(s)
- Hans C Arora
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Michele Fascelli
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Jj H Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Sudhir Isharwal
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
| | - Steven C Campbell
- Center for Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA.
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13
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Affiliation(s)
- Conan So
- University of Maryland, Baltimore, MD
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14
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Lee BH, Zabor EC, Tennenbaum D, Furberg H, Benfante N, Coleman JA, Jaimes EA, Russo P. Renal function recovery after radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 2017; 36:257-263. [PMID: 29209771 DOI: 10.1007/s00345-017-2139-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 11/21/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To understand the longitudinal renal function trends in patients undergoing radical nephroureterectomy (RNU) and identify clinicopathologic characteristics associated with estimated glomerular filtration rate (eGFR) recovery. METHODS 147 patients were available for analysis. Longitudinal eGFR trends were assessed by plotting each patient's eGFR measurements over time. The patient population was dichotomized using eGFR < 60 ml/min/1.73 m2 versus ≥ 60 ml/min/1.73 m2. Cumulative incidence and competing risk regression analysis were used to estimate recovery of postoperative eGFR to the preoperative level and identify clinicopathologic characteristics associated with eGFR recovery. RESULTS Median age was 68.7 years and median preoperative eGFR was 55.9 ml/min/1.73 m2. 63.6% were male and 95.8% were white. The cumulative incidence of eGFR recovery was significantly higher in patients with baseline eGFR < 60 ml/min/1.73 m2 compared to those with baseline eGFR ≥ 60 ml/min/1.73 m2 (p = 0.01), with recovery rates at 2 years of 56.6% vs. 27.7%, respectively. Multivariable analysis revealed that preoperative hydronephrosis (HR 1.80) and preoperative eGFR < 60 ml/min/1.73 m2 (HR 1.87) were associated with increased chance of eGFR recovery. CONCLUSION Over half of patients with preoperative eGFR < 60 ml/min/1.73 m2 achieved eGFR recovery within the first 3 years after RNU, and hydronephrosis was a significant predictor of recovery. These findings should be considered when counseling patients regarding chronic kidney disease progression after RNU and timing of perioperative chemotherapy for high risk tumors.
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Affiliation(s)
- Byron H Lee
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Emily C Zabor
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Daniel Tennenbaum
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Helena Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Nicole Benfante
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Jonathan A Coleman
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Edgar A Jaimes
- Department of Medicine, Renal Service at Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Paul Russo
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
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15
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Jaunarena JH, Cristallo C, González MS, Daels FP, De la Rosette J, Laguna MP. [Management of malignant ureteral obstruction.]. ARCH ESP UROL 2016; 69:507-517. [PMID: 27725327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe the different therapeutic alternatives in malignant ureteral obstruction (MUO), and to analyze short and long-term results. METHODS We conducted a bibliographic search about MUO in Spanish and English languages in PubMed and Google Scholar. We examined the most relevant reviews, original manuscripts and their respective citations. Last search was on April 2016. RESULTS Polymeric double J stent is the cheapest and most accessible internal urinary diversion, but has also the shortest duration. Early and late failure rates were 0-35% and 14-49% respectively. Mean time to late failure was 3-12 months. Percutaneous nephrostomy is the safest alternative in terms of failure rates, though it has frequent complications such as tube dislodgement, and may have a negative effect on quality of life. The only metallic double J stent with enough bibliographic background is the Resonance® stent. Early failure was 0-15% and late failure 4-41%, with a mean time to late failure of 2.6-13 months. Regarding metallic stents, Memokath 051® has obtained the best results, with 0-5% early failure rates, 19-49% late failures and mean time to late failure of 7-11 months. In patients with polymeric double J stent failure, patients benefited from tandem double J stents, metallic double J catheters or metallic stents, avoiding the need of a percutaneous nephrostomy. The evidence level was low in all cases. CONCLUSIONS Results in MUO are very heterogeneous and have a low evidence level. Factors that influence results include stent characteristics, status and prognosis of the obstructive condition and probably patient and physician's preferences. Polymeric double J stents seem to have higher early and late failure rates than metallic double J catheters and metallic stents. Even though, the difference is not clearly evident. Prospective, multicenter, multidisciplinary trials are necessary to elucidate convenience and adequate selection of each type of stent.
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Affiliation(s)
- J H Jaunarena
- Hospital Italiano de Buenos Aires. Buenos Aires. Argentina
| | - C Cristallo
- Hospital Italiano de Buenos Aires. Buenos Aires. Argentina
| | - M S González
- Hospital Italiano de Buenos Aires. Buenos Aires. Argentina
| | - F P Daels
- Hospital Italiano de Buenos Aires. Buenos Aires. Argentina
| | | | - M P Laguna
- AMC. University of Amsterdam. Amsterdam. The Netherlands
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16
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Singla N, Hutchinson R, Haddad A, Sagalowsky A, Lotan Y, Margulis V. Preoperative hydronephrosis is associated with less decline in renal function after radical nephroureterectomy for upper tract urothelial carcinoma. Can J Urol 2016; 23:8334-8341. [PMID: 27544555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION To compare renal function changes after radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC) based on the presence of preoperative hydronephrosis. MATERIALS AND METHODS Clinicopathologic data of 208 patients with UTUC treated surgically from 1998 to 2013 were compiled. Patients with bilateral disease, less than 1 month follow up, missing hydronephrosis data, or who underwent nephron-sparing approaches were excluded. Estimated glomerular filtration rate (eGFR) was calculated preoperatively, at first follow up (within 3 months) and at last follow up using the Modification of Diet in Renal Disease equation. Events were defined as new-onset stage III chronic kidney disease (CKD) or worsening of CKD stage in preexisting CKD. Kaplan-Meier event-free survival was assessed. Cox regression was performed to identify predictors of events. RESULTS A total of 132 patients were analyzed, including 62 (47.0%) with hydronephrosis. Median follow up was 28.6 months. Patients with hydronephrosis had larger tumors (p = 0.045) and higher pathologic stage (p = 0.010) than those without hydronephrosis. Baseline eGFR was comparable between groups (p = 0.088). Patients without hydronephrosis experienced greater declines in eGFR following surgery (p < 0.001) and higher event rates at first (42.8% versus 24.2%, p = 0.028) and last (54.2% versus 30.6%, p = 0.008) follow up. On Cox regression, hydronephrosis predicted lower event likelihood in the long term (univariate HR 0.54, p = 0.033), while ureteral tumor location predicted lower event likelihood in the short term (HR 0.52, p = 0.030). CONCLUSIONS Patients with hydronephrosis undergoing RNU for UTUC experience less decline in renal function than those without hydronephrosis. Given the prevalence of renal dysfunction in patients with UTUC, our results may help inform preoperative counseling.
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Affiliation(s)
- Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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17
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Chen JS, Lu CL, Huang LC, Shen CH, Chen SCC. Chronic Kidney Disease is Associated With Upper Tract Urothelial Carcinoma: A Nationwide Population-Based Cohort Study in Taiwan. Medicine (Baltimore) 2016; 95:e3255. [PMID: 27057873 PMCID: PMC4998789 DOI: 10.1097/md.0000000000003255] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Increased urinary tract malignancy has been reported in end-stage renal disease (ESRD). However, little is known about chronic kidney disease (CKD). This study is designed to explore the association between CKD and upper tract urothelial carcinoma (UTUC).Using Taiwan's Longitudinal Health Insurance Database, we studied CKD patients between January 2000 and December 2011. The non-CKD controls were selected at a ratio of 4:1 and frequency matched by gender, age group, and index date. We used the chi-square test and t test to analyze the sociodemographic information and comorbidities. Cox regression analysis was used to calculate the hazard ratio (HR) and 95% confidence interval (CI).The selected cases included 45,321 CKD cases and 181,284 controls. A significantly higher incidence of UTUC was noted in the CKD group (0.22% vs 0.07%, P < 0.001). In univariate analysis, CKD, female gender, age, hypertension, hematuria, repeated urinary tract infection, bladder cancer, and ESRD were all associated with UTUC. In multivariate analysis, only CKD, female gender, age, hematuria, bladder cancer, and ESRD were significantly associated. The HR for CKD was 1.63 (95% CI: 1.26-2.13). Females had a higher HR of 1.38 (95% CI: 1.11-1.71). After excluding those patients who progressed to dialysis or kidney transplantation, the risk for CKD was still high, with an HR of 1.72 (95% CI: 1.33-2.33).CKD is a significant factor associated with UTUC. We should pay attention to the possibility of UTUC for CKD patients before they progress to ESRD.
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Affiliation(s)
- Jeng-Sheng Chen
- From the Department of Urology (J-SC), Sinying Hospital, Ministry of Health and Welfare, Sinying; Department of Urology (J-SC, C-HS); Department of Medical Research (C-LL, SC-CC); Department of Psychiatric (L-CH), Ditmanson Chiayi Christian Hospital, Chiayi; Department of Public Health (C-LL), Medical College, National Cheng-Kung University, Tainan; and Department of Pediatrics (SC-CC), School of Medicine, Taipei Medical University, Taipei, Taiwan
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18
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Khan M, O'Kane D, Du Plessis J, Hoag N, Lawrentschuk N. Primary malignant melanoma of the urinary bladder and ureter. Can J Urol 2016; 23:8171-8175. [PMID: 26892061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Primary malignant melanoma of the urinary bladder is a rare lesion. We report the case of a 78-year-old male with no previous history of cutaneous melanoma who presented with hematuria. Further investigation with imaging and cystoscopy raised suspicion of a primary bladder and ureteric melanoma, which had subsequently metastasized. This was confirmed with histological assessment and a thorough search for alternative primary lesions. Unfortunately, our patient passed away prior to receiving any oncological treatment for his metastatic melanoma, underscoring both the high mortality of this lesion and the need for a consensus on definitive treatment.
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Affiliation(s)
- Munad Khan
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia
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19
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Moriyama H, Yonehara S, Yoshino T. [Clear Cell Variant of Invasive Urothelial Carcinoma of the Ureter : A Case Report]. Hinyokika Kiyo 2015; 61:241-244. [PMID: 26153053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Clear cell variant of invasive urothelial carcinoma is an extremely rare tumor. Here, we report a case of clear cell variant of invasive urothelial carcinoma of the ureter. A 59-year-old man, who complained of gross hematuria was referred to our hospital for precise examination and treatment. Computerized tomographic scanning confirmed the presence of a tumor in the right lower ureter. Urine cytology was positive. He had undergone retroperitoneoscopy-assisted right radical nephroureterectomy. Typical urothelial carcinoma with partial clear cell appearance made it difficult to make a precise pathological diagnosis and immunohistochemical stain helped to diagnosis the case as clear cell variant of invasive urothelial carcinoma. To our knowledge this is the first case of clear cell variant of invasive urothelial carcinoma of the ureter in the world.
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Affiliation(s)
| | - Shuji Yonehara
- The Department of Pathology, JA Onomichi General Hospital
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20
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Toshiyama R, Tokuoka M, Ide Y, Yamato H, Yamamoto Y, Takeda M, Hashimoto Y, Matsuyama J, Yokoyama S, Morimoto T, Fukushima Y, Nomura T, Kodama K, Sasaki Y, Takeda M. [A case of synchronous sigmoid cancer and ureter cancer]. Gan To Kagaku Ryoho 2015; 42:511-513. [PMID: 25963704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 78-year-old-man visited a nearby doctor for treatment of hepatitis C and high blood pressure.He was diagnosed with right hydronephrosis by abdominal echography conducted in follow-up of hepatitis C treatment in November 2011; he was then introduced to our hospital for close inspection and medical treatment.We observed wall hyperplasia and narrowing of the lumen in the central sigmoid part by contrast-enhanced computed tomography (CT).The right ureter at the L4/5 level showed wall hyperplasia and a deep color, and the right ureter, renal pelvis, and calix were expanded on the head side. By examination for CF, we observed a type 2 lesion in the sigmoid colon, and a biopsy showed well-differentiated adenocarcinoma. Based upon these findings, he was diagnosed with synchronous sigmoid colon cancer (cT4aN0M0, cStage II) and ureter cancer (cT2N0M0, cStage II); we performed laparotomy sigmoidectomy(D3 dissection)and full extraction of the right kidney urinary tract (lymph node dissection in front of the vena cava, the latter outside and between the aorta and vena cava). The postoperative course was particularly uneventful, and the patient was discharged from the hospital on day 38 after the operation. More than 2 years after the surgery, the patient exhibits no sign of sigmoid colon cancer or ureter cancer recurrence.
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Khan IA, Shahab D, Rehman A, Jamil I, Akhter S. URETERIC ANGIOMYOLIPOMA CAUSING UNILATERAL PELVI-URETERIC JUNCTION OBSTRUCTION. J Ayub Med Coll Abbottabad 2015; 27:234-235. [PMID: 26182785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 63-year-old lady, presented to us with nonspecific abdominal pain. Ultrasonography (USG) and CT scan abdomen and pelvis, showed right moderate hydronephrosis, with no evidence of mass at pelvi-ureteric junction (PUJ) obstruction. Per-operatively mass upper ureter was found obstructing PUJ. Mass was excised and pyeloplasty done, with Double J (DJ) Stenting. Stent was removed after a week. Histopathology of specimen showed upper ureteric Angiomyolipoma.
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22
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Nason GJ, O'Kelly F, Mulvin DW. Double trouble--ureteric obstruction due to bilateral urothelial carcinoma. Ir Med J 2013; 106:182-183. [PMID: 23909157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Upper tract urothelial carcinoma (UTUC) represents -5% of all urothelial carcinomas. Synchronous bilateral tumors are extremely rare with only 19 reports in the literature. Haematuria is the main presenting complaint. We report a case of synchronous bilateral tumors of the ureters in a gentleman with frank haematuria treated with staged aggressive resection.
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Affiliation(s)
- G J Nason
- Department of Urology, St Vincent's University Hospital, Elm Park, Dublin 4.
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23
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Chadachan VM, Lee SK. Disseminated intravascular coagulation complicating urothelial malignancy. Singapore Med J 2012; 53:e161-e162. [PMID: 22941143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Transitional cell carcinoma has rarely been reported to be associated with disseminated intravascular coagulation (DIC). We report a 55-year-old Chinese man who was diagnosed with transitional cell carcinoma with vertebral metastasis. He presented with severe anaemia and thrombocytopenia, and subsequent evaluation revealed features of DIC. Interestingly, he did not have fever, any localising symptoms or signs of infection. He was treated aggressively with transfusion of packed cells, platelets, intravenous vitamin K and fresh frozen plasma. Despite aggressive treatment, the coagulation abnormalities were resistant to correction. The patient continued to deteriorate and eventually died of cardiac arrest. This case illustrates that transitional cell carcinoma can also be associated with DIC, possibly due to the expression of certain unidentified procoagulant factors similar to the tissue factor responsible for DIC.
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24
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Cohen L, Shipov A, Ranen E, Bruchim Y, Segev G. Bilateral ureteral obstruction in a cat due to a ureteral transitional cell carcinoma. Can Vet J 2012; 53:535-538. [PMID: 23115367 PMCID: PMC3327593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 15-year-old cat was presented with a history of lethargy and vomiting. Serum biochemistry revealed severe azotemia. Ultrasonography revealed a small left kidney and hydronephrosis of the right kidney. There was an abdominal mass between the kidneys. Necropsy revealed a mass circumflexing both ureters and histopathology confirmed a diagnosis of transitional cell carcinoma.
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Affiliation(s)
| | | | | | | | - Gilad Segev
- Address all correspondence to Dr. Gilad Segev; e-mail:
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25
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Sharifiaghdas F, Soltani MH, Nasiri M. Urothelial carcinoma of the ureter in a patient with functional single kidney. Urol J 2012; 9:429. [PMID: 22395843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Farzaneh Sharifiaghdas
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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26
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Kawamura N, Takao T, Nagahara A, Mukai M, Fukuhara S, Yoshioka I, Ichimaru N, Takayama H, Miyagawa Y, Tsujimura A, Okuyama A. [A case report of retrocaval ureter associated with right ureteral tumors]. Hinyokika Kiyo 2011; 57:565-567. [PMID: 22089155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A case of retrocaval ureter associated with right ureteral tumor in a 70-year-old male is reported. The diagnosis was confirmed by CT and RP. Retroperitoneoscopic nephroureterectomy was performed. The histology of the tumor was urethelial carcinoma. After 20 months, there was neither evidence of recurrence nor metastasis. To our knowledge, this is the 11th case of retrocaval ureter associated with upper urinary tract tumors.
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Affiliation(s)
- Norihiko Kawamura
- The Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
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27
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Affiliation(s)
- Boris Gershman
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA
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28
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Ohashi Y, Maeda H, Minoru H. [Ureteral cancer found in megaureter]. Hinyokika Kiyo 2011; 57:251-253. [PMID: 21743283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 74-year-old female consulted our hospital for follow up of bilateral megaureter. She requested continued follow-up, but in February 2009, she had gross hematuria. We could not make a diagnosis by drip infusion pyelography and retropyelography, so enhanced computed tomography (CT) and magnetic resonance-urography were performed. They revealed right ureteral cancer with severe megaureter. Right nephroureterectomy and partial cystectomy was performed in August 2009. The pathological findings were urothelial carcinoma. She did not receive adjuvant chemotherapy and has had no recurrence for 6 months.
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Affiliation(s)
- Yasuto Ohashi
- The Department of Urology, Yodogawa Christian Hospital
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29
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Chen ZF, Zheng SB, Wu P, Zhang P, Jiang YD, Zhao SC, Mao XM, Chen ZR, Shan ZF. [Synchronous squamous cell carcinoma of the renal pelvis and squamous cell carcinoma of the ureter: report of two cases and review of literature]. Nan Fang Yi Ke Da Xue Xue Bao 2010; 30:2765-2767. [PMID: 21177201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To study the clinicopathological characteristics of synchronous squamous cell carcinoma (SCC) of the renal pelvis and SCC of the ureter. METHODS The clinical data of two cases of synchronous SCC of the renal pelvis and SCC of the ureter were retrospectively reviewed and analyzed. In case 1, a 68-year-old man with hematuria for a month, imaging modalities revealed a right renal pelvis tumor and a right distal ureter tumor. The patient underwent nephroureterectomy and excision of the bladder cuff. Case 2, a 60-year-old man with the complaint of lower abdominal pain and left flank pain for a month, was diagnosed as left distal ureteral stone in another hospital. Ureterolithotomy was performed and a ureteral tumor was found at the lower site of the stone intraoperatively. The pathological report demonstrated SCC, and the patient was transferred to our hospital for further treatment. We found a left renal mass invading the left hemicolon during surgery, and nephroureterectomy was performed with a bladder cuff excision, left hemicolon resection, and also complete lymph node dissection. Neither of patients received adjuvant radiotherapy/chemotherapy. RESULTS Moderately differentiated SCC was reported in both of renal pelvis and ureter in case 1 and the tumor invaded the subepithelial connective tissue in the renal pelvis and superficial muscle in the ureter. In case 2, moderately differentiated SCC of the left renal pelvis with colon metastasis and poorly differentiated SCC of the ureter was reported with two retroperitoneal lymph node metastases. The two patients died from tumor recurrence and metastasis 5 and 6 months after the surgery, respectively. CONCLUSION Synchronous SCC of the renal pelvis and SCC of the ureter are rare and has high likeliness of early recurrence and metastasis, often with poor prognosis.
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Affiliation(s)
- Zhuang-fei Chen
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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30
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Modi AP, Ritch CR, Arend D, Walsh RM, Ordonez M, Landman J, Gupta M, Knudsen BE. ACE2 and angiotensin 1-7 are increased in a human model of cardiovascular hyporeactivity: pathophysiological implications. J Endourol 2010; 24:1189-93. [PMID: 20575695 DOI: 10.1089/end.2010.0121] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND ACE and ACE2 produce angiotensin II (Ang II), a vasopressor that induces cardiovascular remodeling, and Ang 1-7, a vasodilator with an antiremodeling effect. While Ang 1-7 has antiarrhythmic properties, at higher concentration it may induce ventricular tachycardia and sudden death. ACE2, therefore, may play an essential role in blood pressure homeostasis, in the long-term complications of hypertension (cardiovascular remodeling), and in the induction of cardiac electric abnormalities. This study evaluated the levels of ACE2 and Ang 1-7 in Bartter's/Gitelman's patients (BS/GS) who have elevated Ang II and endogenous blockade of Ang II type 1 receptor signaling compared with healthy subjects (C) and essential hypertensives (EH). BS/ GS patients were also considered because of their predisposition to cardiac arrhythmias, which has yet to be completely clarified. METHODS Mononuclear cell ACE2 and Ang 1-7 were evaluated using western blot. RESULTS One-way ANOVA showed that ACE2 and Ang 1-7 levels were significantly different between the three groups (p=0.0074 and p=0.0001, respectively). Post-hoc analysis (Tukey's HSD) showed that both ACE2 (1.59+/-0.63) and Ang1-7 (2.26+/-1.18) were significantly elevated in BS/GS compared with either C (0.98+/-0.45; p=0.008; 1.12+/-0.48, p=0.002, respectively) or EH (1.06+/-0.24; p=0.043; 0.72+/-0.28; p=0.0001, respectively). ACE2 and Ang 1-7 directly correlated only in BS/GS (r=0.91, p<0.0003). CONCLUSIONS The elevated ACE2 and Ang 1-7 in BS/ GS patients mirror those in hypertensives and are in line with the clinical, hemodynamic and pathophysiological characteristics of BS/GS, likely contributing to them. In consideration of the clinical picture of these syndromes, the opposite of hypertension, the results of this study further strengthen the importance of the ACE2/Ang 1-7 system in the regulation of vascular tone and cardiovascular biology.
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Affiliation(s)
- Achal P Modi
- Department of Urology, The Ohio State University Medical Center, Columbus, Ohio, USA
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Zaman F, Chowdhury A, Masood J, Nargund V. Re: Management of ureteral obstruction due to advanced malignancy: optimizing therapeutic and palliative outcomes: E. Kouba, E. M. Wallen and R. S. Pruthi J Urol 2008; 180: 444-450. J Urol 2009; 181:1505-6. [PMID: 19157435 DOI: 10.1016/j.juro.2008.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Indexed: 11/27/2022]
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Inahara M, Kojima S, Takei K, Naito H, Kito H, Yamazaki K, Ishida Y, Furuya Y. [Two cases of spontaneous rupture of upper urinary tract caused by the primary ureteral or renal pelvic tumor: a case report]. Hinyokika Kiyo 2009; 55:31-34. [PMID: 19227210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report two cases of spontaneous urinary rupture caused by primary ureteral or renal pelvic cancer. Case 1: A 76-year-old man presented with macrohematuria and left back pain. Magnetic resonance imaging showed left middle ureteral tumor and rupture of upper ureter. Left nephroureterectomy was performed. Histological findings revealed urothelial carcinoma, G2, pT1, lt-u0, ew0, ly0, v1. At five months postoperatively, he died of lymph node metastases after two courses of adjuvant chemotherapy. Case 2: A 59-year-old man presented with macrohematuria and left back pain. Computer tomography showed left renal pelvic tumor with extravasation of urine. Left nephroureterectomy was performed. Examination of surgical specimen revealed a renal pelvic tumor and rupture hole at the renal pelvis. Histological finding revealed urothelial carcinoma, G3, pT3, lt-u0, ly0, v1. One course of adjuvant chemotherapy was performed. At six months postoperatively, he was free from recurrence.
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Chung SD, Chen KH, Tu CC, Chen Y. Re: Cho KS, et al. Grade of hydronephrosis and tumor diameter as preoperative prognostic factors in ureteral transitional cell carcinoma (Urology 2007;70:662-666). Urology 2008; 73:212-3; author reply 213-4. [PMID: 19111739 DOI: 10.1016/j.urology.2008.08.500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 08/10/2008] [Accepted: 08/11/2008] [Indexed: 11/15/2022]
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Jankovic Velickovic L, Hattori T, Dolicanin Z, Visnjic M, Krstic M, Ilic I, Cukuranovic R, Rajic M, Stefanovic V. Upper urothelial carcinoma in Balkan endemic nephropathy and non-endemic regions: a comparative study of pathological features. Pathol Res Pract 2008; 205:89-96. [PMID: 19106018 DOI: 10.1016/j.prp.2008.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 09/01/2008] [Accepted: 09/08/2008] [Indexed: 11/18/2022]
Abstract
Upper urothelial carcinoma (UUC), a rare neoplasm, occurs more frequently in some regions of Balkan countries than in other areas in the world. The aim of this study is to compare phenotypic morphological characteristics of UUC in Balkan endemic nephropathy (BEN) region and control rural and city populations free of BEN, and to determine the characteristic(s) that could discriminate tumors in endemic and non-endemic regions. The authors analyzed biopsies from 88 patients with UUC, 40 patients who live in Balkan endemic (BEN) settlements and 48 control subjects. The histological sections were used to assess morphological variables: histologic grade, pathologic stage (pT), growth pattern, pattern of invasion, lympho-vascular invasion (LVI), presence of necrosis and metaplastic changes (squamous or glandular) within the tumor. Statistically significant differences between the groups were found concerning tumor grade, pattern of invasion, growth pattern and metaplastic changes. High-grade tumors and trabecular/infiltrative patterns of invasion were more frequent in the group of BEN tumors (chi(2)=4.583, p<0.05; chi(2)=8.064, p<0.05). Moreover, solid growth and metaplastic changes are significant in BEN tumor, chi(2)=9.696, p<0.01; chi(2)=9.35, p<0.01, respectively. Discriminant analysis of morphological variables had indicated that BEN and control tumors are significantly different (Wilks' lambda=0.833, chi(2)=15.044 and p<0.05). The best characteristic that differentiated them was growth pattern; i.e., solid growth for BEN tumors and papillary for control tumors.
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Chung SD, Lai MK, Chueh SC, Wang SM, Yu HJ. An unusual cause of pyonephrosis and intra-peritoneal abscess: ureteral urothelial carcinoma. Int J Infect Dis 2008; 13:e39-40. [PMID: 19111235 DOI: 10.1016/j.ijid.2008.06.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 06/14/2008] [Accepted: 06/19/2008] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shiu-Dong Chung
- Department of Surgery, Division of Urology, Far Eastern Memorial Hospital, Taipei, Taiwan
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Abstract
BACKGROUND To evaluate the efficacy of antegrade insertion of the ureteric stent using pull-through technique in tight ureteric stricture that a guide-wire traversed, but a 5-F catheter could not. MATERIALS AND METHODS Seven patients (M:F = 2:5, mean age 56 years) who underwent antegrade ureteric stent insertion using pull-through technique due to tight ureteric stricture were retrospectively evaluated. The strictures were due to impacted ureter stone (n = 3), metastasis from rectal cancer (n = 1), and idiopathic ureter stricture (n = 3). After failing to traverse a 5-F catheter through the stricture along the guide-wire, a 7-F introducer sheath was inserted through the urethra. The distal end of the guide-wire was snared and retrieved through the urethral introducer sheath. Then using pull-through technique, antegrade ureteric stent insertion was performed. RESULTS Double-J ureteric stent was successfully placed in all seven patients using the pull-through technique. Complications included abdominal/flank pain (n = 7), gross hematuria (n = 5) and elevated blood pressure (n = 1). All complications were relieved within 3 days after the procedure with conservative treatment. CONCLUSIONS Antegrade double-J ureteric stent insertion using the pull-through technique is a safe and useful method, which can be used in tight ureteric strictures, where a ureteric stent cannot follow the passed guide wire.
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Affiliation(s)
- Byung Moon Kim
- Department of Diagnostic Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Republic of Korea.
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Abstract
Self-expanding metallic stents for the treatment of hydronephrosis were implanted in 12 ureters with malignant compression in 10 patients. In 3 ureters the stents were introduced percutaneously by a transrenal route; in 8 ureters introduction was transurethral and in one ureter by a combined route. Patency rate after 6 months was 90.9%. In all cases the stent was able to withstand pressure by the tumour for the remainder of the patient's life. In one patient there was incrustation of both stents after 30 weeks, in another patient the ureter was kinked between the level of the stent and the distal ureter due to growth of the tumour. In all cases it was possible to overcome the obstruction during the lifetime of the patient by the use of a stent or by combining the stent with a plastic endoprosthesis.
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Affiliation(s)
- H Lugmayr
- Abteilung Radiologie I, Krankenhaus der Barmherzigen Schwestern vom Heiligen Kreuz, Wels
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Basiri A, Karami H, Mehrabi S, Javaherforooshzadeh A. Laparoscopic distal ureterectomy and Boari flap ureteroneocystostomy for a low-grade distal ureteral tumor. Urol J 2008; 5:120-122. [PMID: 18592466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center and Department of Urology, Shahid Labbafinejad Hospital, Shahid Beheshti University (MC), Tehran, Iran.
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Murakami T, Makiyama K, Miyoshi Y, Ito Y, Iguchi K, Sano F, Nakaigawa N, Ogawa T, Uemura H, Yao M, Kubota Y. [A case of laparoscopic heminephroureterectomy for ureter cancer in a horseshoe kidney]. Nihon Hinyokika Gakkai Zasshi 2007; 98:786-789. [PMID: 17929462 DOI: 10.5980/jpnjurol1989.98.786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We reported a case of laparoscopic heminephroureterectomy for ureter cancer in a horseshoe kidney. A 59-year-old woman presented with frequency and diagnosed as left lower ureter cancer with a horseshoekidney. We performed transperitoneal laparoscopic nephroureterectomy. Feeding vessels were four arteries and two veins. Isthmus of the horseshoe kidney was divided using LCS and hemostasis was made using monopolar shears. Operating time was 300 minutes. Total Blood loss was 400 ml. Laparoscopic pyeloplasty or ishmusectomy to benign disease of the horseshoe kidney is often reported, but that of heminephrectomy to malignancy is seldom reported. Laparoscopic Heminephectomy for a horseshoe kidney is difficult surgery for aberrant vessels and isthmus, so it tends to be avoided for safety. But if anatomical consideration about aberrant vessels etc is well done and we operate carfully, so we will be able to do it for safety and small invasive opration.
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Affiliation(s)
- Takayuki Murakami
- Department of Urology, Yokohama City University School of Medicine, Japan
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Giannarini G, Schumacher MC, Thalmann GN, Bitton A, Fleischmann A, Studer UE. Elective management of transitional cell carcinoma of the distal ureter: can kidney-sparing surgery be advised? BJU Int 2007; 100:264-8. [PMID: 17532855 DOI: 10.1111/j.1464-410x.2007.06993.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the long-term oncological outcome of patients with primary transitional cell carcinoma (TCC) of the distal ureter electively treated with either kidney-sparing surgery (KSS) or radical nephroureterectomy (RNU) in a retrospective, non-randomized, single-centre study. PATIENTS AND METHODS Of 43 consecutive patients with a primary solitary distal ureter TCC, 19 had KSS, consisting of distal ureter resection with bladder cuff excision and ureter reimplantation, and 24 had RNU with bladder cuff excision. RESULTS The median (range) age at surgery was 69 (31-86) years for the KSS group and 73 (59-87) years for the RNU group, patients in the latter having worse hydronephrotic kidneys. The median (range) follow-up was 58 (3-260) months. A recurrent bladder tumour was diagnosed after a median of 15 months in five of the 19 patients treated by KSS and after a median of 5.5 months in eight of the 24 treated by RNU. Five of the 19 patients treated by KSS and six of the 24 treated by RNU died from metastatic disease despite chemotherapy. Recurrence-free, cancer-specific and overall survival were comparable in the two groups. In two patients (11%) treated by KSS an ipsilateral upper urinary tract TCC recurred after 42 and 105 months, respectively. CONCLUSION Treatment by distal ureteric resection is feasible in patients with primary TCC of the distal ureter. The long-term oncological outcome seems to be comparable with that of patients treated by RNU. Furthermore, kidney preservation is advantageous if adjuvant or salvage chemotherapy is required.
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Yeh CC, Lin TH, Wu HC, Chang CH, Chen CC, Chen WC. A High Association of Upper Urinary Tract Transitional Cell Carcinoma with Nonfunctioning Kidney Caused by Stone Disease in Taiwan. Urol Int 2007; 79:19-23. [PMID: 17627162 DOI: 10.1159/000102907] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 09/26/2006] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although many studies have reported that upper urinary tract stones in patients with nonfunctioning kidneys are associated with malignancy, the incidence and frequency of the tumor cell type remain unclear. Therefore, we aimed to investigate the percentage of malignancies present in patients with nonfunctional kidneys who underwent nephrectomy. MATERIALS AND METHODS From July 1995 to December 2005, we reviewed a total of 47 patients who underwent nephrectomy to treat a nonfunctional kidney due to urolithiasis with clinical symptoms such as complicated chronic infection. Pathology revealed malignancies in 24 patients. Relationships between clinical presentations and malignancy were analyzed. RESULTS Malignancy was diagnosed in 24 patients after nephrectomy. Image studies revealed possible malignancy in only 7 patients before surgery. A high incidence (17/24) of transitional cell carcinoma was noted. The remaining malignancies included 5 renal cell carcinomas, 1 squamous cell carcinoma and 1 epidermoid carcinoma. There were 5 deaths during the follow-up interval. CONCLUSIONS There is a high incidence of malignancy associated with nonfunctional kidney caused by stone disease. We suggest careful examination of the pathological specimens from nephrectomy for nonfunctional kidney regardless of clinical manifestations.
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Affiliation(s)
- Chin-Chung Yeh
- Department of Urology, China Medical University Hospital, Taichung, Taiwan, ROC
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Lloyd SN, Tirukonda P, Biyani CS, Wah TM, Irving HC. The Detour Extra-Anatomic Stent—a Permanent Solution for Benign and Malignant Ureteric Obstruction? Eur Urol 2007; 52:193-8. [PMID: 17126477 DOI: 10.1016/j.eururo.2006.11.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Accepted: 11/03/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We describe our experience of the Detour extra-anatomic stent (EAS) (Mentor-Porgés, UK) for permanent bypass of complete upper urinary tract obstruction. The self-retaining expanded polytetrafluoroethylene-silicone tube, placed in the kidney using a percutaneous route, is tunnelled under the skin and sutured into the bladder to establish extra-anatomical urinary drainage. METHODS From April 2002 to November 2005, a total of nine Detour stents were inserted into eight patients; one patient needed bilateral stent insertions. The causes for ureteric obstruction were persistent malignant disease in three and complicated benign disease in five patients. RESULTS To date, four of five patients with benign disease are alive; one died unexpectedly of metastatic malignancy. The only stent-related complications were infection and haematuria. The two patients with malignancy have subsequently died, but there were no urinary drainage problems for their second and third years of life, respectively. CONCLUSIONS The preliminary data presented here suggest that the Detour EAS offers a permanent and minimally invasive method to establish internalisation of urinary drainage to bypass complete ureteric obstructions for which conventional stenting has failed, open surgery has been tried and failed or was not considered feasible, and long-term nephrostomy drainage was not favoured.
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Affiliation(s)
- Stuart N Lloyd
- Department of Urology, St James's University Hospital, Leeds, England, UK.
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Sagristani M, Caraglia M, Villa MR, Lucania A, Esposito M, Petriccione L, Improta S, Marra M, Iannaci G, Rossiello R, Mastrullo L. Concomitant occurrence of a primary renal NHL and of a papillary urothelial ureter cancer. J Exp Clin Cancer Res 2007; 26:291-2. [PMID: 17725112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In this manuscript for the first time we describe the concomitant diagnosis of primary renal non-Hodgkin lymphoma (PRL) and of a papillary urothelial cancer in a patient with megaloblastic anemia. PRL is a rare disease, since the kidney is one of the extranodal organs usually not containing lymphoid tissue. The disease usually affects adults with an average age of 60 years and slight male preponderance. Flank pain is the most common presenting symptom and different histologies have been reported. A review of literature indicated that simultaneous diagnosis of PRL and papillary urothelial carcinoma of the urether, makes our case unique. The early diagnosis of both diseases allowed the eradication of the two neoplasms by nephro-ureterecthomy and by performing subsequent systemic chemotherapy.
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Affiliation(s)
- M Sagristani
- Division of Haematology, S. Gennaro Hospital, ASL Napoli 1, Naples, Italy
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Wong LM, Cleeve LK, Milner AD, Pitman AG. Malignant ureteral obstruction: outcomes after intervention. Have things changed? J Urol 2007; 178:178-83; discussion 183. [PMID: 17499300 DOI: 10.1016/j.juro.2007.03.026] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Indexed: 12/15/2022]
Abstract
PURPOSE We reviewed the clinical outcome for patients who underwent decompression of malignant ureteral obstruction by analyzing potential prognostic factors, technical success, complication rates and days spent in hospital. MATERIALS AND METHODS Retrospective analysis of 102 patients who underwent decompression for malignant ureteral obstruction from 1991 to 2003 was performed. Data on overall survival, prognostic factors, technical failure, complications and days of hospitalization after decompression were examined. RESULTS Median overall survival was 6.8 months (95% CI 4.8-9.3) and the overall survival rate at 12 months was 29% (95% CI 21%-39%). Univariate analyses found inferior overall survival associated with patients having metastases (p=0.041), undergoing nephrostomy (p=0.046), prior treatment for cancer (p=0.024) and diagnosis of malignant ureteral obstruction in previously established malignancy (p=0.043). After multivariate analysis poor prognostic factors were presence of metastases (p=0.020) and diagnosis of malignant ureteral obstruction in previously established malignancy (p=0.039). Unfavorable cohorts with 3 or 4 unfavorable baseline risk factors had an inferior overall survival (p=0.008) with 12-month overall survival rates of 12% to 19%. Initial decompression of malignant ureteral obstruction failed in 6% of patients (95% CI 2%-12%) and complications were experienced by 53% (95% CI 43%-63%). Patients were more likely to experience a complication if they had therapy after decompression (p=0.03). The median percentage of their remaining lifetime spent in hospital was 17.4% (range 0.21% to 100%). CONCLUSIONS The overall survival of patients with malignant ureteral obstruction remains poor. Prognostic factors for decreased overall survival and prolonged hospital stay have been identified. Although the technical success of decompression has improved the subsequent complication rate is still high.
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Affiliation(s)
- Lih-Ming Wong
- Division of Surgical Oncology, Urology, Peter MacCallum Cancer Centre, East Melbourne, Australia
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Abstract
AIMS To assess efficacy of Mémotherm BARD ureteral metallic stent in the treatment of non-operable ureteral stenoses. MATERIAL AND METHOD Prospective evaluation of ureteral stenoses consecutively treated using Mémotherm BARD ureteral metallic stent. Assessment criteria (recurrence frequency, permeability, tolerance, complications) were measured by clinical examination, Intra Veinous Pyelography, renal sonography, urine culture at 1, and every 3 months. RESULTS Thirteen stents were inserted in 12 patients (mean age: 68 yrs) presenting with subsequent ureteral stenosis (9 neoplastic, 3 following radiotherapy) over a 3 year period. No technical difficulty was observed. Mean follow-up was 19 months. Stenosis recurrence was observed in 5 patients, due to tumoural progression, but with no tumour in-growth. There was non incrustation or migration, pain, hematuria, infection due to the stent. All stent remained permeable and functional in surviving patients. CONCLUSIONS In our experience, Mémotherm BARD ureteral metallic stent could be considered a useful cost-effective alternative to double J stent or traditional surgery in non-operable or end-of-life patients. The high ureteral stenosis recurrence rate was linked to the patient initial pathology. Considering these encouraging results, this study could represent the first stage of a multicenter tracker-study, which would permit to take into account further technological development of this type of material.
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Affiliation(s)
- Louis Sibert
- Service d'Urologie-CHU Rouen-Hôpital Charles Nicolle, Rouen, France.
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Carrafiello G, Laganà D, Lumia D, Giorgianni A, Mangini M, Santoro D, Cuffari S, Marconi A, Novario R, Fugazzola C. Direct primary or secondary percutaneous ureteral stenting: what is the most compliant option in patients with malignant ureteral obstructions? Cardiovasc Intervent Radiol 2007; 30:974-80. [PMID: 17468910 DOI: 10.1007/s00270-007-9016-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 12/14/2006] [Accepted: 01/12/2007] [Indexed: 10/23/2022]
Abstract
The objective of this study was to analyze three ureteral stenting techniques in patients with malignant ureteral obstructions, considering the indications, techniques, procedural costs, and complications. In the period between June 2003 and June 2006, 45 patients with bilateral malignant ureteral obstructions were evaluated (24 males, 21 females; average age, 68.3; range, 42-87). All of the patients were treated with ureteral stenting: 30 (mild strictures) with direct stenting (insertion of the stent without predilation), 30 (moderate/severe strictures) with primary stenting (insertion of the stent after predilation in a one-stage procedure), and 30 (mild/moderate/severe strictures with infection) with secondary stenting (insertion of the stent after predilation and 2-3 days after nephrostomy). The incidence of complications and procedural costs were compared by a statistical analysis. The primary technical success rate was 98.89%. We did not observe any major complications. The minor complication rate was 11.1%. The incidence of complications for the various techniques was not statistically significantly. The statistical analysis of costs demonstrated that the average cost of secondary stenting (637 euros; SD, 115 euros) was significantly higher than that of procedures which involved direct or primary stenting (560 euros; SD, 108 euros). We conclude that one-step stenting (direct or primary) is a valid option to secondary stenting in correctly selected patients, owing to the fact that when the procedure is performed by expert interventional radiologists there are high technical success rates, low complication rates, and a reduction in costs.
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Abstract
To better define the demographics, urothelial distribution and typical gross anatomic and radiologic appearances of fibroepithelial polyps of the ureter in children. We reviewed 15 cases of fibroepithelial polyps of the ureter with hydronephrosis from the archives of our department. Data were collected from radiographic studies, gross anatomic pathology and pathology and radiology reports and categorized by age, sex, clinical presentation, lesion size and location. The mean patient age was 9.1 years, and 80% were male. All of them presented with hematuria and/or flank pain. The polyps were located in the upper ureter or ureteropelvic junction (UPJ) and pelvis. Of the polyps, 60% were multiple polyps or filiform, and 40% were single or bilobed and 1-6 cm in size. Only four cases showed typical filling defect on intravenous urography. In five cases, sonography showed a mildly echogenic structure extending into the ureter from the renal pelvis. Enhanced CT revealed soft tissue filling UPJ or/and proximal ureter in six cases, and hydroureter was found in one case by three-dimensional (3D) image. Fibroepithelial polyps were diagnosed in all cases by postoperative histological examination. Fibroepithelial polyps are the most common benign tumors of the ureter. Congenital factor may be associated with the origin of fibroepithelial polyps in children. The preoperative diagnosis of ureteral polyps is difficult. A history of flank pain, hematuria or both, other than abdominal mass, light-to-moderate hydronephrosis with soft-tissue in UPJ or upper ureter, shown by sonography and radiological examination, may help in the diagnosis of ureteral polyps in children. Ureteral polyps should be recognized as an important etiology for hydronephrosis in children.
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Affiliation(s)
- Zhi Bin Niu
- Shengjing Hospital of China Medical University, 36 Sanhao Road, Heping District, Shenyang, China.
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Dickson BC, Fornasier VL, Streutker CJ, Stewart RJ. Ureteric obstruction: an unusual presentation of metastatic colon carcinoma. Can J Urol 2007; 14:3526-8. [PMID: 17466162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We present the case of a 78-year-old male who presented to clinic for follow-up of a papillary transitional cell carcinoma of the urinary bladder. Notably, the patient also had a history of colorectal resection for an adenocarcinoma. The follow-up appointment revealed left hydronephrosis with evidence of a distal ureteric stricture. Cytology and biopsy from the ureter subsequently disclosed the presence of malignant cells that were originally thought to be of urothelial origin. Upon surgical resection the lesion was found to be an adenocarcinoma, morphologically consistent with a metastasis from the patient's primary colonic adenocarcinoma. This case illustrates a diagnostically challenging situation, with metastatic colonic carcinoma to the ureter occurring in a patient with two previously documented malignancies.
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Affiliation(s)
- Brendan C Dickson
- Division of Pathology, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
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Abstract
Fibroepithelial polyps are extremely rare benign mesodermal tumours in children that can cause ureteropelvic junction (UPJ) obstruction. We report on a 10-year-old boy presenting with UPJ obstruction due to a fibroepithelial polyp, and review 28 similar published paediatric cases.
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Affiliation(s)
- E Cassar Delia
- Department of Paediatric Surgery, John Radcliffe Hospital, Oxford, UK.
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