Minimally invasive therapy for upper tract urothelial cell cancer has assumed an important role in the management of this relatively uncommon genitourinary malignancy. In this review, current standards for patient selection, surgical approach, as well as overall outcomes will be discussed. Moreover, the use of intraluminal agents in upper tract disease is examined along with its efficacy and associated complications.
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References
1.
RoupretM, BabjukM, ComperatE, et al.European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol, 2013; 63:1059–1071.
2.
FangD, SeisenT, YangK, et al.A systematic review and meta-analysis of oncological and renal function outcomes obtained after segmental ureterectomy versus radical nephroureterectomy for upper tract urothelial carcinoma. Eur J Surg Oncol, 2016; 42:1625–1635.
3.
RaheemAA, AlatawiA, KimDK, et al.Feasibility of robot-assisted segmental ureterectomy and ureteroureterostomy in patient with high medical comorbidity. Int Braz J Urol, 2016; [Epub ahead of print]; DOI: 10.1590/S1677-5538.IBJU.2016.0026
4.
PedrosaJA, MastersonTA, RiceKR, et al.Oncologic outcomes and prognostic impact of urothelial recurrences in patients undergoing segmental and total ureterectomy for upper tract urothelial carcinoma. Can Urol Assoc J, 2015; 9:E187–E192.
5.
SeisenT, ColinP, RoupretM. Risk-adapted strategy for the kidney-sparing management of upper tract tumours. Nat Rev Urol, 2015; 12:155–166.
6.
GadzinskiAJ, RobertsWW, FaerberGJ, et al.Long-term outcomes of immediate versus delayed nephroureterectomy for upper tract urothelial carcinoma. J Endourol, 2012; 26:566–573.
7.
PakRW, MoskowitzEJ, BagleyDH. What is the cost of maintaining a kidney in upper-tract transitional-cell carcinoma? An objective analysis of cost and survival. J Endourol, 2009; 23:341–346.
8.
CollinsAJ, FoleyRN, HerzogC, et al.Excerpts from the US renal data system 2009 annual data report. Am J Kidney Dis, 2010; 55:S1–S420.
9.
BusMT, MullerBG, de BruinDM, et al.Volumetric in vivo visualization of upper urinary tract tumors using optical coherence tomography: A pilot study. J Urol, 2013; 190:2236–2242.
10.
BrownGA, MatinSF, BusbyJE, et al.Ability of clinical grade to predict final pathologic stage in upper urinary tract transitional cell carcinoma: Implications for therapy. Urology, 2007; 70:252–256.
11.
RoupretM, ColinP, YatesDR. A new proposal to risk stratify urothelial carcinomas of the upper urinary tract (UTUCs) in a predefinitive treatment setting: Low-risk versus high-risk UTUCs. Eur Urol, 2014; 66:181–183.
12.
BrienJC, ShariatSF, HermanMP, et al.Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol, 2010; 184:69–73.
13.
GrassoM, FishmanAI, CohenJ, et al.Ureteroscopic and extirpative treatment of upper urinary tract urothelial carcinoma: A 15-year comprehensive review of 160 consecutive patients. BJU Int, 2012; 110:1618–1626.
14.
CutressML, StewartGD, TudorEC, et al.Endoscopic versus laparoscopic management of noninvasive upper tract urothelial carcinoma: 20-year single center experience. J Urol, 2013; 189:2054–2060.
15.
MotamediniaP, KeheilaM, LeavittDA, et al.The expanded use of percutaneous resection for upper tract urothelial carcinoma: A 30-year comprehensive experience. J Endourol, 2015; 30:262–267.
16.
SmithAK, MatinSF, JarrettTW. Urolothelial tumors of the upper urinary tract. In: WeinAJ, ed. Campbell-Walsh Urology, 11th edn. Elsevier, Pennsylvania, PA, 2016, pp. 1365–1402.
17.
WolfJSJr., BennettCJ, DmochowskiRR, et al.Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol, 2008; 179:1379–1390.
18.
KleinmannN, HealyKA, HuboskySG, et al.Ureteroscopic biopsy of upper tract urothelial carcinoma: Comparison of basket and forceps. J Endourol, 2013; 27:1450–1454.
19.
GuarnizoE, PavlovichCP, SeibaM, et al.Ureteroscopic biopsy of upper tract urothelial carcinoma: Improved diagnostic accuracy and histopathological considerations using a multi-biopsy approach. J Urol, 2000; 163:52–55.
20.
WasonSE, SeigneJD, SchnedAR, et al.Ureteroscopic biopsy of upper tract urothelial carcinoma using a novel ureteroscopic biopsy forceps. Can J Urol, 2012; 19:6560–6565.
21.
AugeBK, PietrowPK, LallasCD, et al.Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol, 2004; 18:33–36.
22.
GorinMA, Santos CortesJA, KyleCC, et al.Initial clinical experience with use of ureteral access sheaths in the diagnosis and treatment of upper tract urothelial carcinoma. Urology, 2011; 78:523–527.
23.
BagleyDH, GrassoM3rd. Ureteroscopic laser treatment of upper urinary tract neoplasms. World J Urol, 2010; 28:143–149.
24.
WeizerAZ, FaerberGJ, WolfJSJr.Progression of disease despite good endoscopic local control of upper tract urothelial carcinoma. Urology, 2007; 70:469–472.
25.
ElashryOM, ElgamasyAK, SabaaMA, et al.Ureteroscopic management of lower ureteric calculi: A 15-year single-centre experience. BJU Int, 2008; 102:1010–1017.
26.
ChenGL, BagleyDH. Ureteroscopic surgery for upper tract transitional-cell carcinoma: Complications and management. J Endourol, 2001; 15:399–404.
MotamediniaP, HoenigD, OkekeZ, et al.A case for nephron sparing surgery in the management of upper tract urothelial carcinoma. J Endourol, 2016; 30Suppl 1:S18–S22.
29.
RastinehadAR, OstMC, VanderbrinkBA, et al.A 20-year experience with percutaneous resection of upper tract transitional carcinoma: Is there an oncologic benefit with adjuvant Bacillus Calmette Guerin therapy?. Urology, 2009; 73:27–31.
30.
RheeJJ, JarrettTW. Percutaneous management of upper urinary tract transitional cell carcinoma. In: SmithAD, PremingerG, BadlaniG, eds. Smith's Textbook of Endourology. Wiley-Blackwell, Hoboken, NJ, 2011, vol. 1, pp. 316–326.
31.
ArgyropoulosAN, TolleyDA. Upper urinary tract transitional cell carcinoma: Current treatment overview of minimally invasive approaches. BJU Int, 2007; 99:982–987.
32.
JarrettTW, SweetserPM, WeissGH, et al.Percutaneous management of transitional cell carcinoma of the renal collecting system: 9-year experience. J Urol, 1995; 154:1629–1635.
33.
HuangA, LowRK, deVere WhiteR. Nephrostomy tract tumor seeding following percutaneous manipulation of a ureteral carcinoma. J Urol, 1995; 153:1041–1042.
34.
SchwartzmannI, PastoreAL, SaccaA, et al.Upper urinary tract urothelial carcinoma tumor seeding along percutaneous nephrostomy track: Case report and review of the literature. Urol Int, 2016; 98:115–119.
35.
ChangSS, BoorjianSA, ChouR, et al.Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guidelines. J Urol, 2016; 196:1021–1029.
36.
BouffiouxC, KurthKH, BonoA, et al.Intravesical adjuvant chemotherapy for superficial transitional cell bladder carcinoma: Results of 2 European organization for research and treatment of cancer randomized trials with mitomycin C and doxorubicin comparing early versus delayed instillations and short-term versus long-term treatment. European Organization for Research and Treatment of Cancer Genitourinary Group. J Urol, 1995; 153:934–941.
37.
ShapiroEY, LipskyMJ, ChaDY, et al.Outcomes of intrarenal Bacillus Calmette-Guerin/interferon-alpha2B for biopsy-proven upper-tract carcinoma in situ. J Endourol, 2012; 26:1645–1650.
38.
YossepowitchO, LifshitzDA, DekelY, et al.Assessment of vesicoureteral reflux in patients with self-retaining ureteral stents: Implications for upper urinary tract instillation. J Urol, 2005; 173:890–893.
39.
CarmignaniL, BianchiR, CozziG, et al.Intracavitary immunotherapy and chemotherapy for upper urinary tract cancer: Current evidence. Rev Urol, 2013; 15:145–153.
40.
GiannariniG, KesslerTM, BirkhauserFD, et al.Antegrade perfusion with Bacillus Calmette-Guerin in patients with non-muscle-invasive urothelial carcinoma of the upper urinary tract: Who may benefit?. Eur Urol, 2011; 60:955–960.
41.
AboumarzoukOM, SomaniB, AhmadS, et al.Mitomycin C instillation following ureterorenoscopic laser ablation of upper urinary tract carcinoma. Urol Ann, 2013; 5:184–189.
42.
EasthamJA, HuffmanJL. Technique of mitomycin C instillation in the treatment of upper urinary tract urothelial tumors. J Urol, 1993; 150:324–325.
KeeleyFXJr., BagleyDH. Adjuvant mitomycin C following endoscopic treatment of upper tract transitional cell carcinoma. J Urol, 1997; 158:2074–2077.
45.
CutressML, StewartGD, ZakikhaniP, et al.Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): Systematic review. BJU Int, 2012; 110:614–628.
46.
YakoubiR, ColinP, SeisenT, et al.Radical nephroureterectomy versus endoscopic procedures for the treatment of localised upper tract urothelial carcinoma: A meta-analysis and a systematic review of current evidence from comparative studies. Eur J Surg Oncol, 2014; 40:1629–1634.
47.
MargulisV, ShariatSF, MatinSF, et al.Outcomes of radical nephroureterectomy: A series from the upper tract urothelial carcinoma collaboration. Cancer, 2009; 115:1224–1233.
48.
AlmasB, HalvorsenOJ, GjengstoP, et al.Grading of urothelial carcinoma of the upper urinary tract according to the World Health Organization/International Society of Urological Pathology classification from 2004 is a valuable tool when considering whether a patient is suitable for endoscopic treatment. Scand J Urol, 2016; 50:298–304.
