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Instillationstherapien beim Urothelkarzinom des oberen Harntraktes

Instillation therapies for urothelial carcinoma of the upper urinary tract

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Zusammenfassung

Traditionell galt das Urothelkarzinom des oberen Harntrakts (OHT) als klare Indikation zur radikalen Nephroureterektomie mit Blasenmanschettenresektion. Bei gut selektionierten Patienten und abhängig vom Tumorstadium zeigt sich jedoch, dass eine nierenerhaltende Therapie onkologisch zu ähnlich guten Ergebnissen wie eine Nephroureterektomie führen kann. Eine wichtige Rolle in der nierenerhaltenden Therapie nimmt nebst der lokalen Tumortherapie mittels ablativer ureteroskopischer Verfahren (u. a. Laserverfahren) das Verhindern von Rezidiven lokal wie auch in der Blase ein. Instillationstherapien des OHT mit Bacillus Calmette-Guérin und/oder Mitomycin C haben diesbezüglich Erfolge erzielt. Die Datenlage ist jedoch aufgrund der Seltenheit der Erkrankung sowie der meist retrospektiven Studien eingeschränkt. Im Folgenden geben wir einen Überblick über die Indikationen, die technische Durchführung und die Resultate der Instillationstherapie des OHT.

Abstract

Traditionally, urothelial carcinoma of the upper urinary tract was a clear indication for radical nephroureterectomy with bladder cuff excision. It has been shown that in well-selected patients and depending on tumor stage, a kidney-sparing approach can be pursued with good oncological outcome and equivalent to the radical approach. The prevention of local and bladder recurrences is an important factor. Instillation therapies with bacillus Calmette-Guérin and/or mitomycin C have been successfully used to this end. Due to the low incidence of upper tract urothelial cancer and due to the usually retrospective nature of existing literature, however, data is limited. In this article, we provide a review of the indication, technical execution and results of instillation therapies of the upper urinary tract.

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Authors and Affiliations

  1. Urologische Universitätsklinik, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz

    P. Bosshard,  G. N. Thalmann & B. Roth

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  1. P. Bosshard
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  2. G. N. Thalmann
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  3. B. Roth
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Correspondence to G. N. Thalmann.

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Interessenkonflikt

P. Bosshard, G.N. Thalmann und B. Roth geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Bosshard, P., Thalmann, G.N. & Roth, B. Instillationstherapien beim Urothelkarzinom des oberen Harntraktes. Urologe 58, 25–29 (2019). https://doi.org/10.1007/s00120-018-0830-0

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