Skip to main content
SpringerLink
Log in

Surgical and Minimally Invasive Management of Upper Urinary Tract Tumours

  • Chapter
  • First Online:
Urological Oncology

  • 1617 Accesses

Abstract

Primary urothelial carcinoma (UCa) of the upper tract (ureter and renal pelvis) is a relatively rare urological cancer. The disease usually manifests as haematuria and is often multifocal with a high tendency for local and systemic recurrences. The current standard of surgical treatment for patients with upper tract urothelial tumours is complete excision of kidney, ureter and a cuff of urinary bladder (radical nephroureterectomy). As an approach for all types of upper tract transitional cell carcinoma, it has been debated, especially with the introduction of minimally invasive approaches for selected group of patients. Laparoscopic radical nephrouretectomy has been adopted as an alternative to open surgery for the past couple of decades. Endoscopic approaches (percutaneous or ureteroscopic) for selected patients with or without adjuvant treatments are being practised at many centres across the world with good oncological and functional outcomes. Role of adjuvant endocavitary or systemic chemotherapy is under focus to prevent recurrences. Higher local recurrences in endoscopic management of these tumours could be attributed to the failure to visualize these lesions using white light ureteroscopy and this is being addressed with new technique such as blue light uretersoscopy and narrow band imaging. The role of pre-operative ureteroscopic biopsy in the era of multidetector CT urogram remains to be examined. This chapter aims to focus on surgical and minimally invasive treatment of the disease with objectives to discuss some of the recent advancements and delineate areas of future work.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Devesa SS, Silverman DT, McLaughlin JK, et al. Comparison of the descriptive epidemiology of urinary tract cancers. Cancer Causes Control. 1990;1(2):133–41.

    Article  CAS  PubMed  Google Scholar 

  2. Azemar MD, Comperat E, Richard F, et al. Bladder recurrence after surgery for upper urinary tract urothelial cell carcinoma: frequency, risk factors, and surveillance. Urol Oncol. 2011;29(2):130–6.

    Article  PubMed  Google Scholar 

  3. Jabbour ME, Desgrandchamps F, Cazin S, et al. Percutaneous management of grade II upper urinary tract transitional cell carcinoma: the long-term outcome. J Urol. 2000;163(4):1105–7; quiz 1295.

    Article  CAS  PubMed  Google Scholar 

  4. Hall MC, Womack S, Sagalowsky AI, et al. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology. 1998;52(4):594–601.

    Article  CAS  PubMed  Google Scholar 

  5. Browne RF, Meehan CP, Colville J, et al. Transitional cell carcinoma of the upper urinary tract: spectrum of imaging findings. Radiographics. 2005;25(6):1609–27.

    Article  PubMed  Google Scholar 

  6. Pommer W, Bronder E, Klimpel A, et al. Urothelial cancer at different tumour sites: role of smoking and habitual intake of analgesics and laxatives. Results of the berlin urothelial cancer study. Nephrol Dial Transplant. 1999;14(12):2892–7.

    Article  CAS  PubMed  Google Scholar 

  7. McLaughlin JK, Silverman DT, Hsing AW, et al. Cigarette smoking and cancers of the renal pelvis and ureter. Cancer Res. 1992;52(2):254–7.

    CAS  PubMed  Google Scholar 

  8. Mazeman E. Tumours of the upper excretory urinary tract, calices, renal pelvis and ureter. J Urol Nephrol. 1972;78(s9):1–219.

    Google Scholar 

  9. McDougal WS, Cramer SF, Miller R. Invasive carcinoma of the renal pelvis following cyclophosphamide therapy for nonmalignant disease. Cancer. 1981;48(3):691–5.

    Article  CAS  PubMed  Google Scholar 

  10. Stewart JH, Hobbs JB, McCredie MR. Morphologic evidence that analgesic-induced kidney pathology contributes to the progression of tumors of the renal pelvis. Cancer. 1999;86(8):1576–82.

    Article  CAS  PubMed  Google Scholar 

  11. Colin P, Koenig P, Ouzzane A, et al. Environmental factors involved in carcinogenesis of urothelial cell carcinomas of the upper urinary tract. BJU Int. 2009;104(10):1436–40.

    Article  CAS  PubMed  Google Scholar 

  12. Watson P, Lynch HT. The tumor spectrum in HNPCC. Anticancer Res. 1994;14(4B):1635–9.

    CAS  PubMed  Google Scholar 

  13. Raman JD, Ng CK, Scherr DS, et al. Impact of tumor location on prognosis for patients with upper tract urothelial carcinoma managed by radical nephroureterectomy. Eur Urol. 2010;57(6):1072–9.

    Article  PubMed  Google Scholar 

  14. Munoz JJ, Ellison LM. Upper tract urothelial neoplasms: incidence and survival during the last 2 decades. J Urol. 2000;164(5):1523–5.

    Article  CAS  PubMed  Google Scholar 

  15. Khadra MH, Pickard RS, Charlton M, et al. A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice. J Urol. 2000;163(2):524–7.

    Article  CAS  PubMed  Google Scholar 

  16. Krogh J, Kvist E, Rye B. Transitional cell carcinoma of the upper urinary tract: prognostic variables and post-operative recurrences. Br J Urol. 1991;67(1):32–6.

    Article  CAS  PubMed  Google Scholar 

  17. Palou J, Rodriguez-Rubio F, Huguet J, et al. Multivariate analysis of clinical parameters of synchronous primary superficial bladder cancer and upper urinary tract tumor. J Urol. 2005;174(3):859–61; discussion 861.

    Article  PubMed  Google Scholar 

  18. Nabi G, Dadeya S, Dogra PN, Lal H. Eye metastasis form urothelial tumours. Int Urol Nephrol. 2002;34(1):51–4.

    Article  CAS  PubMed  Google Scholar 

  19. Chlapoutakis K, Theocharopoulos N, Yarmenitis S, Damilakis J. Performance of computed tomographic urography in diagnosis of upper urinary tract urothelial carcinoma, in patients presenting with hematuria: systematic review and meta-analysis. Eur J Radiol. 2010;73(2):334–8.

    Article  PubMed  Google Scholar 

  20. Caoili EM, Cohan RH, Inampudi P, et al. MDCT urography of upper tract urothelial neoplasms. AJR Am J Roentgenol. 2005;184(6):1873–81.

    Article  PubMed  Google Scholar 

  21. Takahashi N, Glockner JF, Hartman RP, et al. Gadolinium enhanced magnetic resonance urography for upper urinary tract malignancy. J Urol. 2010;183(4):1330–65.

    Article  PubMed  Google Scholar 

  22. Takahashi N, Kawashima A, Glockner JF, et al. Small (<2-cm) upper-tract urothelial carcinoma: evaluation with gadolinium-enhanced three-dimensional spoiled gradient-recalled echo MR urography. Radiology. 2008;247(2):451–7.

    Article  PubMed  Google Scholar 

  23. Williams SK, Denton KJ, Minervini A, et al. Correlation of upper-tract cytology, retrograde pyelography, ureteroscopic appearance, and ureteroscopic biopsy with histologic examination of upper-tract transitional cell carcinoma. J Endourol. 2008;22(1):71–6.

    Article  PubMed  Google Scholar 

  24. Skolarikos A, Griffiths TR, Powell PH, et al. Cytologic analysis of ureteral washings is informative in patients with grade 2 upper tract TCC considering endoscopic treatment. Urology. 2003;61(6):1146–50.

    Article  CAS  PubMed  Google Scholar 

  25. Shiraishi K, Eguchi S, Mohri J, Kamiryo Y. Role of ureteroscopic biopsy in the management of upper urinary tract malignancy. Int J Urol. 2003;10(12):627–30.

    Article  PubMed  Google Scholar 

  26. Matsumoto A, Tobe T, Kamijima S, et al. The usefulness of ureterorenoscopic examination in evaluation of upper tract disease. Int J Urol. 2006;13(5):509–14.

    Article  PubMed  Google Scholar 

  27. Chitale S, Mbakada R, Irving S, Burgess N. Nephroureterectomy for transitional cell carcinoma – the value of pre-operative histology. Ann R Coll Surg Engl. 2008;90(1):45–50.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Guarnizo E, Pavlovich CP, Seiba M, et al. Ureteroscopic biopsy of upper tract urothelial carcinoma: improved diagnostic accuracy and histopathological considerations using a multi-biopsy approach. J Urol. 2000;163(1):52–5.

    Article  CAS  PubMed  Google Scholar 

  29. Keeley Jr FX, Bibbo M, Bagley DH. Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma. J Urol. 1997;157(5):1560–5.

    Article  PubMed  Google Scholar 

  30. Akkad T, Brunner A, Pallwein L, et al. Fluorescence in situ hybridization for detecting upper urinary tract tumors–a preliminary report. Urology. 2007;70(4):753–7.

    Article  PubMed  Google Scholar 

  31. Tavora F, Fajardo DA, Lee TK, et al. Small endoscopic biopsies of the ureter and renal pelvis: pathologic pitfalls. Am J Surg Pathol. 2009;33(10):1540–6.

    Article  PubMed  Google Scholar 

  32. Chen AA, Grasso M. Is there a role for FISH in the management and surveillance of patients with upper tract transitional-cell carcinoma? J Endourol. 2008;22(6):1371–4.

    Article  PubMed  Google Scholar 

  33. Johannes JR, Nelson E, Bibbo M, Bagley DH. Voided urine fluorescence in situ hybridization testing for upper tract urothelial carcinoma surveillance. J Urol. 2010;184(3):879–82.

    Article  PubMed  Google Scholar 

  34. Luo B, Li W, Deng CH, et al. Utility of fluorescence in situ hybridization in the diagnosis of upper urinary tract urothelial carcinoma. Cancer Genet Cytogenet. 2009;189(2):93–7.

    Article  CAS  PubMed  Google Scholar 

  35. Mian C, Mazzoleni G, Vikoler S, et al. Fluorescence in situ hybridisation in the diagnosis of upper urinary tract tumours. Eur Urol. 2010;58(2):288–92.

    Article  PubMed  Google Scholar 

  36. AJCC. Renal pelvis and ureter. In: Edge SB, Byrd DR, Compton CC, et al., editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. p. 491–6.

    Google Scholar 

  37. Sauter G, Algaba F, Amin M, et al. Non-invasive urothelial tumours. In: Eble JN, editor. Pathology and genetics of tumours of the urinary system and male genital organs, World health organization classification of tumours, vol. 6. Lyon: IARC Press; 2004. p. 110–23.

    Google Scholar 

  38. Olgac S, Mazumdar M, Dalbagni G, Reuter VE. Urothelial carcinoma of the renal pelvis: a clinicopathologic study of 130 cases. Am J Surg Pathol. 2004;28(12):1545–52.

    Article  PubMed  Google Scholar 

  39. Roupret M, Fromont G, Azzouzi AR, et al. Microsatellite instability as predictor of survival in patients with invasive upper urinary tract transitional cell carcinoma. Urology. 2005;65(6):1233–7.

    Article  PubMed  Google Scholar 

  40. Rassweiler JJ, Schulze M, Marrero R, et al. Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: is it better than open surgery? Eur Urol. 2004;46(6):690–7.

    Article  PubMed  Google Scholar 

  41. Rai BP, Shelley M, Coles B, et al. Surgical management for upper urinary tract transitional cell carcinoma. Cochrane Database Syst Rev. 2011;(4):CD007349.

    Google Scholar 

  42. Simone G, Papalia R, Guaglianone S, et al. Laparoscopic versus open nephroureterectomy: perioperative and oncologic outcomes from a randomised prospective study. Eur Urol. 2009;56(3):520–6.

    Article  PubMed  Google Scholar 

  43. Cummings KB. Nephroureterectomy: rationale in the management of transitional cell carcinoma of the upper urinary tract. Urol Clin North Am. 1980;7(3):569–78.

    CAS  PubMed  Google Scholar 

  44. Capitanio U, Shariat SF, Isbarn H, et al. Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. Eur Urol. 2009;56(1):1–9.

    Article  PubMed  Google Scholar 

  45. Murphy DP, Gill IS, Streem SB. Evolving management of upper-tract transitional-cell carcinoma at a tertiary-care center. J Endourol. 2002;16(7):483–7.

    Article  PubMed  Google Scholar 

  46. Roupret M, Hupertan V, Traxer O, et al. Comparison of open nephroureterectomy and ureteroscopic and percutaneous management of upper urinary tract transitional cell carcinoma. Urology. 2006;67(6):1181–7.

    Article  PubMed  Google Scholar 

  47. Soderdahl DW, Fabrizio MD, Rahman NU, et al. Endoscopic treatment of upper tract transitional cell carcinoma. Urol Oncol. 2005;23(2):114–22.

    Article  PubMed  Google Scholar 

  48. Cai G, Liu X, Wu B. Treatment of upper urinary tract urothelial carcinoma. Surg Oncol. 2011;20(1):43–55.

    Article  PubMed  Google Scholar 

  49. Pak RW, Moskowitz EJ, Bagley DH. 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(3):341–6.

    Article  PubMed  Google Scholar 

  50. Lee BR, Jabbour ME, Marshall FF, et al. 13-year survival comparison of percutaneous and open nephroureterectomy approaches for management of transitional cell carcinoma of renal collecting system: equivalent outcomes. J Endourol. 1999;13(4):289–94.

    Article  CAS  PubMed  Google Scholar 

  51. Gadzinski AJ, Roberts WW, Faerber GJ, Wolf Jr JS. Long-term outcomes of nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma. J Urol. 2010;183(6):2148–53.

    Article  PubMed  Google Scholar 

  52. Eastham JA, Huffman JL. Technique of mitomycin C instillation in the treatment of upper urinary tract urothelial tumors. J Urol. 1993;150(2 Pt 1):324–5.

    CAS  PubMed  Google Scholar 

  53. Goel MC, Mahendra V, Roberts JG. Percutaneous management of renal pelvic urothelial tumors: long-term followup. J Urol. 2003;169(3):925–9; discussion 929–30.

    Article  PubMed  Google Scholar 

  54. Keeley Jr FX, Bagley DH. Adjuvant mitomycin C following endoscopic treatment of upper tract transitional cell carcinoma. J Urol. 1997;158(6):2074–7.

    Article  CAS  PubMed  Google Scholar 

  55. Giannarini G, Kessler TM, Birkhauser FD, 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(5):955–60.

    Article  PubMed  Google Scholar 

  56. Compton CC, Byrd DR, Garcia-Aguilar J, et al. Renal pelvis and ureter. In: AJCC cancer staging atlas. New York: Springer; 2012. p. 567–74.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Medical Research Institute, Ninewells hospital and Medical School, Dundee, Scotland, UK

    Bhavan Prasad Rai MBBS, MRCSEd & Clare Sweeney MBBS, MRCSEd, FRCS (Urol)

  2. Department of Urology, Ninewells Hospital, University of Dundee, Dundee, Scotland, UK

    Ghulam Nabi MS, MD, M Ch, FRCS (Urol)

Authors
  1. Bhavan Prasad Rai MBBS, MRCSEd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clare Sweeney MBBS, MRCSEd, FRCS (Urol)
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ghulam Nabi MS, MD, M Ch, FRCS (Urol)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ghulam Nabi MS, MD, M Ch, FRCS (Urol) .

Editor information

Editors and Affiliations

  1. Department of Urology, Homerton University Hospital & Formerly St. Bartholomew's Hospital, London, United Kingdom

    Vinod H. Nargund

  2. Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina, USA

    Derek Raghavan

  3. Radiation Oncology, Cedars Sinai Cancer Center, Los Angeles, California, USA

    Howard M. Sandler

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Rai, B.P., Sweeney, C., Nabi, G. (2015). Surgical and Minimally Invasive Management of Upper Urinary Tract Tumours. In: Nargund, V., Raghavan, D., Sandler, H. (eds) Urological Oncology. Springer, London. https://doi.org/10.1007/978-0-85729-482-1_37

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-482-1_37

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-481-4

  • Online ISBN: 978-0-85729-482-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation