Colonic Conduit in Children: Protection of the Upper Urinary Tract 16 Years Later?

Purpose

Complication rates of up to 86.6 percent have been reported after creation of an ileal conduit. In contrast to others, we construct an antirefluxing isoperistaltic colonic conduit for incontinent diversion in children.

Materials and Methods

Between 1968 and 1989 a colonic conduit was created in 105 patients up to age 20 years for neurogenic bladder (76), bladder exstrophy (16)and other reasons (13). Long-term followup (minimum 5 years, mean 16.3 years, range 5 to 26) was possible in 84 patients (159 renal units).

Results

Early and late stenosis at the ureterocolic anastomosis, and stomal stenosis occured in 7.6 and 15.5 percent of the cases, respectively. Renal calculi developed in 8.2 percent of the renal units. Eight kidneys without function after recurrent pyelonephritis, calculi or stenosis at the ureterocolic anastomosis were removed during followup. Compared to preoperative status 3 of the remaining 151 renal units had increased dilatation of the upper urinary tract at the last followup. A total of 31 patients had complications during followup and 18 underwent conversion to continent urinary diversion.

Conclusions

When incontinent urinary diversion is necessary in children, a colonic conduit with the option of continent conversion should be created before deterioration of the upper urinary tract.     

Urinary Calculi as a Late Complication of the Indiana Continent Urinary Diversion: Comparison with the Kock Pouch Procedure

Purpose

Although urinary calculi have been frequent late complications of the Kock continent urinary diversion, they have not been regarded as significant problems in patients with the Indiana pouch because of the lack of foreign material present. However, stones developed in a significant percentage of our patients with an Indiana pouch. We investigated the characteristics of stone formation in patients with the Indiana pouch and compared them to those with a Kock pouch.

Materials and Methods

Detailed clinical courses regarding stone formation were reviewed in 72 patients with a Kock pouch and 54 with an Indiana pouch who had a minimum followup of 12 months.

Results

Stones developed in 7 of 54 patients (12.9 percent) with an Indiana pouch compared to 31 of 72 (43.1 percent) with a Kock pouch. The incidence gradually increased with longer followup but it was lower in the Indiana than in the Kock pouch group (5-year stone-free rate 84 percent versus 66 percent, respectively). Although the stones consisted principally of a mixture of struvite, carbonate apatite and ammonium hydrogen urate, variable amounts of calcium oxalate were identified in 50 percent of the Indiana pouch calculi.

Conclusions

Not only urinary infections but also metabolic factors were considered to be involved in stone formation within the Indiana pouch. However, the substantially higher rate of stone formation in our Kock and Indiana pouch groups than has been reported in the United States suggested that no or infrequent pouch irrigations in our patients were important risk factors for urinary calculi.     

GERIATRIC UROLITHIASIS

Purpose

We define the differences between geriatric patients with urinary stone disease compared to a younger cohort.

Materials and Methods

A data base, including serum biochemical profiles, 24-hour urinalyses and standardized questionnaires, was retrospectively evaluated from more than 6,000 consecutive patients with urinary stone disease.

Results

Geriatric stone formers comprised 12% (721) of all stone patients. Two-thirds of these elderly patients had aberrant urinary values and 29% had isolated hypocitraturia compared to 17% in the younger group. Of geriatric stone forming patients 76% had recurrent urinary stones (mean 3.5 stone episodes), which was similar to the younger comparable group (77%, mean 3.3 stone episodes). The severity of urinary stone disease was similar between the 2 groups based on the need for urological intervention. Geriatric stone patients, in general, experienced the first stone episode later in life (after age 50 years) compared with younger patients. Elderly patients had an increased incidence of uric acid stones, but had a similar incidence of struvite calculi. Geriatric stone patients underwent parathyroid surgery more frequently (2.7 versus 0.7%). Geriatric stone forming patients rarely had renal failure.

Conclusions

The incidence, recurrence and severity of recurrent urinary stone disease were similar between geriatric and younger stone forming patients. Geriatric stone patients had an increased incidence of isolated hypocitraturia, uric acid calculi and previous parathyroidectomy. The geriatric stone population is not merely an extension of younger stone forming patients presenting at an older age. Rather, geriatric patients commonly experience the first symptomatic stone episode later in life.     

URODYNAMIC FACTORS INFLUENCE THE DURATION OF ESCHERICHIA COLI BACTERIURIA IN DELIBERATELY COLONIZED CASES

Purpose

We evaluated the influence of urodynamic factors on the establishment of bacteriuria, after deliberate intravesical inoculation with Escherichia coli.

Materials and Methods

Nine women and 7 men with recurrent symptomatic urinary tract infections underwent intravesical injection of E. coli 83972. This strain had documented ability to persist in the urinary tract and it lacks expressed virulence factors associated with urinary tract infection.

Results

Successful long-term colonization (5 months to 3 years) was achieved in 6 of 12 patients with neurogenic bladder disorder, including normal or high bladder capacity, normal or low detrusor pressure and residual urine. Short-term bacteriuria (13 days) occurred in 1 but long-term bacteriuria was not established in the 4 patients with normal lower urinary tract function. Occasionally urine samples from the colonized patients contained other bacterial strains, which cleared spontaneously except for a Klebsiella strain that became established in 2 and subsequently eliminated E. coli 83972.

Conclusions

E. coli 83972 bacteriuria could only be established in a subset of patients with defective bladder voiding, suggesting that urodynamic defects permit a nonvirulent strain to establish in the urinary tract, but that additional host factors determine if bacteriuria will persist.     

Clinical course of pediatric urolithiasis: follow-up data in a long-term basis

Objective

To evaluate the natural course of the stone disease in pediatric patients from different perspectives among which the spontaneous passage and stone recurrence rates evaluated during the follow-up.

Materials and methods

A total of 142 children referring with primary urinary stone disease were evaluated and followed. All children in the study were divided into two groups with respect to the age (Group 1: 0?C5 years and Group 2: 6?C15 years). Children were followed with respect to spontaneous passage rates, recurrence-regrowth rates, physical as well as the renal growth rates.

Results

Stone recurrence has been noted in 44% of patients in group 1, this value was 31% in group 2. Children with at least one identifiable metabolic abnormality tended to have higher recurrence rates than the others despite conservative measures. The average stone recurrence rate in children without any metabolic abnormality was 14% and nearly 50% in children with an identifiable metabolic abnormality.

Conclusions

We may emphasize that due to the high recurrence and re-growth rates, all children with urinary stone disease should be followed closely with regular visits. The evaluation of metabolic risk factors in children with renal stone disease is the basis of medical treatment aimed at preventing recurrent stone events and the growth of pre-existing calculi.     

Urethral Recurrence in Patients with Orthotopic Ileal Neobladders

Purpose

We identified the risk of urethral recurrence following cystectomy for transitional cell bladder carcinoma, stratified by pathological characteristics of the bladder tumor and type of urinary diversion.

Materials and Methods

The pathological characteristics and clinical courses of 174 men with a Kock ileal neobladder and 262 with a cutaneous urinary diversion were analyzed for time to urethral recurrence.

Results

Urethral recurrence was identified in 34 patients at a median of 1.6 years after cystectomy, for an overall 7.9 percent 5-year risk of recurrence. Carcinoma in situ (p = 0.71) and multifocality (p = 0.17) did not independently confer an increased risk of recurrence. Prostatic urethral involvement, particularly stromal invasion, significantly increased the probability of recurrence (p less than 0.001). Patients with a Kock ileal neobladder had a significantly lower probability of recurrence compared to those with cutaneous diversion (p = 0.015), even when associated with prostatic urethral involvement.

Conclusions

Patients with a Kock ileal neobladder have a lower risk of urethral recurrence than those with cutaneous urinary diversion, even when associated with a high risk pathological condition predicting increased risk of urethral recurrence.     

Long-term follow-up of endoscopically treated upper urinary tract transitional cell carcinoma

Objectives

This report focuses on the long-term follow-up of patients with endoscopically treated upper tract transitional cell carcinoma (TCC) to determine the effectiveness of endoscopic therapy.

Methods

From May 1983 to April 1994, 44 patients with TCC of the upper urinary tract underwent conservative endourologic treatment with either electrocautery fulguration or neodymium:yttrium-aluminumgarnet laser at our institution. The mean follow-up period was 5 years (range, 3 months to 11 years).

Results

Renal pelvic tumor sizes ranged from 0.4 to 4.0 cm (mean, 1.5) and ureteral tumors from 0.2 to 1.0 cm (mean, 0.5). The majority of tumors were of pathologic grade 3 or less, and all were Stage T2 or less. Seventeen of 44 patients (38.6%) had local tumor recurrence (mean time to recurrence, 12.8 months; range 1.5 to 64). Mean recurrence time was 7.3 months for renal pelvic tumors and 17.8 months for ureteral tumors. Nineteen of 44 patients (43.2%) developed bladder tumors. The overall 5-year disease-free rate was 57%. No recurrent tumor was shown to have increased in grade, and one recurrent tumor was proved to have progressed in stage. Six patients (14%) ultimately required a nephroureterectomy for recurrence. There were no major complications as a result of endoscopic therapy. Six patients (14%) died of the effects of metastatic TCC, 5 of whom had known muscle invasive bladder TCC.

Conclusions

Endourologic techniques and the conservative treatment of upper urinary tract TCC is an evolving field and can be safely and effectively used as a first-line treatment for upper tract TCC in selected patients.     

La lithiase du bas appareil urinaire: Analyse rétrospective de 111 cas au CHU de Conakry

Objective

To analyze the epidemiologic, diagnostic and therapeutic aspects of lower urinary tract calculi in the Urology Department of the University Hospital of Conakry, Republic of Guinea.

Patients and Methods

This retrospective study, carried out over a period of 5 years (January 2000 — December 2004), included 86 patients with a total of 111 lower urinary tract calculi. The parameters studied included the presenting symptoms, the findings on clinical, imaging and laboratory investigations and the methods of treatment.

Results

Lower urinary tract calculi represented 4% of the total admissions to the Urology Department of the University Hospital of Conakry during the study period. The patients’ mean age was 33 (range: 3 — 70) years. Men were more frequently affected (83%) than women. The socio-economic groups most affected by lower urinary tract calculi were farmers, pupils and university students, as well as workers accounting for 48%, 22% and 18%, respectively. Clinically, hypogastric pain and dysuria were the main presenting symptoms. Urinalysis performed in 55 patients revealed urinary tract infection in 15 with Staphylococcus aureus representing the most frequently isolated organism. Radiology helped in the diagnosis of 102 bladder calculi and 7 ureteric stones. The underlying uropathy causing stone formation could be identified in 75% of the patients. Treatment consisted of surgical removal of the calculi associated with the appropriate treatment of the underlying uropathy. Follow-up was uneventful in 91% of the cases.

Conclusion

Lower tract urinary calculi are not rare in our daily practice. Their diagnosis is based on clinical examination and radiology. Conventional surgery remains the treatment of choice in our environment.     

CT-calculometry (CT-CM): advanced NCCT post-processing to investigate urinary calculi

Purpose

This study aimed at evaluating the potential of CT-calculometry (CT-CM) as a novel method to determine mineralisation, composition, homogeneity and volume of urinary calculi based on preoperative non-contrast-enhanced computed tomography (NCCT) scans.

Materials and methods

CT-CM was performed in preoperative NCCTs of 25 patients treated for upper tract urinary calculi by ureterorenoscopy or percutaneous nephrolithotomy. Absolute mineralisation values were achieved by use of quantitative CT-osteoabsorptiometry and compared to Fourier infrared spectroscopy as a reference for stone composition. Homogeneity was assessed by advanced software-based NCCT post-processing and visualised by using a maximum intensity projection algorithm. Volumetric measurement was performed by software-based three-dimensional reconstruction.

Results

CT-CM was feasible in all of the 25 NCCTs. Absolute mineralisation values calculated by quantitative CT-OAM might be used to identify the most frequent stone types. High levels of inhomogeneity could be detected even in pure component stones. Volumetric measurement could be performed with minimal effort.

Conclusions

CT-CM is based on advanced NCCT post-processing software and represents a novel and promising approach to determine mineralisation, composition, homogeneity and volume of urinary calculi based on preoperative NCCT. CT-CM could provide valuable information to predict outcome of different stone treatment methods.

     

POTASSIUM-MAGNESIUM CITRATE IS AN EFFECTIVE PROPHYLAXIS AGAINST RECURRENT CALCIUM OXALATE NEPHROLITHIASIS

Purpose

We examined the efficacy of potassium-magnesium citrate in preventing recurrent calcium oxalate kidney calculi.

Materials and Methods

We conducted a prospective double-blind study of 64 patients who were randomly assigned to receive placebo or potassium-magnesium citrate (42 mEq. potassium, 21 mEq. magnesium, and 63 mEq. citrate) daily for up to 3 years.

Results

New calculi formed in 63.6% of subjects receiving placebo and in 12.9% of subjects receiving potassium-magnesium citrate. When compared with placebo, the relative risk of treatment failure for potassium-magnesium citrate was 0.16 (95% confidence interval 0.05 to 0.46). potassium-magnesium citrate had a statistically significant effect (relative risk 0.10, 95% confidence interval 0.03 to 0.36) even after adjustment for possible confounders, including age, pretreatment calculous event rate and urinary biochemical abnormalities.

Conclusions

Potassium-magnesium citrate effectively prevents recurrent calcium oxalate stones, and this treatment given for up to 3 years reduces risk of recurrence by 85%.     

Long-Term Stone Recurrence Rate After Extracorporeal Shock Wave Lithotripsy

Purpose

We followed patients who were stone-free after extracorporeal shock wave lithotripsy (ESWL^*) to investigate the factors that contributed to recurrent calculi.

Materials and Methods

For longer than 5 years 903 patients without residual fragments 3 months after ESWL were enrolled in this study. Plain abdominal films and/or excretory urograms were evaluated every 6 months for recurrent stones on the side of ESWL. Patients who presented with colic pain or other complaints and who were suspected of having recurrent stones were also examined. Stone recurrence rates were calculated with the Kaplan-Meier method. We assessed the influence of patient age; size, location, composition and configuration of the original stones, and pyuria after ESWL on stone recurrence.

Results

Mean followup was 25 months and stones recurred in 183 of 903 renal units (20.3 percent). Kaplan-Meier recurrence rates were 6.7, 28.0 and 41.8 percent after 1, 3 and 5 years, respectively. There was a significant correlation between stone recurrence and multiple stones on one hand, and pyuria after ESWL on the other hand. Stones recurred most frequently in the lower calix. Recurrent stones were passed without intervention in 33 cases, while ESWL was repeated in 53.

Conclusions

These data demonstrate the importance of long-term followup and the search for an effective prophylactic therapy to prevent recurrence.     

EARLY CLINICAL EXPERIENCE WITH 5-AMINOLEVULINIC ACID FOR THE PHOTODYNAMIC THERAPY OF UPPER TRACT UROTHELIAL TUMORS

Purpose

Photodynamic therapy is effective in the treatment of superficial urothelial cancer of the bladder. We report our experience with photodynamic therapy for the treatment of upper urinary tract transitional cell carcinoma.

Materials and Methods

Photodynamic therapy after oral administration of 5-aminolevulinic acid was performed in 4 patients with widespread superficial papillary tumors of the upper urinary tract.

Results

Complete remission occurred in 2 patients who remained free of local recurrence at 7 and 17 months of followup. In the other 2 patients residual tiny papillary tumors were found in the distal ureter after photodynamic therapy. These tumors were coagulated with neodymium: YAG laser irradiation. Both patients are disease-free at 24-month followup.

Conclusions

Photodynamic therapy with 5-aminolevulinic acid is a minimally invasive approach for organ preserving treatment of multifocal superficial transitional cell carcinoma of the upper urinary tract.     

Complications of the Afferent Antireflux Valve Mechanism in the Kock Ileal Reservoir

Purpose

Since 1982 the Kock ileal reservoir has been the primary form of urinary diversion in patients requiring lower urinary tract reconstruction at our institution. The intussuscepted afferent nipple valve of the Kock ileal reservoir is designed to prevent reflux and protect the upper urinary tract. Problems associated specifically with the afferent antireflux valve have been few. We defined and characterized all complications associated with the Kock pouch antireflux nipple valve.

Materials and Methods

From November 1984 through July 1992, 802 patients underwent construction of a continent Kock ileal reservoir. All complications associated with the afferent antireflux valve in this group and their management were identified.

Results

Overall, 79 of 802 patients (9.8 percent) had a total of 84 complications of the afferent antireflux valve (10.4 percent), including formation of stones on staples securing the afferent nipple valve in 42 cases (5.2 percent), stenosis of the afferent valve in 35 (4.3 percent) and prolapse of the valve in 7 (0.9 percent). A total of 81 patients required surgical intervention to correct the afferent valve complication: 56 (7.0 percent) were treated endoscopically and 25 (3.1 percent) required open surgical revision.

Conclusions

We report an overall complication rate of 10.4 percent associated with the afferent antireflux nipple valve in the Kock ileal reservoir. Most complications can be treated endoscopically without difficulty on an outpatient basis with the use of local sedation. With these results, and only a 3 percent incidence of open surgical correction of all afferent nipple problems, we encourage the continued use of the intussuscepted afferent nipple valve whenever continent urinary diversion is performed.     

Long-Term Results of Ureterosigmoidostomy in Children With Bladder Exstrophy

Purpose

We evaluated long-term results of patients with bladder exstrophy who underwent ureterosigmoidostomy.

Materials and Methods

Of 4 women and 23 men monitored at our institution 16 (59 percent) underwent primary diversion by ureterosigmoidostomy, while 11 (41 percent) underwent primary bladder closure or an ileal conduit procedure before conversion to ureterosigmoidostomy. Average followup after ureterosigmoidostomy was 17 years.

Results

Significant upper urinary tract changes developed in 18 percent of the patients. Metabolic acidosis was well compensated in most patients but 2 had problems with urinary retention leading to hyperammonemia and acidosis. Of the 19 patients monitored with biennial colonoscopy benign polyps were removed in 4. Daytime continence was achieved in 92 percent of cases and nighttime continence in 58 percent.

Conclusions

Our experience with ureterosigmoidostomy in children with bladder exstrophy has been favorable through long-term followup. With proper imaging, metabolic surveillance, biennial colonoscopy and nonsteroidal anti-inflammatory drugs we offer ureterosigmoidostomy as a viable alternative for patients with small bladders.     

Advanced non-contrasted computed tomography post-processing by CT-Calculometry (CT-CM) outperforms established predictors for the outcome of shock wave lithotripsy

Objectives

To evaluate the predictive value of advanced non-contrasted computed tomography (NCCT) post-processing using novel CT-calculometry (CT-CM) parameters compared to established predictors of success of shock wave lithotripsy (SWL) for urinary calculi.

Materials and Methods

NCCT post-processing was retrospectively performed in 312 patients suffering from upper tract urinary calculi who were treated by SWL. Established predictors such as skin to stone distance, body mass index, stone diameter or mean stone attenuation values were assessed. Precise stone size and shape metrics, 3-D greyscale measurements and homogeneity parameters such as skewness and kurtosis, were analysed using CT-CM. Predictive values for SWL outcome were analysed using logistic regression and receiver operating characteristics (ROC) statistics.

Results

Overall success rate (stone disintegration and no re-intervention needed) of SWL was 59% (184 patients). CT-CM metrics mainly outperformed established predictors. According to ROC analyses, stone volume and surface area performed better than established stone diameter, mean 3D attenuation value was a stronger predictor than established mean attenuation value, and parameters skewness and kurtosis performed better than recently emerged variation coefficient of stone density. Moreover, prediction of SWL outcome with 80% probability to be correct would be possible in a clearly higher number of patients (up to fivefold) using CT-CM-derived parameters.

Conclusions

Advanced NCCT post-processing by CT-CM provides novel parameters that seem to outperform established predictors of SWL response. Implementation of these parameters into clinical routine might reduce SWL failure rates.

     

Can excretory phase computed tomography predict bacteremia in obstructive calculous pyelonephritis?

Purpose

Acute pyelonephritis (AP), a complication of urolithiasis, can be fatal if it progresses to septic shock. We aimed to evaluate the performance of excretory phase computed tomography (CT) in predicting bacteremia among AP patients with upper urinary tract calculi.

Methods

We reviewed medical records of 250 patients diagnosed with AP and upper urinary tract calculi and who were admitted to our institute. We analyzed 132 patients who underwent excretory phase CT. Excretory phase CT images were obtained 7 min after injection with the contrast agent. Obstruction was classified either as high or low grade. Univariate and multivariate analyses were performed to identify the risk factors of bacteremia.

Results

Of 132 patients, 73 (55.3%) had bacteremia. Escherichia coli was the most frequently identified pathogen in blood cultures. Univariate analysis demonstrated that high-grade obstruction on excretory phase CT and quick Sepsis-related Organ Failure Assessment (qSOFA) score?≥?2 were correlated with bacteremia. In addition, the administration of vasopressors was significantly associated with bacteremia (31.5% vs. 6.8%; p?<?0.001). Multivariate analysis identified high-grade obstruction on excretory phase CT [odds ratio (OR) 6.68; p?<?0.001] and qSOFA score?≥?2 (OR 3.59, p?=?0.03) as independent risk factors for bacteremia.

Conclusions

Excretory phase CT images can be used to predict bacteremia by evaluating the degree of ureteral obstruction. The evaluation of the passage of urine shown by excretory phase CT is critical in patients with AP associated with upper urinary tract calculi.

     

New Stone Formation: A Comparison of Extracorporeal Shock Wave Lithotripsy and Percutaneous Nephrolithotomy

Purpose

There is theoretical concern that stone recurrence rates may be higher following extracorporeal shock wave lithotripsy (ESWL*) compared to other techniques because of residual stone debris.*Dornier Medical Systems, Inc., Marietta, Georgia.

Materials and Methods

We documented all new stone formations in 298 consecutive patients who initially achieved a stone-free status following ESWL for renal calculi less than 2 cm. in largest dimension, and compared the findings to those of 62 patients treated with percutaneous nephrolithotomy without ultrasonic fragmentation. Stone-free status was assessed by a centrally reviewed plain abdominal film and renal tomograms at 3 months. A plain abdominal film was repeated at 12 and 24 months to detect recurrence.

Results

New stones formed in 22.2 percent of patients after ESWL and 4.2 percent after percutaneous nephrolithotomy at 1 year (p = 0.004), and in 34.8 percent versus 22.6 percent, respectively, at 2 years (p = 0.190). Furthermore, more new stones recurred in the lower and mid calices compared to baseline location in the ESWL group (chi-square less than 0.0001), which was not observed in the percutaneous nephrolithotomy group.

Conclusions

Our data support a trend toward higher stone recurrence rates in ESWL treated patients, which may be due to microscopic sand particles migrating to dependent calices and acting as a nidus for new stone formation.     

Blasenaugmentation und -ersatz bei Kindern und Jugendlichen

Background

In children and adolescents, the indication for continent urinary diversion or bladder augmentation is rare. Today, for most patients with a neurogenic bladder, conservative treatment (clean intermittent catheterization [CIC] and pharmacotherapy) is the method of choice, while for patients with bladder exstrophy-epispadias complex (BEEC), primary reconstruction is recommended. Only after failure of conservative treatment or primary reconstruction should bladder augmentation or urinary diversion be considered. Other rare indications include patients with malignant tumor involving the lower urinary tract (e.?g., rhabdomyosarcoma).

Discussion

In patients with a hyperreflexive, small capacity, and/or low compliance bladder with a normal upper urinary tract, bladder augmentation (bowel segments/ureter) is an option. For those unable to perform CIC via the urethra, a continent cutaneous stoma should be offered. In patients with irreparable sphincter defects and normal renal function, a continent cutaneous diversion is an option and in those with a competent anal sphincter the rectosigmoid pouch can be offered.

Conclusion

In this review, surgical options with their advantages and disadvantages are discussed.

     

Intracorporeal Lithotripsy With the Holmium:YAG Laser

Purpose

Preliminary evaluations of the holmium:YAG laser have demonstrated a variety of potential urological applications, including ablation of soft tissue lesions as well as stone fragmentation. We present our experience with the holmium:YAG laser for intracorporeal lithotripsy of urinary calculi.

Materials and Methods

During a 24-month period 75 patients underwent 79 laser procedures, including retrograde ureteroscopy for ureteral calculi (71) and fragmentation of caliceal stones remote from the nephrostomy tract during percutaneous nephrolithotripsy (8).

Results

Complete stone fragmentation without need for additional procedures or lithotripsy was achieved in 85 percent of the cases. Treatment failures included 1 case of stone migration, 7 incomplete fragmentation requiring other lithotripsy devices and 3 laser malfunction. One ureteral perforation occurred when the laser was activated without direct visual guidance.

Conclusions

The holmium: YAG laser has demonstrated its efficacy as a method of intracorporeal lithotripsy. Advantages include ability to fragment stones of all composition, and the multipurpose, multispecialty applications of the holmium wavelength. This laser has potential soft tissue effects, and careful attention to technique during lithotripsy is required to avoid ureteral wall injury.     

Upper Tract Tumors in Patients with Primary Bladder Cancer Followed for 15 Years

Purpose

We evaluated the long-term incidence of upper tract tumors in patients with primary superficial bladder cancer.

Materials and Methods

A total of 86 patients with stages Ta, T1 and Tis bladder tumors, who were entered into a prospective trial of bacillus Calmette-Guerin between 1978 and 1981, was followed for 15 years or longer.

Results

Of the 86 patients 18 (21 percent) had upper tract tumors after a median interval of 7.3 years (range 1 to 15). Tumors occurred within 5 years of followup in 6 cases, between 5 and 10 years in 7, and between 10 and 15 years in 5. The majority of cancers were invasive and 7 patients died of upper tract tumors.

Conclusions

Patients with primary bladder tumors are at risk for upper urinary tract disease for up to 15 years, which suggests the need for lifelong regular upper tract monitoring in these cases.