Multiple simultaneous inverted papillomas of the upper urinary tract. A case report with a review of ureteral and renal pelvic inverted papillomas

An asymptomatic 73-year-old woman was found to have multiple, simultaneous, inverted papillomas of the renal pelvis and ureter. A review of the world literature yielded 34 cases of inverted papillomas in the upper urinary tract: 13 in the renal pelvis, and 21 in the ureter. Among these 34 cases, there were 26 male and five female patients, with gender not given for three others. Patients ranged in age from 19 to 89 years (mean, 64.1 years). Many cases lacked complete clinical details but, among the others, gross painless hematuria was the presenting symptom in seven; hematuria with flank pain or colic in six; and pain without hematuria in six. Only six patients lacked urinary tract symptoms, and three of these had microscopic hematuria. Only two patients had more than one inverted papilloma, and these were not multicentric. Adequate pathologic documentation and follow-up data were, unfortunately, absent in many of the cases. Although inverted papillomas are curable with surgical resection, with a low rate of local recurrence, they appear to be associated with synchronous or asynchronous carcinomas, especially other transitional cell tumors in the urinary tract.     

Treatment of epithelial tumors of the upper urinary tracts

The authors present the results of different operative treatments of tumors of the upper urinary tracts (UUT). A total of 116 patients with UUT tumors were examined and treated from 1990 to 2002 (age 19-80 years, mean age 61.3+/- 1.3 years; males 82, females 34). Tumors of the renal pelvis and the ureter were detected in 76 (65.5%) and 40 (34.5%) patients, respectively (8.0 and 4.3% of a total number of patients with tumors of the kidneys and UUT). 107 (92.2%) patients were operated. Nephroureterectomy and ureterectomy with resection of the urinary bladder were performed in 73 (68.2%) patients, TUR of the urinary bladder wall, ureteral ostium with pelvic part of the ureter and nephroureterectomy (including endovideosurgery) in 22 (20.6%), nephroureterocystectomy in 4 (3.7%), resection of the pelvic ureter with Boari's operation in 5 (4.7%), nephroscopy, ureteroscopy with removal of urothelial tumor in 3 (2.8%) patients. Postoperative complications (most of them infectious-inflammatory) developed in 10 (9.3%) patients. Lethality was 0.9%. Tumor recurrences occurred in 27 (25.2%) patients within 5-year follow-up. 15 (14.0%) patients were reoperated. 5-year survival reached 67.0%. Conventional and radical method of treating patients with tumors of the renal pelvis and ureter is nephroureterectomy with urinary bladder resection and its modification. In invasion of the tumor in the muscular layer of the bladder wall surgery should be extended and supplemented with cystectomy. Conservative surgical interventions are indicated in tumors of the sole kidney, bilateral process, benign or surface tumor of the urothelium.     

Extravesicular ectopia of the ureter

The article provides detailed information on a rare malposition of the ureter--extravesicular ureteral ectopia (EUE)--concerning formation of the anomaly and clinical manifestations with reference to gender. EUE occurs more frequently in females, more frequently ectopic ureter drains upper part of the double kidney, less frequently--cavitary system of the non-double kidney. In males ectopic ureter drains cavitary system of the non-double kidney and falls in the posterior urethra, seminal vesicles, deferent duct. Fifty-six cases of EUE are analysed. Age of the patients varied from 6 months to 47 years. In group 1 of 49 females ectopic ureter in 47 of them drained an upper part of the double kidney (in 6 cases in both sides), in 2--the cavitary system of the non-double kidney. Of 7 males of group 2 ectopy was from the upper part of the double kidney, in 5--from non-double kidney. The percent of children with the anomaly among urological patients of the children's department for 26 years was 0.11 (52 out of 48756 children). All the patients were operated. 37 upper heminephrureterectomies were made in group 1 (in 1 case laparoscopic) as well as 5 nephrureterectomies and 5 ureteral reimplantations with preservation of the upper pole of the double kidney. 2 upper heminephrureterectomies and 5 nephrureterecmomies were performed in group 2. Short- and long-term results of urinary retention were good. 4 cases of EUE in males and females are reported.     

Carcinomas of the Renal Pelvis,Ureters, and Urinary Bladder Share a Carcinogenic Field as Revealed in Epidemiological Analysis of Tumor Registry Data

BackgroundUrothelial carcinomas are the most common malignant tumors in the upper and lower urinary tract. Renal cell carcinomas (RCCs) have a different pathoepidemiologic incidence and characteristics. We describe a population-based approach of differentiating between urothelial and renal carcinomas as a basis to support shared morphologic phenotypes.Materials and MethodsData from 2000 through 2014 from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute were used to calculate the incidence rates for cancers of the kidney, renal pelvis, ureter, and urinary bladder. Graphic plots of the epidemiologic patterns were analyzed according to age frequency density and double logarithmic (log-log) plots of age-specific incidence rates and age of diagnosis.ResultsRCCs were initially more common than cancers of the urinary bladder, but after age 60, cancers of the bladder became more common with age-specific rates rapidly rising in all age groups. The age frequency density plot for RCC peaked earlier than for urothelial cancers indicating a different tumorigenic process. Log-log plots revealed near parallel proportional rate patterns for cancers of the renal pelvis, ureters, and urinary bladder, suggesting similar carcinogenic pathways among these tumors, whereas they were not parallel for RCCs. Similar slopes indicate that cancer incidence is increasing at similar rates regardless of the incidence of each cancer.ConclusionTumors that arise in the renal pelvis, ureters, and urinary bladder share a common carcinogenic field on the basis of pathoepidemiologic analysis. The definition of a carcinogenic field should expand to include epidemiological parameters as well as common morphologic and embryological patterns.     

Role of the level of obstruction and urodynamics of the upper urinary tract in infectious-toxic complications in urolithiasis. (Clinical and experimental study).

Clinical studies have revealed that location of the occlusion in the kidney and upper third of the ureter raises the risk of severe infectious-toxic complications of urolithiasis. It is shown experimentally that mechanisms of compensation of impaired urinary transport along the upper urinary tracts differ in obstruction of the upper and lower third of the ureter.     

Metastasis to the ovaries from transitional cell carcinoma of the bladder and renal pelvis: a report of two cases

Ovarian metastases from a primary urinary tract carcinoma are extremely rare. This can be difficult to distinguish from transitional cell carcinomas (TCC) of ovarian origin because of histologic similarity. A 65-year-old woman who was diagnosed with renal pelvis TCC 4 months prior was referred for evaluation of a left ovarian mass. A 47-year-old woman who underwent radical cystectomy due to bladder TCC 1 year ago was referred because of a right ovarian mass. Both patients underwent a bilateral salpingo-oophorectomy. The tumor cells had morphology identical to those of the primary urinary tract tumors. Gynecologic oncologists should consider metastatic TCC of the ovary from urinary tract origin, as well as breast, and gastrointestinal tract origins.     

Autotransplantation of the kidney in ureteral injuries

In 1988-2003 we operated 156 patients with various ureteral lesions. Of them 7 patients (6 males and 1 female, mean age 34-43 years) received kidney transplant (autotransplantation). Ureteral lesions were caused by previous surgery (n=3), gunshot wound (n=2), urolithiasis (n=2. The follow-up results (for 15 period maximum) show that operative outcomes were satisfactory in 6 patients. One transplant was removed 7 days after the transplantation because of purulent pyelonephritis and necrosis of the ureter. The rest patients retain good function of the transplanted kidney and passability of the upper urinary tract. Thus, surgical autotransplantation of the kidney performed in affected middle and low thirds of the ureter is an alternative to life-long nephrostomy and nephrectomy and has a good long-term prognosis in relation to function of a transplanted kidney.     

Angioleiomyoma of the ureter

Angioleiomyoma of the urinary excretory tract is an unusual, but benign condition. A case of pure angioleiomyoma of the ureter is reported. Renal tract ultrasonography showed hydronephrosis on the right side in a 15-year-old boy without urinary symptoms. Subsequent retrograde biopsy suggested leiomyoma. Nephrureterectomy was performed. Histologically, the removed specimen indicated ureteral angioleiomyoma. Difficulties in diagnosis and surgical treatment are discussed.     

尿沉渣联合干化学法检测在泌尿系统肿瘤患者尿路感染中的诊断价值

目的探讨分析尿沉渣联合干化学法检测在泌尿系统肿瘤患者尿路感染中的诊断价值。方法选取2011年2月至2013年2月间收治的84例泌尿系肿瘤患者,其中膀胱癌49例,前列腺癌14例,肾癌11例,肾盂输尿管肿瘤10例。采用UF-100和干化学分析仪检测所有患者清洁中段尿中的白细胞、细菌、白细胞酯酶(LEU)及亚硝酸盐(NIT)。84例患者均进行尿细菌培养,比较结果。结果定量尿细菌培养阳性率为58.3%(49/84)。干化学法检测特异性为93.2%,敏感性为31.2%,与尿细菌培养结果比较,差异有统计学意义(P<0.05)。UF-100尿沉渣分析结果阳性52例,灵敏度为81.8%,特异度为73.3%。尿沉渣分析联合尿干化学法检查结果为阳性44例,阴性40例,特异度为71.9%,灵敏度为93.6%。定量尿细菌培养阳性49例,阴性39例,差异无统计学意义(P>0.05)。结论 UF-100型全自动尿沉渣分析仪联合尿干化学分析仪使用可作为肿瘤患者尿路感染诊断的重要辅助指标,有重要临床意义。     

Prognostic variables in patients with upper urinary tract cancers

Background We conducted a retrospective analysis of patients with upper urinary tract cancers in order to examine the usefulness of some clinicopathological factors as prognostic predictors. Methods Between January 1985 and December 1994, 74 patients underwent surgical treatment for primary upper urinary tract cancers. Clinicopathological patient data were examined based on the criteria of The Japanese Urological Association. Results In this series, 40 tumors were located in the renal pelvis, 30 in the ureter, and 4 in both the renal pelvis and ureter. Associated bladder cancers were found in 27 patients. Histopathological examination revealed that the tumor grade was grade 1 or grade 2 in 45 patients and grade 3 in 29 patients; the pathological stage was Ta or T1 in 36 patients, and T2, T3 or T4 in 38 patients. Vascular invasion was found in 34 patients. The 5-year survival rates were 53% for all patients, 73% for patients with grade 1 and 2 tumors, and 28% for those with grade 3 tumors (P<0.0005) 70% for patients with stage Ta and T1 tumors, and 36% for those with stage T2, T3, and T4 tumors (P<0.005); 89% for patients without vascular invasion and 0% for those with vascular invasion (P<0.0001). Multivariate analysis revealed a strong independent correlation of vascular invasion with poor prognosis. Conclusions Tumor grade, pathological stage, and vascular invasion were significantly important prognostic parameters in patients with upper urinary tract cancers, and among them only vascular invasion was an independent predictor of poor prognosis.     

Upper urinary tract hypertrophy of the solitary kidney

17 dogs were examined 1 and 3 months, 1-1.5 years after unilateral nephrectomy. It was found that compensatory hypertrophy develops not only in the parenchyma of the remaining kidney but in the upper urinary tracts as well. 1 month after the nephrectomy ureteral activity for urine evacuation enhanced as compared to its preoperative activity. 3 months and 1-1.5 years after the nephrectomy ureteral performance remained elevated. High performance was supported due to increased amplitude of the contractions and their prolongation. Frequency of the contractions reduced. Basal and peristaltic pressure in the ureter, as a rule, rose. Diuretic lazix load 3 months after nephrectomy and more led to higher elevation of the intraureteral pressure. Ureteral wall lock in contraction promoting active urinary transport was observed whereas this locking mechanism before nephrectomy was decompensated even in lower intraureteral pressure. Ureteral hypertrophy was followed by negative effects such as defective generation and conduction of excitation through the ureter, higher incidence of endogenous infection in the urinary tracts.     

A case of a primary localized amyloidosis (amyloid tumor) of the renal pelvis and ureter

A 62-year-old woman complaining of asymptomatic hematuria was hospitalized. Although a cytologic examination of the urine was negative, abnormal findings in the right renal pelvis by DIP, RP and CT led us to suspect a pelvic tumor, and a right nephroureterotomy was performed. Light microscopy revealed deposits of amorphous, eosinophilic material in the pelvis and proximal portion of upper ureter, however tumor cells were not found. Electron microscopy revealed that these materials were aggregates of linear, non-branching fibrils, measuring about 8 nm in diameter. Histochemically, these were seen to be consistent with amyloid, producing an apple-orange birefringence with Congo red staining under a polarized light. Alkali Congo red staining after pretreatment of KMnO4 demonstrate that this amyloid protein was composed largely of AA protein in addition to lesser amounts of non-AA protein, and a primary localized amyloidosis (amyloid tumor) was diagnosed. A clinicopathologic study that was performed on 12 cases of primary localized amyloidosis of the pelvis, including our case, also is reported.     

Synchronous bilateral ureteral and renal pelvic carcinomas: incidence, etiology, treatment and outcome

BACKGROUND: Synchronous bilateral urothelial tumors of the upper urinary tract are very rare. The authors reported baseline and long-term follow-up data for all patients in western Sweden during a 28-year period. METHODS: The authors performed a clinical and histopathologic study of all patients in western Sweden who were diagnosed with a malignant neoplasm in the renal pelvis or ureter between 1971 and 1998. RESULTS: Of 936 patients, 15 (1.6%) had synchronous bilateral tumors. The incidence of such tumors decreased in each successive decade. Abuse of phenacetin-containing analgesics by patients also decreased during the study period, as did the incidence of renal papillary necrosis. The median age at diagnosis of bilateral tumors was 68 years, and 80% of the patients were male. Eleven patients had bilateral tumors of the renal pelvis, two had bilateral ureteral tumors, and two had tumors of the renal pelvis and contralateral ureter. Partial renal pelvic, ureteral, or kidney resection on at least one side was possible in eight patients, and four patients were left untreated on at least one side. Only three patients underwent bilateral nephroureterectomy. Twelve patients (80%) had bladder carcinoma diagnosed either before or after diagnosis of the upper tract tumors. The median survival period for the 11 patients who received surgery for their bilateral tumors was 84 months. CONCLUSIONS: The decreasing incidence of synchronous bilateral upper tract tumors may be related to the prohibition of phenacetin-containing analgesics in the 1960s. Partial resection with preservation of the renal parenchyma was possible in the majority of patients. Survival for patients with bilateral tumors did not differ from that of patients with unilateral tumors.     

Quelle place pour la radiothérapie et la chimiothérapie dans le traitement adjuvant des carcinomes urothéliaux des voies excrétrices urinaires supérieures ?

Urothelial carcinomas of the upper urinary tract are rare entities. Surgery remains the mainstay of the management. The use of others therapeutic modalities is not clearly defined yet. However, the frequency of local recurrence and locoregional encourage us to evaluate the indication of adjuvant therapies. We conducted a synthesis of key data in the literature on the use of chemotherapy and radiotherapy in the treatment of urothelial carcinoma of the renal pelvis and ureter. A literature search on PubMed was performed using the following keywords (MeSH) “urothelial carcinoma”, “upper urinary tract”, “radiation”, “chemotherapy”, and adjuvant.     

6种根治性肾盂、输尿管尿路上皮癌的手术方式比较研究

背景与目的：根治性肾盂输尿管癌手术方式多种多样,每种手术方式各有优缺点,选择何种手术方式进行治疗仍有争议,该研究选择了6种根治性肾盂输尿管癌的手术方式,探讨不同术式的安全性及有效性。方法：回顾性分析2002年1月—2013年10月吉林省延吉市延边大学医院收治的135例肾盂及输尿管癌患者的临床资料,比较6种手术方式的各项指标,包括手术时间、出血量、术后肠道功能恢复时间、术后再发膀胱癌概率和术后生活质量评分差异等情况。结果：A、B组均顺利完成手术,C组5例因输尿管残端未能完全拖出而更改为A组手术方式,D组2例因输尿管残端未能完全拖出而更改为A组手术方式,E组因术区黏连或术中出血,3例更改为D组手术方式,1例更改为A组手术方式,F组1例因术中出血更改为A组手术方式,各种手术方式术后生存率比较差异无统计学意义。结论：6种治疗肾盂输尿管癌的手术方式均安全有效,但各有优缺点,临床上需根据具体情况选择不同手术方式。     

Papillary Ureteral Neoplasm of Low Malignant Potential in the Upper Urinary Tract: Endoscopic Treatment

IntroductionPapillary ureteral neoplasm of low malignant potential (PUNLMP) is a rare diagnosis, and to our knowledge, has not yet been reported in the upper urinary tract. In this study, we aimed to present our experience in managing a very rare diagnosis, PUNLMP, in the upper urinary tract, with endoscopic treatment.Materials and MethodsFiles of patients who received surgery between January 2007 and January 2013 for upper urinary tract tumors were reviewed and patients treated for PUNLMP in the upper urinary tract in 4 urology clinics were reviewed. Patients included in the study had at most 2 tumors in the ureter and had a pathology of PUNLMP.ResultsThe study included 11 patients with a mean age of 58.5 years. There were 9 men, and 2 women with a smoking rate of 81.8%. Nine patients (8 in the distal and 1 in the mid ureter) were managed using a semirigid ureteroscope. Two patients (1 with mid ureteral and 1 proximal) were treated using flexible ureteroscopy. The mean hospital stay was 1.56 days. Mean surgical time was 37.18 ± 7.14 minutes. The mean follow-up was 31.5 (range, 7-72) months. In the follow-ups, 3 patients had recurrences of 3, 2, and 4 mm in 9, 15, and 17 months, respectively.ConclusionFor tumors with a low risk of progression and relatively low risk of recurrence, organ-sparing treatments should be the choice of preference. To support our initial findings, randomized controlled studies on larger cohorts should be designed.     

组织蛋白酶D在肾盂输尿管移行细胞癌中表达的意义

目的：探讨组织蛋白酶D在上尿路移行细胞癌中表达的临床意义。方法：应用免疫组织化学ABC法，对组织蛋白酶D在43例肾盂、输尿管移行细胞癌中的表达进行检测。结果：肿瘤细胞阳性表达19例（44．2％）；间质细胞阳性表达14例（32．6％）。两表达与肿瘤分级、分期无显差异（P＞0．05）。间质细胞组织蛋白酶D阳性表达的患术后肿瘤复发明显高于阴性表达（P＜0．05），且5年生存期明显低于阴性表达（P＜0．05）。结论：上尿路移行细胞癌间质细胞组织蛋白酶D的检测，对术后肿瘤复发、生存期的判断具有一定的临床价值，可能用作判断预后的指标之一。     

Change of pressure in renal pelvis in acute and chronic course of pyelonephritis

We studied urodynamics of the upper urinary tract in a different course of renal inflammation with consideration of the drainage method. Pressure in the renal pelvis was measured in 64 patients with acute obstructive and non-obstructive, and chronic pyelonephritis in different time of establishment of surgical or transcutaneous puncture nephrostomas and ureteral catheters. We assessed changes in intrapelvic pressure in respiratory (regular and forced respiration) and orthostatic (lying, sitting, standing positions) functional tests. The autonomic status of the body was evaluated by parameters of the spectral analysis of heart rate variability. We have found that intrapelvic pressure increases with progression of renal inflammation. Dynamics of the above indices in patients with acute non-obstructive and obstructive pyelonephritis versus patients with renal colic in the absence of evident inflammation allowed us to specify mechanisms of pressure formation in renal pelvis including inflammatory edema of the parenchyma and nervous-reflectory links of upper urinary tract regulation. Pressure in the renal pelvis may serve an important diagnostic criterion in choice of renal drainage method in pyelonephritis and criterion of inflammation course prognosis.     

上尿路肿瘤术后再发膀胱癌的危险因素分析

目的：探讨上尿路肿瘤术后再发膀胱癌的因素。方法：采用回顾性研究对上尿路肿瘤76例进行总结。结果：术后膀胱癌再发率36％（27／76），70％（19／27）发生于术后2年。多器官性肿瘤者的再发率69％（11／16）高于单发肿瘤者的27％（16／60）。输尿管下段肿瘤者的再发率50％（8／16）高于肾盂输尿管上段者的18％（8／44）。Ⅱ-Ⅲ级、T3者再发率高。未切除患侧输尿管口周围膀胱壁的再发率49％（21／43），高于肾输尿管膀胱部分切除术的18％（6／33）。结论：上尿路肿瘤的部位、多器官性、病理分级、分期是术后膀胱癌再发的危险因素，切除输尿管口周围膀胱壁是防止再发的关键。     

Effects of pressure and flow rate of irrigation liquid on hydrodynamics of the upper urinary tract in contact ureterolithotripsy

We studied the influence of pressure and rate of irrigative liquid flow on hydrodynamics of the upper urinary tracts in contact pneumatic lithotripsy (Litoclast lithotriptor) in 68 patients with ureteroliths and nephrostomic drainage. To a nephrostome the device was attached on which the linear change of pressure inside the pelvis was measured at the moment of visualization of the stone, its destruction and final ureteroscopy. 45 patients had nephrostome with a pelvis curl. In this group of patients at the moment of stone destruction the pressure inside the pelvis and the speed of irrigative flow were increased. In patients with marked local inflammation on the place of stone location the pressure inside the pelvis was the highest. The effect of communicating vessels was seen. The stone was completely destroyed in 34 (75.5%) patients, in 9 (20%) patients the stone was destroyed partially. In 2 cases the stone migrated in the cavitary system of the kidney. A nephrostome-intubator was placed antegradely in 23 patients. The balloon-obturator was placed in the ureter above the stone through the nephrostome. The pressure inside the pelvis during contact lithotripsy was not increased. Full destruction of the stone was achieved in 26 patients (92.8%), migration of the stone in the cavitary system and partial destruction of the stone was observed in 2 (2.2%) patients.