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1.
We report 54 patients with urothelial tumors in upper urinary tract admitted to our hospital between July, 1962 and December, 1985. The patients consisted of 38 males and 16 females; side their ages ranged from 47 to 88 years with a mean of 63.4 years. The affected side was the right side in 21 cases, and the left side in 33 cases. Macro-or microhematuria was observed in 87% of the patients. Pathologically, 53 of the patients had transitional cell carcinoma and 1 had papilloma. Six patients had a past history of bladder tumor. Simultaneous bladder tumor was identified in 10 cases. Vesical recurrence was observed in 5 cases. Total nephroureterectomy with bladder cuff resection was employed as the surgical method in 21 cases, and total nephrectomy without bladder cuff resection in 11 patients. The actual five-year survival rate was 53% for all the patients; 52% for patients with renal pelvic tumors, 75% for those with ureteral tumors and 15% for those with renal pelvic and ureteral tumors. The patients who received nephroureterectomy had a postoperative survival rate similar to that of those who received nephroureterectomy with bladder cuff resection. A simultaneous bladder tumor lowered the survival rate.  相似文献   

2.
目的 分析低分期肾盂及中上段输尿管尿路上皮癌行根治性肾切除术与经典肾盂癌根治性手术后肿瘤复发率的差异,探讨低分期上尿路上皮癌患者不行膀胱袖状切除的可行性.方法 回顾性分析2000-2007年收治73例上尿路上皮癌患者的资料.男36例,女37例.平均年龄66(45~87)岁.其中肾盂癌46例,中上段输尿管癌27例.根据术式分为经典肾盂癌根治性手术组(35例)和根治性肾切除组(38例).分析2组患者病理及随访结果,比较2组患者术后复发率的差异.结果 经典肾盂癌根治性手术组肿瘤复发8例(22.9%),其中T1患者复发率20.0%(3/15);根治性肾切除组肿瘤复发8例(21.1%),其中T1患者复发率19.0%(4/21),2组总复发率和T1肿瘤复发率差异无统计学意义(P>0.05).经典肾盂癌根治性手术组19例肾盂癌中,肿瘤复发4例(21.1%);16例中上段输尿管癌中,肿瘤复发4例(25.0%),2组肿瘤复发率差异无统计学意义(P>0.05).根治性肾切除组27例肾盂癌中,肿瘤复发3例(11.1%);11例中上段输尿管癌中,肿瘤复发5例(45.5%),2组肿瘤复发率差异有统计学意义(P<0.05).结论 低分期上尿路上皮癌患者可不行膀胱袖状切除术,但肿瘤位于输尿管者应行膀胱袖状切除术.  相似文献   

3.
PURPOSE: We report our experience with hand assisted laparoscopic (HALS) nephroureterectomy and describe the associations of preoperative, operative and pathological factors with outcome. MATERIALS AND METHODS: HALS nephroureterectomy was performed in 54 consecutive patients using modified transurethral resection of the ureteral orifice (TURUO) or a 1 port transvesical endoscopic cuff technique for the distal ureter in all except 8. Data were collected prospectively and retrospectively, and followup was distinguished for bladder, contralateral upper tract and nonurothelial (local recurrence and distant metastases) sites. RESULTS: The endoscopic cuff was associated with significantly shorter mean operative time than the transurethral resection of the ureteral orifice method (234 vs 295 minutes, p = 0.002) but the comparison was confounded by the effect of experience. With 28% of patients having stage II or greater tumors and 49% having high grade bladder disease, contralateral upper tract and nonurothelial recurrences developed in 55%, 11% and 25% of evaluable patients at a median followup of 25.1, 24.4 and 24.9 months, respectively, in those without recurrence. At a median followup of 25.0 months cancer specific survival was 94%, 86% and 80% at 1 to 3 years, respectively. Three-year cancer specific survival was 100% in patents with grade 1 or 2, or stage 0 or I tumors but only 57% and 36% in patients with grade 3 and stage II or IV tumors, respectively. CONCLUSIONS: HALS nephroureterectomy is associated with 3-year outcomes that are strongly associated with stage and grade. We prefer the endoscopic cuff method for the distal ureter because it is performed after nephrectomy, does not require patient repositioning and is expedient.  相似文献   

4.
The 15 cases of the primary ureteral tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The incidence of primary ureteral tumors among the outpatients in our urologic clinic was 0.15%. The patients ranged in age from 50 to 75 years old (average: 65.5 years old). There were 11 males and 4 females, the ratio being 2.8:1.0. The right ureter and the lower third of the ureter were involved more frequently than other areas. The most frequent symptom was macrohematuria which was seen in 12 cases (80%). The major finding of IVP was non-functioning kidney, which was seen in 11 cases (73.3). Positive urinary cytology was obtained in 9 cases (60%). Twelve patients underwent nephroureterectomy with bladder cuff or total cystectomy. Histologically, all cases were transitional cell carcinoma. Simultaneous urothelial tumors were seen in the bladder in 4 cases (26.7%). The over-all actual survival rates at 1, 3 and 5 years were 59%, 42%, 42%, respectively. The 5-year actual survival rate was 63% for the low grade group and 0% for the high grade group. The 5-year actual survival rate was 82% for the low stage group and 0% for the high stage group. Among several factors, grade and stage of the tumor were the most influencing factors for prognosis.  相似文献   

5.
PURPOSE: Transitional cell carcinoma is the most common urinary tract cancer in Taiwanese patients on dialysis. It is a unique finding compared within Western countries. Due to this geographic difference and a higher recurrence rate a more extensive operation and aggressive followup protocols should be refined for these patients on dialysis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all patients with transitional cell carcinoma who had end stage renal disease and underwent hemodialysis. Records were reviewed for hemodialysis duration, initial tumor location, tumor grade, stage, operative method, operative complication and final surgical status. Tumor grade and stage was determined by the WHO and proposed Jewett systems. Six patient groups were classified according to final surgical status for comparative analysis. RESULTS: A total of 30 patients were included in this study. Painless gross hematuria and urethral bloody discharge were the most common complaints. Tumor in 25 of the 30 cases was high grade and all were early stage. Of the patients 11 (36.7%) had undergone bilateral nephroureterectomy and radical cystectomy in as a 1 or multiple step procedure. Six patients (20%) had undergone bilateral nephroureterectomy at 1 or 2 sequential operations. Seven of the 13 patients (53.8%) in whom low urinary tract transitional cell carcinoma was initially treated with transurethral resection unfortunately had recurrent transitional cell carcinoma of the upper urinary tract. Ten of the 14 patients (71.4%) with upper urinary tract transitional cell carcinoma who underwent nephroureterectomy and bladder cuff excision had subsequent transitional cell carcinoma within the bladder. CONCLUSIONS: Patients with transitional cell carcinoma on dialysis had a higher recurrence rate in the upper urinary tract than patients not on dialysis. Most cases were at an early stage but with high grade tumor behavior. In 11 patients (36.7%) total exenteration of the urinary tract except the urethra was eventually done. The final bilateral nephroureterectomy rate was 56.7%. Since the rate of total exenteration and bilateral nephrectomy was abnormally high at such a short followup, 1-step bilateral nephroureterectomy and radical cystectomy are a recommended treatment for patients with transitional cell carcinoma on dialysis.  相似文献   

6.
目的:探讨后腹腔镜肾输尿管全长与膀胱袖状切除的最佳手术方式.方法:对110例肾盂或输尿管癌伴膀胱癌患者采用三种不同术式行肾输尿管全长及膀胱袖状切除术:A术式即后腹腔镜肾输尿管全长切除+下腹部切口膀胱壁内段袖状切除术,共行32例 B术式即后腹腔镜肾输尿管全长切除+经尿道电切膀胱袖状切除+经腹部切口取肾术,共行19例 C术式即经尿道电切膀胱袖状切除+后腹腔镜肾输尿管全长切除+经腹部切口取肾术,共行59例.结果:手术经过均顺利.三种术式的手术时间、术中出血量、平均住院时间差异无统计学意义.围手术期死亡3例.出院后获定期随访58例,随访8~85个月,平均38.3个月,46例失访.因肿瘤转移死亡4例,因气胸、脑血管病死亡各1例.三种术式术后早期并发症、对侧病变、膀胱痛复发情况差异无统计学意义 但C术式术后死亡及转移例数较少.结论:肾盂或输尿管癌伴膀胱癌者可优先选择经尿道电切膀胱袖状切除+后腹腔镜肾输尿管全长切除+经腹部切口取肾术,而仅有肾盂或输尿管癌者可考虑行后腹腔镜肾输尿管全长切除+下腹部切口膀胱壁内段袖状切除术.  相似文献   

7.
PURPOSE: We document recurrence and survival following laparoscopic radical nephroureterectomy (LNUX) for upper tract transitional cell carcinoma (TCC) using primarily 2 methods of managing the bladder cuff. MATERIALS AND METHODS: The records of 60 patients undergoing LNUX at our institution for upper tract TCC were reviewed retrospectively. En bloc excision of the bladder cuff was primarily performed transvesically by our described cystoscopic secured detachment and ligation method (CDL) or extravesically using a laparoscopic stapling device (LS). RESULTS: Median followup was 23 months (range 1 to 45). Recurrence developed in 27%, 7% and 12% of cases in the bladder at a median of 5 months, retroperitoneum at 8 months and distant sites at 8 months, respectively. Compared to the novel CDL technique LS resulted in a higher positive margin rate (p = 0.046). Overall survival correlated with bladder recurrence (p = 0.003), upper tract TCC stage (p = 0.01) and method of bladder cuff control when comparing CDL vs LS (p = 0.04). Freedom from recurrent upper tract disease was related to pathological stage (p = 0.015) and bladder cuff excision method (p = 0.02). CONCLUSIONS: These data underscore the aggressive nature of high stage, high grade upper tract TCC and validate the importance of complete excision of the distal ureter and bladder cuff during LNUX. In patients without coexisting bladder tumor the CDL method, which allows formal bladder cuff excision in a secured manner akin to that of established open surgical principles, appears oncologically valid.  相似文献   

8.
The 15 cases of the primary renal pelvic tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The patients ranged in age from 41 to 74 years old (average: 58.3 years old). There were 11 males and 4 females, the ratio being 2.8:1.0. The affected side was left in 9 cases and right in 6 cases. The most frequent symptom was macrohematuria, which was seen in 12 cases (80%). The major finding of IVP was non-functioning kidney, which was seen in 8 cases (53.3%). Positive urinary cytology was obtained in 8 cases (53.3%). As the surgical method, total nephroureterectomy with bladder cuff was performed in 8 cases, nephroureterectomy in one case and nephrectomy in 6 cases. Histologically, 14 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumors were seen in the bladder of 2 patients. A subsequent ureteral tumor was found in one of the 7 cases in which ureters were resected incompletely, and subsequent bladder tumors were found in 8 of the 15 cases receiving surgical treatment in the follow-up period. All of tumors were found within 2 years after operation. Over-all actual survival rates at 1, 3 and 5 years were 87%, 67%, 48%, respectively. Three and 5 year actual survival rates were 100%, 100% respectively for the low stage group and 59%, 29% respectively for the high stage group. Three and 5 year actual survival rates were 100%, 78%, respectively for the low grade group and 44%, 27% respectively for the high grade group. Among several factors, stage and grade of the tumor were the most influencing factors for prognosis.  相似文献   

9.
OBJECTIVE: To report the oncological outcome of retroperitoneoscopic nephroureterectomy (RNU) with bladder cuff excision for upper urinary tract transitional cell carcinoma (TCC), and to compare the outcome with that of the traditional open nephroureterectomy (ONU). PATIENTS AND METHODS: From January 2001, 48 patients with upper urinary tract TCC were enrolled in the study; 25 had RNU and 23 had ONU. Oncological parameters (disease-free survival and disease-specific survival) were calculated from the time of surgery to the date of last follow up and were analysed by the Kaplan-Meier method. RESULTS: Mean follow up was 24.3 months in the RNU group, significantly shorter than in the ONU group. Bladder recurrence was identified in two patients with grade 3 pathological stage pT3, one patient with grade 3 stage pT2 disease and two patients with grade 2 stage pT2 disease. Multiple organ metastases in the lung, liver and lymph nodes were associated with bladder recurrence in two cases (grade 2 stage pT3, and grade 3 stage pT3). The recurrence rate was 20% (5 of 25 cases) and mean time to recurrence was 9.5 months. In the ONU group, bladder recurrence and metastases developed in four and three patients, respectively. The recurrence rate was 17% (4 of 23 cases) and mean time to recurrence was 23.4 months. No significant difference was detected in the disease-free survival rate and cancer-specific survival rate between the two groups (P=0.759 and P=0.866, respectively). CONCLUSION: The oncological outcome of RNU appears to be equivalent to that of ONU. Moreover, long-term follow up is necessary to evaluate the oncological outcome in comparison to ONU.  相似文献   

10.
BACKGROUND: A 72-year-old man was admitted with gross hematuria. Investigations revealed bilateral renal pelvic tumors. METHODS/RESULTS: Via a midline incision, left nephroureterectomy with bladder cuff resection was performed for the large left-sided tumor. The right small solitary right-sided tumor was endoscopically resected simultaneously. Histologically, both tumors were grade 2 transitional cell carcinomas without muscular invasion. CONCLUSION: There has been no evidence of recurrence or metastasis 30 months postoperatively.  相似文献   

11.
目的 探讨后腹腔镜联合经尿道电切镜治疗上尿路移行细胞癌的效果和安全性. 方法 2003年3月~2006年7月,我院采用后腹腔镜联合经尿道电切镜治疗83例上尿路移行细胞癌.经尿道袖状电切患侧输尿管口周围1.5 cm范围膀胱壁达膀胱外脂肪组织,采用后腹腔镜切除肾及全长输尿管.术后留置导尿管7 d.11例术后辅助放疗. 结果 83例手术均成功.手术时间115~205 min,平均156 min.术中出血50~150 ml,平均80 ml.无术中并发症.术后住院7~11 d,平均8.5 d.病理报告:82例上尿路移行细胞癌,1例肾盂上皮中~重度不典型增生.术后随访3~38个月,平均10.8月.术后12个月内行膀胱镜检查发现膀胱肿瘤6例,其中5例行经尿道膀胱肿瘤电切,1例行腹腔镜根治性膀胱全切术、左侧输尿管皮肤造口术.2例肾盂肿瘤(pT3 G3和pT2 G3)于术后3个月肝转移.2例输尿管中段肿瘤(pT3 G3和pT3 G2~3)术后6个月原位复发并肺转移.1例输尿管下段肿瘤(pT3 G3)术后6个月骨转移.失访1例.其余71例均未发现肿瘤复发、切口转移及远处转移. 结论 对于上尿路移行细胞癌,采用后腹腔镜联合经尿道电切镜行肾、输尿管全切及膀胱袖套状切除具有创伤小、安全、恢复快等优点,值得临床推广应用.  相似文献   

12.
再次经尿道电切术治疗非肌层浸润性膀胱癌   总被引:2,自引:0,他引:2  
目的 总结再次经尿道电切术(Re-TUR)治疗非肌层浸润性膀胱癌的疗效.方法 2004年3月至2008年8月共收治462例非肌层浸润性膀胱癌,男性350例,女性112例,年龄35~83岁.在初次经尿道电切术后根据肿瘤分期和分级,以及标本有无肌层组织进行评估,有125例患者在术后4~6周行Re-TUR,其中Ta期49例,T1期76例;低级别癌58例,高级别癌67例;T1期肿瘤标本内未见肌层组织30例.结果 125例非肌层浸润性膀胱癌患者行Re-TUR,34.4%(43/125)发现有肿瘤残留,其中35例肿瘤未侵犯肌层,Ta期15例,T1期20例;8例肿瘤侵犯肌层.高级别癌的肿瘤残留率较低级别癌高(P<0.05);初次电切标本中无肌层的肿瘤残留率较有肌层的高(P<0.05).12例(9.6%)患者在初次电切术时肿瘤分期被低估.Re-TUR术中发生膀胱穿孔6例,膀胱出血7例.随访3~56个月;Re-TUR发现肿瘤残留的患者,37.2%(16/43)复发,高于Re-TUR未发现肿瘤残留的患者(12.2%,P<0.05).结论 T1期、高级别或初次电切标本无肌层的非肌层浸润性膀胱癌患者术后4~6周应行Re-TUR.Re-TUR能提高分期的准确性.  相似文献   

13.
原发性输尿管恶性肿瘤(附14例报告)   总被引:8,自引:0,他引:8  
1975~1994年诊治原发性输尿管恶性肿瘤14例,其中移行细胞癌13例,腺癌1例。病程3天~9年,平均11.5个月。A期3例,B期5例,C期3例,D期2例。手术治疗13例,5年存活率35.71%(5/14)。对本病的诊断、治疗和预后进行了讨论。  相似文献   

14.
目的 探讨后腹腔镜下肾输尿管切除加经尿道膀胱袖状切除治疗上尿路上皮癌的临床效果.方法 上尿路上皮癌患者82例(肾盂癌69例,输尿管癌13例).男39例,女43例.平均年龄65(37~82)岁.电切镜经尿道膀胱袖状分离输尿管管口及壁内段,后腹腔镜下切除肾、输尿管.观察手术时间、术中出血量、引流管留置时间、尿管留置时间、术后住院日及术后并发症等.随访肿瘤转移与复发情况.结果 82例手术顺利.手术平均时间135(95~210)min.术中平均失血110(60~260)ml.术后引流管平均留置3(2~4)d.尿管平均留置6(5~7)d.术后平均住院7(6~9)d.74例患者获随访平均31(6~76)个月.高级别浸润性癌随访16例,复发转移3例;高级别与低级别非浸润性癌分别随访29例,膀胱内复发5例(高级别3例,低级别2例);切口部位肿瘤转移复发1例.3年随访肿瘤复发率为10.6%(5/47).结果 后腹腔镜下肾输尿管切除加经尿道膀胱袖状切除治疗上尿路上皮癌,输尿管口周围组织及输尿管壁内段切除确切,创伤小、康复快,手术安全易行,疗效可靠.  相似文献   

15.
原发性输尿管肿瘤的外科治疗   总被引:20,自引:0,他引:20  
分析24例输尿管肿瘤外科治疗结果。83%的患者有肉眼血尿。约20%的患者同时有同侧输尿管或肾盂肿瘤。施行手术23例,包括肾输尿管全长切除10例,肾及部分输尿管切除6例,部分输尿管切除及输尿管膀胱再植4例,部分输尿管切除及端端吻合2例。18例随访5~34个月。术后继发膀胱肿瘤7例,4例死于肿瘤远处转移。认为低级低期肿瘤可采用保守性开放手术或内窥镜手术,浸润性高级期肿瘤则应作肾输尿管全长切除术。术后必须长期随访包括膀胱镜、B超及CT等检查。  相似文献   

16.
OBJECTIVE: To report a multicenter analysis after laparoscopic radical nephroureterectomy for pathologically confirmed upper tract transitional cell carcinoma. MATERIALS AND METHODS: A total of 116 patients (72 males; mean age 68 years) underwent laparoscopic radical nephroureterectomy at five international institutions: 51 transperitoneally, 65 retroperitoneally. Location of the primary tumor was pelvicalyceal in 70 patients (60%), ureteral in 27 (23%), and multifocal in 19 (17%). In 18 patients (15%), transurethral resection was performed for concomitant bladder tumor. The median follow-up time was 25 months (range 3-93). A minimum follow-up of 1 and 2 years was available in 77 and 41 patients, respectively. RESULTS: Five patients (4%) were converted to open surgery. The specimen was extracted intact in all 116 patients: using an Endocatch bag in 78 patients, a Lapsac in 5, and manually in 33. Pathologic staging was pTis in 5 (4%), pTa in 41 patients (35%), pT1 in 31 (26%), pT2 in 18 (15%), pT3 in 16 (13%), and pT4 in 5 (4%). Pathological grade was grade I in 26 patients (23%), grade II in 41 (35%), grade III in 34 (29%) and grade IV in 15 (12%). Histopathology revealed a positive surgical margin in five patients (4.5%): renal hilum (one), periureteral soft tissue (two), distal edge of the ureter/ bladder cuff (two). Local recurrence was noted in two patients (1.7%). Bladder recurrence was noted in 28 patients (24%) with a mean time to recurrence of 13.9+/-11.5 months. Distant metastases occurred in 11 patients (9%): lung (5), liver (3), bones (2), adrenal (1); mean time to metastasis was 13 months. Overall, 23 patients (20%) died. One-year and 2-year cancer-specific survival was 92% and 87%, respectively. Two-year cancer-specific survival according to pathologic stage was 89% for patients with pT1 disease, 86% for pT2, 77% for pT3, and 0% for pT4 (p=0.0001). Two-year survival according to pathologic grade was 88% for grade I, 90% for grade II, 80% for grade III, and 90% for grade IV (p>0.05). CONCLUSION: Laparoscopic radical nephroureterectomy appears to be an effective minimally invasive treatment for select patients with upper tract transitional cell carcinoma. Although the 2-year survival data reported herein are encouraging, longer follow-up is needed before laparoscopy can be considered as a standard treatment.  相似文献   

17.
PURPOSE: We studied prognostic factors for 5-year disease specific and recurrence-free survival in patients treated for upper urinary tract transitional cell carcinoma. MATERIALS AND METHODS: Since July 1987, 72 patients with a mean age of 58.9 years have undergone nephroureterectomy with bladder cuff excision. Median followup was 62.2 months (range 6 to 192). Patient age, sex, detection duration and mode, bladder tumor history, smoking habit, stone disease history, and tumor stage, grade and location were evaluated as prognostic factors. RESULTS: Overall 5-year disease specific and recurrence-free survival rates were 74.9% and 67.8%, respectively. Univariate analysis revealed anemia, positive bladder tumor history, T stage, grade and tumor location in the upper tract as significant prognostic factors. On multivariate analysis T stage, grade and tumor location in the urothelium were the only significant variables for the 5-year disease specific and recurrence-free survival rates. CONCLUSIONS: High tumor stage and grade, and ureteral location were significantly associated with worse disease specific and recurrence-free survival in patients with upper urinary tract transitional cell carcinoma. Our results may help define the patient groups that need adjuvant therapy and they may form a basis for further controlled studies.  相似文献   

18.
OBJECTIVE: The objective of this study was to define recurrence patterns after nephro-ureterectomy (NU) for urothelial upper tract tumor (UUTT), and to suggest guidelines for follow-up. METHODS: The effects of age, gender, UUTT grade, stage, size, location in the urinary system, and the administration of adjuvant chemotherapy on disease-free survival were assessed retrospectively. RESULTS: Fifty-three patients (mean age 62.7 years) underwent NU for UUTT and were followed with periodic cystoscopy, urinary cytology, and CT of the chest and abdomen. During a median follow-up period of 72 months, 26 patients (49%) developed tumor recurrence. Almost 95% of the recurrences occurred within the first 48 months following surgery. Two distinct patterns of recurrence were identified: vesical and extra-vesical recurrences. Vesical recurrence occurred in 19 patients (35.8%) and did not impair survival. The risk of vesical recurrence was independent of UUTT grade or stage. Patients who had Grades 1 or 2 UUTT developed only low-grade vesical recurrence, while patients with Grade 3 UUTT developed either high- or low-grade vesical recurrences. Extra-vesical recurrence occurred in 8 patients (15.1%); all had an initial Grade 3 UUTT, and were associated with short median survival. CONCLUSIONS: Patients presenting with Grades 1 or 2 UUTT are at risk of developing low-grade bladder tumors. Therefore, cystoscopic surveillance is recommended. Patients presenting with Grade 3 UUTT are at risk of developing both high- and low-grade bladder tumors as well as extra-vesical recurrence. An aggressive multimodality program including cystoscopy, urinary cytology, and CT of the chest and abdomen is advisable.  相似文献   

19.
AIM: Reports specifically addressing transitional cell carcinoma (TCC) of the ureteral orifice are scarce. This paper presents our experiences of such tumors, including the characteristics of the disease and the incidence of subsequent upper urinary tract recurrence. METHODS: This study included 572 new cases of TCC of the urinary bladder diagnosed in our institute during a period of 5 years. Thirty-one (5.4%) patients had superficial tumors involving ureteral orifices. All 31 patients underwent transurethral resection of the bladder tumors, including the involved ureteral orifices. After the surgery, patients received regular follow up with cystourethroscopy, urine cytology and periodic intravenous pyelography (IVP). Ureterorenoscopy was performed in cases of suspicious IVP or urine cytology findings. RESULTS: Thirty-one patients with superficial tumors involving the ureteral orifice were followed up for 5-8 years or until death. The pathological stage was Ta in 16 cases and T1 in 15 cases. Bladder tumor recurrence was noted in three (18.8%) of the pTa patients and in seven (46.7%) of the pT1 patients. Subsequent upper urinary tract tumors developed in four (12.9%) patients between 33 and 67 months (mean: 33.5) after the first transurethral resection. All four cases of upper tract recurrence had pT1 primary bladder tumor, which recurred for 1-3 times (mean 1.8) before upper tract recurrence. None of these patients had ureteral stenting after bladder tumor resection. Three of four patients with upper tract recurrence had single lower ureteral tumor, while the remaining one patient had multiple tumors. Patients with subsequent upper urinary tract tumors underwent nephroureterectomy and bladder cuff excision. One died of the disease; the other three cases were free of the disease after the therapy. CONCLUSIONS: Patients with primary superficial bladder transitional cell carcinoma involving the ureteral orifice have a higher risk of developing subsequent upper urinary tract tumors, particularly for pT1 primary bladder tumors. Frequent and close follow up is recommended.  相似文献   

20.
PURPOSE: We present the long-term outcome of percutaneous resection of renal urothelial tumor. MATERIALS AND METHODS: A total of 24 patients underwent primary percutaneous resection of renal urothelial tumor. Patients with low stage pT0-1 disease were treated primarily with percutaneous surgery. All pelvicaliceal tumors were taken for biopsy and treated with percutaneous resection. Patients with multi-segmental pelvicaliceal system involvement, stage greater than pT1, high grade histology or additional ureteral tumors were considered for nephroureterectomy. Topical chemotherapy (mitomycin C or epirubicin) was administered via nephrostomy tube or intravesical instillation after Double-J stent (Medical Engineering Corp., New York, New York) insertion. Surveillance included upper tract cytology, nephroscopy or fiberoptic ureterorenoscopy. Long-term followup was correlated with histopathology. RESULTS: Of the 24 cases 2 had squamous cell carcinoma, 5 had grade III transitional cell carcinoma, 15 had grade I to II transitional cell carcinoma and 2 had no tumor. Control was established with initial percutaneous resection in 18 (75%) cases and second look nephroscopy in 4. Early recurrences were detected by excretory urography (IVP) in 3 cases, small pelvic recurrences by IVP in 2, fiberoptic ureterorenoscopy in 2 and bladder tumors by flexible cystoscopy in 3 after 1 year. A total of 10 nephroscopies were performed in 5 cases, 24 flexible uretereorenoscopies in 9 and IVP in 6. Three synchronous, grade I bladder tumors were managed conventionally. All patients with high grade disease died of malignancy except one (with no further treatment) and 6 of the 15 patients with low grade noninvasive transitional cell carcinoma underwent nephroureterectomy during followup either due to progression of disease, concomitant tumor or complications. Two patients with solitary kidneys died of renal failure unrelated to malignancy. High grade tumors or tumors greater than T1 were treated with nephroureterectomy early during management. There was no perioperative mortality and 9 (60%) of the low grade cases the kidneys were preserved at a mean followup +/- SD of 64 +/- 15 months. All excised tracks from patients who underwent nephroureterectomy and the renal fossae were free of tumor on histopathological examination. CONCLUSIONS: Percutaneous resection of transitional cell tumor should be considered primarily in patients with early stage disease excluding tumors crossing caliceal infundibula, ureteropelvic junction tumor, tumor extending over multiple calices and synchronous ureteral tumors. The long-term outcome of low grade tumors is good and they should be managed by either form of minimally invasive surgery. Nephron sparing is possible in a large percentage of low grade disease but high grade tumors should be treated with nephroureterectomy.  相似文献   

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