Skip to main content

Ureteroscopic Management of Upper Tract Urothelial Carcinoma

  • Chapter
  • First Online:
Ureteroscopy

Abstract

Upper urinary tract urothelial carcinoma (UTUC) represents a difficult to treat oncologic entity. Although relatively uncommon, traditional treatment of UTUC with radical nephroureterectomy (RNU) with lymph node dissection is associated with potential significant morbidity and mortality. With advancements in technology over the last few decades “nephron- sparing” approaches have been developed. While this used to be only reserved for “imperative” indications, nephron-sparing approaches are now becoming more feasible for the everyday urologist. In this chapter, ureteroscopic management of UTUC is discussed in detail including diagnosis of UTUC, ureteroscopic management strategies, and surveillance. The authors also discuss their diagnostic algorithm and tips and tricks for successful ureteroscopic management of UTUC.

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

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover 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

Similar content being viewed by others

References

  1. Ploeg M, Aben KK, Kiemeney LA. The present and future burden of urinary bladder cancer in the world. World J Urol. 2009;27(3):289–93.

    PubMed  PubMed Central  Google Scholar 

  2. Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009;115(6):1224–33.

    PubMed  Google Scholar 

  3. Soria F, Shariat SF, Lerner SP, Fritsche HM, Rink M, Kassouf W, et al. Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World J Urol. 2017;35(3):379–87.

    PubMed  Google Scholar 

  4. Mandalapu RS, Matin SF. Contemporary evaluation and management of upper tract urothelial cancer. Urology. 2016;94:17–23.

    PubMed  Google Scholar 

  5. Pan S, Smith AD, Motamedinia P. Minimally invasive therapy for upper tract urothelial cell cancer. J Endourol. 2017;31(3):238–45.

    PubMed  Google Scholar 

  6. Roupret M, Babjuk M, Comperat E, Zigeuner R, Sylvester RJ, Burger M, et al. European Association of Urology Guidelines on upper urinary tract urothelial carcinoma: 2017 update. Eur Urol. 2018;73(1):111–22.

    PubMed  Google Scholar 

  7. Van Der Molen AJ, Cowan NC, Mueller-Lisse UG, Nolte-Ernsting CC, Takahashi S, Cohan RH. CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol. 2008;18(1):4–17.

    Google Scholar 

  8. Messer JC, Terrell JD, Herman MP, Ng CK, Scherr DS, Scoll B, et al. Multi-institutional validation of the ability of preoperative hydronephrosis to predict advanced pathologic tumor stage in upper-tract urothelial carcinoma. Urol Oncol. 2013;31(6):904–8.

    PubMed  Google Scholar 

  9. Millan-Rodriguez F, Palou J, de la Torre-Holguera P, Vayreda-Martija JM, Villavicencio-Mavrich H, Vicente-Rodriguez J. Conventional CT signs in staging transitional cell tumors of the upper urinary tract. Eur Urol. 1999;35(4):318–22.

    CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  12. Fang D, Xiong G, Li X, Kang Y, Zhang L, Zhao G, et al. Incidence, characteristics, treatment strategies, and oncologic outcomes of synchronous bilateral upper tract urothelial carcinoma in the Chinese population. Urol Oncol. 2015;33(2):66.e1–11.

    Google Scholar 

  13. Messer J, Shariat SF, Brien JC, Herman MP, Ng CK, Scherr DS, et al. Urinary cytology has a poor performance for predicting invasive or high-grade upper-tract urothelial carcinoma. BJU Int. 2011;108(5):701–5.

    PubMed  Google Scholar 

  14. Malm C, Grahn A, Jaremko G, Tribukait B, Brehmer M. Diagnostic accuracy of upper tract urothelial carcinoma: how samples are collected matters. Scand J Urol. 2017;51(2):137–45.

    PubMed  Google Scholar 

  15. Dodd LG, Johnston WW, Robertson CN, Layfield LJ. Endoscopic brush cytology of the upper urinary tract. Evaluation of its efficacy and potential limitations in diagnosis. Acta Cytol. 1997;41(2):377–84.

    CAS  PubMed  Google Scholar 

  16. Hendin BN, Streem SB, Levin HS, Klein EA, Novick AC. Impact of diagnostic ureteroscopy on long-term survival in patients with upper tract transitional cell carcinoma. J Urol. 1999;161(3):783–5.

    CAS  PubMed  Google Scholar 

  17. Verges DP, Lallas CD, Hubosky SG, Bagley DH Jr. Endoscopic treatment of upper tract urothelial carcinoma. Curr Urol Rep. 2017;18(4):31.

    PubMed  Google Scholar 

  18. Cho SY. Current status of flexible ureteroscopy in urology. Korean J Urol. 2015;56(10):680–8.

    PubMed  PubMed Central  Google Scholar 

  19. Vashistha V, Shabsigh A, Zynger DL. Utility and diagnostic accuracy of ureteroscopic biopsy in upper tract urothelial carcinoma. Arch Pathol Lab Med. 2013;137(3):400–7.

    CAS  PubMed  Google Scholar 

  20. Brown GA, Matin SF, Busby JE, Dinney CP, Grossman HB, Pettaway CA, et al. Ability of clinical grade to predict final pathologic stage in upper urinary tract transitional cell carcinoma: implications for therapy. Urology. 2007;70(2):252–6.

    PubMed  PubMed Central  Google Scholar 

  21. Keeley FX, Kulp DA, Bibbo M, McCue PA, Bagley DH. Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol. 1997;157(1):33–7.

    CAS  PubMed  Google Scholar 

  22. Kleinmann N, Healy KA, Hubosky SG, Margel D, Bibbo M, Bagley DH. Ureteroscopic biopsy of upper tract urothelial carcinoma: comparison of basket and forceps. J Endourol. 2013;27(12):1450–4.

    PubMed  Google Scholar 

  23. Ritter M, Bolenz C, Bach T, Strobel P, Hacker A. Standardized ex vivo comparison of different upper urinary tract biopsy devices: impact on ureterorenoscopes and tissue quality. World J Urol. 2013;31(4):907–12.

    CAS  PubMed  Google Scholar 

  24. Hao YC, Xiao CL, Liu K, Liu YQ, Ma LL. Application of narrow-band imaging flexible ureteroscopy in the diagnosis, treatment and follow-up of upper tract urothelial carcinomas. Zhonghua wai ke za zhi [Chin J Surg]. 2018;56(3):222–6.

    CAS  Google Scholar 

  25. Osman E, Alnaib Z, Kumar N. Photodynamic diagnosis in upper urinary tract urothelial carcinoma: a systematic review. Arab J Urol. 2017;15(2):100–9.

    PubMed  PubMed Central  Google Scholar 

  26. Baard J, Freund JE, de la Rosette JJ, Laguna MP. New technologies for upper tract urothelial carcinoma management. Curr Opin Urol. 2017;27(2):170–5.

    PubMed  Google Scholar 

  27. Audenet F, Traxer O, Yates DR, Cussenot O, Roupret M. Potential role of photodynamic techniques combined with new generation flexible ureterorenoscopes and molecular markers for the management of urothelial carcinoma of the upper urinary tract. BJU Int. 2012;109(4):608–13; discussion 13–4.

    PubMed  Google Scholar 

  28. Capitanio U, Terrone C, Antonelli A, Minervini A, Volpe A, Furlan M, et al. Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function. Eur Urol. 2015;67(4):683–9.

    PubMed  Google Scholar 

  29. Seisen T, Colin P, Roupret M. Risk-adapted strategy for the kidney-sparing management of upper tract tumours. Nat Rev Urol. 2015;12(3):155–66.

    PubMed  Google Scholar 

  30. Bin X, Roy OP, Ghiraldi E, Manglik N, Liang T, Vira M, et al. Impact of tumour location and surgical approach on recurrence-free and cancer-specific survival analysis in patients with ureteric tumours. BJU Int. 2012;110(11 Pt B):E514–9.

    PubMed  Google Scholar 

  31. Fajkovic H, Klatte T, Nagele U, Dunzinger M, Zigeuner R, Hubner W, et al. Results and outcomes after endoscopic treatment of upper urinary tract carcinoma: the Austrian experience. World J Urol. 2013;31(1):37–44.

    PubMed  Google Scholar 

  32. Grasso M, Fishman AI, Cohen J, Alexander B. Ureteroscopic and extirpative treatment of upper urinary tract urothelial carcinoma: a 15-year comprehensive review of 160 consecutive patients. BJU Int. 2012;110(11):1618–26.

    PubMed  Google Scholar 

  33. Hoffman A, Yossepowitch O, Erlich Y, Holland R, Lifshitz D. Oncologic results of nephron sparing endoscopic approach for upper tract low grade transitional cell carcinoma in comparison to nephroureterectomy – a case control study. BMC Urol. 2014;14:97.

    PubMed  PubMed Central  Google Scholar 

  34. Roupret M, Hupertan V, Traxer O, Loison G, Chartier-Kastler E, Conort P, et al. Comparison of open nephroureterectomy and ureteroscopic and percutaneous management of upper urinary tract transitional cell carcinoma. Urology. 2006;67(6):1181–7.

    PubMed  Google Scholar 

  35. Raman JD, Park R. Endoscopic management of upper-tract urothelial carcinoma. Expert Rev Anticancer Ther. 2017;17(6):545–54.

    CAS  PubMed  Google Scholar 

  36. Barbalat Y, Velez MC, Sayegh CI, Chung DE. Evidence of the efficacy and safety of the thulium laser in the treatment of men with benign prostatic obstruction. Ther Adv Urol. 2016;8(3):181–91.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Fried NM, Murray KE. High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. J Endourol. 2005;19(1):25–31.

    PubMed  Google Scholar 

  38. Defidio L, De Dominicis M, Di Gianfrancesco L, Fuchs G, Patel A. First collaborative experience with thulium laser ablation of localized upper urinary tract urothelial tumors using retrograde intra-renal surgery. Arch Ital Urol Androl: Organo Ufficiale Soc Ital Ecografia Urol Nefrol. 2011;83(3):147–53.

    Google Scholar 

  39. Musi G, Mistretta FA, Marenghi C, Russo A, Catellani M, Nazzani S, et al. Thulium laser treatment of upper urinary tract carcinoma: a multi-institutional analysis of surgical and oncological outcomes. J Endourol. 2018;32(3):257–63.

    PubMed  Google Scholar 

  40. Cutress ML, Stewart GD, Zakikhani P, Phipps S, Thomas BG, Tolley DA. Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review. BJU Int. 2012;110(5):614–28.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bradley F. Schwartz .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Baas, W., Klein, A., Schwartz, B.F. (2020). Ureteroscopic Management of Upper Tract Urothelial Carcinoma. In: F. Schwartz, B., D. Denstedt, J. (eds) Ureteroscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-26649-3_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-26649-3_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26648-6

  • Online ISBN: 978-3-030-26649-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics