Norm D. Smith

Management of Upper Tract Urothelial Carcinoma

Locally advanced upper tract urothelial carcinoma has a poor prognosis.  While surgery represents the only potentially curable therapeutic intervention, recurrences are common and typically systemic in nature.  It is thus reasonable to consider perioperative chemotherapy in an effort to decrease the risk of recurrence.  There are very little direct data providing clinical guidance in this scenario.  For urothelial cancer of the bladder, there are randomized phase III data demonstrating a survival advantage with neoadjuvant cisplatin-based combination chemotherapy.  Although arguments favoring adjuvant chemotherapy could be made for upper tract urothelial cancer, the loss of renal function that occurs with nephrectomy can complicate administration of appropriate perioperative treatment.  Therefore, by analogy to urothelial carcinoma of the lower tract, it is argued that cisplatin-based neoadjuvant chemotherapy should be the standard of care for patients with locally advanced upper tract urothelial cancer.

Peter H. O&#39;Donnell

Walter M. Stadler

The Role of Chemotherapy in Upper Tract Urothelial Carcinoma

The incidence of transitional cell carcinoma of the kidney and ureter is 
				low and for that reason limited data exists regarding the appropriate management of 
				regional retroperitoneal lymph nodes.  Lymph node metastases have consistently 
				been associated with an adverse prognosis.  However, five-year cancer-specific survival 
				following nephroureterectomy and lymphadenectomy for patients with lymph node involvement ranges 
				from 0&#x02013;39&#x00025;, suggesting a therapeutic benefit.  This review covers the primary tumor characteristics 
				associated with lymph node involvement, imaging of the lymph nodes, as well as the rationale, 
				role, patient selection, suggested anatomic templates, and technical 
				considerations for lymphadenectomy.

Shilajit D. Kundu

Scott E. Eggener

Retroperitoneal Lymph Nodes in Transitional Cell Carcinoma of the Kidney and Ureter

Laparoscopic nephroureterectomy (LNU) is becoming an increasingly common alternative treatment for transitional cell carcinoma (TCC) of the renal pelvis and ureter due to decreased perioperative morbidity, shorter hospitalization, and comparable oncologic control with open nephroureterectomy (ONU). Mobilization of the kidney and proximal ureter may be performed through a transperitoneal, retroperitoneal, or hand-assisted approach. Each technique is associated with its own benefits and limitations, and the optimal approach is often dictated by surgeon preference. Our analysis of the literature reflects equivalent cancer control between LPN and OPN at intermediate follow-up with significantly improved perioperative morbidity following LPN. Several methods for bladder cuff excision have been advocated, however, no individual technique for management of the distal ureter proved superior. Overall, complete en-bloc resection with minimal disruption of the urinary tract should be optimized to maintain oncologic outcomes. Longer follow-up and prospective studies are needed to fully evaluate these techniques.

Davis P. Viprakasit

Amanda M. Macejko

Robert B. Nadler

Laparoscopic Nephroureterectomy and Management of the Distal Ureter: A Review of Current Techniques and Outcomes

Nephroureterectomy is currently the gold standard for management of upper urinary tract urothelial carcinoma despite it results. This review article in the loss of a renal unit.  The ultimate aim of endoscopic
management of this condition is cancer control whilst preserving renal function and the integrity of the urinary tract. Endoscopic treatments of upper tract TCC include the antegrade percutaneous and retrograde ureteroscopic approaches.  This review article summarizes the endoscopic management of upper tract urothelial carcinoma, surveillance of the disease after endoscopic management and adjuvant therapy. The main message regarding endoscopic management of upper tract urothelial cancer is that patients must be carefully selected. Patient selection is based on tumour size, grade, and multifocality. Single low-grade tumours, less than 1.5 cm in size, generally have a good outcome with endoscopic treatment provided that they have regular ureteroscopic surveillance. Ureteroscopic treatment of high-grade tumours is essentially palliative. It is essential that patients are motivated and compliant as lifetime follow-up is necessary. However, until large randomized trials with long-term follow-up are performed, endoscopic management cannot be considered a standard treatment and should be limited to poor performance status patients.

K. Moore

J. Khastgir

M. Ghei

Endoscopic Management of Upper Tract Urothelial Carcinoma

Traditionally, nephroureterectomy is the gold standard therapy for upper tract recurrence of transitional cell carcinoma (TCC) following cystectomy and urinary diversion. With advances in endoscopic equipment and improvements in technique, conservative endourologic management via a retrograde or antegrade approach is technically feasible with acceptable outcomes in patients with bilateral disease, solitary renal units, chronic renal insufficiency, or significant medical comorbidities. Contemporary studies have expanded the utility of these techniques to include low-grade, low-volume disease in patients with a normal contralateral kidney. The aim of this report is to review the current outcomes of conservative management for upper tract disease and discuss its application and relevance in patients following cystectomy with lower urinary tract reconstruction.

Jeffrey John Tomaszewski

Marc Christopher Smaldone

Michael Cecil Ost

Endourologic Management of Upper Tract Transitional Cell Carcinoma following Cystectomy and Urinary Diversion

Urothelial carcinoma of the upper urinary tract represents only 5&#37; of all urothelial cancers. The 5-year cancer-specific survival in the United States is roughly 75&#37; with grade and stage being the most powerful predictors of survival. Nephroureterectomy with excision of the ipsilateral ureteral orifice and bladder cuff en bloc remains the gold standard treatment of the upper urinary tract urothelial cancers, while endoscopic and laparoscopic approaches are rapidly evolving as reasonable alternatives of care depending on grade and stage of disease. Several controversies remain in their management, including a selection of endoscopic versus laparoscopic approaches, management strategies on the distal ureter, the role of lymphadenectomy, and the value of chemotherapy in upper tract disease. Aims of this paper are to critically review the management of such tumors, including endoscopic management, laparoscopic nephroureterectomy and management of the distal ureter, the role of lymphadenectomy, and the emerging role of chemotherapy in their treatment.

Georgios Koukourakis

Georgios Zacharias

Michael Koukourakis

Kiriaki Pistevou-Gobaki

Christos Papaloukas

Athanasios Kostakopoulos

Vassilios Kouloulias

Comprehensive Management of Upper Tract Urothelial Carcinoma

Transitional cell carcinoma affecting the upper urinary tract, though uncommon, constitutes a serious urologic disease. Radical nephroureterectomy remains the treatment of choice but has undergone numerous modifications over the years. Although the standard technique has not been defined, the laparoscopic approach has gained in popularity in the last two decades. The most appropriate oncological management of the distal ureteral and bladder cuff has been a subject of much debate. The aim of the nephroureterectomy procedure is to remove the entire ipsilateral upper tract in continuity while avoiding extravesical transfer of tumor-containing urine during bladder surgery. A myriad of technical modifications have been described. In this article, we review the literature and present an overview of the options for dealing with the lower ureter during radical nephroureterectomy.

Shalom J. Srirangam

Ben van Cleynenbreugel

Hein van Poppel

Laparoscopic Nephroureterectomy: The Distal Ureteral Dilemma

Introduction. Laparoscopic radical nephroureterectomy (LNU) is being increasingly performed at several centers across the world. We review oncologic outcomes after LNU procedure and the techniques for the management of distal ureter. Materials and Methods. A comprehensive review of the literature was performed on the oncological outcomes and management of distal ureter associated with LNU for upper tract transitional cell carcinoma (TCC). Results and Discussion. LNU for upper tract TCC is performed pure laparoscopically (LNU) or hand-assisted (HALNU). The management of the distal ureter is still debated. LNU appears to have superior perioperative outcomes when compared to open surgery. Intermediate term oncologic outcomes after LNU are comparable to open nephroureterectomy (ONU). Conclusions. Excision of the distal ureter and bladder cuff during nephroureterectomy remains controversial. Intermediate term oncologic outcomes for LNU compare well with ONU. Initial long-term oncologic outcomes are encouraging. Prospective randomized comparison between LNU and open surgery is needed to define the role of these modalities in the current context.

Andre Berger

Amr Fergany

Laparoscopic Nephroureterectomy: Oncologic Outcomes and Management of Distal Ureter; Review of the Literature

A select group of patients with upper tract urothelial carcinoma may be appropriate candidates for minimally invasive management. Organ-preserving endoscopic procedures may be appropriate for patients with an inability to tolerate major surgery, solitary kidney, bilateral disease, poor renal function, small tumor burden, low-grade disease, or carcinoma in situ.  We review the published literature on the use of topical treatment for upper tract urothelial carcinoma and provide our approach to treatment in the office setting.

Kenneth G. Nepple

Fadi N. Joudi

Michael A. O&#39;Donnell

Review of Topical Treatment of Upper Tract Urothelial Carcinoma

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Advances in Urology provides a forum for urologists, nephrologists, and basic scientists working in the field of urology. The journal publishes articles focusing on the male and female urinary tract and the male reproductive organs.

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Advances in Urology provides a forum for urologists, nephrologists, and basic scientists working in the field of urology. The journal publishes articles focusing on the male and female urinary tract and the male reproductive organs.

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Advances in Urology | Hindawi

Advances in Urology

This Issue is now open for submissions.
Papers are published upon acceptance, regardless of the Special Issue publication date.

Advances in Urology

Comprehensive Management of Upper Tract Urothelial Carcinoma

Comprehensive Management of Upper Tract Urothelial Carcinoma

Articles

Management of Upper Tract Urothelial Carcinoma

The Role of Chemotherapy in Upper Tract Urothelial Carcinoma

Retroperitoneal Lymph Nodes in Transitional Cell Carcinoma of the Kidney and Ureter

Laparoscopic Nephroureterectomy and Management of the Distal Ureter: A Review of Current Techniques and Outcomes

Endoscopic Management of Upper Tract Urothelial Carcinoma

Endourologic Management of Upper Tract Transitional Cell Carcinoma following Cystectomy and Urinary Diversion

Comprehensive Management of Upper Tract Urothelial Carcinoma

Laparoscopic Nephroureterectomy: The Distal Ureteral Dilemma

Laparoscopic Nephroureterectomy: Oncologic Outcomes and Management of Distal Ureter; Review of the Literature

Review of Topical Treatment of Upper Tract Urothelial Carcinoma