Percutaneous renal surgery for renal pelvic tumors: Overcoming the difficulties

Brian Duty, Michael Blute, Zhamshid Okhunov, Arthur D. Smith, Zeph Okeke

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Upper tract transitional cell carcinoma accounts for roughly 5 % of all urothelial malignancies. Tumors of the renal collecting system and ureter rarely remain clinically silent. Most patients present with either hematuria and/or flank pain. A variety of diagnostic approaches may be utilized; however, computed tomography urography is currently the most sensitive and specific imaging modality. Urinary cytology continues to be important because of its sensitivity for high-grade lesions. Ureteroscopy has both a diagnostic and therapeutic role. Although ureteroscopic biopsies rarely provide accurate staging, multiple studies have demonstrated the strong correlation between tumor grade and stage. Percutaneous resection of collecting system tumors has traditionally been reserved for patients with a solitary kidney, bilateral tumors, renal insufficiency, or significant medical comorbidities. Multiple series have demonstrated a low recurrence rate (approximately 20 %) in patients with low-grade disease. Recurrence and renal preservation rates are much less favorable for patients with high-grade tumors. Two studies have compared the efficacy of percutaneous resection to nephroureterectomy. Both found equivalent oncologic outcomes in patients with low-grade disease. Percutaneous resection is well tolerated in the majority of patients. However, tract recurrences have been described in a few case reports. Therefore, it is imperative to ensure that the access sheath remains in the collecting system at all times to minimize tract exposure. The efficacy of bacillus Calmette-Guerin adjuvant therapy has not been conclusively demonstrated. Nevertheless, most authors still recommend the use of adjuvant therapy given the absence of level one data. Radical nephroureterectomy remains the treatment of choice for patients with high-grade disease who are surgical candidates. Elective percutaneous management should be considered in patients with low-grade disease given its equivalent oncologic efficacy, relative safety, and minimal impact on overall renal function.

Original languageEnglish (US)
Title of host publicationDifficult Cases in Endourology
PublisherSpringer-Verlag London Ltd
Pages107-114
Number of pages8
ISBN (Print)9781848820838, 1848820828, 9781848820821
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

Fingerprint

Kidney
Neoplasms
Recurrence
Ureteroscopy
Flank Pain
Transitional Cell Carcinoma
Urography
Hematuria
Therapeutics
Ureter
Mycobacterium bovis
Renal Insufficiency
Cell Biology
Comorbidity
Tomography
Biopsy
Safety

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Duty, B., Blute, M., Okhunov, Z., Smith, A. D., & Okeke, Z. (2013). Percutaneous renal surgery for renal pelvic tumors: Overcoming the difficulties. In Difficult Cases in Endourology (pp. 107-114). Springer-Verlag London Ltd. https://doi.org/10.1007/978-1-84882-083-8_11

Percutaneous renal surgery for renal pelvic tumors : Overcoming the difficulties. / Duty, Brian; Blute, Michael; Okhunov, Zhamshid; Smith, Arthur D.; Okeke, Zeph.

Difficult Cases in Endourology. Springer-Verlag London Ltd, 2013. p. 107-114.

Research output: Chapter in Book/Report/Conference proceedingChapter

Duty, B, Blute, M, Okhunov, Z, Smith, AD & Okeke, Z 2013, Percutaneous renal surgery for renal pelvic tumors: Overcoming the difficulties. in Difficult Cases in Endourology. Springer-Verlag London Ltd, pp. 107-114. https://doi.org/10.1007/978-1-84882-083-8_11
Duty B, Blute M, Okhunov Z, Smith AD, Okeke Z. Percutaneous renal surgery for renal pelvic tumors: Overcoming the difficulties. In Difficult Cases in Endourology. Springer-Verlag London Ltd. 2013. p. 107-114 https://doi.org/10.1007/978-1-84882-083-8_11
Duty, Brian ; Blute, Michael ; Okhunov, Zhamshid ; Smith, Arthur D. ; Okeke, Zeph. / Percutaneous renal surgery for renal pelvic tumors : Overcoming the difficulties. Difficult Cases in Endourology. Springer-Verlag London Ltd, 2013. pp. 107-114
@inbook{63eddf937c52474d8545b73d35e66879,
title = "Percutaneous renal surgery for renal pelvic tumors: Overcoming the difficulties",
abstract = "Upper tract transitional cell carcinoma accounts for roughly 5 {\%} of all urothelial malignancies. Tumors of the renal collecting system and ureter rarely remain clinically silent. Most patients present with either hematuria and/or flank pain. A variety of diagnostic approaches may be utilized; however, computed tomography urography is currently the most sensitive and specific imaging modality. Urinary cytology continues to be important because of its sensitivity for high-grade lesions. Ureteroscopy has both a diagnostic and therapeutic role. Although ureteroscopic biopsies rarely provide accurate staging, multiple studies have demonstrated the strong correlation between tumor grade and stage. Percutaneous resection of collecting system tumors has traditionally been reserved for patients with a solitary kidney, bilateral tumors, renal insufficiency, or significant medical comorbidities. Multiple series have demonstrated a low recurrence rate (approximately 20 {\%}) in patients with low-grade disease. Recurrence and renal preservation rates are much less favorable for patients with high-grade tumors. Two studies have compared the efficacy of percutaneous resection to nephroureterectomy. Both found equivalent oncologic outcomes in patients with low-grade disease. Percutaneous resection is well tolerated in the majority of patients. However, tract recurrences have been described in a few case reports. Therefore, it is imperative to ensure that the access sheath remains in the collecting system at all times to minimize tract exposure. The efficacy of bacillus Calmette-Guerin adjuvant therapy has not been conclusively demonstrated. Nevertheless, most authors still recommend the use of adjuvant therapy given the absence of level one data. Radical nephroureterectomy remains the treatment of choice for patients with high-grade disease who are surgical candidates. Elective percutaneous management should be considered in patients with low-grade disease given its equivalent oncologic efficacy, relative safety, and minimal impact on overall renal function.",
author = "Brian Duty and Michael Blute and Zhamshid Okhunov and Smith, {Arthur D.} and Zeph Okeke",
year = "2013",
month = "8",
day = "1",
doi = "10.1007/978-1-84882-083-8_11",
language = "English (US)",
isbn = "9781848820838",
pages = "107--114",
booktitle = "Difficult Cases in Endourology",
publisher = "Springer-Verlag London Ltd",

}

TY - CHAP

T1 - Percutaneous renal surgery for renal pelvic tumors

T2 - Overcoming the difficulties

AU - Duty, Brian

AU - Blute, Michael

AU - Okhunov, Zhamshid

AU - Smith, Arthur D.

AU - Okeke, Zeph

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Upper tract transitional cell carcinoma accounts for roughly 5 % of all urothelial malignancies. Tumors of the renal collecting system and ureter rarely remain clinically silent. Most patients present with either hematuria and/or flank pain. A variety of diagnostic approaches may be utilized; however, computed tomography urography is currently the most sensitive and specific imaging modality. Urinary cytology continues to be important because of its sensitivity for high-grade lesions. Ureteroscopy has both a diagnostic and therapeutic role. Although ureteroscopic biopsies rarely provide accurate staging, multiple studies have demonstrated the strong correlation between tumor grade and stage. Percutaneous resection of collecting system tumors has traditionally been reserved for patients with a solitary kidney, bilateral tumors, renal insufficiency, or significant medical comorbidities. Multiple series have demonstrated a low recurrence rate (approximately 20 %) in patients with low-grade disease. Recurrence and renal preservation rates are much less favorable for patients with high-grade tumors. Two studies have compared the efficacy of percutaneous resection to nephroureterectomy. Both found equivalent oncologic outcomes in patients with low-grade disease. Percutaneous resection is well tolerated in the majority of patients. However, tract recurrences have been described in a few case reports. Therefore, it is imperative to ensure that the access sheath remains in the collecting system at all times to minimize tract exposure. The efficacy of bacillus Calmette-Guerin adjuvant therapy has not been conclusively demonstrated. Nevertheless, most authors still recommend the use of adjuvant therapy given the absence of level one data. Radical nephroureterectomy remains the treatment of choice for patients with high-grade disease who are surgical candidates. Elective percutaneous management should be considered in patients with low-grade disease given its equivalent oncologic efficacy, relative safety, and minimal impact on overall renal function.

AB - Upper tract transitional cell carcinoma accounts for roughly 5 % of all urothelial malignancies. Tumors of the renal collecting system and ureter rarely remain clinically silent. Most patients present with either hematuria and/or flank pain. A variety of diagnostic approaches may be utilized; however, computed tomography urography is currently the most sensitive and specific imaging modality. Urinary cytology continues to be important because of its sensitivity for high-grade lesions. Ureteroscopy has both a diagnostic and therapeutic role. Although ureteroscopic biopsies rarely provide accurate staging, multiple studies have demonstrated the strong correlation between tumor grade and stage. Percutaneous resection of collecting system tumors has traditionally been reserved for patients with a solitary kidney, bilateral tumors, renal insufficiency, or significant medical comorbidities. Multiple series have demonstrated a low recurrence rate (approximately 20 %) in patients with low-grade disease. Recurrence and renal preservation rates are much less favorable for patients with high-grade tumors. Two studies have compared the efficacy of percutaneous resection to nephroureterectomy. Both found equivalent oncologic outcomes in patients with low-grade disease. Percutaneous resection is well tolerated in the majority of patients. However, tract recurrences have been described in a few case reports. Therefore, it is imperative to ensure that the access sheath remains in the collecting system at all times to minimize tract exposure. The efficacy of bacillus Calmette-Guerin adjuvant therapy has not been conclusively demonstrated. Nevertheless, most authors still recommend the use of adjuvant therapy given the absence of level one data. Radical nephroureterectomy remains the treatment of choice for patients with high-grade disease who are surgical candidates. Elective percutaneous management should be considered in patients with low-grade disease given its equivalent oncologic efficacy, relative safety, and minimal impact on overall renal function.

UR - http://www.scopus.com/inward/record.url?scp=84929909599&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929909599&partnerID=8YFLogxK

U2 - 10.1007/978-1-84882-083-8_11

DO - 10.1007/978-1-84882-083-8_11

M3 - Chapter

AN - SCOPUS:84929909599

SN - 9781848820838

SN - 1848820828

SN - 9781848820821

SP - 107

EP - 114

BT - Difficult Cases in Endourology

PB - Springer-Verlag London Ltd

ER -