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  • Title: Endoscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys.
    Author: Thompson RH, Krambeck AE, Lohse CM, Elliott DS, Patterson DE, Blute ML.
    Journal: Urology; 2008 Apr; 71(4):713-7. PubMed ID: 18267338.
    Abstract:
    OBJECTIVES: We report our experience using ureteroscopic or percutaneous management of upper tract transitional cell carcinoma (TCC) in elective situations. METHODS: Between 1983 and 2004 we identified 83 patients who underwent endoscopic management of upper tract TCC in the setting of a normal contralateral kidney. We performed a retrospective chart review and conducted outcome analyses. RESULTS: Median age at diagnosis was 71 years (range, 37 to 90 years) and median tumor size was 0.8 cm (range, 0.2 to 3.0 cm). Grade 3 tumors were present in 8 patients (10%), whereas the remaining 75 (90%) patients were grade 1 or 2 or diagnosed as visual low grade. Tumor stage was Ta or visual Ta in 78 patients (94%). Median follow-up was 4.6 years (range, 0.4 to 17 years) during which 46 patients (55%) developed 76 upper tract recurrences and 37 patients (45%) developed a recurrence in the bladder. At last follow-up, 27 patients (33%) required a nephroureterectomy and 9 patients (11%) died from TCC. Patients with high-grade (risk ratio, 9.8; P = 0.001) and non-Ta stage tumors (risk ratio, 5.7; P = 0.003) were at significant risk of death from disease. Among 43 patients with a diagnosis based on visual inspection only, 9 (21%) developed grade 3 TCC during follow-up. CONCLUSIONS: Our results underscore the need for strict surveillance after endoscopic management of upper tract TCC. Recurrence is common and nearly one-third of patients in this cohort eventually required nephroureterectomy. Patients with a visual diagnosis, without adequate tissue for pathologic analysis, can experience recurrence of high-grade invasive TCC.
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