• TCC of the renal pelvis
  • Antegrade nephroscopy and tissue ablation. Appropriate for low grade papillary lesions in the ureter and accessible areas in the renal pelvis. Ablation can be performed with diathermy, cold knife of laser. Role of BCG or mitomycin is incompletely defined.
  • Nephroureterectomy. Standard therapy for large or high grade lesions in the renal pelvis. Laparoscopic approach has gained significant appeal in the past several years. Resection of the renal unit, the entire ureter and a portion of bladder cuff is mandatory for effective therapy.
• TCC of the ureter
  • Partial ureterectomy and reimplantation. Appropriate for bulky low grade lesions and moderate to high grade lesions in the lower ureter without evidence of other disease foci. Also high risk surgical candidates, a solitary renal unit, and renal insufficiency.
  • Nephroureterectomy. Appropriate for lesions of the upper two thirds of the ureter and full ureter with multifocal disease.
• Chemotherapy
  • Large series of BCG or mitomycin treated lesions not available
  • Low grade solitary lesions respond well. Multiple recurrences in initial multifocal disease
  • MVAC or Cis platinum plus Gemcitabine combinations acceptable for higher stage lesions. Taxol plus Carboplatinum combination good for patients with renal insufficiency

References

• Carroll PC, Dixon CM. Surgical anatomy of the male and female urethra. Urol Clin North Am 19:339-346, 1992.
• Cataluna WJ: Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous vein: Technique and preliminary results. J Urol 140:836, 1988.
• deKernion JB, Abi-Aad AS: Controversies in ilioinguinal lymphadenectomy for cancer of the penis. Urol Clin North Am 19:319-324, 1992.
• Forman JD, Lichter AS: The role of radiation therapy in the management of carcinoma of the male and female urethra. Urol Clin North Am 19:383-390, 1992.
• Gerbaulet A, Lambin P: Radiation therapy of cancer of the penis: Indications, advantages, and pitfalls. Urol Clin North Am 19:325-332, 1992.
• Johnson DE, Ames FC: Groin Dissection. Chicago, Yearbook Medical Publishers, 1985.
• Lowe FC: Squamous cell carcinoma of the scrotum. J Urol 130:423, 1983. Russo P, Gaudin P: Carcinoma of the penis: Diagnosis and staging. Cont Urol 4:12-31, 2000.
• Schellhammer PF, Jordan GH, Schlossberg SM: Tumors of the penis. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED, eds. Campbell's Urology, 6th ed. Philadelphia, Saunders, 1992, pp 1264-1298.
• Skinner EC, Skinner DG: Management of carcinoma of the female urethra. In: Skinner DG, Lieskovsky G, eds. Diagnosis and Management of Genitourinary Cancer. Philadelphia, Saunders, 1988, pp 490-497.

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