Ureteroscopic Management of Large ≥ 2 cm Upper Tract Urothelial Carcinoma: A Comprehensive Twenty-three Year Experience.

To evaluate the effectiveness of ureteroscopy (URS) with laser ablation as an alternative treatment for UTUC lesions larger than 2 cm. Traditionally, patients with large upper tract urothelial carcinoma (UTUC) are treated with radical nephroureterectomy (RNU).

However, in patients with pre-existing renal disease, a solitary kidney, or those who decline RNU, management of UTUC may prove challenging METHODS: An institutional database review identified 80 patients with biopsy proven low grade UTUC who had at least one lesion larger than 2 cm. We collected clinical data including: demographics, operative parameters and pathologic features. Follow-up for all patients was standardized and included cystoscopy and ureteroscopy every 3 months until clear, every 6 months through the fifth year and yearly thereafter. We calculated rates of recurrence, progression and overall survival.

86 unique lesions ≥ 2cm were identified in the 80 qualifying patients; mean tumor size was 3.04 cm. Median follow-up was 43.6 months. During follow-up of patients treated curatively, 90.5% of tumors had ipsilateral recurrence and 31.7% progressed in grade at a median of 26.3 months. RNU was performed in 16 patients (20%); mean time to surgery was 23.2 months. Overall survival was 75% and cancer specific survival was 84% at five year follow-up.

Under strict surveillance, ureteroscopic management of large (≥ 2cm) UTUC lesions is a viable treatment alternative to RNU. While recurrence is common, ureteroscopy can potentially preserve renal units in patients with large lesions.

Urology. 2018 Jun 29 [Epub ahead of print]

Kymora B Scotland, Nir Kleinmann, Dillon Cason, Logan Hubbard, Ryuta Tanimoto, Kelly A Healy, Scott G Hubosky, Demetrius H Bagley

Department of Urologic Sciences, University of British Columbia, Vancouver,British Columbia,Canada., Department of Urology, Sheba Medical Center, Tel Hashomer, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania., Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan., Department of Urology, Columbia University Medical Center-New York Presbyterian Hospital, New York, NY., Department of Urology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania., Department of Urology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.. Electronic address: .