BERKELEY, CA (UroToday.com) - Our article discusses an issue of great interest among urologists and oncologists. Upper tract TCC still remains a relatively rare disease. Among those patients, the presence of low-grade upper tract TCC is even more rare, making it more difficult to evaluate the best management and treatment options. Therefore, there is a paucity of data regarding optimal treatment and follow-up protocols in such cases.
Although no real head-to-head prospective trials have been conducted, a conservative nephron-sparing approach has been considered the new standard of care in low-grade upper tract TCC. The main concerns in practicing it is missing a concurrent high-grade upper tract TCC (either by transitional endothelial field changes or by TCC upstaging), followed by increased low-grade TCC recurrence rate.
We suggest a strict patient selection: endourological procedure without concurrent nephroureterectomy, selected when there is a small tumor burden (up to 1.5 cm for a single lesion and the ability for a complete resection of all lesions), and the ability of the urologist and the patient to adhere to a strict follow-up protocol.
In our opinion, adhering to the protocol presented in the article allows kidney function preservation while minimizing morbidity and mortality. However, a demanding follow-up protocol has its price – relatively frequent upper tract imaging and possibly the need for frequent bladder and upper tract endourological procedures should be taken into consideration when choosing nephron-sparing option for treating low-grade upper tract TCC.
Azik Hoffman as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Institute of Urology, Rabin Medical Center - Beilinson Campus, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, 49100 Tel Aviv, Israel