Effects of tumor location on the prognosis of upper tract urothelial carcinoma and development and validation of a prognostic nomogram / 现代泌尿外科杂志

【Objective】 To investigate the prognostic value of tumor location in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU), and to develop and validate a nomogram model for predicting the overall survival (OS). 【Methods】 UTUC patients undergoing RUN at our hospital during Jan.2010 and Dec.2022 were retrospectively collected, 70% of whom were included in the training group and 30% in the validation group.According to the tumor location, patients were divided into renal pelvis tumor (RPT) group and ureteral tumor (UT) group.The differences in clinicopathological features and prognosis were analyzed.Based on multivariate Cox results, a nomogram model for predicting OS was developed and validated. 【Results】 A total of 366 patients (196 RPT and 170 UT) were included in this study.There were statistically significantly differences in urine cytology (P=0.001), hydronephrosis (P<0.001), history of bladder tumor (P=0.021), pathological T stage (P<0.001) and histological structure (P=0.037) between the two groups.Multivariate Cox results showed that patients with UT had a worse prognosis (HR=2.00, 95%CI: 1.22-3.27, P=0.006).Factors of the nomogram for predicting OS included age, tumor location, lymphovascular invasion and pathological T stage.The model showed good discrimination and calibration, and performed well in internal verification. 【Conclusion】 Compared with RPT, UT has a worse prognosis and the fat around the tumor should be surgically removed more thoroughly to avoid micro-residual.We successfully coustructed a nomogram model that can be used to predict the OS of UTUC patients after RNU surgery.

[Robot-assisted left-side partial nephrectomy with a segmental resection of left lower ureter and Boari reconstruction].

Renal cell carcinoma (RCC) accounts for more than 90% of cases of malignant kidney tumors and represents 2-3% of all malignancies worldwide. Clear cell renal cell carcinoma (ccRCC), the most common type of RCC, comprising 70-80% of cases. RCC most commonly metastasizes to the lungs, bones, lymph nodes, liver, adrenal glands, and brain. Synchronous metastasis of RCC to the ipsilateral ureter represents an extremely rare event. Ureteral metastasis is a significant diagnostic challenge, since it is quite difficult to determine whether it has metastatic origin (RCC) or it is a primary urothelial tumor. Moreover, due to the rarity of disease, treatment strategy is not well established. We present a rare case of patient with the RCC of a single left kidney and metachronous metastasis to the ipsilateral ureter that was initially assumed to be primary urothelial carcinoma. The robotic-assisted left-side partial nephrectomy with a segmental resection of left lower ureter and Boari reconstruction was performed. This case of successful treatment with robotic-assisted approach shows a great organ-sparing potential of robotic surgery in the treatment of complex oncological patients for whom it is extremely important to preserve the maximum volume of functioning renal tissue, particularly in those with a metastatic RCC of a single kidney.

Localized amyloidosis of the ureter: a case report.

BACKGROUND: Amyloidosis is a collection of disorders characterized by the extracellular deposition of amyloid, a specialized fibrous protein, in diverse tissues, leading to functional impairments. CASE PRESENTATION: A 70-year old Asian-Japanese female was referred to our department for further examination of her left hydronephrosis come from lower ureteral obstruction. Contrast enhanced CT and retrograde pyelo-nephrography revealed left ureteral tumor. Though ureteroscropic biopsy did not show malignant pathological findings, ureteroscopic image suspected malignant disease, thus nephroureterectomy was performed. Pathological findings revealed localized ureteral amyloidosis. Whole body examination including gastro endoscopy and cardio ultrasonography could not reveal amyloidosis except ureter. She was free from recurrence 9 months postoperatively. CONCLUSION: We herein report a rare case of localized ureteral amyloidosis.

Gross hematuria as the presentation of ureteral paraganglioma: a case report and literature review.

BACKGROUND: Paraganglioma of genitourinary tract is uncommon, and origin from ureter is even rarer. We aim to present a case of paraganglioma from ureter in a 48-year-old female patient, who presented with gross hematuria. CASE PRESENTATION: We present a 48-year-old female who complained of gross hematuria for one week. A left ureteral tumor was found by image study. However, hypertension was unexpectedly recorded during diagnostic ureteroscopy survey. Due to persisted gross hematuria and bladder tamponade, she underwent left nephroureterectomy with bladder cuff resection. Blood pressure surged again when the tumor was surgically approached. Ureteral paraganglioma was confirmed according to pathological report. After the surgery, the patient recovered well, and no more gross hematuria was noted. She is now under regular follow-up at our outpatient clinic. CONCLUSION: Ureteral paraganglioma should be kept in mind not only when blood pressure fluctuates during operation, but also before we manipulate the ureteral tumor when gross hematuria is the only sign. Whenever the presumption of paraganglioma is raised, laboratory evaluation and anatomical or even functional imaging should be considered. The concomitant anesthesia consultation before the surgery should not be deferred, either.

Upper tract urothelial carcinoma in Germany: epidemiological data and surgical treatment trends in a total population analysis from 2006 to 2019.

PURPOSE: To report contemporary epidemiological data and treatment trends for upper tract urothelial carcinoma (UTUC) in Germany over a 14-year period. METHODS: We analyzed data from the nationwide German hospital billing database and the German cancer registry from 2006 to 2018/2019. The significance of changes over time was evaluated via regression analysis. Survival outcomes were calculated using the Kaplan-Meier method. RESULTS: There was a non-significant increase in the age-standardized incidence rate from 2.5/100,000 in 2006 to 2.9/100.000 in 2018. 13% of patients presented with lymph node metastasis and 7.6% of patients presented with distant metastasis at primary diagnosis. The 5-year overall survival was estimated at 45% and the 10-year overall survival at 32%. Endoscopic biopsies of the renal pelvis and ureter as well as ureteroscopies with excision/destruction of UTUC all increased significantly over the study period. The number of radical nephroureterectomies (RNU) for UTUC steadily increased from 1643 cases in 2006 to 2238 cases in 2019 (p < 0.005) with a shift from open surgery towards minimally invasive surgery. Complex reconstructive procedures like ileal ureter replacement or autotransplantation are rarely performed for urothelial carcinoma of the ureter. CONCLUSION: Diagnostic and therapeutic procedures for UTUC have increased and minimally invasive nephroureterectomy is the predominant approach concerning radical surgery in 2019.

A case of localized ureteral amyloidosis / 中华泌尿外科杂志

Localized ureteral amyloidosis is a rare disease clinically and radiographically similar to ureteral carcinoma. We reported a 56-year-old man with painless gross hematuria. CT and Magnetic resonance urography (MRU) examinations showed tumor signs and ureteral amyloidosis was diagnosed by ureteral biopsy. Laparoscopic partial ureterectomy combined with boari flap was performed and the patient's renal function was preserved. There was no local recurrence and distant metastasis during the 1-year follow-up.

Renal pelvic rupture: A case report of an unexpected cause.

INTRODUCTION: Renal pelvic rupture (RPR) is a rare condition, that is most usually caused by obstructive calculi. In another hand, primal ureteral tumors are also uncommon, with only a few cases reporting their involvement in a RPR. PRESENTATION OF CASE: We report a case with a multimodality discussion of an ureteral tumor, with a spontaneous renal pelvic rupture (RPR) forming a large retrorenal urohematoma. DISCUSSION: Only few series reported the subject of RPR in the English literature. Only some single cases reported the causality of urinary tract tumors in RPR. RPR is an imaging based diagnosis. Herein, upper urinary tract tumors show a variable appearances at imaging. CONCLUSION: By reporting this case, we highlight the role of both computed tomography (CT) and magnetic resonance (MR) imaging in the diagnosis of the RPR and their accuracy in the detection of the ureteral tumor. We also consolidate the effectiveness of the conservative attitude in the management of the RPR.

Clinical practice patterns for upper tract urothelial carcinoma: a nationwide survey in Japan.

OBJECTIVE: A comprehensive survey has not yet been conducted to investigate care patterns by urologists for the management of upper tract urothelial carcinoma. METHODS: We conducted a nationwide survey for urologists treating upper tract urothelial carcinoma patients. The questionnaire was approved by the Japanese Urological Association and sent by mail in February 2014 to 1119 institutes in Japan. We identified 627 responders for this study. RESULTS: Our survey demonstrated that (i) the mean number of radical nephroureterectomy cases per institution in 2013 was 7.6, (ii) the main detecting tool for upper tract urothelial carcinoma is contrast-enhanced computed tomography, (iii) the need for ureteroscopic evaluations is highly dependent on voiding urine cytology results, (iv) 67% of urologists always or often perform radical nephroureterectomy by laparoscopic surgery, (v) more than half of the urologists do not aggressively perform lymph node dissection, (vi) 75% of the urologists perform bladder cuff incision through an extravesical approach, (vii) urologists perform kidney-sparing surgery following various indications, (viii) 59% of the urologists always perform adjuvant systemic chemotherapy for high-risk upper tract urothelial carcinoma patients, (ix) the combination of gemcitabine and cisplatin is the most frequent chemo-regimen for metastatic upper tract urothelial carcinoma, and gemcitabine and cisplatin with dose reductions is also the first choice even in patients with impaired renal function and (x) 10.5% of urologists always or sometimes perform single intravesical chemotherapy immediately after radical nephroureterectomy. CONCLUSIONS: The management strategy for upper tract urothelial carcinoma has changed with the introduction of new devices and development of instruments. The lack of clear evidence for relatively uncommon upper tract urothelial carcinoma affects the consistency of its treatment strategies.

The effect of tumor location on oncologic outcomes in patients with upper urinary tract urothelial carcinoma stratified by pathologic stage.

OBJECTIVES: The aim of this study was to investigate the effect of tumor location on oncologic outcomes in patients with upper urinary tract urothelial carcinoma (UTUC) stratified according to pathologic stage. MATERIAL AND METHODS: Between January 1996 and March 2009, 503 patients with UTUC were enrolled who had undergone radical nephroureterectomies and had no nodal or distal metastases. Preoperative chemotherapy or radiation therapy was not administered to any study patient. Clinicopathologic patient characteristics were obtained and used to analyze recurrence-free survival (RFS), cancer-specific survival, and overall survival with the Cox proportional hazards model. RESULTS: During the median follow-up of 52 months, patients with pathologic tumor (pT) stage 3 ureteral tumors had a shorter duration of RFS compared with those with pT3 renal pelvis tumors (5-y RFS: 50% and 71%, P = 0.047). There was no prognostic relevance to the tumor location in pTa/Tis/T1 and pT2 diseases. RFS and cancer-specific survival were significantly shorter in duration in pT3 ureteral disease compared with pT2 diseases (P<0.001 and P = 0.028). No differences were found in oncologic outcomes between pT3 renal pelvic and pT2 diseases. The presence of pT3 ureteral tumors actually increased the risks of disease recurrence (hazard ratio [HR] = 7.82, P<0.001), cancer-specific death (HR = 5.08, P<0.001), and overall mortality (HR = 3.25, P = 0.031). CONCLUSIONS: Patients with UTUC and pT3 ureteral tumors had an increased risk of disease recurrence and cancer-specific death. These results underscore the need for close follow-up and the consideration of adjuvant chemotherapy for patients with pT3 ureteral cancer.

Evidenced-based clinical practice guideline for upper tract urothelial carcinoma (summary--Japanese Urological Association, 2014 edition).

Upper tract urothelial carcinoma is more rare than bladder cancer, although they are both categorized as urothelial carcinoma. Because of the low incidence, little clinical evidence is available regarding the treatment of the former. However, recently such evidence has slowly begun to accumulate. The guideline presented herein was compiled for the purpose of ensuring proper diagnosis and treatment by physicians involved in the treatment of upper tract urothelial carcinoma. We carefully selected 16 clinical questions essential for daily clinical practice and grouped them into four major categories: epidemiology, diagnosis, surgery and systemic chemotherapy/other matters. Related literature was searched using PubMed and Japan Medical Abstracts Society databases for articles published between 1987 and 2013. If the judgment was made on the basis of insufficient or inadequate evidence, the grade of recommendation was determined on the basis of committee discussions and resultant consensus statements. Here, we present a short English version of the original guideline, and overview its key clinical issues.

Squamous cell carcinoma of the middle rectum: Report of a case and literature overview.

INTRODUCTION: Squamous-cell carcinoma (SCC) of the middle rectum is a rare disease with an estimated incidence of 0.1-0.25/1000 colorectal neoplasms. Literature is represented essentially by case report and short series, and only seventy-six cases of colorectal squamous carcinoma have been documented in literature. PRESENTATION OF CASE: We report the case of a SCC of the middle rectum, associated to an ureteral inverted papilloma, occurred in a patient with a past history of prostate cancer treated with prostatectomy and radiotherapy. DISCUSSION: Colorectal squamous-cell carcinoma is a rare disease. This localization is more frequent than the right colon, but no more epidemiological informations are actually available apart from a slight predominance of the female sex. Risk factors for SCC of the rectum are unknown and many hypotheses have been evocated. Because of its rarity, the interpretation of available information is clouded by a lack of uniformity in diagnosis and treatment. CONCLUSION: Treatment of SCC remains very challenging, and the acquisition of more consistent data is needed.

Ureterectomía radical distal por cáncer urotelial y reconstrucción ureteral asistida por robot / Radical distal ureterectomy secondary to an urotelial cancer and ureteral reconstruction robot-assisted: case report

Objective: To report a case of distal ureterectomy with robotic-assisted laparoscopic reimplantation using a Boari flap technique. Material and Methods: We report a 55 year old man with a diagnosis of distal ureteral urothelial carcinoma without multifocality. Results: A radical distal ureterectomy and robotic-assisted laparoscopic vesicoureteral reimplantation using a Boari flap technique was performed with the da Vinci S-HD surgical system. The operative time was 210 minutes, the estimated blood loss was 200 mL. The hospital stay was 48 hours, without perioperative complications. The histopathological study showed a high grade non-muscle invasive urothelial carcinoma of the distal ureter (pT1NxMx) with negative margins. Conclusions: The distal radical ureterectomy with Boari replacement is feasible and more precise with robotic assistance. Its oncological role must be demostrated with a larger number of cases.

Objetivo: Comunicar un caso de tumor ureteral distal tratado con ureterectomía radical y neoimplante vesicoureteral con técnica de Flap Boari asistida por robot. Material y Métodos: Paciente hombre de 55 años, con diagnóstico de carcinoma urotelial de uréter distal sin compromiso multifocal. Resultados: Se realizó ureterectomía distal radical y neoimplante vesicoureteral con Flap Boari asistido por Robot da Vinci S-HD. El tiempo operatorio fue de 210 minutos, con un sangrado estimado de 200 ml. La estadía hospitalaria fue de 48 horas, sin complicaciones perioperatorias. El estudio histológico mostró un carcinoma urotelial de alto grado con infiltración de la lámina propia (pT1NxMx) y márgenes quirúrgicos negativos. Conclusiones: La ureterectomía radical distal con reconstrucción tipo Boari es técnicamente factible y más precisa con la asistencia robótica. Su rol oncológico requiere de validación con mayor número de casos.

Two Cases of Unusual Ureteral Tumor / 대한비뇨기과학회지

We report 2 cases of unusual ureteral tumor. A case appeared as bladder tumor causing ureteral obstruction by outgrowing of the tumor of terminal ureter into the bladder wall. The surface of bladder mucosa was intact. The other one presented as a large retroperitoneal mass causing obstruction of the external iliac vein such as an ovarian tumor. The literature is reviewed briefly.

A Clinical Observation on the Renal Pelvis and Ureteral Tumors / 대한비뇨기과학회지

A clinical observation was made on 14 cases of transitional cell carcinoma of the renal pelvis and ureter whose diagnosis was confirmed pathologically at Kyung Hee University Hospital during the period tom November, 1971 to June, 1984. The results were as follows 1. The age of patient at the time of the diagnosis ranged from 42 to 75 years (mean 57.9 years), with highest incidence during the 6th decade. 11 tumors occurred in male patients and 3 in female patients, for a ratio of 3.7 : 1. 2. Common presenting symptoms were gross hematuria (92.8 %) and pain (28.5 %). 3. IVP was performed in all patients. A filling defect in the renal pelvis or ureter was found in 6 cases, and non-visualized kidney in 6 cases. RGP was performed in 9 patients and was useful to demonstrate a filling defect. 4. Urine cytology was positive in 6 of 13 patients. 5. Nephroureterectomy including a cuff of bladder was performed in 13 patients and simple nephrectomy was done in 1 patient who was misdiagnosed as hydronephrosis due to UPJ obstruction. 6. The tumors were staged into 4 Stages postoperatively. 5 patients had Stage A tumors, 2 Stage B, 5 Stage C and 2 Stage D. 1 patient had Grade I tumor, 6 Grade II, 4 Grade III and 3 Grade IV. In 3 patients, there were synchronous tumors in renal pelvis and ureter. Three patients subsequently developed bladder tumor. 7. 7 patients were died in 3 to 18 months (average 7.8 months) after initial treatment and all were categorized into Stage C and D.

Primary Ureteral Tumor, 15 Cases / 대한비뇨기과학회지

Records of 15 patients of primary ureteral tumor which were managed in Seoul National University Hospital during 13.5 years period from January 1971 to June 1983. 1. Primary ureteral tumor comprised of 2% of all urothelial tumors and the ratio of bladder:pelvis:ureter was 40:2:1. 2. There were 11men and 4 women (ratio of 3:1) with a mean age of 62.7 years. 3. The most frequent site of ureteral tumor was the lower one third of the ureter (53%). 4. Most frequent presentation was gross hematuria. usually intermittent and painless (100%). 5. Non-visualization of the kidney was the most prevalent finding (73%) on excretory urogram. Retrograde pyelogram was necessary in 11 patients whose findings of IVP was insufficient for diagnosis, and these procedures provided definite diagnosis in 9 of 11 patients. 6. Urine cytology was positive in 4 of 13 patients. 7. Cystoscopy was performed in all patients and which revealed concomitant bladder tumor in3 patients and tumor in ureteral orifice in 2 patients. 8. There was close correlation between the grade of cellular anaplasia and the degree of invasion. 9. There were 3 recurrences (50%) in the ureteral stump in 6 patients treated by nephrectomy and partial ureterectomy.

A Case of Primary Ureteral Tumor / 대한비뇨기과학회지

Primary ureteral tumor accounts for an estimated about 1 percent of all tumors of the urinary tracts. We observed one case of the ureteral tumor in 65 years old male patient and he was treated by complete nephroureterectomy with an excision of a cuff bladder wall around ureteral orifice. A case of primary ureteral tumor was reported with a brief review of the literatures.

Clinical Consideration of Ureteral Tumor Associated with Ureteral Stone / 대한비뇨기과학회지

Tumor of the ureter is malignant and rare, but recently the incidence rate was progressively increased due to developed methods of diagnostic procedures. Here, we report two cases of ureteral cancer combined with urinary stones in the department of urology, Seoul Red Cross Hospital, with some literatures.

A Case Report of Primary Ureteral Tumor combined with Giant Hydronephrosis / 대한비뇨기과학회지

A case of primary ureteral tumor combined with giant hydronephrosis (3,500ml) was presented with a review of the literature. This case was confirmed with the retrograde pyeloureterogram and biopsy.

Two Cases of Primary Ureteral Tumor / 대한비뇨기과학회지

Additional two cases of the primary ureteral tumor with a literatural review were presented.