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1.
PLoS One ; 17(12): e0278038, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36454803

RESUMO

BACKGROUND: To evaluate the prognostic impact of lymph node dissection (LND) in patients who underwent radical nephroureterectomy (RNU) with bladder cuff excision (BCE) for clinically node-negative (cN0) upper urinary tract urothelial carcinoma (UTUC). METHODS: We retrospectively enrolled 520 patients with cN0 UTUC in a single tertiary referral center from 2000 to 2015. The patients were divided into three groups: patients with and without pathologically proved lymph node metastasis (pN1-3 and pN0, respectively) and patients without LND (pNx). We analyzed associations between overall survival (OS)/ disease-free survival (DFS)/ cancer-specific survival (CSS) and clinical characteristics. RESULTS: The patients were divided into three groups (pN1-3, pN0 and pNx with 20, 303, and 197 patients, respectively). OS/DFS/CSS in the pN1-3 group were significantly worse (all p<0.001) compared with the pN0 group. However, there were no significant differences between the pNx and pN0 groups. In the multivariate analyses, CSS was only affected by age [(hazard ratio (HR) = 1.03, p = 0.008]), positive surgical margin (HR = 3.38, p<0.001) and pathological T3-4 stages (HR = 4.07, p<0.001). In the subgroup analyses for patients with LND, locally advanced disease (pT3 and pT4) had significantly more metastases [T3-4: 13.91% (16/115) vs. T0-2: 1.92% (4/208), p<0.001]. CONCLUSIONS: In the pN0 group, LND for cN0 UTUC did not show therapeutic benefits in terms of DFS, CSS, and OS. However, LND with RNU allowed optimal tumor staging, through patients still had a poor prognosis. Clinically occult LN metastases were found in 6.2% of our patients.


Assuntos
Carcinoma de Células de Transição , Neoplasias Renais , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Sistema Urinário , Humanos , Nefroureterectomia , Carcinoma de Células de Transição/cirurgia , Prognóstico , Estudos Retrospectivos , Neoplasias Ureterais/cirurgia , Excisão de Linfonodo
2.
Diagn Pathol ; 17(1): 94, 2022 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-36564794

RESUMO

BACKGROUND: Phyllodes tumors belong to a spectrum of biphasic fibroepithelial lesions and are most commonly found in the breast. They are extremely rare in the urinary tract and only one case of bladder phyllodes tumor has been reported. CASE PRESENTATION: We present a 69-year-old man with gross hematuria without an apparent cause. Computed tomography-urography and cystoscopic examination revealed a 5 × 4 cm lesion in the right ureteral orifice. He underwent a laparoscopic nephroureterectomy and partial cystectomy. Postoperative pathology confirmed a leaf-like structure consisting of myxoid stroma and peripheral urothelium. Stromal cells were spindle-shaped and stellate in appearance with no conspicuous cytological atypia or mitosis. The outlining urothelium had varying degrees of dysplasia, while in areas with moderate-to-severe dysplasia, active mitotic activity, abnormal giant cells, and focal early infiltration were observed. Overall, this case had the morphological features of benign phyllodes tumors and concomitant invasive urothelial carcinoma inside. The patient remained disease-free at 7 months after surgery. CONCLUSION: We report the first ureteral tumor with the morphological characteristics of a phyllodes tumor and concomitant invasive urothelial carcinoma inside. Considering the potential for local recurrence of phyllodes tumors and invasive urothelial carcinoma, long-term clinical and radiological follow-up of such lesions are advisable.


Assuntos
Neoplasias da Mama , Carcinoma de Células de Transição , Tumor Filoide , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Masculino , Humanos , Idoso , Neoplasias da Bexiga Urinária/patologia , Carcinoma de Células de Transição/patologia , Neoplasias Ureterais/cirurgia , Neoplasias Ureterais/patologia , Tumor Filoide/cirurgia , Tumor Filoide/complicações
3.
Zhonghua Yi Xue Za Zhi ; 102(44): 3532-3536, 2022 Nov 29.
Artigo em Chinês | MEDLINE | ID: mdl-36418252

RESUMO

Objective: To investigate the efficacy and safety of complete transabdominal laparoscopic nephroureterectomy in treating primary upper tract urothelial carcinoma (UTUC) for post kidney transplantation patients. Methods: The clinical data of patients with primary renal pelvis and ureter tumors after kidney transplantation in Beijing Chaoyang Hospital from May 2016 to December 2019 were retrospectively analyzed. Seventeen patients (including 9 patients in ipsilateral transplanted kidney group and 8 patients in contralateral transplanted kidney group) underwent traditional retroperitoneoscopic nephroureterectomy (TRNU), and 24 patients (including 14 patients in ipsilateral transplanted kidney group and 10 patients in contralateral transplanted kidney group) underwent complete transperitoneal laparoscopic nephroureterectomy (CTNU). The perioperative clinical indicators of all patients were recorded and analyzed, and the surgical indicators of two techniques were compared. Results: Forty-one patients [16 males and 25 females, with a median age of 57 (53, 70) years old] were finally included. The operation time in the contralateral transplanted kidney group [(95±44) min] from CTNU was significantly decreased compared with that in the ipsilateral group from CTNU [(159±49) min] and the contralateral [(196±20) min] or ipsilateral [(205±21) min] groups from TRNU (all P<0.01). The blood loss volume [(84±39) ml vs (106±44) ml vs (109±20) ml vs (112±21) ml, P=0.271] and postoperative hospital stay [(10.6±2.1) d vs (11.8±1.7) d vs (10.3±1.5) d vs (11.4±1.5) d, P=0.171] were not statistically different among these four groups. During the median follow-up of 24 months, 13 patients developed contralateral recurrence or metastasis, 8 patients developed intravesical recurrence, and 5 patients died of UTUC. Conclusions: Single-position complete transabdominal laparoscopic nephroureterectomy for the treatment of primary renal ureteral tumors after kidney transplantation has the advantage of a short operation time, without increasing intraoperative blood loss or perioperative complications. It is suitable for the treatment of urothelial carcinoma after kidney transplantation, especially for the contralateral side of the transplanted kidney.


Assuntos
Carcinoma de Células de Transição , Neoplasias Renais , Transplante de Rim , Laparoscopia , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Masculino , Feminino , Humanos , Carcinoma de Células de Transição/cirurgia , Nefroureterectomia , Neoplasias da Bexiga Urinária/cirurgia , Estudos Retrospectivos , Nefrectomia/métodos , Neoplasias Ureterais/cirurgia , Neoplasias Renais/cirurgia , Laparoscopia/métodos
4.
Can J Urol ; 29(5): 11323-11325, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36245204

RESUMO

Non-urothelial malignant ureteral obstruction (MUO) causes hydronephrosis, renal damage and infectious sequelae. The overall condition, symptoms, and plans for systemic therapy inform urologic intervention. In well-selected cases, there is a role for definitive reconstruction. We describe a robotic-assisted distal ureterectomy and reimplant for definitive repair of obstructive metastatic melanoma.


Assuntos
Melanoma , Procedimentos Cirúrgicos Robóticos , Ureter , Neoplasias Ureterais , Humanos , Melanoma/complicações , Melanoma/cirurgia , Ureter/cirurgia , Neoplasias Ureterais/complicações , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Procedimentos Cirúrgicos Urológicos
5.
World J Urol ; 40(11): 2771-2779, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36203101

RESUMO

PURPOSE: To investigate prevalence and predictors of renal function variation in a multicenter cohort treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). METHODS: Patients from 17 tertiary centers were included. Renal function variation was evaluated at postoperative day (POD)-1, 6 and 12 months. Timepoints differences were Δ1 = POD-1 eGFR - baseline eGFR; Δ2 = 6 months eGFR - POD-1 eGFR; Δ3 = 12 months eGFR - 6 months eGFR. We defined POD-1 acute kidney injury (AKI) as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5 1.9-fold from baseline. Additionally, a cutoff of 60 ml/min in eGFR was considered to define renal function decline at 6 and 12 months. Logistic regression (LR) and linear mixed (LM) models were used to evaluate the association between clinical factors and eGFR decline and their interaction with follow-up. RESULTS: A total of 576 were included, of these 409(71.0%) and 403(70.0%) had an eGFR < 60 ml/min at 6 and 12 months, respectively, and 239(41.5%) developed POD-1 AKI. In multivariable LR analysis, age (Odds Ratio, OR 1.05, p < 0.001), male gender (OR 0.44, p = 0.003), POD-1 AKI (OR 2.88, p < 0.001) and preoperative eGFR < 60 ml/min (OR 7.58, p < 0.001) were predictors of renal function decline at 6 months. Age (OR 1.06, p < 0.001), coronary artery disease (OR 2.68, p = 0.007), POD-1 AKI (OR 1.83, p = 0.02), and preoperative eGFR < 60 ml/min (OR 7.80, p < 0.001) were predictors of renal function decline at 12 months. In LM models, age (p = 0.019), hydronephrosis (p < 0.001), POD-1 AKI (p < 0.001) and pT-stage (p = 0.001) influenced renal function variation (ß 9.2 ± 0.7, p < 0.001) during follow-up. CONCLUSION: Age, preoperative eGFR and POD-1 AKI are independent predictors of 6 and 12 months renal function decline after RNU for UTUC.


Assuntos
Injúria Renal Aguda , Carcinoma de Células de Transição , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Sistema Urinário , Neoplasias Urológicas , Humanos , Masculino , Lactente , Nefroureterectomia , Carcinoma de Células de Transição/cirurgia , Nefrectomia , Taxa de Filtração Glomerular , Neoplasias da Bexiga Urinária/cirurgia , Estudos Retrospectivos , Neoplasias Urológicas/cirurgia , Rim/cirurgia , Rim/fisiologia , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Neoplasias Ureterais/cirurgia
6.
World J Urol ; 40(11): 2755-2763, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36197507

RESUMO

BACKGROUND: The European Association of Urology provides Clinical Practice Guideline on upper tract urothelial carcinoma (UTUC). Due to the rarity of UTUC, guidelines are necessary to help guide decision-making based on the highest quality of care evidence available. OBJECTIVES: To evaluate guideline adherence in the management of UTUC by assessing recommendations on diagnostics needed for risk classification and subsequent treatment selection; to assess predictors for the latter. PARTICIPANTS: Data from the Clinical Research Office of the Endo Urology Society UTUC-registry were included for analysis. STATISTICAL ANALYSIS: Overall compliance were evaluated by cross-tables, differences in risk groups characteristics and treatment selection were assessed by Chi-square tests, predictors for treatment selection by logistic regression analysis. RESULTS: Data from 2380 patients were included. Imaging by CT-scan had highest adherence (85%) but was low for other diagnostics (17.7-49.7%). Multivariable regression analysis showed higher odds of receiving radical nephroureterectomy in patients with large tumours (OR 5.45, 95% CI 3.77-7.87, p < 0.001), signs of invasion (OR 3.07,CI 2.11-4.46, p < 0.001), high tumour grade (OR 2.05, CI 1.38-3.05, p < 0.001) and multifocality (OR 1.76,CI 1.05-2.97, p =0.032). CONCLUSIONS: CT-imaging is the most used and most impactful decision tool for risk-stratification and treatment selection in UTUC. Due to the low compliance in most of the diagnostic recommendations, proper risk stratification is not possible in a significant group of patients raising the question whether current stratification is deemed applicable in daily practice. Established prognostic factors on survival guides decision-making regarding radical versus kidney-sparing surgery. Tumour size was the most influencing factor on treatment decision. CLINICAL TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (ClinicalTrials.gov NCT02281188; https://clinicaltrials.gov/ct2/show/NCT02281188 ).


Assuntos
Carcinoma de Células de Transição , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Urologia , Humanos , Carcinoma de Células de Transição/diagnóstico por imagem , Carcinoma de Células de Transição/terapia , Nefroureterectomia/métodos , Sistema de Registros , Neoplasias Ureterais/terapia , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/cirurgia
7.
Rev Med Chil ; 150(2): 172-177, 2022 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-36156642

RESUMO

BACKGROUND: Upper urinary tract urothelial carcinoma (UTUC) represents 5-10% of urothelial carcinomas. It is managed with nephroureterectomy (NUR); however, kidney-sparing techniques are growingly used. AIM: To report the results of a 20-year series of NUR conducted in an academic center. PATIENTS AND METHODS: Review of clinical and pathological characteristics of patients undergoing NUR between 1999 and 2020. Patients were followed for 63 months. Global survival curves (OS) and mortality predictors were established through Cox regression. RESULTS: We included 90 patients with a median age of 68 years undergoing NUR, of whom 68 (75%) had a pelvic tumor and 22 (25%) had a proximal ureteral tumor. A laparoscopic NUR was performed in 60 patients (66%). Thirty-three patients (37%) had tumors confined to the urothelium (pTa), penetrating the lamina propria (pT1) or carcinoma in situ (CIS), 10 patients (11%) had a tumor spreading to the muscle layer (pT2) and 47 (52%) had a tumor spreading to nearby organs (pT3 / T4). Average tumor size was 3.69 cm, nodal disease (pN) was present 12 patients (13%). Twelve patients (13%) received adjuvant chemotherapy. A higher mortality was observed among smokers (Hazard ratio (HR) 8.79, 95% confidence intervals (CI) 1.5-49.0, p = 0.01), patients with tumors classfied as pT≥ 2 (HR 1.09, 95% CI 0.01-1.0, p = 0.04) and those with tumors larger than 2 cm (HR 14.79, CI 95% 1.5-272, p = 0.01). CONCLUSIONS: Smoking patients, those with invasive tumors (T2-T4) and greater than 2 cm have higher mortality. Therefore, they should not be candidates for conservative management.


Assuntos
Carcinoma de Células de Transição , Neoplasias Renais , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Idoso , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Humanos , Rim/patologia , Neoplasias Renais/cirurgia , Nefroureterectomia , Prognóstico , Estudos Retrospectivos , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/cirurgia
8.
Urol Oncol ; 40(10): 454.e17-454.e23, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35961847

RESUMO

PURPOSE: Renal function dictates sequencing and eligibility for definitive therapy in upper tract urothelial carcinoma. We investigated longitudinal glomerular filtration rate (GFR) changes after neoadjuvant chemotherapy (NAC) and nephroureterectomy (RNU). MATERIALS AND METHODS: Patients treated with ≥3 cycles of chemotherapy prior to RNU for UTUC from 2000 to 2019 were included. GFR was calculated by CKD-Epi before chemotherapy, before RNU, 1 to 3 months, and 12 months post-RNU. Pathologic stage and overall survival were compared in those with stable GFR (+/-10% of baseline) to the rest of the cohort. RESULTS: One hundred and fifty-two patients received ≥3 cycles of NAC, with 121 (79%) receiving at least 1 cycle of cisplatin. Renal function dropped by mean of 22.3 ml/min/1.73 m2 from the beginning of chemotherapy to 1-year post-surgery. In patients receiving cisplatin, a mean decline of 26.2 ml/min/1.73 m2 was observed vs. 8.8 ml/min/1.73 m2 without cisplatin-based NAC (P < 0.01). GFR after RNU was unchanged between 3 and 12 months postoperatively. At 1 to 3 months after RNU, 19% of patients had GFR<30 ml/min/1.73m2. Improvement in GFR during NAC was associated with invasive final pathologic stage (P = 0.018) and worse overall survival (P = 0.049). CONCLUSIONS: In patients managed with NAC prior to RNU, renal function stabilizes at 1 to 3 months post-operatively and remains clinically similar for cisplatin or non-cisplatin-based therapy. Improvement in GFR during NAC was associated with higher pathologic stage and poorer survival, especially in those receiving non-cisplatin-based therapy, an observation that requires further investigation.


Assuntos
Carcinoma de Células de Transição , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Cisplatino/uso terapêutico , Taxa de Filtração Glomerular , Humanos , Terapia Neoadjuvante , Nefroureterectomia , Estudos Retrospectivos , Neoplasias Ureterais/tratamento farmacológico , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/cirurgia
9.
Beijing Da Xue Xue Bao Yi Xue Ban ; 54(4): 621-627, 2022 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-35950383

RESUMO

OBJECTIVE: To investigate the correlation between drinking habits and pathological characteristics of patients with upper tract urothelial carcinoma (UTUC). METHODS: A preoperative questionnaire survey was conducted to understand the drinking habits of UTUC patients who were admitted to the Department of Urology, Peking University First Hospital for radical nephroureterectomy within one year from August 2020 to July 2021, and statistical analysis was performed in combination with their postoperative pathological characteristics. The statistical procedure was performed using SPSS 22.0 software, and firstly, the preliminary analysis was performed one by one using the columnar χ2 test on the pathological characteristics of UTUC tumors as the dependent variable and the factors related to patients' general information, past history and drinking habits as the independent variables, and the independent variables that met P < 0.2 between the case and control groups for each dependent variable were specified for screening. The screened variables were included in the binary Logistic regression analysis. A difference of P < 0.05 was used to indicate a statistically significant difference. RESULTS: A total of 239 patients, 134 males and 105 females, with a mean age of (68.1±9.98)years and a median disease duration of 4.8 months, were included in this study. Multifactorial Logistic regression results suggested that after adjusting for the effects of other variables, UTUC patients who had the habit of drinking at least once every hour during the daytime had a significantly increased risk of high grade (G3) tumors(OR=1.941, 95%CI: 0.352-1.029, P < 0.01); these patients also had a significantly decreased risk of multifocal UTUC tumors (OR=0.344, 95% CI: 1.18-5.582, P=0.004). The patients who had the habit of drinking over 100 mL water each time had a significantly decreased risk of mutifocal UTUC incidence (OR=0.477, 95%CI: 0.225-1.012, P=0.046). Patients who pay attention to daily water intakes had a significantly increased risk of renipelvic carcinoma (OR=2.530, 95%CI: 1.434-4.463, P=0.001) and a significantly decreased risk of ureteral carcinoma (OR=0.314, 95%CI: 0.172-0.573, P < 0.01). Other variables included in the regression model did not differ significantly in their effects on the occurrence of tumor pathological characteristics. CONCLUSION: Having the awareness of drinking water every 1 h during the day, drinking over 100 mL water each time, having the awareness of daily drinking habits correlated significantly with pathological characteristics of UTUC such as the presence of G3 tumor, multifocal tumors and location of the tumor. This conclusion still needs to be verified by subsequent trials with higher levels of evidence.


Assuntos
Carcinoma de Células de Transição , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/cirurgia , Feminino , Hábitos , Humanos , Masculino , Recidiva Local de Neoplasia/epidemiologia , Estudos Retrospectivos , Neoplasias Ureterais/epidemiologia , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Água
10.
Urol Oncol ; 40(10): 452.e17-452.e23, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35934609

RESUMO

INTRODUCTION: Perioperative intravesical chemotherapy (IVC) at or around the time of radical nephroureterectomy (RNU) reduces the risk of intravesical recurrence. Guidelines since 2013 have recommended its use. The objective of this study is to examine IVC utilization and determine predictors of its administration within a large international consortium. METHODS AND MATERIALS: Data was collected from 17 academic centers on patients who underwent robotic/laparoscopic RNU between 2006 and 2020. Patients who underwent concomitant radical cystectomy and cases in which IVC administration details were unknown were excluded. Univariate and multivariate analyses were utilized to determine predictors of IVC administration. A Joinpoint regression was performed to evaluate utilization by year. RESULTS: Six hundred and fifty-nine patients were included. A total of 512 (78%) did not receive IVC while 147 (22%) did. Non-IVC patients were older (P < 0.001), had higher ECOG scores (P = 0.003), and had more multifocal disease (23% vs. 12%, P = 0.005). Those in the IVC group were more likely to have higher clinical T stage disease (P = 0.008), undergone laparoscopic RNU (83% vs. 68%, P < 0.001), undergone endoscopic management of the bladder cuff (20% vs. 4%, P = 0.008). Multivariable regression showed that decreased age (OR 0.940, P < 0.001), laparoscopic approach (OR 2.403, P = 0.008), and endoscopic management of the bladder cuff (OR 7.619, P < 0.001) were significant predictors favoring IVC administration. Treatment at a European center was associated with lower IVC use (OR 0.278, P = 0.018). Overall utilization of IVC after the 2013 European Association of Urology (EAU) guideline was 24% vs. 0% prior to 2013 (P < 0.001). Limitations include limited data regarding IVC timing/agent and inclusion of minimally invasive RNU patients only. CONCLUSIONS: While IVC use has increased since being added to the EAU UTUC guidelines, its use remains low at academic centers, particularly within Europe.


Assuntos
Carcinoma de Células de Transição , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Administração Intravesical , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/cirurgia , Humanos , Recidiva Local de Neoplasia/cirurgia , Nefroureterectomia/métodos , Estudos Retrospectivos , Neoplasias Ureterais/tratamento farmacológico , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia
11.
Curr Opin Urol ; 32(5): 531-535, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35849701

RESUMO

PURPOSE OF REVIEW: This article aimed to investigate the efficacy of drug instillation therapy in preventing the recurrence of postsurgical upper urinary tract urothelial carcinoma (UTUC) by reviewing recently published research articles. RECENT FINDINGS: Several clinical trials have shown new potential forms of postsurgical intracavitary and intravesical drug instillation methodologies with better efficacy and less toxicity for use in UTUC. With the improvement of endoscopic imaging techniques and laser sciences, diverse attempts in drug instillation have shown an improved recurrence rate after kidney-sparing surgery in low-grade, low-tumor burden cancers in the upper urinary tract. A gel-form type of mitomycin-C in intracavitary instillation further reduced recurrence rates in UTUC. Other studies have compared different drug instillation methodologies with varying initiation times and timed instillation. They have shown that early instillation with multiple rounds resulted in better protective effects for recurrence rates before, during, and after surgery. SUMMARY: A new gel-form of intracavitary instillation of mitomycin-C, the timing of drug instillation, and refining techniques can result in better recurrence-free survival of patients with UTUC after surgery. Further large-scale prospective clinical trials are needed to validate these new forms of drugs and methodologies to change the therapeutic guidelines of UTUC.


Assuntos
Carcinoma de Células de Transição , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/cirurgia , Humanos , Instilação de Medicamentos , Rim , Mitomicina/uso terapêutico , Recidiva Local de Neoplasia/prevenção & controle , Estudos Prospectivos , Neoplasias Ureterais/tratamento farmacológico , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/prevenção & controle , Neoplasias da Bexiga Urinária/cirurgia
12.
BMC Cancer ; 22(1): 787, 2022 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-35850759

RESUMO

BACKGROUND: Periostin is an extracellular matrix protein that has been known to be implicated in fibrillogenesis and cell migration, including cancer metastasis. Periostin overexpression in cancer cells and/or intervening stroma is usually related to tumor progression and poor patient outcomes in various human cancers; however, its role in urothelial carcinoma, especially upper urinary tract urothelial carcinomas (UTUCs), remains inconclusive. METHODS: Samples from 126 consecutive cases of invasive UTUC (69 renal pelvic cancers and 57 ureteral cancers) were histologically reviewed and analyzed for periostin expression using immunohistochemistry. The intensities of immunoreactivity and the fraction of positive cancer cells and stroma (i.e., epithelial and stromal expression, respectively) were classified into four categories each (intensity, 0-3; fraction, 0-25% = 1; 26-50% = 2; 51-75% = 3; and > 75% = 4). The overall score was determined by multiplying both scores, and overall scores ≥ 6 were considered to indicate high periostin expression. RESULTS: Among 126 UTUCs, 55 (44%; 27 renal pelvic and 28 ureteral cancers) showed high stromal periostin expression. None of the cases were considered to have high epithelial periostin expression. High stromal periostin expression was associated with non-papillary gross findings, higher pathological T category, lymphovascular invasion, concomitant carcinoma in situ, subtype histology, lymph node metastasis, positive surgical margins, high tumor budding, and high tumor-associated immune cell status. Multivariate analysis revealed that high stromal periostin expression was an independent predictor of overall survival (p = 0.00072, hazard ratio = 3.62), and lymphovascular invasion and high stromal periostin expression were independent predictors of cancer-specific survival (p = 0.032 and 0.020, hazard ratio = 2.61 and 3.07, respectively). CONCLUSIONS: Stromal periostin expression was often observed in invasive UTUCs with adverse clinicopathological factors and may be a useful predictor of patient outcomes.


Assuntos
Carcinoma de Células de Transição , Neoplasias Renais , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Sistema Urinário , Carcinoma de Células de Transição/patologia , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Prognóstico , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/patologia , Sistema Urinário/patologia
13.
Urology ; 167: e3, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35728672

RESUMO

Ureteral fibroepithelial polyps (UFP) are benign neoplasms of mesodermal origin. In this report, we describe the rare presentation and robotic surgical management of UFP in an adult female. A 25-year-old female with recurrent bilateral UFP s/p multiple ureteroscopic ablations and right partial ureterectomy with ureto-ureteral anastomosis presented with left flank pain. Four-phase CT with delayed images demonstrated a filling defect in the left ureter. Ureteroscopy confirmed the left UFP. The number, size, and multifocality precluded endoscopic management. Creatinine was normal and the split function was 53%/47%. The patient was recommended for robotic repair. After mobilization of the colon, the ureter was identified and traced up to the hilum. There was an inflammatory rind surrounding the ureter through the majority of its length. Care was taken to avoid circumferential dissection of the ureter. Upon longitudinal incision of the ureter, polyps erupted with a release of hydronephrotic urine, despite pre-stenting. Polyps were transected at their base, revealing abnormal underlying urothelium. A ureteroscope was advanced through a robotic port to examine the proximal ureter and renal pelvis. The remaining polyps were removed after which a wire and stent were placed antegrade into the open distal ureter and proximally into the renal pelvis. The anastomosis was performed with 5-0 PDS. ICG and firefly confirmed suitable blood flow to the ureter. Pathology revealed benign fibroepithelial polyps with reactive changes to the urothelium. A retrograde pyelogram 2 months later revealed a patent ureter. This video demonstrates the successful robotic surgical management of large, multifocal UFPs.1-5.


Assuntos
Neoplasias Renais , Pólipos , Procedimentos Cirúrgicos Robóticos , Ureter , Neoplasias Ureterais , Adulto , Creatinina , Feminino , Humanos , Neoplasias Renais/patologia , Pelve Renal/cirurgia , Pólipos/diagnóstico , Pólipos/patologia , Pólipos/cirurgia , Ureter/patologia , Ureter/cirurgia , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia
15.
J Endourol ; 36(9): 1206-1213, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35607848

RESUMO

Objectives: The aim of this study was to investigate the oncological outcomes and recurrence patterns in clinically node-negative patients with renal pelvic and/or upper or middle ureteral tumors after template-based retroperitoneal lymph node dissection (RPLND) in conjunction with retroperitoneal laparoscopic radical nephroureterectomy (LRNU). Materials and Methods: A total of 283 patients who received LRNU with and without RPLND at three Japanese institutions were enrolled. The template for RPLND included the renal hilar and para-aortic lymph nodes (LNs) (left side) and renal hilar, paracaval, retrocaval, and intra-aortocaval LNs (right side). The LNs and kidneys were removed en bloc. The primary endpoint was set as recurrence-free survival. All RPLND cases were matched one-to-one with no-RPLND cases using a propensity score matching approach, and 47 matched pairs were included in analyses. Results: Compared with the control group, significant differences were not observed in the RPLND group in terms of operation time, blood loss, postoperative complication rate, and pathological findings. The estimated 5-year recurrence-free survival was significantly higher in the RPLND group (86.8%) compared with the group without RPLND (64.2%) (p = 0.014). The estimated 5-year cancer-specific survival showed a similar tendency; however, it did not reach a statistically significant difference (87.5% vs 71.3%, respectively; p = 0.168). As for the first recurrence site, the RPLND group showed a lower incidence of distant recurrence, while no significant difference was observed in the rate of regional LN recurrence. Conclusions: This study suggests that template-based RPLND in conjunction with retroperitoneal LRNU efficiently improves recurrence-free survival by reducing distant recurrences.


Assuntos
Laparoscopia , Neoplasias Testiculares , Neoplasias Ureterais , Humanos , Excisão de Linfonodo , Masculino , Análise por Pareamento , Nefroureterectomia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Neoplasias Testiculares/cirurgia , Neoplasias Ureterais/cirurgia
16.
Int Urol Nephrol ; 54(8): 1777-1785, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35610528

RESUMO

Upper-tract urothelial carcinoma is a relatively rare malignancy. Current guidelines strongly recommend radical nephroureterectomy with bladder cuff excision and template-based lymph node dissection for all high-risk upper-tract urothelial carcinomas. Although the open approach is still considered the standard of care, evolution of minimally invasive approaches especially the robotic-assisted approach, has been found to be oncologically equivalent. Since its initial description in 2006, the surgical technique as well as the robotic surgical system has gone through a major evolution. With well-established advantages of the minimally invasive approach, robotic radical nephroureterectomy also has the ability to address both upper and lower urinary tract simultaneously without the need of patient repositioning, standardized single docking technique, ease of performing crucial steps like excision of ureterovesical junction and bladder cuff with watertight cystotomy closure, allowing perioperative instillation of intra-vesical chemotherapy. Robot-assisted radical nephro-ureterectomy and template-based lymph node dissection is gradually emerging as the current standard of care to achieve the best possible oncologic and functional outcomes. In this review article we are focusing on the evolution of this approach in the management of upper-tract urothelial carcinoma along with a review of oncologic outcomes.


Assuntos
Carcinoma de Células de Transição , Procedimentos Cirúrgicos Robóticos , Robótica , Ureter , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Humanos , Nefroureterectomia/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Padrão de Cuidado , Ureter/patologia , Ureter/cirurgia , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/cirurgia
17.
Eur Urol Oncol ; 5(4): 451-459, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35504834

RESUMO

BACKGROUND: The appropriate surveillance protocol after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) is still poorly addressed. OBJECTIVE: To evaluate the appropriate intensity and duration of oncologic surveillance following RNU, according to a prior history of bladder cancer (BCa). DESIGN, SETTING, AND PARTICIPANTS: We identified 1378 high-risk UTUC patients, according to the European Association of Urology (EAU) guidelines, from a prospectively maintained database involving eight European referral centers. Surveillance protocol was based on cystoscopies and cross-sectional imaging, as per the EAU guidelines. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: First, we evaluated the noncumulative risk of bladder and other-site recurrences (including distant metastasis and locoregional relapse) against the follow-up time points, as suggested by the current EAU guidelines. Second, in an effort to identify the time points when the risk of other-cause mortality (OCM) exceeded that of recurrence and follow-up might be discontinued, we relied on adjusted Weibull regression. RESULTS AND LIMITATIONS: The median follow-up was 4 yr. A total of 427 and 951 patients with and without a prior BCa history, respectively, were considered. At 5-yr, the time point after which cystoscopies should be performed semiannually, the bladder recurrence risk was 10%; at 4 yr, the bladder recurrence risk was 13%. At 2 yr, the time point after which imaging should be obtained semiannually, the nonbladder recurrence risk was 42% in case of nonprior BCa and 47% in case of prior BCa; at 4 yr, the nonbladder recurrence risk was 23%. Among patients without a prior BCa history, individuals younger than 60 yr should continue both cystoscopies and imaging beyond 10 yr from RNU, 70-79-yr-old patients should continue only imaging beyond 10 yr, while patients older than 80 yr might discontinue oncologic surveillance because of an increased risk of OCM. Limitations include the fact that patients were treated and surveilled over a relatively long period of time. CONCLUSIONS: We suggest intensifying the frequency of imaging to semiannual till the 4th year after RNU, the time point after which the risk of recurrence was almost halved. Cystoscopies could be obtained annually from the 4th year given a similar risk of recurrence at 4 and 5 yr after RNU. Oncologic surveillance could be discontinued in some cases in the absence of a prior BCa history. PATIENT SUMMARY: In this study, we propose a revision of the current guidelines regarding surveillance protocols following radical nephroureterectomy. We also evaluated whether oncologic surveillance for high-risk upper tract urothelial carcinoma could be discontinued and, if so, in what circumstances.


Assuntos
Carcinoma de Células de Transição , Ureter , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/patologia , Humanos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Nefroureterectomia/métodos , Estudos Retrospectivos , Ureter/patologia , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/cirurgia
18.
BMC Urol ; 22(1): 63, 2022 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-35439980

RESUMO

BACKGROUND: Ureteral granulation tissue hemangiomas are rare benign vascular lesions, and they may be clinically asymptomatic or present with massive or recurrent hematuria. Sometimes hemangiomas are difficult to distinguish from malignant ureteral tumors, and most ureteral hemangiomas are confirmed by postoperative pathological examination. This article aims to present a case of granulation tissue-type hemangioma of the ureter and briefly review the current literature on this condition. CASE PRESENTATION: A 30-year-old male patient presented with complaints of painless macroscopic hematuria for 2 months. Computerized tomography of the urinary system showed that the upper 1/3 of the right ureter was occupied, and then the possibility of tumor lesions was considered. The urine cytology showed occasional nuclear abnormalities and many light-stained crystals in urine. Because of suspicious radiological and cytological findings, the patient underwent the right ureteroscopy and the laparoscopic right ureteral mass resection. The postoperative pathological report showed that it was a mesenchymal tumor. The morphological and immunohistochemical staining was consistent with that of hemangioma, tending to granulation tissue hemangioma. After surgery, the patient was in a good state and recovered well at the last follow-up. CONCLUSIONS: Ureteral granulation tissue hemangiomas are an easily misdiagnosed disease. Intermittent painless hematuria is an important characteristic of this disease. Therefore, we suggest that unnecessary radical surgery can be avoided when clinicians consider the possibility of benign ureteral tumors during the evaluation.


Assuntos
Hemangioma , Ureter , Neoplasias Ureterais , Adulto , Erros de Diagnóstico/efeitos adversos , Feminino , Tecido de Granulação/patologia , Hemangioma/complicações , Hemangioma/diagnóstico , Hemangioma/cirurgia , Hematúria/diagnóstico , Hematúria/etiologia , Humanos , Masculino , Ureter/patologia , Ureter/cirurgia , Neoplasias Ureterais/diagnóstico , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia
19.
Int Braz J Urol ; 48(5): 876-877, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35363457

RESUMO

INTRODUCTION: Upper tract urothelial carcinoma (UTUC) accounts for 5-10% of all urothelial tumors (1). Radical nephroureterectomy (RNU) remains the standard treatment for high, and low-grade UTUC (2). Although the open approach has been considered the gold standard, robotic techniques have shown comparable oncological outcomes with potential advantages in terms of peri-operative morbidity (3). MATERIALS AND METHODS: We present a novel "Keyhole" technique for management of distal ureter and bladder cuff during robotic RNU. This technique allows the surgeon to directly visualize the ureteric orifices, delineate resection borders, and maintain oncologic principles of en-bloc excision without necessitating secondary cystotomy incision or concomitant endoscopic procedure. Descriptive demographic characteristics, surgical, pathological, and oncological outcomes were analyzed. Complications were reported using the Clavien-Dindo classification system. RESULTS: Between 2015 and 2020, ten patients underwent robotic RNU with bladder cuff excision using the Keyhole technique (single-dock, single-position). Median age was 75 years. Eight patients underwent surgery for right-sided tumors. Median operative time, estimated blood loss, and length of hospital stay were 287 min, 100 mL, and 3 days, respectively. No intraoperative complications occurred, and one grade II complication occurred during the 90-day postoperative period. All patients had high-grade UTUC, being 90% pure urothelial. Bladder recurrences occurred in 30% of patients with an overall median follow-up of 11.2 months. CONCLUSIONS: Keyhole technique for the management of distal ureter and bladder cuff during RNU represents a feasible approach with minimal 90-day complications and low bladder recurrence rate at centers of experience.


Assuntos
Carcinoma de Células de Transição , Procedimentos Cirúrgicos Robóticos , Ureter , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Idoso , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Humanos , Nefrectomia/métodos , Nefroureterectomia/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/patologia , Ureter/cirurgia , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/cirurgia
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