| Article Title: |
Summary of Endoscopic diagnosis and treatment of upper-tract urothelial tumors: A preliminary report (by Jeffry L. Huffman, MD, Demetrius H. Bagley, MD, Edward S. Lyon, MD, Michael J. Morse, MD, Harry W. Herr, MD, and Willet F. Whitmore, Jr, MD) |
| Abstract: |
Purpose: The availability of endoscopic instruments designed specifically for use in the upper urinary tract allows the urologist to investigate conditions of the ureter and intrarenal collecting system that are suspicious for malignancy. This report evaluates the feasibility of performing direct vision rigid ureteroscopy and pyeloscopy, documents the success rate for obtaining biopsy material satisfactory to make a diagnosis, and reviews the complication rate associated with the procedure.Patients and Methods: Thirty-one patients with either unilateral upper tract hematuria (191, tumor at the ureteral orifice (61, or radiographic filling defects (6) underwent rigid ureteroscopy using an 11.5E ureteropyeloscope after dilation of the ureteral orifice to 15F. Twenty-eight patients had the procedure performed successfully. In two patients, the orifice could not be dilated sufficiently to allow passage of the 11.5E instrument and one patient had a tortuous ureter that would not permit instrument passage.Results: Of the 28 procedures performed successfully, 12 had examinations that were negative, one had bleeding localized to a calyx (probable hemangiomal, three were found to have uric acid stones, and 12 upper tract malignancy. The 12 patients with tumor had the diagnosis confirmed by biopsy and then underwent mapping of the urothelium to identify areas of tumor involvement. Three patients subsequently underwent either nephroureterectomy or segmental ureterectomy. The remaining patients had endoscopic removal and fulguration of the tumor, followed by surveillance procedures. Two complications were noted: one patient developed acute pyelonephritis after the procedure with blood cultures that tested positive for Gram-negative bacilli, and one patient in whom the ureteral orifice had been resected previously for tumor-developed stenosis of the orifice. The patient with pyelonephritis responded to intravenous antibiotics and became asymptomatic within 48 hours. This initial report confirms the usefulness of an endoscopic technique, rigid ureteroscopy, to evaluate conditions of the upper urinary tract that are suspicious for malignancy. The procedure was found to be safe and reliable in obtaining a diagnosis. Its usefulness in the treatment of upper tract tumors cannot be assessed because of the few number of patients who were treated and the short period of followup.Copyright (c) 1997 by W.B. Saunders Company |
