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Rigid Uretero-Resectoscopic Management of Ureteral Tumors

  • Joel Hillelsohn
  • Majid Eshghi
Chapter

Abstract

Ureteroscopic resection of upper tract is indicated by patient preference, medical comorbidities, and location/size of tumor. The literature on ureteral recurrence reports a recurrence rate of 48% for low grade and 60% for high grade, but the real recurrence rate is likely to be higher. Risk factors for recurrence include size >2 cm, grade, prior history of urothelial cell carcinoma and stage. The most important factor appears to be grade. Patients who failed conservative therapy and had a delayed radical nephroureterectomy had similar disease-specific survival and pathological stage to those who choose immediate radical nephroureterectomy. In our experience, ureteral tumors are best treated with ureteraoresectoscope. One must be careful with resecting near vessels such as the iliacs in the mid-ureter. In many cases, the resection will need to be staged secondary to the bulky nature of the tumor. If the lesion appears to be extensive or high grade, we instill Mitomycin C at the end of the procedure.

Keywords

Ureteroscopic resection Upper tract recurrence Risk factors for recurrence Uretero-resectoscope Mitomycin C Upper tract urothelial carcinoma 

Notes

Acknowledgements

Author acknowledges the contribution of Sean Fullerton, MD, Westchester Medical Health Network, New York Medical College, Valhalla, NY and thanks him for his helpful comments and feedback.

Supplementary material

Video 21.1

Ureteroscopic resection using the Wolf rigid uretero-resectoscope (MP4 487420 kb)

Video 21.2

Uretroscopic resection using the Storz rigid ureteroresectoscope (MP4 33409 kb)

Video 21.3

Second session for resection of residual tumor and margins that are now better visualized (MP4 132258 kb)

Video 21.4

Follow-up digital video-ureteroscopy now shows no residual tumor. The previously resected orifice allows for reflux into distal ureter for topical treatment (MP4 183005 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyWestchester Medical Health Network/New York Medical CollegeValhallaUSA

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