[Endoscopic management of urothelial tumours of the upper urinary tract].

OBJECTIVE

The reference treatment for filling defects of the upper urinary tract is nephroureterectomy with excision of a perimeatal bladder segment. The authors evaluated the role of endoscopy and laser in the management of filling defects of the upper urinary tract.

MATERIAL AND

METHODS

Filling defects of the upper urinary tract were evaluated by biopsies performed during ureteroscopy followed by 10 Watt Holmium-YAG laser vaporisation. High-grade or incompletely vaporised tumours or multifocal tumours or tumours more than 2 cm in diameter received complementary treatment. Low-grade and completely vaporised tumours were followed by ureteroscopy at 3 months and then every 6 months. The authors conducted a prospective study from March 2002 to September 2004. Fifteen consecutive patients were managed according to this protocol. The mean age was 70 years (range: 53 to 85 years). Thirty nine tumours were treated. The mean tumour diameter was 1.05 cm (range: 0.3 to 2.5 cm).

RESULTS

In this series of 15 patients treated according to this protocol, 39 tumours were diagnosed and treated. The grade was determined by biopsy in 66% of cases. Seven patients have a median recurrence-free survival of 18 months (range: 12 to 34 months). Overall, conservative management was able to be performed in twelve patients, corresponding to a 22-month kidney preservation rate of 80%. Two patients died during follow-up, one from prostatic cancer and the other from invasive urothelial bladder tumour. One patient who had had recurrence ans had been re-treated was lost for report.

CONCLUSION

Filling defects of the upper urinary tract can be investigated by ureteroscopy to obtain a histological diagnosis and to perform treatment by laser vaporisation. Complementary treatment is then performed depending on the histological results, either by complementary vaporisation or by nephroureterectomy. Laser treatment ensures a high kidney preservation rate but with a recurrence risk. Conservative endoscopic treatment, which is considered to be acceptable in cases of necessity, may also be useful in the context of small, unifocal, minimally invasive tumours with a normal contralateral kidney.