Ureteroscopic Management of Large ≥2 cm Upper Tract Urothelial Carcinoma: A Comprehensive 23-Year Experience

Kymora B. Scotland, Nir Kleinmann, Dillon Cason, Logan Hubbard, Ryuta Tanimoto, Kelly A. Healy, Scott G. Hubosky, Demetrius H. Bagley

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: To evaluate the effectiveness of ureteroscopy (URS) with laser ablation as an alternative treatment for upper tract urothelial carcinoma (UTUC) lesions larger than 2 cm. Traditionally, patients with large UTUC are treated with radical nephroureterectomy (RNU). However, in patients with pre-existing renal disease, a solitary kidney, or those who decline RNU, management of UTUC may prove challenging Methods: An institutional database review identified 80 patients with biopsy proven low-grade UTUC who had at least one lesion larger than 2 cm. We collected clinical data including demographics, operative parameters, and pathologic features. Follow-up for all patients was standardized and included cystoscopy and URS every 3 months until clear, every 6 months through the fifth year, and yearly thereafter. We calculated rates of recurrence, progression, and overall survival. Results: In total, 86 unique lesions ≥2cm were identified in the 80 qualifying patients; mean tumor size was 3.04 cm. Median follow-up was 43.6 months. During follow-up of patients treated curatively, 90.5% of tumors had ipsilateral recurrence and 31.7% progressed in grade at a median of 26.3 months. RNU was performed in 16 patients (20%); mean time to surgery was 23.2 months. Overall survival was 75%, and cancer specific survival was 84% at 5-year follow-up. Conclusion: Under strict surveillance, ureteroscopic management of large (≥ 2cm) UTUC lesions is a viable treatment alternative to RNU. While recurrence is common, URS can potentially preserve renal units in patients with large lesions.

Original languageEnglish
JournalUrology
DOIs
Publication statusAccepted/In press - Jan 1 2018

ASJC Scopus subject areas

  • Urology

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    Scotland, K. B., Kleinmann, N., Cason, D., Hubbard, L., Tanimoto, R., Healy, K. A., Hubosky, S. G., & Bagley, D. H. (Accepted/In press). Ureteroscopic Management of Large ≥2 cm Upper Tract Urothelial Carcinoma: A Comprehensive 23-Year Experience. Urology. https://doi.org/10.1016/j.urology.2018.05.042