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ORIGINAL ARTICLE
Year : 2020  |  Volume : 36  |  Issue : 4  |  Page : 276-281

Long-term follow-up and outcomes of percutaneous nephron-sparing surgery for upper tract urothelial carcinoma


Department of Urology, Birmingham Heartlands Hospital, University Hospitals of Birmingham, Birmingham, UK

Correspondence Address:
Piyush Bhargav Sarmah
Department of Urology, Birmingham Heartlands Hospital, University Hospitals of Birmingham, Birmingham
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_93_20

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Introduction: Upper tract urothelial carcinoma (UTUC) is uncommon, accounting for 5%–10% of all urothelial carcinomas. Current standard of care for localized disease consists of radical nephroureterectomy (RNU) which leads to loss of half the patient's functioning nephrons. Percutaneous nephron-sparing surgery (PCNSS) is an alternative minimally-invasive approach in selected cases where nephron preservation is desired. The long-term outcomes of this procedure at a single center are described. Methods: All patients undergoing PCNSS, with the operation carried out by a single surgeon, were included. Equipment used was a standard 26Ch resectoscope through a 30Ch Amplatz sheath, with all patients receiving postoperative intrapelvic Mitomycin. Data for each patient were collected on patient age; tumor size at diagnosis; grade; stage; oncological recurrence; requirement for subsequent RNU; and overall survival. Primary outcomes were disease recurrence and overall mortality, and secondary outcome was rate of subsequent RNU. Results: Fifteen patients in total underwent PCNSS, 14 were diagnosed with UTUC; benign leiomyoma was proven in one patient and excluded from final analysis. Overall survival at 5 and 10 years was 92.9% and 78.6%, respectively, with disease-specific mortality at 10 years of 7.1% (one patient who developed metastatic carcinoma); 21.4% of patients had recurrent ipsilateral UTUC and all required subsequent RNU for this indication. No patients had seeding of the percutaneous tract. Conclusion: PCNSS for UTUC is a feasible approach to consider in carefully selected patients who agree to intensive follow-up, even for higher grade tumors. Where recurrent UTUC occurs, further management options still exist for disease treatment.


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