LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 104-105
Author Reply Re; Sarmah PB, Ehsanullah SA, Sarmah BD. Long-term follow-up and outcomes of percutaneous nephron-sparing surgery for upper tract urothelial carcinoma. Indian J Urol 2020;36:276-81
Piyush Bhargav Sarmah1, Syed Ali Ehsanullah2, Bhupendra Dev Sarmah3
1 Department of Urology, City Hospital, Birmingham, UK
2 Department of Urology, Russells Hall Hospital, Dudley, UK
3 Department of Urology, Birmingham Heartlands Hospital, Birmingham, UK
|Date of Submission||30-Oct-2020|
|Date of Acceptance||12-Dec-2020|
|Date of Web Publication||1-Jan-2021|
Piyush Bhargav Sarmah
Department of Urology, City Hospital, Birmingham
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sarmah PB, Ehsanullah SA, Sarmah BD. Author Reply Re; Sarmah PB, Ehsanullah SA, Sarmah BD. Long-term follow-up and outcomes of percutaneous nephron-sparing surgery for upper tract urothelial carcinoma. Indian J Urol 2020;36:276-81. Indian J Urol 2021;37:104-5
|How to cite this URL:|
Sarmah PB, Ehsanullah SA, Sarmah BD. Author Reply Re; Sarmah PB, Ehsanullah SA, Sarmah BD. Long-term follow-up and outcomes of percutaneous nephron-sparing surgery for upper tract urothelial carcinoma. Indian J Urol 2020;36:276-81. Indian J Urol [serial online] 2021 [cited 2021 Jan 27];37:104-5. Available from: https://www.indianjurol.com/text.asp?2021/37/1/104/306055
Many thanks for providing this response to our article, and we would like to reply to the points raised in it.
There was only one patient with multifocal tumors (size 4 cm) (this was made clear in Table 2 of the original article), and was converted to radical nephro-ureterectomy (RNU) at the same time as percutaneous nephron-sparing surgery (PCNSS) was attempted. The European Association of Urology (EAU) guidelines were first published in 2015; the study period was from 1994 to 2012. All patients operated on with tumor sizes of >2 cm did not have any upper tract urothelial carcinoma (UTUC) recurrence, however in our department after the EAU guidelines were published, the protocols have now been modified so that such patients are managed via RNU.
When the resection was performed, each resected tumor chip was removed individually immediately after the resection. The diathermy settings were at the lowest possible where it was effective. In addition, a fixed volume of distilled water was instilled into the pelvicalyceal system prior to nephrostomy tube insertion for every patient, as outlined in the methods' section.
All recurrent UTUCs were of high grade, but all the patients who developed these in fact had Grade 2 (low grade as defined in our paper) primary tumors proven from PCNSS and were therefore considered suitable for PCNSS in the first place. One of these patients with recurrent UTUC was mentioned in the discussion section as the patient continued to smoke heavily in the postoperative period; this was very likely to have contributed to the patient's disease recurrence rather than the absence of early RNU as suggested (and again outlines the limitations from the small numbers in our series).
When examining the literature, Motamedinia et al. reported the largest series of patients undergoing PCNSS for UTUC. In this, 47% of the patients had high-grade tumor after initial resection; these patients post-PCNSS were managed in the same way as those with low-grade tumor.
None of the patients with high-grade primary tumors after PCNSS developed UTUC recurrence; all these patients agreed to a strict follow-up regime with the understanding that RNU was the recommended treatment in the event of UTUC recurrence, which subsequently did not occur at all in any of these patients who eventually had their kidney spared.
| References|| |
Rouprêt M, Babjuk M, Böhle A, Burger M, Compéerat E, Cowan N, et al
. EAU guidelines on urothelial carcinomas of the upper urinary tract. Eur Urol 2018;73:111-22.
Motamedinia P, Keheila M, Leavitt DA, Rastinehad AR, Okeke Z, Smith AD. The expanded use of percutaneous resection for upper tract urothelial carcinoma: A 30-year comprehensive experience. J Endourol 2016;30:262-7.