Endoscopic treatment of multiple ureteral tumors in eighty-year old patient (SIU 2011)

  • uploaded: Jul 11, 2011
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Jul 11, 2011 / Duration: 06:33 / Views: 150 / 0 comments

Authors:

Tomislav Pejcic, Biljana Markovic, Vladan Andrejevic, Borivoj Milkovic, Aleksandar Janjic, Jovan Hadzi-Djokic

Institution:

Urological Clinic, Clinical Center of Serbia, Belgrade, Serbia
Categories:

Abstract

Introduction:
We present the case of 80-year old lady with multiple small superficial tumors in the left ureter, treated endoscopically. The patient had 15 year-long history of multiple bladder tumors, treated by transurethral resection (TUR) and fulguration.

Case report:
1. Routine control cystoscopy revealed the presence of tumor protruding from the left orifice; pathological examination confirmed transitional cell carcinoma (TCC) stage Ta, grade I
2. IVU revealed multiple defects along left ureter: five defects in the upper ureter and about ten defects in the lower/ pelvic portion.

Operative technique:
1. Ureterorenoscopy revealed 15-20 small, superficial papillary lesions, 3-5mm in diameter, with narrow base. There were no tumors in the renal pelvis.
2. One week after, the patient underwent URS with the fulguration of all tumors in the left ureter, starting from the left renal pelvis to the left ureteral orifice.
3. After the procedure was completed, JJ stent was inserted and remained for four weeks.

Follow-up:
There were no recurrence on the control URS after two, four and six months. In addition, CT-urography after eight and 20 months were normal.

Conclusion:
The standard treatment of upper urinary tract (UUT) tumors is nephroureterectomy. However, in selected patients, with single, low-grade, small (<1.5cm) tumors, especially in cases with solitary kidney and significant comorbidities, endoscopic treatment is sufficient. In this case, an 80-year old patient with multiple small urothelial tumors is free of the disease, 20 months after the treatment.

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