V03-03 PERCUTANEOUS RESECTION OF BULKY RENAL PELVIS AND CALYCEAL TUMORS
INTRODUCTION AND OBJECTIVE:
The standard of care for upper tract urothelial carcinoma (UTUC) is radical nephroureterectomy; however, certain patient populations such patients with significant medical comorbidities precluding surgical intervention, bilateral foci of UTUC or requirement for nephrotoxic chemotherapy for non-urologic malignancy may benefit from a conservative treatment approach. Ureteroscopic resection of small upper tract tumors has been reported; however, this technique has not been shown to be effective for large tumors. This video demonstrates an endoscopic surgical approach for management of large bulky upper tract tumors.
The location and size of the tumor dictate which instruments are required. For smaller tumors involving the renal calyx or infundibulum we utilized a 19 Fr miniscope with a 15.5 bipolar mini resectoscope. For larger tumors involving the renal pelvis we use a 24 or 27 standard transurethral resectoscope. Debulking of the ureteropelvic junction should be done with cold cup forceps to avoid thermal injury and prevent future obstruction secondary to ureteral stricture.
At our institution, we have completed 22 such cases over 16 years. We have not observed any upstaging of upper tract disease after resection on routine surveillance. Two mortalities have been reported; however, neither was due to progression of urothelial malignancy.
Patients with contraindications to radical nephroureteretomy may benefit from conservative management utilizing a combination of percutaneous endoscopic resection and intracavitary chemotherapy.
Source of Funding: