When is surgery indicated for urothelial tumors of the renal pelvis and ureters?

Updated: Aug 07, 2020
  • Author: Kyle A Richards, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Nephroureterectomy with excision of the bladder cuff is the criterion standard treatment for all forms of upper tract transitional cell carcinoma (TCC). Contemporaneously, it is indicated in patients with large-volume renal pelvis TCC, regionally extensive disease, and high-grade or high-stage lesions.

Laparoscopic nephroureterectomy is being used in many cases and offers the potential benefits of lower blood loss and shorter hospitalization. Cancer control outcomes appear to be equivalent.

Segmental ureterectomy coupled with ureteral reimplantation can be used for lower-grade superficial urothelial tumors located in the distal ureter.

Renal-sparing surgery (including segmental ureterectomy or endoscopic or percutaneous resection) is typically used in patients with small, lower-grade, superficial lesions. Additionally, patients who would be at risk for dialysis after nephroureterectomy and those who are medically unfit for radical surgery can be offered minimally invasive and renal-sparing techniques.


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