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Nephrectomy and partial nephrectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Imran Mushtaq, Alberto Mantovani, Judy Hung Wing Suet
The most common indications for nephrectomy or nephroureterectomy in modern pediatric practice include: Congenital poorly functioning dysplastic kidneyReflux-associated nephropathy with loss of function (LOF)
Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Along with colorectal cancer, there is a patient history of nephroureterectomy, consistent with previous urothelial malignancy. The family history reveals endometrial cancer and glioblastoma. These all fit with Lynch syndrome, otherwise known as hereditary non-polyposis colorectal cancer. This is the most common cancer syndrome and increases the risk of urinary tract transitional cell carcinoma, endometrioid endometrial cancer and glioblastoma as well as ovarian, small bowel and gastric cancers.
Kidneys and ureters
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The standard treatment of UTTCC is nephroureterec- tomy. In most cases, the surgery to mobilise (a) the kidney and (b) the distal ureter is accomplished using different surgical approaches depending on whether the tumour is high up in the renal pelvis or involves the distal ureter. If the tumour is in the renal pelvis, laparoscopic mobilisation of the kidney and ureter can be combined with endoscopic resection of the ipsilateral intramural ureter to allow nephroureterectomy. If the tumour involves the distal ureter, the distal ureter is usually dissected out using a lower midline incision and opening the bladder - with again laparoscopic mobilisation of the kidney which is then delivered through the open incision. A catheter is needed for around 10 days after nephroureterec- tomy to allow the bladder to heal satisfactorily. Robotic assistance for this operation is likely to continue to develop.
S-phase – an independent prognostic marker in upper tract urothelial carcinoma
Published in Scandinavian Journal of Urology, 2022
Camilla Malm, Georg Jaremko, Marianne Brehmer
In a previous study, we examined tumour characteristics associated with invasiveness and cancer-specific survival [12] and found that, in addition to the previously known prognostic markers, the tumour stage and grade, proliferation rate determined by the proportion of cells in S-phase of the cell cycle (S-phase fraction) using flow cytometry, was strongly associated with cancer-specific survival. S-phase fraction has not been much studied in UTUC. Flow cytometry is a relatively inexpensive and objective method that can be used to measure S-phase fraction in tumour cells from both radical nephroureterectomy specimens and from in-situ barbotage. The latter is easy to secure at diagnostic ureterorenoscopy and provides ‘pre-radical nephroureterectomy’ risk assessment. To further evaluate the usefulness of S-phase fraction as a predictor of invasiveness and of cancer-specific survival, we investigated S-phase fraction in an extended cohort of patients with non-metastatic UTUC treated with radical nephroureterectomy, with long-term follow-up.
Robot-assisted nephroureterectomy for upper tract urothelial carcinoma—feasibility and complications: a single center experience
Published in Scandinavian Journal of Urology, 2022
F. Liedberg, J. Abrahamsson, J. Bobjer, S. Gudjonsson, A. Löfgren, M. Nyberg, A. Sörenby
Pathological report data including grade and tumour multiplicity is available in Table 3, however, information on tumour size in the nephroureterectomy specimen was not uniformly reported and is therefore not known. Upstaging from ≤ T1 to > T1 occurred in 51 (35%) of patients when comparing clinical and pathological stages in the nephroureterectomy specimen. The proportion of patients with up-staged tumours was similar among those subjected to preoperative ureteroscopy [19/61 (31%)] compared to those who did not [32/85 (38%)] (p = 0.3). In one patient, no tumour was found in the nephroureterectomy specimen. Preoperatively, this patient had a benign voided urinary cytology, blood flow from the right ostium at cystoscopy, and a contrast defect in the lower renal pelvis was observed with a corresponding contrast enhancement. This was interpreted as a pelvic tumour in both the primary radiology report and following radiological review during the MDT.
Operative management in patients with upper tract urothelial carcinoma in Iceland: a population-based study
Published in Scandinavian Journal of Urology, 2021
Oddur Björnsson, Eiríkur Jónsson, Eiríkur Orri Guðmundsson, Valur Þór Marteinsson, Sigfús Þór Nikulásson, Sigurður Guðjónsson
The long-term survival rate among patients with UTUC is known to be highly dependant on tumor grade and stage [7–9]. In this study, there is a marked difference in CSS between patients with a T2 stage tumor or higher compared to patients with T1 tumor or lower, as would be expected (Figure 2). The 5-year CSS in this study was 67%. Similar results have been described by Rouprêt et al. in a large multi-center study where CSS after nephroureterectomy for those with UTUC at 5 years was 73% [10]. Rouprêt et al. described survival after nephroureterectomy, whereas in this study survival is reported for patients undergoing nephroureterectomy and KSS. However, studies have shown that CSS of UTUC patients treated with RNU versus KSS is similar [3]. It has also been demonstrated that KSS results in a similar or even better overall survival compared to RNU when treating low stage and low grade tumors, most likely because it saves renal function while resulting in a similar oncologic outcome [11]. During the 14-year study period only eight kidney-sparing procedures (13%) were performed. That can be considered a fairly low number since 18 patients (29%) had a low grade and Ta stage tumor in this study. The most likely reason for this is that firstly the evidence of clinical guidelines for KSS in the treatment of UTUC was not as strong 15 years ago as it is today. Second, because of the low volume in Iceland, there are too few cases for surgeons to get the appropriate training in the complex endourologic procedures that may be required.