13-year experience with percutaneous management of upper tract transitional cell carcinoma

Purpose: We determined the immediate and long-term results of percutaneous management of upper trace transitional cell carcinoma in regard to rates of tumor recurrence and preservation of renal function. Materials and Methods: Since July 1985, 12 men and 5 women 50 to 86 years o ld (mean age 72.2) years old underwent percutaneous management of upper tra ct transitional cell carcinoma. Of the patients 12 (71%) had a solitary kid ney and 1 was treated bilaterally. In 16 of the 18 treated renal units (89% ) definitive percutaneous resection of the tumor was followed by 6 weekly p ercutaneous installations of bacillus Calmette-Guerin. Results: Complete resection was accomplished in 17 of the 18 renal units. O f the 18 renal units 15 (83.3%) had documented stage pTa lesions and 14 (77 .8%) had grade 1/3 or 2/3 disease. Followup for all patients ranged from 1. 7 to 75.5 months (mean 20.5). At the latest followup II patients (64.7%) ar e alive with no evidence of disease, and 6 (35.3%) died, 3 of whom (17.6%) had metastatic transitional cell carcinoma. Of the 13 patients undergoing t reatment to solitary kidneys or bilaterally followup ranged from 1.7 to 75. 5 months (mean 23.6). Serum creatinine ranged from 1.1 to 3.5 mg./dl. (mean 1.6) before percutaneous tumor resection and from 1.1 to 2.2 mg./dl.. (mea n 1.6) at the latest followup. Only 1 of these 13 patients (7.7%) with a so litary kidney has required dialysis. Ipsilateral local recurrence developed in 6 of the 18 renal units (33%), and in 4 of these 6 patients (67%) the t umor was grade 2/3 or 3/3 at initial resection. These recurrences were trea ted endoscopically in 4 patients, 3 of whom are currently without evidence of disease, and with nephroureterectomy in 2. Of the 17 patients only 1 (5. 9%) with high grade (3/3), invasive (pT2) primary tumor at initial resectio n died of locally persistent or recurrent disease. Conclusions: Percutaneous management of upper tract transitional cell carci noma is technically feasible and applicable in a significant number of pati ents in whom nephron sparing management is otherwise warranted. In carefull y selected patients the results are at least comparable to other forms of " conservative" management in terms of tumor control and preservation of rena l function.