Minimally invasive treatment of upper urinary tract lesions
Šunjara Mario, Ferenčak Vladimir, Krhen Ivan, Grković Marija, Kaštelan Željko
INTRODUCTION
With advances in endourologic equipment no part of urinary tract is left inaccessible to endoscopic diagnosis and treatment. Lesions that previously required open exploration and often nephroureterectomy can nowadays be treated endoscopically in selected patients.
PATIENTS AND METHODS
From January of 2011. to March of 2013. 24 patients underwent ureterorenoscopy for suspicious upper urinary tract lesions other then urinary stones.
In 7 patients we also acted therapeutically – in 5 patients biopsies of suspicious tissue were taken and subsequently lesions were ablated using laser, in one patient upper urinary tract bleeding was stopped using laser and one patient had subepithelial collection of pus perforated using biopsy forceps.
RESULTS
13 patients were discharged for further follow up with no pathology found.
4 patients were found to have significant tumor mass in renal pelvis and calices and were treated with nephroureterectomy.
All procedures were completed without complications. There was no need for conversion to open surgery and no need for blood transfusion, recovery in all patients was swift.
Biopsy samples revealed following: 3 patients had urothelial cancer, 2 patients had nephrogenic metaplasia. Follow up is too short to give final conclusion in patients with upper urinary tract tumors.
CONCLUSION
Endoscopic treatment of upper urinary tract lesions, combining semirigid ureteroscope, flexible ureterorenoscope, biopsy forceps and laser is safe and effective procedure. It aids greatly in diagnostic algorithm when it comes to upper urinary tract tumours and provides treatment for selected patients