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The presence of adenocarcinoma in urothelium is rare and mucinous adenocarcinoma is even rarer. A case of primary ureteral papillary mucinous adenocarcinoma was reported. The patient was admitted to hospital due to dull pain in the left lumbar abdomen with abdominal distension for 2 years and aggravation with fever for 1 week. CT examination revealed left ureteral calculi, severe left renal hydronephrosis, and renal cortical atrophy. The diagnosis was left ureteral calculus with hydronephrosis and left renal dysfunction. Left kidney puncture and drainage were performed first, followed by laparoscopic nonfunctional nephrectomy and ureterolithotomy. The pathological diagnosis was left ureteral mucinous adenocarcinoma. The patient refused further adjuvant therapy and died 16 months after surgery due to extensive tumor metastasis.
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Objective: To evaluate the clinical effects of retroperitoneal and transperitoneal laparoscopic radical nephroureterectomy for upper urinary tract urothelial carcinoma. Methods: We trospectively analyzed the clinical data of 85 patients with upper urinary tract urothelial carcinoma (UTUC) who underwent laparoscopic radical nephroureterectomy in West China Hospital, Sichuan Universi-ty, from January 2012 to December 2016. Forty-nine patients (Group A) underwent retroperitoneal laparoscopic radical nephroureter-ectomy while 36 (Group B) underwent transperitoneal laparoscopic radical nephroureterectomy. Operative time, blood loss volume, time of incision drainage, catheterization time, recovery time of postoperative intestinal function, postoperative hospitalization time, operative complications, postoperative local recurrence, and distant metastasis were compared between the two groups. Results: All operations were successfully performed. Mean operative time was (126.9 ± 11.6) min in Group A, while it was (109.9 ± 14.7) min in Group B; thus, mean operative time was significantly shorter in Group B than in Group A (P<0.05). Mean blood loss volume was (108.5±24.1) mL in Group A, while it was (95.1±19.9) mL in Group B; thus, mean blood loss volume was significantly lower in Group B than in Group A (P<0.05). Mean recovery time of postoperative intestinal function was (1.8±0.5) days in Group A, while it was (2.3± 0.4) days in Group B; thus, mean recovery time of postoperative intestinal function was significantly longer in Group B than in Group A (P<0.05). The other evaluated indicators did not differ significantly between the two groups. Conclusions: Both retroperitoneal and transperitoneal laparoscopic radical nephroureterectomy are safe and effective as minimally invasive treatment for upper UTUC.
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Objective To evaluate the safety and efficacy of 125I seed strands cavity brachytherapy for ureteral carcinoma.Methods To tally 10 patients with ureteral carcinoma underwent Carm CT and DSA guided percutaneous nephrostomy with 125I seed strands cavity brachytherapy.The technical success rate,complications,tumor local control rate,ureteral patency andsurvival time,and compared the Karnofsky scores,Girignon grade,pain score before and after treatment were evaluated.The dose related parameters were compared between pre-and post-treatment.Results 125I seed strands implantation was successfully completed in all patients with technical success rate of 100％.The mean procedure time was (12.3 ±3.8) min.No severe complications such as ureteral perforation,infection,severe bleeding occurred.Local tumor response was CR in 4 cases and PR in 6 cases,showing local control efficiency (CR + PR) 100％ after 2-3 months.Ureteral patency rate was 50％ (5/10).Postprocedure Karnofsky scores,Girignon grades,and pain scores were significantly improved (Z =-2.72,-2.88,-2.83,P＜0.01).The average follow-up time was (14.6 ±6.5) months (5-25 months),tumor progression was observed in 3 cases,stable disease in 7 cases.Nine cases were alive and one died due to multiple organ failure.The differences of D90％,mPD,V100％,V150％,V200％,CI,EI,HI between the preand post-treatment were not statistically significant (P ＞ 0.05).Conclusions 125I seed strands cavity brachytherapy for ureteral carcinoma is an effective and safe procedure without serious complications,and an effective alternative treatment for patients who are unable to undergoor refuse surgery.
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Objective To observe the effect of Boari bladder muscle flap surgery in nephron sparing surgery for patients with middle and lower ureteral carcinoma. Methods Totally 80 patients with middle and lower ureteral carcinoma underwent surgery in our hospital from March 2009 to March 2012 were selected and divided into the control group and the observation group,with 40 cases in each group. Patients of the control group were treated with ureteral carcinoma radical prostatectomy while patients of the observation group were treated with Boari bladder muscle flap surgery,and all of them were followed up for 3 years after operation. Observed the renal function,renal tumor markers and the level of inflammatory symptoms of the 2 groups before the operation and 3 months after the operation,and compared the long-term progno-sis of the 2 groups. Results There was no significant difference between the 2 groups in renal function index before operation. The level of BUN,Scr,blood urea and serum uric acid index in the 2 groups were all increased compared with those before operation,but the increase of the control group was significantly higher with statistically significant differences (P0. 05). The survival rate 1 year,2 years and 3 years after operation also had no significant difference between the 2 groups (P>0. 05). Conclusion The use of Boari bladder muscle flap surgery in nephron sparing surgery for patients with middle and lower ureteral carcinoma can effectively maintain the renal function of patients without affecting the radical and long-term prognosis.
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Background and purpose:Radical nephroureterectomy can be performed in a variety of ways, and each method has its advantages and disadvantages. It still remains controversial for choosing the surgical methods. In this study, we chose six surgical methods and investigated the safety and efficacy of different methods in treating upper urinary tract carcinoma.Methods:We retrospectively analyzed 135 patients with upper urinary tract transitional cell carcinoma who underwent operations in our hospital from Jan. 2002 to Oct. 2013, and compared the data of six different operations in-cluding operating time, volume of bleeding, time of bowel function recovery and incidence of bladder carcinomas.Results:The operations were successfully completed in groups A and B. Five cases in group C were transferred into group A be-cause of failing to pull the nub of the ureter. Two cases in group D were transferred into group A because of failing to pull the nub of the ureter. Three cases in group E were transferred into group D and 1 case was transferred into group A because of adhesion or bleeding. One case in group F was transferred into group A because of bleeding. There was no statistically significant difference in survival rates among six operations.Conclusion:Six operations are all safe and effective for the treatment of upper urinary tract carcinomas. Each method has its advantages and disadvantages. We should choose differ-ent methods according to particular cases.
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Objective To discuss the MSCT diagnosis and differential diagnosis of primary ureteral carcinoma and non-specific u-reteritis.Methods The pre-contrast and three-phase post-contrast MSCT scans were performed in a group of 12 patients with prima-ry ureteral carcinoma and 5 patients with non-specific ureteritis confirmed by pathology.The MPR,CPR,CTU images were genera-ted from raw data.The MSCT image feature of the primary ureteral carcinoma and non-specific ureteritis were observed respective-ly.Results ①1 2 cases of primary ureteral carcinoma pathologically diagnosed as transitional cell carcinoma,The manifestations of MSCT:9 cases (9/12)showed irregular thickened wall and eccentricity lumen stenosis,5 cases had soft tissue mass in lumen,3 ca-ses (3/12)showed irregular thickened wall and central lumen stenosis.The lesions lumen was significant stenosis,edges and broken ends were irregular.②The non-specific ureteritis manifestations of MSCT:1 case (1/5)showed irregular thickened wall and eccen-trical lumen stenosis;3 cases (3/5)showed irregular thickened wall and central lumen stenosis,and the edge of obstruction was rel-atively smooth.1 case (1/5)prompted hydronephrosis and hydroureter.The lesions lumen was still relatively smooth,had no sig-nificant thickening.③On non-enhanced CT,primary ureteral carcinoma attenuation was equal to the non-specific ureteritis (P>0.05).The degree of enhancement was higher than non-specific ureteritis during all enhanced phases (All P<0.05).Conclusion Main performance characteristics of primary ureteral carcinoma and non-specific ureteritis can both cause the ureteral wall thickening in different appearances and degrees.The MSCT enhanced scan with varies images processing techniques such as MPR,CPR and CTU showed some clinical application potentiality in both diseases diagnosis and discrimination.
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Objective To study the application of transurethral bipolar plasma kinetic vaporization of the distal ureterectomy in radical nephroureterectomy for renal pelvic or ureteral carcinoma. Methods A total of 6 patients with renal pelvic or ureteral carcinoma without involvement in ipsilateral distal ureter,ureteral orfice,and the bladder were included.Radical nephroureterectomy was performed by using transurethral bipolar plasma kinetic vaporization combined with either flank incision nephrectomy (5 patients) or retroperitoneal approach laparoscopic nephrectomy(1 patient). Results The operation was completed smoothly in the 6 patients with comparatively little blood loss.The operation time was 120~210 min(mean,150 min).Obturator nerve reflex happened in no patients during the operation.Postoperative bladder irrigation found no bleeding in the bladder.The time of indwelling the catheter was 7~9 d(mean,8 d).Hypogastralgia and fever occurred in 1 patient on the 5th postoperative day.And the patient was confirmed as having mild urinary extravasation and was given catheter indwelling for 5 days. Transuretheral cystography found no leakage and a full recovery of voiding function was achieved.Postoperative pathological findings showed negative margins in all the patients.One patient died of myocardial infarction 3 months after operation,while follow-up in the remaining 5 patients for 7~21 months(mean,16 months) showed no tumor recurrence. Conclusions Application of transurethral bipolar plasma kinetic vaporization of the distal ureterectomy is micro-invasive,with little hemorrhage and few complications.It is an effective assistant option in radical nephroureterectomy.
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Objective To evaluate the preoperative diagnosis of ureteral carcinoma.Methods The clinical features and selection of imaging and endoscope in 32 ureteral carcinoma patients were analyzed.Results The common symptom was hematuria.32 cases were confirmed by pathological examination as ureteral carcinoma and the diagnostic corresponding rate was 100% by color doppler and endoscopic technique.Conclusion Imaging and endoscopic examination are very important in hematuria patients without unknown reasons.Ureteral carcinoma should be considered when B mode ultrasound and venous urography show hydronephrosis and no development.Retrograde ureteropyelography and ureteroscopy are the most important diagnostic methods among various examinations.
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Two cases of primary carcinoma of the ureter were reported with review of the literatures.