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Objective: Among the opioids used for treating dyspnea in cancer patients, the evidence for clinical use of fentanyl is not adequate. We report a case that suggested that fentanyl citrate patch improved dyspnea caused by lung metastasis of ureteral cancer.Case: An 86-year-old female was scheduled to start opioids for dyspnea caused by exacerbation of lung metastasis from ureteral cancer. Morphine hydrochloride was not chosen due to renal dysfunction, and oxycodone hydrochloride extended-release tablet was initiated. However, one day after starting medication, the patient refused to take the tablet because of vomiting. Given the difficulties in using morphine hydrochloride and oxycodone hydrochloride extended-release tablet, fentanyl citrate patch 0.5 mg/day was started for the purpose of improving dyspnea. The dose was eventually increased to 1.0 mg/day. Dyspnea improved and she was discharged.Conclusion: This case suggested the possibility that use of fentanyl citrate patch may be effective for dyspnea. Fentanyl citrate patch may provide one option when other drugs such as morphine hydrochloride and oxycodone hydrochloride cannot be used. However, since this is a report of a single case, further verification is required to clarify the effectiveness of fentanyl citrate patch for dyspnea.
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Objective To verify the safety and advantages of total transperitoneal laparoscopic nephroureterectomy (ttLNU) in the treatment of upper urinary tract urothelial carcinoma (UTUC).Methods From Jun.2013 to Jun.2014,there were 13 UTUC patients treated with ttLNU,including 7 males and 6 females.The mean age was 70.4 ± 8.3 yrs,and BMI was 23.3±4.1.Of them,11 cases were diagnosed with renal pelvis carcinoma,6 in the left and 5 in the right.2 cases were diagnosed with left ureteral carcinoma.TNM stages were T1-T3N0M0.Patients were put on lateral position and the position was not changed during the operation.A ttLNU was performed,and the specimen was removed from the middle extended inferior umbilical incision.Results The mean operative time was 188±33 (150-240) min,the intraoperative blood loss was 150.5±60.1 (50-700) ml,and the time of out-of-bed activity was between 1 and 4 d.The mean postoperative drainage time was 6.8±4.6 (3-6) d.The mean postoperative bowel function recovery time was 1.5± 1.0 (2-4) d and postoperative hospital stay was 12.8±7.0 (3-27) d.The ttLNU procedures were successfully performed in all cases without conversion to open surgery.Pathological results showed urothelial carcinoma in all cases,including 8 high grade and 5 low grade.All the surgical margins were negative.The followed up was from 2 to 12 mon,and there was no tumor recurrence and metastasis found.Conclusions Total transperitoneal laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma is characterized by short operative time,low blood loss,decreased trauma and quick recovery.This is a safe and effective treatment option for the treatment of upper urinary tract urothelial carcinoma.
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Objective To investigate the clinical and pathological features,diagnosis,differential diagnosis,treatment and prognosis of secondary Hodgkin's lymphoma of ureter.Methods We retrospectively analyzed one case with retroperitoneal Hodgkin's lymphoma involving right ureter.A 63-year-old male patient was referred to our hospital on January 22th,2013 with right hydronephrosis for 15 days,detected by abdominal color Doppler ultrasound due to constipation and difficult defecation without any urinary symptoms.Urinary CT scan revealed that there were dilation and hydrops of right pelvic and ureter in the middle and upper segment.The distal portion of ureteral wall was thick with a stenosis lumen.There was multiple larged lymph nodes surrounding the abdominal aorta.So,it was clinically diagnosed as right ureteral carcinoma with lymphadenopathy and right hydronephrosis.The patient was then performed ureteroscopic inspection under general anesthesia.There was too narrow to go through smoothly the proximal ureter when the ureteroscope ascended 15 cm.Then,the exploratory surgery of right ureter was subsequently undergone.During operation,periureteral nodular mass and thickened wall were seen in the distal segment of ureter.Then the ureter lesion was partially excised with 1 cm and fast frozen pathology was undergone during operation.The result suggested chronic inflammation of ureteral.A 6Fr double J stent was left in the ureter.Then,the ureter was closed by 3-0 monocryl suture.Results The final pathological diagnosis was retroperitoneal Hodgkin's lymphoma with the lymph node involving the right ureter.After 40 days,the patient manifested high fever,night sweat,general lymphoadenomegalies.So,the clinical stage was classified as stage Ⅱ EB and poor prognosis group.Then,the patient received regular chemotherapy according to the ABVD (pirarubicin 20 mg/m2,bleomycin 10 mg/m2,vinblastine 1.4 mg/m2,dacarbazine 375 mg/m2) regimen over 8 cycles.Finally the symptomatology and diagnostic reassessment (hemato-chemical examinations and PET/CT) showed a clinical complete recovery after the follow-up period of 3 months.The follow-up plan is ongoing.Conclusions Because secondary Hodgkin's lymphoma of ureter is rare with concealed onset feature,lacking of characteristic clinical manifestations,it is relatively difficult to achieve the diagnosis and differential diagnosis.Therefore,pathology and immunohistochemistry should be assigned to confirm the diagnosis.It is stressed that physicians should be aware of the possibility of malignant lymphoma when unexplained hydronephrosis and thickness of the ureteral wall are found clinically.Generally it has a good prognosis and combination therapy for the treatment is given priority to with chemotherapy.
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Objective To discuss the diagnosis and treatment experience of primary ureteral cancer.Methods We retrospectively analyzed the clinical data of 24 patients with ureteral carcinoma treated in Beijing hospitals between 2001～2007.Compared various examination methods and tried to figure out the existing problems in the diagnosis and treatment.Results The preoperative diagnosis of 22 in 24 cases were clarified,19 of them received surgery.Postoperative pathology reports show of the 19 cases18 have pathology classification as transitional cell carcinoma,only 1 concurrent with small squamous cell carcinoma.Conclusion The combination of different examination method include B-type ultrasonic inspection,IVP,cystoscopy,retrograde pyelography,the detection of cancer cells from urine,CT,MRI and ureteroscopy can increase the preoperative diagnosis rate of primary ureteral carcinoma.The B-type ultrasonic inspection is a basic screening tool,cystoscopy + retrograde pyelography check is the most important examination.Surgery is the major treatment.Sleeve resection of the affected kidney-ureter-bladder is the primary choice of treatment of ureteral cancer.The prognosis mainly depends on the tumor stage and grade,so improve early diagnosis of great significance.
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Ureteral tumors are relatively uncommon, accounting for approximately 1.2% of all urothelial tumors. Metastatic ureteral tumors are even rarer. The primary lesions include breast, melanomas, bladder, colon, stomach, lung, and esophageal, prostate, ovarian, kidney, urethral and vaginal carcinomas. Patients usually have lumbar or flank pain, dysuria, frequency, and in the latter stages, anuria. We report a case of a metastatic ureteral tumor from a lung squamous cell carcinoma after complete remission.
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Humanos , Anuria , Mama , Carcinoma de Células Escamosas , Colo , Disuria , Dor no Flanco , Rim , Pulmão , Melanoma , Metástase Neoplásica , Próstata , Estômago , Ureter , Neoplasias Ureterais , Bexiga UrináriaRESUMO
Objective To investigate the outcomes of a modified operation for renal pelvis and ureteral cancer.Methods A total of 13 cases of renal pelvis or ureteral cancer was treated in this hospital from January 1998 to July 2005.During the operation,for the first step,the kidney and the majority of the ureter were excised through a waist incision. Then a double-J catheter was inserted into the bladder by way of the residual ureter,and was fastened to the ureter.Afterwards,a transurethral resection of the ureteral orifice and part of bladder mucosa was conducted.Finally,the ureter was pulled down oversleevely into the bladder.Results Except for 1 case of failure of oversleeve excision,in which a re-operation via a lower abdominal incision was required,the surgery was successfully completed in all the other 12 cases.The operation time was 60～90 min(mean,78 min).The intraurethral catheter was indwelled for 7～9 d(mean,7.6 d).The postoperative length of hospitalization was 7～10 d(mean,7.9 d).The 13 cases were followed for 8～18 months(mean,11.5 months).Examinations of exfoliated cells in urine,cystoscopy,and B-ultrasonography found no recurrence.Conclusions Single waist incision combined with transurethral oversleeve resection has smaller surgical trauma,fewer complications,and faster recovery compared with the traditional surgery.