雙側上泌尿道腫瘤治療處置-病例報告
吳翊豪 陳文祥 黃賢祥 林政鋒 林承家 吳俊德
基隆長庚紀念醫院 泌尿外科 外科部
Management and treatment of bilateral upper urolithial callular carcinoma- case report
Yi-Hao Wu, Wen-hsiang Chen, Shian-shiang Huang, Cheng-Feng Lin, Cheng-Chia Lin, Chun-Te Wu
Department of urology, Chang Gung Memorial Hospital, Keelung, Taiwan
Background: Despite improvements in endoscopic methods, the gold standard for managing localized proximal ureteral and renal pelvic transitional cell carcinoma remains nephroureterectomy with the removal of the ureteric orifice within a cuff of bladder. Patients with bilateral disease, cancer in a solitary kidney or renal insufficiency may be rendered functionally anephric by traditional surgery thus encouraging conservative renal parenchyma–sparing procedures. We presented the management and treatment of a patient with bilateral renal TCC.
Case summary: A 80 year-old female with underlying disease of hypertension suffered from painless gross hematuria intermittently. Radiology and endoscopy revealed left renal pelvis, calyx and upper ureter tumor associated with right renal pelvis tumor. Robotic-assisted left nephroureterectomy with hilar LN dissection and right laser ablation with FURS were completed. Patients were followed for reoccurrence by cytoscopy, retrograde pyelography regularly.
Discussion: In low stage tumours and especially in patients with bilateral tumours or solitary kidneys, renal-sparing surgery may be attempted, in which tumors are locally excised often endoscopically. We present a case with bilateral renal pevis TCC status post robotic-assisted left nephroureterectomy and laser ablation. Although renal function was preserved, regular follow-up was needed.