1608190 © 1990 S. Karger AG, Basel 0302—2838/90/0183—0197$2.75/0
EurUrol 1990;18:197-200
Organ-Preserving Surgery in Patients with Urothelial Tumors of the Upper Urinary Tract U. Maier, G. Merli, K. Pummer, W. Hold, W. Tomschi, C. Mrstik, J. Flamm, P. Petritsch, H. Pum, M. Riccabona, F. Kaufmann, G. Studier, E. Diltel, G. Donner Urological Departments in Vienna, Graz, Linz, Wiener Neustadt, Krems and St. Pölten, Austria
Key Words. Urothelial tumors, upper urinary tract • Organ-preserving surgery ■ Recurrences Abstract. The Austrian Urological Oncology Group reports on 55 organ-preserving operations in 52 patients with tumors of the upper urinary tract epithelium. The data were gathered from 12 urological departments in the country. There was no evidence of distant métastasés in any of the patients at the time of surgery. The observation period ranged from 0.5 to 12 years. 69.2% (36 of 52) of the patients were alive and recurrence-free at the time of data collection, after a mean observation period of 41.4 months. 9.6% died for reasons other than cancer after an average of 18.8 months, and 21.2% were still alive with or had died due to recurrent tumors. The recurrence rate after open surgery was similar in tumors of the upper ureter or pelvis (15.3%) as in tumors of the lower ureter (17.6%). After endoscopic treatment 4 of 9 patients showed recurrences. 92% (22 of 24) of the patients with no compelling indi cation for organ-preserving therapy were alive and recurrence-free or had died due to other causes. Therefore organ-preserving surgery appears to be appropriate in tumors of the upper urinary tract epithelium.
The tendency to perform organ-preserving surgery in patients with tumors of the upper urinary tract epithe lium prompted the Austrian Urological Oncology Group of the Austrian Society for Urology to carry out an Aus tria-wide survey on the specific experience and success in order to obtain relevant information in a representa tive number of patients.
Material and Methods It was possible to obtain data concerning a total of 60 organpreserving operations in 57 patients from 12 urological depart ments. The following data were collected: age, sex, reason for organ preservation, histology (TNG), type of operation and the patient’s fate following surgery (relating to a recurrence-free life, a life with recurrences, death from tumor or for other reasons). The data pro cured were evaluated by the first author. Urological departments of
the following hospitals, listed according to the number of patients submitted, took part in the survey: General Hospital, Graz (n = 11); Rudolfstiftung, Vienna (n = 8); University Clinic, Vienna (n = 8); Kaiser Franz Josef Hospital, Vienna (n = 8); Hanusch Hospital, Vienna (n = 4); Wilhelminen Hospital, Vienna (n = 3); University Clinic, Graz (n = 3); Wiener Neustadt Hospital (n = 3); Barmher zigen Schwestern Hospital, Linz (n = 3); General Hospital, Linz (n = 2); Poliklinik, Vienna (n = 1); St. Pölten Hospital (n = 1).
Results
Patients, Operations and Histology 57 patients who had undergone 60 operations were documented (3 patients had bilateral tumors). The male:female ratio was 30:27 and the average age 66.7 years, ranging from 49 to 88 years. 20 patients had a renal pelvic tumor (one of which was bilateral) and 37 showed a tumor of the ureter (2 patients with bilateral tumors). The reasons for organ-preserving procedure in these 57 patients are shown in table 1. In 4 ‘high risk’ Downloaded by: University of Exeter 144.173.6.94 - 1/26/2020 8:00:49 PM
Introduction
Maier/Mertl/Pummer/Höltl/Tomschi/Mrstik/Flamm/Petritsch/Pum/Riccabona/Kaufmann/Studler/Dittel/Donner
198
Table 1. Reason for organ-preserving surgery in 57 patients n No compelling indication Solitary kidney Impaired kidney function High risk Bilateral tumor1
1 2 3 4 5
i
24 16 11 4
2
One patient with bilateral tumor is listed under 4.
Table 2. Staging and grading of 60 tumors Grade
Stage
Total
patients, only endoscopic operations were performed. The relationship between the stage of the tumor and the grade of malignancy is shown in table 2. There was no evidence of distant métastasés in any patient. Open sur gery was carried out in 50 cases. In 32 of these, excision of the ureter with primary anastomosis or excision of the renal pelvis with primary reconstruction was done. In 18 cases with a distal tumor of the ureter, a ureter-cystoneostomy (Boari or psoas hitch) was performed. In 9 patients the tumor was endoscopically resected. 5 pa tients could not be considered in the evaluation (table 3). Thus our report considers 55 operations in 52 patients with an observation period ranging from 0.5 to 12 years.
n
3 9 4
0 I II III
10 10 3
X
i
t3
t4
l1 1 5 4
3
1
1 1
1
Total
2
t2
16
23
12
4
2
tx
1 1
4 21 24 9
l2
2
2
60
Inverted papilloma. Sample not evaluable.
Table 3. Reason for drop out n No follow-up Perioperative death
2
Postoperative death
1
2
Recurrences (4 of 52 = 7.7 %) 4 patients experienced recurrences after 2-7 months. One patient, who had had a ureteral tumor resected endoscopically, showed recurrences after 2 and 7 months. The fate of these patients are listed in table 5.
(T2, Gnl, Ta, Go) (T4, Gni, cardiopulmonary; T|, Gn, liver cirrhosis) (T 1, Gn, pneumonia 3 months postoperatively)
Table 4. Staging and grading in 36 patients without recurrences Grade
Stage
Total
Ta
T,
T2
Tj
8 6
1> 1 1
1
2
0 I II III
2 .
12
1
16
Inverted papilloma.
3 18 11
2
1
Total
Tx
2
X
l
1
t,
4
2
Recurrence-Free (36 of 52 = 69.2%) At the time of data collection almost 70% of the patients were alive without local recurrence or demon strable métastasés. 30 open and 6 endoscopic operations were carried out. Tumor expansion and grade of differ entiation may be found in table 4. 77.7% of these tumors were superficial (Ta or T|), and in 2 cases (5.5%) it was not possible to determine the stage of the tumor. As the ‘inverted papilloma’ cannot really be defined as a malig nant tumor, there remain 5 tumors (13.8%) with muscle infiltration, which could be removed operatively while preserving the organ. The mean observation period for these patients was 41.4 months.
1
2
2
36
Died of Tumor (7 of 52 = 13.5%) 1 patients, 3 of whom exhibited stage 1 at the time of op eration, died after an average of 21.6 months (table 6). Died for Other Reasons (5 of 52 = 9.6%) 5 patients died for reasons other than carcinoma after an average of 18.8 months (table 7). In conclusion 11 of the 52 patients (21.2%) experi enced a recurrence or died due to the tumor and in 41 patients (78.8%), who had been operated with curative aim, the organ-preservation was successful. The mean observation period of almost 3.5 years of the recurrencefree living patients allows some representative state ments. Downloaded by: University of Exeter 144.173.6.94 - 1/26/2020 8:00:49 PM
T,
Ta
Surgery of Ureter and Renal Pelvis Tumors
199
Table 5. Alive with recurrences (4 of 52 = 7.7%)
Endoscopic pelvic resection Reimplantation Pelvic resection + ureterectomy Endoscopic ureteral resection
Reason of organ-preserving
Histol-
surgery
ogy
Time to recurrence months
solitary kidney no compelling indication solitary kidney high risk
TxGi T2 Gm
7 6 (heterotopic)
Ta Gu T2G„
2
Discussion
Although there are frequent reports in the literature on organ-preserving surgery in patients with tumors of the upper urinary tract epithelium, the number of cases presented is rarely over 10 [1-12]. Studies with a larger number of patients [13-17] are hardly comparable be cause of the heterogeneous cases included [16, 17], lack of classification according to stages [14, 16, 17] and/or missing data regarding differentiation [13], For this rea son a multicenter retrospective analysis with predeter mined formulation of questions seemed to be of certain importance. While analyzing the presented data, it is remarkable that in 42% (24 of 52) of the operations per formed, primary organ preservation was attempted with out compelling indications such as single kidneys, im paired kidney function or high surgical risk. 92% (22 of 24) of these patients are alive and recurrence-free today or have died of causes other than cancer. Of the 17 patients who were subjected to reimplanta tion subsequent to excision of the distal ureter tumor, 3 (17.6%) experienced recurrence or died of the tumor. Of 26 patients with tumor excision and primary clos ing of the renal pelvis or primary ureter anastomoses, 4 (15.3%) experienced recurrence, and 4 of 9 (44.4%) patients after endoscopic resection, respectively. From the data received, it may be concluded that, on one hand, primary organ preservation in tumors of the upper urinary tract appears to be appropriate as 92 % of the patients on whom surgery was performed with this objective, remained recurrence-free. On the other hand, the rate of recurrence does not depend on the location of the tumor, as in distal tumors (after reimplantation) rates of recurrence are similar to those of higher lying tumors. In the cases presented, the often discussed ten dency [18-21] to heterotopic recurrences does not ap pear to be an argument against attempting primary organ preservation. Whether endoscopic excision offers a ge nuine alternative to open surgery cannot be answered,
2+7
Fate
nephroureterectomy endoscopic resection endoscopic resection
Table 6. Death due to cancer (7 of 52 = 13.5%) Operation
Reason for organ-preserving
Histology
Time to death months
solitary kidney impaired kidney function solitary kidney
T2 G„ Ti Gi
49 36
T2 Gm
4
high risk probatoria solitary kidney no compelling indication
T4 Gu T, Gu
4 15 18 19
surgery Ureteral resection Reimplantation Ureteral resection Endoscopic ureteral resection Reimplantation Pelvic resection Reimplantation
Ti G„ T2 Gm
Table 7. Death not due to cancer (5 of 52 = 9.6%) Operation
Reasons for organ-preserving
Histology
surgery Ureteral resection Ureteral resection Pelvic resection Endoscopic pelvic resection Pelvic resection
high risk solitary kidney solitary kidney
T3 G„
high risk impaired kidney function
T, G,i
T3G„i
TaG„
T1 Gp
Time to death months 27 12 21 25 9
owing to the small sample and the admittedly specifi cally selected patients in this group. A correlation between the recurrence rate and the stage of tumor could not be observed, as 3 of the 7 patients died of a tumor diagnosed as stage 1 at the time of surgery. It must also be added that the definition of infiltration in the upper urinary tract epithelium is essentially more difficult for the pathologist than in the bladder and it is certainly interpreted differently as well. Downloaded by: University of Exeter 144.173.6.94 - 1/26/2020 8:00:49 PM
Operation
Maier/Mertl/Pummer/Höltl/Tomschi/Mrstik/Flamm/Petritsch/Pum/Riccabona/Kaufmann/Studler/Dittel/Donner
References 1 Aufderklamm J, Jakse G: Konservativ-chirurgisches Vorgehen beim distalen Hamleitertumor. Akt Urol 1982;13:252-255. 2 Babaian RJ, Johnson DE: Primary carcinoma of the ureter. J Urol 1980;123:357-359. 3 Bloom NA, Vidone RA, Lytton B: Primary carcinoma of the ureter: A report of 102 new cases. J Urol 1970;103:590-598. 4 Brown HE, Roumani GK: Conservative surgical management of transitional cell carcinoma of the upper urinary tract. J Urol 1974;112:184-187. 5 Dieckmann KP, Sosna M, Jonas D, Bauer HW: Das Urothelkarzinom des Harnleiters, Häufigkeit, Diagnose, Therapie. VerhBer Dt Ges Urol, 37. Tag, Mainz, Okt 1985. Stuttgart, Thieme, 1986. 6 Ghazi MR, Morales PA, Askari SA: Primary carcinoma of ure ter. Report of 27 new cases. Urology 1979;1:18-21. 7 Johnson DE, Babaian RJ: Conservative surgical management for noninvasive distal ureteral carcinoma. Urology 1979;4:365— 367. 8 Kjaer TB, Jörgensen TM, Frederiksen P, Genster HG: Transi tional cell tumours of the upper urinary tract: Radical or conser vative treatment? Scand J Urol Nephrol 1981;15:235-238. 9 Matthiesen B, Sökeland J: Zur organerhaltenden Therapie von Harnleiter- und Nierenbeckentumoren. Urologe A 1974; 13: 248-253. 10 Murphy DM, Zincke H, Furlow WL: Management of high grade transitional cell cancer of the upper urinary tract. J Urol 1981; 125:25-29. 11 Wallace DM, Wallace DM, Whitfield HN, Hendry WF, Wick ham JEA: The late results of conservative surgery for upper tract urothelial carcinomas. Br J Urol 1981;53:537-541.
12 Williams CB, Mitchell JP: Carcinoma of the ureter: A review of 54 cases. Br J Urol 1973;45:377-387. 13 Booth CM, Cameron KM, Pugh RC: Urothelial carcinoma of the kidney and ureter. Br J Urol 1980;52:430-435. 14 Mazeman E: Tumours of the upper urinary tract calyces, renal pelvis and ureter. Eur Urol 1976;2:120-128. 15 Mufti GR, Gove JRW, Badenoch DF, Fowler CG, Tiptaft RC, England FIR, Paris AMI, Singh M, Hall MH, Blandy JP: Transi tional cell carcinoma of the renal pelvis and ureter. Br J Urol 1989;63:135-140. 16 Petkovic SD: Conservation of the kidney in operations for tumours of the renal pelvis and calyces: A report of 26 cases. Br J Urol 1972;44:1-8. 17 Petkovic SD: Epidemiology and treatment of renal pelvic and ureteral tumors. J Urol 1975; 1 14:858-865. 18 Flamm J, Woher L: Diagnostik und Klinik epithelialer Nieren becken- und Harnleitertumoren. Wien Med Wschr 1980;23: 765-770. 19 Rubenstein MA, Walz BJ, Bucy JG: Transitional cell carcinoma of the kidney: 25 years experience. J Urol 1978;119:594-597. 20 Steffens J, Nagel R: Therapie und Rezidivrate bei Urotheltumoren des Nierenbeckens und Harnleiters. VerhBer Dt Ges Urol, 37. Tag, Mainz, Okt 1985. Stuttgart, Thieme, 1986. 21 Williams CB, Mitchell JP: Carcinoma of the renal pelvis: A review of 43 cases. Br J Urol 1973;45:370-376.
Univ.-Dozent Dr. U. Maier Urologische Universitätsklinik Wien Alser Strasse 4 A-1090 Wien (Austria)
Downloaded by: University of Exeter 144.173.6.94 - 1/26/2020 8:00:49 PM
200
EurUrol 1990;18:197-200
Organ-Preserving Surgery in Patients with Urothelial Tumors of the Upper Urinary Tract U. Maier, G. Merli, K. Pummer, W. Hold, W. Tomschi, C. Mrstik, J. Flamm, P. Petritsch, H. Pum, M. Riccabona, F. Kaufmann, G. Studier, E. Diltel, G. Donner Urological Departments in Vienna, Graz, Linz, Wiener Neustadt, Krems and St. Pölten, Austria
Key Words. Urothelial tumors, upper urinary tract • Organ-preserving surgery ■ Recurrences Abstract. The Austrian Urological Oncology Group reports on 55 organ-preserving operations in 52 patients with tumors of the upper urinary tract epithelium. The data were gathered from 12 urological departments in the country. There was no evidence of distant métastasés in any of the patients at the time of surgery. The observation period ranged from 0.5 to 12 years. 69.2% (36 of 52) of the patients were alive and recurrence-free at the time of data collection, after a mean observation period of 41.4 months. 9.6% died for reasons other than cancer after an average of 18.8 months, and 21.2% were still alive with or had died due to recurrent tumors. The recurrence rate after open surgery was similar in tumors of the upper ureter or pelvis (15.3%) as in tumors of the lower ureter (17.6%). After endoscopic treatment 4 of 9 patients showed recurrences. 92% (22 of 24) of the patients with no compelling indi cation for organ-preserving therapy were alive and recurrence-free or had died due to other causes. Therefore organ-preserving surgery appears to be appropriate in tumors of the upper urinary tract epithelium.
The tendency to perform organ-preserving surgery in patients with tumors of the upper urinary tract epithe lium prompted the Austrian Urological Oncology Group of the Austrian Society for Urology to carry out an Aus tria-wide survey on the specific experience and success in order to obtain relevant information in a representa tive number of patients.
Material and Methods It was possible to obtain data concerning a total of 60 organpreserving operations in 57 patients from 12 urological depart ments. The following data were collected: age, sex, reason for organ preservation, histology (TNG), type of operation and the patient’s fate following surgery (relating to a recurrence-free life, a life with recurrences, death from tumor or for other reasons). The data pro cured were evaluated by the first author. Urological departments of
the following hospitals, listed according to the number of patients submitted, took part in the survey: General Hospital, Graz (n = 11); Rudolfstiftung, Vienna (n = 8); University Clinic, Vienna (n = 8); Kaiser Franz Josef Hospital, Vienna (n = 8); Hanusch Hospital, Vienna (n = 4); Wilhelminen Hospital, Vienna (n = 3); University Clinic, Graz (n = 3); Wiener Neustadt Hospital (n = 3); Barmher zigen Schwestern Hospital, Linz (n = 3); General Hospital, Linz (n = 2); Poliklinik, Vienna (n = 1); St. Pölten Hospital (n = 1).
Results
Patients, Operations and Histology 57 patients who had undergone 60 operations were documented (3 patients had bilateral tumors). The male:female ratio was 30:27 and the average age 66.7 years, ranging from 49 to 88 years. 20 patients had a renal pelvic tumor (one of which was bilateral) and 37 showed a tumor of the ureter (2 patients with bilateral tumors). The reasons for organ-preserving procedure in these 57 patients are shown in table 1. In 4 ‘high risk’ Downloaded by: University of Exeter 144.173.6.94 - 1/26/2020 8:00:49 PM
Introduction
Maier/Mertl/Pummer/Höltl/Tomschi/Mrstik/Flamm/Petritsch/Pum/Riccabona/Kaufmann/Studler/Dittel/Donner
198
Table 1. Reason for organ-preserving surgery in 57 patients n No compelling indication Solitary kidney Impaired kidney function High risk Bilateral tumor1
1 2 3 4 5
i
24 16 11 4
2
One patient with bilateral tumor is listed under 4.
Table 2. Staging and grading of 60 tumors Grade
Stage
Total
patients, only endoscopic operations were performed. The relationship between the stage of the tumor and the grade of malignancy is shown in table 2. There was no evidence of distant métastasés in any patient. Open sur gery was carried out in 50 cases. In 32 of these, excision of the ureter with primary anastomosis or excision of the renal pelvis with primary reconstruction was done. In 18 cases with a distal tumor of the ureter, a ureter-cystoneostomy (Boari or psoas hitch) was performed. In 9 patients the tumor was endoscopically resected. 5 pa tients could not be considered in the evaluation (table 3). Thus our report considers 55 operations in 52 patients with an observation period ranging from 0.5 to 12 years.
n
3 9 4
0 I II III
10 10 3
X
i
t3
t4
l1 1 5 4
3
1
1 1
1
Total
2
t2
16
23
12
4
2
tx
1 1
4 21 24 9
l2
2
2
60
Inverted papilloma. Sample not evaluable.
Table 3. Reason for drop out n No follow-up Perioperative death
2
Postoperative death
1
2
Recurrences (4 of 52 = 7.7 %) 4 patients experienced recurrences after 2-7 months. One patient, who had had a ureteral tumor resected endoscopically, showed recurrences after 2 and 7 months. The fate of these patients are listed in table 5.
(T2, Gnl, Ta, Go) (T4, Gni, cardiopulmonary; T|, Gn, liver cirrhosis) (T 1, Gn, pneumonia 3 months postoperatively)
Table 4. Staging and grading in 36 patients without recurrences Grade
Stage
Total
Ta
T,
T2
Tj
8 6
1> 1 1
1
2
0 I II III
2 .
12
1
16
Inverted papilloma.
3 18 11
2
1
Total
Tx
2
X
l
1
t,
4
2
Recurrence-Free (36 of 52 = 69.2%) At the time of data collection almost 70% of the patients were alive without local recurrence or demon strable métastasés. 30 open and 6 endoscopic operations were carried out. Tumor expansion and grade of differ entiation may be found in table 4. 77.7% of these tumors were superficial (Ta or T|), and in 2 cases (5.5%) it was not possible to determine the stage of the tumor. As the ‘inverted papilloma’ cannot really be defined as a malig nant tumor, there remain 5 tumors (13.8%) with muscle infiltration, which could be removed operatively while preserving the organ. The mean observation period for these patients was 41.4 months.
1
2
2
36
Died of Tumor (7 of 52 = 13.5%) 1 patients, 3 of whom exhibited stage 1 at the time of op eration, died after an average of 21.6 months (table 6). Died for Other Reasons (5 of 52 = 9.6%) 5 patients died for reasons other than carcinoma after an average of 18.8 months (table 7). In conclusion 11 of the 52 patients (21.2%) experi enced a recurrence or died due to the tumor and in 41 patients (78.8%), who had been operated with curative aim, the organ-preservation was successful. The mean observation period of almost 3.5 years of the recurrencefree living patients allows some representative state ments. Downloaded by: University of Exeter 144.173.6.94 - 1/26/2020 8:00:49 PM
T,
Ta
Surgery of Ureter and Renal Pelvis Tumors
199
Table 5. Alive with recurrences (4 of 52 = 7.7%)
Endoscopic pelvic resection Reimplantation Pelvic resection + ureterectomy Endoscopic ureteral resection
Reason of organ-preserving
Histol-
surgery
ogy
Time to recurrence months
solitary kidney no compelling indication solitary kidney high risk
TxGi T2 Gm
7 6 (heterotopic)
Ta Gu T2G„
2
Discussion
Although there are frequent reports in the literature on organ-preserving surgery in patients with tumors of the upper urinary tract epithelium, the number of cases presented is rarely over 10 [1-12]. Studies with a larger number of patients [13-17] are hardly comparable be cause of the heterogeneous cases included [16, 17], lack of classification according to stages [14, 16, 17] and/or missing data regarding differentiation [13], For this rea son a multicenter retrospective analysis with predeter mined formulation of questions seemed to be of certain importance. While analyzing the presented data, it is remarkable that in 42% (24 of 52) of the operations per formed, primary organ preservation was attempted with out compelling indications such as single kidneys, im paired kidney function or high surgical risk. 92% (22 of 24) of these patients are alive and recurrence-free today or have died of causes other than cancer. Of the 17 patients who were subjected to reimplanta tion subsequent to excision of the distal ureter tumor, 3 (17.6%) experienced recurrence or died of the tumor. Of 26 patients with tumor excision and primary clos ing of the renal pelvis or primary ureter anastomoses, 4 (15.3%) experienced recurrence, and 4 of 9 (44.4%) patients after endoscopic resection, respectively. From the data received, it may be concluded that, on one hand, primary organ preservation in tumors of the upper urinary tract appears to be appropriate as 92 % of the patients on whom surgery was performed with this objective, remained recurrence-free. On the other hand, the rate of recurrence does not depend on the location of the tumor, as in distal tumors (after reimplantation) rates of recurrence are similar to those of higher lying tumors. In the cases presented, the often discussed ten dency [18-21] to heterotopic recurrences does not ap pear to be an argument against attempting primary organ preservation. Whether endoscopic excision offers a ge nuine alternative to open surgery cannot be answered,
2+7
Fate
nephroureterectomy endoscopic resection endoscopic resection
Table 6. Death due to cancer (7 of 52 = 13.5%) Operation
Reason for organ-preserving
Histology
Time to death months
solitary kidney impaired kidney function solitary kidney
T2 G„ Ti Gi
49 36
T2 Gm
4
high risk probatoria solitary kidney no compelling indication
T4 Gu T, Gu
4 15 18 19
surgery Ureteral resection Reimplantation Ureteral resection Endoscopic ureteral resection Reimplantation Pelvic resection Reimplantation
Ti G„ T2 Gm
Table 7. Death not due to cancer (5 of 52 = 9.6%) Operation
Reasons for organ-preserving
Histology
surgery Ureteral resection Ureteral resection Pelvic resection Endoscopic pelvic resection Pelvic resection
high risk solitary kidney solitary kidney
T3 G„
high risk impaired kidney function
T, G,i
T3G„i
TaG„
T1 Gp
Time to death months 27 12 21 25 9
owing to the small sample and the admittedly specifi cally selected patients in this group. A correlation between the recurrence rate and the stage of tumor could not be observed, as 3 of the 7 patients died of a tumor diagnosed as stage 1 at the time of surgery. It must also be added that the definition of infiltration in the upper urinary tract epithelium is essentially more difficult for the pathologist than in the bladder and it is certainly interpreted differently as well. Downloaded by: University of Exeter 144.173.6.94 - 1/26/2020 8:00:49 PM
Operation
Maier/Mertl/Pummer/Höltl/Tomschi/Mrstik/Flamm/Petritsch/Pum/Riccabona/Kaufmann/Studler/Dittel/Donner
References 1 Aufderklamm J, Jakse G: Konservativ-chirurgisches Vorgehen beim distalen Hamleitertumor. Akt Urol 1982;13:252-255. 2 Babaian RJ, Johnson DE: Primary carcinoma of the ureter. J Urol 1980;123:357-359. 3 Bloom NA, Vidone RA, Lytton B: Primary carcinoma of the ureter: A report of 102 new cases. J Urol 1970;103:590-598. 4 Brown HE, Roumani GK: Conservative surgical management of transitional cell carcinoma of the upper urinary tract. J Urol 1974;112:184-187. 5 Dieckmann KP, Sosna M, Jonas D, Bauer HW: Das Urothelkarzinom des Harnleiters, Häufigkeit, Diagnose, Therapie. VerhBer Dt Ges Urol, 37. Tag, Mainz, Okt 1985. Stuttgart, Thieme, 1986. 6 Ghazi MR, Morales PA, Askari SA: Primary carcinoma of ure ter. Report of 27 new cases. Urology 1979;1:18-21. 7 Johnson DE, Babaian RJ: Conservative surgical management for noninvasive distal ureteral carcinoma. Urology 1979;4:365— 367. 8 Kjaer TB, Jörgensen TM, Frederiksen P, Genster HG: Transi tional cell tumours of the upper urinary tract: Radical or conser vative treatment? Scand J Urol Nephrol 1981;15:235-238. 9 Matthiesen B, Sökeland J: Zur organerhaltenden Therapie von Harnleiter- und Nierenbeckentumoren. Urologe A 1974; 13: 248-253. 10 Murphy DM, Zincke H, Furlow WL: Management of high grade transitional cell cancer of the upper urinary tract. J Urol 1981; 125:25-29. 11 Wallace DM, Wallace DM, Whitfield HN, Hendry WF, Wick ham JEA: The late results of conservative surgery for upper tract urothelial carcinomas. Br J Urol 1981;53:537-541.
12 Williams CB, Mitchell JP: Carcinoma of the ureter: A review of 54 cases. Br J Urol 1973;45:377-387. 13 Booth CM, Cameron KM, Pugh RC: Urothelial carcinoma of the kidney and ureter. Br J Urol 1980;52:430-435. 14 Mazeman E: Tumours of the upper urinary tract calyces, renal pelvis and ureter. Eur Urol 1976;2:120-128. 15 Mufti GR, Gove JRW, Badenoch DF, Fowler CG, Tiptaft RC, England FIR, Paris AMI, Singh M, Hall MH, Blandy JP: Transi tional cell carcinoma of the renal pelvis and ureter. Br J Urol 1989;63:135-140. 16 Petkovic SD: Conservation of the kidney in operations for tumours of the renal pelvis and calyces: A report of 26 cases. Br J Urol 1972;44:1-8. 17 Petkovic SD: Epidemiology and treatment of renal pelvic and ureteral tumors. J Urol 1975; 1 14:858-865. 18 Flamm J, Woher L: Diagnostik und Klinik epithelialer Nieren becken- und Harnleitertumoren. Wien Med Wschr 1980;23: 765-770. 19 Rubenstein MA, Walz BJ, Bucy JG: Transitional cell carcinoma of the kidney: 25 years experience. J Urol 1978;119:594-597. 20 Steffens J, Nagel R: Therapie und Rezidivrate bei Urotheltumoren des Nierenbeckens und Harnleiters. VerhBer Dt Ges Urol, 37. Tag, Mainz, Okt 1985. Stuttgart, Thieme, 1986. 21 Williams CB, Mitchell JP: Carcinoma of the renal pelvis: A review of 43 cases. Br J Urol 1973;45:370-376.
Univ.-Dozent Dr. U. Maier Urologische Universitätsklinik Wien Alser Strasse 4 A-1090 Wien (Austria)
Downloaded by: University of Exeter 144.173.6.94 - 1/26/2020 8:00:49 PM
200
