Kafka Mona, Zanier Johannes, Horninger Wolfgang
Department of Urology, Medical University of Innsbruck, Innsbruck, Austria.
J Endourol Case Rep. 2019 Aug 30;5(3):110-112. doi: 10.1089/cren.2019.0032. eCollection 2019.
Upper tract urothelial carcinomas (UTUCs) are infrequent neoplasms occurring in the pelvis renalis or the ureter with an incidence between 5% and 10% of all urothelial carcinomas. In addition, a synchronous bilateral appearance is extremely rare with a quantity of only 1.6% of all UTUCs. Since an oncologically-safe treatment would be a radical nephroureterectomy, consequently leading to dialysis, a satisfying therapy is challenging. We present the case of a 64-year-old woman with bilateral UTUCs at primary diagnosis and the sincere wish of a kidney-preserving treatment option. Therefore, multiple endoscopic ablations with a laser were performed, until a tumor-free status could be achieved. Owing to her medical history with a gynecologic tumor, a genetic examination was initiated, revealing the diagnosis of a Lynch syndrome. Based on promising results in the first 3-month follow-up we decided on a short-term endoscopic follow-up to keep control of tumor progression by endoscopic ablations when needed. In this way we are trying to spare our patient the dialysis. An oncologically satisfying treatment for bilateral UTUCs stays a challenging problem in urology. Despite little available data and expected high recurrence rates, we decided on an endoscopic kidney-preserving therapy approach to eventually spare our patient the dialysis. Up to now we are pleasantly surprised about the result and since a short-term follow-up is possible in our department, we hope to attain endoscopic control of the tumor. In addition, we want to point out that genetic background might be underestimated and should be keep it in mind for special cases. In this way, an early detection of other related tumors or tumor detection in relatives could be possible through preventive checkups.
上尿路尿路上皮癌（UTUCs）是发生在肾盂或输尿管的罕见肿瘤，占所有尿路上皮癌的5%至10%。此外，同步双侧出现极为罕见，仅占所有UTUCs的1.6%。由于肿瘤学上安全的治疗方法是根治性肾输尿管切除术，这将导致透析，因此令人满意的治疗具有挑战性。我们报告一例64岁女性，初诊时为双侧UTUCs，她真诚希望有保留肾脏的治疗选择。因此，进行了多次激光内镜消融，直到达到无瘤状态。由于她有妇科肿瘤病史，启动了基因检查，结果诊断为林奇综合征。基于前3个月随访的良好结果，我们决定进行短期内镜随访，以便在需要时通过内镜消融控制肿瘤进展。通过这种方式，我们试图避免患者进行透析。对于双侧UTUCs，肿瘤学上令人满意的治疗在泌尿外科仍然是一个具有挑战性的问题。尽管可用数据很少且预期复发率很高，但我们决定采用内镜保留肾脏的治疗方法，最终避免患者进行透析。到目前为止，我们对结果感到惊喜，由于我们科室可以进行短期随访，我们希望实现对肿瘤的内镜控制。此外，我们想指出，遗传背景可能被低估，在特殊情况下应予以考虑。通过这种方式，可以通过预防性检查早期发现其他相关肿瘤或亲属中的肿瘤。
