Endoscopic Managment of UTUC

Question 1

What are favorable clinical and pathologic features for nephron preservation? (5)
Grade
Architecture
Size
Focality
Invasiveness

Answer 1

Low grade
Papillary
Less than 1.5cm
Unifocal
Non invasive

Question 2

Is ureteroscopic and percutaneous management = to nephroureterectomy in survival outcomes?

Answer 2

Yes

Question 3

Less favorable factors for nephron preservation?
Grade
Focality
Architecture
Size
Stage
Location

Answer 3

High grade
Multifocal
Flat or sessile 
>1.5
cT2-T4
Mid and proximal tumors
Tumors crossing the infundibulum

Question 4

Relationship to infundibulum and UPJ

Answer 4

Crossing

Question 5

Imperative indications for conservative therapy of UTUC: 4

Answer 5

Solitary kidney
Bilaterality
CKD
Hereditary predisposition

Question 6

Percutaneous or ureteroscopic surgical procedures available: 3

Answer 6

Tumor fulguration/cauterization
Tumor resection using electrical energy, baskets, or cold cup devices with fulguration of the tumor bed
Laser therapies

Question 7

Extirpative surgical procedures:
For distal ureteral tumors
For proximal and mid ureteral tumors

Answer 7

For distal tumors: segmental ureterectomy with or without ureteral reimplantation

For proximal or mid ureteral tumors: complete ureterectomy with ileal ureter replacement

Question 8

Topical immunotherapy and chemotherapy management
Agents
Route of administration
Induction and maintenance therapy regimen

Answer 8

BCG, mito
Percutaneous antegrade is preferred or retrograde ureteral catheters

Induction and maintenance are the same as intravesical regimens