Surgical treatment of epithelial tumors of the upperurinary tracts

The authors present the results of different operative treatments
of tumors of the upper urinary tracts (UUT). A total of 116 patients
with UUT tumors were examined and treated from 1990 to 2002 (age
19-80 years, mean age 61.3± 1.3 years; males 82, females 34). Tumors
of the renal pelvis and the ureter were detected in 76 (65.5%) and 40
(34.5%) patients, respectively (8.0 and 4.3% of a total number of patients
with tumors of the kidneys and UUT). 107 (92.2%) patients
were operated. Nephroureterectomy and ureterectomy with resection
of the urinary bladder were performed in 73 (68.2%) patients, TUR
of the urinary bladder wall, ureteral ostium with pelvic part of the ureter
and nephroureterectomy (including endovideosurgery) - in 22
(20.6%), nephroureterocystectomy - in 4 (3.7%), resection of the pelvic
ureter with Boari's operation - in 5 (4.7%), nephroscopy, ureteroscopy
with removal of urothelial tumor - in 3 (2.8%) patients. Postoperative
complications (most of them infectious-inflammatory) developed
in 10 (9.3%) patients. Lethality was 0.9%. Tumor recurrences
occurred in 27 (25.2%) patients within 5-year follow-up. 15 (14.0%)
patients were reoperated. 5-year survival reached 67.0%. Conventional
and radical method of treating patients with tumors of the renal
pelvis and ureter is nephroureterectomy with urinary bladder resection
and its modification. In invasion of the tumor in the muscular layer
of the bladder wall surgery should be extended and supplemented with
cystectomy. Conservative surgical interventions are indicated in tumors
of the sole kidney, bilateral process, benign or surface tumor of
the urothelium.