Search

Background Previous classification of renal pelvicalyceal anatomical structure may be difficult to intuitively understand and unpractical for endourological surgery. We aim to put forward a modified Takazawa anatomical classification of renal pelvicalyceal system based on three-dimensional (3D) virtual reconstruction models for endourological surgery. Methods We retrospectively collected data on 225 patients (320 kidneys) in total between Apr. 2017 and Dec. 2020, spatial anatomical structure of renal pelvis and calyces were modeled and corresponding morphological parameters were measured after 3D virtual reconstruction of computed tomography urography (CTU). The modified Takazawa renal pelvicalyceal anatomical classification was advanced based on the renal pelvicalyceal morphological parameters [bifurcated branches of renal pelvis, cross sectional area of renal pelvis and ureteropelvic junction (UPJ), infundibuloureteral angle (IUA), lower pole infundibular calyceal length (IL)] by 3D virtual reconstruction models, and comparison of renal pelvicalyceal system morphological parameters were performed to evaluate the differences in various classification types of renal pelvis and calyces. Results Anatomical structure of renal pelvis and calyces were divided into two main types (Type A and Type B) according to renal pelvic branch patterns. A single pelvis without bifurcated branch was regarded as Type A (62%) and subclassified into three subtypes: Type A1 (22%), Type A2 (27%) and Type A3 (13%), the slimline pelvis was classified as Type A1, the typical pelvis as Type A2 and the broad pelvis as Type A3. A divided pelvis with bifurcated branches was seen as Type B (38%) and subclassified into two subtypes: Type B1 (15%) with the wide and flat lower calyx branch, Type B2 (23%) with the narrow and steep lower calyx branch. Conclusions Previous studies have reported that the visualization and classification of renal pelvicalyceal anatomical structure by endocast, autopsy, ultrasonography and excretory urography, the modified Takazawa classification system based on 3D virtual reconstruction models enables to standardized different anatomical morphology of renal pelvicalyceal system and provide intuitive and concise information on anatomy, thus leading to the improvement in treatment modality.

BACKGROUND: Studies regarding the prevalence and factors associated with severe pre-operative chronic kidney disease (CKD) in upper tract urinary carcinoma (UTUC) patients were rare due to the low prevalence of UTUC. We conducted the present study to investigate the prevalence, clinicopathological features, and prognosis in UTUC patients with severe preoperative CKD. METHODS: The study included 731 patients with UTUC treated with radical nephroureterectomy (RNU) in a large Chinese center. Estimated glomerular filtration rate (eGFR) was calculated by re-expressed Modification of Diet in Renal Disease (MDRD) formulas for the Chinese population. Severe preoperative CKD was defined as CKD stage 4–5 (eGFR

Background To analyze the safety and clinical significance of performing ureteroscopy after ureteral reconstruction with autologous onlay/graft. To describe the ureteroscopic appearances of the appendiceal onlay flap and lingual mucosa graft. Methods Beginning in August 2018, we conducted a prospective cohort study of autologous onlay/graft techniques to repair ureteral strictures. The perioperative data of 42 patients who had undergone surgery more than 6 months prior were collected prospectively. During the postoperative follow-up, ureteroscopy was performed in 27 patients (64.3%) after surgery (group A), and ureteroscopy was not performed in the other 15 patients (35.7%) (group B). We carried out a comparative study of these two groups of patients. Analyses were conducted mainly on complications related to ureteroscopy and the success rate of ureteral reconstruction surgery. Results There were no significant differences in patient demographic data or the length of ureteral reconstruction between the two groups (P>0.05). For the ureteroscopy group, the median time from repair surgery to ureteroscopy was 3 (range, 2-7) months, there was no poor healing of the anastomosis, and the ureteral lumen of all patients was unobstructed. Some expected observations can be found in the ureteral lumen, such as mucosa edema, stones, follicles and granulation tissue. Among the 27 patients, one patient (3.7%) developed bleeding intraoperatively and 7 patients (25.9%) were found to have low-grade (Clavien-Dindo I and II) postoperative complications, including 5 cases of fever and 2 cases of bleeding. The mean follow-up times of patients in group A and group B were 16.7±6.4 and 19.0±10.1 months, respectively. The objective success (imaging showed hydronephrosis ease) rate of the two groups was 100%. The subjective success (symptom relief) rates of group A and group B were 96.3% and 100%, respectively. Conclusions Patients after autologous onlay flap/graft ureteroplasty do not need to undergo routine ureteroscopy unless there is aggravation of hydronephrosis or other indications for ureteroscopy, such as stones.

BACKGROUND: Traditional ureteral stricture balloon dilation was performed with fluoroscopic assistance. The use of a C-arm X-ray machine delivered hazardous radiation to both surgeons and patients. In attempt to eliminate the radiation hazard, we developed a F4.5/6.5 ureteroscope assisted intraoperative X-ray free balloon dilation surgical approach to treat ureteral stricture and to verify its safety and efficacy. Specifically, this method had not been previously reported in the literature. METHODS: We demonstrated an intraoperative X-ray free balloon dilation with detailed step-by-step procedures description and video illustration. Clinical data of patients undergoing minimally invasive endourological treatment for ureteral stricture between February 2015 and November 2019 were retrospectively analyzed. All steps of X-ray free balloon dilation were carried out under direct vision of a ureteroscope, and two indwelling F7 ureteral stents were used for 3 months postoperatively. Preoperative, intraoperative, and postoperative clinical data were evaluated, and follow-up results were reported. Successful outcome was defined as disappearance of preoperative symptoms, relief of hydronephrosis and stable of renal function. Univariate and multivariate prognostic analyses were performed. RESULTS: We identified 109 patients who received endourological treatment for ureteral stricture in our hospital’s medical database. After excluding patients undergone simple catheter dilation, endoureterotomy and other treatment method, 76 patients received balloon dilation without intraoperative fluoroscopic guidance were included in our study. 4/76 patients report a grade II complication (urinary tract infections, UTIs) according to Clavien Dindo classification. In the 22.5 months median follow-up time, the one-year cumulative success rate and two-year cumulative success rate were 85.9% and 80.2% (61/76), respectively, and the majority (13/15, 86.7%) recurrence of ureteral stricture or hydronephrosis deterioration were found within two years after surgery. The longer stenotic lesion length (>5 mm) or multiple ureter stenosis and compromised blood supply of ureter were significantly associated with postoperative stenosis recurrence. CONCLUSIONS: X-ray free endoscopic balloon dilation is a safe and effective procedure that could be performed on patients with ureteral stenosis.

Objective To evaluate the association between tumor squamous and/or glandular differentiation and tumor biological characteristics, to validate the impact of these histologic variants on oncologic outcomes of UTUC patients. Methods We retrospectively analyzed the data of 687 UTUC patients who underwent radical nephroureterectomy in our institute, from Aug 1, 1999 to Dec 31, 2011. All pathologic sections were reevaluated for histologic differentiation variations (squamous and glandular). The clinicopathological variables of patients were reviewed. Results Among the 687 UTUC patients in our study, 53 (7.7%) had squamous differentiation, 20 (2.9%) had glandular differentiation and 8 (1.2%) had both histologic variants. Patients with mixed histologic variant tended to have significant larger percentage of sessile tumor architecture (58.0% vs. 18.2%), presence of CIS (7.4% vs. 2.3%), advanced T stage, advanced tumor grade and lymph node metastasis (17.3% vs. 6.6%) (all P

Objective Prognostic epigenetic biomarkers and clinical factors in upper tract urothelial carcinoma (UTUC) are inconclusive. We conducted this study to identify gene promoter (ABCC6, BRCA1, CDH1, GDF15, HSPA2, RASSF1A, SALL3, THBS1, TMEFF2 and VIM) methylation status and clinical predictors for UTUC patients (N=687). Methods Using methylation-sensitive polymerase (MSP) chain reaction, we examined 10-gene promoter methylation status in 687 UTUC patients. The log-rank test and Cox regression were applied, and two nomograms were utilized to construct the prognostic model for cancer specific survival (CSS) and bladder recurrence free survival (BRFS), respectively. Results Methylation in tumor tissue was detected in 14.3% for ABCC6, 17.3% for BRCA1, 14.3% for CDH1, 49.9% for GDF15, 41.2% for HSPA2, 26.6% for RASSF1A, 34.4% for SALL3, 25.2% for THBS1, 43.2% for TMEFF2 and 63.2% for VIM. A methylated promoter of CDH1 (P=0.045), HSPA2 (P

Objectives To analyze the predictive factors for worse pathological outcome (muscle invasive (pT2+), non-organ-confined (pT3+ or N+) and histological Grade 3) of upper tract urothelial carcinoma (UTUC) in Chinese population from a nationwide high volume center of China. Materials and methods Predictors was studied by retrospectively reviewed the clinicopathological dates of 729 consecutive UTUC patients treated in our center from January 2002 to December 2010. Univariate and multivariate logistic regression analyses were used. Results There were more female patients (56.4%) than males, more tumors located in ureter (52.7%) than pelvis. In multivariate analysis, male gender (HR =1.898, P=0.001), sessile architecture (HR =3.249, P

Background Aberrant methylation of cytosine-guanine dinucleotide (CpG) islands is one of the most common epigenetic modifications involved in the development of urothelial carcinoma. However, it is unknown that the predictive role of methylation to contralateral new upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). Objective To evaluate the role of methylation of ten genes in predicting contralateral UTUC recurrence after RNU. Design, setting, and participants In a retrospective design, methylation of ten genes was analyzed on tumor specimens belonging to 664 consecutive patients treated by RNU. Median follow-up was 48 mo (range, 3-144 mo). Outcome measurements statistical analysis Gene methylation was accessed by methylation-sensitive polymerase chain reaction, and we calculated the methylation index (MI), a reflection of the extent of methylation in the ten genes. The log-rank test and Cox regression were used to identify the predictor of contralateral UTUC recurrence after RNU. Results and limitations Thirty (4.5%) patients developed a subsequent contralateral UTUC after a median follow-up time of 27.5 (range, 2-139) months. Promoter methylation was present in 88.9% of UTUC. Fewer methylation and lower MI were seen in the tumors with contralateral UTUC recurrence than the tumors without contralateral recurrence. Methylation for several genes was correlated with age, gender, architecture, tumor size, multifocal disease, stage, and grade. High MI was significantly correlated with poor prognostic parameters (advanced grade, increased stage, positive lymph nodes and sessile architecture) and poor cancer-specific survival. Multivariate analysis indicated that unmethylated RASSF1A, lack of bladder recurrence prior to contralateral UTUC, history of renal transplantation, and preoperative renal insufficiency are independent risk factors for contralateral UTUC recurrence after RNU. The major limitation of this study is related to its retrospective design. Conclusions Methylation is frequent in the UTUC generally, and relative infrequent in the tumors with contralateral UTUC recurrence. Methylation is a new promising predictor of contralateral UTUC recurrence after RNU.

Objective To explore the risk factors and treatment outcomes of contralateral new upper tract urothelial carcinoma (UTUC) after nephroureterectomy in a large single-center cohort of UTUC patients. Methods A retrospective analysis of the clinicopathological data of 509 consecutive patients treated by nephroureterectomy from 2000 to 2010 at a high-volume center in China was conducted. Results Thirty-five patients (6.9%) were found to develop contralateral UTUC. Gross hematuria was a common symptom, and aristolochic acid (AA) containing Chinese herbs were identified as an underlying cause. In multivariate analysis, renal transplant recipients (HR =16.507) and preoperative renal insufficiency (HR =2.523) were independent risk factors. No correlation was found in the clinical and pathological characteristics of primary and subsequent contralateral UTUC. A second round of nephroureterectomy should be performed on renal transplant patients, whereas patients who are older, exhibit relatively better renal function, and have tumors that are single, located in the ureter and small size could be treated with nephron-sparing surgery. No survival difference was detected between the two treatment groups, and developing contralateral UTUC was not associated with worse survival. Conclusions Contralateral UTUC is comparatively rare, and gross hematuria is a common symptom. Renal transplant history and renal insufficiency are independent risk factors, and prophylactic contralateral nephroureterectomy is considered for uremic UTUC patients with proper renal replacement treatment or renal transplant recipients. These features are likely related to the mechanisms of multifocality of UTUC, and the potential correlation with AA remains to be elucidated. Tumor characteristics and renal function are informative for the decisions concerning surgical options for contralateral UTUC.

Background/Purpose There is relatively little literature on prevalence of chronic kidney disease (CKD) prior to surgery in patients with upper urinary tract urothelial carcinoma (UTUC). We evaluated the prevalence and clinical associated factors of baseline CKD in patients with UTUC. Materials and methods There were 785 patients with a pathologic diagnosis of UTUC from January 2002 to December 2011 who were analyzed in this study. Estimated glomerular filtration rate (eGFR) was calculated by re-expressed Modification of Diet in Renal Disease (MDRD) formulas for the Chinese population. A multivariate logistic regression was performed to evaluate the odds ratios (ORs) for CKD stage 3 or higher in UTUCs after data differences were tested. Results The prevalence of CKD in UTUCs presenting at our hospital was 58.6% and 70.8% in the group age 70 years and older. Older age [per year increased; OR =1.050; 95% confidence interval (CI): 1.034-1.067], lower tumor stage (T stage; per stage increased; OR =0.666; 95% CI: 0.544-0.816), higher tumor grade (per grade increased; OR =1.392; 95% CI: 1.004-1.930) and the main tumor locating in the pelvis (ureter as reference; OR =0.648; 95% CI: 0.475-0.885) were independently associated with decreased kidney function in the multivariate logistic regression. The use of serum creatinine (Scr) only to evaluate the renal function would ignore a large proportion of patients suffering from CKD stage 3 in UTUCs, especially in those older than 70 years (39.3% vs. 54.1%, P=0.022). Conclusions We demonstrated a high prevalence (58.6%) of CKD in patients with UTUC, particularly in the group older than 70 years (70.8%). Older age, lower T stage, higher tumor grade, and the main tumor locating in pelvis (ureter as reference) were independently associated with CKD in UTUCs.

Objectives To identify prognostic predictors of upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU), we tested the hypothesis that preoperative anemia could be a potential predictor of the prognosis of UTUC. Patients and methods Clinical and pathological data on 686 patients with UTUC who underwent RNU at Peking University First Hospital, Beijing, China, between 1990 and 2012 were retrospectively analyzed. The chi-square test was used to analyze the associations with preoperative anemia, and the Kaplan-Meier test and Cox proportional hazards regression models were used to perform survival analysis. Results Preoperative anemia was associated with gender, lymph node metastasis, increased tumor grade, concomitant CIS, tumor necrosis, renal function and age. Preoperative anemia was an independent risk factor for overall mortality (HR =1.861) and cancer-specific mortality (HR =1.688). Conclusions The preoperative anemia is an independent risk factor for cancer-specific mortality and overall mortality. Therefore, hemoglobin levels should be considered during patient counseling and decision-making for further therapy.

Purpose Epigenetic biomarkers and prognostic clinical factors in upper tract urothelial carcinoma (UTUC) are inconclusive. We conducted this study to identify gene promoter methylation status and predictors for UTUC patients. Experimental design We prospectively collected data for pathologically diagnosed UTUC patients who were treated with surgery in Peking University First Hospital (Beijing, China) from Aug 1, 1999 to Dec 31, 2011. Analysis for hypermethylation at ten CpG islands, which was performed for each DNA sample using bisulfite transformation and methylation-sensitive polymerase (MSP) chain reaction. The log-rank test and Cox regression were applied to identify prognostic factors, and two nomograms were utilized to construct the prognostic model for cancer specific survival (CSS) and bladder recurrence free survival (BRFS), respectively. Results Among the 687 patients analyzed, the median follow-up were 65 months (range, 3-144 months) for CSS and 49 months (range, 2-144 months) for BRFS. Two hundred and twenty-five (32.8%) patients died as a consequence of UTUC and 228 (33.2%) patients developed bladder recurrence (BR) during the follow-up period. Older age (P5 cm, P

Objective To determine the effect of diagnostic ureteroscopy on intravesical recurrence in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). Methods We conducted a retrospective analysis of 664 patients who were treated with RNU for UTUC from June 2000 to December 2011, excluding those who had concomitant/prior bladder tumors. Of the 664 patients, 81 underwent diagnostic ureteroscopy (URS). We analyzed the impact of diagnostic ureteroscopy on intravesical recurrence (IVR) using the Kaplan-Meier method. Univariate and multivariate analyses were used to determine the independent risk factors. Results The median follow-up time was 48 months [interquartile range (IQR): 31–77 months]. Patients who underwent ureteroscopy were more likely to have a small (P

Objective To compare the prognosis of locally advanced upper tract urothelial carcinoma (UTUC) and bladder cancer (BC) in patients treated with radical surgeries. Methods A retrospective analysis of the clinicopathological data of 228 consecutive UTUC patients and 174 BC patients treated by radical surgeries from 2000 to 2012 at a high-volume center in China was conducted. Kaplan-Meier method and Cox regression were used to compare overall survival (OS) and cancer-specific survival (CSS) and to find prognostic factors. Results BC were associated with male sex (P