Diagnosis And Treatment Of Primary Ureteral Canter

[Object] To summarize the experience in the diagnosis , treatment and prognosis of primary ureteral cancer.[Methods] A retrospective analysis of diagnosis, treatment and prognosis of 55 cases of primary ureteral cancer which was in ShanDong provincial hospital from 2000 to 2006.[Results] Between 2000 and 2006 55 patients underwent primary ureteral cancer in our department.The patients consisted of 28 males and 27 females.The range of age was 32 to 85,especially there were 38 patients whose age was from 60 to 70.Most patients complained of flank pain and hematuria,and 9 patients were examined through health examination.The history of disease was 3 days to 5 years.The cancer was right sided in 23 patients and left sided in 32 patients.The cancer was superior in 9 patients,middle in 7 patients,inferior in 38 patients,and multiple in 1 patients.In addition,9 patients had renal inadequacy in the opposite kidney.All cases were confirmed ultrasound,of which 6 cases were examined tumor in ureter and 38 cases were examined hydronephrosis.37 cases were confirmed intravenous pyelography,of which 23 cases did not develop images in involved kidney and ureter,2 cases did not develop perfectly,and 6 cases developed images of filling defect in ureteral lumens.35 cases were confirmed retrograde pyelograph,of which 3 cases failed,and 29 cases developed images of filling defect or stricture in ureteral lumens.31 cases were confirmed CT,of which 30 cases were detected tumors of soft tissue in lumens. 24 cases were confirmed MR, of which 22 cases were detected tumors in lumens..11 cases were confirmed MRU,all of which developed images of interrupting obstruction in ureteral lumens.In 36 cases of receiving examination of exfoliocytology,17 cases expressed positive.Examination of cystoscope were given to 35 cases,of which 5 cases were detected neoplasm in ureteric orifice,and 14 cases were detected jetting blood in ureteric orifice.Examination of ureteroscope was given to 7 patients,of which 4 patients were detected tumors in ureter,and later the tumors were all confirmed transitional cell carcinoma by pathological examination.Except for 5 cases rejecting operation,the others 50 cases all recepted it.27 cases were given operation of cutting the involved kidney,total length ureter,and urinary baldder like cuffs, 3 cases were given operation of cutting involved part of ureter and end-to-end anastomosis,20 cases were given operation of cutting inferior part of ureter and part urinary bladder and transplantation of ureter and urinary bladder.45 cases proved to be transitional cell carcinoma by pathological section after operation,of which 2 cases were I grade,4 cases were I—II grade,24 cases were II grade,7 cases were II—III grade,8 cases were III cases. 1 case was squamous cell carcinoma. 1 case was adenocarcinoma of middle differentiation. 1 case was malignant fibrohistiocytoma.2 cases were compound carcinoma,of which 1 case was mostly squamous cell carcinoma and the rest transitional cell carcinoma of II grade,the other was partly adenocarcinoma and partly transitional cell carcinoma of II—III grade.21 cases had been followed-up for 6 to 70 months.7 patients died within 3 years,of which 6 patients died of relapse of tumor,and the cancer was high stage and high grade,1 patients died of accidents.5 patients were still alive after 5 years,who were given operation of cutting the involved kidney,total length ureter,and urinary baldder like cuffs.4 patients died 3 to 5 years after the operation.And the others 5 patients were still alive after 6 to 36 months.The 3 patients who were given operation of cutting involved part of ureter and end-to-end anastomosis recurred 7 months, 13 months and 19 months after the operation, and the patient who recurred 7 months after the operation died of heart failure 1 month later.The others 2 patients both received irrigation of bladder and examination of ultrasound regularly and up to now they were still alive. [Conclusion] 1.Ultrasound is the conventional method to diagnose primary ureteral cancer.Because of cheap and atrauma,it can screening the disease.2.As to patients who are detected abnormal by ultrasound,urography is the further method to diagnose primary ureteral cancer.If filling defect is detected,we should pay attention to the existence of urinary calculus.3.CT can be used to diagnose and stage primary ureteral cancer;there is no report to show that MR is superior to CT up to now,but MR may replace retrograde pyelography,especially when obstructive disease of urinary tract exists.4.Examination of ureteroscope and biopsy is the most precise method to diagnose primary ureteral cancer.But because of its expension and atrauma,it only be used to few patients.5.Primary ureteral cancer is mainly treated with operation,which is usually cutting the involved kidney,total length ureter,and urinary baldder like cuffs.But as to patients who are not fit to receive the classic operation style such as solitary kidney,renal inadequacy in the opposite kidney,intolerant to operation or tumors of upper urinary tract exist in both sides,conservative operation of reserving kidney can be used,and follow-up should be strengthened.