TUMORS OF URINE COLLECTION SYSTEM AND URETER

Tumors of the urinary collection system (renal pelvis) and ureter are rather rare.

Usually these are revealed by the effect of urinating blood. Very rarely it also gives pain complaints, which are comparable to renal colic (= ascending and descending, very severe pain on the flank).

Diagnosis

If you come to the urologist with urinating blood, the urologist will request several tests. This is to rule out all possible causes of blood urination.

1. CT scan: A CT scan with intravenous contrast will be requested to see if the following items are present: kidney stones or tumors of the renal pelvis / ureter / bladder.

2. Cystoscopy: This is an examination in which we use a camera in the bladder to see if there are no 'polyps' (= tumors) in the mucous membrane of the bladder. This is done under local anesthesia and is an outpatient examination, ie you can go home immediately after the examination.

If unfortunately a tumor of the ureter or renal pelvis is suspected, an additional examination may be necessary to confirm the diagnosis:

1. Diagnostic ureterorenoscopy: We go under complete anesthesia with a camera through the bladder into the ureter and the renal pelvis to see if a tumor can actually be seen at the suspected site. If the tumor is indeed visualized, biopsies will also be taken at this time. This will provide us with information about the type of tumor, the depth of ingrowth and the aggressiveness of the tumor.

Therapy

Treatment will depend on the type of tumor, the depth of ingrowth, the aggressiveness and whether or not metastases are already present. The standard treatment for a tumor of the renal pelvis or of the ureter is the surgical removal of the entire kidney and ureter into the bladder, this is called a 'radical nephro-ureterectomy'.

Within our service, this operation is standard robot assisted. This means that we will remove the kidney and ureter under complete anesthesia through a few small incisions. Compared to the classic 'open' operation, this has the advantage that there is less post-operative pain for the patient and that the patient usually recovers more quickly from the procedure.

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If it concerns a very small, not very aggressive tumor, it is sometimes also possible to opt for 'kidney-sparing' surgery. Kidney-sparing surgery may also be preferred if you only have one kidney left, in order to avoid dialysis.

1. Endoscopic treatment: A camera is inserted under complete anesthesia into the ureter up to the tumor (in the ureter / renal pelvis) and an attempt is made to remove the tumor using laser energy.

2. Distal ureterectomy: If the small, not very aggressive tumor is located in the lowest part of the ureter, it is sometimes also possible to opt for a kidney-sparing procedure. The diseased piece of ureter will be removed with the aid of a robotic keyhole surgery, and the healthy remaining ureter will be sewn back into the bladder.