Focus on renal pelvis and ureteral carcinoma

The leading clinical symptom of a renal pelvis or ureteral tumour is usually a painless admixture of blood in the urine - sometimes this is only visible under the microscope. It is often the initial and only symptom. Flank pain can also be one of the symptoms of urinary stasis kidneys. General symptoms (e.g. unintentional weight loss, fever, night sweats) are rather rare and may indicate advanced tumour disease.

In addition to urological ultrasound, the diagnosis of tumours of the upper urinary tract also includes a cytological examination of the urine in the laboratory. Computed tomography of the abdomen with excretory phase ("CT urography") is the method of choice for the diagnosis of urothelial carcinomas of the upper urinary tract. This allows a statement to be made about the extent of the tumour and the potential presence of metastases. Endoscopic endoscopy of the ureter and/or renal pelvis ("diagnostic ureterorenoscopy") with removal of a tissue sample is often necessary. The final diagnosis and the exact stage classification is then made on the basis of a microscopic histological examination of the tissue by the pathologist. The further treatment recommendation depends on this.

Endoscopic organ-preserving surgical procedures

In an endoscopic operation, the mucous membrane is assessed using a reflective instrument (endoscope; so-called "ureterorenoscope") and the tumour is removed as completely as possible. This can be done using a laser. The procedure should only be used for small tumours that are limited to the upper layers of the mucous membrane.

Open surgical procedures / minimally invasive surgery

In the case of ureteral tumours that are not very advanced and are located in the lower ureter, partial removal of the ureter may be possible. If the tumour has exceeded a certain size or has already reached an advanced stage, radical removal of the kidney and ureter (nephroureterectomy) is the treatment of choice. The procedure can be minimally invasive (robot-assisted with the DaVinci® system) or open surgery. Postoperatively, a single local chemotherapy of the urinary bladder with mitomycin C can also be performed to reduce the risk of recurrence of tumours in the urinary bladder.

Drug tumour therapy

Drug treatment of urothelial carcinoma of the upper urinary tract plays an important role, particularly in advanced tumour stages. Our team of doctors has extensive experience with chemotherapy and immunotherapy, both in their implementation and in the prevention and treatment of possible therapy-related side effects. In addition to guideline-compliant patient care, we also want to give our patients access to innovative therapies that are offered at our clinic as part of clinical trials. This can be examined and discussed in an individual, detailed consultation with a doctor. If you are taking part in a clinical trial, care and monitoring will always be carried out via our trial centre in consultation with and with the involvement of your treating urologist in private practice.

The exact cause of the development of urothelial carcinomas in the upper urinary tract (renal pelvis and ureter) has not yet been clarified. Nevertheless, risk factors that favour the development of such tumours are known. They are similar to the risk factors for the development of bladder cancer. Tobacco smoking is therefore one of the main risk factors. Occupational risk factors from cancer-causing substances such as paints, tar, dyes and solvents can also play a role. In very rare cases, a genetic cause and a familial occurrence can be observed.

Preventive screening along the lines of mammography for the detection of breast cancer or colonoscopy for the earliest possible detection of colon cancer is not recommended for urothelial carcinoma of the upper urinary tract, as the probability of detecting a tumour is significantly lower. If symptoms occur (blood in the urine, flank pain or urinary retention), a doctor should be consulted for further advice. Even if in many cases the cause of the symptoms turns out to be comparatively harmless, the presence of a tumour must usually at least be ruled out.

A biopsy and endoscopic removal of the tumour is almost always necessary. If the tumour is detected in good time and is limited to the upper layers of the mucous membrane, the ureter or kidney can often be preserved. In more aggressive forms of the disease, complete surgical removal of the ureter and/or kidney is the best way to achieve a permanent cure. Alternatively, drug therapy can be used if surgical removal is not appropriate or possible or if the patient refuses it.