Bernabei M, Fabbri N, Romeo D, Paiolo E, Bandi M, Simone M. Conservative management of an early abdominal complication during a Tullio percutaneous endoscopic excision of renal pelvis urothelial carcinoma: A case report. World J Clin Urol 2024; 13(1): 1-6 [DOI: 10.5410/wjcu.v13.i1.1]
Corresponding Author of This Article
Nicolò Fabbri, MD, Surgeon, Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Azienda USL of Ferrara, Via Valle Oppio 2, Ferrara 44100, Italy. n.fabbri@ausl.fe.it
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Urol. Feb 2, 2024; 13(1): 1-6 Published online Feb 2, 2024. doi: 10.5410/wjcu.v13.i1.1
Conservative management of an early abdominal complication during a Tullio percutaneous endoscopic excision of renal pelvis urothelial carcinoma: A case report
Massimiliano Bernabei, Elisa Paiolo, Martina Bandi, Maurizio Simone, Department of Urology, Azienda USL di Ferrara, Ferrara 44100, Italy
Nicolò Fabbri, Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Azienda USL of Ferrara, Ferrara 44100, Ferrara, Italy
Danila Romeo, Local Health Agency of Ferrara, Ferrara 44100, Italy
Author contributions: Bernabei M, Fabbri N designed the research study, performed the research; Bernabei M, Fabbri N, Romeo D, Paiolo E, Bandi M, Simone M analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nicolò Fabbri, MD, Surgeon, Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Azienda USL of Ferrara, Via Valle Oppio 2, Ferrara 44100, Italy. n.fabbri@ausl.fe.it
Received: December 2, 2023 Peer-review started: December 2, 2023 First decision: December 19, 2023 Revised: December 28, 2023 Accepted: January 22, 2024 Article in press: January 22, 2024 Published online: February 2, 2024
Abstract
BACKGROUND
Upper tract urothelial carcinoma (UTUC) representing only a small fraction of all urothelial tumors. It predominantly affects the renal pelvis in men, often coexisting with bladder carcinoma. UTUC displays a more aggressive genetic profile compared to bladder neoplasms, with the majority of patients presenting with advanced disease. Histologically, about a quarter of UTUC cases exhibit high-grade subtypes, associated with a worse prognosis. Tobacco use and past exposure to aromatic amines are significant risk factors for UTUC. Imaging modalities such as Uro-computed tomography and magnetic resonance imaging play crucial roles in diagnosis. Ureterorenoscopy is vital for direct visualization and biopsy sampling, but its limited sampling capacity presents challenges in determining tumor depth and staging. Traditionally, nephroureterectomy with bladder cuff excision has been the gold-standard treatment for UTUC. Endoscopic conservative treatment has recently emerged as a viable option for selected patients, offering comparable oncological outcomes to radical surgery. Percutaneous access is also feasible for larger intrarenal tumors.
CASE SUMMARY
We present a case of an 84-year-old woman who underwent percutaneous endoscopic excision of a renal pelvis neoplasm using the Tullio laser. Despite successful tumor removal, the patient experienced a postoperative complication with abdominal fluid leakage. Conservative management effectively resolved the complication. Given the patient's age and refusal for radical surgery, the conservative approach proved to be a valid therapeutic choice.
CONCLUSION
Overall, UTUC remains a diagnostic and therapeutic challenge due to its rarity. However, advances in endoscopic and percutaneous techniques provide valuable alternatives for selected patients, warranting further exploration in this evolving field.
Core Tip: Upper tract urothelial carcinoma remains a diagnostic and therapeutic challenge due to its rarity. Advances in endoscopic and percutaneous techniques provide valuable alternatives for selected patients, warranting further exploration in this evolving field. However, complications from these new procedures are still infrequent, and their treatment or management poses a new challenge for the doctor. With this case, we aim to propose a damage management approach to handle future complications.
