Nine patients with renal pelvic transitional cell carcinomas were selected for treatment with percutaneous resection because of a solitary kidney (3), bilateral synchronous disease (1), renal insufficiency (1), poor surgical risk (2) or preoperative evidence of a single, low grade, superficial tumor (2). Eight patients underwent second-look procedures 2 to 28 days postoperatively, at which time 6 received neodymium:YAG laser irradiation. Supplemental intracavitary therapy through the nephrostomy tube was given in 6 patients (mitomycin C in 1 and bacillus Calmette-Guerin in 5). Of those patients 2 had third-look procedures. Five patients remain free of recurrence with a followup of 3 to 28 months (mean 9.5 months). In the other 4 patients there was recurrent disease in the renal pelvis (3) or reappearance of positive cytology studies (1) 4 to 5 months postoperatively. Extrarenal tumor recurrence was not observed. Percutaneous surgery provided adequate information to assess tumor architecture, grade, invasiveness and multifocality, and the presence of contiguous mucosal abnormalities, which, along with positive cytology and a history of or concurrent tumors in other segments of the urinary tract, increased the likelihood of tumor recurrence. Second-look procedures appeared to be useful to assess the effectiveness of the initial procedure and to remove any residual disease. Our results suggest that percutaneous surgery can provide results similar to those of an open conservative operation, although further investigation is needed to determine the ultimate place of this technique.
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