PERCUTANEOUS ELECTROVAPORIZATION OF UPPER TRACT TRANSITIONAL-CELL CARCINOMA IN PATIENTS WITH FUNCTIONALLY SOLITARY KIDNEYS

Objectives. We present the first reported experience using percutaneous electrovaporization with both a rollerball and the VaporTrode electrode of large upper tract transitional cell carcinoma (TCC) in 2 individuals with functionally solitary kidneys. Methods. Under general anesthesia and in the prone position, 2 patients underwent electrovaporization of upper tract TCC through upper pole percutaneous access. Using either a rollerball (Case 1) or the VaporTrode (Case 2) electrode at 200 W pure cutting current, the tumors were completely vaporized. Results. Average operating room time was 145 minutes. Hemostasis was excellent. No significant perioperative complications were noted. A nephrostogram at the end of the procedure revealed no extravasation in either case. There was no appreciable change in serum creatinine. Both patients received postoperative mitomycin (40 mg in 1000 cc normal saline over 20 hours) through the nephrostomy tube. One patient (Case 2) is completely free of disease via antegrade nephroscopy and biopsy at 2 weeks' follow-up. The other patient (Case 1) had two remaining focal areas of tumor via antegrade nephroscopy 3 weeks postoperatively; both lesions were treated with electrovaporization via a flexible electrode through the flexible cystoscope and the VaporTrode, respectively. Conclusions. Percutaneous electrovaporization of upper tract TCC appears to provide a simple, rapid, and effective endosurgical treatment in properly selected patients. Long-term follow-up will be needed to assess this new treatment modality definitively.