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Erschienen in: Journal für Urologie und Urogynäkologie/Österreich 2/2018

04.01.2018 | Originalien

Organerhaltende Therapie beim Urothelkarzinom des oberen Harntraktes (UTUC)

verfasst von: Univ. Prof. Dr. Shahrokh F. Shariat, Priv.-Doz. Dr. Mesut Remzi, Dr. Irene Resch

Erschienen in: Journal für Urologie und Urogynäkologie/Österreich | Ausgabe 2/2018

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Zusammenfassung

Das UTUC („upper tract urothelial carcinoma“) ist eine seltene Erkrankung, die sich bei der Erstdiagnose in vielen Fällen als bereits invasiv wachsender Tumor präsentiert. In dieser Situation gilt nach wie vor die radikale Nephroureterektomie als Goldstandard. In ungefähr 20 bis 40 % der Fälle besteht jedoch bei der Erstdiagnose ein nichtinvasiver Tumor (pTa) mit guter Differenzierung („low grade“). Bei diesen Patienten stellt die Standardtherapie potenziell eine Übertherapie dar, sodass bei betreffenden Patienten in ausgewählten Fällen eine nierenerhaltende Therapie in Erwägung gezogen werden kann. Eine organerhaltende Strategie kann auch im Fall aggressiverer Tumoren bei Einzelniere oder eingeschränkter Nierenfunktion diskutiert werden. Das onkologische Ergebnis bei niedriggradigen Tumoren war in einigen Studien ähnlich dem einer radikalen Nephroureterektomie und ermöglichte, einen Großteil der Nierenfunktion zu erhalten. Im Fall eines Nierenerhalts wird der Tumor meist mittels Ureterrenoskopie oder immer seltener über einen perkutanen Zugang mittels Laser abgetragen. Aufgrund der hohen Rezidivrate ist ein genaues Follow-up der Patienten mit regelmäßigen Zystoskopien, Zytologien und CT sowie invasiven Kontrollureterrenoskopien notwendig. Um die Rezidivrate zu verringern, werden oft auch topische Therapien verwendet. Diese können intravesikal verabreicht werden, um ein Blasenrezidiv zu verhindern, aber auch über einen Ureterkatheter oder eine perkutane Nephrostomie in den oberen Harntrakt instilliert werden, um die Gefahr eines Lokalrezidivs zu verringern. Ein klarer Nutzen für eine Instillationstherapie ist noch nicht gänzlich geklärt.
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Metadaten
Titel
Organerhaltende Therapie beim Urothelkarzinom des oberen Harntraktes (UTUC)
verfasst von
Univ. Prof. Dr. Shahrokh F. Shariat
Priv.-Doz. Dr. Mesut Remzi
Dr. Irene Resch
Publikationsdatum
04.01.2018
Verlag
Springer Vienna
Erschienen in
Journal für Urologie und Urogynäkologie/Österreich / Ausgabe 2/2018
Print ISSN: 1023-6090
Elektronische ISSN: 1680-9424
DOI
https://doi.org/10.1007/s41972-017-0017-8

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