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The use of ¹²³I-Hippuran renography in the management of synchronous bilateral upper urinary tract transitional cell carcinomata

Department of Urology, University Hospital of South Manchester, West Didsbury, Manchester, UK ^* Department of Radiology, University Hospital of South Manchester, West Didsbury, Manchester, UK

This excerpt was created in the absence of an abstract.

Bilateral simuitaneously occurring malignant tumours of the upper tracts are very rare, and present the difficult problem of preservation of renal function and adequate tumour clearance. We report such a case and discuss the difficulties and value of the modern methods of management, including ureteroscopy and ¹²³I-Hippuran gamma camera renography with creatinine clearance to assess total and split renal function and recovery.

A 62-year-old housewife was referred with right loin and back ache associated with haematuria. Two years earlier she had been investigated for right loin pain without haematuria and had normal excretion urography at that time. A repeat urogram revealed a radiolucent filling defect in the upper pole calyx of the right kidney (Fig. la), with hydronephrosis and hydroureter on the left side resulting from probable tumour in the distal ureter (Fig. 1b). Serum creatinine was normal. A ¹²³I-Hippuran renogram demonstrated the obstructed left kidney to contribute 36% of global function.

At initial cystoscopic assessment the urethra, bladder and ureteric orifices were normal. Ureteroscopy was not attempted on the left as the developing urographic appearances were considered to be pathognomonic of ureteric tumour (Fig. lb). Right ureteroscopy (9.5 FG) was successful in reaching the pelvis and tumour-like fronds were seen in the upper pole, but adequate biopsy material could not be obtained. Right retrograde ureteropyelogram appeared to confirm a right pole tumour, although pelvic urine draining from the catheter surprisingly did not subsequently provide positive cytological proof of malignancy.

Key Words: Ureteric tumours • ¹²³I-Hippuran renogram • Ureteroscopy

Received for publication April 15, 1991. Revision received July 8, 1991. Accepted for publication September 20, 1991.