History and problems of ureteroscopic surgery in Japan

Abstract

  The standard surgical treatment for renal pelvis and ureter cancer is total nephroureterectomy. Recently, laparoscopic surgery has become less invasive than the previous open surgery. However, minimally invasive transurethral endoscopic treatment is considered useful for elderly patients with comorbidities or for patients with a single kidney who desire kidney-sparing surgery. It is expected to be highly beneficial to patients by reducing physical invasion and medical costs (avoiding dialysis therapy). In Europe and the United States, endoscopic kidney-sparing surgery has become widely used for low-grade non-muscle invasive cancer, and the transurethral endoscopic surgery for this disease has been proposed in European and American clinical guidelines (EAU/NCCN). Although this treatment was presented as an optional surgical treatment in the Japanese guidelines, it is actually performed only at a limited number of facilities and is not yet widely used. One of the reasons for this is that ureteroscopic surveillance is essential due to the high frequency of recurrence in the upper urinary tract, but the most important factor may be the lack of proficiency in ureteroscopic surgical techniques for this disease. At present, there is no educational system for ureteroscopic surgery for this disease in Japan, and the establishment of such a educational system in Japan is considered to be an urgent issue. This paper outlines the history and problems of ureteroscopic surgery in Japan.