Endourologic Treatment of Transitional Cell Carcinoma of the Upper Urinary Tract

Endourologic treatment was used for transitional cell carcinoma of the upper urinary tract in 16 patients. The presenting symptom was hematuria in 13 patients and flank pain in 1; in 2 cases, the diagnosis was made by chance at intravenous urography (IVU). Ureterorenoscopy (URS) was attempted in 11 cases, with removal of superficial transitional tumors of the ureter in 6 cases. In five cases, URS was diagnostic only. The remaining 10 patients were treated percutaneously. Pathological examination revealed 11 Ta Grade 1-2 papillary tumors, 4 T1 Grade 1-2 lesions, and 1 inverted papilloma. A single-J ureteral catheter was left in place after the procedure in 10 cases for 48 to 72 hours. In six cases, a nephrostomy tube was left in place in order to perform BCG immunotherapy (five cases) or mitomycin C chemotherapy (one case). Cytologic, radiographic, and endoscopic studies were negative after a median follow-up of 17 months in 10 patients. Four patients underwent nephroureterectomy for recurrence of tumor at 3 (two cases), 30 (1 case), and 36 (one case) months. One patient died of myocardial infarction, and one refused follow-up examinations. We believe that URS is the first-choice modality in the diagnosis and treatment of superficial transitional cell tumors of upper urinary tract. A percutaneous approach is a feasible option in selected cases, particularly those with a high surgical risk.