Ureteroscopic Approach to Transitional Cell Carcinoma of the Upper Urinary Tract
Ioannis M. Varkarakis1
and Thomas W. Jarrett2
Summary. In patients for whom renal sparing surgery is mandated secondary to a solitary kidney, renal insufﬁciency, bilateral disease, or high surgical risk, or patients with small, low-grade tumors, ureteroscopic management is evolving as an alternative to radical nephroureterectomy. Smaller rigid and ﬂexible uretero- scopes have allowed for the detection and sampling of urothelial tumors located almost anywhere in the upper urinary tract. New laser technologies provide effective tumor ablation capabilities with low risk of complications. Long-term safety in properly selected patients has been proven in several studies. However, recurrences are expected and thus vigilant follow-up of the entire upper urinary tract and bladder is necessary. Adjuvant topical therapies appear to be safe but conﬁrmation of any beneﬁts awaits the results of further large studies.
Keywords. Transitional cell carcinoma, Ureteroscopy, Management
Introduction: Natural History of Upper Urinary Tract TCC and Indications for Conservative Therapy
Upper urinary tract urothelial tumors are rare, accounting for 1%–2% of all gen- itourinary tumors . The vast majority are transitional cell carcinomas (TCC) (90%), while only 10% are squamous cell carcinomas and 1% adenocarcinomas . Urothelial tumors of the ureter are 3–4 times less frequent than those located in the renal pelvis .
The incidence of upper urinary tract TCC increases with age in both sexes, and appears most frequently during the 6th and 7th decades of life. Males present with this disease 3 times more frequently than women .
Second Department of Urology, University of Athens, 1 Sismanogliou Str, 15126, Marousi, Greece