Ureteropyeloscopy for upper urinary tract diagnosis

The recent introduction of endoscopic technology specifically designed to provide access to the upper tracts has quickly become accepted as a routine part of the urologic armanentarium. Diagnostic ureteropyeloscopy clearly has an important role for those patients in whom the etiology of a filling defect or obstructing lesion cannot be determined by standard techniques. Additionally, ureteropyeloscopy offers the option of direct visual biopsy. In our experience, transureteroscopic biopsy has been most valuable when a tumor has been visualized in the setting of negative urine cytology. Transureteroscopic biopsy has also proven useful when preoperative knowledge of tumor grading or even pathologic staging may change the ultimate surgical approach. In fact, the role of transureteroscopic biopsy is becoming similar in many respects to cystoscopic biopsy. As such, it is not difficult to predict the further evolution of ureteropyeloscopy from a diagnostic procedure to a routine therapeutic modality utilized for a wide range of urologic disorders. With increasing experience, it has become evident that the initial optimism for ureteropyeloscopy was well founded and the expectations have already been met or have even been exceeded.