Ureteroscopic management of transitional cell carcinoma of the upper urinary tract

Upper tract tumors may be diagnostic problems, and the importance of obtaining tissue in a closed fashion has been illustrated. This is probably the most important advantage of the ureteroscopic approach to these tumors. Ureteroscopy is safe and reliable and allows examination of about 95 per cent of all patients evaluated. Success rates will continue to improve with the expanded use of flexible instruments. Ureteroscopy may also be used for treatment. However, before this mode of therapy can be accepted, further work must be done comparing the findings of the endoscopic biopsy with the pathologic stage of the cancer. Nevertheless, it does appear that low-grade localized distal ureteral tumors can be managed effectively by ureteroscopic means. Possibly low-grade tumors in the renal pelvis can also be managed by this method (see also following article). Again, methods of surveillance such as radiographic studies and urinary cytology must be used in addition to endoscopic examination for follow-up (Table 2). Extensive pyelocaliceal tumors, high-grade pelvic tumors, and high-grade ureteral tumors probably cannot be managed effectively by ureteroscopic means. Either polychronotropism or failure to control a primary tumor may prove an indication for adjuvant topical therapy. Potential side effects such as systemic absorption resulting in myelosuppression need to be considered. However, if standard dosages known to be relatively safe intravesically are employed, there should be no significant problems.