Endoscopic Management of Upper Tract Transitional Cell Carcinoma

Upper tract urothelial carcinoma is rare and the gold standard for treatment remains radical nephroureterectomy with excision of the bladder cuff. To avoid the loss of kidney function and other morbidities associated with radical nephroureterectomy, a conservative endoscopic approach can be used in select cases, including low grade tumors. Advances in endoscopic technique and technology have facilitated this approach.

We review the role of endoscopy in the diagnosis of upper tract urothelial carcinoma, indications for its endoscopic management, surgical technique and complications, as well as the currently available outcomes in the literature.

Upper tract urothelial carcinoma can be approached either ureteroscopically in a retrograde fashion or antegrade with a percutaneous technique. Several options for tissue resection and ablation exist. Appropriate patient selection is critical to success with endoscopic management and patients who undergo renal sparing therapy must be committed to a lifetime of followup with radiographs and endoscopy.

An endoscopic approach to upper tract urothelial carcinoma provides a nephron sparing, low morbidity option in select cases. Currently, there is moderate evidence to support the safety and efficacy of endoscopic management but definitive conclusions cannot be made until long-term outcome data are available and prospective trials are completed.