Abstract
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.
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